Friday, September 28, 2012

Acute rhinosinusitis in Russia

Acute rhinosinusitis in Russia: differences and similarities

In Russia, the pathogens most commonly involved in the development of acute bacterial rhinosinusitis are Streptococcus pneumoniae and Haemophylus influenzae, in that order.

Their distribution is similar to the rest of Europe, although with a higher prevalence of the beta-haemolytic pneumococcus (more than 15%), which is furthermore associated with more severe episodes of acute rhinosinusitis.
In West Europe, one of the biggest problems faced in the management of this disease is the growing bacterial resistance to the main antibiotics of choice, particularly in countries such as France or Spain (39% of the pneumococci are resistant to cephalosporins, 37% are resistant to macrolides, 28% are resistant to penicillins). The situation is less dramatic in East Europe, with lower resistance rates (although the trend is for resistance to increase). In fact, to date, only the pneumococcus’s resistance to two reference antibiotics is worrying: co-trimoxazole (32.4%) and tetracycline (29.4%). However; resistance to other antibiotics, such as moxifloxacin, amoxicillin or amoxicillin/clavulanic acid, is virtually non-existent. A similar situation is observed for H. influenzae, which is not very sensitive to the effect of co-trimoxazole and clarithromycin, but poses virtually no resistance problems to other antibiotics of choice.


 Another difference between the management of acute bacterial rhinosinusitis in Russia and in West European countries is that, in cases of mild disease, the Russian specialists usually do not recommend the use of systemic antibiotics, preferring to use nasal irrigations, decongestants and/or topical antibiotics.
On the other hand, no significant divergences are seen between the main reference antibiotics, with the first-choice antibiotics being amoxicillin and amoxicillin/clavulanic acid. In more severe cases (patients in whom a prior antibiotic therapy against the same episode of rhinosinusitis has failed), it is preferred to use drugs such as quinolones (third or fourth generation), macrolides or i.v. ceftriaxone.

As the speaker stressed, the Russian specialists show particular commitment to the treatment of acute rhinosinusitis. “Not only do they follow the recommendations given in national and international guidelines in a high percentage of cases but, in certain cases, they often prescribe alternative treatment methods, such as antral puncture or phytotherapy.”
Antibiotic resistance: Europe


Results with cyclamen extract 
Administration of cyclamen extract for the treatment of acute rhinosinusitis is becoming increasingly common in the Russian Federation. Russian otorhinolaryngologists have been showing a keen interest in the therapeutic properties of this product for some time and participate actively in numerous research projects that not only analyse the treatment’s clinical outcome but also seek to ascertain the pathophysiological mechanisms that enable cyclamen to be an effective treatment for this disease.
To illustrate this point, explained the design and results of a laser Doppler flowmetry study that has quantified nasal blood flow in 30 people distributed in equal numbers to three groups: healthy volunteers, patients with acute rhinosinusitis and patients with chronic rhinosinusitis. The results of this study suggest that the increased nasal blood flow over a prolonged period may play a crucial role in this product’s mechanism of action, with effects on the nasal mucous glands and secretion accumulation.

Prof. A. S. Lopatin
ENT Clinic. Sechenov Medical Academy. Moscow

Thursday, September 27, 2012

Effects of cyclamen extract on cell osmosis

Effects of cyclamen extract on cell osmosis

Importance of Rhinosinusitis and its Management
The cyclamen extract acts in the nasal passages, triggering a reflex nasal secretion that facilitates drainage and elimination of the mucus retained in the nasal passages and paranasal sinuses.

It has recently been observed that it also has a direct osmotic effect on the nasal mucosa, facilitating mucin secretion and reducing nasal mucosa oedema and congestion.
The mechanism of action of cyclamen extract is currently the subject of active research. The biotechnology company Advancell has carried out studies using the calu-3 cell line as model. These cells are obtained from a carcinoma of the submucous glands in human tracheobronchial epithelium. Calu-3 is one of the few respiratory cell lines capable of forming tight junctions, which enables it to be used as a model of the airway epithelial barrier, reproducing the features of the differentiated, functional epithelial cells of the human respiratory epithelium.
Using this model, it has been found that the presence of cyclamen is associated with a significant increase in mucin secretion 5 minutes after administration (marked differences from the control and similar effects to those obtained with seawater).
The ultrastructural analysis by electron microscope clearly shows this product’s marked osmotic effect; and when the observation is extended to 10 minutes, the evidence is not only reproduced but cyclamen’s osmotic effect on airway epithelium is seen to be increased. This effect is reversible, which gives it added interest as it guarantees total integrity of the cells after exposure. In her conclusions, Dr. Fabre stated that “the analysis of cyclamen’s in vitro effect for 5 minutes is particularly interesting, as it matches the time that the extract is in contact with the nasal epithelium in vivo (due to the mucus secretion and clearing effect).” She added, “in this experimental system, the cyclamen extract induces a powerful mucus secretion without disrupting the membrane (similar to the secretion obtained with hypertonic seawater). In addition, this effect of cyclamen is reversible, as shown by the fact that normal epithelial morphology is restored in vitro after 24 hours.” In short, these studies have shown that the cyclamen extract has a specific, reversible effect on mucus secretion in the nasal epithelium, due to an osmotic mechanism of action.
“The cyclamen extract has a direct osmotic effect on the nasal mucosa, facilitating mucin secretion and reducing nasal mucosa oedema and congestion”

