Nasal Polyposis Group Research Articles

Anatomical evaluation of sphenoid sinus, foramen rotundum, and vidian canal for ventrolateral skull base surgery: A radiological study

Introduction: We aimed to evaluate the pneumatization of the sphenoid sinus (SS) and configuration of the vidian canal (VC) and foramen rotundum (FR). Materials and Methods: This study was performed on a total of 259 coronal and sagittal computed tomography (CTs) scans that we divided into rhinosinusitis (RS), nasal septum deviation (NSD), nasal polyposis (NP), and control (C) groups. We performed various morphometric measurements on CTs and evaluated the SS pneumatization and the position and protrusion of the FR and VC. Results: The mean age was found to be 42.42 ± 1.28 and 44.06 ± 1.45 in 149 males and 110 females, respectively. Significant differences were found among all morphometric measurements in the right and left side measurements and between genders except for the distance between VC and FR on both sides. The rotundum angle and bilateral VC distance values were found to be high in the NP and NSD groups. There was a difference in the distribution of categorical data between patient groups. We found prevalence of the FR and VC Type I as 3.3% and 13.3%, Type II as 35.5% and 43.65%; Type III as 61.2% and 43.05%, respectively. The position of FR was medial in 45.15%, online in 35.95%, and lateral in 18.9% of cases and SS pneumatization with lateral recess in 41.6%, tangent in 16.7%, and less pneumatized in 41.7% of cases in total. Discussion and Conclusion: Our findings show that the configuration of the structures, which are important anatomical landmarks for ventrolateral skull base surgery, changes in patients with anatomical variations and inflammatory sinonasal diseases.

Evaluation of Advanced Oxidation Protein Products (AOPP) and Superoxide Dismutase (SOD) Tissue Levels in Patients with Nasal Polyps.

The aim of this study is to eveluate levels of advanced oxidation protein products (AOPP) which are thought to increase in the polyp tissue and superoxide dismutase (SOD), an antioxidant enzyme, with using specthrophotometry in polyp tissue and healthy mucosa. 30 nasal polyp patients without inflammatory disease except for nasal polyposis were included in the study. The control group consisted of 18 patients who did not have allergy, asthma, inflammatory and granulomatous disease and planned surgery due to septum deviation and concha hypertrophy. AOPP and SOD tissue levels were measured by spectrophotometry in polyp tissue specimens taken from patients with nasal polyps and concha samples taken from patients in the control group. The mean AOPP tissue level of patients in the nasal polyposis group was statistically significantly higher than the control group. (p < 0.05). The meanSODactivity level was significantly lower in the nasal polyposis group than the control group. (p < 0.05) As a result of this study, high AOPP levels in polyp tissue and low SOD levels in polyp tissue compared to healthy nasal mucosa, oxidative stress plays an important role in nasal polyp development.

Pterygopalatine fossa: a computed tomography analysis and classification

Background Nasal polyposis (NP) is a multifactorial disorder that is correlated with multiple inflammatory, environmental, as well as genetic factors. Moreover, tumor necrosis factor (TNF)‑alpha is regarded as the most prominent pro‑inflammatory cytokine that contributes to the pathogenesis of NP. Multiple polymorphisms of that gene can influence its function. Aim The aim of this study was to detect TNF‑α polymorphism in patients with nasal polypi to determine its contribution to the pathogenesis of nasal polypi in the Egyptian population. Methods This is a case–control study, in which 25 patients with NP as well as 25 healthy participants were included, who attended Ain Shams University hospital. Participants were examined and prepared for the study. Participants were subjected to DNA extraction, and restriction fragment length polymorphism–polymerase chain reaction was administrated to detect polymorphism. The comparison of the genotype frequency distribution and the TNF‑alpha gene alleles with NP was done using χ2 test. Results The results showed a statistically marked difference between the G/G genotype in the two groups (P=0.0001). In addition, the presence of allele A in the patient group and control group was 10 and 1%, respectively, which is statistically significant (P=0.0001). The genotype G/G, A/A, as well as G/A frequency in the NP group was 8, 40, and 52%, and it was 76, 1, and 5% in the control group, respectively. The findings of the present study showed that the polymorphism in TNF‑alpha gene is probably an important NP risk agent in the Egyptian population. The presence of the TNF‑alpha G308A allele in our study was to some extent higher compared with the other populations in other previous studies. Conclusion According to the scientific evidence for G/A 308 polymorphism related to the promoter of TNF‑α gene in Egypt, the genotypic pattern distribution in all regions appears to be the same. Nonetheless, the amount of allele A was higher in the current research than in the control group, in addition to the incidence of the NP‑associated G/A genotype. However, to obtain accurate findings, larger samples are required. Regarding the results of the present study, this polymorphism may be determined as a risk agent for NP susceptibility in relation to the Egyptian population. Keywords: chronic rhinosinusitis, eosinophil cationic protein, intercellular adhesion molecule‑1, nasal polypi.

MiR‑155‑5p downregulation inhibits epithelial‑to‑mesenchymal transition by targeting SIRT1 in human nasal epithelial cells.

Epithelial-to-mesenchymal transition (EMT) in nasal epithelial cells is involved with tissue remodeling of nasal polyps. The present study investigated the molecular mechanisms through which miR-155-5p regulated EMT in chronic rhinosinusitis (CRS). Patients were divided into the following groups: CRSsNP, CRS without nasal polyposis group, CRSwNP, CRS with nasal polyposis and controls. The expression of transforming growth factor (TGF)-β1, EMT markers, sirtuin 1 (SIRT1) and miR-155-5p were determined by western blotting and reverse transcription-quantitative PCR. Cell morphology following TGF-β1 treatment in the presence of miR-155-5p inhibitors or controls was observed under a microscope. Target genes and potential binding sites between miR-155-5p and SIRT1 were predicted by TargetScan and confirmed using dual-luciferase reporter assay. In patients with CRS, the expression levels of E-cadherin were downregulated and the expression levels of TGF-β1, mesenchymal markers and miR-155-5p were upregulated. Additionally, these changes in expression levels were reduced or increased to a greater extent in the CRSwNP group compared with the CRSsNP group. Furthermore, TGF-β1 expression promoted EMT in human nasal epithelial cells (HNEpCs) and upregulated miR-155-5p expression. These effects were reversed by miR-155-5p inhibitors. Additionally, SIRT1 was predicted as a target gene of miR-155-5p. Downregulation of miR-155-5p upregulated epithelial marker expression and downregulated mesenchymal marker expression by regulating SIRT1. Therefore, the downregulation of miR-155-5p inhibited EMT in HNEpCs by targeting SIRT1.

Quality of life after functional endoscopic sinus surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This paper aims to assess improvement in quality of life (QOL) after functional endoscopic sinus surgery through questionnaire sino-nasal outcome test (SNOT)-22.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was conducted on 50 patients in Department of ENT and HNS, SMGS Hospital, GMC Jammu during a time period of July 2017 to September 2019. All the patients with age ≥18 years who failed to respond to medical therapy (3 months) and underwent functional endoscopic sinus surgery (FESS) were included in the study. SNOT-22 questionnaire was used to assess the improvement. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, preoperative SNOT scores were higher (54±8.05) but after FESS they reduced significantly at 1st (16.47±5.51), 3rd (13.86±4.19), 6th months (12.9±8.05) post operatively. Chronic rhinosinusitis (CRS) with nasal polyposis group had greater mean difference of SNOT-22 scores (43.93) between preoperative period and 3 months postoperative period than patients grouped as CRS without nasal polyposis (41.47).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that FESS is the best surgical intervention for chronic rhinosinusitis. It significantly improves the quality of life of patients of chronic rhinosinusitis.&lt;/p&gt;

Montelukast Has no Impact on the Systemic Production of TGFβ-1 in Patients with Nasal Polyposis Associated with Aspirin Intolerance.

Introduction Nasal polyposis is a disease characterized by a mechanical dysfunction of the nasal mucosa, closely related to the unique makeup of its extracellular matrix, which develops as the result of an anomalous tissue remodeling process. Transforming growth factor beta 1 (TGF-β1) is reduced not only in the nasal polypoid tissue, but also in the plasma of aspirin-intolerant patients. These patients exhibit an imbalance in the production of eicosanoids characterized by an increase in leukotrienes. Thus, it is important that the relationship between the production of leukotrienes and TGF-β1 be assessed. Objective To evaluate the effects of the cysteinyl leukotriene (CysLT) receptor antagonist montelukast on the systemic production of TGF-β1 in patients with nasal polyposis, with or without concomitant aspirin intolerance. Methods The sample comprised 48 individuals with diagnosis of nasal polyposis and 15 healthy controls for comparison of the baseline TGF-β1 levels in the peripheral blood and after treatment with CysLT receptor antagonist montelukast in the nasal-polyposis group. Results There was no difference in the change in TGF-β1 levels after the treatment with montelukast in the subgroup of patients with polyposis and asthma ( p = 0.82) and in the subgroup with polyposis, asthma, and aspirin intolerance ( p = 0.51). Conclusion we found no impact of the therapy with a leukotriene receptor blocker on the production of TGF-β1, making the antileukotriene therapy a highly questionable choice for the treatment of nasal polyposis, particularly from the standpoint of seeking to modify the remodeling process in this disease.

