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}{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{juthika rai} \author[2]{Dr. Gourav S Shetty} \affil[1]{ A.J. INSTITUTE OF MEDICAL SCIENCES} \renewcommand\Authands{ and } \date{\small \em Received: 12 December 2016 Accepted: 31 December 2016 Published: 15 January 2017} \maketitle \begin{abstract} Background: Nasal polyposis has been recognized as a clinical entity since several centuries. The earliest physicians talked about their tendency to recur which is echoed by modern day rhinologists. Objectives: The objective of this study is to attempt to identify allergy as a major contributing factor in the etiology of Nasal Polyposis. Materials & Methods: The study consists of 50 patients who presented to the Out Patient Department with nasal polyposis diagnosed by clinical & radiological methods and confirmed by histopathology. These patients were evaluated for the presence of allergy by a detailed questionnaire and clinical examination. Absolute Eosinophil count and serum IgE were estimated. The results were then compiled and compared and data was analysed for statistical significance by Chi Square test. The patients were followed up for a period of 12 months to evaluate recurrence. Results: Out of the 50 patients a majority (78%) of them had Sinonasal polyposis. A significant percent of patients (69%) with Sinonasal polyposis gave a positive history of allergy and significantly high levels of serum IgE were seen in patients of this group. Seven cases showed recurrence on follow up, all of whom showed positive allergic status. Conclusion: Sinonasal polyposis patients had allergy as their major etiological factor in this study, and the majority of the recurrences were seen in this group. Failure to recognize and treat this association adds to the morbidity of the disease and results in poor treatment outcome. Objectives:The objective of this study is to attempt to identify allergy as a major contributing factor in the etiology of Nasal Polyposis. Materials & Methods:The study consists of 50 patients who presented to the Out Patient Department with nasal polyposis diagnosed by clinical & radiological methods and confirmed by histopathology. These patients were evaluated for the presence of allergy by a detailed questionnaire and clinical examination. Absolute Eosinophil count and serum IgE were estimated. The results were then compiled and compared and data was analysed for statistical significance by Chi Square test. The patients were followed up for a period of 12 months to evaluate recurrence. \end{abstract} \keywords{allergy, nasal polyposis, raised serum IgE.} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \let\tabcellsep& \section[{I. Introduction}]{I. Introduction}\par cience has progressed through many centuries to the present day. Nasal polyps have been recognized as a clinical entity since several centuries. Nobody is really sure why polyps occur, many theories have been proposed but none confirmative. One of the earliest etiologies proposed was that of allergy. A number of studies done by numerous rhinologists stands to either confirm or contradict this theory. Whatever be the school of thought, there is undeniable evidence that allergy is associated with nasal polyps. Unrecognized allergy almost definitely causes a recurrence thereby initiating the effort to distinguish atopics \& non atopics. This study is an attempt to identify allergy as a major contributing factor in the etiology of nasal polyposis on the assumption that isolation of an atopic patient will lead to better treatment of the underlying pathology.\par Author ? ? ?: A.J. Institute of Medical Sciences. e-mails: excelcior999@yahoo.com, gouravshetty@yahoo.com \section[{II. Aims and Objectives}]{II. Aims and Objectives}\par To evaluate the incidence of allergy in Nasal polyposis. To co-relate allergy and the type of Nasal polyposis. To evaluate recurrence in Nasal polyposis. \section[{III. Materials and Methods}]{III. Materials and Methods}\par The study consisted of 50 patients with nasal polyps who presented to the Out Patient Department of the Department of Otorhinolaryngology. The study was cross sectionally designed and lasted for 2 years.\par Patients who came to the O.P.D with nasal complaints of obstruction, headache, sneezing, itching, loss of smell were examined clinically to diagnose polyps. All cases that were diagnosed clinically were confirmed with histopathological examination.\par The diagnosed and confirmed patients based on clinical examination, Diagnostic Nasal Endoscopy (DNE) and radiology (CT PNS), were then divided into 2 categories: a. Sinonasal polyposis -multiple unilateral or bilateral polyps arising from the paranasal sinuses.