What is the Impact of Positive Airway Pressure in Nasal Polyposis? An Experimental Study

Abstract

Introduction It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE—Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened (p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size (p = 0.04). Conclusions Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, as measured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.

The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity

“…All patients gave their written and informed consent to participate in the study. Given the exploratory nature of the study and scarce information in the literature, a convenience sample size was decided based on examples of published studies 32,33 . The study was developed in the context of a PhD project and funded by a prize from the NOVARTIS|Excellence in Medicine program and a grant from NOVA Saúde (Universidade Nova de Lisboa Rectorate).…”

Nasal Polyposis: More than a Chronic Inflammatory Disorder—A Disease of Mechanical Dysfunction—The São Paulo Position

“…To evaluate the accuracy of the pressure-response imbalance theory of the pathogenesis of NP, in one study, patients with NP were acutely exposed to continuous positive pressure in the nasal cavity. Surprisingly, the nasal polyp volume was reduced 40 , probably due to the successful transmission of continuous pressure to the affected tissue, raising the interstitial hydrostatic pressure and consequently facilitating the flow of water back into the capillaries.…”

CD133, a Progenitor Cell Marker, is Reduced in Nasal Polyposis and Showed Significant Correlations with TGF-β1 and IL-8

“…6 However, new therapeutic modalities that act directly on mechanical dysfunction have been suggested, mainly trying to increase interstitial hydrostatic pressure. 12,13 By the way, studies reported that the presence of mesenchymal stem cells in the polypoid tissue was associated with a decreased number of inflammatory cells and proinflammatory interleukins, as well as increased regulatory T-cells and interleukin-10 (IL-10), which consequently led to the reduction of the chronic inflammatory process. 14,15 In addition, it was demonstrated that nasal polyp-derived mesenchymal stem cells presented decreased expression of immunoassociated molecules, but presented overexpression of progenitor genes when compared with bone marrowderived mesenchymal stem cells, 16 which may be associated with the altered remodeling process.…”

“… 6 However, new therapeutic modalities that act directly on mechanical dysfunction have been suggested, mainly trying to increase interstitial hydrostatic pressure. 12 13 …”