Nasal polyposis : more than a chronic inflammatory disorder : a disease of mechanical dysfunction : the São Paulo position

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP

Prospective open-label evaluation of long-term low-dose doxycicline for difficult-to-treat chronic rhinosinusitis with nasal polyps

Introdução: A rinossinusite crônica com polipose nasal constitui um subgrupo particular da rinossinusite crônica, caracterizado por uma inflamação da mucosa que leva a um espessamento da mesma e à formação de pólipos, podendo ser especialmente difícil de tratar. A Doxiciclina é um antibiótico bacteriostático, de largo espectro, que também tem uma ação antiinflamatória, e tem se mostrado útil no controle dos sintomas das recidivas desta doença, promovendo inclusive uma diminuição do pólipo. Objetivo: avaliar se o uso de baixas doses de Doxiciclina, por períodos prolongados, pode melhorar o controle clínico da rinossinusite crônica com polipose nasal, de difícil tratamento. Métodos: este é um estudo prospectivo, aberto, realizado em 60 pacientes com rinossinusite crônica de difícil tratamento que se submeteram a cirurgia endoscópica nasal. Os pacientes foram divididos em 2 grupos: 28 pacientes receberam corticóide nasal, lavagem nasal com soro fisiológico, e Doxiciclina (200mg no primeiro dia, seguido por 100mg uma vez ao dia) por 12 semanas, enquanto 30 pacientes receberam apenas corticóide nasal e lavagem nasal com soro fisiológico. O principal resultado avaliado foi a existência de uma melhora, dose efeito, clinicamente significativa do SNOT-20 após o tratamento com a Doxiciclina. Outros resultados avaliados foram os valores do SNOT-20, NOSE e do Lund-Kennedy. Os seguintes parâmetros também foram analisados: asma, rinite, doença respiratória exacerbada pela Aspirina (DREA), níveis séricos de IgG, IgA, IgE, IgM, ANCA e contagem de eosinófilos. Resultados: oy tratamento com a Doxiciclina promoveu uma melhora, dose efeito, clinicamente significativa do SNOT-20. Pacientes que receberam a Doxiciclina também tiveram resultados significativamente melhores do SNOT-20, NOSE e Lund-Kennedy. Houve uma associação negativa entre a melhora clinicamente significativa do SNOT-20 e a presença de asma, DREA e níveis séricos elevados de IgE pré-tratamento. Conclusão: os achados sugerem que a doxiciclina pode ter uma ação benéfica nos pacientes com rinossinusite crônica com polipose nasal, especialmente naqueles pacientes sem asma, DREA ou níveis séricos elevados de IgE prétratamentoIntroduction: Chronic rhinosinusitis with nasal polyps is a particular subset of chronic rhinosinusitis characterized by a mucosal inflammation that leads to mucosal thickening and polyp formation, and can be especially difficult to treat. Doxycycline is an oral, available, broad-spectrum bacteriostatic antibiotic which also has anti-inflammatory action, that has been used to treat this disease and has shown a successful control of symptoms even reducing the volume of polyps. Objective: Evaluate if long-term low-dose doxycycline is effective in controlling clinical symptoms of difficult-to-treat chronic rhinosinusitis with nasal polyps. Methods: This was a prospective, open-label study of 60 patients with difficultto- treat chronic rhinosinusitis with nasal polyps who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count. Results: There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment. Conclusion: These findings suggest that doxycycline may have a beneficial role for chronic rhinosinusitis with nasal polyps patients, especially for those without asthma, NERD or high levels of serum IgE before treatmen

Prospective open-label evaluation of long-term low-dose doxycycline for difficult-to-treat chronic rhinosinusitis with nasal polyps

Background: This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP). Methods: This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count. Results: There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment. Conclusion: These findings suggest that doxycycline may have a beneficial role for CRSwNP patients, especially for patients without asthma, NERD or high levels of serum IgE before treatment

Nasal polyposis : more than a chronic inflammatory disorder-A disease of mechanical dysfunction : the Sao Paulo Position

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP