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Use of a new plant extract-based product in acute purulent rhinosinusitis
BEZSHAPOCHNY S.
Director of the Otorhinolaryngology Department
of the Ukrainian Academy of Medicine and
Odontology Rhinologist General of the Ukraine
Therapeutics and Clinical Risk Management.
Special Issue in Spanish. Supplement I 2006.
Therapeutics and clinical risk management 2006 - PDF
INTRODUCTION
The acute inflammatory diseases of the nasal cavity and paranasal sinuses (rhinosinusitis) are the diseases that are most commonly seen at otorhinolaryngology offices.
In fact, it is estimated that about 20 million people are diagnosed each year with acute rhinosinusitis in the United States. Furthermore, during periods of massive increase of acute viral respiratory infections and flu epidemics, the incidence of rhinosinusitis increases considerably (Berg et al 1986; Gwaltney 1996; Jackson et al 2006).
The most common type is the inflammation of the maxillary sinuses: maxillary sinusitis.
The obstruction of the drainage orifices from the paranasal sinuses to the nasal passages is the fundamental factor in the development of this type of condition, both by retaining secretions, which foster bacterial growth, and by decreasing oxygen supply, favoring the growth of anaerobic germs (Matiño et al 2003).
Due to this high incidence, acute rhinosinusitis is the cause of a considerable direct health expense and also causes a large number of days off work or school every year (Ober 1998; Ray et al 1999). Therefore, effective treatment of this condition is a current priority in rhinology.
However, in spite of the considerable importance this disease has, the otorhinolaryngologist still sometimes faces difficulties in choosing the most suitable treatment method.
Sometimes, it is necessary to puncture the maxillary sinuses, which many patients find difficult to accept (Matiño et al 2003). Therefore, new alternatives are needed that help relieve the symptoms associated with these conditions and others that reduce the possibility of complications caused by sinusitis and which avoid it progressing to the point where it is necessary to perform techniques such as irrigation of the paranasal sinuses using the displacement method, use of the YAMIK catheter, and a series of non-traditional methods (Shilenkova & Markow 1995; Cohen et al 2000; Michel 2006).
Although, in certain parts of Europe, they have been included for some time in the armamentarium of natural products for the treatment of purulent rhinosinusitis, it has not been until recent years that various plant extracts have used to a sufficiently extensive degree in the field of otorhinolaryngology. These plant extracts activate the physiological cleansing and drainage mechanisms in the nasal cavity, facilitating natural secretion in the paranasal sinuses, thereby clearing the purulent matter accumulated in the sinuses (Zasritskaia et al 2006; Khechinashvili et al 2006; Chernisheva & Siniachenko 2006).
A study was performed to assess this product’s efficacy in patients with acute purulent rhinosinusitis.
PATIENTS AND METHODS
A total of 28 patients with a diagnosis of acute purulent rhinosinusitis were included in this study. The study was performed between 17.06.04 and 20.07.04, at the AMOU’s Department of Otorhinolaryngology, in the city of Poltava.
In all cases, the diagnosis had been established from the results of the general clinical examinations, the optical endoscopy of the nasal cavity and nasopharynx, the data obtained from the X-ray studies.
In some patients, the results of a CAT, NMR, contrast X-ray of the paranasal sinuses and a diagnostic sinuscopy were considered. The latter examination (in two patients) was necessary to rule out a cystic or polypous process in the maxillary sinuses (which are contraindications for use of the product).
Each patient underwent a single irrigation of the nasal cavity in the mornings. All of the objective and subjective (patient sensation) responses to the administration were carefully analyzed. In order to visualize the endoscopic data, it was performed as photoendoscopy and videoendoscopy in all patients.
RESULTS
A total of 28 patients diagnosed with acute rhinosinusitis were included.
2-3 minutes after administration in the nasal cavity, the patients started to experience abundant rhinorrhoea with secretion of mucus and pus. This secretion continued for 2 - 3 hours.
After the rhinorrhoea had stopped, most patients noted symptom relief and improvement in the nasal congestion and in the difficulty in breathing through the nose. They also reported disappearance of the sensation of heaviness in the projection area of the paranasal sinuses and reduced severity of the headaches.
