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New Treatment approaches to Rhinosinusitis:
Less is more

Crete. Greece. 15-19 June 2008
Keywords New Treatment approaches to Rhinosinusitis - PDF

OVERVIEW

In recent years, rhinosinusitis has become a major health problem and its incidence is steadily increasing throughout the world. Millions of people suffer from this disorder, which has major medical repercussions and a negative socioeconomic impact. However, in spite of its growing negative implications, until a few years ago there were no treatments available that were capable of providing a permanent solution for this disease.

As part of the 22nd Congress of the European Rhinologic Society / 27th International Symposium of Infection and Allergy of the Nose, held on the Greek island of Crete on 15-19 June, Hartington Pharmaceuticals sponsored a symposium that highlighted the new treatment possibilities for acute rhinosinusitis, based on the use of cyclamen europaeum extract (in a nasal aerosol for administration once daily). The meeting was moderated by Professor Andrey Lopatin, head of the Moscow Medical Academy’s Otorhinolaryngology Clinic in Moscow (Russia), and speakers of acknowledged international repute in the field of ENT accompanied him.

As the meeting’s moderator defined, “acute rhinosinusitis is a health problem with a major social impact for which there is still no effective solution.”

Acute rhinosinusitis

Normally, antibiotics are the drugs of choice in patients with signs of rhinosinusitis but, paradoxically, many cases are not caused by bacteria. Furthermore, a growing bacterial resistance to antibiotics has been documented in Europe (and in the rest of the world) due to the – and not always indicated – overuse of antibiotics. A paradigmatic example is the growing resistance by Streptococcus pneumoniae to the main drugs of choice, with resistance rates in Spain up to 26% against Penicillin, 37% against the Macrolides, and almost 40% against the early-generation Cephalosporins.

THE SEARCH FOR ALTERNATIVES

As his main reflection, Dr. Lopatin pointed out that “antibiotics are not always necessary to treat acute rhinosinusitis. Hence, the importance of distinguishing correctly between viral and bacterial acute rhinosinusitis.” Unfortunately, he argued, “until now we had limited alternative resources for managing the mild and moderate forms of acute rhinosinusitis and we did not have an extensive body of evidence on the efficacy of new alternative therapies.”

Antibiotic resistance in Europe

With the addition to the treatment armamentarium of products such as cyclamen europaeum extract, a resource that has been known and studied for many centuries and whose formulation has now been standardised and clinically assessed, an important step has been taken towards the goal of controlling the symptoms of rhinosinusitis and even reversing its natural course, making it easier to cure. In recent years, a large number of studies have been published in medical literature that endorse its efficacy and safety and have also provided further insights into its mechanism of action and possible indications in clinical practice.

It is a natural product that facilitates physiological drainage of the sinuses and cleansing of the nasal and paranasal cavities and middle ear. By means of physical contact, the saponins it contains are adsorbed onto the cell surface and are able to change the ion concentrations (Na/K), thereby stimulating the free sensory endings of the trigeminal nerve, acting on the mucous membranes of the nasal cavity and paranasal sinuses. This induces an intense reflex secretion associated with abundant mucus discharge, together with an antioedematous effect.

The cyclamen extract triggers the discharge of retained seromucous secretions, reducing/eliminating nasal congestion and tissue oedema (a direct osmotic effect, with the opening of cell pores). It effectively opens nasal spaces, facilitating physiological drainage of the sinuses and clearing the nasal and ear cavities. It can be particularly useful in acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis (provided that there are no obstructions in the meatus), sinonasal postoperative care, and in acute and secretory otitis media.


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