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.”

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