Effect of Local Antifungal Treatment on Nasal Polyposis

Nasal polyposis (NP) is considered as the ultimate stage of chronic rhinosinusitis. The exact pathogenesis of NP is unknown, but recent studies have suggested that allergic fungal rhinosinusitis could be involved in the development of NP. The aim of the present study was to evaluate the effects on NP of an intranasal administration of a fungicide suspension. One hundred and fifteen consecutive patients suffering from NP over 6 months were included. Patients in group I (n = 75) performed nasal lavages with 20 ml of a 1‰ amphotericin B suspension in each nostril, twice a day, during 4 weeks. Patients in group II (n = 40) used the same amphotericin B suspension as a nasal spray twice a day (total volume 800 µl) for 4 weeks. All patients continued their saline nasal lavages and their treatment with a conventional topical corticosteroid spray (400 µl/day). After antifungal nasal lavages, total disappearance of NP was observed in 29 patients (39%). Following fungicide nasal spray, total disappearance of NP was found in 17 patients (43%). In patients who had had previous endoscopic sinus surgery, total disappearance of NP was seen in 48 and 64% of patients from groups I and II, respectively. The beneficial effects of nasal lavage versus nasal spray with a fungicidal suspension are similar. Hyperreactivity to fungal organisms could be one of the mechanisms underlying the development of NP. However, a direct effect of amphotericin B suspension on the integrity of the cell membranes of the polyp epithelium could not be excluded.