Effect Of Topical Amphotericin B On Postoperation In Chronic Sinusitis With Nasal Polyps

ObjectiveChronic sinusitis with nasal polyps is the most common chronic disease that is frequently refractory to treatment.Although the recovery rate elevates larger than before,there are still have many patients don't recovery.Fungal elements were suspected to be the callsative agent of chronic sinusitis by some scholars.The purpose of this study was to evaluate the efficacy of intranasal amphotericin B in palients who have chronic sinusjtis with nasal polyps.Methods1,patientsA total of 47 chronic sinusitis with nasal polyps patients were consecutively enrolled from our outpatient department from July 2007 to December 2007.The diagnosis of the disease was based on the clinical symptom,endoscopic examination,CT and Pathological examination.Before the study they have no nasal operation,no allergic rhinitis,no asthma,no steroid.The average age is 45,and case history is 6.65 years.According to the guideline of 1997 Hai Kou Standard,the patients were divided into three types.2,methods(1)Clinic Materials:During the FESS operation,we take the nasal polyp tissue or the membrana mucosa,making to paraffin blocks in 5um.(2)Blade Staining:HE,Gridley Fungus(GF)and carbol chrometrope 2R(3)Group:All patients using saline to irrigate the nasal cavity.The odd number people who have fungus in polyp tissue are the A group(6 patients),which using the intranasal amphotericin B.The even number people who have fungus in polyp tissue are the B group(6 patients),which not using the intranasal amphotericin B.We select randomly 6 patients from the other people which is C group.(4)Irrigate and Recheck:the patients were instructed to instill 20 ml amphotericin B(100ug/ml)to each nostril twice daily for 4 weeks.All patients were observed for 3 months.Record the eosinophils and the time of epithelial.3,Statistical analysis:Apply the SPSS 13.0 software for statistics.Data was presented as mean±SD. Between group comparisons were performed with one-way analysis of variance and SNK.P≤0.05 is considered as statistical significance.Results1.There are no differences in patient characteristics including sex,age,disease degrees(P＞0.05).2.There are 12 patients in 47 have fungus,account to 25.53%.3.Irrigating four weeks and three months,A,B,C group of eosinophils infiltration level has significantly reduced(P＜0.05).4.There wasn't significant statistical difference between the A group and B group about eosinophils number 4 weeks after irrigating(F=0.097,P＞0.05);but there was difference between the B group and C group(F=24.043,P＜0.05).5.There wasn't significant statistical difference between the three groups about the eosinophils number 3 months after irrigating(F=1.497,P＞0.05).6.There wasn't significant statistical difference between the three groups about the time of epithelial(F=0.193,P＞0.05).ConclusionAccounting for 25.53%fungal components can be detected in nasal polyps.The experimental application of amphotericin B on endoscopic surgery and pathology confirmed fungal components of nasal polyps in patients with chronic sinusitis of irrigation treatment,there has a decrease of eosinophils in the number of infiltration, shortening the time of epithelial cavity to a certain extent.But the results did not superior to simple saline irrigation.