Dual and triple modulator therapy for chronic rhinosinusitis in cystic fibrosis patients.

BACKGROUND: The introduction of CFTR modulators has changed the landscape in the treatment of cystic fibrosis (CF) and early case series have shown improvements in sinonasal outcomes in this patient population. METHODOLOGY: A real-word data study was performed to evaluate the impact of dual therapy with tezacaftor/ivacaftor (TEZ/IVA) and triple therapy with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on CF-related chronic rhinosinusitis (CRS), by comparing subjective and objective outcome measures at baseline, 12 months after treatment with TEZ/IVA and six months after treatment with ELX/TEZ/IVA. RESULTS: In total, 43 CF patients, with a mean age of 32 years, were included. After triple therapy, significant improvements in overall visual analogue scale, SNOT-22, Lund Kennedy, nasal polyps, and Lund-Mackay scores were observed, whereas no beneficial effect could be seen in patients treated with dual therapy. Bacterial upper airway colonization did not differ pre- and postmodulator therapy in the present study. The number of responders to dual and triple therapy is 23.8% and 63.2% of the patients, respectively. CONCLUSIONS: Triple therapy with ELX/TEZ/IVA is superior to dual therapy with TEZ/IVA in the treatment of CF-CRS, as significantly reduced sinonasal complaints, nasal endoscopy and CT scores were observed after triple therapy, whereas this was not the case for dual therapy.

Nasal hyperreactivity in allergic rhinitis and chronic rhinosinusitis with polyps: a role for neuronal pathways.

BACKGROUND: Nasal hyperreactivity (NHR) is prevalent in all chronic upper airway inflammatory phenotypes, including allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Although NHR in patients with non-allergic rhinitis is mediated by neuronal pathways, AR and CRSwNP are mainly characterized by type 2 inflammation. METHODS: Eighteen healthy controls and 45 patients with symptomatic AR/CRSwNP underwent a cold, dry air (CDA) provocation test for objective diagnosis of NHR. Before and after, questionnaires were filled out and nasal secretions and biopsies were collected. Markers for neurogenic inflammation (substance P, calcitonin gene-related peptide, neurokinin A), epithelial activation (IL-33), and histamine were measured in secretions by ELISA; and expression of neuronal markers PGP9.5, TRPV1, and TRPM8 was studied in biopsies by RT-q-PCR. Effects of histamine on TRPV1/A1 were studied with Ca2+-imaging using murine trigeminal neurons. RESULTS: CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/patients CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/patients. Subjective (subjectively reported effect of CDA) and objective (decrease in PNIF) effects of CDA were significantly correlated. Levels of neuropeptides and histamine in nasal secretions and mRNA expression of PGP9.5, TRPV1, and TRPM8 correlated with CDA-induced PNIF-reduction. CDA-provocation induced an increase in IL-33-levels. Both TRPV1 and TRPA1 expressed on afferent neurons were sensitized by exposure to histamine. CONCLUSION: NHR is not an on/off phenomenon but spans a continuous spectrum of reactivity. A neurogenic inflammatory background and increased histamine-levels are risk factors for NHR in AR/CRSwNP.

Endoscopic septoplasty: literature review, surgical techniques and retrospective analysis at the University Hospitals Leuven.

BACKGROUND: Endoscopic septoplasty is an alternative approach for a deviated nasal septum. Since its introduction, numerous techniques have been developed, each with its own advantages and limitations. A literature review is presented, along with our experience with endoscopic spur resection. METHODS: The Medline and Google Scholar databases were searched for relevant literature, and the records of all patients undergoing endoscopic spur resection at the University Hospitals Leuven between 2001 and 2015 were reviewed.Results and conclusionEndoscopic septoplasty offers improved visualisation and the option of limited flap dissection, which are particularly helpful when dealing with isolated spurs, posterior deviations and revision septoplasty. It enhances teaching and improves surgical transition to endoscopic sinus surgery. Reported success and complication rates are comparable to those seen in traditional approaches. Endoscopic spur resection, as conducted at the University Hospitals Leuven, was shown to be a quick, safe and efficient technique when dealing with isolated septal spurs, especially when combined with endoscopic sinus surgery.

Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre.

