Friday, June 29, 2012

PHYTOTHERAPY

Non-pharmacological sinusitis treatment


In the treatment of rhinosinusitis, we can use several plants that can be used both for preventive purposes and in the actual treatment, whether this be internal or topical.
Decongestive nasal plants: these reduce the excessive or abnormal accumulation of blood in the sinusoidal vessels

    • Mint (Mentha piperita) :
    • Eucalyptus (Eucaliptus globulus)
    • Eyebright (Euphrasia officinalis)

Mucolytic plants: these act by liquefying and fluidising the mucus, rendering elimination easier.

    • Anise (Pimpinella anisum)
    • Mint (Mentha piperita)
    • Eucalyptus (Eucaliptus globulus)
    • Mallow (Malva silvestris)

Antiseptic plants: these are capable of reducing the propagation of infectious agents

    • Purple coneflower (Echinacea purpurea)
    • Mint (Mentha piperita)
    • Eucalyptus (Eucaliptus globulus)
    • Thyme (Thymus vulgaris)
    • Pine buds (Pynus silvestris)
    • Rosemary (Rosmarinus officinalis)
    • Propolis

Immunostimulant plants: these stimulate the phagocytic power of macrophages, increasing the number of white blood cells

    • Purple coneflower (Echinacea purpurea)
    • Propolis

Mint

  • The active part of the plant is the fresh or dried leaves. The essential oils (menthol (38-48%), menthone (20-30%), cineole (5-6%), and flavonoids (12%) are extracted from the leaves and are used for inhalation. Despite the fact the plant does not have any noteworthy toxicity, essential oils should be dosed with caution due to their central nervous system (CNS) toxicity.
  • It must be remembered that this essential oil cannot be used in children under the age of three, pregnant women or adults with asthmatic bronchitis or asthma.
  • The topical pharmaceutical forms may cause allergic dermatitis.

Eucalyptus

  • The active part of the plant is comprised of leaves rich in essential oils (up to 80% eucalyptol). In addition to the leaves, the essential oils and liquid and dry extracts are also used in clinical practice. The most common dosage form is wet inhalations. The role of water vapour is very important, since it has been demonstrated that to achieve a quantifiable volume of secretion in the respiratory tract, the inspired air must have more than 80% humidity and be hot.
  • Essential oil is also contraindicated in pregnant and breast-feeding women as well as children under the age of 2, as it may cause bronchospasms.
  • Topical pharmaceutical forms may cause allergic dermatitis.

Eyebright

    • The active element is the aerial part of the plant. It is rich in glycosides of iridoids, essential oils, tannins (7%), choline and flavonoids.
    • Internal administration is falling into disuse due to its toxicity.
    • It is contraindicated at high doses in hypertensive patients, people with glaucoma and women in pregnancy or who are breast-feeding.

Anise

  • The active parts of the plant are the dried fruits. These are rich in essential oils (transanethol [93-95%]), coumarins, flavonic glycosides and mucilages. The essential oil is contraindicated during pregnancy and breast-feeding as well as during oestrogen treatments due to the possible synergistic action.
  • At high doses, anethole is neurotoxic with convulsant and narcotic action which can also lead to muscular paralysis and coma.
  • It may cause contact dermatitis in topical use.

Mallow

  • The active part is in the flowers. It contains mucilages, flavonoids, and phenolic acids. Although the leaves are rich in mucilages and flavonoids, they are not used often due to their intense mucilaginous flavour. They are used in infusions.

Purple coneflower

  • Both the roots and the aerial parts of different species are used in therapy. The posology depends on the species and the part of the plant which is used. It consists of essential oils, phenolic acids and heteroxides and may be administered in the form of tablets, capsules, infusions, decoctions, liquid extracts, dyes, etc.
  • The plant is considered non-toxic when taken orally, but the presence of alkaloid renders its use advisable in a period of less than 8 weeks.
  • No adverse effects are known, but it is not recommended in children under the age of 12, pregnant or breast-feeding women or people with autoimmune diseases or on immunosuppressives, corticosteroids or cytostatics.
  • Concomitant use with alcohol or hepatotoxic drugs may boost the toxicity of the coneflower in prolonged treatments.

