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. The Epidemiological and Clinical Aspects of Nasal Polyps that Require Surgery.

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The objective of this retrospective cross-sectional study was to obtain epidemiological data from the charts of 297 patients with nasal polyposis who were operated on in a referral hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal polyps. The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on), as well as ear problems and facial deformity. Nasal polyposis affects men (60.3%) more frequently, at a mean age of 39.5 years. The most frequent symptom was nasal blockage (81.1 %) followed by rhinorrhea (37.7%). A total of 11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had first-degree relatives who suffered from asthma or allergic rhinitis. This study highlights the need for large-scale epidemiologic research exploring the prevalence and incidence of nasal polyposis in Iran.
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Iranian Journal of Otorhinolaryngology
No.2, Vol.24, Serial No.67, Spring-2012
75
Original Article
The Epidemiological and Clinical Aspects of Nasal Polyps That
Require Surgery
Meymane Jahromi Ahmad1,*Shahabi Ayeh2
Abstract
Introduction:
The objective of this retrospective cross-sectional study was to obtain epidemiological data
from the charts of 297 patients with nasal polyposis who were operated on in a referral
hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal
polyps.
Materials and Methods:
The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family
history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal
obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on), as well as ear
problems and facial deformity.
Results:
Nasal polyposis affects men (60.3%) more frequently, at a mean age of 39.5 years. The most
frequent symptom was nasal blockage (81.1 %) followed by rhinorrhea (37.7%). A total of
11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with
nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had
first-degree relatives who suffered from asthma or allergic rhinitis.
Conclusion:
This study highlights the need for large-scale epidemiologic research exploring the prevalence
and incidence of nasal polyposis in Iran.
Keywords:
Clinical features, Epidemiology, Nasal polyposis.
Accepted date: 15 Jun 2011
Received date: 27 Dec 2011
1Assistant Professor of Otolaryngology. Department of Otorhinolaryngology, Imam Reza Hospital, Faculty of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2Otolaryngology Resident. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
*Corresponding author
Address: Imam Reza University Hospital, Ahmadabad Ave, Mashhad, Iran.
Postal Code: 91766-99199
Tel: +98 9122886266
E-mail: shahabipoura871@mums.ac.ir; shahabi.ayeh@yahoo.com
Nasal Polyps
76, Iranian Journal of Otorhinolaryngology No.2, Vol.24, Serial No.67, Spring-2012
Introduction
Nasal polyps are mucosal lesions of the
nasal or paranasal sinuses that can result
from a response to inflammatory or
infectious stimuli. They appear as smooth,
round, semi-translucent masses that are
most commonly found in the middle
meatus and ethmoid sinuses and affect 1%
to 4% of the population. Males are
affected more than females and adults
more than children. If it happens in
childhood, mucociliary and
immunodeficiency diseases must be ruled
out, for example, patients with cystic
fibrosis have a prevalence of nasal
polyposis between 6% and 48% (1).
Patients with nasal polyposis may present
clinically with complaints of nasal
obstruction, congestion, hyposmia,
rhinorrhea, epistaxis, postnasal drip,
headaches, and snoring. Although nasal
polyps more commonly appear bilaterally
they can also present unilaterally. In
unilateral nasal masses, benign or
malignant pathologies must be considered
and distinguished by nasal endoscopy, CT
scan, and biopsy (1).
The etiology of nasal polyps has been the
subject of research for many years.
Elevated levels of histamine and IgE found
around polyps, and mast cells and
eosinophilia found within polyps provide
evidence suggesting that inflammation is a
major factor in polyp formation (2).
Previous studies have also revealed a
relationship between nasal polyposis,
aspirin intolerance, and allergic rhinitis
and asthma (4,5). The prevalence of nasal
polyposis is higher in subjects with asthma
than in non-asthmatics and 16.5% of
asthmatic patients over 40 years of age
have been shown to have nasal polyps (3).
The management of nasal polyposis can
be both medical and surgical. Topical
corticosteroids are drug of choice as they
reduce the size of the polyp and improve
nasal breathing and prevent recurrence. In
patients who do not response to medical
therapy or have large-sized polyps,
functional endoscopic sinus surgery (FESS)
is used to perform a polypectomy (4,5). The
objective of this study was to obtain clinical
data from patients with nasal polyposis who
were managed surgically.