RATIONALE: The European Position Paper on Sinusitis (EPOS) guidelines provide composite criteria to evaluate chronic rhinosinusitis (CRS) control, taking into consideration the severity of patients' symptoms, aspect of nasal mucosa and medical intake as parameters of CRS control. OBJECTIVES: To study the degree of CRS control using novel EPOS control criteria at 3-5 years after a functional endoscopic sinus surgery (FESS) and correlate these data to symptoms scores. METHODS: Adult CRS patients (n = 560) who had undergone bilateral FESS for chronic inflammatory sinonasal disease 3-5 years prior to the study were included. Patients received a postal questionnaire asking for control items according to EPOS control criteria, visual analogue scale (VAS) scores for total and individual sinonasal symptoms, sinonasal outcome test (SNOT)-22 and Short Form (SF)-36 questionnaires. MEASUREMENTS AND MAIN RESULTS: About 19.5% of CRS patients were well controlled, with 36.8% of patients being partly controlled and 43.7% uncontrolled. The levels of control corresponded to mean total VAS, SNOT-22 and SF-36 scores. Subgroup analysis revealed that female gender, aspirin intolerance and revision FESS were associated with higher prevalence of uncontrolled CRS, whereas allergy, asthma and smoking status did not alter the percentage of patients in each category of control. In 81 patients attending the outpatient clinic, nasal endoscopy changed classification in only four patients (4.9%). CONCLUSIONS: Based on the novel EPOS control criteria, at least 40% of CRS patients are uncontrolled at 3-5 years after FESS. Therefore, better treatment strategies leading to higher disease control are warranted in CRS care.

Draf III frontal sinusotomy: influence of patient characteristics on outcome.

Draf III frontal sinusotomy: influence of patient characteristics on outcome. OBJECTIVE: To identify positive and negative predictive outcome factors for the Draf III procedure based on the experience of a single center. METHODS: Seventy-two patients who underwent a Draf III procedure between 2005 and 2011 at the ENT department of University Hospitals Leuven were included. Patient demographics, history of frontal sinus surgery, clinical features, and computed tomographic evaluations were reviewed and analyzed for associations with symptom control and endoscopic outcome. RESULTS: The mean age was 48 years (16-82 years), and the male-to-female-ratio was 2:1. Major indications were chronic rhinosinusitis (with or without nasal polyps) and mucoceles. Supplementary frontal (recess) cells were found in the majority of patients. Osteoneogenesis was present in one out of four patients. At the end of follow-up (mean 35 months), the neo-ostium patency rate was 89%. Stenosis or closure of the neo-ostium was seen in 11% of patients, and 15% of patients required revision surgery. Subjective improvement was reported by 88%. CONCLUSION: The results of Draf III frontal sinusotomy were positive in the long term. Previous frontal sinus surgery, the presence of allergy or aspirin-exacerbated respiratory disease (AERD), asthma, smoking, and variants in frontal recess anatomy did not affect outcome. Osteoneogenesis and chronic mucosal inflammation could be controlled by creating a large drainage pathway.

Vascular endothelial growth factor receptor 1 expression in nasal polyp tissue.

BACKGROUND: Edema represents a key feature of nasal polyp (NP) disease. Members of the vascular endothelial growth factor (VEGF) family may be involved, but the precise role of VEGF-A, VEGF-B, placental growth factor (PlGF), and their receptors VEGFR1 and VEGFR2 in NP edema formation remains elusive. OBJECTIVE: Exploring the expression of VEGF family members and their receptors and their correlation with clinical, radiological, and edema markers in NP. METHODS: The expression of VEGF-A, VEGF-B, PlGF, VEGFR1, and VEGFR2 was measured in NP (n = 23) and control tissue (n = 22) at mRNA and protein level. Edema was evaluated by measuring albumin levels and wet/dry ratios. Computed tomography (CT) scans were scored using the Lund-Mackay scoring system. IL-5 mRNA expression was determined by real-time RT-PCR. Cell suspensions from NP (n = 10) and control tissue (n = 12) were stimulated in vitro with IL-1ß or TNFα. RESULTS: mRNA expression of VEGFR1 and VEGF-B was significantly higher in NP compared with control tissue. Expression levels of VEGF-B and VEGFR1 significantly correlated with NP albumin content (VEGF-B: P = 0.0208; VEGFR1: P = 0.0293), CT scan scores (VEGF-B: P = 0.0075; VEGFR1: P = 0.0068), and IL-5 mRNA (VEGF-B: P = 0.0027; VEGFR1: P = 0.0001). In vitro stimulation of control and NP tissue cell suspensions with IL-1ß or TNFα significantly reduced the expression of VEGFR2 in control tissue, without altering VEGFR1 and VEGF-B expression. hVEGF-B induced nitric oxide production in NP macrophages (P < 0.05). CONCLUSION: Expression levels of VEGFR1 and VEGF-B correlate with edema and clinical markers of NP disease and therefore represent potential therapeutic targets.

