Wednesday, October 31, 2012

Nasodren management in nasal polyps and cysts within the sinuses.

Nasodren management in nasal polyps and cysts within the sinuses.

Nasal cysts and small polyps within the sinuses are quite common (the most common being a small cyst in the maxillary sinus). In most cases there are no symptoms or problems caused by these benign structures. Sometimes, a cyst or a polyp obstructs a sinus opening and can block the drainage passageways and therefore result in chronic rhinosinusitis. Nasal cysts and polyps are treated successfully with corticosteroids alone or with surgery.


 Pharmacists and General Practitioners (GPs) cannot see whether a patient suffers from nasal cystis or polyposis. However, pharmacists and GPs could ask the patient about the symptoms he is suffering. If the patient is suffering from an acute episode, he probably does not have a cyst or polyps and therefore the pharmacist can recommend Nasodren® or the GPs can prescribe it. However, if the rhinosinusitis is recurrent and has lasted longer than 12 weeks, probably the patient is suffering from chronic rhinosinusitis due to a cyst or polyp obstruction. Therefore, the pharmacist should refer to a physician to determine if the patient has nasal cysts or polyps, and ensure the appropriate treatment. The GPs should recommend consulting an ENT specialist. In general, it should be noted that any nasal irrigation is not recommended for people with nasal polyps or cysts. This is because pressure from a nasal irrigation procedure can be traumatic in that the fluid stream would be pushing against the sensitive and exposed tissue of the polyp. In addition, nasal polyps or cysts can block the mucus secretions, worsening ventilation and drainage functions, and consequentlydecreasing the efficacy of Nasodren® treatment. Hartington has no clinical data, in terms of efficacy or local irritation, regarding patients with nasal polyps or cysts treated with Nasodren.

Tuesday, October 30, 2012

Stinging Nettle: one of popular natural remedies for sinusitis

Different communities around the world have been using a broad spectrum of natural remedies for sinusitis. They use stinging nettle or nettle (Urtica dioica) for allergic rhinitis (hay fever), mild symptoms of viral sinusitis, arthritis, anemia and benign prostatic hyperplasia. However, it is not clear how the herb works. 


     The plant
The plant grows in Asia, North America and Europe. It blooms in August September in Asia.
In Latin, Urtica means “to sting.” The perennial plant has stinging hairs on stem and leaves. The leaves cause stinging sensation on touch. Stinging nettle injures if you walk on it because it has small spines. 
The mineral-rich leaves contain ant-allergic substance. 
The plant hairs contain acetylcholine, serotonin and histamine. 
The phytochemical profile of the herb includes acetic acid, betaine, beta-carotene, caffeic acid, lecithin, p-coumaric acid and scopoletin.
The nutrient rich herb contains vitamins B1-B3, E and C, zinc, sulfur, calcium, iron, copper and potassium.
Nettle and sinusitis
The herb with strong antioxidant properties reduces sinus cavity’s inflammation and protects against allergen attacks. 
Astringent properties and peppery flavor dry out the sinuses and therefore relieve sneezing and allergy-related congestion in allergic rhinitis.
It reduces itching and sneezing in hay fever patients.
The plant heals eye irritation and sneezing in allergic patients.
The herb reduces histamine production in the body. Therefore, it acts as antihistamine. Antihistamines are used to treat some forms of sinus infection.
Nettle has preventive uses as well. Take it before allergy season starts.
The plant may be used as main therapy for patients suffering from allergic chronic rhinosinusitis or as an adjunct therapy.
How to use
You can make tea from the leaves.
Buy nettle capsules from health-food stores.
Nettle leaf extracts are also available in pill form.
Other uses
Flowers, leaves and roots are used in different medicines. Nettle act as tonic, pain reliever, expectorant and diuretic. 
Nettle is also added to hair care products to control scalp oil.
Natural remedies for sinusitis are age-old but require physicians’ advice for right amount of dosage for two reasons: adverse effects and very limited scientific research work focusing on the herb’s role in curbing sinusitis symptoms. Especially, not much data is available whether the herb is safe for breastfeeding and pregnant women. So, consult the doctor before using the herb. The patients suffering from bleeding disorders and diabetes should also consult their doctors.

Friday, October 26, 2012

Devices that keep sinuses open after the surgery

Sinus surgery resolves many symptoms in the patients suffering from polyposis and sinus infections. The surgery opens ostia of the swollen sinuses, enabling the airflow and drainage to heal the infection and check its recurrence. However, the procedure may lead to complications, such as stenosis, recurrence of polyps and / or inflammation, causing obstructions and thus requiring revision surgery. 
To avoid the obstructions and subsequent surgeries, different devices are used to keep the sinus ostia clear and open. The devices include gels, sponges, packing and stents.

Propel™ sinus implant, a drug-eluting stent, is designed for the patients with chronic sinusitis, wherein swollen sinuses cause discomfort persistently. PROPEL is placed into the ostium after the procedure. The bioabsorable stent releases slowly corticosteroid mometasone furoate within the treated area. The device prevents swelling and obstruction due to adhesion, and stabilizes the middle turbinate. Recent clinical studies’ results published in the International Forum of Allergy & Rhinology (June 2012) highlight that PROPEL usage reduces further surgical interventions after an endoscopic sinus surgery (ESS). The implant also reduces dosage of oral steroids required for treating the inflammation. Fast healing and less inflammation enhance durability of the surgical procedure. 
PROPEL improves result of the sinus surgery. The implant opens blocked and swollen sinuses and delivers steroids effectively, safely and directly to the sinus membrane. The self-expanding device easily adjusts with the anatomy of the sinus. 

Stratus MicroFlow Spacer
The spacer releases fluids into the paranasal sinuses slowly to ensure that the ostium remains open and clear. The device can be used in ethmoid and frontal sinuses. 
Stratus MicroFlow Spacer, a catheter-based implant, features a microporous reservoir that moistens the ethmoid sinus cells. At the end of the reservoir, a pair of radiopaque markers is located. The Stratus Deployment Guide (Ethmoid) is used to deliver the spacer into the sinus. The single-use spacer is sterilized with ethylene oxide gas. The spacer is used after the surgery to maintain ostial patency of the frontal and ethmoid sinuses up to two weeks. Since reuse may lead to contamination and affect the performance of the device, use it and throw it.

Thursday, October 25, 2012

Sinusitis can be cured

Sinusitis can be cured with balloon dilation techniques

Various advancements in minimally invasive techniques have expanded the sinusitis treatment spectrum. For instance, balloon dilation techniques can be used in the ear, nose, throat (ENT) clinic and require local anesthesia only. These effective techniques are safe and comparatively easy to perform. The patients can resume work within a day. Another plus is that Medicare covers these modern techniques. Thus, the patients spend less. 


