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Efficacy of cyclamen in postoperative care
POPOVICH V.
ORL Department.
Ivano-Francovsk University. 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
In recent years, a sustained increase in the morbidity associated with chronic rhinosinusitis has been observed. In the Ukraine, the annual increase in the prevalence of this disorder is 1.8-2%, while its incidence in hospitalised patients is 50-60%.
In order to counteract this trend, new treatment strategies are being studied. Of these, one that has recently aroused particular interest is minimally invasive endoscopic surgery. In these cases, it is seen that an acute sinusitis syndrome starts in the immediate postoperative period.
In the postoperative period, it is virtually impossible to drain the sinuses through a supplementary orifice, as this may severely disrupt the area, causing hyperaemia and oedema and leading to the development of obstruction of the nasal orifice. In the presence of a chronic inflammation of the mucous membrane, these changes give rise to a pathological regeneration of the membrane, tending towards polypous transformation. Hence the fact that a crucial goal in the postoperative recovery of these patients is to try to avoid the appearance of this acute sinusitis syndrome, to promptly counteract it if it does appear, seeking physiological regeneration of the mucous membrane and rapid restoration of its main functions.
EXPERIENCE WITH POSTOPERATIVE TREATMENT
Dr. Popovich presented the results of a study performed by him which sought to evaluate the possible increased efficacy of the combined therapy in surgical patients with chronic rhinosinusitis, using an early postoperative treatment based on the administration of cyclamen extract. A total of 110 patients with chronic rhinosinusitis were included, most of whom had polypous ethmoid maxillary rhinosinusitis (48%) or polypous ethmoid rhinosinusitis (38%) (Figure 1).
All of the patients had undergone endoscopic surgery for their disease (sinusotomy), although more than half of them also underwent concurrently other types of surgery (plastic surgery procedures). On the second postoperative day, all of the patients started rehabilitation procedures: one group was given saline solution while the other group was given cyclamen extract + saline solution.
As Dr. Popovich explained, there are many obvious clinical reasons for indicating the use of cyclamen extract in these patients with chronic rhinosinusitis: “With the surgery, all of the morphological conditions that could cause obstruction of the nasal sinuses had been eliminated; in addition, there was a clear need to attain effective drainage of the nasal passages and cavities that had undergone surgery; lastly, this preparation has been shown to increase the reflex secretion, favouring natural drainage of the paranasal sinuses.”
In order to determine the efficacy of this type of approach, general clinical (individual tolerance of the preparation), local (nasal secretion, nasal obstruction, headache), and rhinoscopic criteria (pathological secretion, mucous membrane oedema, mucous membrane hyperaemia) have been used.
Objective measurement parameters have also been used, such as CAT and functional criteria (status of the mucous membrane and nasal and paranasal sinuses at different stages of the disease, analysing, among other things, the status of the mucociliary transport system).
As regards individual tolerance of the preparation, this study shows that the rhinorrhoea starts 13-15 min. after administration, often accompanied by mild/moderate nasal itching. None of the patients complained of strong smarting, headache or watering eyes. The secretions continued for 1-5-2 h on average. Once the rhinorrhoea had stopped, the patients reported a significant improvement in breathing through the nose and a sensation of dryness in the nose.
The local symptoms are similar in both treatment groups one day after surgery, with a virtually identical rate of documented cases of headache, nasal obstruction and nasal secretion. However, by the third postoperative day, a much greater improvement is seen in the local symptoms in the patient group who received the cyclamen extract compared with the control group; this finding, as the Ukrainian expert pointed out, “has considerable clinical significance, as it shows the virtual disappearance of these symptoms in a very short time (by the seventh day, presence of these symptoms is marginal) and this means that we have eliminated almost entirely the main pathological factors of postoperative rhinosinusitis.”
The rhinoscopic picture on the first postoperative day is to be expected and no significant differences are observed between the treatment groups, with mucus-containing scabs in both cases.
However, by the third postoperative day, the rhinoscopic picture has changed substantially and is clearly better in the patients treated with cyclamen extract; in particular, a marked reduction in the hyperaemia, oedema and pathological secretion is observed. By the seventh postoperative day, the rhinoscopic picture features a complete absence of symptoms in the patients treated with cyclamen extract (except for a minimal presence of mucus secretion in a small group of patients).
Mucociliary clearance and transport is restored by the third day in the patients treated with cyclamen extract, while this function is not restored until the seventh day in the control group. A similar picture is obtained when the temperature of the mucous membrane is measured; by the seventh day, this temperature is normal in the group that received active therapy.
The monitoring CT scan of the paranasal sinuses performed after surgery confirms disappearance of the hyperplastic processes present during chronic inflammation of the paranasal sinuses, with normal opening and function.
In conclusion, cyclamen extract is an effective treatment in the postoperative period in patients with chronic rhinosinusitis. Individual tolerance of this preparation is good. The subjective symptoms (headache, difficulty in breathing through the nose, nasal secretion) disappear by the 5th-6th day of treatment, and are accompanied by restoration of a normal rhinoscopic picture.
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