Tuesday, September 25, 2012

Plant extract, outlook

However, the near future promises to bring new products which, will enrich our armamentarium and facilitate a natural, safe approach to various sinonasal disorders.

The most interesting of these are those that contain plant extracts which have a local effect on the mucous membranes in the nose and paranasal sinuses. According to the experts, such products may provide rapid, safe symptom relief.
Plant extracts have been used successfully in traditional medicine. After cyclamen extract use, “there is a reflex secretion by the mucous membrane lining the nasal passages and paranasal sinuses and this increase in secretion is associated with an intense natural cleansing of the nasal passages and
paranasal sinuses.

Shortly after application, the patient may have a sensation of mild or moderate smarting and irritation of the nose and heavy sneezing bouts. Meanwhile, the product causes an intense reflex secretion that begins a few minutes after application and which may continue for a couple of hours.
Through the intense secretion, the mucosa is dehydrated virtually instantly, causing diminished tissue oedema, decrease in mucosal inflammation and opening of the ostiomeatal complex. The secretion is associated with an intense physiological drainage of the nasal passages and paranasal sinuses, which is very effective in providing symptom relief. , referring to his own personal experience with this product, “expulsion of the mucus secretion into the sinuses and nasal passages and its subsequent drainage could be compared in a way with inserting a sponge inside the nose, causing a marked drying effect.” This effect, as he pointed out, “is caused by activation of the mucociliary clearing processes during administration of the cyclamen extract.

Case Observations
Thus, one case was shown with clear signs of hyperaemia and congestion and purulent mucus in the middle meatus. Just 3 minutes after first administration of the cyclamen extract, mucus started to be expelled in large quantities from the nasal cavity and the sinuses through the ostiomeatal complex. By 5-10 minutes after administration, drainage of the mucopurulent secretions from the sinuses to the nasal passages began (for subsequent expulsion and removal). After 1 hour, the secretions became more abundant. If the patient starts to sneeze, this causes expulsion of large quantities of mucopurulent secretions. After three hours, the secretion’s nature starts to change, taking on a much more seromucous form. After three days, there are mucupurulent secretions in the middle meatus. By the third day, mucus and pus are drained from the ostiomeatal complex just 5 minutes after applying the product. Finally, after 5 days, recovery is almost complete. In short, as the speaker concluded, “spraying with these plant extracts has an effect that, above all else, consists of intensifying physiological nasal mechanisms.

As a general rule and as his main observation, the expert pointed out that “all patients were symptom-free by the end of the treatment period and no rescue systemic or local therapy was required in any case.
The symptom results obtained with this product in postoperative care or cleansing are also satisfactory. An improvement is observed in symptoms after the sixth day in the patients treated with the product. The treatment was started in all cases on the third day after surgery (after removing the merocel).
This side effect is variable and may even be absent in postoperative patients. Sneezing, watery rhinorrhoea or isolated pain may also appear in obstructive conditions. In any case, these are mild, passing, rarely seen but expected effects that have a negligible clinical significance.
This new product is also useful in postoperative care after sinonasal surgery. , “it has been shown to be useful in clearing the surgical cavity; it reduces the need for aggressive care, diminishes the number of postoperative dressing changes (longer time between changes), promotes physiological drainage, may speed up the re-epithelialisation process, and can be used jointly with topical corticoids.”
Topical steroids and the combination of both therapies are the treatments associated with the best level of evidence for the management of acute rhinosinusitis.
For the treatment of chronic rhinosinusitis, topical steroids have a level of evidence IIb and a degree of recommendation A.
For the treatment of nasal polyps, the treatments of choice may be oral antibiotics for 12 weeks (level III, degree C) and topical steroids (Ib, recommendation A).
The plant extracts have a local effect on the mucous membranes in the nose and paranasal sinuses. According to the experts, such products may provide rapid, safe symptom relief.
The secretion is associated with an intense physiological drainage of the nasal passages and paranasal sinuses, which is very effective in providing symptom relief.
The plant extracts have been shown to be useful in clearing the surgical cavity, reducing the need for aggressive care, diminishing the number of postoperative dressing changes, and promoting physiological drainage.


