Postoperative Management of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps: Impact of High-Dose Corticosteroid Nasal Spray

Abstract Introduction Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrentmild andmoderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg). All the patients were prescribed mometasone furoate, administered at a dose of 2 sprays (100 μg) in each nostril twice a day (400 μg) for 6 months. Results The average scores of the symptoms during the regular dose of intranasal steroid treatment were 5.2 ± 2.2, but 6 months after the high-dose application, they had significantly decreased to 2.5 ± 1.4 (p < 0.05). The polyp size showed an average score of 1.38 during the regular dose which was significantly reduced to 0.43 (p < 0.01) by the double dose. Glycated hemoglobin (HbA1c) showed normal ranges in all the patients tested. The cortisol plasma concentration was also normal. Conclusion Doubling the dose of the nasal topical spray mometasone furoate might be recommended for the treatment of recurrent nasal polyps in the postoperative follow-up of intractable ECRS. (AU)

Nasal polyposis: more than a chronic inflammatory disorder-a disease of mechanical dysfunction - the São paulo position

Introduction: The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective: To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data: Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion: The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP (AU)

Polymorphisms in chronic rhinosinusitis with nasal polyps - a systematic review / Polimorfismos na rinossinusite crônica com pólipos nasais - uma revisão sistemática

Abstract Introduction: Chronic rhinosinusitis with nasal polyps is a multifactorial disease with a complex pathophysiology involving multiple genetic and environmental factors. Objective: The purpose of this work review is to focus on the importance of genetic studies in chronic rhinosinusitis with nasal polyps besides the several barriers that exists for its understanding. Methods: A systematic review on studies of association between single nucleotide polymorphisms and chronic rhinosinusitis with nasal polyps based on a PubMed/Medline and Periódicos CAPES search of all articles published between January 2005 and January 2015 was made. The search was guided on studies containing the terms polymorphisms, rhinosinusitis, and polyps. Results: Two studies found an association of MMP-9 and MMP-2 polymorphisms and chronic rhinosinusitis with nasal polyps, but not in patients with recurrent nasal polyps. Other studies found an association of nasal polyps with MMP-9 polymorphisms, but not with MMP-2 ones. There is evidence of an association of LTC4S, NOS2A, PTGDR, MET, COX-2, OSF-2, and LF polymorphisms and the risk of developing nasal polyps, especially when combined with chronic allergic rhinitis and asthma. Conclusion: Genetic studies on chronic rhinosinusitis with nasal polyps are promising and may offer insights into its pathophysiology, which is likely affected by multiple genetic factors.

Resumo Introdução: A rinossinusite crônica com pólipos nasais é uma doença multifatorial com uma fisiopatologia complexa envolvendo múltiplos fatores genéticos e ambientais. Objetivo: O objetivo deste trabalho é enfatizar a importância dos estudos genéticos na rinossinusite crônica com pólipos nasais, além das diversas barreiras existentes para sua compreensão. Método: Realizou-se uma revisão sistemática de estudos de associação entre polimorfismos de nucleotídeo único e rinossinusite crônica com pólipos nasais com base em uma busca feita nos bancos de dados PubMed/Medline e Periódicos CAPES de todos os artigos publicados entre janeiro de 2005 e janeiro de 2015. A busca foi direcionada à estudos contendo os termos polimorfismos, rinossinusite e pólipos. Resultados: Dois estudos encontraram uma associação entre os polimorfismos MMP-9 e MMP-2 e rinossinusite crônica com pólipos nasais, mas não em pacientes com pólipos nasais recorrentes. Outros estudos encontraram uma associação de pólipos nasais com polimorfismos MMP-9, mas não com MMP-2. Existem evidências de uma associação dos polimorfismos LTC4S, NOS2A, PTGDR, MET, COX-2, OSF-2 e LF e o risco de desenvolver pólipos nasais, especialmente quando combinados com rinite alérgica crônica e asma. Conclusão: Estudos genéticos sobre rinossinusite crônica com pólipos nasais são promissores e podem oferecer conhecimento sobre sua fisiopatologia, que é provavelmente afetada por múltiplos fatores genéticos.

