ABSTRACT
Intranasal topical synthetic salmon-clcitonin [SCT] has been widely used in the treatment of osteoporosis. Although the medication is well tolerated, adverse side effects of specific relevance to Rhinologist had been reported. This study was conducted to determine the histopathological changes induced by topical SCT on the nasal mucosa. A total of 48 patients suffering from osteoporosis and requiring SCT nasal spray of 200 IU/day were selected. Tiny punch biopsies were taken before the start of treatment and histopathological changes were observed in group A, B and C after 3, 6 and 9 months of treatment, respectively. In our study, epithelial changes in the form of partial loss of the epithelial cilia were noted in 12.5% of patients in group A, while epithelial cells destruction and exfoliation were observed in 56%, and 25% of patients in group B and C. respectively. Infiltration with mononuclear inflammatory cells were found in 69%, 56% and 44% of patients in group A. B, C, respectively. The mucous acini were found to be increased in number and diameter in group A [25%], group B [31%] and group C [25%]; while congestion and diltation of the blood vessels were observed in the lamina propria in 69%, 44% and 12.5% in patients of group A, B and C, respectively. In addition connective tissue changes in the form of an increase in the collagen fibres were found in group A [25%], group B [44%] and group C [56%]. Scanning electron microscopic findings showed a decrease in the number of ciliated cells and an increase in the number of goblet cells; and the cilia themselves became shortend and decreased in numbers in 12.5%, 56% and 25% in patients of group A, B and C, respectively. The grades of the ciliary changes varied from near normal state to scattered decrease in ciliated cells and occasionally, extreme decrease in the ciliated cells and substitution by a remarkable increase in the goblet cells. The adverse clinical side effects of topical SCT were found in 12 patients [25%]. A positive correlation was found between the clinical adverse side effects and salmon-calcitonin-induced histopathological changes. In conclusion and based on the histopathological changes we can suggest that the adverse nasal side effects of topical salmon-calcitonin may be due to allergic inflammatory reactions. Therefore, periodic nasal examination should be done before the start of treatment and also, at any time that nasal complaints, may occur. Also, immunological studies about the effect of topical salmon-calcitonin on the nasal mucosa to be recommended