Long-lasting clinical, radiological and immunological remission of severe nasal polyposis by means of ‘reboot’ surgery

2020 ◽  
Vol 13 (4) ◽  
pp. e233726
Author(s):  
Luca Malvezzi ◽  
Francesca Pirola ◽  
Armando De Virgilio ◽  
Enrico Heffler

A 68-year-old woman with a long history of relapsing chronic rhinosinusitis with nasal polyps (CRSwNP) underwent a complete reboot surgery and nasal biopsy prior to and after surgery. Remarkable improvement of symptoms and no signs of mucosal oedema and no complaints of initially worsening nasal functions were still present 12 months after reboot surgery. Biopsy demonstrated an outstanding reduction in eosinophilic infiltration and re-epithelisation of nasal mucosa with normal features after reboot approach compared with previous surgeries. Therefore, reboot approach may become an effective instrument in plurioperated patients with CRSwNP who suffer from a nasal condition that is recalcitrant to pharmacological therapies and is unsatisfactorily treated by standard surgical techniques.

Author(s):  
Wagner Vargas Souza Lino ◽  
André Luis Lacerda Bachi ◽  
José Arruda Mendes Neto ◽  
Gabriel Caetani ◽  
Jônatas Bussador do Amaral ◽  
...  

Abstract Introduction Combination of chronic inflammation and an altered tissue remodeling process are involved in the development of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Studies demonstrated that mesenchymal stem cells expressing the progenitor gene CD133 were involved in a significant reduction of the chronic inflammatory process in the polypoid tissue. Objective To evaluate the levels of CD133 (Prominin-1) in nasal polypoid tissue and its correlation with interleukin-8 (IL-8) and transforming growth factor β1 (TGF-β1). Methods A total of 74 subjects were divided in the following groups: control group (n = 35); chronic rhinosinusitis with nasal polyps nonpresenting comorbid asthma and aspirin intolerance (CRSwNPnonAI) group (n = 27); and chronic rhinosinusitis with nasal polyps presenting comorbid asthma and aspirin intolerance (CRSwNPAI) group (n = 12). Histologic analysis and also evaluation of the concentration of CD133, IL-8, and TGF-β1 by enzyme-linked immunosorbent assay (ELISA) kits were performed in nasal tissue obtained from nasal polypectomy or from middle turbinate tissue. Results Higher eosinophilic infiltration was found in both CRSwNP groups by histologic analysis. Lower levels of TGF-β1 and IL-8 were observed in both CRSwNP groups when compared with the control group, whereas the CD133 levels were significantly reduced only in the CRSwNPnonAI group compared with the control group. Conclusion It was demonstrated that the nasal mucosa presenting polyposis showed a significant reduction of CD133 levels, and also that this reduction was significantly correlated with the reduction of TGF-β1 levels, but not with IL-8 levels. Therefore, these findings may be involved in the altered inflammatory and remodeling processes observed in the nasal polyposis.


OTO Open ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 2473974X1987507
Author(s):  
Ashley Lonergan ◽  
Theoharis Theoharides ◽  
Eirini Tsilioni ◽  
Elie Rebeiz

This pilot study was undertaken to isolate and quantify substance P (SP) and hemokinin 1 (HK-1) in the nasal lavage fluid of patients with chronic rhinosinusitis with nasal polyps to better elucidate the pathophysiology underlying this inflammatory process, which remains poorly understood. Mucus samples were collected from this introductory cohort of 10 patients diagnosed with chronic rhinosinusitis with nasal polyps at Tufts Medical Center (Boston, Massachusetts). Relative levels of SP and HK-1 were measured with enzyme-linked immunosorbent assay methods. Both inflammatory neuropeptides were found in detectable and comparable amounts in patient samples and in concentrations up to 100-fold those established in past literature. The presence of SP and HK-1 necessitates further investigation into their role in nasal polyposis and the potentiation of the chronic inflammation inherent to chronic rhinosinusitis. Downregulating these peptides could therefore provide novel treatment targets to manage this disease process.


2020 ◽  
Vol 21 (18) ◽  
pp. 6878 ◽  
Author(s):  
Emanuela Chiarella ◽  
Nicola Lombardo ◽  
Nadia Lobello ◽  
Annamaria Aloisio ◽  
Teodoro Aragona ◽  
...  