57th National Congress of the Spanish
Society of Otorhinolaryngology
Granada, 1 October 2006

Friday, September 21, 2012

Corticosteroids in Chronic Rhinosinusitis (CRS) with nasal polyps (NP)

Corticosteroids in Chronic Rhinosinusitis (CRS) with nasal polyps (NP)

Nasal polyps appear as grape-like structures in the upper nasal cavity, originating from within the ostiomeatal complex. They consist of loose connective tissue, oedema, inflammatory cells as well as some glands and capillaries, and are covered with varying types of epithelium, mostly respiratory pseudostratified epithelium with ciliated and goblet cells. 


 The reason why polyps develop in some patients and not in others remains unknown. There is a definite relationship in patients with: asthma, non-steroidal anti-inflammatory drugs (NSAID) sensitivity and nasal polyps. However, not all patients with NSAID sensitivity have nasal polyps, and vice-versa. 
The prevalence of NP has been found to be 4.2%, with a higher prevalence (6.7%) in asthmatic patients. In general, NP occurs in all races and becomes more common with age. The average age of onset is approximately 42 years, which is 7 years older than the average age of the onset of asthma. NP are uncommon under the age of 20 and are more frequently found in men than in women.

Large NP can be visualized by anterior rhinoscopy, whereas nasal endoscopy is warranted for the diagnosis of smaller NP. Nasal endoscopy appears to be a prerequisite for an accurate estimate of the prevalence of NP, as not all patients that claim to have NP actually have polyps on nasal endoscopy (1).
Polyps that become symptomatic may remain undiagnosed, either because they are missed during anterior rhinoscopy and/or because patients do not see their doctor for this problem. Indeed, one third of patients with CRS with NP do not seek medical advice for their sinonasal symptoms (2).
Compared to patients with CRS with NP not seeking medical attention, those actively seeking medical care for CRS with NP had more extensive NP with more reduction of peak nasal inspiratory flow and greater impairment of the sense of smell (3).
Topical corticosteroids
It is of value to look separately at the effect on rhinitis symptoms associated with polyposis and the effect on the size of nasal polyps per se.
Systemic corticosteroids

Traditionally systemic steroids have been used in CRS patients with NP although no placebo-controlled studies or dose-effect studies have supported the concept. 
Studies on systemic steroids in NP have recently been published giving support to the clinical impression that they are effective after two weeks use in doses acceptable for a majority of patients. As well as symptom relief, an effect on polyp size and MRI (Magnetic Resonance Imaging) changes are observed.

Side effects of corticosteroids
The Anti-inflammatory effects of corticosteroids cannot be separated from their metabolic effects, as all cells use the same glucocorticoid receptor; therefore when corticosteroids are prescribed measures should be taken to minimize their side effects. Clearly, the chance of significant side effects increases with the dose and duration of treatment and so the minimum dose necessary to control the disease should be given.
The safety of nasal and oral corticosteroids has been the subject of concern in medical literature since many patients with chronic sinus disease are prescribed these drugs due to their efficacy. Suppression of the hypothalamic-pituitary-adrenal axis, osteoporosis or changes in bone mineral density, growth retardation in children, cataracts and glaucoma have been reported to be the main adverse effects of corticosteroid treatment (6). In relation to adverse effects of corticosteroids, it is obvious that a clear distinction needs to be made between nasal (topical) and oral corticosteroids.
Nasal corticosteroid treatment represents one of the long-term treatment modalities in patients with chronic sinus disease. It is well established that absorption into the systemic circulation takes place after nasal administration of corticosteroids. However, several factors influence the systemic absorption, like the molecular characteristics of the corticosteroid, the prescribed dose, the mode of delivery and the severity of the underlying disease (4)
There is insufficient evidence from the literature to relate the use of nasal corticosteroids at licensed doses to changes in bone mineral biology, cataract and glaucoma. Adrenal suppression may occur with some nasal corticosteroids at licensed doses, but the clinical relevance remains uncertain. Overuse of nasal corticosteroids may be responsible for adrenal insufficiency and decrease in bone mineral density.  Of note, inhaled corticosteroids are the mainstay of treatment for children and adults with asthma and are more often associated with systemic side effects than the nasal route of treatment for rhinosinusitis. Intranasal administration of corticosteroids is associated with minor nose bleeding in a small proportion of recipients. This effect has been attributed to the vasoconstrictor activity of the corticosteroid molecules, and is considered to account for the very rare occurrence of nasal septal perforation (5) although it is also hypothesized that it could be related to repeated traumas on the nasal mucosa and septal cartilage by the nasal device, to the underlying nasal disorder for which corticosteroids were prescribed. However, it should be remembered that minor nosebleeds are common in the population.
Nasal biopsy studies do not show any detrimental structural effects within the nasal mucosa with long-term administration of intranasal corticosteroids (6).
Short treatment with oral corticosteroids is effective in chronic rhinosinusitis with nasal polyps. It is obvious that repeated or prolonged use of oral corticosteroids is associated with a significantly enhanced risk of the above-mentioned side effects.
In summary, intranasal corticosteroids are highly effective in cases of NP; nevertheless, they are not completely devoid of systemic effects. Thus, care has to be taken, especially in children, when long-term treatments are prescribed.
Nasodren, corticosteroids and NP

