Ο ρόλος του περιβάλλοντος στη δημιουργία ρινικών πολυπόδων στον ενήλικο πληθυσμό

Abstract

Nasal polyps are the most common tumors of the nasal cavity. Its prevalence is estimated about 2.1-4%. They can impair the quality of life, causing nasal obstruction and leading to acute or chronic sinusitis, hyposmia or anosmia, sleep apnea and nasal bones destruction. There are several pathogenic theories but the precise mechanism of nasal polyps is not completely understood. Nasal polyps or nasal polyposis is considered as a subgroup of chronic rhinosinusitis. It is therefore related to a chronic inflammatory condition of the nasal cavity, where eosinophils have a predominant role. Hereditary and allergic mechanisms have been investigated and seem to play a significant role. Environmental determinants like smoking, occupation and pollution are not clear and sometimes controversial. Taking into account the lack of sufficient epidemiological data, we attempted by this study to investigate the frequency of eventual risk factors among patients with nasal polyps and to compare it with this of healthy controls. It involves a retrospective case control study realized in Athens from September 2006 to Jun 2009. One hundred patients with nasal polyps admitted to the ENT department of three hospitals in Athens and 102 healthy controls matched for age, participated in the study. All cases and controls were over 18 years old. A questionnaire was completed by interview on chosen eventual risk factors like gender, educational level, family’s history, allergies, smoking, occupational activities and environmental exposure. The prevalence of each determinant was compared between cases and controls using multiple logistic regression and the odds ratio were estimated. Since there are not known occupational risk factors related to nasal polyps, as high risk activities were considered these with exposure to dusts, fumes, formaldehyde, chrome, nickel, arsenic, irritatants, colours, solvents and other volatile organic compounds. According to the results of this study 13.3% of the patients and none of the controls had history of polyps in the family. Using multiple logistic regression the odds ratio for certain allergies was 24.8 and for probable allergy 12.5, with the prevalence among patients 64% and 12% respectively. The OR for certain environmental exposures was 15.4 and for occupational exposures 19.9. Occupational exposure to chemicals seems to be a predominant factor among patients and the environmental pollution seems to contribute to the etiology of nasal polyps. No significant difference was found between nasal polyps and educational level or smoking habits. In our study the environmental and the occupational exposure seems to have an important role as a determinant of nasal polyps, independently of back-up allergies or family history. It seems that 5% of the patients have had intolerance to acetylsalicykic acid. In our study the smokers were 36% among cases, but no significant difference of smoking prevalence was found between the two groups, although subjects with nasal polyps had higher smoking exposure. The conclusion of this study is that family aggregations, allergies, occupational and environmental exposure, independently viewed, are much more frequent among patients with nasal polyps in comparison to the general population. The role of smoking remains unclear and more sophisticated studies with bigger samples are for this purpose necessary. The appearance of the disease beyond genetic factors depends on environmental factors inducing either allergic or irritating inflammatory effects.