The study of the subjective and objective data showed that, after only 3 days of treatment, the symptoms associated with nasal congestion, the headaches and the sensation of heaviness in the area of the paranasal sinuses had disappeared in most patients (21).
Normalization of the rhinoscopic picture was observed after 7 days of treatment.
The patients reported that, at some time, they suffered a brief bout of sneezing that did not cause any significant discomfort and which they tolerated well.
There follows an example of the product’s action in the patients included in our sample, together with the endoscopic images.
Patient A, 56 years old, received outpatient treatment at the AMOU’s otorhinolaryngology clinic, in Poltava, from 08.07.04 to 17.07.04, with a diagnosis of: acute, purulent, right-sided maxillary sinusitis. The product was administered daily as a monotherapy for 6 days.
Before administration of product, the patient showed hyperemic nasal mucosa, with moderate mucopurulent secretion in the middle nasal meatus (Figure 1).
The diagnostic sinuscopy performed on the day prior to administration of the treatment confirmed the presence of a large quantity of purulent viscous secretion at the bottom of the sinus and on its walls (Figure 2).
FIGURE 1. HYPERAEMIA AND OEDEMA OF THE NASAL
MUCOSA IN THE REGION OF THE MIDDLE NASAL MEATUS
(BEFORE TREATMENT)
FIGURE 2. ACCUMULATION OF PURULENT EXUDATE
IN THE MAXILLARY SINUS (BEFORE TREATMENT)
First day. Just 3 minutes after spraying in the nasal cavity, there was an abundant secretion of mucus in all sections of the nasal cavity, but particularly in the area of the osteomeatal complex (Figure 3).
About 10 minutes later, the mucus secretion was accompanied by growing quantities of a purulent secretion. This process was accompanied by sneezing, during which a large quantity of mucopurulent substance was expelled (Figure 4).
The purulent secretion appeared as a narrow strip in the middle of the mucus band. The secretion of purulent material from the sinus was varying, alternately increasing and decreasing (Figure 5).
Three hours after administration, the nature of the substance secreted changes, becoming mainly mucus. The pulsatile secretion of mucus decreases (Figure 6).
FIGURE 3. ABUNDANT SECRETION OF TRANSPARENT
MUCUS 5 MINUTES AFTER ADMINISTRATION.
FIGURE 4. PURULENT SECRETION IN THE REGION
OF THE MIDDLE NASAL MEATUS (15 MINUTES
AFTER THE FIRST ADMINISTRATION).
FIGURE 5. INTENSIFICATION OF PUS SECRETION
(30 MINUTES AFTER STARTING ADMINISTRATION
OF THE PREPARATION).
FIGURE 6. AFTER 2 HOURS, THE MUCUS SECRETION
DIMINISHES AND THE PURULENT EXUDATE
DISSAPEARS.
Third day. A reduction in the hyperemia of the nasal cavity mucous membranes is observed (Figure 7), but without accumulation of purulent exudate, except moderately in the area of the sinus’s drainage orifice (Figure 8).
A band of pus is observed in the middle nasal meatus (Figure 9).
Figure 10 shows the mucosa 1 minute after administration of the product in the nasal cavity. Five minutes after administration of the preparation, the entire mucous membrane is covered with a thick layer of transparent mucus (Figure 11); the quantity of mucus secreted has diminished (Figure 12).
After 20 minutes, mucus and pus secretion is observed from the area of the osteomeatal complex (Figure 13).
The mucus secretion is accompanied by a marked pulsatile reflex (Figure 14); pus secretion is intermittent (Figure 15).
This process continues for about 1 hour. The quantity of mucopurulent secretion decreases, being gradually replaced by the secretion of mucus only (Figure 16). The pulsatile secretion continues for several hours (Figure 17).
The exudate consists entirely of mucus (Figure 18).
FIGURE 7. DECREASED HYPERAEMIA OF THE NASAL
MUCOSA AND PRESENCE OF PURULENT EXUDATE IN
THE MIDDLE NASAL MEATUS.