Dynamic thiol-disulfide balance in patients with chronic sinusitis with and without nasal polyposis

Aim: Reactive oxygen species (ROS) have a crucial role in the pathogenesis of chronic rhinosinusitis (CRS). The current study investigates a novel oxidative stress marker (thiol (SH)/disulfide (SS) homeostasis) in patients with CRS with and without nasal polyposis (NPs).Materials and Methods: A total of 167 subjects, including 94 patients with CRS and 73 healthy controls, were included in the study. The patients were subdivided into two groups those with CRS with NP and those with CRS without NP. Comparisons were made between the groups in respect of serum native SH, total thiol (TT), and SS levels and the SS/SH and SS/TT ratios. Results: There was no significant difference in TT between the CRS with the NP group and the CRS without the NP group (p> 0.05). There was a significant difference (p 0.05) between the CRS without the NP group and the control group in %SH/TT, %SS/TT, %SS/SH, SS, and SH. A significant difference (p 0.05) was found between the CRS with the NP group and the control group in %SH/TT, %SS/TT, %SS/SH, SS and SH values. Conclusion: Dynamic SH/SS homeostasis shifts towards SS formation as a result of SH oxidation in patients with CRS.

What is the Impact of Positive Airway Pressure in Nasal Polyposis? An Experimental Study.

Introduction It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE—Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE ( p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR ( p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly ( p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened ( p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size ( p = 0.04). Conclusions Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, as measured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.

TNF-alpha G/A308 polymorphism association with nasal polyposis in North part of Iran.

Nasal Polyposis (NP) is a complex multi-factorial disease; associated with several environmental, genetic and inflammatory factors. TNF-alpha is one of the major pro-inflammatory cytokines involved in NP pathogenesis. Some of the polymorphisms of this gene affect its expression. Therefore, the aim of this study was to evaluate the polymorphism of TNF-alpha G/A308 gene and its association with nasal polyposis in north part of Iran. In this case-control study, 60 patients with NP and 75 healthy individuals referred to Guilan University hospital were evaluated. After DNA extraction, RFLP-PCR was used to determine polymorphism. Chi-square test was used to compare the frequency distribution of genotype and alleles of TNF-alpha gene with NP. The frequency of genotype G/G, A/A and G/A in the NP group was 46.7, 10.0 and 43.3%, and in the control group was 65.3, 5.3 and 29.3%, respectively. There was a statistically significant difference between genotype G/G in two groups (P = 0.006, OR 2.58, CI 1.27-5.23). In addition, the frequency of allele A in patients and controls was 31.7 and 20%, respectively; and this difference was statistically significant (p = 0.02). The findings of this study demonstrated that polymorphism in TNF-alpha gene might be a risk factor for NP in north part of Iran and the minor frequency of G308A allele in the current study is slightly more than other major populations. However, more investigations with high number of population are necessary in future.

Electrophysiological assessment of the concentration and attention in patient with nasal polyposis.

BackgroundNasal polyposis is a chronic disease presenting with nasal obstruction as the most frequent complaint. It has been documented that nasal polyposis results in deterioration of quality of life and disturbances of sleep. However, remarkable consequences of nasal polyposis such as psychological and cognitive outcomes are relatively poorly studied.ObjectiveThe aim of the present study was to evaluate whether there is an impairment of concentration and attention in nasal polyposis patients due to hypoxia caused by nasal obstruction.MethodsThis cross-sectional, case-control study was carried out on 30 male patients with nasal polyps and 30 healthy subjects serving as controls. Participant ages were 41.6 ± 10.2 years in the nasal polyps group and 41.3 ± 6.2 in the control group. All participants underwent systemic, neurological, and otorhinolaryngological examinations together with routine hematological and biochemical tests. Patients with nasal polyposis had bilateral complete obstruction of nasal cavity. P300 component of electroencephalography-derived event related potentials were used to monitor concentration and attention. Nasal polyposis and control groups were compared in terms of amplitude and latency of P300.ResultsThere were significant differences between control and nasal polyposis groups in terms of latency of P300 (p < 0.001). Nasal polyposis patient latencies in P300 were longer than controls (345.8 ± 16.6 msec, 309.3 ± 16.6 msec, respectively). However, there were no significant differences between control and nasal polyposis groups in terms of amplitude of P300 (p > 0.05).ConclusionResults of the current study indicate that hypoxia due to complete nasal obstruction may result in impairment of attention and concentration in nasal polyposis patients. Assessment of patients with P300 latency subcomponent can be a useful diagnostic tool to detect cognitive and psychological consequences.

