Effect of nasal antifungal therapy on nasal cell activation markers in chronic rhinosinusitis.
OBJECTIVE
To examine the effect of nasal antifungal treatment on eosinophil cationic protein (ECP) and tryptase levels in samples of nasal lavage fluid from patients with chronic rhinosinusitis and nasal polyps.


METHODS
Prospective double-blind placebo-controlled clinical trial.


METHODS
Tertiary surgical center.


METHODS
Subjects with severe chronic rhinosinusitis and nasal polyps. Of 120 screened patients, 76 were eligible. Six patients withdrew because of minor adverse events, and 10 dropped out for other reasons. In total, 60 patients completed the study according to the study protocol.


METHODS
Nasal treatment with amphotericin B or saline control for 8 weeks.


METHODS
Nasal lavages were performed before and after treatment. Fungal elements were assessed by culture and with different polymerase chain reaction assays. Levels of ECP and tryptase were determined by fluorescent enzyme immunoassay.


RESULTS
No correlation between cell activation markers and fungus detection was observed before treatment (all P>.20). Nasal amphotericin B treatment had no effect on levels of ECP (P = .17) or tryptase (P = .09) in nasal lavage samples. Moreover, successful fungus eradication, defined as fungus detection before but not after treatment, did not influence nasal ECP or tryptase levels (all P>.40).


CONCLUSIONS
Neither topical amphotericin B therapy nor fungal state before and after treatment had any significant influence on activation markers of nasal inflammatory cells in chronic rhinosinusitis.
Weschta
Michael
M
Department of Otorhinolaryngology-Head and Neck Surgery, University of Ulm, Ulm, Germany. michael.weschta@uni-ulm.de
Rimek
Dagmar
D
Formanek
Marc
M
Podbielski
Andreas
A
Riechelmann
Herbert
H
D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000187:drug effects / Q000382:microbiology; D009298:Nasal Polyps / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D012220:Rhinitis / Q000188:drug therapy* / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B