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Introduction
Nasal polyposis (NP) is one of the chronic transparent, the hallmark cells in sinonasal
severe airway diseases. It is known as a polyposis. Infiltrated eosinophils in nasal
non-neoplastic inflammatory process of polyp tissue syntheses the transforming
nasal mucosa that eventually leads to the growth factor beta (TGF-β), which leads to
outgrowth of abnormal masses inside the the specific grape like clusters and without
mucosa of nasal cavity and paranasal sinuses. bleeding (1). They contain loose connective
The polyps are most frequently detected in tissue, edema and pro-inflammatory cells,
middle meatus and ethmoid region. They which are mostly eosinophils (almost in
are usually bilateral and multiplex with soft, 85% of NP). Due to high rate of eosinophils
*Corresponding author: Fereshteh Esmatinia. This is an Open Access article distributed under the
Sinus and Surgical Endoscopic Research terms of the Creative Commons Attribution License
Center, School of Medicine, Mashhad (http://creativecommons.org/licenses/by/3.0),
University of Medical Sciences, Mashhad, Iran which permits unrestricted use, distribution, and
E-mail: F.esmatinia@yahoo.com reproduction in any medium, provided the original
Tel: 051-38012689 work is properly cited.
in nasal polyp’s tissue, they are proposed different methods. Applying corticosteroids
as structural changes of nasal polyps such are the most significant medical treatment
as fibrosis of stromal and thickening of among wide range of pharmacotherapy
membrane. TGF-β and interleukin 5 (IL- method, which have been applied pre- or
5) produced by eosinophils contributes postsinonasal surgical interventions for
in the pathogenesis of NP (2,3). Different obtaining more success. The mechanism
disease conditions such as asthma, chronic of corticosteroids is mainly through
sinusitis, and aspirin sensitivity are related decreasing the infiltration of eosinophils
to the higher risk of NP occurrence. and production of IgE by increasing the
NP is a chronic health complication, expression of anti-inflammatory genes, or
which affects the patient’s quality of life enhancing the apoptosis of inflammatory
more that other chronic diseases (4). cells (7,8).
Nasal obstruction is the major symptom of In different conditions, applying
sinonasal polyposis, which shows various medication would not be sufficient for NP
intensity based on the polypsis and location. treatment, which leads to use of sinonasal
Nasal congestion, anosmia, rhinorrhea, surgeries. Polypectomy and endoscopic
postnasal drip, headache, hyposmia/ sinus surgery (ESS) are surgical options,
anosmia, loss of smell and coughing are which have shown considerable efficacy
other common presentations of NP. In one in treating inflammatory diseases of
study, it is demonstrated that small size paranasal sinuses. Although there might be
polyps lead to lower level of sinonasal various side effects along with performing
complications (5). surgical interventions, considerable levels
of reduction in NP complications and
Diagnosis and treatment methods improvement in patient’s quality of life
Conventional radiography is not sensitive have been observed (9).
enough to use for NP investigations. This Although the prevalence of NP is still a
method can only illustrate the opacification controversial issue, the general prevalence
of the involved sinuses. Performing nasal of NP has been estimated to be low in
endoscopy and computed tomography be- general population (range from 1-4%), with
fore any intervention usually provides con- higher frequency in adults compared with
siderable data about the initial diagnosis of children under 10 (10).
bilateral and symmetric NP. Nasal endosco- The incidence rate of the NP is dependent
py is known as the gold standard method for on the studied population. According to the
NP diagnosis. For the unilateral NP, more investigations, elderly and patients with
diagnostic procedures are required (6). cystic fibrosis, Churg-Strauss syndrome,
Different medical treatments have been used sarcoidosis and asthma are at higher risk for
for reducing the NP irritating presentations NP (11,12).
(e.g., nasal obstruction, congestion and
sinus inflammation) in patients. The main The etiology of NP
purpose of pharmacotherapy or even Although there are multiple predisposing
sinonasal surgery is providing a sinonasal factors in the development and pathogenesis
environment without any stimuli for polyp of NP, but the exact causes are under
development. Topical and oral steroids, debate. NP occurs almost due to unknown
macrolide antibiotics, diuretic nasal washes or idiopathic causes and has high relapse
and intrapolyp steroid injection are among tendency, which leads to complex treatment