Materials and Methods
We reviewed the hospital charts of 297
patients with nasal polyposis (unilateral
and bilateral) who were operated on
between 1998 and 2002 in our referral
hospital in Mashhad, Iran. The procedures
performed included simple polypectomy,
the Caldwell-Luc procedure, external
ethmoidectomy, and functional endoscopic
sinus surgery (FESS). In all cases, the
patient’s medical history and notes from
an otolaryngological physical examination
were reviewed and a check list of 22
variables was completed. The variables
included age, age of onset, gender, season
of referral, location of nasal symptoms
(bilateral or unilateral). History of allergic
rhinitis, asthma, or cystic fibrosis was
extracted from the hospital records.
Symptoms of nasal polyps such as nasal
obstruction, rhinorrhea, facial pain and
headache, epistaxis, snoring, mouth
breathing, voice changes, ear problems,
and facial deformity due to polyposis were
also included in the check list. Family
history of asthma or allergy and previous
medical or surgical treatments were other
variables that were routinely present in the
hospital records of our patients in the
Otorhinolaryngology ward. All of our
patients had a histologic diagnosis of
inflammatory nasal polyps.
For the quantitative data, descriptive
statistical analysis was conducted to
determine the mean and standard
deviation. For the qualitative data, we
calculated percentages of the recorded
variable. Our study was approved by the
Institutional Board Review of Mashhad
University of Medical Sciences.
Results
Among the 297 patients with nasal
polyps, 118 were female (39.7%) and 179
Iranian Journal of Otorhinolaryngology No.
were male
(60.3%). The average age of the
patients with nasal polyps
included in the
study was 39.49 ±16.63
years old,
range of 7 to 79 years old. The average age
of onset was 29.2 ± 15.93
years old
respect to age and age of onset
polyps were most
common in
decade of life, followed by the third and
then fourth decades.
occurred in the spring
(36.7%) and
summer (23.2%). In 161
(54.2%)
patients the
polyps were bilateral.
the total number of patients with
polyps, 31
(10.4%) presented
associated asthma and received treatment
54 (18.2%) presented with
allergic
and 22
(7.4%) indicated that they had
first-
degree relative (father/mother,
brother/sister, son/daughter)
who
from asthma or allergy
. None of the
patients
had been diagnosed
fibrosis.
The frequency of the
major symptoms of
nasal p
olyps in the patients studied can be
seen in Figure 1.
Fig 1:
Frequency of major symptoms of nasal
polyps (%)
The most common symptom among
patients was nasal obstruction (81.1%).
our study 11.1% of patients
had
of epistaxis. A total of
15 patients out of
297 (5.1%) had otorrhea
,
symptoms of chronic otitis media
media with effusion according to history,
otoscopy,
and tympanometry.
(2.7%)
their nasal polyps had cause
deformity, 141 patients
(44.1%) had
Iranian Journal of Otorhinolaryngology No.
2, Vol.24
, Serial
(60.3%). The average age of the
included in the
years old,
with a
range of 7 to 79 years old. The average age
years old
. In
respect to age and age of onset
, nasal
common in
the second
decade of life, followed by the third and
Most of
the referrals
(36.7%) and
(54.2%)
of the
polyps were bilateral.
Out of
the total number of patients with
nasal
(10.4%) presented
with
associated asthma and received treatment
,
allergic
rhinitis,
(7.4%) indicated that they had
a
degree relative (father/mother,
who
suffered
. None of the
had been diagnosed
with cystic
major symptoms of
olyps in the patients studied can be
Frequency of major symptoms of nasal
The most common symptom among
patients was nasal obstruction (81.1%).
In
had
a history
15 patients out of
,
signs and
symptoms of chronic otitis media
, or otitis
media with effusion according to history,
and tympanometry.
In 8 patients
their nasal polyps had cause
d facial
(44.1%) had
received medications before surgery,
74
patients (24.9%) had
of polypectomy.
Discussion
Nasal polyposis is a condition that more
commonly affects middle
our study, the pea
k age of presentation was
in the second decade of life and the mean
age of patients was 39.34 ± 16.63 years. In
a Nigerian district hospital, Chukuezi
reported that the maximum presentation
rate was between 31 and 40 years old (7).
In France, the estimated
polyposis increased with age, reaching a
peak in the 50 to 59 year age group (8). In
another study in France the mean age of
patients was 49.4 ± 17.6 (9). Thus, our
patients were younger than in previous
studies.
