The role of ZEB1 in regulating tight junctions in antrochoanal polyp.

Background: Antrochoanal polyp (ACP) is a benign nasal mass of unknown etiology. Tight junctions (TJs) are essential to the epithelial barrier that protects the body from external damage. However, the phenotype of tight junction in ACP is currently unclear. Methods: The samples were collected from 20 controls, 37 patients with ACP and 45 patients with chronic rhinosinusitis with nasal polyp (CRSwNP). Quantitative Real-Time PCR (qRT-PCR) and immunofluorescence staining (IF) were performed to analyze the expressions of TJs markers (ZO-1, claudin-3 and occludin) and ZEB1. hNEpCs were transfected with ZEB1 small interfering RNA (si-ZEB1) or ZEB1 over-expression plasmid (OE-ZEB1). qRT-PCR and Western blotting were used to determine the levels of TJs-related markers. Primary human nasal epithelial cells (hNECs) were stimulated with IL-17A and si-ZEB1, and the expression of epithelial barrier markers were measured by qRT-PCR and Western blotting. Results: Compared to the control group, ACP group showed a significant downregulation in both mRNA and protein levels of ZO-1, occludin, and claudin-3. Furthermore, disease severity correlates positively with the degree of disruption of tight junctions. In addition, higher expression levels of ZEB1, IL-17A, and IFN-γ were observed in the ACP group compared to controls. Overexpression of ZEB1 in hNEpCs led to impairments in the levels of ZO-1, occludin, and claudin-3, while silencing of ZEB1 expression was found to enhance the barrier function of epithelial cells. Finally, IL-17 stimulation of hNECs impaired the expression of TJs-associated molecules (ZO-1, occludin, and claudin-3), which was effectively reversed by the IL-17A + si-ZEB1 group. Conclusions: The tight junctions in ACP were extremely damaged and were correlated with the severity of the disease. ZEB1 was involved in the pathogenesis of ACP mediated by IL-17A through regulating tight junctions.

The anatomical variations of paranasal sinuses may be related to the formation of antrochoanal polyp by computed tomography imaging study.

Background: There is little investigation into the connection between anatomic variations and the development of antrochoanal polyp (ACP), and the etiology of ACP remains unclear. The study aims to explore the relationship among anatomic variations, maxillary sinus volume, nasal meatus-related parameters, and the occurrence of ACP. Methods: There were 127 patients included in this retrospective cross-sectional study with unilateral ACPs hospitalized at Shandong Provincial ENT Hospital between February 2010 and February 2020. Evaluation indicators included anatomic variations, maxillary sinus volume, and nasal meatus-related parameters in 45 children and 82 adults, which were evaluated twice by 3DSlicer software. Parameters were assessed using the Kolmogorov-Smirnov test, followed by paired t-test and Chi-squared test for multiple comparisons. Results: Significant differences were found in the accessory maxillary ostium (AMO) and maxillary sinus retention cyst between two sides (both P<0.001). Maxillary sinus volume and sex had an association of statistical significance on adults' ACP side (P=0.026) and non-antrochoanal polyp (non-ACP) side (P=0.032). The affected side's maxillary sinus volume was significantly larger than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was larger than the non-ACP side in children (P=0.044). Males' length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was considerably greater than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate (P=0.014) and the length from the inferior turbinate to the nasal septum (P=0.013) on the non-ACP side was higher than the affected side in adults. Males' length from the inferior turbinate to the nasal septum was higher on the healthy side than the affected side (P<0.001). Males had a greater maximum length from the maxillary sinus lateral wall to the nasal septum (P=0.024) and the length from the inferior turbinate to the nasal septum (P=0.003) on the non-ACP side than females. Males had a larger maximum length from the maxillary sinus lateral wall to the nasal septum on the ACP side than females (P=0.011). Conclusions: In our study, the occurrence of the AMO, the maxillary sinus's expanded size, and the stenosis of the associated channels around the ostiomeatal complex and common meatus are regarded as probably connected to the formation of ACPs. In addition, the anatomic variations that involve the ostiomeatal complex and may lead to a change in maxillary sinus pressure and nasal ventilation are important factors in the formation of ACPs.

Difference of Antrochoanal Polyps Between Children and Adults in the Chinese Population.

