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Activity of cyclamen in rhinosinusitis
BEZSHAPOCHNY S.
ENT Department. Poltava. Ukraine
New Horizons in the Non-Invasive Management of Sinonasal Disorders.
International ENT Medical Summit.
Barcelona, 19 September 2007.
Keywords of New Horizons in the Non-Invasive management of sinonasal disorders - PDF
INTRODUCTION
It is currently estimated that 14% of the world’s population is affected by an episode of rhinosinusitis. In many cases, antibiotics are the treatment of choice for attacking this disease (almost 20% of total antibiotics consumption is for the treatment of this disease).
Rhinosinusitis is one of the most prevalent chronic diseases in developed countries. Within this context, there has been a consistent search for new treatment alternatives that overcome the limitations or complications associated with the main reference therapies.
Nasodren® facilitates physiological drainage and cleansing of the nasal cavities. Regarding its mechanism of action, it has been confirmed that it acts on the mucous membranes of the nasal cavity and paranasal sinuses, inducing an intense reflex secretion which rapidly produces an abundant discharge of mucus (the increased mucus secretion enables thorough cleansing of the paranasal sinuses) (Figure 1).
Thus, retained seromucous secretions and inflammation mediators are expelled, reducing/eliminating tissue congestion and oedema (direct osmotic effect, with opening of cell pores).
In short, it effectively opens the nasal spaces. The rapid discharge of the secretions from the nasal and paranasal cavities and also from the submucous glands helps reduce the oedema by removing retained fluid, with the resulting shrinkage of the inflamed mucosa. All of this helps clear the osteomeatal complexes.
Nasodren® has been shown to be effective in a broad range of respiratory disorders, including acute rhinosinusitis. However, to paraphrase the speaker, “given the intense biological activity of this natural, plant-based preparation, it is necessary to take certain precautions.” Its use is currently contraindicated in rhinosinusitis with polyposis, when there are cysts in the paranasal sinuses, in pregnant women and individuals who show intolerance of the medication.
The recommendation to not use Nasodren® when there are polyps is basically because these cysts block the entrance to the maxillary sinuses; the polypous structures block the entrance to the osteomeatal complex and consequently prevent drainage of the cavities preceding the paranasal sinuses.
CYCLAMEN EXTRACT IN ACUTE PURULENT RHINOSINUSITIS
In order to assess the clinical efficacy of Nasodren®, Dr. Bezshapochny’s study group at the Department of Otorhinolaryngology in Poltava have performed a study with 128 patients diagnosed with acute purulent rhinosinusitis. In all cases, the diagnosis has been confirmed by the usual methods and those subjects with a clinical picture where use of the cyclamen extract is contraindicated have been excluded.
Each patient received a single daily spray (in the morning) with Nasodren®. After 2-3 minutes, abundant rhinorrhoea was observed with mucus and pus secretion. This secretion continued for 2-3 hours. Many of the patients reported sneezing fits after administration, which did not prevent continuation of the treatment (it was well tolerated).
After the rhinorrhoea had stopped, most of the patients assured that their nose felt clearer, it was easier to breathe through the nose, with a marked decrease in the severity of the headaches (by the third day, most of the patients no longer suffered this symptom) and rhinorrhoea (normal rhinology findings by day 7-10).
This evidence has been confirmed by imaging techniques, which have clearly shown a general improvement of the acute rhinosinusitis after administration of the cyclamen extract (from the first day of treatment).
Just 3 minutes after administration of this product, the endoscopic examination shows an abundant mucus discharge from the entire nasal cavity and osteomeatal complex; after 5-10 minutes, discharge of the purulent secretions begins; after 3 hours, the nature of the secretions changes, looking more like mucus again.
During the first day of treatment, activation of the mucociliary clearance process is observed; in addition, the quantity of secretions increases, accompanied by repeated sneezing which facilitates the expulsion of a large quantity of mucopurulent secretions. On the first day, purulent discharges take place intermittently with varying degrees of intensity.
By the third day after starting treatment, and before spraying the extract, it is obvious that the hyperaemia of the nasal mucosa has diminished; just 5 minutes after administration, the entire nasal mucosa is covered by abundant transparent mucus; after 10 minutes, a significant increase in the quantity of mucus is documented; after 20 minutes, the mucus and pus are expelled from the osteomeatal complex (this process continues for approximately one hour); later on, the quantity of mucopurulent secretions diminishes and the secretions become clear mucus; by the third day, a moderate hyperaemia of the mucosa is observed during treatment but with virtually no production of purulent matter; a moderate quantity accumulates in the area of the sinus’s drainage orifice.
During the fifth day of treatment, expulsion of large quantities of mucus continues, but without the presence of purulent substances; to quote the speaker, “by the fifth day, the patient is close to being cured.”
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