FIGURE 8. 10 MINUTES AFTER ADMINISTRATION,
AN INTENSE SECRETION OF PURULENT EXUDATE
IS OBSERVED IN THE MIDDLE NASAL MEATUS.
FIGURE 9. AFTER 1 HOUR, THE SECRETION IS
MOSTLY MUCOPURULENT.
FIGURE 10. AFTER 2 HOURS, ISOLATED PUS
PARTICLES ARE OBSERVED AMONG THE
ABUNDANT MUCUS SECRETION.
FIGURE 11. AFTER 3 HOURS, THE SECRETIONS
CONSIST MOSTLY OF MUCUS.
FIGURE 12. AFTER 3 HOURS, A MUCOPURULENT
SECRETION IS OBSERVED IN THE MIDDLE
NASAL MEATUS.
FIGURE 13. AFTER 3.5 HOURS, PERIODIC
INTENSIFICATION OF THE PUS SECRETION
IN THE MIDDLE NASAL MEATUS IS OBSERVED.
FIGURE 14. AFTER 5 HOURS, PUS SECRETION
STOPS.
FIGURE 15. AFTER 10 MINUTES: ABUNDANT MUCUS
SECRETION IN THE MIDDLE NASAL MEATUS;
THE PRESENCE OF PUS PARTICLES CAN BE SEEN.
FIGURE 16. AFTER 1 HOUR: ABUNDANT SECRETION
OF TRANSPARENT MUCUS.
FIGURE 17. AFTER 2 HOURS (AFTER ASPIRATION
OF THE MUCUS): NO SIGNS OF PUS.
FIGURE 18. AFTER 3 HOURS: TRANSPARENT MUCUS
IN THE COMMON NASAL MEATUS.
Fifth day of treatment. Secretion of large quantities of mucus is still observed, but without any purulent components (Figure 19); however, the pulsations diminish slightly (Figure 20).
An activation of the mucociliary clearance processes is observed as a result of the use of the product.
FIGURE 19. AFTER 4 HOURS: TRANSPARENT MUCUS
IN THE MIDDLE NASAL MEATUS.
FIGURE 20. SINUSCOPY. AFTER 5 HOURS:
SECRETION OF TRANSPARENT MUCUS THROUGH
THE SINUS’ DRAINAGE ORIFICE (PRESENCE OF
BLOOD IN THE SECRETION).
DISCUSSION
Our results confirm the benefit provided by the use of plant extracts in the drainage of secretions in acute rhinosinusitis. These results have been confirmed in other studies performed on sinus diseases and in post-surgical care (Zasritskaia et al 2006; Khechinashvili et al 2006; Chernisheva & Siniachenko 2006).
An early sufficient treatment of acute rhinosinusitis significant reduces the need to use antibiotics. This will lead to a decrease both in costs and in the possibility of side effects appearing (Torralba et al 2006).
In addition, studies that analyze the usefulness of antibiotics in acute sinusitis have given inconsistent results, possibly due to the inclusion of patients with viral rhinosinusitis. Indeed, as some recommendations indicate, they should not be used when it is suspected that the aetiology is viral (mild-moderate rhinosinusitis, lasting less than 7 days, without fever or persistent headache) (Engels et al 2000; Piccirillo et al 2004).
As regards the patient’s symptoms, including nasal congestion, it is important to facilitate rapid drainage of the accumulated mucus.
The use of this new plant extract-based product is a significant improvement as it is able to act on the problem’s cause, facilitating rapid and effective drainage of the accumulated mucus, accompanied by symptom relief in more than 90% of the cases.
In addition, by acting locally (it is not absorbed through the tissues into the bloodstream), it does not cause significant side effects.
Some mild associated effects may appear (smarting, sneezing) which do not require stopping treatment. On the other hand, being a natural product, it has no irritant or toxic effects and allergies to the product are unlikely to occur.
In conclusion, the use of plant extracts is an effective, rapid and safe alternative.
REFERENCES
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Use of a new plant extract-based product in acute purulent rhinosinusitis - Abstract
Therapeutics and clinical risk management 2006 - Index
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