     Sinusitis can be cured safely easily and efficiently with advanced minimally invasive technologies developed by the US-based Entellus Medical.  The company offers FinESS and XprESS tools, in-office technologies for the sinus dilation.
FinESS™ is designed to treat the anterior ethmoid and maxillary sinus diseases. With the system, physicians can manage anatomical difficulties present in the nasal region easily, effectively and safely. FinESS allows remodeling of the anatomy. The system enables visualization and direct access to the sinus. The treatment can be done under local anesthesia in the office. The dilation system shortens the recovery period to up to two days from up to two weeks in case of FESS. During the dilation treatment, the drainage channels are widened for long lasting relief.
The system uses an endoscope to visualize and balloon catheter to dilate the maxillary ostium and ethmoid infundibulum. The simple in-office dilation procedure resolves sinusitis symptoms. The procedure benefits both patients suffering from maxillary disorder and the patients having symptoms of anterior ethmoid and maxillary diseases. The patient can resume work and daily activities within two days. Thus, it is well-tolerated treatment.
XprESS™ Multi-Functional Sinus Dilation Tool, an advanced edition of balloon sinus dilation technology, is used to treat symptoms of the sinuses lying behind the cheeks and above the eyebrows. The tool is thus suitable for frontal, maxillary and sphenoid sinus diseases. Sinusitis can be cured with the new minimally invasive balloon sinus dilation treatment that also prevents recurrence of the disease. The tool is used to perform sinus surgery. It uses a balloon to open the obstructed sinus drainage channels. The tool reduces loss of tissue as compared to that in conventional sinus surgery. However, XprESS has some side effects: allergy to anesthesia and other medicines administered during the operation, swelling, pain and bleeding.
If physician decides to use XprESS for resolving the sinus symptoms, the device is positioned in the affected area. Then, treatment area is dilated before removing the device. The dilation displaces the sinus structures and nearby bone to reshape the sinus outflow tract. This versatile tool performs more than one function, including balloon dilation, confirmation, irrigation, suction and seeker. The tip is malleable, thus can be used in frontal, maxillary or sphenoid sinuses. A variety of balloon configurations enhances precision of treatment and placement. Balloons of different sizes can be used to meet needs of all types of patients.

Wednesday, October 24, 2012

New instrument for revision surgery of maxillary sinusitis patients

New instrument for revision surgery of maxillary sinusitis patients

Sometimes revision surgery is required to remove the remaining chronic or recurrent maxillary sinusitis. However, the revision surgery needs a unique approach due to missing standard structural landmarks that guided the surgeon in the first surgery. If fibrosis and inflammation persist for long, revision surgery becomes more challenging. To simplify the surgery, ENTrigue Surgical, Inc. unveiled a new instrument, Ventera®-R (Revision) Sinus Dilation System, in September 2012. The US-based ENTrigue designs, manufactures and markets medical devices required for surgery of the ear, nose and throat (ENT)

Features of Ventera®-R (Revision) Sinus Dilation System

  • The instrument is developed for revision surgery of patients suffering from sphenoid, frontal and / or maxillary sinusitis.
  • The Ventera deploys a reusable tool to deliver a single-use balloon that ensures controlled dilation. The tool features SerpENT articulating instrument technology developed by the company. The instrument neither uses a cannula nor guide wire used in traditional surgeries to position the balloon. There is no need to shape up the tip manually either.
  • The system can easily move around and take up the position within the nasal channels, making easy to manage differences in the sinus anatomies.
  • Balloon dilation offers less-invasive approach to revision sinus surgery without compromising on effectiveness.
  • The new cost-effective and user-friendly system dilates the ostium during repeat surgery. Reusable delivery tool enhances its cost-effectiveness by minimizing costs of disposables. The green delivery tool features five different locking positions, thus, the balloon can be positioned in the most suitable position considering the anatomy of the sinus cavity. The sterile balloon quickly interfaces with the delivery tool.
  • Since the system resembles regular ENT surgical devices, it fits well in the standard sinus surgery toolkit.
  • It is simple because fewer parts need to be assembled and used during the surgical procedure.  Ergonomically designed instrument and the balloon ensure optimal and easy access to the maxillary, frontal and sphenoid sinuses. The instrument is aimed at adult patients.
  • The system is compatible with standard analog balloon inflation devices.
  • Diameter of the guide tip is 2mm. The 10-mm long balloon enables controlled dilation. The balloon measuring 6 mm in diameter optimizes dilation of the sinuses in revision surgery.
The new system simplifies the revision surgery. However, commercial edition of the instrument is available only in the U.S.A.

Tuesday, October 23, 2012

Sinusitis Toolbox

What is Sinusitis Toolbox?

Recently the Canadian Rhinosinusitis Best Practices and Standards Working Group (R.W.G.) released Sinusitis Toolbox, an application to find difference between cold and sinus infection. Tech-savvy physicians can download this free application from the iTunes App Store. The application uses features of a tablet computer and an iPhone to demonstrate management of these two diseases, which are generally confused with each other. The application, a novel learning tool, is based on the Canadian Clinical Practice Guidelines for Acute and Chronic Rhinosinusitis for adults over 18 years.

Features of the tool
The interactive tool can be used in different types of clinical settings.
The tool helps in recording educational videos of various nasal pathologies, diagnosis and treatment. These recordings can be watched from anywhere.
With educational videos, medical practitioners can enhance their nasal examination and diagnosis skills, and select the most suitable treatment. Better understanding of the disorder will curb misuse of antibiotics, reducing chances of complications and antibiotic resistance.
The information collected through the application will also help in reviewing and improving the diagnosis, management, prescription and treatment guidelines and related policy.
The videos present images gathered from a CT scan or an endoscope. Brief information about the condition represented in the images is also included. The image library covers different conditions such as chronic rhinosinusitis with allergic fungal sinusitis, nasal polyposis, allergic rhinitis, acute bacterial rhinosinusitis and base-line normal.
The self-assessment feature of the tool consists of a quiz that reveals user’s level of understanding.
The tool will facilitate uniform treatment of sinusitis.
The application uses algorithms, mnemonics, pictures and videos to assess sinusitis symptoms. You can slide or touch the screen to browse the algorithms.
While making a clinical decision, the application asks you a question about clinical test results, symptoms or duration of symptom. As soon as you answer the question, recommendations appear on the next screen.
The tool features an easy training session for nasal examination. The session also highlights useful practical tips.
Questions answered by the application
The application guides in finding answers to various clinical questions related to sinusitis. For instance, how do you find difference between cold and sinus infection and allergy?  How do you distinguish between acute and chronic sinusitis? Which is the correct examination method for the patients who may be suffering from chronic or acute condition? Is an antibiotic course necessary for managing acute bacterial sinusitis? What are the ways to identify complications in sinusitis patients? Which is the optimal management method? What should be the best management method for chronic sinusitis patients?
So next time use the application to identify difference between cold and sinus infectionand win heart of your tech-savvy patients.

