Changes in Nasal Epithelium and Polyps in Patients with Polyposis after Treatment with Amphotericin B and Budesonide. A Preliminary Clinicopathologic and Electron Microscopic Study

Aim: Recent studies on the efficacy of the intranasal amfotericin B (AB) have been proposed as an effective treatment of cronic rhinosinusitis (CRS) with nasal polyps (NP). The aim of this study is to investigate the effect of intranasal application of (AB) and budesonide nasal spray (BN) in patients with CRS.

Methods: Twenty-one volunteer patients with NP received AB solution and BN nasal spray twice a day for 6 weeks. All patients, prior to and after the treatment, underwent nasal epithelium biopsies of the inferior turbinate and of the NP. All specimens were evaluated by light and transmission electronic microscope. Additional outcome variables included a sinus symptom score (SSS), an endoscopy score, and a saccharin test.

Results: The evaluation of the post-treatment polyp specimens by electron microscopy demonstrated: (1) atrophic epithelium with extremely few ciliated and goblet cells, and (2) disconnection of epithelial cells throughout the entire epithelial thickness and destruction of nuclear structures and cellular organoids. Statistically significant alterations in post-treatment SSS measurements were found (p < 0.001). No statistically significant alterations in saccharin nasal transit time measurements were found (p = 0.33).

Conclusion: AB had a cytotoxic effect on polyps. The epithelium of nasal turbinate remained unimpaired, and the mucociliary clearance tended to improve.