Myospherulosis as a complication of functional endoscopic sinus surgery: a double case report.

INTRODUCTION: Paraffinomas (also known as 'sclerosing lipogranulomas' or 'myospherulosis') are a widely acknowledged complication of cosmetic paraffin injections but they are rare following functional endoscopic sinus surgery. CASE PRESENTATIONS: Our first case features a 45-year-old woman presenting with a peri-ocular swelling two weeks after functional endoscopic sinus surgery. The procedure was complicated by a fractured lamina papyracea. A nasal packing with antibiotic ointment was left in situ. Initially, the inflammation was controlled successfully with corticosteroids but the swelling persists to this day. Our second case is a 45-year-old man who suffered from a recurrent swelling of the right eyelid after endoscopic sinus surgery. Multiple treatments with oral antibiotics and corticosteroids brought about no improvement. Debulking surgery was performed and a PDS film was placed between the peri-orbita and the bony orbital floor but the swelling recurred. The patient finally consulted a plastic surgeon as a last resort, but the reconstructive procedure only exacerbated the clinical picture. In both cases a biopsy was performed which established the foreign body reaction typical of a paraffinoma. At present, both patients still suffer from this condition. CONCLUSION: The complete resection of a paraffinoma is seldom possible because of diffuse infiltration and recurrence is very likely. We therefore conclude that paraffin-based ointments should not be used with nasal packing after sinus surgery, especially when there has been a lesion involving the orbital wall.

Long-term effects of cutting versus non-cutting instruments in FESS.

BACKGROUND: Currently most ENT surgeons advocate using cutting instruments in Functional Endoscopic Sinus Surgery (FESS), based on the assumption of superior wound healing due to mucosal preservation. However, there is no scientific evidence of superiority of the cutting instruments. METHODS: A prospective, randomized double blinded study was performed in 100 patients undergoing FESS, operated one side with non-cutting and the contra lateral side with cutting instruments. After a mean follow-up of 12 years after FESS, unilateral and global sino-nasal symptoms were scored by the patients using VAS, endoscopic abnormalities scored at both sides at the Outpatient clinic and radiologic abnormalities were described. RESULTS: No significant differences between the sides operated by cutting and non-cutting instruments were found for sino-nasal symptomatic or for radiologic abnormalities between both sides. For the endoscopic parameters there was no difference for secretion or mucosa. Only for the presence of endoscopic synechiae there was a statistically significant difference between both groups. At the non-cutting side more synechiae were noticed, but no interference with sinus access, neither ventilation nor drainage was observed. CONCLUSION: FESS performed with cutting instruments results in less synechiae formation compared to non-cutting instruments. However, the presence of synechiae is not associated with more symptoms or CT scan abnormalities.

Negative impact of occupational exposure on surgical outcome in patients with rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by functional endoscopic sinus surgery (FESS) when medical treatment fails. Endogenous as well as exogenous factors may be responsible for persisting symptoms after FESS. The role of occupational exposures on success of FESS has never been investigated. METHODS: In this case-control study, we tested the hypothesis that the outcome of FESS procedures is related to exposures at work. Questionnaires were sent to 890 patients who had undergone one or more FESS procedures and to 182 controls. Three independent experts assessed blindly the reported work exposures to inhaled agents. The relationship between exposure and the number of FESS procedures was analyzed. RESULTS: Relevant occupational exposure was reported by 25% of all responding patients undergoing FESS (n = 467) and 12% of controls (n = 69). The prevalence of occupational exposures increased linearly with the number of FESS procedures from 21% in those who had one FESS to 44% in those who had four or more FESS (χ(2)  = 12.74, P < 0.001). Logistic regression analysis with adjustments for potential confounders, including smoking, atopy, and asthma, confirmed that the odds ratio (OR) for reporting occupational exposures was significantly higher in those needing more than one FESS (OR = 1.64) or more than two FESS (OR = 1.97). These results were mainly driven by exposure to low molecular weight agents. CONCLUSION: Exposure at work appears to be a risk factor for the occurrence of CRS and for its recurrence or persistence, as evidenced by the need for revision surgery.

Specific medical and surgical treatment for chronic inflammatory diseases in children.

