Postoperative application of amphotericin B nasal spray in chronic rhinosinusitis with nasal polyposis,with a review of the antifungal therapy

Chronic rhinosinusitis (CRS) affects 1–4% of the adult population. The etiology of this multifactorial, chronic disease, which leads to a significant impairment of the quality of life, often accompanied by nasal polyposis, is not fully understood. In the past decade, it was presumed that the disease, which causes characteristic eosinophilic infiltration of the nasal mucosa, is triggered by an enhanced (but not classical allergic IgE-type) immune response against fungal organisms in the nasal mucus. If this supposition is correct, then it appears obvious that the administration of amphotericin B nasal spray in adequate concentration following endoscopic polypectomy should be advantageous for these patients, and might even reduce the number of recurrent cases. To check on this assumption, we conducted a prospective randomized placebo-controlled trial involving 33 patients, 30 of whom remained in the study throughout. Patients with nasal polyposis were operated on with an endoscopic technique between 1 November 2005 and 1 October 2006; group A (14 randomly selected patients) were treated with a nasal spray containing 5 mg/ml amphotericin B, while the placebo group B (16 randomly selected patients) received a nasal spray lacking amphotericin B. We evaluated our results with the aid of a modified Lund–Mackay CT score, the SNAQ-11 test (which assesses changes in the symptoms), a quality of life test and endoscopy. The SPSS 14.0 for Windows program was utilized to process the data of examinations performed preoperatively and 1 year postoperatively. The CT scores of the group A patients 1 year after the operation exhibited wide scattering, without signs of recovery. The CT scores of the group B patients indicated a slight improvement, though this did not prove significant relative to group A. Both the SNAQ-11 test and the quality of life test revealed a significant improvement in each group, but the degrees of change in these tests did not differ significantly between the two groups of patients. The endoscopic findings indicated a slight improvement to the advantage of the amphotericin B-treated group 12 months after the operation. These results lead to the conclusion that the administration of amphotericin B nasal spray to patients operated on for nasal polyposis does not give rise to a significant alteration in either CT score, clinical symptoms, or quality of life. The more favorable clinical aspects observed in the amphotericin B-treated group during the endoscopic follow-up did not correspond to an improvement in the symptoms. In connection with the conclusions drawn from this study, the authors discuss the controversial data available on the fungal etiology of CRS. They critically analyze the contradictory observations and conclusions of seven recent clinical studies.     

Clinical significance of eosinophilic cationic protein levels in nasal secretions of patients with nasal polyposis

Nasal polyps are characterized by eosinophilic infiltration, and frequently coexist with asthma, aspirin intolerance and allergy. Eosinophilic cationic protein (ECP) is a specific eosinophil granule protein released upon activation of eosinophils. We investigated the ECP levels in nasal secretions of patients with nasal polyposis (NP) in order to correlate them with disease severity and associated diseases and to compare ECP levels between patients with and without recurrence of NP after surgical treatment. A total of 78 patients who had surgery for NP were followed up for a minimum of 18 months. The presence of asthma, allergies or aspirin intolerance was noted. Nasal secretions were obtained 1 day before the surgery and during the follow-up period after surgery. Immunoassays were used to quantify ECP in nasal secretions and serum and interleukin (IL)-5 in nasal secretions. ECP levels in nasal secretions were higher in patients with asthma or aspirin intolerance than in patients without asthma or aspirin intolerance, while no significant differences were found between allergic and non-allergic patients. ECP levels in nasal secretions correlated significantly with IL-5 levels in nasal secretions, the degree of tissue eosinophilia and computed tomographic (CT) scores. In total, 30 patients (38%) developed recurrent NP during the follow-up period. Preoperative ECP and IL-5 levels in nasal secretions were significantly higher in patients with recurrence compared to patients without recurrence. During the follow-up period, patients without recurrence demonstrated a significant reduction in the ECP levels in nasal secretions, whereas there was no significant reduction in the ECP levels of patients with recurrence. The results of this study provide evidence that ECP levels in nasal secretions of patients with NP correlate with the presence of asthma or aspirin intolerance and severity of NP determined by CT scores.     

Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

This study was carried out to compare the outcomes of endoscopic sinus surgery in patients with chronic sinusitis without nasal polyps (CRS) and those with nasal polyps (NP). We also sought to determine the correlation between preoperative computed tomography (CT) findings and postoperative endoscopy and symptom score improvement. Data were collected from two groups of patients diagnosed as CRS with and without nasal polyps that underwent functional endoscopic sinus surgery with a 1-year postoperative follow up. Preoperative symptoms, CT scores, and endoscopic scores were recorded. Postoperative symptom and endoscopic scores were recorded at 1, 6, and 12 months. Assessment of symptoms was performed subjectively using visual analogue scoring (VAS). CT scan findings were scored using the Lund–Mackay system. Endoscopic examination findings were scored according to the staging system proposed by Lanza and Kennedy. The correlations between the CT score, endoscopic scores and VAS scores were calculated. There was a statistically significant correlation between the preoperative CT, symptom, and endoscopic scores. Postoperative symptom and endoscopic scores also showed a significant correlation. Total CT scores of the CRS group were significantly lower than the scores of the NP group. Also preoperative endoscopy and symptom scores were statistically lower in CRS group compared to NP group. Endoscopy total scores and symptom total scores of both groups were significantly decreased at postoperative 12th month. Statistically significant difference was observed between the preoperative and postoperative symptom and endoscopy scores. The patients with polyps had higher symptom scores and worse objective findings compared to the patients with CRS. In all patients groups, objective and subjective scores seemed to correlate well preoperatively and postoperatively. These data suggest that endoscopic sinus surgery provides significant symptomatic relief and endoscopic healing in patients with CRS and NP.     

慢性鼻窦炎伴鼻息肉的内型研究及其指导下的精准控制与治疗

慢性鼻窦炎伴鼻息肉(CRSwNP)是指病程超过12周、伴息肉形成的鼻腔鼻窦慢性炎症,是一组表型相似但内在机制存在显著差异的复杂疾病。基于其中参与的炎症因子及其病理机制的不同可将其分为1、2、3型炎症,其中2型炎症对应于嗜酸粒细胞浸润为主的CRSwNP。不同内型(endotype)的临床表现、人口学特征、治疗反应性、预后均存在差异。因此,在深入了解不同内型病理机制的基础上,可根据其临床特点建立多种间接预测模型,以优化诊断;还可在内型指导下实现症状的精准控制与治疗,以改善预后。本文就CRSwNP内型的研究进展及其指导下的精准控制与治疗作一综述。     

鼻息肉病与正常鼻黏膜组织的蛋白质组差异分析

目的:建立分辨率高和重复性好的鼻息肉病及对照鼻黏膜双向凝胶电泳(2DE)图谱,筛选鉴定差异表达蛋白质。方法:收集鼻息肉病(鼻息肉病组)及对照鼻黏膜标本(对照组)各7例,固相pH梯度2DE、凝胶银染,扫描图像,ImageMaster2DEElite4.01软件分析,识别差异表达蛋白质,质谱仪得到相应肽质指纹图谱(PMF),PeptIdent软件查询SwissProtandTreMBL数据库,鉴定差异表达蛋白质。结果:①鼻息肉病组和对照组各自随机挑选的1个样本3次重复2DE,平均蛋白质点数分别为891±67和936±62;匹配点数为767±83和821±78,平均匹配百分率为86.1%和87.7%;同一鼻息肉病的3块胶在蛋白质点位置上有较好的重复性,不同胶间蛋白质点在等电聚焦电泳(IEF)方向偏差为(1.13±0.16)mm,在SDS聚丙烯酰胺凝胶电泳(SDSPAGE)方向偏差为(1.45±0.21)mm。分析2种组织各7例样本的2DE图谱的平均凝胶图谱,鼻息肉病组和对照组蛋白质点数为1532和1617,匹配点数为1065个。②质谱分析差异蛋白质点20个,获取16张PMF,查询数据库鉴定出差异蛋白质11个。结论:本研究建立了分辨率高和重复性好的鼻息肉病及鼻黏膜的2DE图谱,识别鉴定出一些与鼻息肉病变相关的差异表达蛋白质。     