OBJECTIVE: This study aims to find the difference in clinical and immunopathological characteristics between children and adults with antrochoanal polyps (ACPs) in the Chinese population. METHODS: The clinical data of 69 patients diagnosed with ACPs were retrospectively analyzed. Cytokine levels in 16 controls and 40 ACPs tissues were determined by quantitative real-time polymerase chain reaction (qPCR). The expression of matrix metalloproteinase (MMP)-9 was measured using qPCR, immunofluorescent staining, and western blot. RESULTS: There were 51 (73.9%) children (<18 years old) and 18 (26.1%) adults (≥18 years old). The sex ratio differed significantly between the two groups (p = 0.0032). There were no significant differences in the nasal side of ACPs and approaches to surgery between the two groups. In both groups, the most common symptom was nasal obstruction, followed by nasal discharge. As for associated nasal diseases, there was a significant difference between the two groups in septal deviation (p = 0.0223). Adult patients showed significantly higher expression of IL-8 mRNA than children (p = 0.0424). The mRNA and protein levels of MMP-9 were also significantly higher in adult patients than in children (p = 0.0498 and 0.0009, respectively). CONCLUSION: In the Chinese population, the comorbidities and immunopathological characteristics of adult ACP patients are different from those of children. The level of IL-8 and MMP-9 was significantly higher in ACPs of adults than in children, which may contribute to the more severe tissue remolding in adult ACP patients. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2093-2099, 2024.

Huge Antrochoanal Polyp: A Case Report.

Antrochoanal polyps are benign lesions arising from the maxillary sinus mucosa. The most common patient complaint is unilateral nasal obstruction. Nasal endoscopy and computed tomography are the gold standard modalities for diagnosis. Treatment is surgical. We report the case of a 19-year-old female suffering from a huge antrochoanal polyp who went to hospital following a choking episode. While being prepared for surgery, she vomited, and the polyp was expelled from her mouth. Right maxillary sinus antrostomy was done to remove the polyp base to avoid recurrence.

Bilateral antrochoanal polyp: a case report of an extremely rare entity managed conservatively with a review from the past 26 years.

Antrochoanal polyp (ACP) is a well-known benign sinonasal polyp first described in the early 20th century. ACP mostly presents as a unilateral mass and is treated solely with surgical excision. Case presentation: We report a rare case of a middle-aged man presenting with nasal obstruction, rhinorrhea, and sleeping disturbances, eventually diagnosed with bilateral ACPs. After confirming the diagnosis with imaging and biopsy studies, the patient was treated conservatively, with marked improvements in his symptoms during 2-3 months of regular follow-ups. A review of the relevant literature regarding the presentation, diagnosis, and outcome of this rare entity is presented, highlighting its controversial etiopathogenesis. Clinical discussion: Presenting symptoms of ACP in most cases is unilateral progressive nasal obstruction. The occurrence of ACP bilaterally is rarely encountered in clinical practice. Diagnosis is mainly clinical and is achievable via nasal endoscopic examination and supported by computed tomography imaging. Treatment remains to be surgical, with 2 years of regular follow-ups being advised to detect any recurrence. Conclusion: This case report adds to the scarce data pool on bilateral ACPs and highlights the necessity of prudent and timely diagnosis of this uncommon entity to avoid unnecessary investigations and lengthy medical or surgical treatment. Additionally, a trial of medical therapy may provide symptomatic relief for patients who do not qualify for surgery.

Temporary Submucosal Inferior Maxillary Antrostomy: A Modification of the Inferior Antrostomy.

Complete removal of maxillary sinus pathology can be challenging in specific locations. In the past, the Caldwell-Luc procedure was used for maxillary sinus disease. Currently, the endoscopic middle meatal antrostomy (EMMA) approach is used. However, it can often be difficult to reach certain locations of lesions by EMMA alone, requiring an endoscopic inferior meatal antrostomy (EIMA), which has been reported in the literature to have numerous complications. Furthermore, multiple techniques have been suggested for a combined bi-meatal approach to remove such lesions. We present a case of a 17-year-old with a challenging antrochoanal polyp (ACP) location requiring EIMA. The patient underwent our modified technique of submucosal inferior antrostomy with mucosal flap with no observed intra-operative and post-operative complications. Maxillary sinus pathology can be challenging due to limited access to specific regions. In this case report, we present a novel technique to achieve a temporary inferior antrostomy through a minimally invasive approach with a promising post-operative course.

