Recurrence Of Nasal Polyposis Research Articles

Nasal polyp antibody-secreting cells display proliferation signature in aspirin-exacerbated respiratory disease

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) causes nasal obstruction and olfactory dysfunction. Aspirin-exacerbated respiratory disease (AERD) is the triad of CRSwNP, asthma and respiratory reactions to cyclooxygenase-1 inhibitors. Patients with AERD have elevated nasal IL-5 levels and high numbers of antibody secreting cells (ASCs), plasma cells (PCs) and plasmablasts, in their polyp tissue, and nasal polyp IgE levels correlate with disease severity and recurrence of nasal polyposis. ObjectiveWe sought to explore differences in the transcriptomic profile, activation markers, and IL-5Rα expression and function of nasal polyp ASCs from patients with AERD and CRSwNP. MethodsNasal polyp tissue was collected from patients with AERD and CRSwNP and digested into single-cell suspensions. Nasal polyp cells were analyzed for protein expression by mass cytometry. For IL-5Rα functional studies, plasma cells were purified and cultured in vitro with/without IL-5 and analyzed by bulk RNA-sequencing. ResultsAERD polyp tissue contained significantly more ASCs and had increased ASC expression of IL-5Rα compared to CRSwNP. AERD ASCs expressed higher protein levels of B cell activation and regulatory markers (CD40, CD19, CD32, and CD38) and the proliferation marker Ki-67. AERD ASCs also expressed more IL5RA, IGHE, and cell cycle and proliferation-related transcripts (CCND2, MKI67, CDC25A and CDC25B) compared to CRSwNP. Stimulation of AERD PCs with IL-5 induced key cell cycle genes (CCND2 and PTP4A3), whereas IL-5 stimulation of ASCs from CRSwNP induced few transcriptomic changes. ConclusionNasal polyp tissue ASCs from patients with AERD express higher levels of functional IL-5Rα and markers associated with cell cycling and proliferation compared to those from aspirin-tolerant CRSwNP patients.

The subjective and objective outcomes of endoscopic sinus surgery for nasal polyposis using microdebrider versus conventional instruments: a randomized controlled trial

BackgroundSince the evolution of the microdebrider technology and its modulations to be suitable for rhinology, many attempts were carried out to replace the conventional instruments with microdebrider especially in cases of nasal polyposis. Also, many studies were conducted to compare the efficacy of both tools in functional endoscopic sinus surgery. Those studies focused on objective outcomes as the duration of surgery and the amount of blood loss.Aim of the studyComparing the efficacy of microdebrider in cases of resistant chronic rhinosinusitis with nasal polyposis to conventional instruments. Analysis of subjective outcomes is mainly the quality of life of our patients, and not neglecting the objective outcomes but analyzing them thoroughly.MethodThis is a randomized controlled clinical trial, conducted on 100 patients which were diagnosed to have resistant chronic rhinosinusitis with polyposis. We used the microdebrider in functional endoscopic sinus surgery for 50 patients and conventional instruments for the other 50 cases. We compared the operative time, amount of blood loss, and postoperative improvement of quality of life, the presence of adhesions, crustations, and complications, or recurrence of nasal polyposis in both groups.ResultsWe found significant differences in favor of microdebrider mainly in the duration of surgery and the amount of blood loss. Patient satisfaction was better in the microdebrider group, especially in the short-term follow-up, while the postoperative clinical scores were better in the long run.ConclusionUsing the microdebrider in dealing with nasal polyposis is much preferable to conventional instruments. For patients, they feel much better in a shorter duration postoperatively. For surgeons, the manipulations are easier, and the operative field is bloodless and clear.

Economic Burden Associated With Nasal Polyposis Recurrence Among Commercially Insured Patients in the United States.