In the only epidemiolog
nasal polyposis in Iran that we could find,
Hashemian and colleagues reported that the
incidence of polyposis in 192 patients with
chronic rhinosinusitis
as 40%, while the sex
distribution of the patients with polyposis
was 60% male and 40% fem
the patients also had a history of
allergy (10).
Patients with nasal polyposis often
present with
associated asthma. Asthmatic
patients older than 40 years have
times greater risk of suffering nasal
polyposis than those under 40 year
(3).
In addition, Slavin
reported that patients with nasal polyposis
present with
more severe asthma than
those without polyps (11)
asthma was found in 10.4% of patients
rate that was
significantly lower than
found in previous studies in France (45%)
and Spain (36.6%) (12,
13)
In contrast to the association with asthma,
i
t is rare for patients with allergic rhinitis
to present with
nasal polyposis. Settipane
and Chafee found that only 1.5% of
patients with alle
rgic rhinitis had nasal
polyposis and that
it was more common to
find nasal polyposis in patients with non
allergic rhinitis than in those with allergic
Jahromi A, et al
, Serial
No.67, Spring-2012,77
received medications before surgery,
and
patients (24.9%) had
a previous history
Nasal polyposis is a condition that more
commonly affects middle
-aged men (6). In
k age of presentation was
in the second decade of life and the mean
age of patients was 39.34 ± 16.63 years. In
a Nigerian district hospital, Chukuezi
reported that the maximum presentation
rate was between 31 and 40 years old (7).
In France, the estimated
incidence of nasal
polyposis increased with age, reaching a
peak in the 50 to 59 year age group (8). In
another study in France the mean age of
patients was 49.4 ± 17.6 (9). Thus, our
patients were younger than in previous
In the only epidemiolog
ic study of
nasal polyposis in Iran that we could find,
Hashemian and colleagues reported that the
incidence of polyposis in 192 patients with
as 40%, while the sex
distribution of the patients with polyposis
was 60% male and 40% fem
ale and 43% of
the patients also had a history of
Patients with nasal polyposis often
associated asthma. Asthmatic
patients older than 40 years have
a four
times greater risk of suffering nasal
polyposis than those under 40 year
s of age
In addition, Slavin
and colleagues
reported that patients with nasal polyposis
more severe asthma than
those without polyps (11)
. In our study,
asthma was found in 10.4% of patients
, a
significantly lower than
that
found in previous studies in France (45%)
13)
.
In contrast to the association with asthma,
t is rare for patients with allergic rhinitis
nasal polyposis. Settipane
and Chafee found that only 1.5% of
rgic rhinitis had nasal
it was more common to
find nasal polyposis in patients with non
-
allergic rhinitis than in those with allergic
Nasal Polyps
78, Iranian Journal of Otorhinolaryngology No.2, Vol.24, Serial No.67, Spring-2012
rhinitis; a difference that was statistically
significant (4).
In our sample, we found that the
incidence of allergic rhinitis among
patients with nasal polyposis was 18.2% in
contrast to 47.9% in Spanish patients in a
study by Monus (13).
In our patients, 45.8 % had unilateral
nasal polyposis and it was more common in
comparison with other studies such as that
by Tritt and colleagues in which only 46
patients out of 301 patients with nasal
polyposis had unilateral polyps and patients
with unilateral polyps were younger at
presentation (mean age: 35) (1). The lower
incidence of asthma and allergic rhinitis
and younger age of our patients could be
explained by higher number of cases of
unilateral polyps included in our study.
The most common complaint of patients
with nasal polyposis is nasal obstruction.
In our study the most frequent symptoms
were nasal obstruction (81.1%) and
rhinorrhea (37.7%), followed by mouth
breathing and snoring. Hyposmia,
headache and facial pain were less
common. In our study, 11.1% of patients
had a history of epistaxis although it had
the lowest incidence among other
symptoms but it was still high when
comparing other studies. Previous studies
often did not mention this symptom,
probably because of low incidence (14),
but Tritt and colleagues demonstrated that
unilateral epistaxis in the presence of
unilateral nasal polyps is statistically
significant for inverted papilloma (1).
Conclusion
An overview of the currently available
literature illustrates the paucity of accurate
information on the epidemiology of nasal
polyposis especially in Iran, and highlights
the need for large-scale epidemiologic
research exploring the prevalence and
incidence of nasal polyposis.