Pheno-Endotyping Antrochoanal Nasal Polyposis.

PURPOSE OF REVIEW: Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the inner wall of the maxillary sinus and extending into the choana. Although the diagnosis and treatment strategies of ACP have changed since this entity was first described, the underlying pathogenic mechanism of APC is poorly understood. This article reviews the current knowledge of the etiology, inflammatory parameters, and microscopic findings of ACP. RECENT FINDINGS: The inflammatory pattern of ACP appears to center around a neutrophilic inflammation T1-dominant endotype. Apart from the inflammatory component of ACP, at the microscopic level, the presence of tissue remodeling, mostly fibrin deposition and edema, and cysts in the epithelium and lamina propria has been described. Although the origin of this T1-dominant endotype immune response of ACPs is not entirely clear, it could be related to a lymphatic obstruction mechanism. This review serves to define a phenotype of ACP with potential endotypes based on the characteristics of the inflammatory parameters, microscopic findings, and hypotheses about the pathogenesis of ACP.

Management of Angiomatous Antrochoanal Polyp: Our Experience.

Antrochoanal polyps are the most common type of choanal polyp. Angiomatous polyp is a rare subtype of Antrochoanal polyp that might be misdiagnosed as malignant lesion due to its clinical features. A retrospective observational study was conducted in a tertiary care hospital in patients who were diagnosed with Angiomatous Antrochonal polyp that underwent functional endoscopic sinus surgery from 2017 to 2020. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with Angiomatous Antrochonal polyp. Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. Antrochoanal polyps all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction are typical on computed tomography imaging but specific for Angiomatous Antrochoanal polyp. The magnetic resonance revealed high signal intensity on T1-weighted images and hypo-intense rim on T2-weighted images. Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of Angiomatous Antrochoanal polyp. Incisional biopsy does help if the clinician suspects a malignant lesion. Complete removal is treatment of choice for Angiomatous Antrochoanal polyp.

Ingrained Insight into Nasal Polyposis; Role of Human Papillomavirus: An Indian Study.

Nasal polyposis (NP) are benign lesion of nasal cavity, affecting up to 1-4% of population. It is known to have up to 70% recurrence rate. The underlying pathophysiology is still undetermined. Recent literatures have thrown light on the viral aetiology for NP. To our knowledge this is the first Indian study done, that aims to evaluate the prevalence of Human papillomavirus (HPV) in NP. It was a prospective case control study done among 40 individuals with NP and 40 healthy controls in a tertiary care centre. All the patients were subjected to routine clinical evaluation, investigations prior to proposed surgeries. The mucosal samples after the surgery were subjected to HPV DNA analysis by RT-PCR. Among the cases, the male to female ratio was 1.3:1. The mean age of patients with NP was 39 ± 14.6. The mean serum IgE levels among the case were 154 IU/ml and was significantly higher as compared to controls. Other inflammatory markers such as absolute eosinophil count, erythrocyte sedimentation rate, and neutrophil to leukocyte ration were found to be not significant. There was no HPV DNA detected among both case as well as controls. There seems to be strong association of IgE and NP, suggesting an IgE mediated pathway for its Causation. There is no association of HPV in NP.

A Comparative Study between Endoscopic Prelacrimal Approach and Middle Meatal Antrostomy for Maxillary Sinus Pathologies.

Aim, To evaluate the treatment outcomes of endoscopic prelacrimal approach in managing various maxillary sinus pathologies, analyzing the associated adverse events and post treatment quality of life and also to compare surgical outcomes of prelacrimal approach with middle meatal antrostomy approach to remove various maxillary sinus pathologies. MATERIALS AND METHODS: A prospective study was conducted from January 2019 to April 2020. We took 60 patients with maxillary sinus pathologies and divided into two groups and done sinus surgery through middle meatal antrostomy approach (group A) and prelacrimal approach (group B). Post operative follow up done for one year and analyzed complications and recurrence. RESULTS: We compared the recurrence rate of antrochoanal polyp in both groups. Out of 12 patients in group A, 6 patients (50%) got recurrence of polyp. In group B, only one patient (8%) got recurrence out of 12 patients of antrochoanal polyp. CONCLUSION: We conclude that prelacrimal recess approach is a better option than middle meatal antrostomy for complete removal of pathologies in maxillary sinus.

Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up.