Monday, October 22, 2012

2 new interesting findings about chronic sinus infection

2 new interesting findings about chronic sinus infection

“Friendly bacteria” may prevent chronic sinus infection
Recent research work published in Science Translational Medicine concluded that “friendly bacteria” might prevent chronic sinusitis. The research highlighted that microbes found in the sinuses of healthy people and those found in the patients with chronic sinusitis are altogether different. The amount of Corynebacterium tuberculostearicum was much higher than the healthy controls in the patients. On the other hand, the amount of Lactobacillus sakei was very high in the people without sinusitis.

With the technique of comparative micro biome profiling, the research team identified bacteria species and their amount in the sinuses. The microbial community was less diverse in the patients with chronic sinusitis. C. tuberculostearicum was abundant in the patients, whereas lactic acid bacteria level was significantly low. The team concluded that Lactobacillus sakei (“friendly bacteria”) protects against chronic sinus infection caused by C. tuberculostearicum. You can read the full study here after logging in.
Dislike for bitter and sour food may help in fighting chronic sinus infection
Have you ever imagined that your tasting abilities and dislike for some tastes may act as a key to sinus infections’ diagnosis and treatment?
According to a latest research reported in the Journal of Clinical Investigation, if you hate sour and bitter foods such as coffee, Brussels sprouts and broccoli, your body has a mechanism to fight against bacteria and viruses causing chronic sinus infection. The sour and bitter receptors on the taste buds not only alert about rotten and toxic foods but also identify viruses. Extremely sensitive bitter taste receptors that are also found in the sinus and nasal cavity can detect viruses.
The research divided the participants into three groups: super-tasters, non-tasters and those who are in between. Super-tasters are over sensitive to bitter and sour flavors. Non-tasters are unable to taste some bitter flavors. After analyzing cell cultures of the sinus and nasal tissues, the research team found that super-tasters are more efficient in detecting some bacteria, alerting the body and initiating an immune action. Therefore, the team suggested that bitter taste receptors detect harmful bacteria and act as guard against them. This newly found feature may help in diagnosing and treating chronic sinus infection.
The research is a collective effort of researchers from the Philadelphia VA Medical Center, the Monell Chemical Senses Center and the Perelman School of Medicine at the University of Pennsylvania. Read the full report.

Friday, October 19, 2012

Causes of severe sinus congestion

Causes of severe sinus congestion

Careless use of decongestants
Excessive and repeated use of nasal decongestants leads to severe sinus congestion.  The sinus membranes are damaged so badly that they cannot be repaired. Thus, never use the medicine without prescription by a qualified medical expert.

Apnea means an end of airflow for less than ten seconds, hampering oxygenation, ventilation and respiration. Obstructive sleep apnea (OSA) is a chronic medical condition in which apnea occurs even when the respiratory muscle is trying to breathe because of an obstruction within the upper respiratory tract. The principal source of blockage is the tongue. Other obstructions include blood and foreign bodies. These obstructions block the airways. The OSA causes a number of problems including sinus congestion, headaches due to weight gain, depression, inattentiveness and sleepiness in daytime. Even alcohol- and drug-induced severe sinus congestion may worsen OSA in the patients with sensitive immune system.

Flu (influenza), a viral infection, may infect the sinuses and cause sinus congestion. After partial recovery from flu, some patients again feel sick as secondary bacterial infections may appear. The infections, such as bronchitis, ear infections or bacterial sinusitis, lead to the congestion.
Other disorders causing sinus congestion
  • Sinusitis
  • Common cold
  • Chug-Strauss syndrome
  • Wegner’s granulomatosis
  • Cystic fibrosis  
  • Gastroesophageal reflux disease (GERD)
  • Allergic rhinitis
  • Dehydration
  • Allergies
  • Nasal deformities and polyps

Why you should not ignore sinus congestion?
Visit a doctor to find the real cause of the congestion. Do not ignore sinus congestion because it could be painful and could interfere with day-to-day life. For instance,
If you are suffering from sinus congestion and the infections of the upper respiratory tract, you should not dive.
Severe congestion impairs the sense of smell and taste.
Extreme sinus congestion spreading to the ears causes vertigo.
Severe congestion may be indicative of asthma.

Thursday, October 18, 2012

Four diseases causing facial pressure

Four diseases causing facial pressure

Face-pressure, a feeling of fullness in the face, is one of the common sinus and nasal symptoms. Facial pressure, a source of discomfort, is different from head and facial pain. The pressure is generally localized to the affected area. For instance, infraorbital facial pressure is one of the major signs of maxillary sinusitis. Chronic ethmoid sinusitis patients may also experience the pressure. The pressure is a diagnostic symptom of acute sinusitis. In classic case of acute sinusitis, the pressure may be unilateral and worsen with bending down.

Chronic sinusitis patients may also complain about the pressure. Facial pressure secondary to sinusitis generally occurs with nasal blockage or congestion. Inefficient mucus drainage creates the pressure. Nasal polyposis may also result in a feeling of fullness in the face.
An anti-inflammatory treatment will relieve face-pressure. Steam and warm compresses may also relieve the pressure. Some times sinus surgery is required, but the surgery may affect sense smell whose recovery may take long.
Inverted papilloma
A benign tumor, inverted papilloma, is a common ailment of the paranasal sinuses and nasal cavity. The tumor arises from the cavity and slowly enters into the sinuses, and sometimes nasopharynx is also affected. The symptoms include facial pain and pressure, headache, hearing loss, nasal obstruction and rhinorrhea.
Chinese restaurant syndrome
  1. The Chinese restaurant syndrome (C.R.S.), a benign medical condition, is ascribed to excessive use of monosodium glutamate (M.S.G.). The glutamate is a common ingredient of the Chinese food items. The symptoms of C.R.S. includes
  • Face-pressure,
  • headache,
  • cramps in abdomen
  • dizziness
  • burning sensation over face, legs and arms, and
  • shortness of breath.

  1. C.R.S. is also called sensitivity to M.S.G. Glutamic acid’s sodium salt is called M.S.G.  The salt enhances food flavor. However, its consumption causes several ailments and symptoms, such as facial pressure, sudden change in mood, pain in chest, diarrhea, nausea and migraine. During migraine, the trigeminal nerve that passes signals of the pain between the brain and face may build pressure in the face and lead to congestion.
About one-third people having Chinese food get the C.R.S. symptoms. So, be extra careful if you love Chinese food!
Allergies and asthma
Allergies and asthma can also cause pressure in the face, resulting in discomfort. For instance, in case of severe dust mite allergy accompanied by mild asthma, the patients experiences congestion and facial pressure, sneezes and wheezes persistently.

Wednesday, October 17, 2012

What is the difference between cold and sinus infection?

