Effect of antioxidants on the clinical outcome of patients with nasal polyposis M SAGIT 1 , H ERDAMAR 2 , C SAKA 3 , S YALCIN 4 , I AKIN 3 1 Department of ENT, Kayseri Training and Research Hospital, Kayseri, 2 Department of Medical Biochemistry, Tunceli Government Hospital, Tunceli, 3 Department of ENT, Dıskapi Yıldırım Beyazıt Training and Research Hospital, Ankara and 4 Department of Anesthesiology, Harran University School of Medicine, Sanliurfa, Turkey Abstract Aim: To investigate the therapeutic effects of antioxidants on the clinical and biochemical outcome of patients with nasal polyposis. Methods: Thirty-four patients with nasal polyposis were divided into two groups receiving either intranasal steroid or intranasal steroid plus per-oral vitamins A, C and E and selenium. Paranasal sinus computed tomography, endoscopy, and polyp tissue and serum sampling were conducted pre- and post-therapy. Serum levels of malondialdehyde, superoxide dismutase, nitrite and myeloperoxidase and tissue levels of malondialdehyde and superoxide dismutase were measured. Group results were compared using the Mann – Whitney U test and Wilcoxon signed-rank test. Results: Both groups had significantly lower tissue parameters, computed tomography scores and serum malondialdehyde levels, comparing pre- versus post-treatment results. Post-treatment, the steroid plus antioxidant group had significantly lower tissue malondialdehyde levels and a greater fall in tissue and serum malondialdehyde, compared with the steroid group. Conclusion: Serum and tissue levels of malondialdehyde (an oxidative marker) were significantly decreased by adding antioxidants to standard therapy. This is the first report of the positive effects of adding antioxidants to steroid therapy for nasal polyposis. Key words: Nasal Polyps; Oxidative Stress; Antioxidants; Pathology; Therapeutics Introduction Nasal polyposis is defined as an inflammatory con- dition of the nasal and paranasal sinus cavities. It fre- quently originates from the paranasal sinus mucosa, especially the anterior ethmoid cells. The aetiology of nasal polyposis is still unknown, but multiple factors can play a role. The most important is inflammation. 1 Most reported studies have investi- gated the inflammatory mechanisms of nasal polyposis. However, recent work has assessed the role of oxygen free radicals in patients with nasal polyposis. 1– 12 Oxygen free radicals can be defined as molecular species containing one or more unpaired electrons. 13 Oxygen free radicals are neutralised in vivo by the body’s antioxidative defence mechanisms. Once the balance between oxygen free radical production and anti- oxidative defence activity is disrupted, oxidative stress can occur, which may result in cell injury or death, sub- sequent tissue damage, and, finally, chronic disease. 14–16 Studies investigating the role of oxygen free radicals and antioxidants in nasal polyposis have revealed strong evidence for the involvement of oxidative stress in the pathogenesis of nasal polyposis. 1 –12 However, the present study is the first to investigate the therapeutic effects of antioxidants on the clinical and biochemical outcome of patients with nasal polyposis. Materials and methods Study population This study included 44 patients from the ENT depart- ment of Dıskapi Yıldırım Beyazıt Training and Research Hospital, with the approval of the institution’s ethics committee. All patients provided written, informed consent regarding participation in the diagnos- tic, interventional and therapeutic aspects of the study. Diagnosis of nasal polyposis was based on anterior rhinoscopy, endoscopic examination and coronal para- nasal sinus computed tomography (CT). We excluded from the study any patients with sys- temic disease (e.g. diabetes mellitus, arthritis, cataract, Accepted for publication 23 December 2010 First published online 14 June 2011 The Journal of Laryngology & Otology (2011), 125, 811–815. MAIN ARTICLE © JLO (1984) Limited, 2011 doi:10.1017/S0022215111001149