Effect of intranasal treatment with capsaicin on the recurrence of polyps after polypectomy and ethmoidectomy

The aim of this study was to evaluate the influence of five intranasal appl ications of capsaicin, performed after endoscopic polypectomy associated wi th partial middle turbinectomy and anterior ethmoidectomy, on the recurrenc e of nasal polyps and the intensity of nasal obstruction and rhinorrhea. Fi fty-one patients (19 females, 32 mules, mean age 43 years) suffering from n asal polyposis for more than I year were included in this double blind, ran domized, placebo-controlled study. During post-surgical controls, local ana esthesia and vasoconstriction of the middle meatus area were performed in a ll patients with a cotton pellet soaked with lidocain and adrenaline. In 29 patients, the same type of cotton pellet soaked with capsaicin (3 x 10(-6) mel. dissolved in 70% ethanol) was left into the middle meatus of both nos trils for 20 min. As a control group, 22 patients, matched for age and sex, were treated with the capsaicin vehicle alone (70% ethanol). All patients studied received the intranasal treatment once a week for 5 weeks. Subjecti ve evaluations of nasal airway resistance (NAR) and rhinorrhea were recorde d by means of a visual analogue scale. Clinical staging of the nasal polypo sis (graded from stage 0 = absence of polyp to stage 3 = polyps occupying t he entire nasal cavity) was evaluated by the same ENT specialist (ZW) using a 0 degrees endoscope. All parameters were recorded For each patient I wee k before surgery. then once a month for 9 months. Patients treated by endos copic surgery followed by intranasal capsaicin application, reported a mark ed reduction in their NAR compared with the pretreatment evaluation (p < 0. 001). In contrast, patients treated with the vehicle alone did not have any significant improvement of their subjective NAR. Subjective rhinorrhea was not modified by either treatment. Patients treated with capsaicin showed a significant smaller staging of their nasal polyposis compared with the con trol group (p < 0.001). These observations suggest that endoscopic surgery followed by intranasal capsaicin application reduces polyps and nasal obstr uction recurrence and could be an alternative treatment to expensive cortic osteroids in developing countries.