What is the difference between cold and sinus infection?

There are a number of differences between cold and sinus infection, such as
  1. Cold, the upper respiratory tract’ infection, is a viral infection attributed to common viruses, whereas a sinus infection is attributed to bacteria, fungi or viruses.
  1. The symptoms of viral cold includes
    • Clear nasal discharge and low fever for a day or two in the initial stage
    • Nasal discharge thickens and becomes green, yellow or white after two days.
    • Thereafter, nasal discharge dries.
    • Generally, the patient experiences cough that worsens at night.
    • Intensity of the symptoms increases after five days. Thereafter the symptoms improve and gradually disappear within ten days.
  1. A bacterial sinus infection symptoms include
  • Symptoms of cold that do not improve and last for over ten days.
  • Fever lasts up to four days.
  • Thick yellow nasal discharge
  • Painful headache in eye area
  • The headache worsens if the patient bends over.
  • Dark circles and swelling surround the eyes.
  • Bad breath

  1. Cold disappears within a week’s time. Sinus infection takes long to heal and may last beyond seven days.
  1. Many times sinus infection follows a bad cold.

  1. Although several over-the-counter (O.T.C.) medicines for cold also reduce the symptoms of a sinus infection, fungi and bacteria present in alarming quantity may interfere with sinus infection treatment and professional help is required.
  1. A bacterial sinus infection is treated with antibiotics, whereas body’s immune system heals cold in most of the cases. There is no treatment for cold like many other viral infections.

  1. Most of viruses causing cold thrive in an atmosphere that has less humidity and low temperature. Thus, cold generally occurs during winter and fall seasons. Over 200 hundred viruses can cause symptoms of cold.
  1. Cold may lead to sinusitis, but vice versa may not be true.

  1. Common cold patients can generally complete their daily routines at school, work and / or home.
  1. Sore throat and cough are typical signs of common cold. However, these are mainly absent in the patients suffering from sinusitis.

  1. Sinus infection impairs smell and taste. However, common cold does not.
  1. In sinusitis, there may be pain in the sinus area affected. However, the cold does not trigger pain.

You may not be able to identify difference between cold and sinus infectionsymptoms, but a professional medical expert will be able to do that. So meet a doctor without any delay.

Tuesday, October 16, 2012

What does cause constant sinus congestion?

What does cause constant sinus congestion?

Sinus congestion refers to an obstruction in the sinus air passages. A sinus congestion that persists for long time is called constant sinus congestion. Symptoms of the congestion include a sensation of pain, pressure or fullness on the part of the face over the sinuses. The pain is generally unilateral. The sinus congestion can be acute and chronic. Both medical conditions and medicines may also contribute to the congestion.

Medical conditions causing constant sinus congestion
Mucociliary dysfunction and / or nasal polyposis may cause the congestion. What constitutes mucociliary dysfunction is not fully clear yet. However, the dysfunction means a combination of disorders that are genetically related. Atypical feature of the disorders is dysfunctional sinonasal mucociliary transport. Acquired mucociliary dysfunction is ascribed to trauma, chronic inflammatory disorder, smoke inhalation, and viral rhinitis. Sinonasal polyposis, called nasal polyposis, is bilateral. An obstruction, injury and chronic mucosal inflammation may cause polyps.

Common cold is the most common cause of acute sinus congestion.  Air-borne and food allergens are responsible for chronic sinus congestion. Even foreign bodies blocking the nose can lead to the congestion. The patients having rhinitis and severe sinusitis may complain about sinus congestion. Hay 

fever causes sinus congestion. The patients who have to spend long period in bed are also prone to sinus congestion.
Chronic dysbiosis (imbalance between good and bad bacteria within the body) in the sinuses and small intestine may also lead to chronic sinus congestion. An overdose of antibiotics may cause dysbiosis by encouraging growth of bad bacteria.

Medicines causing short-term or constant sinus congestion
Recently, the European Commission (E.C.) approved KALYDECO by Vertex Pharmaceuticals Incorporated for cystic fibrosis patients living in the European Union.  The medicine is developed for the patients of >=6 years old and the patients having the cystic fibrosis transmembrane conductance regulator (C.F.T.R.) gene with a G551D mutation. However, the medicine has some adverse effects such as sinus congestion, dizziness, diarrhea and stomachache.
A non-stimulant prescription drug, Strattera (atomoxetine hydrochloride) administered to the patients suffering from attention deficit hyperactivity disorder (A.D.H.D.) may cause sinus congestion.
Metolazone (Zaroxolyn, Mykrox and Diulo), used to treat moderate hypertension and edema secondary to renal disease and heart failure, has several adverse reactions, including depression, insomnia, pain in abdomen and chest, dry mouth, diarrhea and sinus congestion.
Etoposide (Vepesid) is an anti-cancer medicine. The drug is mainly used for Hodgkin’s lymphomas, testicular cancer and small cell lung cancer. Both solution and capsules of etoposide are available in the market. Mild side effects of the drug include watery eyes, running nose, poor appetite and sinus congestion.

Thursday, October 11, 2012

Causes and complications of chronic sinus congestion

Causes and complications of chronic sinus congestion

Deadly ailments causing sinus infection and congestion include chronic fatigue and immune dysfunction syndrome, or chronic fatigue syndrome (C.F.I.D.S / C.F.S.), chronic lymphocyte leukemia (C.L.L.) and human immunodeficiency virus (H.I.V.). The unattended chronic sinus congestion may further predispose you to other diseases.

C.F.I.D.S. / C.F.S.

During C.F.I.D.S / C.F.S. secondary to the congestion, sinus infection travels into the blood channels and infects the blood (transient bacteremia), leading to fatigue. The patients feel excessively tired. They complain about severe sleep deficiency. The syndrome affects day-to-day routine. However, the symptom severity may vary from patient to patient.
Symptoms of C.F.S.

Abnormal changes in hair, skin and nails
Chronic sore throat
General malaise
Joint pains
Odd headaches
Poor concentration level
Rare case of fever
Regular muscle pains and aches
Short-term memory

C.L.L., the second most common form of leukemia in adult population, is a disease of bone marrow and blood. The leukemia worsens gradually with time.
In normal individuals, a blood stem cell matures into a lymphoid stem cell or myeloid stem cell. The lymphoid stem cell develops into three different types of white blood cells (lymphocytes): B, T and natural killer cells. These three cells protect against cancers, infections and viruses.
The myeloid stem cells mature into red blood and white blood cells, and platelets. These structures, for instance, enable oxygen carriage and protect against diseases and infections.