Mean platelet volume in nasal polyps / Volumen medio de las plaquetas en los pólipos nasales

BACKGROUND: Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS: Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data ofpatients with nasal polyp were obtained at the time of diagnosis. RESULTS: There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS: Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPVvalues in patients with nasal polyps.

ANTECEDENTES: Muchos estudios en literatura señalan que las inflamaciones relacionadas con los pólipos nasales dependen en su mayoría de los eosinófilos y sus productos inflamatorios. Además de los eosinófilos, las plaquetas pueden jugar un papel en el desarrollo de los pólipos nasales. Las plaquetas participan en la hemostasia, la reparación de tejidos, y la inflamación. Sin embargo, que sepamos, la literatura existente no reporta estudios acerca de la asociación entre los parámetros de las plaquetas y los pólipos nasales. SUJETOS Y MÉTODOS: Cuarenta y tres pacientes con pólipos nasales y cuarenta y nueve controles sanos se inscribieron en el estudio, de forma retrospectiva. Se obtuvieron datos de laboratorio de los pacientes con pólipos nasales en el momento del diagnóstico. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre los dos grupos en términos de glóbulos blancos, hemoglobina, hematocritos y conteo de plaquetas. El valor medio de las plaquetas (MPV) del grupo con pólipos nasales fue significativamente menor que el del grupo control (p = 0. 025). El conteo medio de eosinófilos fue significativamente elevado en el grupo con pólipos nasales en comparación con el grupo control (p < 0.001). CONCLUSIONES: La reducción de MPVpuede ser un indicador para la formación de pólipos nasales. Se necesitan estudios adicionales con una mayor población de estudio para detectar la posible correlación entre los valores de MPV y el conteo de eosinófilos en pacientes con pólipos nasales.

Fisiopatología de la poliposis nasal / athophysiology of nasal polyposis

ALERGIA:Actualmente se acepta que la alergia es una causa que puede predisponer,o potenciar, ala poliposis nasalVASOMOTORA:Disfunción del sistema nervioso vegetativo de la mucosa nasosinusal,incremento de aminas vasodilatadoras, edema de la submucosa.

Fisiopatología de la poliposis nasal / Pathophysiology of nasal polyposis

TRATAMIENTO DE LA DERMATITIS ATOPICAEl tratamiento de la Dermatitis Atópica Aguda y/o Crónica involucra:1) Cuidados Básicos de la piel2) Medicación3) Control de Alergenos.4) Educación.CUIDADOS BÁSICOS DE LA PIEL1) HIDRATACIÓN: Es esencial para el tratamiento de la D.A, para incrementarel contenido de agua de la piel, por medio de baños o duchas, yaplicando barreras hidrofóbicas para prevenir la evaporación. Los bañosde 15 m. a 20m., dos veces por día evitando el agua caliente.La harina de Avena agregada al baño puede ser tranquilizante pero noincrementa la absorción de agua. Se pueden utilizar limpiadores suaves(Dove, Dial) o limpiadores no jabonosos (Cetafhil), / ó hidrofóbica(Petrolatun).Jabones de PH ácido 5,5-6.Como así también realizar medicación tópica , luego del baño ya que esmejor la penetración en la piel hidratada. Es importante reconocer en quepacientes los baños estarían limitados por que estos exacerban el pruritopor la sequedad de la piel.El uso de emolientes es importante y junto con la hidratación representael principal manejo de la D.A. Los emolientes deben aplicarse continuamenteincluso en ausencia de lesiones.

Polipo antrocoanal: reporte de dos casos y revisión de la literatura / Antrochoanal polyp: case report and review