To compare health care resource utilization (HRU) and costs among commercially insured patients with nasal polyposis (NP) with and without recurrence after endoscopic sinus surgery (ESS). Retrospective matched cohort study. Adults with initial ESS or an NP excision after a new NP diagnosis were identified in Optum's Clinformatics Data Mart Database (October 1, 2014-December 31, 2019). The index date was the date of NP recurrence, identified with a claims-based algorithm for the recurrent cohort, or a random date for the nonrecurrent cohort. Patients in both cohorts were matched 1:1 on baseline characteristics (12 months preindex) via propensity scores and exact matching factors. Annual HRU and costs (2019 US$) were compared between the matched cohorts at 12 months postindex. NP recurrence was identified among 3343 of 16,693 patients with initial ESS; after matching, each cohort comprised 1574 patients (median age, 54 years; 40% female) with similar baseline health care costs (recurrent, $34,420; nonrecurrent, $33,737). At 12 months postindex, the recurrent cohort had higher HRU, including 36% and 51% more outpatient and emergency department visits, respectively (all P < .01). Mean health care costs were $9676 higher in the recurrent cohort ($24,039) relative to the nonrecurrent cohort ($14,363, P < .01). The mean cost difference between cohorts was driven by $8211 in additional outpatient costs, as well as $6062 in additional NP-related outpatient costs, in the recurrent cohort (all P < .01). NP recurrence is associated with a substantial economic burden, which appears to be driven by outpatient services.

Sex and age-related differences in chronic rhinosinusitis with nasal polyps electing ESS

PurposeSex and age of patients are variables affecting across the board all chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes. The main aim of this investigation was to compare the clinical, laboratory, pathological and prognostic characteristics of CRSwNP in male vs female patients stratified according to age (young-adult [20 years ≤ age ≤ 40 years], and elderly [age ≥ 65 years]). This is the first study that analyzed the association of the above-mentioned features with age and sex combination in CRSwNP electing endoscopic sinus surgery (ESS). Materials and methodsOne hundred and five consecutive young-adult patients (62 males and 43 females) and 67 elderly patients (44 males and 23 females) with CRSwNP who had undergone ESS were enrolled. ResultsThe recurrence rate resulted associated with the age and sex combination (p = 0.0165). Young-adult males' recurrence rate (29.0%) was higher than young-adult females (11.6%) and elderly males (4.5%). Allergy resulted associated with age and sex combination (p = 0.0158). Young-adult males' allergy rate (50.0%) was higher than elderly males' (29.5%) and elderly females' (13%). Moreover, allergy rate was higher in young-adult females (41.9%) than in elderly females. ConclusionOur data suggest the possibility of an interaction between sex and age in the recurrence of nasal polyposis after ESS. More studies are needed to understand the role of sex hormones in pathogenesis and prognosis of CRSwNP.

Predictors of sinonasal disease onset, progression, and severity in pediatric cystic fibrosis patients

PurposePediatric cystic fibrosis (CF) patients have a variable onset, severity, and progression of sinonasal disease. The objective of this study was to identify genotypic and phenotypic factors associated with CF that are predictive of sinonasal disease, recurrent nasal polyposis, and failure to respond to standard treatment. MethodsA retrospective case series was conducted of 30 pediatric patients with CF chronic rhinosinusitis with and without polyps. Patient specific mutations were divided by class and categorized into high risk (Class I-III) and low risk (Class IV-V). Severity of pulmonary and pancreatic manifestations of CF, number of sinus surgeries, nasal polyposis and recurrence, age at presentation to Otolaryngology, and Pediatric Sinonasal Symptom Survey (SN-5)/Sinonasal Outcome Test (SNOT-22) scores were examined. Results27/30 patients (90%) had high risk mutations (Class I-III). 21/30 (70.0%) patients had nasal polyposis and 10/30 (33.3%) had recurrent nasal polyposis. Dependence on pancreatic enzymes (23/27, 85.2% vs 0/3, 0.0%, p = 0.009) and worse forced expiratory volumes (FEV1%) (mean 79, SD 15 vs mean 105, SD 12, p = 0.009) were more common in patients with high risk mutations. Insulin-dependence was more common in those with recurrent polyposis (5/10, 50% vs 2/20, 10%, p = 0.026). There was no statistical difference in ages at presentation, first polyps, or sinus surgery, or in polyposis presence, recurrence, or extent of sinus surgery based on high risk vs. low risk classification. ConclusionCF-related diabetes was associated with nasal polyposis recurrence. Patients with more severe extra-pulmonary manifestations of CF may also be at increased risk of sinonasal disease.