Nasodren can be used both in monotherapy and in combination with other products used to treat rhinosinusitis, including, obviously, corticoids.
It has been proven that the addition of Nasodren to any rhinosinusitis treatment or a combination of treatments increases the cure rate by 19% (7).
In cases where the patient has huge polyps, these can obstruct the ostiomeatal complexes, preventing mucus drainage from sinuses. This is perceived as a lack of efficacy of NasodrenĂ¢. Since corticoids reduce polyp size, the concomitant use of NasodrenĂ¢ and corticoids may cause symptom relief. 

  1. Johansson L, Akerlund A, Holmberg K, Melen I, Bende M. Prevalence of nasal polyps in adults: the Skovde population based study. Ann Otol Rhinol Laryngol. 2003; 112(7): 625-9.
  1. Klossek JM, Neukirch F, Pribil C, Jankowski R, Serrano E, Chanal I, et al. Prevalence of nasal polyposis in France: A cross sectional, case-control study. Allergy. 2005; 60(2): 233-7.

  1. Johansson L, Bramerson A, Holmberg K, Melen I, Akerlund A, Bende M. Clinical relevance of nasal polyps in individuals recruited from a general population-based study. Acta Otolaryngol. 2004 Jan; 124(1): 77-81
  1. Cave A, Arlett P, Lee E. Inhaled and nasal corticosteroids: factors affecting the risks of systemic adverse effects. Pharmacol Ther. 1999 Sep; 83(3):153-79.

  1. Salib RJ, Howarth PH. Safety and tolerability profiles of intranasal antihistamines and intranasal corticosteroids in the treatment of allergic rhinitis. Drug Saf. 2003; 26(12):863-93.
  1. Holm AF, Fokkens WJ, Godthelp T, Mulder PG, Vroom TM, Rijntjes E. A 1-year placebo-controlled study of intranasal fluticasone propionate aqueous nasal spray in patients with perennial allergic rhinitis: a safety and biopsy study. Clin Otolaryngol.1998; 23(1):69-73.

  1. Mullol J. Is it possible to cure all forms of acute rhinosinusitis in 4 weeks? Evidence from the PROSINUS study. ERS 2008.

Thursday, September 20, 2012

Chronic sinusitis

Chronic sinusitis

Chronic sinusitis is acknowledged to be due to a gradual obstruction caused by increased tissue formation in the ostiomeatal complex (site where sinuses normally drain into the nasal cavity).

The pathological mechanisms that cause sinusitis to become chronic have been attributed to mucociliary dysfunction, mucus stagnation (which favors bacterial infection) and the consecutive hypoventilations of the sinuses.
The cilia (microscopic filaments that cover the surface of the tissue in the nose) are always at work, refreshing the mucus coating of the nose. In coordinated waves, they sweep a layer of mucus to the back of the nose every 5-8 minutes. The mucus then slips into the throat where it is swallowed, rather than inhaled into the lungs. Rhinosinusitis cause the cilia to stop working (mucociliary dysfunction).
The treatment of chronic sinusitis is aimed at restoring ventilation and drainage of the paranasal sinuses, liquefying the accumulated secretion and removing it from the cavities. Securing good drainage of the affected paranasal sinus is a basic condition for a successful treatment of inflammatory processes in closed cavities
Nasodren reactivates the physiological defense mechanisms that have been counteracted by rhinosinusitis. Nasodren actively improves the mucociliary clearance of the nasal cavity and the paranasal sinuses, thus contributing to the accelerated conclusion of the inflammatory process. Nasodren restores the patency of the natural sinus ostia and clean sinuses and the nasal cavity, which contributes to the complete evacuation of pathologic content from all the paranasal sinuses.
Nasodren also has intense antiedemic action, directly related to the stimulated hypersecretion.
Therefore, Nasodren acts on practically all the mechanisms of sinusitis development being useful in the treatment of acute, and the prevention and treatment of exacerbations of chronic rhinosinusitis.