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.


Author(s):  
Lavinia-Gianina Manciula ◽  
Ionut Isaia Jeican ◽  
Lucian Barbu Tudoran ◽  
Silviu Albu

Introduction. The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhinosinusitis (CRS), with or without nasal polyps, and their relationship to eosinophils and plasma cells. We compared the results with those obtained in nonCRS patients. Methods. A total of 50 patients were included in the study, 30 CRSwNP patients, 10 CRSsNP cases and 10 control patients who were operated for deviated septum. Biofilm detection was performed by means of H&E staining and SEM. Eosinophil and plasma cell values were recorded and compared between groups. Results. Biofilms were identified in 30 patients (60%), 76.6% (23 out of 30) of the CRSwNP patients, 70% (7 out of 10) of the CRSsNP patients and none of the septoplasty patients. Eosinophil and plasma cell values were more elevated in CRS patients, being strongly correlated to biofilm presence and nasal polyposis. Conclusion. Biofilm presence was demonstrated in many of the CRS patients, with no evidence in the control cases. Our study findings indicate that inflammatory cell counts are higher in patients with CRS compared to controls, but also more elevated in patients with polyposis. In biofilm-positive patients, eosinophil and plasma cell counts were greater than those in patients without biofilms, demonstrating the proinflammatory action of the biofilm in the sino-nasal pathology.


2019 ◽  
Vol 10 (1) ◽  
pp. 1-8
Author(s):  
A. Luukkainen ◽  
J. Numminen ◽  
M. Rautiainen ◽  
A. Julkunen ◽  
H. Huhtala ◽  
...  

Objectives: Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) and with Nasal Polyps (CRSwNP) affect 10% and 1-4% of the general population respectively. Early detection and treatment of CRSwNP might prevent recalcitrant disease forms. The aim of this prospective controlled study was to evaluate association between endoscopic, radiologic, and self-reported CRSwNP, and a family history in defining CRSwNP. Methods: This study involved 73 CRS patients aged 18 years or over undergoing CRS-surgical consultation at the Tampere University Hospital. Data of sinus Computed Tomography (CT) scans and nasal endoscopy was obtained from patient records. Sixty controls ±allergic rhinitis underwent clinical examination. All subjects filled a questionnaire. Associations were analyzed by Chi square and adjusted regression models. The predictive performance of various parameters was assessed using the Area Under the Receiver Operating Characteristic curve (AUROC). Results: A total of 33% of CRSwNP patients reported not having Nasal Polyps (NPs), while 18% of CRSsNP patients reported having NPs (p < 0.001). Radiologic Nasal Polyp (NP) score differentiated CRSwNP from CRSsNP with an AUROC of 0.95 (95% CI 0.91-1.00). The AUROC value for Lund-Mackay (LM) score was 0.84 (0.75-0.94). Positive family history of NP did not differ significantly between CRS and control groups. Family history of allergy or asthma was given with certainty, whereas CRS patients had uncertainty of reporting NPs in family compared to controls (adjusted OR=6.02, 95% CI 1.98-18.30, p = 0.002). Conclusion: Our findings suggest that in situations where nasal endoscopy cannot be performed, early detection of CRSwNP could result from information obtained from sinus CT scans and patients, in comparison to family history which has lower predictive value. However validation studies with larger sample sizes are still needed.


Author(s):  
Karla Victoria Nable-Llanes ◽  
Rodante Roldan

ABSTRACT Objective: To determine the prevalence of eosinophilic and non-eosinophilic nasal polyps in Filipino patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) who underwent endoscopic sinus surgery. Methods: Design: Retrospective Chart Review Setting: Tertiary Government Training Hospital Participants: A consecutive sample of adult patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis at the Rizal Medical Center from 2015-2019.   Results: Out of 66 patients who underwent endoscopic sinus surgery during the study period, 36 (54.55%) had an eosinophilic endotype while 30 (45.45%) had a non-eosinophilic endotype. Conclusion: he slight predominance of eosinophilic nasal polyps found in our sample may suggest a contrasting trend compared to our Asian neighbors, who have a predominantly non[1]eosinophilic endotype – Indonesia (90.47%), Thailand (81.9%), South Korea (66.7%) and China (53.6%). However, this predominance is still lower than the 78-88% eosinophilia reported among Caucasians. Larger series may confirm these preliminary findings