Thyme

  • The element used is the flowering part. It contains essential oils (thymol and carvacrol), polyphenol compounds (borneol and linalool), flavonoids and tannins.
  • Essential oils cannot be used during pregnancy and breast-feeding. In aromatherapy, the essential oil may boost the potential toxic action of other essential oils.
  • The oil is neurotoxic and dermocaustic.
  • Its most common use is in infusions.

Pine buds

  • The parts used are the red buds and young shoots. The composition is based on bitter principles, organic acids, lignans and oleoresins.
  • The essential oil is contraindicated in children under 6 years old, as it may trigger bronchospasms.
  • The excessive inhalation of essential oil may cause nervous excitation and an increase in blood pressure.

Rosemary

  • The active element is the flowering parts. These contain essential oils (α-pinene [25%]), terpenic derivatives and polyphenols.
  • It cannot be used in epileptics, pregnant or breast-feeding women or children under 3 years old because it is neurotoxic, epileptogenic and abortive.
  • It may be found in infusions, liquid extracts or, preferably, in essence.

Propolis

    • This is an apiculture product which the bees collect from the resins and secretions that cover the buds of different vegetable species. It contains flavonoids, waxes, resins, phenolic acids, essential oils and mineral salts.
    • The most common pharmaceutical forms are capsules, tablets, bottles, drops and sprays.
    • In general, propolis is harmless, but it may cause dryness of mouth, drowsiness, dizziness and problems in the epigastrium.
    • It can be used in children as long as the dosage is adjusted according to age.

 

Friday, June 22, 2012

CYCLAMEN EXTRACT

Non-pharmacological sinusitis treatment


How does it work?
The aqueous extract obtained from the Cyclamen europaeum root-tuber is rich in saponins. These substances are known for their surfactant activity, which means they are adsorbed through the nasal mucosa without being absorbed into the bloodstream.




The surfactant action of the cyclamen saponins on the nasal mucosa reduces surface tension, facilitating humidification of the zone in addition to the secretion of mucin by goblet cells. This fluidifies the mucous accumulated in the nasal cavity, facilitating its elimination and thereby relieving congestion.
In addition, the saponins stimulate the sensitive receptors present in the nasal mucosa, inducing a nociceptive response transmitted by the trigeminal nerve. The nasal mucosa is entirely innervated by the trigeminal nerve, and therefore the cholinergic response generated in the nasal cavity is observed throughout the nasal mucosa, favouring opening of the ostium, increasing glandular secretions and increasing ciliar movement in the entire area. The accumulated secretions in the sinuses are consequently drained through the nose, providing rapid symptomatic relief of nasal congestion.

How and when should it be used?
Freeze-dried cyclamen extract must be reconstituted with water before use. Once reconstituted, the product should be refrigerated and can be stored for up to 16 days. It is administered once a day by spraying in each nasal cavity, preferably at night, approximately 2 hours before bedtime. Inhalation should be avoided during application so that the saponins act only on the nasal mucosa.
Treatment lasts 7-10 days, and if necessary this may be extended to up to 14 days.

What is recommended for proper use?
The mucosa should be clean and intact. To apply, hold the head in a vertical position and apply the solution by squeezing the nebuliser once in each nostril without inhaling.
When should this product not be recommended?
• In the case of known allergies to plant extracts, especially those in the Primulacea family.
• In patients with frequent nosebleeds.
• In children under 5 years of age.
• Do not use during pregnancy and nursing.

Does this product interact with medications?
The action of cyclamen extract is local, and it is never absorbed into the bloodstream, so there are no known medication interactions associated with it. This product can be prescribed both as a monotherapy and, if needed, in combined therapy with other medications for treating rhinosinusitis. These include antibiotics, corticosteroids and antihistamines. If use of another nasal spray is required, waiting 2 hours between the two products is recommended.