BACKGROUND: Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA). METHODS: The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment. RESULTS: Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months-11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA. CONCLUSIONS: EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs.

Antrochoanal Polyp in Anterior Nasal Cavity: A Case Report.

We report a case of antrochoanal polyp, which has unusual presentation according to the location of the polyp in a 15-year-female patient. The patient came complaining of nasal obstruction, headache, and postnasal drip for a two-week period. The antrochoanal polyp measured 2.5 x 2 cm in the left maxillary sinus and extended to the anterior part of the nasal cavity. CT imaging demonstrated a total opacified left maxillary sinus, maxillary ostium with widening of the left maxillary ostium by polypoid mucosal thickening suggesting an antrochoanal polyp obstructing the left anterior nasal cavity. This case is reported as there are not many articles in world literature describing an antrochoanal polyp presented in the anterior nasal cavity.

Unilateral Concomitant Antrochoanal Polyp and Fungus Ball in Maxillary Sinus: A Case Report.

Antrochoanal polyp (ACP) are benign lesions that arise from the maxillary sinus, grow into the maxillary sinus, and reach the choana, nasal obstruction being their main symptom. A fungal ball (FB) is a dense accumulation of extra mucosal fungal hyphae, usually within one sinus, most commonly the maxillary sinus. We describe a case of a 38-year-old male with a concomitant unilateral maxillary FB and ACP which was surgically excised by endoscopic sinus surgery.

Topical mitomycin C application post endoscopic removal of antrochoanal polyp.

OBJECTIVE: Assessment the effect of topical application of mitomycin-C (MMC) after endoscopic removal of antrochoanal polyp (ACP) on its recurrence rate. METHODS: This prospective study was done on patients with ACP. Endoscopic nasal surgery has been done to remove the polyp after wide middle meatal antrostomy. The patients were categorized into two groups. In MMC group, after endoscopic ACP removal, MMC on a piece of cotton was topically applied inside the maxillary antrum in the suspected site of ACP origin. A second group was used as a control group without MMC application. RESULTS: The study included on 40 patients; 20 patients in each group. Topical MMA application was easily performed. No granulation, crust, infection, or bleeding was reported in all cases of both groups. Recurrent polyp was not reported in MMC group, while recurrent polyp was detected in four cases (20%) in control group without MMA application with statistically significant difference (P = .035). CONCLUSION: Topical MMC application inside the maxillary sinus after endoscopic removal of the ACP is safe, easy, and effective. LEVEL OF EVIDENCE: 2c.

Do Blood Cell Parameters have a Predictive Role in the Etiology and Severity Pediatric Antrochoanal Polyp Cases?

Introduction There are no definitive parameters to guide the etiology and severity of pediatric antrochoanal polyps. Objective The aim of our study is to compare the values of blood cell distribution parameters in cases of pediatric antrochoanal polyps (ACPs) with those of the control group. These values may be guiding parameters in determining the etiology of ACPs and evaluating the severity of the disease and the risk of recurrence. Methods Blood count values of patients operated for pediatric ACPs were retrospectively analyzed and compared with the data of the control group with the same age and gender distribution. The ACPs group was divided into subgroups in terms of inflammation, severity, and recurrence, and these subgroups were statistically compared as well. Results When the ACP patient group and the control group were compared, there was no statistically significant difference between the two groups. When we compared the patients considering the CT findings, there was a statistically significant difference between the stage III patients and the control group in terms of mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR) values ( p < 0.05 in both). Similarly, the MPV and PLR values were significantly higher in the recurrence patient group than in the control group. ( p < 0.05 in both). Conclusion As a result of the data obtained, it can be suggested that inflammatory parameters in pediatric cases of ACPs vary in terms of recurrence and the severity of the disease.

Do Blood Cell Parameters have a Predictive Role in the Etiology and Severity Pediatric Antrochoanal Polyp Cases?

