Thursday, March 28, 2013

Why Cyclamen extract?


Rhinosinusitis is increasing in prevalence globally and is one of the most common reasons for a physician consultation in primary care. Treatment is aimed at relieving these symptoms, preventing disease progression/ recurrence, and most importantly, improving the patient’s quality of life. Currently available therapies often fail to provide adequate symptom relief and new therapeutic options would be a step forward, particularly if they help to avoid antibiotic overuse for a diseasewhich is usually viral in origin. Cyclamen europaeum (CE), a member of the primrose family, has been used in traditional medicine since ancient times. Extracts from CE tubers contain saponins which following nasal instillation, concentrate in the mucous membranes of the lower nasal cavity, inducing a rapid discharge of mucous from the nasal and paranasal cavities, suggesting potential benefits in rhinosinusitis treatment.

The precise mechanism of action of Cyclamen extract is currently the subject of scientific investigation. It appears to have both direct and indirect effects, related to the saponin fraction. The saponins are welldefined topical surface active agents, allowing their adhesion to mucous membranes, where they mediate their effects. Following insertion into the nostrils, Cyclamen extract  is not penetrative and thus its activity is confined to the paranasal cavities and the vestibular area. Here, the extract reduces the surface tension of the cell membrane of the nasal mucosa, and this process facilitates mucin secretion, shrinks the nasal mucosa and decreases congestion through a direct osmotic effect. As the antiedemic action of CE nasal spray is not due to a vasoconstrictive component, this product is essentially different to the analogous effects of decongestants. The local activity of Cyclamen Extract also increases the permeability of nerve terminals, possibly by stretching the terminal axonal membrane, and the resultant influx of Na+ causes the depolarisation that generates the electrical potential which stimulates the trigeminal nerve endings in the basal mucous membrane. This results in a reflex response (nasal burning, sneezing, lacrimation, etc.) which also induces the efflux of secretions from epithelial and submucosal cells in the nasal cavity and paranasal sinuses, accounting for the rapid and abundant discharge. This hypersecretion contributes to the complete evacuation of pathologic content.

A Cyclamen Extract nasal spray has been developed, which in preliminary studies produced encouraging clinical improvement, More recently, in the first phase III randomised, double-blind trial of phytotherapy in rhinosinusitis, CE nasal spray significantly reduced facial pain and increased the level of patient and investigator satisfaction compared with placebo. Overall,
Cyclamen extract  nasal spray was well tolerated. The most frequent symtoms included nasal irritation/burning, which are symptoms of rhinosinusitis or may be due to the method of administration.
Follow-up clinical evaluation of Ciclamen Extract nasal spray in the treatment of rhinosinusitis is required to fully elucidate the potential of this promising natural agent in adults and children with acute and chronic rhinosinusitis.

1. Fabre M. Effects of cyclamen extract on cell osmosis. Presented at the “New
horizons in the non-invasive management of sinonasal disorders” symposium in
Barcelona, 2007.
2. Gedevanishvili MD, Gogitidze NM, Sikharulidze IS. Reflex mechanisms of naso
paranasal secretion in the administration of CE nasal spray. Vestn Otorinolaringol.
3. Pfaar O, Mullol J, Anders C, et al. Cyclamen europaeum in the treatment
of acute rhinosinusitis: a randomized, double-blind, placebo-controlled trial.
Rhinology (submitted).

Tuesday, March 26, 2013

What kind of food produce mucus?

What kind of food produce mucus?

The mucus (or mucous) is a secretion that coats the mucous membranes of the body and containing antiseptic enzymes (substances that help prevent infections by destroying the microbes that cause them) and immunoglobulins (substances that are part of the immune system, defense).

In the respiratory system, mucus traps small particles such as dust and bacteria, preventing their entry into the body, this occurs mainly in the nose. The mucus helps protect the lungs by trapping foreign particles that enter the nose during normal breathing. The increased production of mucus in the airways is a common symptom of many diseases such as the common cold. The presence of mucus in the nose and throat is normal, but larger than normal quantities can impede comfortable breathing and must be cleaned by blowing the nose or expectorating phlegm from the throat. Among the components of nasal mucus are included tears.