Aetiology and Findings of Recurrent Chronic Rhino Sinusitis with Nasal Polyposis after Functional Endoscopic Sinus Surgery

Background: Nasal polyps are the edematous sinonasal mucosa prolapsing into the nasal cavity. Allergy,asthma, aspirin intolerance and fungal rhinosinusitis have been implicated in various studies. Recurrenceof nasal polyposis after functional endoscopic sinus surgery is prevalent but there are no specific causes forrecurrence. Intensity of relapse varies depending on multiple factors that implicated in showing charactersand findings of the recurrence.Objective: To evaluate causes of nasal polyposis recurrence after FESS.Patients and method: 30 adult patients age between 18 and 60 years (with recurrent nasal polyposis afterFESS) were studied in the period between March 2017 and September 2018. Assessment done for allpatients by taking Medical history, documented data from the primary surgery, rhinoscopy with CT-scanexamination.Results: In this study, most of nasal polyp recurrence occur in 1-3 years after primary surgery, patients usingpost-operative steroid showed delay in recurrence, post-operative antibiotic showed no effect on time ofrecurrence,patients with (asthma, allergy, aspirin sensitivity and allergic fungal rhinosinusitis) showed highlund-kennedy and lund-mackay scores and some patients had anatomical findings mainly (40% incompleteanterior ethoidectomy).Conclusions: Recurrence of nasal polyposis could occur at any age mainly in middle age group and malegender showed higher prevalence. Asthma, aspirin sensitivity (Samter’s tried) and allergic fungal sinusitiswere the most important associated diseases. CT-scan showed some anatomical variations like incompleteanterior and posterior ethmoidectomy which occupying the highest percentages. Post-operative steroidshowed delay in time of recurrence.

AERD Associated Nasal Polyposis: Efficacy of Postoperative Antileukotriene Therapy in Comparison with Aspirin Desensitization. A Retrospective Study

Introduction: AERD (aspirin-exacerbated respiratory disease) is a severe form of an inflammatory disease of the upper airway system. Therapy remains challenging due to a complex underlying pathophysiology. Objective: To evaluate the efficacy of postoperative antileukotriene therapy concerning recurrence of nasal polyposis in patients with AERD and to compare it with AD (aspirin desensitization) over time. Methods: In this retrospective study we analyzed AERD patients (N = 61) after functional endoscopic sinus surgery (FESS). Patients were treated at our institution postoperatively with topical mometasone (control group, N = 22), leukotriene-receptor-antagonists (montelukast [MT], N = 18) or underwent an aspirin desensitization (N = 21). Subjective parameters as assessed by SNOT (sinonasal outcome test) questionnaire and endoscopic endonasal examination (polyposis grading) were evaluated throughout a follow-up period of 6–9 and >12 (long-term) months after surgery. Results: Endoscopic endonasal examinations 6–9 months after sinus surgery showed a good disease control in all 3 groups with significant reduction in polyp grading in the AD group. After a follow-up period of more than 12 months, MT and AD patients had significantly less polyp recurrences as compared to the topical treatment group. Subjective sinonasal symptoms revealed that hyposmia and nasal obstruction were prominent factors in all 3 groups throughout the follow-up period. MT group showed significant improvement in sinonasal symptoms over time. Conclusion: Postoperative treatment with leukotriene-receptor-antagonists and aspirin desensitization both significantly reduce nasal polyp recurrence. MT has a positive effect on subjective sinonasal outcomes and patients’ quality of life over time.

Effects of Vitamin D Supplementation on Recurrence of Nasal Polyposis after Endoscopic Sinus Surgery.

Introduction:Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a relatively common disease with serious impacts on patient quality of life. Recurrence of polyps after functional endoscopic sinus surgery (FESS) is a dilemma. Vitamin D3 (VD3) is known to inhibit the proliferation of nasal polyp-derived fibroblasts. The present study aimed to investigate the effects of oral VD3 on the recurrence of polyposis after FESS. Materials and Methods:This triple-blind placebo-controlled clinical trial was conducted on 40 patients with CRSwNP who did not respond to medical treatment and were candidates for FESS. In addition, the patients had VD3 insufficiency. Following the surgery, all the patients received routine treatment (i.e., fluticasone spray, irrigation, cefixime 400 mg daily for 10 days, and montelukast for a month). Moreover, the case group received oral VD3 tablets 4000 IU (single daily dose) for a month, and the control group received placebo in the same manner. The Sino-Nasal Outcome Test (SNOT-22) and Meltzer endoscopic grading scores were recorded at months 1, 3, and 6 after the study. Results:In this study, 6 months following the intervention, the severity of polyposis was reported to be significantly lower in the VD3 group compared to the placebo group based on SNOT-22 (16.25±10.16 in the VD3 group vs. 47.45±13.55 in the placebo group; P<0.001) and Meltzer scores (0.50±0.60 in the VD3 group vs. 2.65±0.93 in the placebo group; P<0.001). No adverse effects were observed in the case group. Conclusion:This study showed the efficacy and safety of vitamin D supplementation in the reduction of polyposis recurrence after FESS in patients with CRSwNP.

