Abstract
Recalcitrant forms of recurrent nasal polyposis are problematic for patients as for rhinosurgeons. In aspirin-sensitive patients, aspirin desensitization is supposed to prevent recurrence by targeting the metabolism of arachidonic acid. Aspirin-sensitive patients (n = 65) following aspirin desensitization after functional endoscopic sinus surgery (FESS) for recurrent nasal polyposis under daily intake of 500-mg aspirin were compared to a post-FESS group (n = 81) of aspirin-sensitive individuals using exclusively topical mometasone. Quality of life (QoL) scores including sinonasal, pulmonal and general QoL items as well as endoscopic endonasal examination findings were evaluated during the postoperative follow-up period. After a follow-up period of minimum 18 months, a significant improvement in nasal obstruction, rhinorrhea, post nasal drip, sense of smell, facial pain, sleep quality and further general QoL items in desensitized patients was found compared to aspirin-sensitive controls. Improvement in sinonasal symptoms was evident, whereas the severity of asthmatic symptoms showed no significant changes. Although the pathophysiology of aspirin sensitivity is still not fully understood and the therapy is not sufficiently investigated, aspirin desensitization seems to have a positive effect on QoL scores concerning sinonasal symptoms and should be regarded as a possible postoperative treatment modality for recurrent nasal polyposis in aspirin-sensitive individuals.
Similar content being viewed by others
References
Samter M, Beers RF Jr (1968) Intolerance to aspirin: clinical studies and consideration of its pathogenesis. Ann Intern Med 68(5):975–983
Janti-Alanko S, Holopainen E, Malmberg H (1989) Recurrence of nasal polyps after surgical treatment. Rhinal Suppl 8:59–64
McFadden EA, Kany RJ, Fink JN, Toohill RJ (1990) Surgery for sinusitis and aspirin triad. Laryngoscope 100(10 Pt 1):1043–1046
Vento SI, Ertama LO, Hytonen ML, Wolff CH, Malmberg CH (2000) Nasal polyposis: clinical course during 20 years. Ann Allergy Asthma Immunol 85(3):209–214
Ostertag P, Kramer MF (2003) Das sinobronchiale Syndrom. Laryngorhinootologie 82(6):440–458
Minor MW, Lockey RF (1987) Sinusitis and asthma. South Med J 80:114–117
Szczeklik A, Gryglewski RJ, Olszewski E, Dembińska-Kiec A, Czerniawska-Mysik G (1977) Aspirin-sensitive asthma: the effect of aspirin on the release of prostaglandins from nasal polyps. Pharmacol Res Commun 9(5):415–425
Picado C, Fernandez-Morata JC, Juan M, Roca-Ferrer J, Fuentes M, Xaubet A, Mullol J (1999) Cyclooxygenase-2 mRNA is downexpressed in nasal polyps from aspirin-sensitive asthmatics. Am J Respir Crit Care Med 160(1):291–296
Kowalski ML, Pawliczak R, Wozniak J, Siuda K, Poniatowska M, Iwaszkiewicz J, Kornatowski T, Kaliner MA (2000) Differential metabolism of arachidonic acid in nasal polyp epithelial cells cultured from aspirin-sensitive and aspirin-tolerant patients. Am J Respir Crit Care Med 161(2 Pt 1):391–398
Awad OG, Lee JH, Fasano MB, Graham SM (2008) Sinonasal outcomes after endoscopic sinus surgery in asthmatic patients with nasal polyps: a difference between aspirin-tolerant and aspirin-induced asthma? Laryngoscope 118(7):1282–1286
Awad OG, Fasano MB, Lee JH, Graham SM (2008) Asthma outcomes after endoscopic sinus surgery in aspirin-tolerant versus aspirin-induced asthmatic patients. Am J Rhinol 22(2):197–203
Fokkens W, Lund V (2007) European position paper on rhinosinusitis and nasal polyps group: European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl 20:1–136
Buyukozturk S, Gelincik A, Aslan I, Aydin S, Colakoglu B, Dal M (2009) Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease? J Asthma 46(10):1037–1041
Woodbury K, Ferguson BJ (2011) Recalcitrant chronic rhinosinusitis: investigation and management. Curr Opin Otolaryngol Head Neck Surg 19(1):1–5
Chiu AG, Palmer JN, Woodworth BA et al (2008) Baby shampoo nasal irrigations for the symptomatic postfunctional endoscopic sinus surgery patient. Am J Rhinol 22:34–37
Lupa M, Amedee R (2010) Is topical amphotericin B efficacious in the treatment of chronic rhinosinusitis? Laryngoscope 120:1080–1081
Adjani T, Marsan J, Ferris W et al (2009) Effectiveness of honey on Staphylococcus aureus and Pseudomonas aeruginosa biofilms. Otolaryngol Head Neck Surg 141:114–118
Stevenson DD, Hankammer MA, Mathison DA, Christiansen SC, Simon RA (1996) Aspirin desensitization treatment of aspirin-sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol 98(4):751–758
Berges-Gimeno MP, Simon RA, Stevenson DD (2003) Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 111(1):180–186
Berges-Gimeno MP, Simon RA, Stevenson DD (2003) Early effects of aspirin desensitization treatment in asthmatic patients with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 90(3):338–341