El pólipo antrocoanal (PAC) es una patología rara en edad pediátrica; representa 4-6 por ciento de todos los pólipos nasales en la pobración general, definiéndose como una masa única, benigna que se origina en el seno maxilar, crece hacia la coana posterior y se puede extender a la nasofaringe. Este articulo presenta dos casos de PAC en niños que consultaron por obtrucción nasal unilateral de 3 o mas meses de evolución. Al examen físico se encontró en ambos casos masa blanca grisácea en fosa nasal derecha. En uno de ellos la masa sobresalía de la nariz en aproximadamente medio centímetro y se apreciaba tambien a nivel orofaringe. Radiografía de senos paranasales mostró velamiento de seno maxilar derecho y presencia de masa larga de tejidos blandos ocupando la naso y orofaringe. La tomografía axilar computarizada (TAC) reportó formación polipoide en nasofaringe, fosa nasal y seno maxilar derecho. Se presentó resección de PAC mediante procedimiento Caldwell-Luc sin complicaciones ni recurrencias hasta el momento. Estudio histológico confirmó PAC

Role of interferon gamma in pathogenesis of allergic nasal polyps in children

Nasal polyposis is a chronic inflammatory disease of the nasal mucosa with inflammatory cell, [especially neutrophil], infiltration and structural modifications of the epithelium [secretory hyperplasia and squamous metaplasia] and lamina propria [basement membrane thickening, extracellular matrix accumulation, and fibrosis]. The etiology of nasal polyosis in the pediatric population is unclear. The pathophysiological mechanisms of formation and growth of nasal polyps remain poorly understood. Nasal polyps were evaluated for distribution and levels of interferon gamma [IFN gamma] in specimens from 30 children with nasal polyposis and 10 controls. Immunohistochemical study revealed IFN gamma staining of eosinophils and epithelium [27 of 30 patients]. ELISA analysis showed elevated INF gamma levels in nasal polyp[NP] tissues 40.5 +/- 8.20 pg/mg total protein [TP] compared with controls [15.2 +/- 4.5 pg/mg TP]. Three groups were identified based on IFN gamma levels: low IFN g group [11.7 +/- 5.51 pg/mg TP]; medium IFN gamma group [30.76 +/- 4.90 pg/mg TP]; and high IFN gamma group [60.54 +/- 11.28 pg/mg TP]. The later levels were approximately 3.5 times the control levels [P<0.005]. Patients with pervious polypectomy showed higher levels of IFN gamma compared with controls [P<0.05]

Poliposis nasal: estudios fisiopatogénicos de diagnóstico y tratamiento / Nasal polyps: physiopathology study of diagnostic and treatment

Material and methods 20 patients with nasal polyps were successively studied. Personal and familiar history of atopy, evolution time, previous surgery, asthmatic crises, medication received, total IgE general and local eosiniphylia skin tests with inhalers, challenge tests with AAS and metacholine test were studied. Surgery was perfomed, histopathologic studies (hematoxylin eosin) and immunoperoxidases for IgG, IgM, IgA, IgE on sections were done. After this early study, patients were divided into 3 groups: group I: patients without brochial hyperreactivity (HRB (-)) without sensitivity to AAS (AAS(-)); Group II: patients HRG (+) AAS (-); Group III: patients HRG(+) AAS(+). Those patients with previous rhinoscopy and with hyperreactivity to metacholine were examined monthly during one year: their symptoms and medication, 3 patients from group II and 3 from Group III were selected. Half of them were prescribed beclomethasone, and the other half, beclomethasone + dexamethasone dipropionate cream locally applied

Origem e conduta nos pólipos antro-coanais / Origin and conduct in antral-choanal polyps

A obstruçäo nasal é um quadro clínico de ocorrência freqüente, que engloba uma grande série de patologias (inflamatórias, infecciosas, traumáticas, tumorais e malignas, etc...). Dentre estas, a ocorrência de pólipos antro-coanais (de Killian), sempre deve ser lembrada no diagnóstico diferencial da obstruçäo nasal apresentando ao exame radiológico um velamento de seio maxilar unilateral. Muitas vezes a massa tumoral polipóide também é visualizada no orofaringe. Tem como tratamento indicaçäo cirúrgica, através de sinusectomoa unilateral pela via Caldwell-Luc (antrostomia), associada à ressecçäo pela cavidade oral. Este trabalho baseia-se na apresentaçäo de 15 casos de pólipos antro-coanais, com sua história clínica,a valiaçäo endoscópica nasal e rinofarígea, radiológica, consideraçöes quanto a sua origem e ao tratamento cirúrgico para sua completa irradicaçäo