Treatment for chronic inflammatory conditions in children should take into account the specific pathophysiological and clinical processes underlying these disorders. These guidelines provide a framework for both the medical and surgical treatment of chronic inflammatory diseases such as otitis media, allergic rhinitis and chronic rhinosinusitis, chronic inflammation of tonsils and adenoids, and laryngitis. In addition, the role of vaccinations and immunomodulatory therapies is discussed. Whenever possible, the evidence levels for specific treatments comply with the Oxford Levels of Evidence.

Malignant ectomesenchymoma of the paranasal sinuses with proptosis.

PROBLEM: A 36-year-old woman presented with a feeling of pressure in the right orbit and proptosis of the right eye after a "common cold". METHODOLOGY: Computed tomography (CT) of the maxillofacial region revealed, and endoscopy confirmed, a mass in the right ethmoid sinus, eroding the lamina papyracea and extending into the orbit. Pathology of multiple biopsies revealed a nasal neoplasm composed of neuroectodermal and mesenchymal neoplastic elements, suggestive of a malignant ectomesenchymoma (MEM). Magnetic resonance imaging was used for MEM staging. Computed tomography of the chest and abdomen show no evidence of distant metastases. RESULTS: Due to the intracranial and intraorbital extension of the tumour, radical surgery was not an option. Appropriate chemotherapy (6 cycles of vincristine/ifosfamide/adriamycin and 2 cycles of vincristine/ifosfamide/cisplatin) and intensity-modulated radiation therapy were administered. CONCLUSION: Twenty-eight months after treatment, there was no evidence of residual or metastatic disease.

Sensitization to common aeroallergens in patients at an outpatient ENT clinic.

OBJECTIVES: The epidemiology of specific sensitization to inhalant allergens remains unknown in patients at tertiary rhinology clinics. We used skin prick testing (SPT) to assess sensitization to major aeroallergens in order to evaluate the prevalence of specific rhinologic diseases, the frequency of polysensitization and the relationship between nasal symptoms, nasal endoscopy parameters, diagnosis and sensitization. METHODS: A retrospective review of medical records was conducted at the ENT Department of the Catholic University Hospital in Leuven, Belgium. The study analyzed the medical data of patients with rhinologic symptoms suspected of having allergies. RESULTS: The study included 1326 patients with a mean age of 35 +/- 18 years (range: 3-88 years); 52.8% were males. Rhinitis without nasal abnormalities (42.1%), chronic rhinosinusitis without nasal polyps (16.5%) and nasal abnormalities (16.1%) were the most prevalent findings. About 31.6% of patients were sensitive to at least one allergen, and the most common aeroallergens were dermatophagoides pteronyssinus (62.1%) and grass pollen (53.2%). Polysensitization was found in 54.2%. The most prevalent clinical symptoms in allergic rhinitis patients were nasal obstruction, clear/watery nasal discharge, sneezing, postnasal drip and headache. Clear nasal discharge, sneezing, and itchy nose and eyes (p < 0.05 for all) were significantly higher in sensitized patients. In contrast, postnasal drip, headache and purulent nasal discharge were also observed in non-sensitized patients (p < 0.05 for all). CONCLUSIONS: At a rhinology clinic at a university ENT clinic, 31.6% of the patients had positive SPT results, mainly to house dust mites and grass pollen. Among sensitized patients, 54.2% were polysensitized.

Type III frontal sinusotomy: surgical technique, indications, outcomes, a multi-university retrospective study of 120 cases.

Draf in 1991. The procedure--which is also known as the modified endoscopic Lothrop procedure--aims to create the largest possible anteroposterior and lateral to lateral opening between both frontal sinuses and the nasal cavities. This requires the resection of the medial floor of both frontal sinuses, the intersinus septum and the superior nasal septum. The authors present a retrospective study including a cohort of 120 patients who underwent surgery in six Belgian university ENT departments. Mean follow-up was 24.6 months (range: 5-36 months). This paper describes the surgical procedure and reviews the indications, comorbidities, outcomes and complications of the type III frontal sinusotomy. Some correlations are also established with the data published in the worldwide literature. The authors conclude that the Draf III is a demanding procedure requiring considerable expertise in endoscopic sinus surgery. The procedure is effective with a success rate of 87.5%. Indeed, 12.5% of patients only experienced closure of the neoostium while 20% of all the patients had unchanged or worse symptomatology. The percentage of post-operative complications is 7.5%. All complications were managed successfully.

Adenocarcinomas of the sinonasal tract: current opinion.