慢性鼻窦炎鼻息肉合并哮喘患者外周血和鼻息肉组织中炎症细胞的对比分析

探讨哮喘对慢性鼻窦炎鼻息肉（CRSwNP）患者外周血、鼻息肉组织炎症细胞数目和比例的影响。方法选取2016年1月—2018年2月就诊于中国医科大学附属第一医院耳鼻咽喉科并接受鼻内镜手术的CRSwNP的住院患者,根据患者症状以及术前肺功能及支气管舒张试验的结果纳入明确诊断哮喘的患者21例,同期随机纳入CRSwNP不合并哮喘的患者56例作为对照比较。所有患者均为双侧鼻息肉,术前CT评估患者息肉严重程度大致相同。术前空腹采血分类计数炎症细胞、检测吸入物变应原。术前1周对患者进行盐水冲洗鼻腔、抗生素治疗、鼻喷激素及黏液促排剂规范化治疗,术中取同部位鼻息肉标本进行切片HE染色,高倍镜下分类计数以嗜酸粒细胞（EOS）为主的各炎症细胞。并统计所有患者2次及多次鼻内镜手术情况。利用SPSS 17.0软件对数据进行统计学分析。结果CRSwNP合并哮喘组比CRSwNP不合并哮喘组有着更高的外周血EOS百分比（P＜0.05）,两组外周血淋巴细胞与中性粒细胞(NEU)百分比无明显差异。而CRSwNP合并哮喘组与CRSwNP不合并哮喘组相比组织EOS、浆细胞、淋巴细胞、NEU及炎症细胞总数的绝对值及百分比均无统计学差异。哮喘组患者患变应性鼻炎比例及二次手术率较非哮喘组高（P＜0.05）。结论炎症细胞数目和比例与CRSwNP合并哮喘有一定相关性,合并哮喘患者提示有更高可能外周血EOS升高。哮喘可能影响鼻息肉组织中炎症细胞分布,但局部炎症细胞的数目和比例可能受多种因素影响。     

Evaluation of nasal mucociliary clearance after medical or surgical treatment of chronic rhinosinusitis

An evaluation of mucociliary clearance, with the use of rhinoscintigraphy and other objectives and subjectives measures, in medically and surgically treated patients with chronic rhinosinusitis, as well in patients with or without nasal polyposis, can add to the understanding of ciliary function and its role in the pathogenesis of chronic rhinosinusitis. Thirty-four patients medically treated and 21 surgically treated (FESS) patients evaluated with rhinoscintigraphy, CT-scans, and SNOT-20. Nine of the surgically treated patients had nasal polyps and studied as a separate group. Although the various groups differ on Lund–Mackay scores (H = 11.659, P = 0.003) and SNOT-20 results (F = 26.904, P < 0.001), a statistically significant difference between mucociliary transport velocity (MTV) values could not be found. Moreover, multiple linear regression could not prove a statistically significant correlation between MTV and other variables. The various groups of chronic rhinosinusitis patients cannot be differentiated on the basis of possible nasal mucociliary clearance alternations.     

36例鼻息肉病的综合治疗及疗效分析

目的：观察鼻息肉病综合治疗后的远期疗效。方法：对36例鼻息肉病患者,手术前应用抗生素1周,全身应用糖皮质激素3d,然后行鼻内镜手术,术后全身应用糖皮质激素5d,鼻腔局部应用糖皮质激素6个月,并在内镜下进行定期观察,随访时间3年以上。结果：36例息者综合治疗后症状都得到明显改善,其中鼻通气改善最为明显,达100％;头痛次之,达95％;嗅觉障碍恢复较差。感冒或局部停用激素后易致息肉复发.结论：对鼻息肉患者采取综合治疗能够有效地控制鼻息肉病的症状。     

Nasal polyposis (or chronic olfactory rhinitis)

The concept of chronic rhinosinusitis with or without polyps is founded on the structural and functional unicity of the pituitary mucosa and its united response to environmental aggression by allergens, viruses, bacteria, pollution, etc. The present review sets this concept against the evo-devo three-nose theory, in which nasal polyposis is distinguished as specific to the olfactory nose and in particular to the non-olfactory mucosa of the ethmoid, which is considered to be not a sinus but rather the skull-base bone harboring the olfactory mucosa. The evo-devo approach enables simple and precise positive diagnosis of nasal polyposis and its various clinical forms, improves differential diagnosis by distinguishing chronic diseases of the respiratory nose and those of the paranasal sinuses, hypothesizes an autoimmune origin specifically aimed at olfactory system auto-antigens, and supports the surgical concept of nasalization against that of functional sinus and ostiomeatal-complex surgery. The ventilation function of the sinuses seems minor compared to their production, storage and active release of nitric oxide (NO) serving to oxygenate arterial blood in the pulmonary alveoli. This respiratory function of the paranasal sinuses may indeed be their most important. NO trapped in the ethmoidal spaces also accounts for certain radiographic aspects associated with nasal polyposis.     