Sinuses are air cavities excavated in the thickness of the skull bones. Communicating with the nostrils through the ostium (a very small hole), and air forced step junction of different drainage pathways. The permeability of this hole allows maintaining sinus physiology. Any persistent obstruction of the ostium engender large and the consequences will be: decreased ciliary movement (cilia are some "hairs" that sweep mucus from the sinuses into the nose through the ostium) accumulation of mucus and sometimes secondary bacterial infection . That is, under normal conditions, it produces mucus and is removed through the nose or swallowed. If you can remove mucus collects in the sinuses causing rhinosinusitis.

Rhinosinusitis is an inflammation of the lining inside the nose and one or more of the sinuses. Its main symptoms are nasal congestion, runny nose, facial pain or pressure, and loss or reduction of smell.

Cyclamen extract acts to increase mucus production, reducing inflammation of the mucosa, opening the ostium, recovering the function of cilia, and thus clean the sinuses and nasal cavity. That is, the physiological active (normal) defense of the upper airway which deteriorate during rhinosinusitis.

In connection with food, are considered food mucosa generators, as is the case of dairy products, which increase the thickened mucus and therefore has moderate consumption when this type suffer from symptoms.

Although there is some lack of knowledge about the exact causes, which itself has been proven is that the moderate or restrict the presence of dairy products in the diet, the amount of mucus decreases significantly, thus facilitating the disappearance of congestion and improve nasal breathing.

Other foods that favor the appearance of the mucus are peanuts, oranges, white refined flours such as wheat, bananas, sweets or any other product containing sugar, fatty or highly concentrated, excess meat, fried foods, and excessive salt.

And just as there are foods that increase mucus secretion, there are others who help her disappearance. Garlic, onions, leeks, watercress, horseradish, mustard, ginger and, to a lesser extent, parsley, celery, green tea, jasmine tea, pickles and lemon are particularly suitable in cases of excess mucus, since they possess expectorant and mucolytic effect, ie they have the property of dissolving or destroy the mucin main constituent of the mucus.

Wednesday, March 20, 2013

Observational Experience in Post-traumatic, Postoperative Rhinosinusitis

Observational Experience in Post-traumatic, Postoperative Rhinosinusitis

While preoperative and intraoperative measures are important, observance of a series of basic recommendations during the postoperative period will guarantee success of surgery in most cases and rapid, effective recovery of the patient. The postoperative period starts during the operation itself, as the postoperative healing process will be optimized if a series of measures are taken into account during the operation (use of punches or microdebriders, preserve the healthy mucosa, choose a suitable tamponading material and use it for the optimum time, leave silastic to prevent synechiae).

The fact is that there is currently no general consensus on what should be done after polyposis or rhinosinusitis surgery to improve the outcome. There is even doubt as to whether wound care should be daily for the first 10 days, whether it is preferable to perform it twice a week or whether it should be weekly.


 Neither is there agreement concerning the frequency of inspections until a complete cure is obtained. In this case, the scientific literature is highly divergent. However, postoperative treatment should be consistent with the phases of the healing process: appearance of scabs after 10 days, obstructive lymph oedema after 30 days, mesenchymal reaction after 3 months and healing from the 3rd month onwards, with the appropriate treatments and monitoring for each phase.
It is essential to clean the area carefully to avoid infection and/or obstruction. There is also the matter of the drugs or products that may be indicated in the postoperative period. Recently, the EP3OS consensus has enabled the level of evidence or recommendation
grade to be established for the main products used in the postoperative care of nasal polyposis and rhinosinusitis. Of particular note is the benefit obtained from the administration of topical corticoids (which act more on the underlying disease than on the healing process), nasal irrigations (particularly hypertonic irrigations) and creams or gels (not ointments). Clinical evidence has also been appearing for phytotherapy, which consistently indicates the benefits that can be obtained from using certain natural products in the recovery process.

My observational experience in postoperative care with cyclamen extract is based above all on 28 patients who underwent ethmoidectomies for polyposis. In 14 cases, saline irrigations were used, while in the remaining 14, a cyclamen extract was administered intranasally
in addition to the irrigations. One spray was administered into each nostril, once a day. The treatment was started on the third day after withdrawing Merocel. The patients treated with the cyclamen extract
experienced a significant improvement in the evolution of the cavities after the sixth day of the postoperative period (third day of treatment).
Only one case of frontal pain caused by frontal sinusitis, requiring discontinuation of the treatment, has been documented.
The endoscopic images of the nasal passages of a case of sinonasal polyposis with superinfection show how abundant mucus from the
maxillary sinus appears only a few minutes after administration of this product. In the patients treated with cyclamen extract, the maxillary sinus is clear after 48 hours, due to the product’s self-cleansing effect. 
By the 4th day after starting treatment, recovery of the affected area is obvious. By the 6th day, there is a clear retention of the mucosal oedema (when normally this happens after 10-12 days); this effect could be due to use of this preparation.
The side effects observed with this product are limited to a smarting sensation during the first few sprays, which is variable or even absent in operated patients. Other side effects may be sneezing and watery rhinorrhoea.
Generally speaking, these effects are mild, transient, expected, rare, with minimal clinical significance.