\par c. These patients were then evaluated for the presence of allergy by a detailed questionnaire, clinical examination, Absolute Eosinophil count and serum IgE.\par The results were then compiled and compared and the data analysed for statistical significance by the Chi Square test for contingency tables. \section[{Inclusion Criteria}]{Inclusion Criteria}\par All patients presenting to the Out Patient Department with nasal obstruction, sneezing, itching of nose with nasal polyposis. All patients between the ages of 10 yrs to 80 yrs. \section[{Exclusion Criteria}]{Exclusion Criteria}\par All patients presenting with nasal complaints due to pathology other than nasal polyposis. Patients below 10yrs of age, and above 80 yrs of age. \section[{IV. Results}]{IV. Results}\par 50 patients of nasal polyposis who presented over the period of 2 years, after a detailed examination were grouped into either Sinonasal or Antrochoanal.\par Out of the 50 patients, 39 were Sinonasal (78\%) and 11 were Antrochoanal (22\%). Patients with Antrochoanal polyps mainly presented in the 0-40 age S b. Antrochoanal polyps -single unilateral polyp arising from the maxillary sinus.\par group while Sinonasal polyposis mainly presented in the 20-80 age groups.\par In both groups the majority of the cases were males. Nasal obstruction, and nasal discharge and headache were common in both groups. Sneezing was present in only 1/3 rd of the patients with Antrochoanal polyps as against 3/4 th of the patients of Sinonasal polyposis.\par There was no history of Asthma in patients with Antrochoanal polyps as against 1/6 th of the patients with Sinonasal polyposis who gave a positive history of Asthma.\par A positive history of Allergy was obtained in 1/5 th of patients with Antrochoanal polyps and in 2/3 rd of patients with Sinonasal polyps. The association among the 2 study groups was highly significant. The estimation of serum Eosinophils in the peripheral blood showed elevated levels in about 1/3 of the patients with Antrochoanal polyps and in almost all the patients with Sinonasal polyposis which was statistically significant. The serum IgE levels were elevated in 36.4 \% of the patients with Antrochoanal polyps and about 95 \% of patients with Sinonasal polyps which was statistically significant.\par When the 2 parameters were considered, 27.3 \% of Antrochoanal polyps and 74.4 \% of Sinonasal polyps were positive for allergy with a Chi Square test (1) = 13.50 and p = 0.0001 which was statistically significant. \section[{V. Discussion}]{V. Discussion}\par Allergy has long been implicated as a causative factor in Nasal polyposis. In this study, a consecutive group of 50 patients with nasal polyposis were studied The youngest patient in our study was 11 yrs old and the oldest was 78 years old. Antrochoanal polyps were associated with presentation in the younger age group in our study similar to the study by Choo et al \hyperref[b0]{1} where a majority of their patients with Antrochoanal polyps were below 16 yrs of age.\par In our study group, 69 \% of patients with Sinonasal polyposis gave a positive history of allergy and 15.4 \% gave a positive history of Asthma. This deferred slightly from that quoted by Farrel et al 2 who detected allergy in 27.83\% and asthma in 29\% and by Drake-Lee et al 3 who noted incidence of allergy in 22 \% and asthma in 27.83 \% of their patients. The notable exception in our study was the absence of history of aspirin sensitivity.\par The Absolute Peripheral Blood Eosinophil Count was elevated in 18.2 \% of patients with Antrochoanal polyps and in 84.6 \% of patients in Sinonasal polyposis in our study group. Kaldenbach et al \hyperref[b3]{4} in their study of 58 patients with Sinonasal polyposis found an increase in Absolute eosinophil count in 66\%. Sheri et al \hyperref[b4]{5} in their study of a total of 303 patients with Sinonasal polyposis found that the correlation between raised Absolute eosinophil count and polyposis was 89 \%.\par The Seum total IgE levels in our study group were elevated in 36.4 \% of the patients with Antrochoanal polyps and 95 \% of patients with Sinonasal polyposis. Drake -Lee and Barker 6 in their study of 29 patients showed raised IgE levels in patients with Sinonasal polyposis.