Wednesday, September 19, 2012

What its Rhinorrea?

Rhinorrhea is a quite frequent condition that can be present at very early ages and is not usually considered dangerous.

It occurs when nasal tissues and blood vessels produce excess fluid or mucous that runs out of your nose or down the back of your throat. Runny nose can be caused by a cold, influenza, allergies to such things as dust, pollen or pet dander, or as a response to irritants such as tobacco smoke.
Some people have a chronically runny nose for no apparent reason, a condition called no allergic rhinitis.

Rhinorrhea is one of the symptoms involved in rhinosinusitis and it is normally accompanied by nasal congestion, facial pain/pressure and loss or reduction of smell
It is always advisable to visit your doctor to know what causes your “runny nose”.
In case you have rhinosinusitis, you can use Nasodren (read the product information leaflet before using it)

Tuesday, September 18, 2012

Polyps symptoms and Nasodren

Polyps overgrowths of the mucosa that frequently accompany chronic rhinosinusitis allergic rhinitis, asthma, aspirin intolerance and other allergies or conditions. The common symptoms are nasal block, sinusitis, anosmia (loss of smell), and secondary infection leading to headache.


 When you have polyps your nose is clogged and you can only breathe a small amount of air in the nose. 
The ENT specialist by mean of endoscopy images makes the diagnosis of polyps (we recommend to visit an ENT specialist)
Nasal polyp treatment seeks to reduce inflammation and usually starts with drugs, which can make even large polyps shrink or disappear. Drug treatments may include: nasal corticosteroids, oral and injectable corticosteroids (can cause serious side effects). Depending on the underlying conditions other drugs may be prescribed: antihistamines to treat allergies and antibiotics to treat a chronic or recurring infection.

If drug treatment doesn't shrink or eliminate nasal polyps your doctor may recommend surgery. The type of surgery depends on the size, number and location of your polyps and the extent of inflammation.
Nasodren can help you in case you have viscous mucus stagnation in your sinus. In this case, Nasodren will help to expulse secretions, will reduce nasal obstruction and will lead to pain relief. Nasodren will not shrink the polyps.
In case you had to undergo surgery, Nasodren would benefit in promoting healing after surgery and in preventing recurrences.
Since Nasodren is a natural product, is efficient and safe. Please, know that if you decide to try Nasodren, the first few times you use it, may produce some itching, sneezing and a brief sensation of mild to moderate burning, These effects are consequence of the mechanism of action of the product and are manifestations of the positive response to the product action. All of these effects usually diminish during the course of treatment.

Monday, September 17, 2012

Can I use Nasodren if I have Polyps?

Sinusitis is the inflammation of the sinuses. Inflammation leads to ostium (the opening that communicate the sinuses with nasal cavity) obstruction and cilia (small hairs that line the sinuses and function to remove mucus from the sinuses) impairment. When it happens mucus are stagnated in the sinuses and sinusitis symptoms appear. If mucus stagnated in the sinuses are infected we have sinus infection. So, not all sinusitis sufferers have infection but all have inflammation, the starting point in this vicious circle of rhinosinusitis (inflammation favors infection and infection favors more inflammation). 
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 helps to reduce and prevent inflammation and therefore decrease the number of exacerbations of chronic rhinosinusitis.

There is no contraindication in using Nasodren in case of polyps, but in case of huge polyps you will not fully benefit of it since nasal obstruction will remain. In case of very impaired quality of life, surgery is often the best, although sometimes polyps reaper. In case you want to avoid surgery, you should visit the ENT specialist who probably will recommend corticoesteroids to reduce inflammation. Nasodren can be used in combination with corticosteroids as well as with antibiotics (do not use concomitantly with decongestants because these reduce its efficacy).
Surgery may sometimes be needed (when exist huge nasal polyps that obstruct the ostiu; in this case, mucus can’t be drained instead of using Nasodren) but it may not provide a permanent solution because polyps tend to recur.

Friday, September 14, 2012

Reasons because Nasodren doesn’t work as expected 

A small percentage of people do not benefit from Nasodren due to unknown reason (idiopathic cause). In other words, a product or a drug that works effectively in a patient may produce no effect in other patient.
Others cause of lack of efficacy is the existence of huge polyps. Huge polyps may block the opening of the sinuses and the nasal passage impeding mucus drainage. Other anatomical malformations can produce similar results. It is advisable to visit the ENT specialist to assess the existence of large nasal polyps and treat them properly. The ENT specialist must assess these conditions and treat them properly.

