Wednesday, January 30, 2013

ENT Questions & Answers II

ENT Questions & Answers II

- What are the keys aspects to be considered in addressing rhinosinusitis?
- The precepts established in the recently created EPOS consensus must be followed and observed. As this consensus indicates, now we have a system for classifying and grading the clinical evidence for each of the treatments of choice and, therefore, it is recommended to use the treatments that have the most clinical evidence supporting them. But we must also keep an eye on the new products that are in the pipeline or about to come on the market and which, although they do not yet have a broad body of evidence behind them, suggest significant benefits.

- Are you referring to the effect of plant extracts?
- Exactly. This is a product that drains the nasal passages and which it is thought could be very effective in the treatment of rhinosinusitis. It may be a revolutionary product in the management of certain cases of mild or moderate acute rhinosinusitis. With an eminently mechanical action, this product seems to be able to assure effective symptom control.
- What is the mechanism of action of these natural plant extracts?
- After intranasal administration, they act on the mucosal surface, triggering a reflex secretory response by the mucous membranes lining the nasal passages and paranasal sinuses. Shortly after administration, the patient may feel smarting or irritation in the nose. At the same time, an intense reflex secretion begins after a few minutes and which may continue for a couple of hours. This rapid secretion dehydrates the mucosa, reducing the swelling and opening the ostiomeatal complex. An intense physiological drainage of the paranasal sinuses occurs, which has effective results in terms of symptom relief.
This product effectively decongests and adequately drains the nasal sinuses. This has significant practical implications. Indeed, rhinosinusitis is basically a problem of congestion and obstruction of sinus ventilation and drainage. Subsequently, infection may appear but the initial problem is that there is this obstruction. It is common for the infection to be treated but without improving the underlying obstruction, thereby increasing the risk of reinfection.
- So, on the basis of what you are saying, is elimination of the obstruction one of the first goals that should be pursued in the treatment of rhinosinusitis?
- If we improve the obstruction, the drainage, the ciliary movement and the quality of the mucus, we will already be moving towards a cure and we will be able to avoid using other treatments. For example, we could avoid the use of antibiotics in many cases and, in others, we could at least shorten the time during which antibiotics must be administered. We need clinical studies that help us confirm this evidence.
- What is your personal experience and personal opinion of the cyclamen extract?
- Very satisfactory. I have even used it personally and I have been able to see for myself how this product works and the rapid symptom improvement it brings. The patients report significant benefits too, with the symptoms improving after just a few days. Although the initial smarting sensation is uncomfortable, the patients tolerate it very well, better than expected. We therefore think that it could offer significant advantages, as major benefits are achieved using a natural, very non-aggressive therapy. On top of that, its dosage schedule is very easy to follow, as it consists of a single daily spray in each nostril for 7 days.

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

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