Thursday, June 21, 2012

Hygiene and dietary measures

Treatments for Rhinosinusitis

1. Hygiene and dietary measures

• Nose-blowing to eliminate mucosity and prevent possible complications.
• Drinking plenty of liquid frequently.
• Using a hypertonic saline solution several times a day.
• Inhaling steam to moisten the mucous and facilitate its elimination.
• Applying moist, hot compresses to the face several times a day.
• If the air is dry, using a humidifier.

 

Wednesday, June 20, 2012

Pharmaceutical indication

This is the professional service in response to the query of a patient or user who enters the pharmacy without knowing which medication to buy and asks the pharmacist about the best remedy for a specific health problem. If the service requires dispensing a medication, this is to be done in accordance with the previous dispensing protocol.
In response to a request for a solution to alleviate the symptoms of rhinosinusitis, the pharmacist must consider the following:

Who is making the inquiry?
Identify the person who is to receive the medication. If this is a child, we should take into account that rhinosinusitis is more frequent in children than adults and that they present more complications, such as otitis and chronification.


What are the characteristic symptoms that confirm a diagnosis of rhinosinusitis?
Rhinosinusitis is a pathology that is confirmed when there is nasal blockage due to congestion/obstruction and/or rhinorrhea/nasal secretion. Most common colds involve rhinosinusitis.


What are the other symptoms we might encounter?
• Facial pain with pressure, forehead pain and headaches. 
• Reduction or loss of smell (hyposmia or anosmia). 
• Pain when moving the eyes, coughing or blowing the nose.





In exceptional cases there may also be: 
• Fever. 
• Coughing. 
• Fatigue. 
• Dental pain. 
• Post-nasal drip.


When should we refer to a doctor?
When symptoms persist or there is facial pain for approximately 8 days or in case of fever.


How can we prevent rhinosinusitis?
• Drink plenty of water (1.5–2 litres/day) to increase moisture. 
• Avoid smoke and pollutants. 
• Reduce or eliminate tobacco use. 
• Wash the hands frequently. 
• Eat plenty of fruits and vegetables, which are rich in anti-oxidants and vitamins that can strengthen the immune system. 
• Reduce stress. 
• Use a humidifier to increase moisture in the nose and sinuses.


Is it necessary to treat the symptoms?
Yes, because this provides symptomatic relief, accelerates resolution of the condition, prevents possible complications and prevents progression to the chronic form.


The overall aim of the treatment is to: 
o Eliminate the accumulated mucuso Avoid infection. o Reduce inflammation and swelling.

Tuesday, June 19, 2012

Pharmaceutical care in rhinosinusitis

As part of the National Health System, pharmacists share with patients, doctors and other healthcare professionals and health authorities the mission of safe, effective and efficient use of medications. In this multidisciplinary environment, the pharmacist must demonstrate specific knowledge and skills to improve the patient's quality of life in relation to drug therapy and its aims.



When patients with rhinosinusitis visit the pharmacy, the pharmacist can facilitate appropriate therapeutic outcomes and avoid to a great extent the appearance of medication-related problems (MRP) through Pharmaceutical Care. In the case of rhinosinusitis, this consists of:
Dispensing, which involves the pharmacist taking an active role in providing medications for treatment.
Pharmaceutical indication, which involves helping the patient make the correct decisions for self-care.
Thanks to the consensus document of the Pharmaceutical Care Forum, the action procedure for community pharmacists for both dispensing and indication has been consolidated.
Dispensing
The pharmacist should guarantee that patients receive and use medications appropriately: according to their clinical needs, at the needed doses, according to their individual requirements and for the right time period. The pharmacist should also ensure that they have information for their proper use, according to the regulations in force.
A prescription being dispensed may refer to a pharmacological or non-pharmacological treatment. The pharmacist must validate that the treatment is appropriate for this patient.
Pharmaceutical indication
This is the professional service in response to the query of a patient or user who enters the pharmacy without knowing which medication to buy and asks the pharmacist about the best remedy for a specific health problem. If the service requires dispensing a medication, this is to be done in accordance with the previous dispensing protocol.

