Treatment Of Nasal Polyposis Research Articles

Correlation Between Lund-Mackay Ct Scores Before and after Surgery for Nasal Polyposis, An Evaluation of Medical and Surgical Treatment in Nasal Polyposis

Objective: To determine the efficacy of functional endoscopic sinus surgery on treating nasal polyps in terms of improvement in the Lund-MacKay score.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of ENT, Combined Military Hospital, Rawalpindi Pakistan, Jul 2021 to Jan 2022.
 Methodology: Seventy patients suffering from chronic rhino-sinusitis were included in this study. All patients were assessed before and three weeks after treatment using the Lund-MacKay computed tomography score. Group-A patients received management with a hybrid therapy using functional endoscopic sinus surgery and drug therapy, while Group-B patients received conservative management alone.
 Results: The majority of the patients in our sample were males 43(61.4%), a mean duration of complaints of 6.47±1.91 months.Hybrid therapy showed a significantly higher improvement in relieving nasal obstruction when compared to conservative management alone (p=0.033). Conservative management appeared to be more effective in relieving nasal discharge and headache, although this did not approach statistical significance (p=0.11 and 0.43, respectively). Facial pain and olfactory function showed a greater improvement with hybrid therapy, which was not statistically significant (p=0.097 and 0.131, respectively).The Lund-MacKay computed tomography scores with conservative and hybrid therapy were 13.91±4.11 and 11.17±4.17 at the end of treatment (p=0.007), demonstrating that hybrid therapy was superior.
 Conclusion: Functional Endoscopic Sinus Surgery combined with limited medical therapy is superior to pure medical therapy in terms of improvement in Lund-MacKay CT scores and relief in symptoms of nasal obstruction.

Subgroups in the treatment of nasal polyposis with dupilumab: A retrospective study.

Dupilumab has been shown to be safe and effective in treating chronic rhinosinusitis with polyposis (CRSwNP). There is to this date no published data whether subgroups like patients with aspirin exacerbated respiratory disease (AERD), increased histologic eosinophilia or elevated blood eosinophil or IgE-levels benefit greater from dupilumab therapy. Moreover, there is no data comparing the efficacy of functional endoscopic sinus surgery (FESS) with dupilumab therapy. We conducted a retrospective chart review of all patients that were treated at a tertiary referral center for CRswNP with dupilumab. We also contacted the patients with a questionnaire to evaluate the efficacy of previous surgeries and dupilumab therapy by visual analogue scale (VAS) and the glasgow benefit inventory (GBI) as well as report on side effects. Overall, 75 patients were included in the study at hand that reported back 138 times. While dupilumab treatment was efficient, we found no systematic evidence of greater efficacy of dupilumab in patients with AERD, histologic eosinophilia or increased blood eosinophil or IgE-levels. All patients showed a considerable decrease in subjective burden of disease, objective smell tests and endoscopic findings. From the patients point of view, dupilumab therapy showed greater efficacy both in the VAS and the GBI overall and all subcategories but "social support." Dupilumab is efficient in treating CRSwNP; this effect is independent from disease characteristics like AERD, histologic eosinophilia, serum IgE-levels or eosinophil counts. There seems to be a group of patients that benefit greater from dupilumab therapy compared to FESS.

Hyaluronic Acid in Rhinology: Its Uses, Advantages and Drawbacks-A Review.

Hyaluronic acid has been increasingly involved in recent research due to its many chemical and physical properties. This is a review of the literature for studies involving the use of hyaluronic acid in rhinology. Hyaluronic acid washes and irrigation have been increasingly used in chronic sinusitis medical therapy and post-operatively with mixed results. It has also been shown to play a role in the treatment of nasal polyposis, allergic rhinitis, acute rhinosinusitis and empty nose syndrome. Its effect on biofilm in many disease entities has also been studied. HA is being recently used as ancillary treatment for several rhinologic conditions such as post-operative endoscopy care and chronic sinonasal infections. The properties of HA have intrigued researchers over the past years particularly in biofilm management, healing and inflammation.

