The Effects of Systemic, Topical, and Intralesional Steroid Treatments on Apoptosis Level of Nasal Polyps

Objective. The purpose of this study was to compare the apoptotic responses to systemic, topical, and intrapolyp injection 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 mu g triamcinolone acetonide 2 times daily for 1 month. Group D received no medication. 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 (PD-A=.0001; PD-B=.003; PD-C=.026) and between groups A and C (PA-C=.012). Group B did not differ significantly from either group A or C (PA-B=.11; PB-C=.75). Conclusions. The apoptotic index in nasal polyps treated with systemic, topical, and intrapolyp injection forms of glucocorticoids was higher than that in the control group. Systemic steroid treatment induced the most apoptosis.