Monday, June 18, 2012



Physiology of the paranasal sinuses. Intrinsic sinusal functions

The paranasal sinusesare a set of pneumatised chamberslocated at the front of the skull which surround the nasal fossae and which are connected to them through small apertures. 





 The role they play with regard to the rest of the body is not fully known. 
Multiple functions have been attributed to them:


- lightening the bone structure of the skull 
- protection of the skull's nervous structures in the event of possible trauma 
- thermal insulation of the brain 
- soundbox and cenaesthetic controller of sound during phonation 
- thermohygrometric conditioner of inspired air 
- regulator of nasal pressure in the course of breathing and abrupt changes in pressure 
- storage of odorous particles 
- contribution to the adult shape of the face

Both the nose and sinuses are covered by a respiratory-type mucosa, although the nasal sinus is different from the sinusal sinus, fundamentally through the functional specialisation of the blood vessels of its chorion.
Any inflammatory process of the nasal mucosa may alter sinusal functionalism to varying degrees by blocking communication with the exterior.

Friday, June 15, 2012

Rhinosinusitis Aetiology

Rhinosinusitis  may be caused by very different factors that may be grouped into two major blocks:
A. Non-allergic rhinosinusitis
Through nonspecific infections, mostly viral, such as the common cold or catarrh, but also bacterial, mixed origin (virus and bacteria), and finally and rarely, fungal.



The main viruses involved are Rhinovirus, Myxovirus, Coronavirus and Adenovirus, and the bacterias that usually superinfect after the virus include Haemophilus influenza and Klebsiella pneumoniae.
In response to vasomotor or irritative factors, triggered by the following aspects: occupational, emotional, environmental, endocrine and medicinal products.
Dental factors particularly due to irregularly positioned teeth (ectopies).
Traumatic or trophic factors that entail the presence of foreign bodies in the mucosa.
B. Allergic rhinosinusitis (Hay fever)
Episodes in which there is an inflammation caused by immunoglobulin E. (IgE) following exposure to an allergen that acts as a trigger for the process. The following typologies are clearly identified:
Seasonal allergic rhinitis, caused by pollens from grass, bushes and trees. The symptoms used to be limited to the pollenisation seasons such as spring and summer. However, due to climate changes and cross reactions in many individuals, episodes are observed throughout the year.
Perennial allergic rhinitis, caused by dust mites and/or animal hairs and feathers. It gives rise to ‘bouts’ throughout the year.
Food and occupational allergic rhinitis, which is caused by intake or inhalation of substances such as latex, flour or seafood.
Talking to the patient in Pharmaceutical Care will help to ascertain and understand the origin of the disease, family history, triggers and previous treatments and responses to them.
The patient will usually require an examination of the nose, eyes, ears and lungs. Complementary tests, particularly for allergies and imaging exams (endoscopy, scanner) to determine the origin and extent of the disease are also common. The patient should be referred to a doctor for these exams. Communication with the patient in Pharmaceutical Care will provide information about the patient's symptoms, the origin of his/her illness, family history, outstanding causes as well as previous and subsequent treatments, which will then affect how we provide pharmaceutical indication consultation.

Thursday, June 14, 2012

Rhinosinusitis Epidemiology

•The difficulty of diagnosing rhinosinusitis makes it hard to establish its prevalence.
•In the case of chronic rhinosinusitis, its prevalence is estimated at around 10.9% of the general population.
•Acute rhinosinusitis is estimated as a complication in between 1% to 2% of all colds.
•Adults suffer from 2 to 3 viral respiratory infections or instances of acute rhinosinusitis per year while children suffer from 3 to 8.
•Only between 0.5% and 2% of all cases of acute rhinosinusitis lead to a bacterial infection which is treatable with antibiotics. The rest neither require nor improve with antibiotics.