\par Sin et al \hyperref[b6]{7} after studying 95 patients with nasal polyposis reported allergy as an etiological factor. The mean serum IgE levels were significantly higher in this group. Bottazzi G et al \hyperref[b7]{8} studied the association between nasal polyposis and airborne allergen hypersensitivity and concluded that airborne allergens played a relevant role in the pathogenesis of nasal polyposis. Bateman et al \hyperref[b8]{9} in their paper documented that nasal polyps have a clear association with asthma, hypersensitivity and cystic fibrosis. Pawankar 10 in their article documented that in majority of nasal polyps, eosinophils comprise more than 60\% of the cell population. \section[{VI. Conclusion}]{VI. Conclusion}\par Allergy has long since been one of the proposed etiological factors in the pathogenesis of Sinonasal Polyposis. From the parameters used in our study there is a statistically significant association between allergy and Sinonasal polyposis. Out of 50 patients in our study seven showed recurrence in the 12 month follow up period, all of whom showed positive allergic status.\par In our study, more parameters like polyp fluid IgE, SPT (Skin Prick Test) or RAST (Radio Allergo Sorbent Test) for specific allergen could not be carried out due to prohibitive cost and lack of patient compliance. All the patients in our study with Sinonasal polyposis had raised IgE levels and more than 80 \% had evidence of raised peripheral blood eosinophilia.\begin{figure}[htbp] \noindent\textbf{12}\includegraphics[]{image-2.png} \caption{\label{fig_0}Figure 1 :Figure 2 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{1} \par \begin{longtable}{P{0.4917857142857143\textwidth}P{0.13357142857142856\textwidth}P{0.06678571428571428\textwidth}P{0.085\textwidth}P{0.07285714285714286\textwidth}} Absolute Eosinophil\tabcellsep \multicolumn{2}{l}{Antrochoanal}\tabcellsep \multicolumn{2}{l}{Sinonasal}\\ Count\tabcellsep \multicolumn{2}{l}{No. \%}\tabcellsep \tabcellsep No. \%\\ Normal\tabcellsep 7\tabcellsep 63.6\tabcellsep 2\tabcellsep 5\\ Elevated\tabcellsep 4\tabcellsep 36.4\tabcellsep 37\tabcellsep 95\\ Total\tabcellsep 11\tabcellsep 100\tabcellsep 39\tabcellsep 100\\ \multicolumn{2}{l}{Chi Square test (1) = 15.007 p= 0.0001}\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par \caption{\label{tab_0}Table 1 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{2} \par \begin{longtable}{P{0.4318548387096774\textwidth}P{0.15766129032258064\textwidth}P{0.07540322580645162\textwidth}P{0.1439516129032258\textwidth}P{0.04112903225806452\textwidth}} Level\tabcellsep \multicolumn{2}{l}{Antrochoanal No. \%}\tabcellsep \multicolumn{2}{l}{Sinonasal No. \%}\\ NORMAL\tabcellsep 7\tabcellsep 63.6\tabcellsep 2\tabcellsep 5\\ ELEVATED\tabcellsep 4\tabcellsep 36.4\tabcellsep 37\tabcellsep 95\\ TOTAL\tabcellsep 11\tabcellsep 100\tabcellsep 39\tabcellsep 100\\ \multicolumn{2}{l}{Chi Square Test (1) = 16.133 p = 0.0001}\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par \caption{\label{tab_1}Table 2 :}\end{figure} \footnote{© 2017 Global Journals Inc. (US)Year 2017} \footnote{© 2017 Global Journals Inc. (US)} \backmatter \begin{bibitemlist}{1} \bibitem[Sin et al. (1997)]{b6}\label{b6} ‘Allergy as an etiological factor in Nasal Polyposis’. A Sin , E Terzioglu , A Veral . \textit{J Investig Allergol Clin Immunol} 1997 Jul-Aug. 7 (4) p. . \bibitem[Drake-Lee et al. ()]{b2}\label{b2} ‘Clinical Profile and recurrence of nasal polyps’. A B Drake-Lee , D Lowe , A Swantson . \textit{The Journal of Laryngology and Otology} 1984. p. . \bibitem[Choo]{b0}\label{b0} ‘Endoscopic Sinus Surgery for treatment of Antrochoanal Polyp’. M J Choo , KimJ W , LeeK . \textit{Korean Journal of Rhinology} 1996 (1) p. . \bibitem[Drake-Lee and Barker ()]{b5}\label{b5} ‘Free and cell bound IgE in nasal polyposis’. A B Drake-Lee , T H Barker . \textit{Journal of Laryngology and Otology} 1982. p. . \bibitem[Farrell ()]{b1}\label{b1} ‘Functional Endoscopic Sinus Surgery: Sinonasal Polyposis and Allergy’. B Farrell . \textit{ENT Journal} 1993. p. . \bibitem[Asero and Bottazzi ()]{b7}\label{b7} ‘Nasal Polyposis: a study of its association with Airborne allergen hypersensitivity’. R Asero , G Bottazzi . \textit{Ann Allergy Asthma Immunol} 2001. 86 (3) p. . \bibitem[Pawankar ()]{b9}\label{b9} ‘Nasal Polyposis: an update’. R Pawankar . \textit{Current Opinion in Allergy \& Clinical Immunology} 2003. 3 (1) p. . \bibitem[Bateman and Fahy (2003)]{b8}\label{b8} ‘Nasal Polyps: still more questions than Answers’. N D Bateman , C Fahy . \textit{J Laryngol Otol} 2003 Jan. 117 (1) p. . \bibitem[Kaldenbach et al. (1999)]{b3}\label{b3} ‘Significance of eosinophilic granulocytes in relation to allergy and aspirin intolerance in patients with sinusitis polyposa’. T Kaldenbach , D Schafer , J Gosepath . \textit{Journal of Laryngorhinootology} 1999 Aug. 78 (8) p. . \bibitem[Sheri et al. (2oo7)]{b4}\label{b4} ‘Total IgE levels and Peripheral Eosinophilia correlation with mucosal disease based on Computed Tomographic Imaging of the Paranasal Sinuses’. A Sheri , Poznanovic , T Kingdom . \textit{Arch Otolaryngol Head Neck Surg} 2oo7. 133 p. . \end{bibitemlist} \end{document}