Efficacy and safety of monoclonal antibody therapy for chronic rhinosinusitis with nasal polyposis

Abstract Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory syndromes reported in the general population, with high prevalence reported. It is classified in two distinct entities depending on the endotype dominance, either type 2 or non-type 2, – chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps. CRSwNP is described as a type 2 inflammatory disease, with the implication of T-helper 2 inflammation mechanisms with a secondary increase in the concentration of eosinophils and total Immunoglobulin E. CRSwNP is characterized by a high recurrence rate even after endoscopic sinus surgery. Considering the challenges associated with the treatment of CRSwNP, new medical therapies, such as monoclonal antibodies, have been developed over the years. Biologics with anti-IL-5, anti-IgE, anti-IL-4 receptor alpha (IL-4-Rα) action have been developed and tested for the treatment of asthma, eosinophilic dermatitis, and secondarily evaluated and approved for the treatment of chronic rhinosinusitis with nasal polyps. In this review, we make a synthesis of the monoclonal antibodies available and their efficacy and safety in the treatment of nasal polyposis.

Exploring Adherence to Treatment in Nasal Polyposis.

Exploring Adherence to Treatment in Nasal Polyposis.

Development and validation of a new stability indicating RP-HPLC method for the quantification of Budesonide in pharmaceutical dosage forms in presence of an internal standard

Budesonide is a glucocortico steroid used for the treatment of nasal polyposis, asthma and Crohn’s disease. A stability indicating RP-HPLC method has been developed and validated for the quantification of Budesonide in pharmaceutical dosage forms in presence of an internal standard, Etoricoxib. Mobile phase including a mixture of formic acid: acetonitrile: methanol (25: 10: 65) was chosen for the chromatographic study with flow rate 1.0 ml/min. The PDA detection was carried at 240 nm and the elution was achieved on isocratic mode using Zorbox C18 column. Beer-Lambert’s law was obeyed over a concentration range 0.05-120 µg/ml and the linear regression equation was y = 0.0489x + 0.003 with correlation coefficient 0.9997). The LOQ and LOD was found to be and 0.0393 and 0.1192 µg/ml. Stress degradation studies such as acidic hydrolysis, alkaline hydrolysis, oxidation and thermal degradation were performed. The method was validated for the parameters linearity, precision, accuracy, robustness as per ICH guidelines and the proposed stability indicating liquid chromatographic method was found to be simple, accurate, precise and robust and can be applied for the assay Budesonide formulations.

Dupilumab in the treatment of nasal polyposis: A retrospective, real-world study

Nasal polyposis is frequently associated with chronic rhinosinusitis, high symptom burden, and poor quality of life. Options for treatment-resistant disease include aspirin desensitization, recurring systemic corticosteroid use, and sinus surgery.1 Dupilumab is a human monoclonal antibody that blocks signaling of interleukin 4 and interleukin 13. These cytokines drive allergic diseases, such as atopic dermatitis, asthma, and nasal polyposis, for which dupilumab is an approved therapy.2 In this retrospective cohort study, we aimed to evaluate real-world efficacy and safety of dupilumab in the treatment of nasal polyposis.

Nasal Polyposis: Insights in Epithelial-Mesenchymal Transition and Differentiation of Polyp Mesenchymal Stem Cells.

Chronic rhinosinusitis is a common inflammatory disease of paranasal sinuses, which causes rhinorrhea, nasal congestion, and hyposmia. The genetic predisposition or the exposure to irritants can sustain the inflammatory response and the development of nasal polyposis. Nasal polyps are benign and teardrop-shaped growths that project in the nasal cavities, and originate from the ethmoid sinuses. This inflammatory process is associated with high expression of IL-4, IL-5 and IL-13 and IgE. Antibodies targeting these cytokines or receptors represent a therapeutic strategy in the treatment of nasal polyposis in combination with corticosteroids. The molecular pathogenesis of nasal polyps in chronic rhinosinusitis (CRS) patients is associated with remodeling transition, a process in which epithelial cells lose their typical phenotype, acquiring a mesenchymal-like aspect. TGFβ/SMAD, ERK, and Wnt/β-catenin pathways are altered during the nasal tissue remodeling. miRNA and inhibitor molecules targeting these signaling pathways are able to interfere with the process; which could lead to alternative therapies. Nasal polyps are an alternative source of mesenchymal stem cells, which can be isolated from surgical biopsies. A molecular understanding of the biology of PO-MSCs will contribute to the delineating inflammatory process underlying the development of nasal polyps.