Abstract Introduction There are no definitive parameters to guide the etiology and severity of pediatric antrochoanal polyps. Objective The aim of our study is to compare the values of blood cell distribution parameters in cases of pediatric antrochoanal polyps (ACPs) with those of the control group. These values may be guiding parameters in determining the etiology of ACPs and evaluating the severity of the disease and the risk of recurrence. Methods Blood count values of patients operated for pediatric ACPs were retrospectively analyzed and compared with the data of the control group with the same age and gender distribution. The ACPs group was divided into subgroups in terms of inflammation, severity, and recurrence, and these subgroups were statistically compared as well. Results When the ACP patient group and the control group were compared, there was no statistically significant difference between the two groups. When we compared the patients considering the CT findings, there was a statistically significant difference between the stage III patients and the control group in terms of mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR) values (p < 0.05 in both). Similarly, the MPV and PLR values were significantly higher in the recurrence patient group than in the control group. (p < 0.05 in both). Conclusion As a result of the data obtained, it can be suggested that inflammatory parameters in pediatric cases of ACPs vary in terms of recurrence and the severity of the disease.

Is There any Possible Role of Neurotrophin 3 in the Pathogenesis of Antrochoanal Polyp?

OBJECTIVE: Antrochoanal polyp (ACP) is a benign soft tissue lesion arising from the inner wall of the maxillary sinus that extends into the nasal cavity and choana. Although it was first explained by Killian in 1906, the underlying pathogenesis has not been yet fully understood. Neurotrophins have been demonstrated to have a possible role in the pathogenesis of allergic rhinitis, idiopathic rhinitis and nasal polyps. To date any study has not investigated the function of neuronal inflammation and neurotrophins in the development of ACP. The objective of this study was to investigate the possible effect of neurotrophin-3 (NT-3) in ACP pathogenesis. METHOD: Twenty adult patients with ACP who underwent endoscopic sinus surgery in our department were included in the study group. The control group included 15 patients with concha bullosa of middle concha who underwent lateral excisional surgery. Nasal tissue NT-3 staining scores were evaluated using immunohistochemical methods. Blood NT-3 levels of both groups were evaluated by enzyme-linked immunosorbent assay (ELISA). RESULTS: There were no statistically significant differences between these two groups regarding tissue NT-3 staining scores (p=0.843) and blood NT-3 levels (p=0.463). In addition, no statistically significant correlation has been observed between tissue NT-3 staining scores and blood NT-3 levels in both ACP (p=0.578) and control (p=0.359) group patients. CONCLUSION: NT-3-related neuronal inflammation does not seem to have any role in ACP pathogenesis.

Treatment and evaluation of recurrence for antrochoanal polyps by endoscopic large middle meatal antrostomy, clinical case series of 25 patients.

INTRODUCTION: The Endoscopic approach for complete removal of antrochoanal polyp is considered a safe and effective procedure with the best control of the attachments of antrochoanal polyps. The mains of our study are to review the clinical features and evaluate the recurrence in the patients affected by antrochoanal polyps (ACPs) and surgically treated by endoscopic middle meatal antrostomy. METHODS: The present research is a retrospective study. it includes the clinical data of subjects affected by ACPs, and referred to ENT Department, Face and Neck Surgery, Hospital 20 August 1953, between January 2016 and January 2019. RESULTS: All patients have been treated surgically with endoscopic middle meatal antrostomy under general anesthesia. Recurrence occurred in 3 cases (12%), in these three recurrent cases, the site of attachment originated from the lateral wall. CONCLUSION: FESS was the first-choice treatment for APCs in the present series; our recurrence rate was encouraged for the practice of the endonasal endoscopic approach. A focus on the detection of the exact origin of the polyp and the resection of the periostium on the point of attachment considered the key to prevent recurrence.

Investigation of Oxidative Stress in Antrochoanal Polyp Etiology.

Antrochoanal polyps (ACPs) are benign lesions of the paranasal sinuses. Similarities between ACPs and nasal polyps have been previously investigated. However, oxidative stress has been implicated but not investigated in terms of the etiology of ACPs. Thus, the aim of this study was to investigate oxidative stress in the etiology of ACPs. The study population comprised 93 patients divided into 3 groups. Group 1 consisted of 30 patients with ACPs. Group 2 consisted of 33 patients with nasal septal deviation. Group 3 comprised 30 healthy individuals. Venous blood was taken from all participants, and total thiol, native thiol, disulfide, and ischemic modified albumin (IMA) levels were evaluated. When the values of native thiol (P = .097), disulfide (P = .221), total thiol (P = .140), and IMA (P = .091) were compared, no significant differences were found among the 3 groups. While many studies have been conducted related to nasal pathologies and the role of oxidative stress in their etiologies, our study concluded that oxidative stress plays no role in ACP etiology.