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)” 

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