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.