• Users Online: 745
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 35  |  Issue : 3  |  Page : 246-249

Nasal polyposis and the role of alphintern


Otorhinolaryngology Department, Benghazi Medical Center, Benghazi, Libya

Date of Submission06-Jan-2019
Date of Acceptance22-Feb-2019
Date of Web Publication21-Aug-2019

Correspondence Address:
Agila Al-Barasi
AFSA Universiy Sofia Antipolis Nice France, DLO Baulsabatier France, Libyan Board Libya, MBBCH Libya, Otorhinolaryngology Department, Benghazi Medical Center, Benghazi
Libya
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejo.ejo_7_19

Rights and Permissions
  Abstract 


Introduction Nasal polyposis is a chronic inflammatory disease of the nasal mucosa. The pathogenesis of nasal polyps is still not entirely known. This makes definitive treatment very challenging. The aim of our study is to evaluate the effect of alphintern on the treatment of nasal polyposis.
Patients and methods Patients received alphintern tablet for 2 weeks. Before and after drug intake all patients were asked to fill in a questionnaire in which they rated their overall symptoms on visual analog scale; endoscopic physical findings were scored on the Lindholdt staging system.
Results Twenty-three patients were included in the study, 14 men and nine women in the age range from 25 to 56 years. Statistical analysis shows no significant difference (P>0.05) before and after treatment with alphintern for severity of symptoms and endoscopic staging of nasal polyposis.
Discussion The main goals in the treatment of nasal polyposis, whether medical or surgical, are to relief patient symptoms and to prevent complications. There are few direct comparisons of the medical and surgical treatment in the literature. Those that exist suggest that most patients should be treated medically, with surgery reserved for patients who respond poorly. Intranasal corticosteroids are by far the best documented type of medical treatment for nasal polyposis. Researches for other drugs for the treatment of nasal polyposis were done. In this study, the use of alphintern for the treatment of nasal polyposis shows no significant improvement in the severity of symptoms and size of polyps.
Conclusion Topical intranasal steroids are the best documented medical treatment. Alphintern shows no significant effect on the management of nasal polyposis. Further studies with more patients and longer duration of treatment are required for more evaluation of drug effect.

Keywords: alphintern, intranasl steroids, nasal polyposis


How to cite this article:
Al-Barasi A. Nasal polyposis and the role of alphintern. Egypt J Otolaryngol 2019;35:246-9

How to cite this URL:
Al-Barasi A. Nasal polyposis and the role of alphintern. Egypt J Otolaryngol [serial online] 2019 [cited 2019 Sep 22];35:246-9. Available from: http://www.ejo.eg.net/text.asp?2019/35/3/246/265007




  Introduction Top


Nasal polyposis is a chronic inflammatory disease of the nasal mucosa. The prevalence of nasal polyps seems to vary between 1 and 4% of the population [1]. and accounts for 40% of chronic nasal disease [2].

Nasal polyposis is the end result of a variety of pathologic processes. The pathogenesis of nasal polyps is still not entirely known and has been debated for many years. This lack of understanding makes definitive treatment very difficult [3].

Although the etiology of nasal polyposis remains unknown, emerging evidence showing elevated local IgE levels and eosinophilic infiltration suggests an allergic etiology [4]. Activated eosinophils are a prominent feature of nasal polyps. Their presence in the tissue results from a complex series of events that regulate their influx from the vasculature, as well as their movement, activation, and survival within the tissue. Several studies have demonstrated that there are many potent chemoattractants that can activate eosinophils and trigger the inflammatory response [3].

Patients with nasal polyposis commonly present with nasal obstruction, nasal discharge, facial pressure/pain, and hyposmia of prolonged duration [5].

The aims of the treatment are to relieve nasal blockage, restore olfaction, and improve sinus drainage [6].

Alphintern (chymotrypsin–trypsin) is an anti-inflammatory antiedematous medication used to treat ecchymosis and skin bruises. It has been used by some local physicians to treat nasal polyposis.

The aim of this study was to evaluate the effect of the course of alphintern on nasal symptoms, and endoscopic finding in patients with nasal polyposis.


  Materials and methods Top


A prospective, before-after study was performed on 23 patients diagnosed as chronic nasal polyposis who were referred to the ENT Clinic, Benghazi Medical Center, Benghazi, Libya in the period from March 2013 to July 2013.

Written consent was obtained from each patients before enrollment into the research project.

