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Michael Weschta, MD; Dagmar Rimek, MD; Marc Formanek; Andreas Podbielski, PhD; Herbert Riechelmann, PhD

Arch Otolaryngol Head Neck Surg. 2006;132:743-747.

Objective  To examine the effect of nasal antifungal treatment on eosinophil cationic protein (ECP) and tryptase levels in samples of nasal lavage fluid from patients with chronic rhinosinusitis and nasal polyps.

Design  Prospective double-blind placebo-controlled clinical trial.

Setting  Tertiary surgical center.

Patients  Subjects with severe chronic rhinosinusitis and nasal polyps. Of 120 screened patients, 76 were eligible. Six patients withdrew because of minor adverse events, and 10 dropped out for other reasons. In total, 60 patients completed the study according to the study protocol.

Interventions  Nasal treatment with amphotericin B or saline control for 8 weeks.

Main Outcome Measures  Nasal lavages were performed before and after treatment. Fungal elements were assessed by culture and with different polymerase chain reaction assays. Levels of ECP and tryptase were determined by fluorescent enzyme immunoassay.

Results  No correlation between cell activation markers and fungus detection was observed before treatment (all P>.20). Nasal amphotericin B treatment had no effect on levels of ECP (P = .17) or tryptase (P = .09) in nasal lavage samples. Moreover, successful fungus eradication, defined as fungus detection before but not after treatment, did not influence nasal ECP or tryptase levels (all P>.40).

Conclusion  Neither topical amphotericin B therapy nor fungal state before and after treatment had any significant influence on activation markers of nasal inflammatory cells in chronic rhinosinusitis.

Author Affiliations: Department of Otorhinolaryngology–Head and Neck Surgery, University of Ulm, Ulm, Germany (Drs Weschta and Riechelmann and Mr Formanek); and Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Rostock, Germany (Drs Rimek and Podbielski). Dr Rimek is now with the Department of Medical Microbiology, Thuringian State Office for Food Safety and Consumer Protection, Erfurt, Germany.

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