•Both acute and chronic rhinosinusitis have a great impact on the patient's quality of life, and they consume a considerable amount of healthcare resources. Studies demonstrate an impact similar to that of asthma or peptic ulcers.
•It is estimated that between 65% and 70% of patients with rhinosinusitis self-medicate.

Wednesday, June 13, 2012


THE NASAL CYCLE

The airflow that passes through the nasal fossae are subject to spontaneous changes during the day: this is called the nasal cycle.




Humidification: The fossae reheat the air inspired and humidify it. 
The humidification of the inspired air is fundamental to ciliary activity throughout the respiratory tree and to alveolar epithelium functions, since gaseous exchange would not be possible if it were not coated by a liquid film which comes from the vaporisation of the water of the mucus covering.


Purification  of inspired air and defence of the nasal mucosa function: The nasal fossae act as a filter that opposes the entrance of inert or microbial inhaled particles and clean the inspired air to protect the pulmonary alveoli from the deposition of these particles in suspension. The filtered particles are deposited on the the nasal mucosal coating. They are then eliminated from the mucosa by means of the mucociliary function, which acts as a mechanical transport agent, pushing  the attached particles towards the rhinopharynx, preventing them from penetrating into the chorion. The bactericidal function of the mucus is made possible by the action of lysozymes, IgA and interferons which are capable of neutralising infectious agents. If the mucociliary function is unable to prevent an infectious element from entering the chorion, there is a second barrier, namely the inflammation mechanisms. With inflammation, the polynuclear cells and macrophages reach the chorion, which will phagocytize and kill the foreign elements, while also mobilising the T-cells.

Tuesday, June 12, 2012

Physiology of the nasal mucosa: vasomotor secretion function

The nasal secretion and vasomotor function of the nasal fossae is an autonomous function regulated by the neurovegetative system. The nasal mucosa has parasympathetic and sympathetic vegetative innervation. The parasympathetic fibres are excito-secretors that come from the sphenopalatine ganglion. Secretory response is fundamentally cholinergic and vascular response is noradrenergic. The sympathetic fibres are phreno-secretors, they come from the superior cervical ganglion. Sympathetic stimulation involves a vasoconstriction action that is also accompanied by nasal hyper secretion.




Respiratory physiology 

Respiratory function regulates the path of the movement of air currents and the passage of the air current.
In the human being, the core function of the nasal fossae is respiratory. The nasal fossae account for a resistance of 30-40% of total resistance to the entrance of air in inspiration, it is symmetrical and may vary according to the calibre of the nasal fossa.

Monday, June 11, 2012

Physiology of the nose, nasal fossae

  • A. Physiology of the nose
The nasal fossae perform a series of functions associated with each other, which include:
  • Respiratory function: This transports air to the tracheobronchial tree. This is its function par excellence.
  • Sensory function:  This conveys the odorous particles towards the olfactory mucosa.
  • Defensive function:  This protects against agents from the environment, which stimulate the nasal mucosa leading to reflex responses, the most important one being the sneeze reflex.
  • Phonatory function.

Physiology of the nasal mucosa: glandular secretion function

The nasal mucosa is coated by a layer of mucus, a permeable barrier between the mucosa and inspired air and the centre of all its metabolic exchanges.

The mucous lining is comprised fundamentally of water and mucus.
The mucus is secreted by the goblet cells and the mucosal glands. 
The water comes from the serous glands through secretion and the epithelial cells through transudation, but is also accumulated through the condensation of water vapour from the inspired air.

Nasal secretion is called rhinorrhea and is a common symptom in all nasal conditions. Rhinorrhea comes from the glands of the nasal mucosa and the transudate of blood serum.
Physiological function of nasal secretion:
Humidification of inspired air as it passes through the fossae and maintenance of the moisture needed for the cilia to work properly.
Heating of inspired air on evaporating. Effect of heat regulation: the evaporation process, which heats inspired air, in turn cools the blood of the nasal mucosa.
Filtering of inspired air
Bacteriostatic or bactericidal action of nasal secretion.