Kramer MF, Rasp G, Kastenbauer E (2003) Health-Related Quality of Life in rhino surgery. Am J Otolaryngol 24(2):97–105
Bousquet J, Clark TJ, Hurd S, Khaltaev N, Lenfant C, O’byrne P, Sheffer A (2007) GINA guidelines on asthma and beyond. Allergy 62(2):102–112
Eriksson NE (1990) Allergy screening with Phadiatop and CAP Phadiatop in combination with a questionnaire in adults with asthma and rhinitis. Allergy 45:285–292
Stammberger H, Posawetz W (1990) Functional endoscopic sinus surgery: concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247(2):63–76
Juniper EF, Thompson AK, Ferrie PJ, Roberts JN (2000) Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire. Clin Exp Allergy 30(1):132–140
Batra PS, Kern RC, Tripathi A, Conley DB, Ditto AM, Haines GK 3rd, Yarnold PR, Grammar L (2003) Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma. Laryngoscope 113(10):1703–1706
Ferguson BJ, Otto BA, Pant H (2009) When surgery, antibiotics, and steroids fail to resolve chronic rhinosinusitis. Immunol Allergy Clin N Am 29(4):719–732
Sweet JM, Stevenson DD, Simon RA, Mathison DA (1990) Long-term effects of aspirin desensitization–treatment for aspirin-sensitive rhinosinusitis-asthma. J Allergy Clin Immunol 85(1 Pt 1):59–65
Stevenson DD, Szczeklik A (2006) Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 118(4):773–786
Szczeklik A, Stevenson DD (1999) Aspirin-induced asthma: advances in pathogenesis and management. J Allergy Clin Immunol 104(1):5–13
Stevenson DD, Pleskow WW, Simon RA, Mathison DA, Lumry WR, Schatz M, Zeiger RS (1984) Aspirin-sensitive rhinosinusitis asthma: a double-blind crossover study of treatment with aspirin. J Allergy Clin Immunol 73(4):500–507
Asad SI, Kemeny DM, Youlten LJ, Frankland AW, Lessof MH (1984) Effect of aspirin in “aspirin sensitive” patients. Br Med J (Clin Res Ed) 288(6419):745–748
Melillo G, Balzano G, Bianco S, Dahlén B, Godard P, Kowalsky ML, Picado C, Stevenson DD, Suetsugu S (2001) Report of the INTERASMA Working Group on standardization of inhalation provocation tests in aspirin-induced asthma: oral and inhalation provocation tests for the diagnosis of aspirin-induced asthma. Allergy 56(9):899–911
Nizankowska E, Bestyńska-Krypel A, Cmiel A, Szczeklik A (2000) Oral and bronchial provocation tests with aspirin for diagnosis of aspirin-induced asthma. Eur Respir J 15(5):863–869
Milewski M, Mastalerz L, Nizankowska E, Szczeklik A (1998) Nasal provocation test with lysine-aspirin for diagnosis of aspirin-sensitive asthma. J Allergy Clin Immunol 101(5):581–586
Alonso-Llamazares A, Martinez-Cócera C, Domínguez-Ortega J, Robledo-Echarren T, Cimarra-Alvarez M, del Castillo MM (2002) Nasal provocation test (NPT) with aspirin: a sensitive and safe method to diagnose aspirin-induced asthma (AIA). Allergy 57(7):632–635
Kowalski ML (1992) Management of aspirin-sensitive rhinosinusitis-asthma syndrome: what role for aspirin desensitization? Allergy Proc 13(4):175–184
Brenner DJ, Hall EJ (2007) Computed tomography: an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284
Stewart MG, Sicard MW, Piccirillo JF, Diaz-Marchan PJ (1999) Severity staging in chronic sinusitis. Are CT scan findings related to patient symptoms? Am J Rhinol 13(3):161–167
Rozsasi A, Polzehl D, Deutschle T, Smith E, Wiesmiller K, Riechelmann H, Keck T (2008) Long-term treatment with aspirin desensitization: a prospective clinical trial comparing 100 and 300 mg aspirin daily. Allergy 63(9):1228–1234
Yaniv E, Hadar T, Shvero J et al (1997) Objective and subjective nasal airflow. Am J Otolaryngol 18:29–32
Lee JY, Simon RA, Stevenson DD (2007) Selection of aspirin dosages for aspirin desensitization treatment in patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 119(1):157–164
Chiu JT (1983) Improvement in aspirin-sensitive asthmatic subjects after rapid aspirin desensitization and aspirin maintenance (ADAM) treatment. J Allergy Clin Immunol 71(6):560–567
Kowalski ML, Grzelewska-Rzymowska I, Szmidt M, Rozniecki J (1986) Clinical efficacy of aspirin in “desensitised” aspirin-sensitive asthmatics. Eur J Respir Dis 69(4):219–225
Gosepath J, Schaefer D, Amedee RG, Mann WJ (2001) Individual monitoring of aspirin desensitization. Arch Otolaryngol Head Neck Surg 127(3):316–321
Conflict of interest
The authors declare that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Havel, M., Ertl, L., Braunschweig, F. et al. Sinonasal outcome under aspirin desensitization following functional endoscopic sinus surgery in patients with aspirin triad. Eur Arch Otorhinolaryngol 270, 571–578 (2013). https://doi.org/10.1007/s00405-012-2048-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-012-2048-x