Are neutrophil, platelet and eosinophil-to-lymphocyte ratio and red blood cell distribution width can be used for nasal polyposis?

The aim of this study is to explore the relationship of neutrophil, platelet and eosinophil-to-lymphocyte ratios and red blood cell distribution width values with nasal polyposis, and whether this could be a predictive parameter that can be used for the severity and recurrence risk of the disease. Neutrophil/lymphocyte, platelet/lymphocyte, eosinophil/lymphocyte ratios and red blood cell distribution width values were compared between nasal polyposis patients who were reviewed in a retrospective manner and the control group comparable for age and sex. Moreover, the nasal polyposis group was grouped for nasal polyposis severity and recurrence, and these subgroups were statistically compared, too. When the nasal polyposis patient group and the control group are compared, no statistically significant difference was found between two groups except for eosinophil/lymphocyte ratio. While only the difference between nasal polyposis severity and eosinophil/lymphocyte ratio is statistically significant, there was no parameter with statistically significant difference for recurrence. We think that caution should be exercised when using these new hematological parameters which can be affected by many factors for the presence, severity and recurrence risk of nasal polyposis, and literature data should be proven by conducting different and objective studies on this subject.

Is Nasal Polyposis Related to Levels of Serum Vitamin D and Vitamin D Receptor Gene Expression?

BackgroundNasal polyposis (NP) is the most frequent cause of nasal masses. Despite considerable research on the subject, its etiology has not been fully elucidated, and effective treatment methods have not been developed. Some etiological factors causing low or high expression of genes in genetically predisposed individuals may play a role in the pathogenesis of the disease. The purpose of this study was to assess the relation between levels of vitamin D receptor (VDR) gene expression and serum vitamin D with NP.Material/MethodsThe study included 46 subjects with NP (NP group) and 40 volunteers (control group). Nasal polyp tissue samples were taken from the NP group and nasal mucosa samples were taken from the control group. Levels of VDR gene expression in the tissue samples were assessed using the real-time polymerase chain reaction (RT-PCR) method.ResultsMean serum 25(OH)D levels were 13.38±14.08 ng/ml in the NP group and 10.57±6.44 ng/ml in the control group (p=0.249). VDR gene expression was present in 17.5% of the NP group and 3.3% of the control group, and the difference between the 2 groups was statistically significant (likelihood ratio χ2=3.887; p=0.049).ConclusionsThis is the first study to assess levels of VDR gene expression in subjects with NP. Our results suggest that VDR gene expression may be associated with the pathogenesis or progression of NP.

Food Sensitization in Medically Resistant Chronic Rhinosinusitis with or without Nasal Polyposis

Background: Nasal polyposis is a common nasal mass with unknown etiology. It has been assumed that allergy predisposes to polyp formation. Our objective was to compare the prevalence of food sensitization in medically resistant chronic rhinosinusitis patients with or without nasal polyposis. Methods: One hundred and fifty-five patients who fulfilled the inclusion and exclusion criteria were incorporated into this study. The results of their total serum IgE and food-specific IgE levels were examined. Results: The average age was 33 years (± 13) with 96 males and 59 females. The percentage of patients in each group that had a positive result for at least one tested allergen was 84% (88 patients in the sinusitis without polyposis group and 42 patients in nasal polyposis group). Patients without nasal polyposis reacted to an average of 4.6 foodstuffs, whereas patients with nasal polyposis reacted to 4.1. Egg white, sheefish and cherry were the most common type of sensitized food. There were no significant differences in the prevalence, type, number of positive food allergens and class level between the two groups. Conclusions: Food sensitization is common in medically resistant chronic rhinosinusitis. Since food sensitization prevalence, type and severity do not significantly differ between the two groups studied, food atopy is unlikely to be a major factor in nasal polyposis pathogenesis.

Expression profiling of nasal polyp epithelial cells identifies two distinct phenotypes and suggests a role for neurogenic inflammation

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammation of the nasal mucosa of unknown etiology. As airway epithelial cells have a well-accepted role in the regulation of innate defence and other local inflammatory processes we wanted to explore whether nasal polyp epithelial cells could play a role in the pathophysiology of CRSwNP. Primary epithelial cells were isolated from nasal polyps of 24 affected individuals and from the middle turbinates of 9 healthy controls. After a limited culture period RNA was extracted and the expression profile determined using Human Genome U133 Plus 2.0 Genechip Array (Affymetrix inc., Santa Clara, CA, USA). Supernatants collected from the epithelial cells and immunohistochemistry on biopsies were used for validation. The expression pattern in nasal polyp epithelial cells showed an aberrant expression for 23 genes compared to healthy controls. Furthermore, the expression pattern suggests two distinct epithelial profiles within the nasal polyposis group. Detailed analysis of these two distinct profiles reveals a deregulation of epithelial differentiation markers (KRTADP and CNFN) and of key regulators of neurogenic inflammation (SLURP1, LYNX1, and SLC44A4). Our data identified neurogenic inflammation as a potential novel player in the pathophysiology of CRSwNP and a possible dichrotomy of nasal polyp epithelial cells. The implications of these differences with healthy epithelial cells are not yet fully understood, but merit further investigation.

New predictive parameters of nasal polyposis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio

This study aims to investigate the correlations between nasal polyposis (NP) and NP density with neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The study included 105 patients (72 males, 33 females; mean age 41.33±12.85 years; range 16 to 63 years) diagnosed as NP (NP group) and 83 healthy individuals (54 males, 29 females; mean age 44.01±8.50 years; range 18 to 62 years) (control group). Nasal polyposis density score was calculated with preoperative Lund-Mackay computed tomography grading system. Neutrophil to lymphocyte and PLR ratio values of NP and control groups were calculated and statistically compared. Neutrophil to lymphocyte and PLR values were statistically compared in terms of NP density in the NP group. Mean NLR value was 2.26 in the NP group and 1.75 in the control group with a statistically significant difference (p=0.001). Mean PLR value was 120.79 in the NP group and 109.84 in the control group with a statistically insignificant difference (p=0.073). Neutrophil to lymphocyte ratio value may be used as a novel marker that is easily administered in patients with nasal polyps and obtained with low-cost tests. New studies with larger patient series are needed for the value of PLR.

Investigation of SCGB3A1 (UGRP2) gene arrays in patients with nasal polyposis

The aim of the current study is to investigate the potential relationship between polymorphisms and nasal polyposis (NP) pathogenesis in the SCGB3A1 (UGRP2) gene, which is a member of the secretoglobin gene super family. Genotypic variations were studied by performing DNA sequencing in blood samples of 80 patients with NP and 70 healthy individuals to evaluate nucleotide changes and their positions that might be in the SCGB3A1 gene (promotor, splicing points, and exon distributions). In the SCGB3A1 gene, three single-nucleotide changes labeled IVS1-89 T>G, c. -183 G>T, IVS1-189 G>A were identified. IVS1-89 T>G and IVS1-189 G>A belong to the first intronic region of the gene, whereas c. -183 G>T was observed in the promoter region of the gene. The IVS1-89 T>G nucleotide change was observed in the patient and control groups, whereas c. -183 G>T and IVS1-189 G>A nucleotide changes were observed in the control group only. SCGB3A1 (IVS1-89) genotype frequencies between patients with NP and control group were not significantly different (p = 0.311). There was a statistically significant difference in the control group in comparison to patients with NP in terms of SCGB3A1 (c. -183 GT) and SCGB3A1 (IVS1-189 GA) frequency (p = 0.0045 and p = 0.009, respectively). The findings of the current study suggest that SCGB3A1-183 T and SCGB3A1 IVS1-189 A alleles might have a protective effect against NP, and that SCGB3A1 (-183 GT and IVS1-189 GA) genotypes should be studied in future population-based studies.

Assessment of early atherosclerotic findings in patients with nasal polyposis

To investigate early markers of atherosclerosis in patients with nasal polyposis (NP) through measurements of carotid artery intima-media thickness (CIMT), flow-mediated vasodilatation (FMD) of the brachial artery and serum paraoxonase-1 (PON-1) activity. Forty-five patients with NP were included in the study group and 45 healthy individuals in the control group. The diagnosis of patients with NP was predicated on anterior rhinoscopy, endoscopic nasal examination and coronal paranasal sinus computed tomography (CT). Measurements of CIMT and FMD of the brachial artery were performed by high-resolution ultrasonography. Serum PON-1 activity was evaluated by measuring the rate of paraoxon hydrolysis. Mean CIMT values were found to be increased in the NP group compared to the control group. However, mean FMD % values and serum PON-1 activity were significantly lower in the NP group compared to the control group. Moreover; the endoscopic polyps' scores and paranasal sinus CT scores were positively correlated with CIMT and negatively correlated with FMD % values and PON-1 activity. Disease duration also was positively correlated with CIMT and negatively correlated with FMD % values. Impaired FMD, increased CIMT and decreased serum PON-1 activity may be considered to be risk factors for accelerated atherosclerosis in patients with NP who may have subclinical atherosclerosis and be at risk for cardiovascular events in the future.