Salicylate Food Intolerance and Aspirin Hypersensitivity in Nasal Polyposis.

A clear association between allergy and nasal polyposis (NP) is not determined and the role of food intolerance in patients with NP is not investigated by oral food challenge (OFC). To investigate the relation of salicylate food intolerance and atopy in patients with NP according to recurrence and aspirin sensitivity. A cross sectional multicenter study was done in two tertiary centers for allergy in Iran. Adult patients with NP were selected for the study that had been referred to allergy clinics. The oral aspirin challenge (OAC) test was performed to identify aspirin exacerbated respiratory disease (AERD) and the OFC test was used to investigate food intolerance. Atopic evaluation was performed by skin-prick tests, nasal smear and blood eosinophil count as well as serum total IgE. One hundred and nineteen Iranian patients (female to male ratio 1.05) with NP were enrolled (mean age, 38 ± 11 years). Recurrence of nasal polyposis was 64.7%. OAC was performed in all cases; 43.79% cases had aspirin hypersensitivity. In addition, OFC tests determined that 69.9% of patients had salicylate food allergy. Salicylate food intolerance was significantly higher in NP cases with AERD than in aspirin tolerant patients (p<0.05). Yet, positive skin prick test was not associated with NP recurrence and AERD. Atopy and NSAID exacerbated respiratory disease; therefore, they can both be considered as predictors of NP recurrence. Our study also showed that salicylate food intolerance was associated with AERD in nasal polyposis.

Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disease process that is driven, in part, by intrinsic mucosal inflammation. Surgery plus continued medical therapy is commonly elected by medically recalcitrant, symptomatic patients. The objective was to evaluate the prevalence of nasal polyp recurrence up to 18 months after endoscopic sinus surgery (ESS) with congruent continuing medical management. Prospective, multicenter cohort of adult patients undergoing ESS for medically recalcitrant CRSwNP performed between August 2004 and February 2015. All patients received baseline nasal endoscopy quantified using Lund-Kennedy grading. All patients included for final analysis provided at least 6 months of postoperative endoscopy examinations. Multivariate analysis was used to identify risk factors for polyp recurrence. Three hundred sixty-three CRSwNP patients having undergone ESS involving polypectomy were enrolled. A total of 244 (67%) participants had graded postoperative endoscopies with average of follow-up of 14.3 ± 7.0 months. Surgery plus postoperative medical management significantly improved endoscopy total scores at 6 months (P < .001). The recurrence of nasal polyposis 6 months after ESS was 35% (68/197), compared to 38% (48/125) after 12 months, and 40% (52/129) after 18 months. Multivariate analysis identified both prior ESS (odds ratio [OR]: 2.6, 95% confidence interval [CI]: 1.5-4.6; P = .001) and worse preoperative polyposis severity (OR: 1.4, 95% CI: 1.1-1.8; P = .016) as risk factors for recurrent polyposis. Polyp recurrence is common after ESS with control of polyps up to 18 months found in approximately 60% to 70% of patients. Investigation into both surgical and medical management strategies is warranted to improve upon the observed prevalence of recurrence. 2c. Laryngoscope, 127:550-555, 2017.

Adhesion Molecules as Predictors of Nasal Polyposis Recurrence

Nasal polyposis is a chronic inflammation of nasal and paranasal sinuses in the pathogenesis of which adhesion molecules may have a significant role. This study investigates the possible role of certain adhesion molecules, mucins, and oncogenes in nasal polyposis recurrence. A sample study of 21 individuals (17 men and 4 women) aged 47.44 ± 15.10 years with nasal polyposis who had undergone nasal surgery twice was used. Twenty-one individuals aged 46.9 ± 12.8 years suffering from nasal polyposis who had undergone surgery only once in the same period were used as a control sample. Statistically significant differences between the two groups were observed regarding epithelial membrane antigen (EMA/mucin 1) of stromal cells (p < 0.001) and CD86 stromal expression (p = 0.009). No patient of the control group exhibited high (++) CD86 stromal expression, whereas six patients of the resurgery group did so. When EMA and CD86 were included in a logistic regression model, stromal EMA was found to be positively related to recurrence. Adhesion molecules may relate to nasal polyp prognosis and recurrence rates.