Recovery of Sense of Smell by Mepolizumab in a Patient with Chronic Rhinosinusitis and Nasal Polyposis – A Case Report

Introduction: To date, there is no permanent medical treatment for nasal polyposis and loss of sense of smell. Mepolizumab is an anti-IL-5 monoclonal antibody approved for the treatment of patients with eosinophilic asthma. It has been suggested that it is capable of improving olfactory dysfunction in patients with chronic rhinosinusitis and nasal polyposis. Case: We present a 35-year-old Emirati male with progressively worsening rhinosinusitis, recurring nasal polyps and total loss of sense of smell. He was treated with oral steroids, normal saline nasal sprays and all available topical steroids without significant or permanent symptom relief. He was commenced on Mepolizumab, and upon receiving the 4th dose, he reported full recovery of his sense of smell. Conclusion: Mepolizumab appears to be very effective in treating loss of sense of smell. Further studies should be conducted to assess the efficacy and effectiveness of Mepolizumab in patients with chronic rhinosinusitis, nasal polyposis and anosmia.

Intrapolyp Corticosteroid Injection versus Oral Corticosteroid versus Topical Nasal Corticosteroid Spray in Treatment of Allergic Nasal Polyposis: Comparative Study

Background: Nasal Polyposis are treated with topical steroids, systemic oral steroids, surgical excision, and intrapolyp steroid injection. Local and systemic steroid treatment is the mainstay of therapy for nasal polyposis. Objectives: The aim of this study was to evaluate the role of intrapolyp steroid injection in the treatment of nasal polyposis and its efficiency, and to compare these results with that of oral and topical nasal spray corticosteroid. Patients and Methods: This study involved 60 patients presented at ENT Outpatient Clinic, Al-Zahraa University Hospital and diagnosed as nasal polyposis. Their age ranged between (18-60) years. They were randomly divided according to type of treatment (nasal corticosteroid spray, oral corticosteroid and intranasal injection of corticosteroid) into 3 groups, each consisted of 20 patients. Results: There were statistically significant differences in total nasal symptom score (TNSS), nasal polyp score (TNPS) and endoscopic analysis. It has been noted that in nasal spray group, Improvement of symptoms with No Regression of Polypis observed in 13 patients (65%) and no change at all in 7 patients (35%). While in oral steroids group, complete regression is observed in 4 patients (20%), partial improvement in 11 patients (55 %), and no response in 5 patients (25%) and in injection group, complete regression of polyps is observed in 2 patients (10%), partial improvement in 13 patients (65%), and no change at all in 5 patients (25%). Conclusion: It could be concluded that intrapolyp steroid injection could be considered one of the alternative treatments of sinonasal polyposis as it is effective, easy, and safe procedure and its effect lasts for at least 3 months.

Evaluation of The Improvement of Clinical and Radiological Scores with Doxycycline in the Treatment of Nasal Polyposis: A Randomized Double Blind Clinical Trial

Although several trials have been proposed for nasal polyposis (NP) treatment, but no standard guideline has been declared yet. We evaluated the effect of doxycycline on NP treatment. In a double- blind randomized clinical trial, 48 patients with bilateral nasal polyposis were assigned to receive doxycycline and placebo capsules for 8 weeks and were followed monthly for 4 months. Patients were assessed for polyp size, severity of symptoms and quality of life according to the endoscopic examination, VAS score, CT scanning and SNOT-22 respectively. polyp size reduced significantly after 8 weeks of treatment in the drug group. The quality of life score has raised significantly after 2 months of treatment with doxycycline. By giving –up the drug, severity of symptoms started to grow-up after 2 months. Although a course of doxycycline improved nasal symptoms, polyp size and CT findings, but further studies with more patients and longer follow-up course are required to establish the foundation to recommend this drug as an important treatment in NP.

