Relapse of Nasal Polyps - Risk Factors

Overview

The submitted paper presents an analysis of anamnestic data and results of individualexaminations in a group of patients with nasal polyposis, followed up on a long-term basis. Theanalysis was focused on the identification of risk factors which influence the therapeutic results.The data were evaluatedin 246 patients of the ENT Clinic and included 100 women and 146 men,mean age 46.1 years (44.5 years in men and 48.3 years in women) with a range from 17 to 78 years.It is a retrospective study. In the group all patients were included with nasal polyposis treated at the ENT Clinic during the investigation period from October 1989 to December 1994 with completehealth records. These patients were followed up for a minimum period of three years after surgeryat the ENT out-patient department of the Clinic. Surgery was the main therapeutic method. Nasalpolyps were in the majority removed by the method based on principles of functional endoscopicsinus surgery by Messerklinger’s technique. From the group patients with typical antrochoanalpolyps were eliminated.The effect of treatment was evaluated with regard to the following factors - age, sex, age when firstcomplaints developed, length of the case-history, previous surgical treatment, concurrent presenceof allergy, presence of bronchial asthma, aspirin intolerance, inflammations of the paranasalsinuses, extent of affection of the nasal cavity and extent of affection of the paranasal sinuses.The therapeutic results were evaluated with regard to the persistence or reappearance of subjectivecomplaints of the patient and the objective rhinoscopic finding of recurrence of nasal polyps. Therelations between the investigated parameters were calculated by correlation coefficients accor-ding to statistical analysis, using the Excell programme.The mean age of patients in the group with a relapse of complaints within three years after surgerywas 50.5 years.The sex ratio was approximately equal. No correlation was found between age and the periodwithout complaints (correlation coefficient 0.03). The mean age at the time of the initial complaintswas 38.6 years with the highest frequency between the age of 30 and 50 years (121 patients, i. e.49.2%), and with an equal sex distribution. A relapse of complaints developed in patients where thefirst complaints developed before the age of 30 (71 patients) occurred in 26.7%. The mean period ofthe history was 4.9 years. There was no marked correlation between the length of the history andthe extent of affection of the nasal cavity (correlation coefficient 0.043), 132 patients, i. e. 55.2% ofthe group were subjected to some type of surgery of the nasal cavity or paranasal sinuses. Amongthe types of surgery polypectomy predominated (113 patients, i. e. 45%) and surgery of the maxillarysinuses according to Caldwell-Luca (26 patients, i. e. 10.6%). The mean interval between individualpolypectomies was 4.2 years. This interval declines with the increasing number of operations.A relapse of complaints occurred in the group of patients after repeated polypectomies in 28.5%.Various forms of allergic reactions incl. allergic reactions to drugs were recorded in 113 patients, i.e. 45.9% with a slightly higher proportion of women (65 patients, i. e. 57.5%). In this group of patients31% developed relapses. Bronchial asthma was present in 54 patients, i. e. 21.9% without predilectionof sex. Among patients with bronchial asthma relapses occurred in 25.9%. Aspirin intolerance wasrecorded in 24 patients, i. e. 9.7%, more frequently in women (18 patients i. e. 75%). A relapse ofcomplaints occurred in 66.7% patients with aspirin intolerance. Sinusitis in the case-history wasreported by 41 patients, i. e. 16.7%, both sexes being represented equally. In the group of patientswith a history of inflammations of the paranasal sinuses relapses of complaints were recorded in39%. The mean score expressing the extent of affection of the nasal cavity was 3.3. No correlationwas found between the extent of affection of the nasal cavity and the length of the history(correlation coefficient 0.032) or with age at the time of the first complaints (correlation coefficient0.026). With the extent of affection of the paranasal cavity increases also the extent of affection ofthe paranasal sinuses (correlation coefficient 0.54). The mean score expressing the extent ofaffection of the paranasal sinuses 13.1. No correlation was found between the extent of affectionand the length of the history (correlation coefficient 0.043) nor with age at the time of the firstcomplaints (correlation coefficient 0.094). The results of analyses in the investigated group ofpatients with nasal polyposis revealed the necessity to differentiate heterogeneous groups ofpatients. Evaluation of therapeutic results in patients suffering from nasal polyposis as a whole can leadto deceptive conclusions. The highest risk factors as regards early relapse are in the authors’ opinion thepresence of aspirin intolerance and concurrent inflammations of the paranasal sinuses. If one of thesetwo factors is detected, long-term follow up and permanent conservative treatment is a necessity.

Key words:
nasal polyposis, risk factors, surgical treatment, aspirin intolerance.