A Prospective Study of Role of FESS in Management of Recurrent Nasal Polyposis

Objectives: Nasal Polyps are the most frequent and very prevalent nasal masses, which the otorhinolaryngologists come across. The uncertain etiologies of this condition have contributed greatly to a wide range of treatment, none of which has been uniformly successful or universally accepted. Hence, this literature looks at the various causes of recurrence of nasal polyposis and also compares the efficacy of conventional and endoscopic endonasal polypectomy in terms of safety, recurrence and postoperative morbidity. Materials and method: The present study was conducted in the Department of Otorhinolaryngology in Vydehi Institute of Medical Sciences and Research Centre from April 2009 to March 2011. Data for this study was collected. All clinically confirmed cases of recurrent nasal polyposis Cases selected were subjected to a complete examination according to the defined proforma. Detailed history was taken and clinical examination done. Acute infections were treated on medical line and then taken up for surgery. All patients received a course of antibiotics starting one day prior to surgery. The patients were treated either by conventional polypectomy or Functional Endoscopic Sinus Surgery (FESS).The patients were discharged when fit and were strictly called for follow-up on the first week, third week, 2nd month, 4th month, 6th month and 1 year from date of surgery. Results: Fifty cases having nasal polyposis were selected and subjected to surgical management. The cases were divided into 2 groups. The first 25 cases were identified as Group-1 and were subjected to surgical management using conventional polypectomy. Similarly, the next 25 cases were identified as Group-2 and were subjected to surgical management using Functional Endoscopic Sinus Surgery (FESS). The salient observations of this study are as follows: 1. Age: The age of the patients ranged from 6-65 years with a mean age of 31.5 years. In case of antrochoanal polyp, the average age was 20 years. 2. Sex: A male preponderance is seen with a male: female ratio of 2.57:1. 3. Complaints: Majority of the patients presented with complaints of nasal obstruction and nasal discharge, followed by headache, sneezing, anosmia and postnasal drip. 4. Diagnosis: Out of 50 cases, 31 patients presented with Ethmoidal polyp and 19 patients presented Antrochoanal polyp. 5. Complications: Bleeding (<50 ml), was the most common intraoperative and postoperative complication. 6. Recurrence: Recurrence was seen in 36% cases with conventional polypectomy and 12% cases with functional endoscopic sinus surgery (FESS), which indicates low recurrence in case of patients who underwent FESS. Conclusion: Nasal polyposis is a prevalent disease and is known for its recurrence. Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. Functional endoscopic sinus surgery revolutionized the management of chronic inflammatory sinus diseases. In nasal polyposis, there is no doubt that the polypoidal mucosa needs to be completely removed to prevent recurrence. Endoscopic technique can help achieve this goal and also preserve the healthy mucosa and its physiological function of mucociliary mechanism. Also, patients usually experience only minimal discomfort. Functional endoscopic sinus surgery has better success rates than conventional polypectomy and is less traumatic to the patients. The complication rate for this procedure is lower than that for conventional sinus surgery.

Analysis of the Roles of Smoking and Allergy in Nasal Polyposis

Recent studies on the etiopathogenesis of nasal polyps have shown that smoking and nonallergenic inhalants such as occupational dust exposure cause chronic inflammation of the nasal mucosa. These factors may be associated with nasal polyps. The aim of this study was to use laboratory tests to investigate the effects of smoking and allergens on the development of nasal polyps. The study included 60 consecutive patients with a diagnosis of nasal polyposis who were treated with functional endoscopic sinus surgery at our clinic and 25 smoker and 25 nonsmoker participants who constituted a control group. In the patient and control groups, the mean absorbance value for cotinine in smokers was found to be statistically significantly lower than that in nonsmokers. There was a significant difference between the groups with respect to blood cotinine positivity. No significant difference was found between the groups in terms of allergy parameters. In the regression model, smoking was found to be the only significant risk factor for the development of nasal polyps, independent of smoking duration, absorbance value, or cotinine positivity. Smoking restriction and avoiding exposure to cigarette smoke by patients with nasal polyps may be an important strategy in the prevention and recurrence of nasal polyposis. No direct relationship was determined between allergy and nasal polyposis.

