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Use of a new plant extract-based product in the early postoperative care of patients with productive rhinosinusitis
POPOVICH, V.
Professor, Doctor of Medicine,
State Academy of Medicine,
Ivano-Frankovsk, Ukraine.
SAVCHUK, O.
Doctor of Medicine,
State Academy of Medicine,
Ivano-Frankovsk, Ukraine.
Otorhinolaryngology, Kiev
Therapeutics and Clinical Risk Management.
Special Issue in Spanish. Supplement I 2006.
Therapeutics and clinical risk management 2006 - PDF
INTRODUCTION
A significant percentage of patients with chronic diseases of the paranasal sinuses have productive conditions.
The hyperplasic forms, such as the polypous forms of both mono- and polysinusitis, account for approximately 50-60% of the otorhinolarynghology cases requiring hospitalization and their incidence continues to increase each year. This group of diseases also includes cysts in the maxillary sinuses which, depending on the series, account for up to 5-7% of the cases (Hamilos 2000; Cohen et al 2000; García-Marcos & Götz 2001; Matiño et al 2003).
A broad variety of modern techniques and methods are available for the surgical and conservative treatment of chronic exudative conditions of the paranasal sinuses. However, agreement is not unanimous as regards the best treatment for productive conditions.
Surgery is virtually the only treatment option for productive conditions (Poliakova et al 1998; Van Cauwenberge & Watelet 2000).
As a result of the development of nasal endoscopic surgery, techniques such as ethmoidectomy or the Caldwell-Luc operation have ceased to be viewed as options in the treatment of hyperplasic conditions. Functional surgery using endoscopy is increasing, particularly in the surgery of the middle nasal meatus. The treatment seeks to restore ventilation of the paranasal sinuses and mucociliary clearance.
During surgery, the pathological parts of the mucosa are removed, restoring drainage and ventilation of the paranasal sinuses (Gerber et al 2003; Aukema & Fokkens 2004; Cohen 2006).
However, the new surgical techniques require a new approach in the postoperative care of these patients.
The surgery leads to certain inflammatory congestive phenomena in the sinuses and middle nasal meatus. This can be defined as acute post-traumatic or postoperative rhinosinusitis. Furthermore, it is not always possible to clear the sinuses through the artificial opening using classic surgical procedures. This situation is further complicated by the presence of tissue oedema and hyperaemia after restoring the natural opening, which may ultimately cause a new obstruction (Gerber et al 2003).
Consequently, it would be interesting to have a product that was able to facilitate natural drainage and secretion from the nasal passages and paranasal sinuses.
In recent years, a plant extract-based product has been developed that, when administered in the nasal passages, activates the physiological clearing mechanisms and facilitates natural secretion in the nasal cavity and paranasal sinuses, thereby eliminating the accumulated mucus content (Zasritskaia et al 2006; Khechinashvili et al 2006; Chernisheva & Siniachenko 2006).
The purpose of this study was to determine this product’s usefulness in patients operated for productive sinusitis and maxillary sinus cysts after administration in the early postoperative period. This is based on two basic premises: surgery is able to remove any morphological abnormality that may predispose to a possible obstruction of the sinuses and the surgically treated structures require effective drainage and clearing.
PATIENTS AND METHODS
This study was carried out at the Otorhinolaryngology Clinic at the State Academy of Medicine of Ivano-Frankovsk.
35 patients were included in the study. 10 patients formed a control group.
In all cases, the diagnosis was confirmed from the data of the medical examination, an optical endoscopy of the nasal cavity and nasopharynx, and by radiodiagnosis methods, which consisted of X-rays and computerized tomography.
The postoperative changes were documented by endoscopy and the data were recorded on a digital medium.
RESULTS
As first phase of the treatment, all of the patients underwent endoscopic surgery, whose extent varied depending on the diagnosis made and the findings obtained.
On the second day after the operation, each of the patients received the new product as monotherapy in the form of a single spray in the nasal cavity.
Between 13-15 minutes after application, the patients presented with rhinorrhoea as a result of the product’s drainage effect. On the first day of treatment, a pink mucus secretion was observed mixed with fragments of coagulated blood. On the following days, the mucus was mixed with a purulent secretion, sometimes stained a pinkish colour. The secretion continued for 1.5 to 2 hours, after which the congestion and breathing through the nose improved.
After administration of the preparation, the patients noted a slight stinging in the nose. None of the patients reported other problems. When the rhinorrhoea stopped, the patients noted an improvement in nasal breathing and a sensation of dryness in the nose.
By the 3rd-4th day after surgery, the secretion was clear and transparent. On the following day, before administration of the product, scabs were observed inside the nasal cavity, mainly in the area affected by the surgery. By the 5th-6th day, the rhinoscopic picture was normal.
In the control group, these findings were still observed on the 8th-9th days.
Some case reports are described below:
Maxillary sinus cysts
Patient А, 26 years, under treatment in the Otorhinolaryngology Clinic, with a diagnosis of cysts in the right maxillary sinus. In the clinic, an endoscopic extranasal maxillary microsinusotomy was performed. Upon examining the cavity of the sinus, cysts were detected on the medial and inferior lateral walls, and also an obliteration by scar tissue of the natural opening.