Another cause of lack of efficacy of Nasodren is the concomitant (simultaneous) use of a decongestant. The mechanism of action of the decongestants (vasoconstriction) impedes the action of Nasodren. It is not necessary to use a decongestant when using Nasodren but in case the patient wants to use both, a gap of at least 2 hours must be left between the applications of both products.
According to our data, about 85% of rhinosinusitis patients significantly improve when using Nasodren.

Nasodren is a very safe product since its active ingredient, saponins, is not absorbed and consequently they do not reach bloodstream and don’t produce systemic side effects, i.e. do not affect the liver, the kidneys or other organs.
I do believe that Nasodren will improve your symptoms and therefore your quality of life as millions of rhinosinusitis sufferers worldwide have already benefit from its use.

Thursday, September 13, 2012

Do you know that Nasodren...

Nasodren acts activating the physiological defense (natural) 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, which leads to a seromucus discharge, reduction of the inflammation of the mucosa and opening of the ostiums (the passages that communicate the sinuses to the nasal cavity), and therefore cleaning sinuses and nasal cavity.

This specific mechanism of action can produce some itching, sneezing, 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 that Nasodren is working properly. All these effects usually diminish during the course of treatment.
Nasodren is a product indicated for the symptomatic treatment of acute and exacerbations (flare ups) of chronic rhinosinusitis. Its main component are saponins, from a cyclamen extract that gives a fast relief from rhinosinusitis symptoms, like nasal blockage, obstruction, congestion or nasal discharge.
Nasodren is a very safe product since its component, saponins, is not absorbed and consequently do not reach bloodstream and don’t produce systemic side effects, i.e. do not affect the liver, the kidneys or other organs and does not affect the nasal mucosa integrity.
In case you use Nasodren please read the patient information leaflet

Wednesday, September 12, 2012

Sphenoid sinusitis can be cured

Sphenoid sinusitis can be cured

Sphenoid sinusitis, a disease of the ethmoid sinuses, generally occurs as a part of pan-sinusitis. The isolated cases of the sphenoid sinusitis, which are rare, predispose to high risk of a number of complications. If you are diagnosed sphenoid sinusitis, do not be afraid, as the sinusitis can be cured. This article will review different medical and surgical treatment options.

  • Uncomplicated sphenoid sinus disorder can be treated with a combination of antibiotics, systemic or topical decongestants, hot fermentation, steam inhalation and steroid nasal sprays. However, complicated conditions require surgery.

  • Surgical drainage of the sinus and antibiotic therapy are necessary if the symptoms do not improve within two days. The sinus drainage will improve the headache and fever.
  • The transnasal puncture of sphenoid procedure is used to drain the sinus in case of the acute sphenoid sinusitis that is unresponsive to the antimicrobial therapy consisting of amoxicillin and ampicillin.

  • If the patient does not respond to antibiotics, there may be fungal sinusitis, which requires surgical removal of the fungus ball and sinus irrigation with an antifungal medicine.
  • Surgical procedures are almost necessary to treat the sphenoid sinus disorders. The procedure, referred to as sphenoidotomy, is performed to drain the sinus, remove the infected mucosa and marsupialize or exteriorize.

  • Sphenoidotomy can heal both the sphenoid sinusitis that is a part of pan-sinusitis and solitary sphenoiditis, but the approaches opted for the surgery will be different. The physician may choose from the antrum and the ethmoid sinus approaches for sphenoidotomy.
  • Treating solitary sphenoiditis is relatively simple.

  • Lavage ( irrigation or washing out an organ) through the sinus ostium
  • Lavage and perforation via the sinus’s anterior wall

  • Open up the sinus via the nose
  • The sinusitis requires aggressive management.

  • Aspiration (drawing in or out by sucking) and decongestion of the sphenoid sinus
  • Use a swab having antibiotics, anti-inflammatory or anti-allergic agents, oral steroids, or epinephrine / tetracaine to block or close (tamponade) the sphenoethmoidal recess.

  • Sphenoid sinusitis with intracranial complications may require a craniotomy, a critical surgical procedure for removing a bone flap from the skull temporarily to reach the brain.
Do consult your doctor well in time because ignored or delayed treatment of acute sphenoid sinusitis may have deadly sequelae. Follow the prescription and be rest assured that the sinusitis could be cured.

Friday, September 7, 2012

Difference between cluster and sinus headaches

Many times, cluster headache symptoms are interpreted as the sinus headache symptoms because some of the signs of the former may origin from the nasal area. It is therefore necessary to understand the difference between the two.
  • The severe sudden pain related to cluster headache lasts for about forty-five (45) minutes. The pain episode may occur several times in a day. The headaches occur in groups.