Influence of allergy on the symptoms and treatment of nasal polyposis

Conclusion. Allergy does not modify the symptoms of nasal polyposis, either initially or after a 1-year medical treatment. Objectives. To assess the role of allergy in the symptoms and treatment of patients presenting with the diagnosis of nasal polyposis. Patients and methods. Two simultaneous studies were carried out. In the first study, 180 consecutive patients with nasal polyposis (60% males, mean age?=?48.4 years) were analyzed to detect whether the severity of their symptoms correlated with the presence of positive allergic tests. In the second study, 74 consecutive patients (57.5% males, mean age?=?48.3 years) were analyzed to detect whether the results of a 1-year medical treatment of nasal polyposis were influenced by the presence of positive allergic tests (Phadiatop®). Five nasal criteria were scored: nasal obstruction, anterior and posterior rhinorrhea, facial pain, and the loss of sense of smell. The frequency of asthma was evaluated. Treatment of nasal polyposis consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of steroid consumption (prednisolone and beclomethasone) was studied. Results. In the first study, mean scores of nasal symptoms did not differ between the two groups of patients with and without allergy. The prevalence of asthma (p?=?0.03) was higher in the group with than without allergy. In the second study, decrease of all nasal symptoms was not statistically different in the two groups. Cumulative consumption of prednisolone and beclomethasone between baseline and year 1 were similar in the two groups.     

白细胞介素-8和白细胞介素-3在人类鼻息肉和鼻息肉病中的表达

目的 :探讨白细胞介素 8(IL 8)和白细胞介素 3(IL 3)在人类鼻息肉及鼻息肉病中的表达情况。方法 :采用免疫组织化学方法检测 31例鼻息肉患者 (鼻息肉组 )、2 6例鼻息肉病患者 (鼻息肉病组 )的息肉组织及 14例正常中鼻甲黏膜 (对照组 )中IL 8和IL 3的表达。结果 :IL 8在对照组、鼻息肉组及鼻息肉病组 3组间呈递增性表达 ,且每两组间差异均有统计学意义 (均P <0 .0 1) ;IL 3在对照组、鼻息肉组及鼻息肉病组 3组间亦呈递增性表达 ,且每两组间差异均有统计学意义 (均P <0 .0 1〉。结论 :IL 8是鼻息肉诸多病因之一 ,对鼻息肉病的复发起重要作用 ;IL 8在鼻息肉及鼻息肉病之间的不同表达提示二者的发病机制有本质差异 ;IL 3对鼻息肉组织中嗜酸性粒细胞的大量浸润起重要作用 ,也是鼻息肉与鼻息肉病二者发病机制差异中的一个重要因素     

一氧化氮在鼻息肉及鼻黏膜慢性炎症中的检测

目的检测正常鼻黏膜一氧化氮(nitric oxide, NO)分布特点以及鼻息肉患者息肉组织中NO含量,探讨其在鼻粘膜炎症过程中的意义。方法采用重氮化反应法(Greiss反应法)检测20例鼻息肉患者(A组)的息肉组织中和下鼻甲黏膜中NO的表达,并与12例健康人(B组)下鼻甲、钩突及嗅裂粘膜对照:A、B两组手术前静脉血中NO含量作比较。结果A组患者血清、息肉组织及下鼻甲黏膜中NO含量分别为(63．8±18．7)μmol／L、(105．6±23．5)μmol／L、(81．4±20．4)μmol／L;B组血清、下鼻甲、钩突及嗅裂黏膜中NO含量分别为(63．3±23．0)μmol／L、(54．5±18．1)μmol／L、(83．0±23．7)μmol／L、(62．3±24．4)μmol／L。两组血清中NO含量差别无统计学意义(P<0．05);鼻息肉组织中NO含量高于鼻黏膜以及正常鼻黏膜组织NO含量(P<0．05);鼻息肉患者下鼻甲黏膜中NO含量高于正常鼻黏膜(除钩突黏膜外)NO含量(P<0．05),正常鼻黏膜中NO含量分布有差别(P<0．05)。结论NO是一种具有广泛生物活性的物质,在鼻息肉发病机理中和导致鼻黏膜持续性炎症中有重要作用。     