Treatment can be started on the day after surgery or when the tamponade is removed and there is no risk of bleeding.
The reason for using Nasodren  only once a day is basically because it induces a very strong expression of mucoid cells. Consequently, readministering after 12 hours would not provide any significantly greater benefit than that obtained by administering every 24 hours.
This treatment can be continued without problems for more than a week. Since it causes no significant adverse effects, it can be used for up to 10-15 days.
Cyclamen extract may be useful in all patients who require postoperative care, provided that there is healthy mucosa. Its effect would be very limited in those cases where the entire mucous membrane has been removed.
The main contraindication for this product is that it should not be used in patients with obstruction.
This treatment can be repeated as often as is wished, and can be stopped when the patient wishes.


Cyclamen extract it is my opinion that it will be very useful in clearing the surgical cavity, it will reduce the need for aggressive postsurgical wound treatments, the time between treatments of the surgical area will be longer, it will facilitate self-cleansing, it will possibly speed up the reepithelialisation process, and will enable topical corticoids to be applied earlier.

MANAGEMENT, Personal observation of Dr. H. Massegur 

Thursday, March 7, 2013

Use of a new plant extract-based product in the early postoperative care of patients with productive rhinosinusitis.

“Use of a new plant extract-based product in the early postoperative care of patients with productive rhinosinusitis”.

The incidence of chronic paranasal sinus conditions continues to increase in spite of the treatments currently available. Endoscopic surgery seeks to restore drainage and ventilation of the paranasal sinuses. However,
in spite of the significant progress achieved with this technique, there remains a significant percentage of patients who suffer further obstruction after surgery. Among other reasons, this is due to the inflammatory congestive process, tissue oedema and hyperaemia caused by the surgical aggression. The
use of products that facilitate natural nasal and paranasal secretion and help cleanse the accumulated content takes on particular significance
in this field.

The purpose of this study was to determine the usefulness of a new plant extract-based product in patients operated for productive rhinosinusitis and maxillary sinus cysts after administration in the early postoperative period. Our results show that its use as monotherapy after surgery is associated with a rapid clearing of the nasal meatus and sinuses, restoring normal rhinoscopic findings between the fifth and sixth day after administration of the preparation.

In spite the development of endoscopic surgery in the field of otorhinolaryngology in
recent years and particularly in the effective treatment of chronic conditions affecting
the paranasal sinuses to restore natural drainage and ventilation, there remains a
significant percentage of patients who suffer further obstruction after surgery.
Among other reasons, this is due to the inflammatory congestive process, tissue oedema and hyperaemia caused by the surgicalaggression. Although various treatments have been used in the postoperative period to palliate this problem, the results are not yet as satisfactory as they should be (Gerber et al. 2003; Aukema & Fokkens 2004; Cohen 2006).

The plant extracts studied have the advantage that they naturally favour drainage of the secretions from the nasal passages and paranasal sinuses, helping to clear the mucus content accumulated after surgery. The results of our study clearly show that their use helps in this process in the immediate postoperative period in patients operated for productive rhinosinusitis and maxillary sinus cysts. Furthermore, it is not only effective but the effect is quicker than other alternatives.

Thus, the use of natural plant extracts rapidly drains the sinuses and nasal meatus. The rhinoscopic findings become normal between the fifth and sixth day of treatment, which is three or four days sooner than with the traditional methods of postoperative care, such as nasal irrigation. The images included with this study clearly illustrate this new product’s usefulness. In addition, its efficacy in other nasal or paranasal conditions has been shown in other studies (Zasritskaia et al. 2006; Khechinashvili et al. 2006; Chernisheva & Siniachenko 2006).