Malignant tumours of the sinonasal tract represent a rare condition, accounting for only 0.5-1% of all malignancies in the Western population. Patients with malignant tumours of the nasal cavity and sinuses form a heterogeneous group when it comes to histology and treatment protocols. This review of adenocarcinoma of the sinonasal tract aims to provide a comprehensive overview of aetiological factors, histological subtypes, diagnostic workup, currently available treatment options, survival analysis and prognostic factors for treatment outcome. The current treatment of choice is surgical resection, using whichever approach allows access for the removal of the entire tumour with a curative intent.

Current Belgian adenotonsillectomy practice: a survey among Belgian ENT specialists.

OBJECTIVES: Tonsillectomies and adenotonsillectomies (TE and ATE) are among the most frequently performed operations in the western world. Despite the lack of generally accepted clinical guidelines about indications, the beneficial role of the procedure has been established. The aim of this study was to identify current practice relating to indications for tonsillectomies and adenotonsillectomies among Belgian ENT specialists. METHODS: An anonymous questionnaire was sent to all Belgian ENT specialists. Part I of the questionnaire included questions about the ENT specialist himself/herself and his/her practice. Part II comprised questions about indications for TE/ATE in children up to 16 years of age. Part III included questions about indications in adults. RESULTS: 238 out of 528 questionnaires were completed and returned. The majority of physicians consider TE/ATE to be indicated if a child or an adult suffers 3 or 4 tonsillitis episodes per year. The decision to operate on children for upper airway obstruction is mainly based on clinical and anamnestic findings. A peritonsillar abscess is usually considered to be an indication for surgery. We compared the results between different groups of ENT specialists and could detect differences in decision-making only according to the number of years of ENT practice. The stringency of surgeons' indications decreases with increasing surgeon age. CONCLUSIONS: The majority of respondents consider tonsillectomies/adenotonsillectomies to be indicated after 3 to 4 episodes of tonsillitis per year. In the case of upper airway obstruction in children, surgical indications are mainly based on clinical and anamnestic findings. Surgical decision-making appears to be influenced by the number of years of ENT practice.

Staphylococcus aureus enterotoxin B augments granulocyte migration and survival via airway epithelial cell activation.

BACKGROUND: Staphylococcus aureus enterotoxin B (SEB) has recently been postulated to be involved in the pathology of granulocyte-dominated disease. Studying the immunologic interaction between SEB and airway epithelial cells in immortalized cell lines or long-term epithelial cell cultures has obvious disadvantages. METHODS: We used a novel technique of freshly isolated and purified human nasal epithelial cells (HNEC) from healthy, nonallergic individuals, which were incubated for 24 h without/with SEB at different concentrations. Chemokine production was evaluated in the supernatant using Cytometric Bead Array. The chemotactic activity of the supernatant was studied in vitro using a Boyden chamber. Survival was evaluated with flow cytometry, using propidium iodide to identify dead cells. RESULTS: Staphylococcus aureus enterotoxin B showed a dose-dependent induction of interferon-inducible protein-10, monokine induced by interferon-gamma, regulated upon activation normal T cell expressed and secreted, monocyte chemoattractant protein 1 (MCP-1) and granulocyte colony stimulating factor production by epithelial cells in vitro. The supernatant of epithelial cells had chemotactic activity for granulocytes in vitro, which was enhanced in the supernatant of SEB-stimulated epithelial cells. Reduced number of propidium iodide positive granulocytes was found in the conditions where supernatant of SEB-stimulated epithelial cells was applied. CONCLUSION: Staphylococcus aureus enterotoxin B exerts a direct pro-inflammatory effect on HNEC, with induction of chemokine and growth factor release, resulting in the migration and prolonged survival of granulocytes in vitro.

A case series of embryonal rhabdomyosarcoma of the head and neck in adults.

Embryonal rhabdomyosarcoma (RMS) is a rare malignant mesenchymal tumour that is believed to arise from cells committed to a skeletal muscle lineage. The head and neck region is among the most frequent locations for embryonal RMS in adults. We present a retrospective review of seven patients treated in our institution between 2000 and 2008. The age at diagnosis ranged from 19 to 41 years. One patient received primary surgery followed by adjuvant radiotherapy. Six inoperable patients were treated along a single chemotherapy protocol: the VIA-VIP regimen (a combination of vincristine, ifosfamide and doxorubicin (VIA) in alternation with etoposide, ifosfamide and cisplatin (VIP) administered in 3-weekly cycles), followed by local therapy, involving radiation therapy and/or surgery. An objective response to chemotherapy was observed in all six patients. Three out of seven patients remain disease-free with a median follow up of 4.5 years. Although the prognosis of head and neck embryonal RMS is worse in adults than in children, a multimodality treatment combining surgery, radiotherapy and intensive chemotherapy is feasible and effective in this population.