Composition of the mucus:
Composition: 95% water, 3% organic elements and 2% minerals.Amount secreted: 0.1 to 0.3 ml/kg/day. A normal individual secretes 1.0 l/day.
Mucus is hypertonic with regard to plasma and presents an osmotic pressure of about 0.314 osmoles. Its ion composition does not change with time. It is comprised mainly of:
Proteins: Mucin, a glycoproteinthatrepresents 60% of the total amount of the mucus proteins and whose amount depends on the viscosity of the nasal mucus, and of albumin, which comes in its entirety from plasma serum through transudation. The nasal mucus proteins have a marked circadian variation, which is four times higher at night than during the day.
Water and mineral salts: The moisturizing of the mucus is indispensable for ciliary functioning. A large part of the water contained in the mucus evaporates with inspiration and is only recovered partially through condensation during expiration. To compensate for this liquid loss, the mucosa exchanges liquids with mucus, generally through the basal membrane.

Mucus properties:
Physical properties  The nasal mucus has a viscosity that changes with the degree of moisturisation and mucin content.  Its pH has night-day time variations.  It has buffer power: This is its most characteristic physical property. Acid or alkaline solutions are normalised at a pH of 7 in a few minutes.

Biological properties
It is an important water reservoir.
It participates in the defence against infectious agents through its antimicrobial action. 
The proteolytic enzymes such as lysozyme and other enzymatic action proteins (lactoferrin, LDH and certain proteases) may support this specific defence system.

Friday, June 8, 2012

Frequently asked questions about rhinosinusitis


Is rhinosinusitis very common?
Yes. It seems that 30% of adults have one episode of rhinosinusitis a year and 3 out of every 8 colds leads to rhinosinusitis in adults.
In Europe, it is estimated that 10.9% of adults “always” suffer from rhinosinusitis. This is what is called Chronic Rhinosinusitis.






How long can it last?
A case of Acute Rhinosinusitis can last up to 12 weeks. After 12 weeks it is considered Chronic Rhinosinusitis.



How is rhinosinusitis treated?
The most important thing to do is to eliminate the mucous. To do this, the mucous must be made more “liquid”. We can achieve this using synergistic treatments: a) increasing the amount of water we drink, b) taking mucolytics that break up the mucous and c) applying a solution, such as cyclamen extract, to the nose that is capable of “drawing out” the mucous.
Antibiotics do not normally need to be taken, since bacterial infection is not frequent.



Is it a hereditary disease?
Indirectly it is, because the shape of the nasal fossae and the passages that connect them are inherited. Some morphologies of the nasal fossae and sinuses make an individual more likely to have rhinosinusitis.



How do I know whether I have rhinosinusitis? It is highly likely that you are suffering from rhinosinusitis if you feel congested and your nose and forehead are full of mucous which is difficult to blow out. As this mucous accumulates, there is a growing feeling of pressure.

Are rhinosinusitis, rhinitis and sinusitis the same?
They are not the same, although in practice it is very hard to tell the difference between them.
They all stem from an inflammation of the nasal mucosa. When this inflammation only affects the nostrils it is rhinitis. If there is also inflammation in the paranasal and frontal fossae, where the mucous accumulates and becomes purulent, then it is sinusitis. The full inflammation of all the nasal and paranasal mucosa is rhinosinusitis.
As a patient it is difficult to understand which one you may have. Only a doctor using specific diagnostic methods can determine the extent of the inflammation.


What can give me rhinosinusitis?
Most cases of rhinosinusitis are caused by unspecified infections such as a common cold or catarrh. 
Another significant cause are allergies, whether they are seasonal, such as those provoked by pollen, or constant such as those triggered by dust mites or animal hair.



What about children?
One in three colds or cases of catarrh in children becomes rhinosinusitis. This incidence is greater than adults, but less frequently becomes chronic in children.



Is having rhinosinusitis all that bad?
Only if cases repeat frequently and it becomes chronic. The risk of bacterial infection of the mucosa is very low. It only occurs in 1% of all cases.



