Clinicopathological Determinants of Treatment Outcomes of Nasal Polyps in a Black African Cohort 

Authors

  • Adekunle Adeyemo Department of Otorhinolaryngology, Obafemi Awolowo University, Ile Ife, Nigeria
  • Temilola O. Owojuyigbe Department of Haematology and Immunology, Obafemi Awolowo University, Ile Ife, Nigeria
  • Ajibola T. Osukoya Department of Otorhinolaryngology Obafemi Awolowo University Teaching Hospital Ile Ife, Nigeria
  • Akumbu S. Ohuche Department of Otorhinolaryngology Obafemi Awolowo University Teaching Hospital Ile Ife, Nigeria
  • Ogochukwu C. Ejiofor Department of Otorhinolaryngology Obafemi Awolowo University Teaching Hospital Ile Ife, Nigeria
  • Y.B. Amusa Department of Otorhinolaryngology, Obafemi Awolowo University, Ile Ife, Nigeria

DOI:

https://doi.org/10.12970/2308-7978.2019.07.04

Keywords:

 Nasal polyps, antrostomy, Functional Endoscopic Sinus Surgery, FESS, simple polypectomy.

Abstract

 Background: The propensity for nasal polyps to recur post treatment is a subject of ongoing research globally. There are however no studies focusing on determinants of post treatment recurrence of polyps in a predominantly black population. Methodology: This was a retrospective review of clinical notes and charts of all black patients managed for nasal polyps in our centre during the study period. Result: Forty-four patients with median age of 27.50 years (IQR = 22.75) were studied. There were 21 males and 23 females. Forty-two patients (94.46%) had an initial medical treatment while two patients presenting with recurrent disease were managed surgically from the onset. Twenty two (52.38%) of patients who had an initial medical treatment had complete disease resolution with no recurrence while 20 (47.62%) patients had persistent disease after one month of medical treatment and were offered surgery. Of the 21 patients who had surgery, 8 patients each had either simple polypectomy or combination of simple polypectomy and antrostomy. The rest (5) had Functional endoscopic sinus surgery. There was no significant difference in outcomes between the different surgical groups with a cumulative post-surgery recurrence rate of 23.81%; however, the addition of antrostomy increased the rate of post-operative adhesions. There was no significant difference in the age, sex, duration of symptoms and treatment modality among patients with respect to recurrence. Conclusion: Nasal polyps recur post treatment in an unpredictable manner, initial medical management is efficacious in eliminating nasal polyps in more than half of the patients potentially avoiding surgeries in such patients. 

References


[1] Aslan F, Altun E, Paksoy S, Turan G. Could Eosinophilia predict clinical severity in nasal polyps? Multidiscip Respir Med
[Internet] 2017 PMC5563888]; 12:
[21 p.]. https://doi.org/10.1186/s40248-017-0102-7
[2] Pietruszewska W, Olejniczak I, Jozefowicz-Korczyaska M, Gryczynski M. Etiology of nasal polyps: an update. Otolaryngol Pol 2006; 60(4): 551-557.
[3] Pawankar R. Nasal polyposis: an update. Current Opinion in Allergy and Clinical Immunology 2003; 3(1): 1-6. https://doi.org/10.1097/00130832-200302000-00001
[4] Cimmino M, Cavaliere M, Nardone M, Plantulli A, Orefice A, Esposito V, et al. Clinical characteristics and genotype analysis of patients with cystic fibrosis and nasal polyposis. Clinical Otolaryngology & Allied Sciences 2003; 28(2): 125- 132. https://doi.org/10.1046/j.1365-2273.2003.00677.x
[5] Jafari A, DeConde AS. Outcomes in Medical and Surgical Treatment of Nasal Polyps. Adv Otorhinolaryngol 2016; 79: 158-167. https://doi.org/10.1159/000445155
[6] Akhtar S, Ikram M, Azam I, Dahri T. Factors associated with recurrent nasal polyps: a tertiary care experience. J Pak Med Assoc 2010; 60(2): 102-104.
[7] Gelardi M, Fiorella R, Fiorella ML, Russo C, Soleti P, Ciprandi G. Nasal-sinus polyposis: clinical-cytological grading and prognostic index of relapse. J Biol Regul Homeost Agents 2009; 23(3): 181-188.
[8] Jantti-Alanko S, Holopainen E, Malmberg H. Recurrence of nasal polyps after surgical treatment. Rhinol Suppl 1989; 8: 59-64.
[9] Okada N, Nakayama T, Asaka D, Inoue N, Tsurumoto T, Takaishi S, et al. Distinct gene expression profiles and regulation networks of nasal polyps in eosinophilic and noneosinophilic chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 8(5): 592-604. https://doi.org/10.1002/alr.22083
[10] Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60(5): 583-601. https://doi.org/10.1111/j.1398-9995.2005.00830.x
[11] Hissaria P, Smith W, Wormald PJ, Taylor J, Vadas M, Gillis D, et al. Short course of systemic corticosteroids in sinonasal polyposis: a double-blind, randomized, placebo-controlled trial with evaluation of outcome measures. Journal of allergy and clinical immunology 2006; 118(1): 128-133. https://doi.org/10.1016/j.jaci.2006.03.012
[12] Lildholdt T, Rundcrantz H, Bende M, Larsen K. Glucocorticoid treatment for nasal polyps: the use of topical budesonide powder, intramuscular betamethasone, and surgical treatment. Archives of Otolaryngology–Head & Neck Surgery 1997; 123(6): 595-600. https://doi.org/10.1001/archotol.1997.01900060037006
[13] Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, et al. Clinical practice guideline (update) adult sinusitis executive summary. Otolaryngology-- Head and Neck Surgery 2015; 152(4): 598-609. https://doi.org/10.1177/0194599815574247
[14] Dessouky O, Hopkins C. Surgical versus medical interventions in CRS and nasal polyps: comparative evidence between medical and surgical efficacy. Current Allergy and Asthma Reports 2015; 15(11): 65-74. https://doi.org/10.1007/s11882-015-0566-5
[15] Becker SS. Surgical management of polyps in the treatment of nasal airway obstruction. Otolaryngol Clin North Am 2009; 42(2): 377-385. https://doi.org/10.1016/j.otc.2009.01.002
[16] Mortuaire G, Leroy X, Gengler I, Chevalier D, Prin L, Picry A. Histopathological classification of refractory chronic rhinosinusitis with nasal polyps. Histol Histopathol 2015; 30(12): 1447-1454.
[17] Mahdavinia M, Benhammuda M, Codispoti CD, Tobin MC, Losavio PS, Mehta A, et al. African American patients with chronic rhinosinusitis have a distinct phenotype of polyposis associated with increased asthma hospitalization. The Journal of Allergy and Clinical Immunology: In Practice 2016; 4(4): 658-664. https://doi.org/10.1016/j.jaip.2015.11.031

Downloads

Published

2019-03-25

Issue

Section

Articles