Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis

Abstract

Recent studies have suggested that allergic fungal rhino-sinusitis could be involved in the development of nasal polyposis. The aim of this study was to evaluate the response of anti-fungal nasal lavages. Patients performed nasal lavage with 20 ml of a one per one thousand amphotericin B suspension in each nostril, twice a day, for four weeks. In addition, all patients continued their saline nasal lavage and their conventional topical corticosteroid spray. This study included 74 patients, with a mean age of 46 years (range from 19 to 73). Before anti-fungal treatment, the distribution of nasal polyposis, according to Malm, was: 13 patients in stage I (17.5 per cent), 48 patients in stage II (65 per cent) and 13 patients in stage III (17.5 per cent). After anti-fungal nasal lavages, the total disappearance of nasal polyposis was observed in 29 patients (39 per cent). Eight patients were stage I, 21 stage II, and none stage III. In patients who have had previous endoscopic polypectomy and functional endoscopic sinus surgery, total disappearance of nasal polyposis was seen in 24 patients (47 per cent). Hyper-reactivity to fungal organisms could be one of the mechanisms underlying the development of nasal polyposis. A direct effect of amphotericin B suspension on the integrity of the cell membrane of the polyps' epithelium could not be excluded.

The value of antifungal therapy in allergic fungal rhinosinusitis

“…The endoscopic findings were either reported as part of validated scoring scales (1,7,(16)(17)(18)(19)21,22,(25)(26)(27)(28) or nonvalidated systems (15,20,23,24,30) . Seven studies reported endoscopic improvement (15,(17)(18)(19)(22)(23)(24) , whereas the remainder of the studies reported no benefit (endoscopic) from antifungal agents. When the outcomes were taken into context of the methodology of individual studies, there appears to be no high quality evidence that supports the benefit of topical or oral antifungal agents in improving endoscopic outcomes in patients with AFS.…”

“…Several studies specified within their inclusion criteria for participants to have recently undergone FESS prior to the study (17)(18)(19)(20)25) or as part of the study (15,22,23,26,30) . However, a number of studies specifically excluded participants whom had recent FESS prior (range 3 to 12 weeks) to the medical intervention (16,21,27,29) .…”

Effect of Amphotericin B on Treatment of Chronic Rhinosinusitis; A Double-blind Randomized Clinical Trial

“…Previous data have demonstrated the therapeutic effects of Amphotericin B against fungi (19). Studies investigating the effects of Amphotericin B on improvement and treatment of CRS have shown different and even controversial results (20)(21)(22). Therefore, the present study aimed to determine the effect of topical Amphotericin B on improvement of the symptoms in patients with CRS.…”

Actualización en el tratamiento con soluciones tópicas no corticoesteroidales en patología rinosinusal: Revisión de la literatura

“…Acerca del uso de irrigaciones nasales con terapia antifúngica en CEF, Riccheti y col 21 , investigaron la eficacia de lavados nasales con anfotericina B en pacientes con poliposis nasal tratada con CEF previa, usando 1 gr. de anfotericina B disuelto en 1.000 ml de agua destilada, 2 veces al día por 4 semanas.…”