In C.L.L. patients, unusually large number of blood stem cells converts into abnormal lymphocytes. The space for healthy platelets, red blood cells and white blood cells, as a result, reduces, causing anemia, bleeding problems and infections.
Both chronic and acute sinusitis are common in the individuals suffering from C.L.L. Generally, there are no apparent symptoms of the disease. However, the following signs may indicate C.L.L.:

Weight loss for which you cannot figure out the cause
Infection and fever
Fullness or pain below the ribs
Excessive fatigue
Lymph node swelling in the groin, neck, stomach or underarm

H.I.V. destroys the cells (CD4 and T cells) that protect against infections and diseases, taking its toll on the human immune system. The virus is quite similar to the virus that causes common cold or flu. However, the cold and flu viruses leave your body after the appropriate treatment, but H.I.V. remains in the body.
More than 65% patients suffering from H.I.V. experience the congestion.  Sinus infection, cough and runny nose may reoccur frequently. Do not allow diseases, including the chronic sinus congestion , to linger for long. Consult a doctor and follow the prescription at the earliest.

Wednesday, October 10, 2012

Can pregnancy be a cause of sinus headache?

Can pregnancy be a cause of sinus headache?

Yes. Pregnancy may become a cause of sinus headache in response to an array of hormonal changes in the body and the bad posture. The hormonal changes may trigger sinusitis and non-allergic or allergy-induced rhinitis.  For instance, the increased level of hormone progesterone may cause swelling of the mucous membranes and in turn, symptoms of sinusitis may develop. The nasal congestion secondary to the hormonal changes may also cause sinus infection, leading to the headache. During pregnancy, the blood flow to the nasal region increases, leading to congestion sometimes.
Extremely sensitive immune system of the expectant mother is more prone to allergen- induced congestion and inflammation that interrupts movement of the cilia within the paranasal sinuses. Static mucus encourages growth of harmful viruses and bacteria, causing infection and may trigger headaches. Avoid foods to which you are allergic.

Dehydration, low blood sugar and / or insufficient sleep due to pregnancy may also cause the headache. The headaches are generally common during the first trimester. The headaches may suddenly appear and disappear. The headache duration varies from a few minutes to a day.
About 30% of the expectant mothers experience sinusitis symptoms. Even the women who do not have a history of nasal symptoms can suffer from sinus infection during pregnancy. Sinusitis may exacerbate during pregnancy, worsening asthma symptoms.
Mucus production and vascularity increase during pregnancy, making the expectant mother more vulnerable to sinus congestion. Increase in the mucus production protects the body against allergens and germs. Thus, the nose may run and the eyes may water. In case of women prone to sinusitis and sinus congestion, incidences of sinus headaches, especially temporal or periorbital headaches, increase during pregnancy.
Since pregnancy may be a cause of sinus headache, resist the temptation to administer over-the-counter (O.T.C.) relief pills without consulting the physician, as these medicines have side effects for the mother and the baby. Especially, consult the doctors before taking popular sinus headache relieving medicines, including Advil Cold & Sinus, Alka Seltzer Plus Sinus, Bayer Select Sinus Pain Relief, Mortin IB Sinus and Sine-Aid IB. Alternatively, you may try warm compresses for the nose and eyes to relieve the sinus headache. Since the nasal cavities are more active and tender during pregnancy, steam inhalation may also help.
There is another reason to consult the physician. Pregnancy can cause different types of headaches, like tension and vascular headaches. Correct diagnosis is the prerequisite to decide the best treatment.

Tuesday, October 9, 2012

Non-invasive method for the drainage of the paranasal sinuses

Non-invasive method for the drainage of the paranasal sinuses

(Russia Case)

The traditional regimen for the treatment of rhinosinusitis includes antibiotic therapy, the use of local decongestants, irrigation of the nasal cavity with isotonic saline solutions, medication with antihistamines and puncture of the maxillary sinus.
When this type of approach is used, the antibiotics ensure total eradication of the causative pathogen, the antihistamines reduce the formation of biologically active substances, and the decongestants act as vasoconstrictors, improving nasal breathing and reducing rhinorrhoea but also decreasing blood flow in the microcirculation. For its part, sinus puncture is a useful but very aggressive method.

Cyclamen extract vs antibiotic therapy 
Given the invasive nature of the puncture of the maxillary sinus, which is commonly used in Russia to cure acute rhinosinusitis, a new non-invasive method has been studied which also enables adequate drainage of the paranasal sinuses in acute bacterial rhinosinusitis.
Bykova et al. have shown that the development of catarrhal inflammation is a natural pathophysiological reaction by the mucous membrane to invasion by a foreign agent. Furthermore, classic studies by Piskunov et al. have also improved our understanding of the secretory activity of the nasal glands, showing, for example, that the duration of the alveolar gland cell secretory cycle is 15-16 hours, while that of the tubular-alveolar gland cells is 24 hours (this is the time required to accumulate and remove the secretion).

On the basis of this evidence, it is currently being debated whether it is better to inhibit (using vasoconstrictor drugs) or accelerate resolution of the inflammatory process. In an attempt to answer this question, a study has been performed with two primary goals: evaluate the efficacy of Nasodren® for the treatment of rhinosinusitis compared with a traditional treatment regimen, and analyse its effect on the function of the nasal mucous membrane. As the speaker underlined, “the goal was to ascertain whether administration of a product that accelerates resolution of the inflammation offers added benefits.” In other studies, Nasodrene® has been shown to increase the secretory activity of the mucous membrane glands and increase blood flow in the microcirculation.

72 outpatients with very similar demographic and disease features were assigned to one of two groups (30 treated with antibiotics and 32 treated with Nasodren®). Patients aged under 14, expecting mothers, people with major concurrent diseases (closed-angle glaucoma) and/or those with severe acute or chronic bacterial rhinosinusitis were excluded. To examine the patients, videoendoscopy, X-rays of the paranasal sinuses and computerised tomography were used, among other methods, also studying the nasal epithelial function and the disease’s severity on the basis of the symptoms reported by the patient.
In the treatment group, Nasodren® was given as a monotherapy for 7-9 days, with one irrigation a day, also using in these cases a sterile seawater solution. In the other patient group (n=30), antibiotic therapy was given combined with nasal irrigations using isotonic saline solutions. In addition to the first visit, there were a further three visits to assess the patient’s progress: 30 minutes after the first irrigation of the nasal mucosa after 4-5 days and after 7-9 days. The microflora was studied in each group and it was concluded that the spectrum of microorganisms was virtually identical in both.

The analysis of the nasal endoscopy reveals that the oedema is significantly reduced both in the patients receiving cyclamen and in the controls. Mucociliary transport was slightly quicker in the Nasodren® group. Even in the rhinograms obtained 7-9 days after starting treatment, it is seen that administration of the natural extract provides important benefits.

