2. Department of Oto Rhino Laryngology, Benha Faculty of Medicine, Egypt.
Background: Nasal polyps (NPs) are benign pedicled mucosal protrusions into the nasal cavity of multifactorial origin. Vitamin D has been demonstrated as having potential immunomodulatory activity and act as an antiproliferative agents.
Aim of the work: To determine the possible antiproliferative effect and immunomodulatory activity of VD on human nasal polyposis.
Material and methods: Based on thirty patients and divided equally into 3 groups. Group Ι (healthy subjects). Group ΙΙ were received low daily oral dose of VD (1000 IU) for 4 weeks. Group ΙΙΙ were received high daily oral dose of VD(4000 IU) for 4 weeks. Each group ΙΙ and ΙΙΙ divided into 2 subgroups; group b: patients with NP before taking VD and group a: patients with NP after taking. Nasal biopsies were obtained of all groups for histological examination and immunohistochemical detection of Toll-like receptors 9 expression.
Results: Patients of nasal polyps before VD taking (groups IIb and IIIb) presented with symptoms of Visual Analogue Scale, VAS score (facial pain, headache, nasal blockage, nasal discharge, post-nasal drip and olfactory disturbance) and endoscopic appearance of Lund and Mackey score (polypi, edema and discharge), damage of respiratory epithelium, extensive accumulation of collagen fibers in lamina propria and highly expressed TLR-9. The high dose VD group (IIIa) showed near normal respiratory epithelium, significant decrease (P<0.05) in all symptoms of VAS score, endoscopic appearance of Lund and Mackey score. The mean area % of submucosal accumulation of collagen fibers and TLR-9 expression were also significant decreased but decrease was insignificant (P<0.05) in the low dose VD group (IIa).
Conclusion: VD participate significantly in protection against human nasal polyposis when used by high therapeutic dose, by reducing the size of nasal polyps, relieving the symptoms and signs of nasal polyposis.
Keywords: Nasal polyposis, vitamin D, TLR-9 expression, visual analogue scale