  • The sinus headache lasts as long as the sinus infection is not healed. Although the headache is worse in the morning, it improves as the day progresses. The headache does not occur in groups.
  • Cluster headaches are vascular headaches. During a vascular headache, swollen blood vessels cause a throbbing pain. The vascular headache may increase with physical work.

  • Sinus headache is an inflammatory headache that involves pathology and inflammation.
  • The sinus headache pain, deep and constant, increases with sudden movement of the head. Other sinus symptoms, like nasal discharge and fever, accompany the pain.

  • The people experiencing cluster headache will become angry, anxious, and restless.
  • Cluster headaches lead to tearing and sweating.

  • Cluster and sinus headaches can appear simultaneously.
  • The confusion between the two also occurs due to related periorbital pain and stuffy nose. However, the patient history will point to cluster headache instead of surmised sinus headache symptoms.

  • Cluster headaches are unilateral, whereas sinus headaches can be unilateral or bilateral.
  • Cluster headache, an extreme case of headache, is rare. Sinus headaches are relatively more frequent.

  • In case of cluster headache, the pain is limited to the temporal, frontal and periorbital regions. However, sinus headache occurs in the area of the sinus affected. If your ethmoid and frontal sinuses are affected, you will experience pain in the forehead.
  • Cluster headaches appear suddenly. However, sinus headache symptoms often appear due to weather change, onset of menstruation cycle and / or head cold.

  • Cluster headaches are common in men since the headaches are linked to cigarette smoking. However, with change in lifestyle, women are also getting these headaches.
  • Both men and women have equal chances of having sinus headaches.

  • Cluster headache can be chronic. Sinus disease rarely leads to chronic headaches.
  • Cluster headache therapy consists of abortive (cure) and prophylactic (preventive) drug treatments and surgery.

  • If you treat the sinus congestion and infection, sinus headache will disappear.  Steam inhalation, antibiotics, nasal sprays and decongestants relieve the congestion and infection.

Thursday, September 6, 2012

Constituent infections of Kartagener’s syndrome

A syndrome is a combination of symptoms of different diseases, which collectively characterize a particular mental or physical disorder. Rare hereditary Kartagener’s syndrome, a subgroup of primary ciliary dyskinesia (P.C.D.), involves infections of the genitals and respiratory tract: male infertility, severe sinus infection symptoms(sinusitis), situs inversus and bronchiectasis.

Kartagener’s syndrome triad
Sinusitis, situs inversus and bronchiectasis are in fact known as Kartagener’s syndrome triad in medical terminology. Although the Russian medical expert Siewert discussed the triad for the first time in 1904, the triad was named after his German counterpart Manes Kartagener for explaining the triad as a unique congenital syndrome in detail in 1933. The Swedish ultrastructuralist Bjorn Afzelius established a link between the syndrome and male infertility, and the fertility disorder was included in the triad in 1976.
The syndrome, an autosomal recessive disease, is ascribed to irregular structure and malfunctioning of cilia. The structural irregularities include absence of the dynein arms of the ciliary microtubule. Principal feature of the syndrome is incorrect (dysmotile) or no (immotile) movement of the ciliated hair cells occupying the mucosa, affecting the mucus drainage in the paranasal sinuses, ears and lungs. The syndrome fiddles with proteins required for the cilia movement in the spermatozoa and respiratory tract.
Bronchiectasis means the irreversible dilation and distortion of the airway passages in the respiratory tract (bronchi). Obstruction of mucocillary clearance in the tracheobronchial tree and paranasal sinuses and nasal passages dilates the passages and triggers sinusitis respectively. Bronchiectasis affects the tissues of the airway, whereas sinusitis involves the sinus tissues.
Situs inversus
The word situs inversus means “position” (situs) and “inverted” (inversus) in Latin. Situs inversus implies reversal of all visceral (large organs of the body) organs, for instance, the liver placed on the left, heart placed on the right… The disorder affects the embryonic node tissues. Males suffering from the syndrome may have infertility problem due to impaired movement of the sperms.
Symptoms of the syndrome
  • Chronic cough throughout the year
  • Chronic bronchitis
  • Disturbed smell sense
  • Nasal polyps
  • Nasal congestion
  • Several episodes of sinus infections occur every year. These episodes improve with antibiotics but may reappear.
  • Recurrent severe sinus infection symptoms generally trigger sinus pressure headache in the eye region and over the maxillary or frontal sinuses.
  • Repeated instances of pneumonia
  • Persistent ear infections
  • Thick mucus discharge