As a closing message, Professor Piskunov reminded that “acute bacterial rhinosinusitis is caused by the presence of pathogenic microflora in only half of the cases.” Referring to the results of his study, he said that “this study consistently shows that it is possible to cure these patients with acute bacterial rhinosinusitis without having to use antibiotics but instead a less aggressive method, such as a natural extract. The efficacy of the monotherapy with Cyclamen extract is comparable with that obtained using more complex traditional therapies to treat acute bacterial rhinosinusitis. We have confirmed that Nasodrene® fosters increased mucociliary transport in the nasal cavity. Further in vitro and in vivo studies are required of this medicine.”

Monday, October 8, 2012

Current status of rhinosinusitis in Spain. The PROSINUS study

Current status of rhinosinusitis in Spain. The PROSINUS study

The PROSINUS study is being carried out with the primary goal of assessing the impact of acute or intermittent rhinosinusitis in Spain (in accordance with the classification given in the EP3OS 2005 guidelines).

This a PROspective epidemiological study of the diagnosis and therapeutic management of acute rhino sinuusitis by ENT specialists in Spain, and also includes an evaluation of the disease’s socioeconomic impact. About 300 specialists are taking part in the study, and 1,531 patients have been assessed. This is an observational study in which the exposure factor is not a medicine but a disease.
The primary goal is to assess the diagnostic, therapeutic and clinical monitoring procedures for acute rhinosinusitis in current clinical practice. The secondary goals are to describe the biodemographic and clinical profile of the acute rhinosinusitis patient, evaluate the prevalence of acute rhinosinusitis, assess the degree to which the European consensus guidelines are applied in the Spanish health system, determine the prevalence of complications of acute rhinosinusitis, evaluate the health-related quality of life of acute rhinosinusitis patients and analyse patients’ treatment compliance. In addition, a pharmacoeconomic goal has been established, consisting of studying the socioeconomic impact of acute rhinosinusitis (evaluate the relationship between resources used and the diagnosis, treatment and evolution of acute rhinosinusitis). 
This study, as Dr. Montserrat stated, “is absolutely necessary, particularly considering the disease’s high morbidity and considerable impact on the patient’s quality of life, which translates into significant social and economic costs.”
The study includes patients of either sex, diagnosed with acute rhinosinusitis and over 18 years of age. Subjects diagnosed with chronic rhinosinusitis, with an intercurrent disease requiring medication that could interfere with the sinonasal disease, and patients who are difficult to monitor or have a high risk of withdrawing prematurely from the study are excluded.
The primary end-points are disease duration, diagnostic resources, number of visits, medication used and the disease’s impact on the patient’s work activity. Other secondary end-points have been analysed, such as the patients’ epidemiological features, treatment compliance, occurrence of complications and the patients’ degree of satisfaction. Although diagnosis of this disease is eminently clinical, endoscopy, rhinoscopy, secretion cultures, plain X-rays, computerised tomography and/or the allergy questionnaire or allergy tests can be used as complementary tests. Morisky-Green’s test has been used to assess the patients’ treatment compliance.

  • It is the first prospective, observational, epidemiological study of the management, diagnosis and treatment of acute rhinosinusitis
  • 82% are cured within the first 4 weeks after diagnosis
  • ENT specialists use less antibiotics but for longer periods
  • ENT specialists perform less X-rays
  • Acute rhinosinusitis has a marked effect on patients’ quality of life
  • Treatment compliance is 68.9%
“The analysis of this preliminary data also shows the significant impact of rhinosinusitis on the patients’ daily activities and work life”

Spech by Dr. J. Montserrat 
ENT Department. Hospital de la Santa Creu i Sant Pau. Barcelona

Friday, October 5, 2012

EP3OS: review of 2007

The EP3OS guidelines offer a series of basic recommendations for the diagnosis and treatment of both chronic and acute rhinosinusitis and nasal polyposis.

These diseases have a high prevalence in the Western world. In the United States, it is calculated that up to 14% of the population (about 40 million people) suffer from this chronic disease and, more importantly, its prevalence continues to increase. However, it is also a disorder associated with a high economic cost. Its impact on the quality of life is not insignificant either, as it has an adverse effect on the performance of daily tasks.
Europe currently suffers from a marked lack of epidemiological studies, which prevents a more realistic approach being taken to this problem. From the studies that have been performed, it is inferred that the milder forms of rhinosinusitis, such as the common cold, affect up to 100% of the European population, with an average of two infections a year per affected person. It is estimated that the prevalence of acute rhinosinusitis in the EU countries is 1-2%, while that of chronic rhinosinusitis is 10%.


 Rhinosinusitis has a negative effect on the patient’s quality of life and, to a certain extent, on that of his family. Recent studies not only show that patients with chronic rhinosinusitis have a significantly worse quality of life (measured with the SF-36 test) than the general population, but also that their quality of life is below that of patients with high blood pressure, diabetes or even angina pectoris.
In 2005, Fokkens et al. (Rhinology 2005, suppl 18: 1-88; Allergy 2005, 60: 583-601, executive summary) published the EP3OS guidelines (European Position Paper on Nasal Polyposis and Rhinosinusitis). The medium/long-term goal was to combine this document with the GINA guidelines (for asthma) and the ARIA recommendations (for rhinitis) in a single guideline, endorsed by the World Health Organisation.

The first EP3OS consensus has been reviewed with the goal of correcting errors and consolidating certain basic ideas in the management of rhinosinusitis and nasal polyposis. With more than 120 pages, the new document will be translated into more than 30 languages. “The need to perform a review after so little time is basically because of the significant number of studies that have been performed on rhinosinusitis in recent years, which have led to substantial changes in the evidence available on the best treatments,” acknowledged Dr. Mullol.
The EP3OS 2007 guidelines pursue many goals: review the knowledge available on rhinosinusitis and nasal polyposis; update diagnostic methods on the basis of recent evidence; revise available treatments applying documented evidence; refine the treatment approach to the disease; and guide the definitions and diagnostic methods used in research.

Thursday, October 4, 2012

Usefulness of cyclamen in otitis media

Usefulness of cyclamen in otitis media

One of the least researched applications to date of cyclamen extract is in patients with otitis media, although there is a growing number of personal observations that indicate that this preparation offers significant benefits in these patients.

Secretory otitis media is the most common middle ear disease, particularly in children. It is often the consequence of an incompletely cured previous acute respiratory infection and/or rhinosinusitis. Among other clinical benefits, effective treatment of otitis media ensures adequate prevention of possible future episodes of loss of hearing.
The main cause of secretory otitis is an impaired function of the auditory canal.
The treatment of secretory otitis media basically seeks to eliminate the causative factor and restore auditory canal function, eradicate middle ear exudate and create suitable conditions for its evacuation, and restore the middle ear mucosa.