Prevention of relapses of nasal polyposis with intranasal triamcinolone acetonide after polyp surgery: A prospective double‐blind, placebo‐controlled, randomised study with a 9‐month follow‐up

To determine whether intranasal triamcinolone acetonide prevents the regrowth of nasal polyps after polyp surgery. Randomised, double-blind, placebo-controlled, prospective study. Helsinki University Central Hospital. Sixty patients with nasal polyps entered the study. Patients were included upon arrival for elective polyp operations determined according to our standard clinical criteria. The recurrence of nasal polyposis was followed up for 9 months after surgical treatment at 3-month intervals. Anterior rhinoscopy, nasal endoscopy, olfactory threshold measurement, active anterior rhinomanometry and acoustic rhinometry were performed at every follow-up visit. On the whole, there was a significant inter-group difference in the change in polyp size of acetylsalicylic acid (ASA)-tolerant patients during the follow-up. In patients with acetylsalicylic acid intolerance, there was no inter-group difference (P = 0.28). No significant differences were noted for nasal resistance, nasal cavity volume, sense of smell and nasal symptoms. Triamcinolone acetonide prevents regrowth of nasal polyps after polyp surgery in acetylsalicylic acid-tolerant patients, but not in acetylsalicylic acid-intolerant patients.

Telomerase in Nasal Polyps

The aim of this study was to determine the presence and location of telomerase activities and the possible influence of elevated human telomerase reverse transcriptase (hTERT) mRNA levels on the outcome after surgical treatment in nasal polyposis. Telomerase activity in nasal polyps of 21 patients was quantified by measuring the hTERT mRNA contents with one-step real-time polymerase chain reaction. Inferior turbinates of 12 patients served as controls. Immunohistochemistry with specific antibodies was performed against hTERT. The number of hTERT marked cells was determined in 15 randomly selected fields. All patients were followed up after surgery for 60 months. Elevated hTERT mRNA expression and number of hTERT+ cells was detected in nasal polyps in comparison with inferior turbinates (p < 0.001). hTERT+ cells were detected in the basal layer of the epithelia, the endothelia, and in some seromucous glands. During follow-up, it was discovered that tissue samples of five patients with recurrent polyposis did not have higher amounts of hTERT when compared with patients without relapse. Telomerase activity is elevated in nasal polyps. Elevated hTERT expression does not predict the recurrence of nasal polyposis after surgical treatment.

Medium‐Term Symptom Outcomes After Paranasal Sinus Surgery in Children and Young Adults With Cystic Fibrosis

To determine the effectiveness of paranasal sinus surgery (PSS) for individual symptoms and recurrence of nasal polyposis in children and young adults with cystic fibrosis and chronic rhinosinusitis (CRS). Nonrandomized, prospective, clinical trial. Children and young adults with medically refractory CRS were examined before and after PSS. The extend of nasal polyposis was graded endoscopically and on computed tomography images. The severity of symptoms of CRS was recorded on a 6-point Likert scale by the investigator. In 26 patients, a complete rhinosinusitis symptom score (RSS) before and after surgery was available. The mean follow-up time after surgery was 23 months. Postoperatively, no polyp recurrence was seen in eight patients (of 26 patients). An improved polyp score was found in 14 patients. In four patients, polyp recurrence to the same extent as before surgery was seen. The mean RSS was significantly improved after surgery. Before surgery, "nasal obstruction" was the most common complaint. "Headache" was the second most common complaint before PSS. After PSS, although improved, "headache" was the most common complaint. During further follow-up, in two patients, endocranial complications caused by recurrent frontal mucopyoceles (1 frontal abscess, 1 subacute meningitis) were observed. After transfrontal revision surgery, both patients recovered without neurologic damage. Even in cases of polyp recurrence, PSS provides significant symptom relief for nasal and facial symptoms associated with CRS. The symptom "headache" requires special attention because it improves least after surgery and may indicate recurrence of frontoethmoidal mucopyoceles or endocranial complication of CRS.