Wednesday, September 5, 2012

Causes of oroantral fistula

An oroantral communication (OAC) means an abnormal connection between the antral and oral cavities. A fistula refers to an unnatural passageway between the two surfaces lined with epithelial tissues. If OAC is not treated, the epithelial tissues may grow in it, leading to the fistula formation. The oroantral fistula (OAF) is an abnormal connection or opening between the maxillary sinus and oral cavity. This abnormal connection is the result of a number of factors, including the following:

Oroantral fistula and maxillary sinus disorder are related. Untreated chronic maxillary sinusitis predisposes to oroantral fistula formation. Even oroantral fistula may cause the sinusitis.
  • Teeth related factors including extraction

    • The most common reason is opening up the maxillary sinus by chance while extracting the maxillary tooth.
    • During teeth removal, if the root or the tooth is forced into the sinus, oroantral fistula may form.

    • Use of contaminated or diseased maxillary implant dentures forms the fistula.
    • If the first maxillary molar tooth’s palatal root breaks during extraction, an oroantral communication channel may develop.

    • During extraction, if a conical maxillary molar tooth slips into the maxillary antrum, especially along the tuberosity fracture, an oroantral perforation will form.
    • A periapical lesion is an abnormality or injury around or at the apex of the tooth root. The lesion destroys the sinus floor, creating oroantral fistula.

    • Occasionally, chronic periapical infection erodes the lamina dura of the root and then the apex and the sinus membrane come in direct contact.
  • Surgeries

  • When the incision line during Caldwell-Luc procedure does not heal, oroantral fistula may develop.
  • Careless use of instruments during maxillary sinusitissurgery may perforate the sinus mucosa and floor.

  • Maxillary sinus surgery performed for removing a big cystic lesion eating into the sinus cavity may lead to fistula formation.
  • Marsupialization (surgical conversion of a closed cavity into an open pocket) performed on defective alveolar antral wall may also result in the fistula.

  • Extensive facial trauma
  • Extensive facial trauma, particularly, because of sharp objects or missiles inserted into the sinus via mouth will lead to oroantral fistula. Even gunshot injuries affecting the sinus walls badly create the fistula.

  • Neoplasms
  • Malignant granuloma and other malignant disorders of the maxillary sinus may erode the oral cavity.

  • The tumors may penetrate the lateral wall of the sinus.
  • Tumors of the upper jaw may reach into the sinus, forming the fistula.

  • Damage to the maxilla due to teratoma, a group of tumors or a single tumor

Tuesday, September 4, 2012

16 tips for inhaling steam

Steam inhalation helps in clearing blocked paranasal sinuses, facilitating mucus drainage and speeding up healing process. Steam soothes the inflamed mucosa, humidifies the respiratory tract, liquefies the crusts and dries the cough. Steam is also used to deliver the drug, for instance, vasoconstrictors. However, while inhaling steam, follow correct procedure and use appropriate material. Here are a few tips:

  1. Use water to make steam.

  1. You can mix herbal oils, fresh herbs or dried herbs for effective treatment. You can choose from a number of herbs, such as burdock, comfrey, eucalyptus, peach bark, fennel and fenugreek.
  1. Remember that purpose of the steam inhalation is soothing the infected parts not scalding the skin. Thus, the steam temperature should be bearable.

  1. Steam inhalation is more effective if done as soon as the symptoms appear. Otherwise, you have to inhale for long.
  1. Use a pot, sink, electric inhaler or kettle.

  1. If using the sink, bring your head over it and inhale the steam for 5-10 minutes. However, protect your face, the steam may irritate and burn your eyes, and skin. Children shall take extra care, as their skin is very heat sensitive.
  1. If using the pot, place the pot at an appropriate height considering your own height and then breathe the steam. If a wide-mouthed pot is being used, cover the pot and head with a sheet / towel to make a tent that will ensure better steam concentration. However, protect your face.

  1. If a child is inhaling the steam, ensure that the pot do not tip over. S/he breathes the steam correctly through the nose.
  1. Children can inhale steam in a hot shower as well.

  1. For sinus treatment, inhale the steam through the nose.
  1. If you want to expectorate or cough while inhaling steam, cover the pot or the spout of the inhaler.

  1. You can make a cone of the stiff paper sheet. Place the wide side of the cone on the pot and breathe the steam from the narrow pointed side of the cone. This will protect your face and eyes from the direct exposure to the steam.
  1. Do not expose eyes to the steam.

  1. Be careful, as steam inhalation some times injures the respiratory tract.
  1. Take deep breathe after inhaling the steam.

  1. You may inhale twice a day. Check with your doctor.