A particular feature of its use in the early postoperative period is the relatively low sensitivity of the mucous membrane to the product.
As a result, patients only feel a slight smarting after administration. When the product’s action has ended, almost all patients report a slight dryness in the nose. This good tolerability is due, among other reasons, to the fact that it is a completely natural product.

In conclusion, the results obtained in this study show that use of this new plant extract- based product provides an effective treatment in the early postoperative care of patients after endoscopic surgery for productive rhinosinusitis.

Popovich V.
Therapeutics and Clinical Risk Management,
Suppl.1, 2006. 25-32.

Tuesday, March 5, 2013

Clinical investigation of the efficacy of a new plant extract product in children with acute rhinosinusitis

Clinical investigation of the efficacy of a new plant extract product in children with acute rhinosinusitis.

In spite of the treatments currently available, the incidence of rhinosinusitis continues to be high in children. Furthermore, the treatments currently available are not without adverse effects. A product obtained from natural plant extracts has been introduced recently whose action consists of promoting a natural drainage of pathological nasal and paranasal mucus secretions after intranasal
administration. The purpose of this study was to assess the use of the product in children suffering from acute rhinosinusitis and study its effects on the condition’s symptoms.
With a view to performing a complete study of these children, the local immunity indexes of the upper airway mucous membranes were also analysed. Thus, 30 children aged between 7 and 14 with acute rhinosinusitis were included. The children were divided into two groups of 15 patients each. In the first group, the plant extract-based product was combined with standard therapy and the
second group received the standard therapy only. The study’s results indicate that, compared with the basic therapy, the treatment that included administration of the plant extracts as part of the therapy showed a more positive evolution of the clinical symptom scores and a greater correction of local mucosal immune reactivity. Consequently, use of the product in children with acute rhinosinusitis is highly effective and very safe.

The results of this study show that the use of this new product containing plant extracts, including cyclamen, is associated with a significant clinical benefit. This positive mucus secretion drainage effect not only avoids having to perform maxillary sinus punctures in some cases but also does so without increasing the incidence of side effects. This is possible for two reasons.

The first is that it is a natural compound. Consequently, the likelihood of developing allergic conditions, which would worsen the disease, is much lower. The second reason is because of its mechanism of action. After administration in the nasal cavity, this plant extract activates the physiological cleansing mechanisms of the mucosa in the nasal cavity, favouring natural secretion and drainage in the nostrils and paranasal sinuses and clearing the accumulated mucopurulent content. In addition, this compound has apurely local action. As it is not absorbed by tissues nor does it enter the bloodstream, a systemic effect is avoided and the likelihood of developing side effects is limited.

This study has established the efficacy of this plant extract-based product in children. Other studies have shown an efficacy in excess of 90% in eliminating the main symptoms of rhinosinusitis, both alone and when combined with other treatments, and both in adults and children (Zasritskaia et al. 2006; Khechinashvili et al. 2006).
Another important aspect of this study is the analysis of local immunity in the saliva of both groups and the changes this immunity undergoes. It had already been pointed out in an earlier study that acute rhinosinusitis is associated with an imbalance in inflammatory cytokine levels (Seleznov et al. 2001). Our study shows that the rapid decrease in nasal and paranasal congestion is accompanied by a correction of local mucosal immune reactivity.
None of the products administered hampered production of the natural secretions
synthesized by the mucosal epithelium.

This fact provides further support for the benefit provided by this plant extract in
acute rhinosinusitis.

· Compared with the basic therapy, the additional administration of the plant extract
to patients as part of their treatment was associated with a more positive evolution of clinical symptom scores and a reduction in the condition’s duration.

· The time required for improvement of the general condition, relief of the rhinosinusitis symptoms and restoration of a normal rhinoscopic picture was shorter.

· Administration of the product was associated with a rapid decrease in the nasal and paranasal congestion, which was accompanied by a correction of the local mucosal immune reactivity. In spite of its topical intranasal administration, the product does not hamper production of the natural secretions synthesized by the mucosal epithelium and which are an integral part of secretory immunoglobulin A (SIgA).
· The improvement is accompanied by an increase in the initially low local immunity indexes.
· Use of the product as part of a combined therapy enabled puncture of the upper maxillary sinuses to be avoided in some patients.

· On the basis of the above, we consider that use of this new plant extract-based product in children with acute rhinosinusitis is highly effective and very safe.

Chernisheva L.
Therapeutics and Clinical Risk Management,
Suppl.1, 2006. 19-23.