During surgery, the cysts were removed and the lumen of the natural opening was restored. The sinus and middle nasal meatus were not plugged.
On the first day after the operation, the endoscopic examination of the middle nasal meatus revealed the presence of scabs of dried cyst fluid with a characteristic yellowish colour.
From the first day after surgery, the product was administered as monotherapy with one spray daily in each nostril. After administration of the preparation, there was an active drainage and secretion of mucus which also removed the scabs from the lumen of the nasal meatus.
On the third day of administration the product, only a small amount of dried mucus scabs were observed in the lumen of the nasal meatus.
The rhinoscopic picture was normal by the 5th day of administration of the product.
Polypous ethmoiditis
Patient В., 43 years, hospitalised for a polypous ethmoiditis. The endoscopic examination revealed polypous changes of the mucous membrane in the middle nasal meatus which obstructed the lumen and the opening of the maxillary sinus.
An endonasal endoscopic procedure was performed, removing the abnormal tissues, restoring the lumen of the middle nasal meatus and the opening of the maxillary sinus.
After surgery, the middle nasal meatus was plugged. The plug was removed on the following day. On the second day after surgery, the endoscopic examination revealed the presence of a large quantity of dried mucohaemorrhagic secretion in the middle nasal meatus.
The product was administered as monotherapy. After administration, drainage of the mucus began with an abundant bloody secretion that facilitated clearing of the meati.
On the third day after surgery, before administration of the product, oedema of the mucosa and a blood-coloured secretion were observed.
On the third day after surgery, after administration of the product, an abundant blood-coloured secretion was observed.
On the fifth day after surgery, the secretion and oedema of the mucosa membrane was seen to be significantly diminished.
After administration of the product the mucus secretion intensified with a slight blood colour.
By the seventh day, the secretion had disappeared and the nasal meatus was clear.
Polypous ethmoid-maxillary sinusitis
Patient C., 48 years, hospitalised for a polypous ethmoid-maxillary sinusitis.
The endoscopic examination revealed a polyposis in the middle nasal meatus.
An endonasal endoscopic procedure was performed, removing the abnormal tissue and visualising the opening of the maxillary sinus.
The middle nasal meatus was plugged, removing the plugs on the following day.
On the second day after surgery, mucohaemorrhagic scabs were detected in the middle nasal meatus which totally filled it.
After administration of the product, an abundant secretion was observed which facilitated clearing of the nasal meatus.
On the fourth day after surgery, the amount of scabs in the middle nasal meatus was seen to decrease. The product stimulated a reddish-coloured secretion.
On the fourth day after surgery, after administration of the product, a reddish-coloured secretion was observed.
On the sixth day after surgery, the middle nasal meatus was clear of scabs and secretion. The opening of the maxillary sinus was functional.
DISCUSSION
In spite of the progress achieved by endoscopic surgery in recent years in the field of otorhinolaryngology, and above all in the adequate, effective treatment of chronic conditions affecting the paranasal sinuses, to restore drainage and ventilation, there persists a significant percentage of patients in whom a new obstruction appears after surgery. Among other reasons, this is due to the inflammatory congestive process, the tissue oedema and the hyperaemia resulting from the aggression produced by the surgery. Although a number of treatments have been used in the postoperative period to palliate this problem, the results are still not as satisfactory as they should be (Gerber et al 2003; Aukema & Fokkens 2004; Cohen 2006).
The plant extracts studied offer the advantage of naturally stimulating drainage of the secretions from the nasal passages and paranasal sinuses, which will help clear the mucus content accumulated after surgery. The results of our study clearly show that its use is able to facilitate this task in the immediate postoperative period in patients operated for productive rhinosinusitis and maxillary sinus cysts. Indeed, it is not only effective but the effect is seen more quickly than with other alternatives. Thus, the use of natural plant extracts rapidly clears the sinuses and nasal meatus. The rhinoscopic findings become normal between the fifth and sixth day after administration of the product, which is three to four days earlier than when the traditional postoperative care methods are used, such as nasal irrigation. The images included in this study provide a clear example of this new product’s usefulness. Furthermore, its efficacy in other nasal and paranasal pathologies has been shown in other studies (Zasritskaia et al 2006; Khechinashvili et al 2006; Chernisheva & Siniachenko 2006).
One particular feature of its use in the early postoperative period is the relatively low sensitivity of the mucous membrane to this product, which means that patients only feel a slight smarting after administration. When the action finishes, almost all of the patients report a slight nasal dryness. This good tolerability, among other reasons, is to be attributed to the fact that it is a totally natural product.
In conclusion, the results of this study show that use of this new plant extract-based product provides an effective therapy in the early postoperative care of patients after endoscopic surgery of the productive forms of rhinosinusitis.
REFERENCES
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Use in the early postoperative care of patients with productive rhinosinusitis - Abstract
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