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Spanish experience in postoperative care with cyclamen

DOÑAMAYOR C.
ENT Diseases Clinic. Madrid

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 traditionally accepted that the postoperative treatment starts with the surgery itself. In this case, during sinonasal endoscopic surgery, two basic recommendations should be followed: try not to damage the mucosa during the operation and insert some type of plugging.

However, there is no consensus on other aspects related with postoperative care after sinonasal endoscopic surgery: whether corticoids and antibiotics should be combined in the plug, the number and frequency of wound care procedures, type of irrigation (isotonic or hypertonic saline solution),...

Stammberger, in 1991, systematised a postoperative care procedure in sinonasal endoscopic surgery. Among other recommendations, he indicated the need to remove the scabs and not use ointments (which may cause cysts). Hosemann, between 1991 and 2000, studied in depth the benefits obtained from the use of the microdebrider in the office.

Bernal, in 2001, systematised the number of wound care procedures that should be performed, indicating that this should be done 3-5 times during the first postoperative day, 1-2 times a week during the first month, and subsequently, once a week until all the eschars have disappeared. The EP3OS guidelines also establish a series of recommendations for the postoperative management of patients operated for chronic rhinosinusitis, stressing the benefits of frequent nasal irrigations.

The problems that most commonly occur in the postoperative course of this type of surgery are the presence of adhering scabs and hard to remove, dried and, sometimes, bloody mucus; all of this prevents normal recovery of the mucous membrane. In any case, the time required for restoration of normal conditions varies considerably from one case to another.

Dr. Doñamayor summarised the basic principles of postoperative care applied in his clinical practice in patients undergoing sinonasal endoscopic surgery: nasal plugging with merocel + betamethasone, removing it after 48 hours; nasal irrigation with saline solution every 4-6 hours; wound care, generally with local anaesthetic; the microdebrider is not used in the doctor’s surgery; the scabs are removed as often as may be required; and, lastly, systematic aspiration of all the secretions.

Antibiotics are only used when the presence of pus is documented (clindamycin 10 days), leaving topical corticoids for those cases in which polyps have been removed; no vasoconstrictors or mucolytics are used. However, since October 2006, he has also included cyclamen extract in the treatment armamentarium of choice for postoperative care.


CLINICAL EXPERIENCE

With the environmental dryness and air pollution in Madrid, scabs are particularly prevalent during the postoperative course of patients in this city and can be treated with cyclamen extract. Because of its mechanism of action, it facilitates expulsion of secretions and purulent matter.

On the basis of this data, Dr. Doñamayor’s study group has acquired an interesting body of experience in recent months in the use of cyclamen extract in the postoperative care of patients with chronic rhinosinusitis and also in patients who have undergone removal of nasal polyps. Since 2006, this preparation has been used for the postoperative care of a total of 11 patients with chronic rhinosinusitis and 32 patients with polyposis.

In 11 patients with chronic rhinosinusitis, the cyclamen extract was given on the third or fourth day after surgery (preferably in the early afternoon), with a single spray in each nostril each day. No complications were observed; on the contrary, there was a significant improvement in mucus discharge and expulsion of the purulent secretions caused by the surgery. In the speaker’s opinion, “It was to expected that there would be no complications, as after the chronic rhinosinusitis patient has undergone surgery and the nasal passages have been opened, administration of the cyclamen extract will promote rapid restoration of normal mucosa.”

As regards the experience acquired in patients who have undergone surgery for sinonasal polyposis, Dr. Doñamayor also rated it as “highly satisfactory.” In these cases, the cyclamen extract was used on the fifth or sixth postoperative day (when the mucous membrane inflammation has been reduced considerably and most of the scabs have been removed). It has been administered once a day (preferably in the afternoon).

Only one significant complication has been reported in the 32 patients analysed (intense headache), probably because of an inappropriate indication of the medicine. A significant improvement in the secretion and scab elimination process has been seen in these patients.

On the basis of this observational experience, it is concluded that the incidence of nasal itching is very irregular, its administration is associated with an intense watery rhinorrhoea (which is particularly abundant during the first few days) and an intense headache may appear if there is obstruction of the meatus.

As regards the benefits of Nasodren®, Dr. Doñamayor underscored that “it improves the elimination of mucus secretions and surgical fluids; it also facilitates cleansing of the surgical cavities, reduces adhering scabs, there is less damaged tissue, it is possible to space wound care procedures further apart, the patient is more comfortable and his quality of life is improved. Although it does not improve the healing process itself, the cyclamen extract does not cause tissue damage or prevents it from occurring due to the presence of scabs, facilitating a normal healing process.”


CONCLUSIONS

In sinonasal endoscopic surgery (with or without polyposis), cyclamen extract helps optimise the results of postoperative care: it makes wound care easier and enables the number of procedures to be reduced, it helps reduce the number and size of the scabs and elimination of the secretions, it is well tolerated by the patients and is associated with very few complications if it is used correctly and, furthermore, it seems to significantly shorten the patient’s postoperative healing process.


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