References
1. Tritt S, McMain KC, Kountakis SE. Unilateral nasal polyposis: Clinical presentation and
pathology. Am J Otolaryngol 2008; 29(4): 230-2.
2. Pawanker R. Nasal polyposis: An update. Curr Opin Allergy Clin Immunol 2003; 3(1): 1-6.
3. Hedman J, Kaprio J, Poussa T, Nieminen MM. Prevalence of asthma, aspirin intolerance, nasal
polyps and chronic obstructive pulmonary disease in a population based study. Inter J Epidemiol
1999; 28: 717-22.
4. Settipane GA, Chafee FH. Nasal polyps in asthma and rhinitis: A review of 6037 patients. J Allergy
Clin Immunol 1977; 59: 7-21.
5. Badia L, Lund V. Topical corticosteroids in nasal polyposis. Drugs 2001; 61(5): 573-8.
6. Lanza DE, Kennedy DW. Current concepts in the surgical management of nasal polyposis. J
Allergy Clin Immunol 1992; 90: 543-6.
6. Settipane GA. Epidemiology of nasal polyps. Allergy Asthma Proc 1996; 17: 231-6.
7. Chukuezi AB. Nasal polyposis in Nigerian district hospital. West Afr J Med 1994; 13(4): 231-3.
8. Larsen K, Tos M. The estimated incidence of symptomatic nasal polyps. Acta Otolaryngol 2002;
122(2): 179-82.
9. Klossek JM, Neukirch F, Pribil C, Jankowsli R, Serrano E, Chanal A, et al. Prevalence of nasal
polyposis in France: A cross sectional, case-control study. Allergy 2005; 60(2): 233-7.
10. Hashemian F, Farahani F. [Frequency of nasal polyposis in chronic rhinosinusitis and role of
endoscopic examination in correct diagnosis]. Scientific journal of Hamadan University of Medical
Sciences 2005; 12(3): 20-3. (Persian)
11. Slavin RG, Lindford P, Fiedman WG. Sinusitis and bronchial asthma. J Allergy Clin Immunol 1982; 102: 69.
12. Rugina M, Serrano E, Klossek JM, Crampette L, Stoll D, Bebear JP, et al. Epidemiological and
clinical aspects of nasal polyposis in France; the ORLI group experience. Rhinology 2002; 40(2): 75-9.
13. Munos AT, Puchol CH, Molinero CN, Simal MG, Cunchillos MN, Campillob A NG. [Epidemiologic
study in patients with nasal polyposis]. Acta Otorrinolaryngol Esp 2008; 59(9): 438-43. (Spanish)
14. Naeimi M, Abdali N. [Endoscopic and imaging prevalence of nasal mucosal contact point and
association between contact point and sinunasal symptoms]. Medical journal of Ahwaz
Jondishapur University 2009; 8(1): 117-53. (Persian)
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... In line with our findings, Jahromi and Pour [6] reviewed the epidemiological data from the charts of 297 patients with NP who were operated on in a referral hospital in Mashhad. NPs affect men (60.3%) more frequently, at a mean age of 39.5 years. ...
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... In line with our findings, Jahromi and Pour [6] reviewed the epidemiological data from the charts of 297 patients with NP who were operated on in a referral hospital in Mashhad. NPs affect men (60.3%) more frequently, at a mean age of 39.5 years. ...
... The current body of epidemiological evidence suggests that males are affected by NP more than females and adults more than children [6]. ...
... In line with our findings, Jahromi and Pour [6] reviewed the epidemiological data from the charts of 297 patients with NP who were operated on in a referral hospital in Mashhad. NPs affect men (60.3%) more frequently, at a mean age of 39.5 years. ...
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Experiment Findings
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Bawaseerul Anf is a growing of excess lahem in the nasal cavity caused by accumulation of Ghaleez khilt (thick humour) infiltrated from the anterior part of the brain and produces nasal obstruction and discharge. This condition corresponds with nasal polyps in modern medicine and is defined as a pedunculated, hypertrophied and oedematous mucosa projecting downwards from the mucous membranes of the nose and paranasal air sinuses into the nasal cavity. It is commonly affecting up to 4% of the population and the recurrence is common with severe disease recurring in up to 10 % of patients. The main objective of this study was to evaluate the efficacy of Punica granatum in the management of Nasal polyps. It was conducted from January to October 2015 in the outpatient department of National Teaching Hospital of Ayurveda, Kotta Road, Borella, Sri Lanka. Diagnosed (n= 30) patients with age group 25-60 years from both sex were selected. The thick decoction of test formula was applied over the polyp mass on the days of 0, 2, 4, 6, 8, 10, 12, 19, and 26. The effectiveness of the study was assessed by using Visual Analog Score (VAS) and Nasal symptom scores (NSS) in 3 follow ups. Data were analyzed by repeated measure of ANOVA with paired t- tests. There was significant improvement in subjective parameters; nasal congestion, headache, post nasal drip and mouth breathing (p<0.01). No adverse effects were reported. In this preliminary study the application of the Punica granatum has been found effective in relieving the symptoms of Bawaseerul Anf.