Melatonin and cortisol rhythm in patients with extensive nasal polyposis

PurposeExtensive nasal polyposis is an inflammatory disease which effects 1%–4% of normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in ENP have not investigated. Materials and methodsSalivary levels of melatonin and cortisol were measured by radioimmunoassay in 31 patients with extensive nasal polyposis and in 27 control subjects matched for age and gender. In both groups none of the subjects did not have obstructive sleep apnea. ResultsThe baseline and the peak levels of salivary melatonin in the extensive nasal polyposis group were significantly lower than in the control group (p<0.001). However, no differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p>0.05). The highest values of melatonin were recorded at 04:00h in both the study and control groups.The amplitude and the 24h mean levels of salivary cortisol in the extensive nasal polyposis group were significantly lower than in the control group (p<0.001). The acrophase was delayed by about 8h in extensive nasal polyposis patients (p<0.001). ConclusionThe circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with extensive nasal polyposis. These results may be applicable as therapeutic tools in the future and melatonin drugs might be useful in the therapy of nasal polyposis like cortisol drugs.

The Effects of Corticosteroid on Tissue Lactoferrin in Patients with Nasal Polyposis

Although, lactoferrin (LF) is the second most important antimicrobial and anti-inflammatory peptide after lysozyme in upper respiratory tract, little is known about its role in chronic rhinosinusitis (CRS). Recent studies pronounced that LF levels were significantly reduced in CRS with nasal polyposis (NP) compared with other subgroups. However, effects of systemic corticosteroid (CS) treatment, which is currently the main NP treatment modality, and subsequent surgical intervention on LF levels are still not known. This study was designed to evaluate the effects of CS treatment and surgical intervention on LF levels in patients with NP. Patients with inflammatory NP who were scheduled to undergo CS treatment and a control group were included in this study. LF levels were determined from mucosal samples taken from both groups, before and after CS treatment, and also 1 month after surgical intervention. Twenty-seven patients with NP and 14 patients who underwent septoplasty were included in the study. Tissue LF levels were significantly lower in the NP group compared with the control group (p = 0.014). Tissue LF levels did not change significantly in NP patients after CS treatment. However, a significant reduction in tissue LF was detected 1 month after endoscopic sinus surgery. Tissue LF concentrations significantly decreased in patients with NP. CS treatment had no effect on tissue LF levels, whereas postendoscopic sinus surgery, tissue LF levels were getting lower because there was also a reduction in inflammatory load (whether from reduction in mucosa surface area or resolution of disease).

Impact of Nasal Polyposis on Erectile Dysfunction

Our male patients with chronic rhinosinusitis with nasal polyposis (NP) declare a better sexual function after functional endoscopic sinus surgery (FESS) with polypectomy. This study was planned to conduct the first prospective, controlled trial evaluating the possible relation between erectile dysfunction (ED) and NP by subjective and objective parameters. Thirty-three male patients with NP and thirty randomly selected male control subjects were evaluated. All subjects underwent assessments of nasal endoscopy, rhinomanometry, body mass index (BMI), Epworth Sleepiness Scale, full in-laboratory polysomnograpy and serum levels of glucose, thyroid hormones, lipid profile, and testosterone. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF-EF) subjectively and nocturnal penile tumescence (NPT) objectively. The NP group was reassessed 6 months after FESS. The mean age, BMI, and laboratory tests of the patients and the control subjects had no significant difference. The well-recognized risk factors for ED were eliminated. Preoperative evaluation of the patients revealed that ED was present in 34 and 24% of the patients by IIEF-EF and NPT, respectively, which was significantly higher than the control group (p = 0.009 and p = 0.018, respectively). There was a significant improvement of ED in the assessment of IIEF-EF and NPT postoperatively (p = 0.014 and p = 0.037, respectively). ED was determined in a high percentage of patients with NP and significantly ameliorated after FESS. NP might present a risk factor in the development of ED.