Thursday, June 7, 2012

RHINOSINUSITIS



The terms Rhinitis, Rhinosinusitis and Sinusitis are often confused, as they are alterations and diseases of the nasal fossae and the paranasal sinuses that are subtly different one to another. They are also covered by the same mucosa and innervated by the same fibres from the neurovegetative system.




The sinonasal pathologies can be defined as follows: 
RHINITIS, an inflammation of the nasal mucosa that always courses with:
  • Oedema and vasodilation that hampers breathing, giving rise to uncomfortable “nasal congestion”;
  • Secretion of variable thickness;
  • Pruritus and irritation that causes sneezing.
These are sometimes accompanied by:
  • Ear, eye and pharyngeal symptoms.


RHINOSINUSITIS, an inflammatory process of the mucosa of the nasal fossae and one or more of the various paranasal sinuses (maxillary, frontal, ethmoid and sphenoidal). The inflammation in the sinuses gives rise to a loss of drainage through the ostium, leading to an accumulation of mucosity and a subsequent increased sensation of congestion.

SINUSITIS is a process limited to the mucosae of the paranasal sinuses. In practice, this localisation does not take place, and the inflammation of the mucosa of the sinuses is accompanied by that of the nasal fossae.
RHINOSINUSITIS is therefore the term of choice, as it figures in most current scientific guidelines, the news and the medical literature, and it is the one that most exactly matches the physiological process that actually occurs. The characteristic symptoms of rhinosinusitis are nasal obstruction, mucopurulent rhinorrhea and localised frontal or facial pain which in some cases may be accompanied by a loss of sense of smell.

Wednesday, June 6, 2012

Physiology of the paranasal sinuses. Intrinsic sinusal functions


The paranasal sinuses are a set of pneumatised chamberslocated at the front of the skull which surround the nasal fossae and which are connected to them through small apertures.

 

The role they play with regard to the rest of the body is not fully known. 
Multiple functions have been attributed to them:


- lightening the bone structure of the skull 
- protection of the skull's nervous structures in the event of possible trauma 
- thermal insulation of the brain 
- soundbox and cenaesthetic controller of sound during phonation 
- thermohygrometric conditioner of inspired air 
- regulator of nasal pressure in the course of breathing and abrupt changes in pressure 
- storage of odorous particles 
- contribution to the adult shape of the face

Both the nose and sinuses are covered by a respiratory-type mucosa, although the nasal sinus is different from the sinusal sinus, fundamentally through the functional specialisation of the blood vessels of its chorion.
Any inflammatory process of the nasal mucosa may alter sinusal functionalism to varying degrees by blocking communication with the exterior.

Tuesday, June 5, 2012

THE NASAL CYCLE

The airflow that passes through the nasal fossae are subject to spontaneous changes during the day: this is called the nasal cycle.





Humidification: The fossae reheat the air inspired and humidify it. 
The humidification of the inspired air is fundamental to ciliary activity throughout the respiratory tree and to alveolar epithelium functions, since gaseous exchange would not be possible if it were not coated by a liquid film which comes from the vaporisation of the water of the mucus covering.

Purification  of inspired air and defence of the nasal mucosa function: The nasal fossae act as a filter that opposes the entrance of inert or microbial inhaled particles and clean the inspired air to protect the pulmonary alveoli from the deposition of these particles in suspension. The filtered particles are deposited on the the nasal mucosal coating. They are then eliminated from the mucosa by means of the mucociliary function, which acts as a mechanical transport agent, pushing  the attached particles towards the rhinopharynx, preventing them from penetrating into the chorion. The bactericidal function of the mucus is made possible by the action of lysozymes, IgA and interferons which are capable of neutralising infectious agents. If the mucociliary function is unable to prevent an infectious element from entering the chorion, there is a second barrier, namely the inflammation mechanisms. With inflammation, the polynuclear cells and macrophages reach the chorion, which will phagocytize and kill the foreign elements, while also mobilising the T-cells.