Expression of interleukins in patients with nasal polyposis

To correlate the levels of interleukins 1beta, 3, 4, and 5 before and after surgery and compare the levels between patients with and without recurrence of nasal polyposis. Thirty-nine patients with NP were selected, 13 of them allergic and 26 nonallergic. A control group of 11 individuals was also studied. The concentrations of interleukins were measured by enzyme-linked immunosorbent assay. There was a higher incidence of NP after the fourth decade of life and among men. The clinical symptoms were similar in both groups of patients with nasal polyposis and characterized by nasal obstruction and anosmia. A significant reduction of all interleukins studied was observed after surgical treatment. Levels of interleukins 1beta, 3, 4, and 5 were significantly reduced after surgery and the levels of interleukins 1beta and 5 were significantly lower in patients without recurrence of nasal polyposis after surgery when compared to those with recurrence.

Sinonasal disease in cystic fibrosis: Clinical characteristics, diagnosis, and management

Cystic fibrosis is an autosomal recessive genetic disorder that causes dysfunction of exocrine glands, and has several clinical manifestations. Among those, sinonasal involvement is almost universal, with or without chronic sinusitis and/or nasal polyposis. This review will detail the pathophysiologic changes of the sinonasal mucosa, and the clinical manifestations, diagnosis, and treatment. Developmental anatomic abnormalities, which are identified radiologically, will also be demonstrated. Medical management is the first treatment for patients with cystic fibrosis, but effective treatment of sinonasal disease in cystic fibrosis relies heavily on surgery. In the past, nasal polyposis was the main indication for surgery, and consisted mostly of polypectomy alone. This procedure was associated with a high recurrence rate. The development of functional endoscopic sinus surgery has contributed to decreasing the morbidity of sinonasal surgery and the recurrence of nasal polyposis in cystic fibrosis. The evolution of the surgical techniques will be discussed and a review of the literature will be provided. Pediatr Pulmonol. 2000; 30:481–489. © 2000 Wiley-Liss, Inc.

Nasal polyposis: clinical course during 20 years

The etiology of nasal polyposis is mainly unknown although it has been connected with many clinical conditions. The long-term clinical course of nasal polyposis is largely unknown, because long-term followup studies on the recurrence of nasal polyposis have rarely been reported. The aim of the study was to find out the clinical course of nasal polyposis over a long period of time. Our report describes a 20-year follow-up study of 41 patients with nasal polyps. These patients had surgery for nasal polyp disease 20 years previously and they were initially grouped according to occurrence of (1) acetylsalicylic acid (ASA) intolerance, (2) atopic allergy (AT), and (3) intrinsic allergy-like disease (INTR). Patients were now re-examined, sinus computed tomography (CT) scanning was made, and a biopsy from polyp or from mucosa of the middle turbinate was taken. Anterior rhinoscopy revealed polyps in 35 of 41 patients. Thus nasal polyposis was still active in 85% of patients after 20 years. Mucosal changes in paranasal sinuses were found in every patient. Anosmia or hyposmia was found in 61% (25/41) of the patients. Eight patients had had 11 or more surgical operations during the 20-year period. Of these, 88% (7/8) belonged to the ASA group. Bronchial asthma was found in all ASA intolerance patients (11/11), and in 36% (4/11) of AT and in 16% (3/19) of INTR patients, respectively. Because of the high recurrence tendency and insidious symptoms of nasal polyposis, patients will require followup for the rest of their lives.

Sinonasal disease in cystic fibrosis: clinical characteristics, diagnosis, and management.

Cystic fibrosis is an autosomal recessive genetic disorder that causes dysfunction of exocrine glands, and has several clinical manifestations. Among those, sinonasal involvement is almost universal, with or without chronic sinusitis and/or nasal polyposis. This review will detail the pathophysiologic changes of the sinonasal mucosa, and the clinical manifestations, diagnosis, and treatment. Developmental anatomic abnormalities, which are identified radiologically, will also be demonstrated. Medical management is the first treatment for patients with cystic fibrosis, but effective treatment of sinonasal disease in cystic fibrosis relies heavily on surgery. In the past, nasal polyposis was the main indication for surgery, and consisted mostly of polypectomy alone. This procedure was associated with a high recurrence rate. The development of functional endoscopic sinus surgery has contributed to decreasing the morbidity of sinonasal surgery and the recurrence of nasal polyposis in cystic fibrosis. The evolution of the surgical techniques will be discussed and a review of the literature will be provided.