The Healthy Skeptic: Menthol ointments appear to pass the smell test
Some smells are strong enough to break through even the stuffiest noses. You can have the cold of the century, but you’ll still be able to sense a splash of Pine-Sol or a ball of wasabi. And no matter how clogged up you are, you can pick up the unmistakable scent of menthol. It feels soothing and oddly cool, almost like a nasal injection of Freon.
Now that the cold and flu season has arrived, the smell of menthol is wafting through many homes. In a ritual that goes back more than a century, stuffed-up kids and adults are going to sleep with gobs of menthol ointments smeared over their chests. If all goes according to plan, the fumes from the ointment will seep into the nose and lungs to ease coughs and congestion.
The most famous and widely used menthol ointment is Vicks VapoRub, a product from Cincinnati-based Procter & Gamble that goes back more than 100 years. In addition to menthol, VapoRub contains camphor and eucalyptus oil, two other highly aromatic compounds. It comes in both regular and lemon varieties and is sold in a range of sizes. You can expect to pay about $10 for a 6-ounce jar or about $4 for 1.76 ounces.
Users are instructed to rub a “thick layer” of the ointment on the chest and throat up to three times per day. According to the label, VapoRub shouldn’t be used by children younger than 2 and shouldn’t be smeared directly in the nostrils.
Another popular option is Mentholatum Ointment, a rub containing a blend of menthol and camphor that has been in use since the McKinley administration at the turn of the last century. Users are instructed to apply the rub on “affected areas” up to three or four times a day. According to the directions, parents should ask a doctor before using the product on a child younger than 2. You can expect to pay about $5 for a 3-ounce jar.
The website for Vicks VapoRub greets visitors by saying, “We’d like to apologize for just how effective VapoRub can be” (but doesn’t explain why anyone would be seeking an apology in the first place). According to the site, VapoRub is a cough suppressant that works for both children and adults. Many people believe VapoRub helps clear up congestion, and the company used to advertise it as a remedy for stuffy noses. But the current site doesn’t say anything about either noses or congestion.
Representatives of Procter & Gamble were unavailable for comment.
The Mentholatum website says that its ointment “offers relief from cold symptoms such as stuffy noses, chest congestion, sinus congestion and muscular aches.” According to the label, however, it’s a “topical analgesic rub,” not a decongestant. Jennifer Hamberger, director of brand communication for the Mentholatum Co. in Orchard Park, N.Y., says that labeling for the product has changed over the decades in step with federal regulations.
Hamberger adds that the ointment has a strong psychological effect. As she explains, just one whiff reminds people of a doting parent nursing them through a long-ago cold.
The bottom line
Although they no longer say so on their packaging, menthol ointments really do seem to help clear up stuffy noses and chests, says Dr. Ian Paul, a professor of pediatrics and public health sciences at Penn State Hershey College of Medicine. Paul decided to take a closer look at Vicks VapoRub after many parents asked if it would help their children breathe easier. “I told them there was no data,” he says, which wasn’t an especially satisfying answer for anyone. “I decided to do the study myself. I didn’t think it was going to work.”
Paul led a study of 138 children ages 2 to 11 with upper respiratory tract infections. The study, published last year in the journal Pediatrics, found that a single application of Vicks VapoRub at bedtime provided more relief than a plain Vaseline-like ointment or no treatment at all. Specifically, kids treated with VapoRub slept better and coughed less through the night. On the downside, 28% of parents in the VapoRub group said their children complained of a burning sensation in the skin, a complaint that never came up with the other two groups.
“I had never touched the stuff before,” Paul says. “But after I saw the results, I used it on my 3-year-old daughter, and I’ve tried it myself.” Paul was a paid consultant for Procter & Gamble at the time of the study, and the company continues to support his research.
As Paul explains, menthol vapors activate receptors in the nose that send a cooling signal to the brain. This blast of “fresh air” makes it feel like the airways are a little more open, Paul says. It’s unclear if the passages really open up or let in any extra air, he adds, but the mere sensation of better breathing could be enough to help a person relax, cough less and sleep more easily.
Menthol ointments made headlines in 2009 when Dr. Bruce Rubin, now chair of pediatrics at Virginia Commonwealth University in Richmond, published a case report of an 18-month-old girl who had been admitted to an emergency room with severe breathing difficulties after her grandparents rubbed Vicks VapoRub right beneath her nostrils. The girl recovered quickly, but Rubin says that he has since learned of 25 or 30 similar cases involving young children that underscore the potential danger.
Rubin says that Vicks VapoRub and similar products can definitely help relieve clogged-up airways and generally make cold sufferers feel more comfortable. But he stresses the importance of heeding the warnings of the label: Don’t use it on children younger than 2, and don’t apply it directly in or under the nostrils.
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