ASA disease: the clinical relationship of nasal polyposis to ASA intolerance

Summary We studied the complex relationship between nasal polyposis and ASA (acetylsalicylic acid) intolerance in 154 patients with nasal polyps. The clinical histories of all patients were reviewed, and diagnostic tests for immune or allergic causes and the responsiveness of patients to challenges with ASA-substitutive drugs were analyzed. A third of our patients tested were found to have positive personal histories of atopy and 35% showed ASA intolerance. Although 40% had bronchial asthma, only 16.8% of all patients had positive tests for allergy. We were unable to find a specific mechanism to explain the relationship between nasal polyposis and ASA intolerance and further investigations are still required.     

Metalloproteinase function in chronic rhinosinusitis with nasal polyposis

OBJECTIVES: Chronic rhinosinusitis with nasal polyposis (CRSwNP) and asthma share characteristic inflammatory features and histopathologic findings of airway remodeling. Remodeling, which is controlled by matrix metalloproteinases (MMP), is a key event in the pathogenesis of asthma. The MMP functions have rarely been evaluated in CRSwNP. STUDY DESIGN: Prospective and in vivo. METHODS: MMP-7, MMP-8, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 concentrations were analyzed by enzyme-linked immunosorbent assay and their molecular forms by Western immunoblotting and gelatin zymography in 24 patients operated on for CRSwNP and in nasal lavages from 19 healthy controls. MMP function, protective or destructive, was evaluated by comparing MMP/TIMP-1 levels with the disease activity, estimated by tissue eosinophilia and a need for re-operations. RESULTS: Significantly increased levels of MMP-8/TIMP-1 and MMP-9/TIMP-1 were found in patients without tissue eosinophilia relative to eosinophil-positive CRSwNP patients and controls, as well as in patients who did not require re-operation in comparison with re-operated patients. In eosinophil-positive and re-operated patients, these parameters were within the same range than in controls. CONCLUSIONS: Proteolytic spectrum is different in eosinophilic and noneosinophilic CRSwNP, suggesting a new mechanism for eosinophil accumulation in the disease pathogenesis. Enhanced MMP-8 and MMP-9 expression was associated with a better prognosis/clinical outcome, and thus these results may represent a synergic, protective role of MMP-8 and MMP-9 in host response in CRSwNP. Because synthetic MMP inhibitors, capable of equilibrating the unfavorable MMP/TIMP-ratio, may be of potential therapeutic value in chronic respiratory tract diseases, the MMP functions in inflammatory conditions need to be carefully established.     

应用鼻腔冲洗器冲洗鼻腔对慢性鼻-鼻窦炎患者鼻腔黏液纤毛功能的影响

目的观察应用鼻腔冲洗器冲洗鼻腔对慢性鼻-鼻窦炎患者鼻腔黏膜纤毛功能的影响。方法60例单纯性慢性鼻-鼻窦炎患者,随机分为治疗组和对照组。治疗组用3%高渗盐水经鼻腔冲洗器冲洗鼻腔,对照组用3%高渗盐水经灌肠袋冲洗鼻腔,均为每日两次,连续冲洗14天,并辅以短期药物辅助治疗。分别于治疗前、治疗2周及疗后3月以糖精试验法检测鼻腔黏液纤毛清除率,比较两组鼻腔黏膜纤毛功能恢复情况和症状与体征的变化。结果治疗前2组的鼻腔黏液纤毛清除率差异无统计学意义;治疗2周后治疗组清除率为6.15±2.16mm/min,对照组为4.99±1.35mm/min,P＜0.05,前者的症状改善程度也较为明显;疗后3月治疗组清除率为6.81±1.45mm/min,对照组为6.69±2.41mm/min,P＞0.05。结论用鼻腔冲洗器冲洗鼻腔可有效促进鼻腔黏膜纤毛功能的早期恢复,对慢性鼻-鼻窦炎有辅助治疗作用。     