Role of Omega-3 Polyunsaturated Fatty Acids in Treatment of Nasal Polyposis.

Background Nasal polyposis is a common disease with steroids either systemic or topical being the key element in its medical treatment. With known side effects of systemic steroids, other anti-inflammatory agents should be evaluated, preferably the natural ones. Objective To evaluate the role of omega-3 polyunsaturated fatty acids in the treatment of nasal polyposis. Methods This is a single-blinded randomized-controlled trial including 164 patients with grade II nasal polyposis receiving a short course of systemic steroids until subsidence of polyposis. Patients were distributed equally after into 2 groups according to maintenance therapy with group I receiving omega-3 fatty acids in a dose of 3 g per day with local budesonide nasal spray and group II receiving only local budesonide nasal spray. Both groups were compared regarding incidence and grade of recurrence of polyposis and duration from onset of maintenance therapy to onset of recurrence. Results A nonsignificant effect for omega-3 was found on the incidence of recurrence of nasal polyposis ( P = .1) and the grade of recurrent polyposis ( P = .66). However, omega-3 intake had a highly significant effect on delaying the incidence of recurrence of polyposis ( P < .0001). Conclusion Omega-3 fatty acid has a beneficial effect on delaying the incidence of recurrence of nasal polyposis through its proven anti-inflammatory mechanism of action. This minimizes the need for systemic steroid administration with its known side effects. Omega-3 fatty acids supplementation should be considered while tailoring the maintenance regimen for medical treatment of chronic rhinosinusitis with nasal polyposis.

Therapeutic Antibodies for Nasal Polyposis Treatment: Where Are We Headed?

This review article aims to outline what is known in the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) and describe the mechanism of the biologic agents being investigated for this disease. Chronic rhinosinusitis with nasal polyposis is an inflammatory disease of the nasal and paranasal mucosa, which causes symptoms of nasal obstruction, hyposmia, and rhinorrhea. Conventional therapy for CRSwNP includes intranasal corticosteroids (INCS) and polypectomy, but INCS offer only modest benefits, and recurrence after surgery is common. Therefore, effective pharmacologic therapies for CRSwNP are being actively sought. Monoclonal antibodies have been successful in other chronic diseases involving eosinophilic inflammation, such as chronic urticaria and asthma. Thus, researchers have begun expanding their scope and investigating the efficacy of these drugs in the treatment of nasal polyposis. The monoclonal antibodies under investigation (omalizumab (anti IgE), dupilumab (anti IL-4/IL-13), and reslizumab and mepolizumab (both anti IL-5), benralizumab (anti IL-5Rα), and etokimab (anti IL-33)) target key players in the pathophysiology of nasal polyposis (NP). Dupilumab has just completed phase III trials for CRSwNP with positive results, while omalizumab, mepolizumab, and benralizumab are currently in phase III trials for this indication. At this time, while there are no FDA-approved biologics for use in NP, research has highlighted the contributions of IL-4, IL-5, IL-13, and IgE as disease mediators in the pathogenesis of NP. The current FDA-approved treatment of intranasal steroids does not provide significant relief for many patients; therefore, these phase III trials of monoclonal antibodies bring hope for an exciting new treatment option.

Uncharted Waters: Challenges in the Era of Biologic Therapies for Nasal Polyposis

Several new, promising, targeted therapies for nasal polyposis are being tested in large-scale clinical trials. These agents target pathways thought to be involved in the disease, including IgE, IL-5, IL-4/IL-13, and others. Designing these trials poses significant challenges: who and when to enroll is not completely clear, optimal dosing is not known, outcome measures are insufficiently robust, there are no validated biomarkers, trial regimens may not comport with how clinicians might use these drugs once approved, and cost-benefit ratios have not been assessed. Thus, there is a need to consider such questions, as trials of these novel treatments continue and these biologics become available. Despite these uncertainties about trial design, there remains a great deal of excitement in the field as we approach the dawn of a new era of therapeutic options for nasal polyposis. In this rostrum, we enumerate these issues and call for a conference that will allow stakeholders in the field to confront them as we enter this new era of opportunity to advance the treatment of nasal polyposis.