Use of cyclamen extract 
A large part of these treatment goals can be achieved with the administration of Nasodren®.“This product has shown that it is able to improve mucociliary clearance of the nasal mucosa and paranasal sinuses, decreasing secretion in the tympanic cavity; furthermore, it improves the auditory canal’s ventilatory and drainage functions,” the Byelorussian expert said.
The interest in using this product in the treatment of otitis media arises from its unique mechanism of action. Through its ability to induce stimulation of the nasal mucosa receptors, it has several interesting clinical effects: mucus hypersecretion, bringing about a decrease in the quantity of mucus, intensified epithelial function and improved nose and sinus clearance, and stimulation of the auditory canal muscles and improvement of the ventilation and drainage functions.

 Mechanism of action of Nasodren® Irritation of nasal mucosa receptors

Hypersecretion, with decrease in mucus quantity
Improved epithelium function and nose and sinus clearance
Stimulation of auditory canal muscles and improved ventilation and drainage

In order to verify these effects of cyclamen extract in otitis media patients, it has been used in 33 patients with acute secretory otitis and 10 patients with chronic secretory otitis (32 were children aged 5-18 years and 11 were adults aged 20-77 years); in 28 cases, the main cause of the secretory otitis was the presence of an acute viral respiratory infection and in 17 it was rhinosinusitis. In the patients with acute secretory otitis, Nasodren® was administered once a day for 3 days; in the patients with chronic secretory otitis, it was administered for 5 days, starting on the second day after myringotomy. In addition, there was a control group with 30 patients (20 cases of acute otitis and 10 cases of chronic otitis).

In the patients with acute secretory otitis, it has been observed that administration of this plant-based preparation improves the patients’ hearing ability and tympanic membrane motility. These benefits are seen clearly and consistently after the fourth or fifth day; in addition, a normal tympanogram is also obtained by this time (confirming evacuation of the exudates from the tympanic membrane). It was not necessary to perform a myringotomy in any of the cases.
The patients with chronic otitis experienced a marked reduction and faster evacuation of the mucus in the tympanic cavity after treatment with Nasodren®.
The detailed analysis of the course followed by the symptoms in all the patients included in this study shows, among other things, that both during the first days of treatment (day 4-5) and later on (days 6-7 and 8-10), the recovery from otitis symptoms is appreciably better in the group treated with Nasodren® than in the control group.
It is also confirmed that the time during which the patients receive treatment is significantly less in the group receiving the cyclamen extract (5-6 days on average) compared with the control group (8-9 days on average).
In her conclusions, Dr. Petrova highlighted that “the administration of Nasodren® for the treatment of acute and chronic otitis enables the treatment time to be shortened and also avoids having to perform myringotomies in patients with acute otitis media.” In her opinion, “Nasodren® is an effective medicine and should be indicated for the treatment of secretory otitis for its marked secretolytic effect and its positive impact on the function of the auditory canal.”

Wednesday, October 3, 2012

Local therapy of acute rhinosinusitis in children

Local therapy of acute rhinosinusitis in children

In many cases, antibiotics are the drugs of choice for acute rhinosinusitis in children. However, they are associated with significant drawbacks, such as the growing prevalence of resistance and, because of this, a reduced efficacy; furthermore, such treatments do not fully remove the pathological content from these patients’ paranasal sinuses.

Another risk commonly associated with the administration of antibiotics in these cases is premature discontinuation of the treatment due to the clear symptom improvement but before the normal treatment cycle has been completed (which increases the risk of recurrence of the disease and appearance of resistance). On other occasions, as Professor Bogomilskiy pointed out, “we see antibiotics being used in situations of acute viral or fungal rhinosinusitis.”

All of these limitations of antibiotic therapy can lead to particularly dramatic events, such as the chronification of the disease process and/or frequent relapses.
The treatment of acute paediatric rhinosinusitis is usually started by the GP or the paediatrician. In the speaker’s opinion, “this is a problem, as it should be the otorhinolaryngologists who prescribe the appropriate treatment. Neither the GPs nor the paediatricians have appropriate endoscopic resources nor do they know the anatomo-physiological details of the otorhinolaryngological organs, which increases the risk of orbital and intracranial complications in these patients (the dangers posed by acute rhinosinusitis are underestimated).”

Local therapies 
Local therapies in acute rhinosinusitis offer significant benefits although a series of requirements must be met in order to optimise their results. It is necessary to create optimal conditions for drainage of the paranasal sinuses, the cavities must be emptied naturally (although sometimes it is necessary to use surgery), steps should be taken to promote mucociliary activity, the purulent content must be removed by puncture or other methods, greater use should be made of physiotherapy and, in some cases, iontophoresis.

Creating the necessary conditions for drainage of the paranasal sinuses
  • Opening the natural exits, sometimes by surgery
  • Clearing the ciliary epithelium of the nasal mucosa
  • Expelling the contents by puncture and other methods
  • Physiotherapy
  • Iontophoresis

In this context, as the speaker assured, “preparations that facilitate drainage of the nasal passages, such as Nasodren®, are particularly attractive.” This product’s active ingredient has a unique mechanism of action and shows major differences compared with other local therapies routinely used in acute rhinosinusitis; this preparation stimulates secretions thanks to its irritant effect on mucous membrane glands. Given this unique mechanism of action, a number of recommendations should be taken into account when using cyclamen extract. In children with acute rhinosinusitis, it is particularly important to clear the nasal meatus, especially in paediatric patients who are still too young to blow their nose correctly by themselves; before administering cyclamen extract, it is necessary to clear the nasal passages. In some cases (acute purulent rhinosinusitis), it is advisable to combine the cyclamen extract with systemic antibacterial therapy. However, as the speaker explained, “these are not drawbacks of Nasodren®, but simply advice that should be followed to improve the outcome and avoid possible adverse effects.”
The main limitation described to date with the use of cyclamen extract in children is due to its stimulant effect on the nasal passages, “but this is a very minor drawback if one considers that this is a treatment and we are achieving significant benefits from its use. It is without doubt a safe product that is not associated with persistent negative consequences in paediatric patients; there are no contraindications to its use in children over 5 and we have not observed any hypersensitivity reactions to the preparation in our studies.”

Take it from: II Round Table, New horizons in the treatment of acute and chronic rhinosinusitis.Prof. M. Bogomilskiy Moscow. Russia

Tuesday, October 2, 2012

Clinical study of cyclamen in acute sinusitis in the United States

Clinical study of cyclamen in acute sinusitis in the United States

A pilot study with Nasodren® has recently been started in the United States in patients with acute sinusitis. This is a randomised, double-blind, placebo-controlled trial in which cyclamen extract will be given for 7 days, with a follow-up period of 90 days (with visits after 15, 28 and 90 days).

50 patients have been included (25 in each treatment group), recruited from about 15 health centres in North America.
The primary goal of this trial is to evaluate the changes in each treatment group in the computerised tomography scores with respect to the baseline score (days 15 and 28); in addition, as a subjective end-point, the change induced by each treatment (cyclamen extract and placebo) with respect to the baseline score in the patients’ symptoms (using the Total Symptom Score, TSS) will be analysed from day 1 to day 4 and from day 8 onwards.