Unique approach to secondary cleft-lip rhinoplasty in facial plastic surgery.

Rhinoplasty occupies a unique position in facial plastic surgery due to the central position of the nose in the face and the vital functions of the nose. Among facial plastic surgeons, secondary rhinoplasty in adult cleft-lip patients is considered to be one of the most challenging surgical interventions due to the congenital distortion of the cartilaginous and bony nasal pyramid, with consequences for both nasal aesthetics and breathing. In spite of the challenging nature of the procedure, post-operative satisfaction is high, matching that of non-cleft-lip patients, as long as appropriate surgical techniques are applied. Specific rhinoplasty methods are used in unilateral or bilateral cleft-lip patients with extensive grafting, combined efforts for aligning the nasal dorsum and the creation of symmetry in the nasal tip, medialisation of the anterior nasal spine with augmentation of the premaxilla, correction of nasal vestibulum stenosis and specific post-operative care with a nasal vestibulum device. This review aims to address some specific surgical issues relating to cleft-lip rhinoplasty, resulting in the high subjective satisfaction rate reported by cleft patients operated upon in the University Hospitals Leuven.

Antibiotic use and doctor visits are reduced after adenotonsillectomy.

OBJECTIVE: A tonsillectomy, with or without an adenotomy ((A)TE), is a common surgical procedure in children. The most important indications are recurrent tonsillitis and upper airway obstruction secondary to adenotonsillar hypertrophy. The aim of this study was to investigate whether the current (A)TE practice in Belgium reduced the need for medical care. STUDY DESIGN AND METHODS: The database of the Christelijke Mutualiteit, one of the most important health insurance organizations in Belgium, provided data on approximately 11,000 (A)TE's in children aged 0 to 15 years, performed by different ENT-specialists from Jan 1st 2002 to Sept 30th 2003. We compared the use of antibiotics during the 12 months before and the 12 months after (A)TE. We also compared the number of visits to pediatricians and general practitioners during the 12 months before and the 12 months after surgery. RESULTS: The median antibiotic use dropped from 4 boxes in the year before the operation to 1 box in the year after the operation. The median number of doctor visits also dropped from 7 visits in the year before to 4 visits in the year after (A)TE. CONCLUSION: Although there are no generally accepted guidelines on the indications for (A)TE in Belgium, the current practice effectively reduced the need for medical care.

Dexamethasone-induced apoptosis of freshly isolated human nasal epithelial cells concomitant with abrogation of IL-8 production.

BACKGROUND: Human nasal epithelial cells (hNECs) are the first line of immune defense and are able to produce mediators that recruit, activate and prolong survival of immune cells, among which IL-8 takes an important place. Studies on IL-8 and effects of dexamethasone on hNECs have been hampered by methodological shortcomings. The purpose of the study is to investigate the contribution of freshly isolated hNECs to IL-8 production in chronic rhinosinusitis with nasal polyps (CRSwithNP). Secondly, the effects of dexamethasone treatment on hNEC apoptosis and IL-8 production are investigated. METHODOLOGY: hNECs were freshly isolated from nasal polyp tissue and healthy inferior turbinate of NP patients (n=12) and from inferior turbinates of healthy donors (n=19) by protease treatment and two negative selection procedures. hNECs were incubated with IL-1ß (10ng/ml), TNFα (10ng/ml) or dexamethasone (10, 100 and 1000 Amicrog/ml). After 24h, IL-8 levels were determined in the supernatants by ELISA. Finally, hNECs were incubated with increasing doses of dexamethasone and stained with trypan-blue and annexin-FITC/PI to study apoptosis. RESULTS: hNECs isolated from nasal turbinates of healthy and NP patients and polyp tissue from NP patients produced similar levels of IL-8. IL-1ß induced higher levels of IL-8 production in all types of hNECs without differences between control and NP tissue. Dexamethasone induced apoptosis of hNECs concomitant with abrogation of IL-8 production by hNECs. CONCLUSIONS: IL-8 production by human nasal epithelial cells does not differ between NP and healthy tissue under baseline nor stimulatory conditions. Dexamethasone induces apoptosis of hNECs and abrogates IL-8 production.