Monday, June 4, 2012

Anatomy of the paranasal sinuses

The paranasal sinuses are a set of 8 aerial cavities or sinuses, four on each side of the nose in the frontal, sphenoid, ethmoid and superior maxillary bones, covered by a fine mucosa of ciliated epithelium and which communicate with the nasal fossae.
The bones that surround the nasal fossae are pneumatised (hollow and containing air). They are coated by a wet mucosa that constantly produces a lubricating mucus that drains through the nasal fossae apertures. They are involved in breathing, phonation, heating and olfaction.




Frontal sinus
These two cavities separated by the interfrontal septum are linked through the back with the anterior cranial fossa and through the bottom with the orbits and the nasal fossae.


Ethmoid sinus
The labyrinth or ethmoidal cells are located on each side of the half and upper third of the nasal and medial cavity to the orbit bone. They are clustered and are closely connected at the side with the orbital content and at the rear with the sphenoidal sinus.


 Maxillary sinus
The Maxillary sinus or antrum of Highmore is the largest of the paranasal sinuses. It has the form of an irregular pyramid with the base towards the nasal fossa and the vertex towards the zygomatic or pyramidal process of the maxillary.


Sphenoidal sinus
This is the farthest anterior and usually septated by 1 or 2 osseous septums. It is located in the body of the sphenoid, hence its size and shape are variable. Each sphenoidal sinus communicates with the superior nasal meatus through small apertures that drain into the sphenoethmoidal recess.


Opening of the sinuses 
The sinuses of each bone open out into a meatus through the ostium, a conduct through which they drain any unnecessary content, this structure is called Ostiomeatal Complex (OMC).

Attic: leads to the sphenoidal sinus, the attic is the area above the superior meatus.
  •  Superior meatus: leads to the posterior ethmoid sinus.
  •  Middle meatus: leads to various paranasal sinuses as the anterior ethmoid sinus, superior maxillary sinus, frontal sinus.
  •  Inferior meatus: lead to the nasolacrimal duct.
  •  Mucosa of the paranasal sinuses
The mucosa of the paranasal sinuses is of the same histological type as that of the nasal fossae, as it is a continuation of the latter. It is different from the nasal mucosa in that it is far less vascularised and is slimmer and more fragile. The epithelium is of the stratified cylinder type and ciliated with muciparous cells. The chorion contains blood vessels, nerves and seromucous glands. The conjunctive tissue is condensed, and there is continuity between the chorion and the periosteum.

Friday, June 1, 2012

About Nasodren

The therapeutic efficacy of Nasodren in relieving the symptoms of ear pathology is determined by the liquefaction capacity of the secretion accumulated in the tympanic cavity and auditory tube, the improvement of the mucociliary clearance of the mucous membrane of the nose and sinuses, the intensification of evacuation and ventilation functions of the auditory tube.,



Nasodren is a natural product. Its active ingredient are saponins, a cyclamen extract that gives a fast relief from rhinosinusitis symptoms, like nasal blockage, obstruction, congestion or nasal discharge. Saponins can’t pass trough to the mucosa membrane and therefore do not reach bloodstream and consequently they do not produce systemic side effects.
Nasodren acts activating the physiological defense mechanisms of the upper airways (increased mucus secretion, greater ciliary cleansing activity and increased arterial blood flow) that are impaired during rhinosinusitis. Nasodren stimulates the trigeminal nerve endings of the nasal mucosa that leads to a seromucus discharge, reduction of the inflammation of the mucosa and opening of the ostiums and therefore cleaning sinuses and nasal cavity
This specific mechanism of action may produce some itching, sneezing, and a brief sensation of mild to moderate burning sensation in the nasopharynx and more rarely, a brief lacrimation and flushing of the face. These are manifestations of the positive response to the product. All these effects usually diminish during the course of treatment.

There are studies showing that when administered locally, Nasodren do no alter neither produce morphological changes in the mucosa of the nasal cavity or sinuses
Nasodren, locally administered, is safe for the nasal mucosa.

Do no use Nasodren in case of allergy to Primulaceae, the family of plants to which Cyclamen europaeum (Nasodren active ingredient) belongs to.