Article
Purpose of review: Nasal polyposis is a chronic inflammatory disease of the upper airway characterized histologically by the infiltration of inflammatory cells like eosinophils or neutrophils. Several hypotheses have been put forward regarding the underlying mechanisms including chronic infection, aspirin intolerance, alteration in aerodynamics with trapping of pollutants, epithelial disruptions, epithelial cell defects/gene deletions (CFTR gene), inhalant or food allergies. The present review is an update on the pathomechanisms of nasal polyposis. Recent findings: In the majority of nasal polyps, eosinophils comprise more than 60% of the cell population. Besides eosinophils, mast cells and activated T cells are also increased. An increased production of cytokines/chemokines like granulocyte/macrophage colony-stimulating factor, IL-5, RANTES and eotaxin contribute to eosinophil migration and survival. Increased levels of IL-8 can induce neutrophil infiltration. Increased expression of vascular endothelial growth factor and its upregulation by transforming growth factor-β can contribute to the edema and increased angiogenesis in nasal polyps. Again, transforming growth factor-β can modulate fibroblast function and thus contribute to eosinophil infiltration and stromal fibrosis. Other mediators like albumin, histamine and immunoglobulins IgE and IgG are also increased in nasal polyps. In addition, the local production of IgE in nasal polyps can contribute to the increased recurrence of nasal polyps via the IgE-mast cell-FcεRI cascade. Finally, mast cell/T cell-epithelial cell/fibroblast interactions can contribute to the persistent eosinophilic inflammation seen in polyps. Summary: Thus although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiology.
To investigate the epidemiologic data in 165 patients suffering nasal polyposis. We collected different variables that included age, gender, asthma, ASA sensitive, allergic rhinitis, smoker, drinker, familiar history. We studied the main symptoms (nasal blockage, rhinorrhea, anosmia, and headache) as well as otological and dermatological involvement. Nasal polyposis affects men (63%) more frequently, with a mean age of 46.5 years. Asthma was found in 36.6 % of patients with nasal polyposis. The most frequent symptom was nasal blockage (88 %) followed by anosmia (78 %). Ears were affected in 42 % of patients and 20 % of first-degree relatives also suffer the same condition. Nasal polyposis affects both genders in middle age and may have an associated genetic factor in some patients. We must rule out asthma in all these patients.
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Data from records of patients with asthma and rhinitis in the Rhode Island Hospital Adult Allergy Clinic and in an adult allergy private were reviewed. The frequency of nasal polyps in the total population of 4,986 was 4.2%; in the asthmatic portion of the population the frequency was 6.7%, and in the rhinitis alone group the frequency was 2.2%. Asthmatics with negative allergy skin tests to inhalant allergers had significantly more nasal polyps than asthmatics with positive skin tests, 12.5% vs 5.0%, p less than 0.01. The frequency of nasal polyps increased with advancing years. Of the total 211 cases of nasal polyps, 71% had asthma and 29% had rhinitis alone. Also, 14% of the patients with nasal polyps had aspirin intolerance, primarily of the bronchospastic type. In addition, 1,051 patients with asthma and rhinitis from the Pediatric Allergy Clinic with a mean age of 6 yr were similarly evaluated. Only 1 (0.1%) of these pediatric patients had nasal polyps.
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One of the most common and occasionally frustrating health care problems is that of nasal polyposis. Patient symptoms are debilitating and have a tendency to recur despite the treatment modality used. Nasal endoscopy is a significant advancement for the early diagnosis and objective assessment of treatment modalities used for nasal polyposis. Surgery used in conjunction with medical therapies offers a safe, thorough means of relieving patient symptoms. It is possible to monitor these patients closely for recurrence with nasal endoscopy as well as debride early recurrences before they become symptomatic.