Inclusion criteria

  1. Age more than18 years.
  2. Patients with chronic nasal polyposis confirmed by symptoms and signs (nasal obstruction, nasal discharge, smell disturbance, postnasal discharge, headache/facial pain, and bilateral visible nasal polyps).


Exclusion criteria

  1. Clinical features of less than 12 weeks.
  2. Patients with previous history of nasal or paranasal sinuses surgery or trauma.
  3. Patients who receive oral or topical steroids, antibiotics the previous month.



  Patients and methods Top


After primary assessment all patients in this study were subjected to the following after signing the informed consent:

Epidemiologic data were collected, including age and sex.

Severity of symptoms (nasal obstruction, nasal discharge, postnasal discharge, smelling disturbance, headache, and facial pain) were assessed with the symptom score instrument [7], which uses a 0–10 visual analog scale (VAS). Patients rated their symptoms ranging from 0 (no symptoms) to 10 (the most severe condition).

Endoscopic physical findings were scored based on the Lildholdt staging system [8] where:
  1. Small polyps not reaching the upper edge of the inferior turbinate.
  2. Polyps reaching between the upper and lower edge of the inferior turbinate.
  3. Large polyps reaching below the lower edge of the inferior turbinate.


Patients received alphintern (AMOUN Pharmaceutical, Egypt) tablet 600 mg three times daily for 2 weeks. Before and after drug intake all patients were asked to fill in a questionnaire in which they rated their overall symptoms on VAS.

Endoscopic physical findings before and after treatment were scored on the Lindholdt staging system.


  Results Top


During the study 23 patients with nasal polyposis were enrolled, 14 men and nine women in the age range from 25 to 56 years. The mean of VAS scores before and after treatment with alphintern are shown in [Table 1]. The difference between before and after treatment scores was statistically not significant (P>0.05) for nasal obstruction, nasal discharge, postnasal discharge, facial pain, and smell disturbance.
Table 1 Results of visual subjective analog scale score before and after treatment

Click here to view


Comparison of endoscopic staging of polyposis before and after treatment is shown in [Table 2]. The frequency between before and after treatment scores was statistically not significant.
Table 2 Nasal endoscopic staging before and after treatment

Click here to view



  Discussion Top


The management of nasal polyposis is undoubtedly a controversial subject. The main goals in the treatment of nasal polyposis are relief of patient symptoms and prevention of complications [9], whether medical or surgical. There are few direct comparisons of medical and surgical treatment in the literature. Those that exist suggest that most patients should be treated medically, with surgery reserved for patients who respond poorly [6]. Oral and intranasal steroids are by far the best documented type of medical treatment for nasal polyposis [10].

Most of the publications are aimed at the registration of new molecules from the pharmaceutical industry which explains why they are confined to a single agent. Payman et al. [11] studied the efficacy of clarithromycin in patients with severe nasal polyposis and found that a course of clarithromycin significantly improved nasal symptoms, polyp size, and computed tomography scan finding. Kieff et al. [12] studied the effect of montelukast in the treatment of nasal polyposis; they found that montelukast appears to be beneficial for some patients with nasal polyposis. Patients with perennial allergies and nasal polyposis seem more likely to respond to the treatment than those with nonallergic nasal polyposis. Haye et al. [13] who studied the effect of cetirizine on symptoms and signs of nasal polyposis found that the number and size of polyps remained unchanged during the study period. Kroflic et al. [14] studied the effect of topical furosemide versus oral steroid in the preoperative management of nasal polyposis and found that subjective symptoms and endoscopy scores did not differ significantly between the groups after the treatment, although improvement of olfaction was significantly better in the steroid group. Helbling et al. [15] studied the efficacy of intranasal amphotericin B on nasal polyposis and found that nasal amphotericin B spray is not effective for nasal polyps and may even cause deterioration.

This study was developed to gain more insight into the effects of alphintern in the treatment of nasal polyposis.

Each tablet of alphintern contains chemotrypsin and trypsin and has a synergistic anti-inflammatory and antiedematous action of two potent proteolytic enzymes, affecting the exudative phase of inflammation and ensuring the destruction of peptidic chains in inflammatory processes, regardless of their origin, used to treat ecchymosis and skin bruises it has been used by some local physicians to treat nasal polyposis.A variety of methods may be used for measuring symptom severity in chronic rhinosinusitis patients. Although Sinonasal Outcome Test-22 has been shown to be the best available test for subjective classification [16], its use is time consuming and rather complicated in a busy clinic. Using simpler methods like VAS scoring is more feasible and enables an accurate and repeatable evaluation of symptoms [7].

In this study, 23 patients were enrolled to this study, 14 men and nine women in the age range from 25 to 56 years. Statistical analysis shows no significant difference (P>0.05) before and after treatment with alphintern for severity of symptoms and endoscopic staging of nasal polyposis.


  Conclusion Top


  1. Nasal polyposis is a common chronic disease of the nose and paranasal sinuses.
  2. Topical intranasal steroids are the best documented medical treatment.
  3. Alphintern shows no significant effect on the management of nasal polyposis.
  4. Further studies with more patient samples and longer duration of treatment are required for more evaluation of drug effects.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Olejniczak I, Kobos J, Gryczyński M, Durko M, Pietruszewska W. Expression of adhesion molecule ICAM-1 in patients with nasal polyps. Otolaryngol Pol 2007; 61:607–611.  Back to cited text no. 1
    
2.
Norès JM, Avant P, Bonfils P. Sino-nasal polyposis. Evaluation of the efficacy of combined local and general corticotherapy in a series of 100 consecutive patients with a 3-year follow-up. Bull Acad Natl Med 2002; 186:1643–1656.  Back to cited text no. 2
    
3.
Figueiredo CR, Silva ID, Weckx LL. Inflammatory genes in nasal polyposis. Curr Opin Otolaryngol Head Neck Surg 2008; 16:18–26.  Back to cited text no. 3
    
4.
Penn R, Mikula S. The role of anti-IgE immunoglobulin therapy in nasal polyposis: a pilot study. Am J Rhinol 2007; 21:428–432.  Back to cited text no. 4
    
5.
Gillespie MB, Osguthorpe JD. Pharmacologic management of chronic rhinosinusitis, alone or with nasal polyposis. Curr Allergy Asthma Rep 2004; 4:478–485.  Back to cited text no. 5
    
6.
Scadding GK. Comparison of medical and surgical treatment of nasal polyposis. Curr Allergy Asthma Rep 2002; 2:494–499.  Back to cited text no. 6
    
7.
Toros SZ, Bölükbasi S, Naiboğlu B, Er B, Akkaynak C, Noshari H, Egeli E. Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps. Eur Arch Otorhinolaryngol 2007; 264:1003–1008.  Back to cited text no. 7
    
8.
Johansson L, Akerlund A, Holmberg K, Melén I, Stierna P, Bende M. Evaluation of methods for endoscopic staging of nasal polyposis. Acta Otolaryngol 2000; 120:72–76.  Back to cited text no. 8
    
9.
Norès JM, Avan P, Bonfils P. Medical management of nasal polyposis: a study in a series of 152 consecutive patients. Rhinology 2003; 41:97–102.  Back to cited text no. 9
    
10.
Mygind N, Valerie J. Nasal polyposis. In: Michael G, George G, Martin J et al. editors. Scott-Brown’s otolaryngology, head and neck surgery. 7th ed. Great Britain: Hodder Arnold 2008. pp. 1549–1559.  Back to cited text no. 10
    
11.
Payman D, Jalal M, Shahin B, Ali M, Zahra M. The efficacy of clarithromycin in patients with severe nasal polyposis. Acta Med Iran 2013; 51:6.  Back to cited text no. 11
    
12.
Kieff DA, Busaba NY. Efficacy of montelukast in the treatment of nasal polyposis. Ann Otol Rhinol Laryngol 2005; 114:941–945.  Back to cited text no. 12
    
13.
Haye R, Aanesen JP, Burtin B, Donnelly F, Duby C. The effect of cetirizine on symptoms and signs of nasal polyposis. J Laryngol Otol 1998; 112:1042–1046.  Back to cited text no. 13
    
14.
Kroflic B, Coer A, Baudoin T, Kalogjera L. Topical furosemide versus oral steroid in preoperative management of nasal polyposis. Eur Arch Otorhinolaryngol 2006; 263:767–771.  Back to cited text no. 14
    
15.
Helbling A, Baumann A, Hänni C, Caversaccio M. Amphotericin B nasal spray has no effect on nasal polyps. J Laryngol Otol 2006; 120:1023–1025.  Back to cited text no. 15
    
16.
Morley AD, Sharp HR. A review of sinonasal outcome scoring systems- which is best? Clin Otolaryngol 2006; 31:103–109.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and me...
Patients and methods
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed202    
    Printed20    
    Emailed0    
    PDF Downloaded46    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]