Clinical and pathologic methods to assess the long-term safety of nasal corticosteroids

Background: The main objective of this long-term prospective local safety s tudy was to evaluate endoscopic and histologic changes in nasal epithelium after 6-month treatment with triamcinolone acetonide (TAA). We describe her e a method to measure quantitatively epithelium thickness. Results were com pared with those seen with the use of cetirizine tan antihistamine) and ano ther oral intranasal corticosteroid, beclomethasone dipropionate (BDP). Methods: Patients were examined by an ENT specialist who first performed an endoscopic evaluation of the nasal cavities, assessing any morphologic abn ormalities and the aspect of the mucosa. Biopsies were taken from the infer ior turbinate before and after 24 weeks of treatment. Biopsies were immedia tely fixed in cold acetone (-20 degrees C) and embedded in glycolmethacryla te; sections of 2 mu m were cut on an ultramicrotome. Morphometric evaluati ons were done in a blinded fashion by computerized image analysis to measur e an epithelial area over a minimum length of 50 mu m. The thickness was as certained by the ratio of area to length. Results: 1) For all three treatment groups, the nasal epithelium thickness decreased slightly from pretreatment to the end of treatment. 2) No statistically significant differences between the three treatment gro ups were found in epithelium thickness. 3) Macroscopically, nasal tissues in all treated groups were normal. Conclusions: These results clearly indicate that long-term treatment with T AA has no atrophic effect on nasal mucosa.