Original Research—Sinonasal Disorders The Effects of Systemic, Topical, and Intralesional Steroid Treatments on Apoptosis Level of Nasal Polyps Otolaryngology– Head and Neck Surgery 147(3) 563–567 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599812446678 http://otojournal.org Burak Kapucu, MD 1 , Engin Cekin, MD 1 , Bulent Evren Erkul, MD 1 , Hakan Cincik, MD 1 , Atila Gungor, MD 1 , and Ufuk Berber, MD 2 No sponsorships or competing interests have been disclosed for this article. Abstract Objective. The purpose of this study was to compare the apoptotic responses to systemic, topical, and intrapolyp injec- tion of glucocorticoid with no treatment in nasal polyps. Study Design. Prospective, randomized controlled study. Setting. Tertiary training hospital. Subjects and Methods. The study was performed on 48 patients with nasal polyposis in the Department of Otorhinolaryngology between 2008 and 2009. Patients were assigned to 1 of 4 groups of 12 patients. Group A was treated with oral methylprednisolone 1 mg/kg/d, and the dose was tapered gradually. Group B received 0.3 mL triamcinolone acetonide (40 mg/mL), which was injected into polyp tissue. Group C was treated with topical 55 mg triamcinolone aceto- nide 2 times daily for 1 month. Group D received no medica- tion. Samples were collected endoscopically after the seventh day for groups A and B, the first month for group C, and the first visit for group D. Apoptotic indexes were determined using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method. Results. Statistically significant differences in apoptotic index were found between each steroid-medicated group and the control group (P D-A = .0001; P D-B = .003; P D-C = .026) and between groups A and C (P A-C = .012). Group B did not differ significantly from either group A or C (P A-B = .11; P B-C = .75). Conclusions. The apoptotic index in nasal polyps treated with systemic, topical, and intrapolyp injection forms of glucocor- ticoids was higher than that in the control group. Systemic steroid treatment induced the most apoptosis. Keywords nasal polyp, nasal polyposis, corticosteroid, intralesional, topical, systemic, apoptosis Received January 6, 2012; revised March 23, 2012; accepted April 6, 2012. N asal polyposis (NP) is defined by an edematous mass caused by chronic inflammation and is charac- terized by nasal mucosal metaplasia, secretory hyperplasia, inflammatory cell infiltration (mostly eosino- phils, lymphocytes, and plasmocytes), increased fibroblast production, extracellular matrix deposition, and fibrosis. 1 The prevalence of NP is 1% to 4%, 2,3 and it is seen almost equally in all races and social classes. Steroids are considered to be the most effective anti- inflammatory drugs. The effects of steroids on NP have been reported, and they are currently the most common drugs used to treat NP. 3 Topical sprays and oral and intrapolyp-injected forms of glucocorticoids are used in treating NP. Apoptosis is physiological cell death caused by develop- mental and environmental stimuli that activate cell suicide programs in multicellular organisms. 4 Apoptosis is an important process in the reduction of inflammatory cells and resolution of the inflammatory processes. Induction of apoptotic cell death has been shown to accompany resolu- tion of the inflammatory process in inflammatory diseases of the respiratory system such as nasal polyposis. Steroids are known to induce apoptosis of fibroblasts and inflamma- tory cells in NP tissue, remove these cells, and resolve inflammation in nasal polyp tissue. 5-11 We compared the different forms of steroid treatments with each other and with no treatment to demonstrate their effects on apoptosis in polyp tissue. Subjects and Methods This prospective, controlled study was performed on 48 patients (40 men, 8 women) who had NP. The age range was 20 to 60 years (mean, 32.2 years). The GATA Medical 1 Department of Otorhinolaryngology, GATA Haydarpasa Training Hospital, Istanbul, Turkey 2 Department of Pathology, GATA Haydarpasa Training Hospital, Istanbul, Turkey This study was presented as a poster presentation at the 2010 AAO-HNSF Annual Meeting & OTO EXPO; September 26-29, 2010; Boston, Massachusetts. Corresponding Author: Bulent Evren Erkul, MD, GATA Haydarpasa Egitim Hastanesi, KBB klinigi 34668 Kadikoy, Istanbul Email: evrenerkul@yahoo.com at Gulhane Askeri Tip Akademisi on March 5, 2015 oto.sagepub.com Downloaded from