鼻息肉、鼻息肉病及对照鼻黏膜蛋白质双向电泳图谱的建立

目的　建立鼻息肉、鼻息肉病及对照鼻黏膜组织蛋白质双向凝胶电泳 (2 DE)图谱。方法　收集并- 80℃冻存鼻息肉、鼻息肉病及鼻黏膜组织样本各 3例 ,双向凝胶电泳分离样本总蛋白、银染凝胶显色 ,扫描图像 ,ImageMaster 2 DEElite4 .0 1软件分析。结果　鼻息肉、鼻息肉病和鼻黏膜组织同一样本三块凝胶平均蛋白质点数分别为 82 5± 78个 ,891± 6 7个和 936± 6 2个 ;平均匹配点数分别为 6 82± 96个 ,76 7± 83个和 82 1± 78个 ,其平均匹配百分率分别为 82 .7%、86 .1%和 87.7% ;位置重复性分析 ,IEF方向平均偏差为 1.13± 0 .16mm ,SDS PAGE方向平均偏差为 1.4 5± 0 .2 1mm。鼻息肉、鼻息病和鼻黏膜三种组织各 3例样品的平均蛋白质点数分别为 876± 95个 ,95 3± 84个和 10 16± 79个。三种组织的 2 DE平均凝胶图谱 :鼻息肉、鼻息肉病和鼻黏膜蛋白质点数分别为116 2个、12 74和 1336个 ,平均匹配点数为鼻息肉与鼻黏膜之间 75 7个 ;鼻息肉病与鼻黏膜之间为 82 5个 ;鼻息肉与鼻息肉病之间为 883个。结论　本实验建立了图像清晰、分辨率高和重复性好的鼻息肉、鼻息肉病及鼻黏膜组织的固相PH梯度 2 DE图谱 ,有助于进一步识别鉴定三者差异表达的蛋白质。     

Topical furosemide versus oral steroid in preoperative management of nasal polyposis

The efficacy of topical nasal furosemide treatment has been shown in the protection of nasal polyp recurrence. The aim of the study was to compare the effect of oral steroid, as standard preoperative treatment, and inhaled furosemide, as alternative treatment, for 7 days preoperatively in terms of subjective improvement of nasal symptoms, polyp size reduction, inflammation in the polyp tissue, and intraoperative blood loss. A group of 40 patients with nasal polyposis entered the study and they were randomly allocated to 7-day preoperative treatment with either oral methylprednisolon (1 mg/kg/day) or topical furosemide by inhalation (6.6 mmol/l solution). Subjective scores of rhinosinusitis symptoms, polyp scores at endoscopy, and biopsy of the most superficial polyp were taken at inclusion. All procedures were repeated on day 7. Intraoperative blood loss was estimated (scores 0–10) by the surgeon at the operation. Eosinophils, mastocytes, and oedema were quantified by histomorphometry. Subjective symptoms and endoscopy scores did not differ significantly between the groups after the treatment although improvement of olfaction was insignificantly better in the steroid group. Steroid treatment significantly reduced eosinophil count, with no effect on mastocytes and oedema. Furosemide treatment did not affect inflammatory cells count significantly, but it has significantly reduced oedema in previously unoperated patients. No difference in intraoperative bleeding was observed between the groups.     

Corticosteroid treatment in nasal polyposis with a three-year follow-up period

OBJECTIVES/HYPOTHESIS: The management of nasal polyposis is undoubtedly a controversial subject. The part played by surgery seems to be steadily growing, if the number of published reports dedicated to this approach is any yardstick. Although the medical treatment remains the undisputed therapeutic mainstay, trials dedicated to the long-term assessment of its overall efficacy are scarce. STUDY DESIGN: Retrospective medical record review. METHODS: The aim of the study is focused on the evaluation of a dual modality, topical and systemic, over a follow-up period of 3 years. In all, 100 patients were treated according to a standardized therapeutic protocol combining short-term oral administration of prednisolone and daily intranasal spray of beclomethasone. RESULTS: Over the follow-up period of 3 years, this dual modality proved to be successful in 85% of the patients; only 15% had to undergo surgery after its failure. The average symptom reduction reached an improvement rate varying from 58% to 80%, according to the symptom type. The daily dosage of prednisolone and beclomethasone was progressively decreased while the gain in nasal comfort was being preserved. CONCLUSIONS: Management of nasal polyps should be primarily medical. Resorting to surgical procedures should not be envisaged before a trial is conducted of dual steroid therapy under a regimen of strict compliance to treatment.