Cyclamen europaeum improves the effect of oral antibiotics on exacerbations and recurrences of chronic rhinosinusitis: a real-life observational study (CHRONOS)

SUMMARY

Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinuses affecting 11% of the European population. Cyclamen europaeum plant extract (CE) has demonstrated efficacy in treating acute rhinosinusitis, but its role in CRS exacerbations remains unknown. In this real-life, prospective, epidemiological, observational study, a total of 317 patients with exacerbations of CRS without nasal polyps (CRSsNP) of moderate severity were treated using three different options: oral antibiotics, CE extract nasal spray, or the combination of oral antibiotic with CE extract. The main outcomes were the effect of treatment on sinonasal symptoms and endoscopic appearance after 6 weeks of therapy, and the number of recurrences of CRS exacerbations after 6 months of follow-up. On the top of oral antibiotics, CE extract significantly improved sinonasal symptoms and endoscopic findings and caused a 4-fold reduction of CRS recurrences. When administered in monotherapy, CE extract was at least as effective as antibiotic in monotherapy on relief of both symptoms and reduction of CRS recurrences. In patients with CRS exacerbation of moderate severity, CE extract nasal spray in monotherapy or added to standard antibiotic treatment significantly reduces sinonasal symptoms and CRS recurrences compared to antibiotics in monotherapy.

The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis

AIM

This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.

METHODOLOGY

112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture.

RESULTS

A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively.

CONCLUSIONS

The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

[Chronic rhinosinusitis: epidemiology, classification, etiology, and pathogenesis. The current view of the problem]

The study of chronic rhinosinusitis is a challenging problem bearing in mind the ever-increasing morbidity and the lack of generally accepted criteria for diagnostics and treatment of this pathology. There is a great variety of factors predisposing to the development of chronic rhinosinusitis whereas its etiology remains controversial. Moreover, the pathogenetic mechanisms of chronic rhinosinusitis remain to be elucidated despite a wealth of publications devoted to this problem The results of many evidence-based investigations are different and even conflicting. Both diagnostic techniques and characteristics of chronic rhinosinusitis vary in a broad range depending on the standards adopted in different countries.

[Avelox efficacy in the treatment of acute purulent rhinosinusitis]

AIM

To compare efficacy of avelox systemic antibiotic therapy with and without maxillary puncture in acute purulent rhinosinusitis (ARS).

MATERIAL AND METHODS

A total of 40 ARS patients were divided into two groups: puncture was not made in 20 patients of the study group and was made in 20 patients of the control group. Subjective assessment of rhinosinusitis symptoms was made by visual scale Kennedy-Lund, objective assessment was made by x-ray or CT findings.

RESULTS

A clinical response was observed in all 40 patients. Complications or side effects associated with avelox administration were not registered. Regress of rhinosinusitis symptoms did not significantly differ between the controls and test patients. The roentgenographic picture did not differ significantly, CT showed that the response came faster without puncture.

CONCLUSION

Systemic antibiotic therapy of uncomplicated purulent rhinosinusitis with avelox is not inferior by efficacy to the standard puncture treatment.

[Maxillary puncture: endoscopic assessment]

Frequency of the injury of the nasolacrimal duct ostium during maxillary puncture through the lower nasal passage was estimated endoscopically. Changes in the maxillary medial wall during the puncture were also studied. Anatomic features of the ostiomeatal complex which may contribute to development of chronic inflammation were determined. Forty one sinuses of 27 deceased middle-aged patients were examined within 24 hours after death. One third of patients in a random population had chronic maxillary inflammation caused by structural anomalies in the ostiomeatal complex. Half of the punctures were made with severe traumas of the nasolacrimal duct ostium. Natural anastomosis of the sinus did not function in about 20% cases. Accessory anastomosis in the posterior fontanelle was registered in 12.2% cases. The posterior fontanelle broke during sinus lavage in 3 cases. Indications for maxillary puncture in acute and chronic maxillary sinusitis should be considered much more carefully in the presence of stable alterations in the ostiomeatal complex and block of the natural anastomosis.

[Prophylaxis of postoperative venous thrombo-embolic complications in patients operated on for tumors of kidneys, bladder and for benign hyperplasia of prostate]

Results of treatment of 725 patients, to whom operative interventions were performed for various diseases of urogenital system, were analyzed. The patients were separated on groups depending on the stage of incidence of the thromboembolic complications (THEC) occurrence. Application of fraxiparine had promoted the significant reduction of the THEC occurrence. Its wide application for the THEC prophylaxis is recommended.