2021 ◽  
Vol 6 (5) ◽  
pp. 255-262
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
O. G. Kuryk ◽  
◽  

The state of the mucoperiostasis of the maxillary sinus is one of the important factors that affect the effectiveness of dental implantation, especially in case of need for augmentation of the maxillary bone. Chronic rhinosinusitis with nasal polyps, chronic rhinosinusitis with fungal bodies, and sinus cysts are among the most common pathological processes in the maxillary sinus that are encountered when performing subantral augmentation. In addition, a separate category of patients is made up of those with a history of sinus surgery in their anamnesis. The condition of sinus mucoperiosteum can be estimated based on results of processus uncinatus research, because it has a similar histological structure, directly contacts with all maxillary sinus excretion and, as usual, gets removed while endoscopic sinusotomy. The purpose of the work was to study the histological features of mucoperiostasis and adjacent bone in the ostiomeatal complex in discrete diseases of paranasal sinuses: chronic rhinosinusitis with nasal polyps, maxillary sinus cysts, fungal balls and postoperative scar changes in the ostium. Materials and methods. Histological features of processus uncinatus fragments removed during endoscopic interventions in 45 patients were investigated: with sinus cysts – 12 patients (group 1), chronic rhinosinusitis with nasal polyps – 13 patients (group 2), sinus fungal body – 13 patients (group 3) and postoperative scarring changes in the ostiomeatal complex – 7 patients. The condition of the epithelial layer of the mucoperiosteum, the structure of its own plate, the periosteal layer and the bone to be treated were evaluated. Results and discussion. In 91.67 ± 0.08% of patients with maxillary sinus cysts, there were no changes in the mucoperiostasis and the bone of processus uncinatus. Most patients in groups 2 and 3 showed mucoperiostal edema with a predominant reaction of the mucosal layer and lamina propria. Fibrous changes of the processus uncinatus were most often detected after the intervention was performed at 71.43 ± 0.13% and in chronic rhinosinusitis with nasal polyps – 53.85 ± 0.14%. This confirms the significance of the mucoperiostasis injury factor with the underlying bone for the development of gross adhesive changes between the periosteum and bone tissue. Osteitis of the processus uncinatus was detected in 38.46 ± 0.13% of patients in group 2, 15.38 ± 0.1% in group 3, and 28.57 ± 0.17% in group 4. Conclusion. Signs of periostitis and processus uncinatus osteitis were most often detected in patients with neutrophilic mucoperiosteum infiltration in chronic rhinosinusitis with nasal polyps and in fungal balls sinus. History of surgery with periosteal and bone trauma promotes scarring and results in a tight connection between bone and periosteum, which can be regarded as a risk factor in relation to the rupture of the later in its peeling off during sinus lifting procedure. Therefore, when performing surgery on the maxillary sinus, in order to maintain conditions for possible dental implantation, excessive trauma of the periosteal layer of mucoperiosteum should be avoided


2021 ◽  
Vol 14 (3) ◽  
pp. e238778
Author(s):  
Sushmitha Kabekkodu ◽  
Suja Sreedharan ◽  
Kirti Gupta ◽  
Nirupama Murali

Mucopolysaccharidosis (MPS) type II is a rare multisystem disorder resulting from the accumulation of breakdown products of glycosaminoglycans in the body tissues. Many patients with this disease undergo ENT (ear, nose and throat) surgeries such as adenotonsillectomy and tympanocentesis at a very early age, much before the diagnosis of MPS. Nasal polyposis is a rare occurrence, with only one case of MPS II with polyposis reported in the literature. We present a patient who presented with recurrent nasal polyposis from the age of 2 years. Hale’s colloidal iron was used to stain these ‘nasal polyps’, which revealed that they are, in fact, mucopolysaccharide-laden sinonasal mucosa prolapsing into the nasal cavities. We believe this is the first time that this stain has been used to stain nasal polyps in MPS. In addition to the histopathological peculiarities of these nasal masses, we also discuss the natural history of nasal polyposis in MPS II.


Sign in / Sign up

Export Citation Format

Share Document