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All cases of nasal polyposis seen in a district hospital in Nigeria over a 5 year period were analysed in a prospective study to determine the aetiological pattern, the prevalence, occurrence and pathological types as well as predisposing factors. Out of the 172 patients treated, 144 had common nasal polyps while 28 patients had nasal polyps resulting from tumors. Out of the 144 patients, 103 had inflammatory polyps, 39 were of allergic origin and 2 due to cystic fibrosis. Peak presentation was between 31-40 years with a total of 58 patients (33.72%). All the patients with nasal polyposis represented 0.74% of all attendances to the ENT clinic over the period. There was no sex difference. Nasal polypectomy was carried out in all the patients while Caldwell-Luc's operation and Antrum Washout were carried out on selected cases. There were recurrences in 18 patients over the period. Delay in reporting to the NET clinic was attributed to ignorance on the part of both the patients and the general practitioners who often treated their presenting symptoms as common cold and catarrh.
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Sinus disease has been assumed to exist in children with respiratory tract allergies. We consecutively evaluated 375 patients (245 male, 130 female) with childhood onset asthma, between 5 and 15 years of age (mean 7.8 years of age). Abnormal Waters radiographs were found in 205 patients (54.7%) which included mucosal wall thickening greater than 6 mm (67.3%), complete opacification (22.9%) and air-fluid levels (9.8%). The level of immunoglobulin (Ig) E was found to be much higher in non-sinusitis asthmatic children than in asthmatic children with sinusitis (1207 IU/mL vs. 644 IU/mL). The IgG, IgA, IgM and erythrocyte sedimentation rate (ESR) values were not significantly different in the two groups. All patients were treated with antibiotics for 3 to 6 weeks. Five patients required surgical intervention after antibiotic treatment had little success. Streptococcus viridans was isolated from 4 patients following surgical aspirates and Peptostreptococcus anaerobius was isolated in only one patient. In conclusion, sinusitis in children may be an aggravating factor for chronic reactive lower airway disease. Optimal treatment may decrease the need of asthmatic medication.
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Nasal polyps are found in 36% of patients with aspirin intolerance, 7% of those with asthma, 0.1% in children, and about 20% in those with cystic fibrosis. Other conditions associated with nasal polyps are Churg-Strauss Syndrome, allergic fungal sinusitis, and cilia dyskinetic syndrome, (Kartagener's) and Young Syndrome. Nasal polyps are statistically more common in nonallergic asthma versus allergic asthma (13% vs 5%, P < 0.01). About 40% of patients with surgical polypectomies have recurrences. There appears to be a hereditary factor for developing nasal polyps. A classification system for staging nasal polyps is proposed in order to standardize treatment, consider differential diagnosis, and harvest meaningful comparative research information.
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Remarkable overlap exists in symptoms between asthma and chronic obstructive pulmonary disease (COPD), and the symptoms of the patients with mild asthma are often falsely thought to be caused by smoking. The objective of the study was to determine the prevalence of doctor-diagnosed asthma, asthmatic symptoms and doctor-diagnosed COPD in an adult population. The prevalence and relation to asthma of aspirin intolerance, nasal polyposis, allergic rhinitis and smoking habits were also examined. Postal questionnaire survey of a population-based random sample (4300) of adult women and men aged 18-65 years served by the Päijät-Häme Central Hospital in southern Finland (a region with 208 000 inhabitants) was performed. The non-response-adjusted prevalence (Drane's linear method) of doctor-diagnosed asthma was 4.4% (95% CI: 3.3-5.5%) and of COPD 3.7% (95% CI: 2.7-4.8%). The prevalence of allergic rhinitis was 37.3% (95% CI: 33.3-41.2%), and of overall aspirin intolerance 5.7% (95% CI: 4.4-7.1%). The observed prevalence of aspirin intolerance causing shortness of breath or attacks of asthma was 1.2% and it was higher in patients with doctor-diagnosed asthma than without (8.8% versus 0.8%, relative risk [RR] = 11.4, P < 0.0001), and higher in those with allergic-like rhinitis than without (2.6% versus 0.3%, RR = 7.7, P < 0.0001). The prevalence of nasal polyposis was 4.3% (95% CI : 2.8-5.8%). The current prevalence of doctor-diagnosed asthma among adults is 4.4%, and allergic rhinitis, nasal polyposis and aspirin intolerance are associated with an increased risk of asthma. There is also association between aspirin-induced asthma and allergic-like rhinitis.