Anti-IgE and Anti-IL5 Biologic Therapy in the Treatment of Nasal Polyposis: A Systematic Review and Meta-analysis.

To determine the role of biologic therapy on sinonasal symptoms and objective outcomes in chronic rhinosinusitis with nasal polyposis (CRSwNP). PubMed, OVID MEDLINE, and Cochrane Central were reviewed from 2000 to 2015. Inclusion criteria included English-language studies containing original data on biologic therapy in CRSwNP patients with reported outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. Of 495 abstracts identified, 7 studies fulfilled eligibility: 4 randomized control trials (RCT), 1 case-control, and 2 case series. Outcome measures included nasal polyp score (NPS,6), computer tomography score (5), and symptom scores (5). Meta-analysis was performed on 5 studies: Anti-IL5 therapy (mepolizumab/reslizumab) and anti-IgE therapy (omalizumab) demonstrated a standard mean difference of NPS improvement of -0.66 (95% CI, -1.24 to -0.08) and -0.75 (95% CI, -1.93 to 0.44), respectively, between biologic therapy and placebo. Quality assessment indicated a low to moderate risk of bias for the RCTs. Biologic therapies may prove beneficial in the treatment of recalcitrant nasal polyposis in select populations. In meta-analysis, anti-IL5 therapy demonstrates a reduction in nasal polyp score. Anti-IgE therapy reduces nasal polyp score in patients with severe comorbid asthma. Additional high-level evidence is needed to assess clinical efficacy.

Does oxymetazoline increase the efficacy of nasal steroids in treating nasal polyposis?

Although nasal steroids are the mainstay treatments in nasal polyposis, up to one-half of patients do not respond and need surgical treatment. This study aimed to evaluate whether oxymetazoline administration produces any additive effect on nasal steroid therapy and whether rebound congestion develops after oxymetazoline treatment. Sixty-eight patients with nasal polyposis were randomly assigned in a 1:1 ratio to receive either oxymetazoline plus mometasone furoate nasal spray (MFNS) or placebo plus MFNS, 2 sprays per nostril twice daily, with an interval of 5 minutes between each medication for 4 weeks. All the patients were then treated with MFNS, 2 sprays per nostril twice daily for 2 weeks. The nasal symptoms score, peak inspiratory flow index, nasal mucociliary clearance time (NMCCT), and total nasal polyps score were used to evaluate treatment outcomes. An intention-to-treat analysis was performed, and a worst case sensitivity analysis was applied to missing cases. Thirty-four patients were allocated to the oxymetazoline-MFNS group, and 34 to the placebo-MFNS group. One patient in each group was lost to last-visit follow-up. At 4 weeks after beginning treatment, the oxymetazoline-MFNS group showed significantly greater improvement in blocked nose, hyposmia, peak flow, NMCCT, and total nasal polyps score than the placebo-MFNS group. During the nasal steroid phase, both groups showed continuing improvement in all outcome variables. However, the oxymetazoline-MFNS group still showed significantly greater improvement in blocked nose, hyposmia, NMCCT, and total nasal polyps score, but not peak flow, than the placebo-MFNS group at the end of the study. The use of nasal steroids with oxymetazoline was more effective over 6 weeks than nasal steroids alone in improving blocked nose, hyposmia, nasal mucociliary clearance, and polyp size in treatment of nasal polyposis. There was no evidence of rebound congestion after 4 weeks of oxymetazoline treatment.

Toll-Like Receptor Gene Expression in Nasal Polyp

Objective: To investigate the expression of Toll-like receptors (TLRs) and the correlation between TLR expression and mucosal changes in chronic sinusitis-related nasal polyposis. Methods: Patients with nasal polyps were enrolled in this study as the study group. The control group consisted of individuals undergoing surgery due to nasal obstruction caused by concha hypertrophy who were not diagnosed with chronic sinusitis-related nasal polyposis (NP). There were 30 patients in the study group (individuals with NP) and 20 patients in the control group. Sterile tissue samples were taken from the patients and were kept at -80°C. A piece of tissue sample was put into the eppendorf tube. Expression of TLR2 and TLR4 gene was investigated in the tissue samples. The samples were taken after the surgery; they were carried into the liquid nitrogen and were kept at -80° C before study. Results: TLR2 and TLR4 expression was measured in both groups and then analyzed using Student’s t-test. In the experimental group, the level of TLR2 expression was significantly higher than in the control group (P < 0.001); however, TLR4 expression was not significantly different between the two groups (P = 0.656). Conclusion: TLRs are thought to play a role in the etiopathogenesis of NP. In addition, the authors consider that a possible treatment for NP could be a TLR-specific treatment. Thus, in the future it will be essential to determine the extent to which TLRs function in NP formation and to apply this knowledge to design a specific therapeutic regimen for the enhanced treatment of NP.

Immunomodulators in the Treatment of Nasal Polyposis.

The inflammatory mechanisms that contribute to chronic rhinosinusitis with nasal polyps (CRSwNP) are complex. In the past, medical options for treating CRSwNP have been limited. Emerging classes of immunomodulators such as omalizumab, anti-leukotrienes, anti-IL-4, anti-IL-5, and recognition of the modulating effects of macrolides have shown promising results in the treatment of CRSwNP. Ultimately, large randomized controlled trials are necessary to establish the efficacy of these medications but for now, the area of medical immunomodulators remains an exciting frontier.

Mometasone furoate nasal spray in the treatment of nasal polyposis in Chinese patients: a double-blind, randomized, placebo-controlled trial.

Although mometasone furoate nasal spray (MFNS) has demonstrated efficacy in nasal polyposis (NP) in Western populations, data in Asian populations is limited. This randomized, double-blind study evaluated MFNS 200 μg twice per day (BID) vs placebo in Chinese adults with bilateral nasal polyps (graded as 1, 2, or 3 by the investigator). A 14-day placebo run-in period was followed by a 16-week treatment period with MFNS 200 μg BID vs placebo (1:1 ratio). The co-primary endpoints were change from baseline in nasal congestion/obstruction averaged over the first 4 weeks of treatment and change from baseline in the total polyp size score (sum of scores from the left and right nasal fossa) at week 16. Secondary endpoints included other sinonasal symptoms scores and safety outcomes such as monitoring laboratory measurements, vital signs, and adverse events (AEs). There were 748 patients randomized, 375 received MFNS 200 μg BID and 373 received placebo. The between-treatment difference in least squares (LS) mean change from baseline in nasal congestion/obstruction over 4 weeks of treatment was -0.14 (95% confidence interval [CI], -0.22 to -0.06) for MFNS vs placebo (p = 0.0007). The between-treatment difference in LS mean change from baseline in total polyp size score at week 16 was -0.30 (95% CI, -0.45 to -0.15) for MFNS vs placebo (p < 0.0001). Serious AEs were rare (0.5% and 0.8% in MFNS and placebo groups, respectively) and considered not drug-related. There were significantly more AEs of epistaxis with MFNS vs placebo (p = 0.009). This study demonstrated that MFNS was effective and well tolerated in this population of adult, Chinese patients with NP.

Influence of the diagnosis chronic rhinosinusitis on asthma response to omalizumab in severe, uncontrolled asthmatics

Background Omalizumab is a humanized anti-immunoglobulin E (IgE) monoclonal antibody that has been approved as add-on therapy for the treatment of adults with moderate-tosevere (United States) or severe (Europe) allergic asthma, inadequately controlled after treatment with high-dose inhaled corticosteroids plus long-acting b-agonists. The clinical efficacy of Omalizumab has not only been shown in the treatment of severe uncontrolled asthma, but also in the treatment of nasal polyposis and comorbid asthma. The aim of this analysis was to examine whether the diagnosis of chronic rhinosinusitis (CRS) influenced the asthma response to Omalizumab treatment.