It is also intended to achieve a very extensive battery of secondary goals with this study. Among others, it is intended to analyse the change in the TSS from baseline to days 15 and 28, the average cure time, the frequency of sinusitis episodes during the three-month follow-up or the presence/absence of purulent mucus and inflamed nasal mucosa in the nasal endoscopy performed at the end of the treatment period.
As main inclusion criteria, it is wished to recruit adult patients (18-70 years), with a total symptom score in the TSS ≥ 3 (up to 6). Of the four characteristic symptoms of acute rhinosinusitis, two will be studied in particular detail: nasal obstruction or congestion and facial pressure or pain; the symptoms will be scored on a 4-point scale (where 0 means no symptoms and 4 means severe symptoms). As other inclusion criteria, the patients recruited for this trial must show evidence of purulent mucus and inflammation in the nasal endoscopy; in addition, the CT scan must show clear radiological signs of acute sinusitis. The patients must confirm their wish to take part in the study and attend all the scheduled visits.
However, patients with at least one of the following limitations are excluded from this study: a known history of hypogammaglobulinaemia, ciliary dyskinesia, atrophic rhinitis, drug-induced rhinitis and/or cystic fibrosis; known hypersensitivity to cyclamen extract; presence of other serious concurrent diseases (such as malignant tumours or serious liver disease); abnormal results in the imaging or laboratory screening; have conditions that may impair the product’s action or assessment of its risks/benefits (mucocele, advanced polyposis,...); existence of bone lesions in the sinus X-ray; pregnancy and/or breast-feeding; history of upper airway viral infection in the last two weeks; fever; facial or periorbital oedema; existence of local complications (such as orbital cellulitis, vein thrombosis,...); disturbed mental state; recent nasal surgery; use of antibiotics and/or decongestants in the days prior to the study; radiotherapy or chemotherapy during the 12 months prior to the study; use of an investigational drug or device during the previous month; abuse of alcohol or other drugs in the last 5 years; and/or presence of unstable organic systemic disease. The existence of chronic rhinosinusitis or the presence of asthma and/or allergic rhinitis are not exclusion criteria.
At the first visit, the patients are randomised and distributed to each of the treatment groups, after carefully checking the exclusion and inclusion criteria. At the visit scheduled for day 8 (just one day after stopping treatment), it is planned to perform a nasal endoscopy and the changes in the patients’ symptoms will be analysed. The CT test will be performed at the visits scheduled for days 15 and 28.

In short, as Michelle Carpenter acknowledged, “this is only a first study, which is necessary in order to understand in greater depth how Nasodren® acts and what effect it induces. This study will provide the foundations for other comparative trials (cyclamen extract vs active therapies) in which more specific clinical goals will be set.” The first results of this trial will be published in early 2008.

Monday, October 1, 2012

Experience with the use of cyclamen in acute rhinosinusitis

Experience with the use of cyclamen in acute rhinosinusitis

Prof. S. Ryazantsev 
Scientific ORL and Speech Research Institute. Saint Petersburg. Russia

The main cause of rhinosinusitis is the existence of abnormal conditions in the osteomeatal complex, associated with impaired mucociliary activity. This impaired mucociliary activity may be caused by different viral and/or bacterial infections.

 Numerous studies performed by Professor S. Ryazantsev’s group have set themselves the goal of improving our understanding of the mucociliary activity. It has been concluded from these studies, for example, that ciliary activity is depressed by the drying process and also by the damage caused by nasal infections, and that some widely used drugs in rhinology can paralyse ciliary activity.
Prof. Ryazantsev’s team has developed a special video system that, when combined with microscope techniques, enables mucociliary activity to be assessed in vivo. It has also invented a formula that interrelates the cilium’s end speed with ciliary movement parameters.
As a result of these studies, some interesting working hypotheses have been proposed. Among them, the speaker suggested that “normal mucociliary clearance may be restored by improving the rheological characteristics of the nasal mucus.” Along the same lines, he suggested that “Nasodren®’s clinical effect is obtained by stimulating the sinonasal area, expelling all of the pathogens residing in the osteomeatal complex. This activates ciliary transport, which is responsible for removing the mucopurulent content. Nasodren® is an effective secretolytic and a powerful stimulant of nasal mucus production.”

Nasodren®’s reflex mechanism has been analysed in detail. It has been seen that the reflex hypersecretion in the paranasal sinuses starts 1-3 minutes after administration and continues for about 30-60 minutes.

Satisfactory results 
A study in 2006 was begun to determine Nasodren®’s influence in the medical treatment of acute rhinosinusitis. The patients were divided into two treatment groups, with one group receiving cyclamen extract and the other group receiving the standard therapy in Russia (antibiotics and mucolytics). Each treatment’s effect on different reference parameters and on the evolution of the nasal secretions or rhinorrhoea was analysed.

The most important finding was that in the group treated with cyclamen extract, mucus secretion had virtually stopped by the fourth day of treatment, while these secretions continued until the eighth day in the group that received conventional therapy. Likewise, other common symptoms of acute rhinosinusitis, such as nasal obstruction, facial pressure, nasal congestion or headache, remitted much earlier in the patients treated with Nasodren®. In contrast, no major differences between the two treatment groups are seen in the immunology studies (immunology of the nasal mucosa); in the Russian expert’s opinion, this finding could indicate that “Nasodren®’s mechanism of action is not related with immune parameters.”
As regards the patient’s clinical condition, Professor Ryazantsev assured that “this trial effectively shows statistically significant differences between the two treatment groups, with greater clinical improvement among the patients treated with Nasodren®.”
The nasal endoscopy also shows significant differences between the treatments chosen. The hyperaemia, hypertrophy and nasal congestion have improved substantially by the fourth day of treatment with cyclamen extract (virtually all these symptoms have disappeared), while they continue until the eighth day in the control patients. The endoscopic examination has also enabled evaluation of each treatment’s effect on the volume of mucopurulent secretions, and it is concluded that administration of Nasodren® is associated with a faster decrease in the amount of mucus secreted by these patients.
With respect to the changes detected in the osteomeatal complex (mucous membrane oedema), it is found that these changes appear much earlier in the patients treated with Nasodren®.
To quote Professor Ryazantsev, “all of this evidence highlights the efficacy of Nasodren® in the treatment of acute rhinosinusitis. Thus, on the basis of our research, we can declare that it is an effective treatment and we recommend it for the treatment of this disease. We now need to determine how it should be used, as a monotherapy or combined with other treatment resources.”
“The hyperaemia, hypertrophy and nasal congestion have improved substantially by the fourth day of treatment with cyclamen extract (virtually all these symptoms have disappeared)”