الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Nasal polypi are an easily recognizable clinical entity. They result
from the prolapsed lining of ethmoid sinuses and block the nose to a
variable degree, depending on their size . It would be expected that
between one in 1000 and 20 in 1000 of adult population would have nasal
polypi once or more in their life (Drake-Lee, 1992).
The condition was first recognized in India, and by 1000 Be
curettes had been devised to remove them. Ancient Egyptian skulls show
the grosser features of nasal polypi . All polypoidal conditions were
initially grouped together until histological classification helped to
differentiate them from the neoplastic (Vancal,1969).
Nasal polypi develop in the ethmoidal and middle turbinate area,
often in relation to inflammatory conditions, their exact etiology and
pathogenesis are still under debate {Shin et aL,2000).
It has been suggested that the formation and growth of nasal polyp
require the remodeling of extracellular matrix. Proteolglycans (pGs) are
major components of the extracellular matrix that maintain the integrity
of structural tissue, the leucine-rich repeat PUs include lumican, dccorin
and biglycan and have many important biologic activities in various
pathologic conditions, includes the remodeling of the extracellular matrix.
Therefore, these small-PG families may be involved in the formation and
growth of nasal polyp (Lee et aL, 2001 ).
Treatment of nasal polypi is a combination of medical and surgical
modalities following the assessment of the patient . Medical treatment
can be conveniently divided into two areas, first including remission and
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second preventing recurrence . There are different views on the type of
surgery required for nasal polypi, starting from simple polypectomy,
transnasal endoscopic ethmoidectomy , intranasal ethmoidectomy , till
external ethmoidectomy (Drak-Lee, 1992).
Recurrence of nasal polypi is one of the problems facing every
otolaryngologist in management of these cases . The rate of recurrence is
variable and a 2-year study showed that just over 40% presented for the
first time and 5% had five or more previous polypectomies. It is difficult
to study factors which are associated with recurrence well but several
factors are important . As expected if a patient develops polypi when
younger and if there is a long history of nasal complaints then recurrence
tends to be more severe (Drake-Lee et al., /984).
Recently, leukotrienes have been implicated in mediation of
bronchoconstriction and inflammatory changes in asthma. Leukotriene
(LTC4) and (LTD4) are the most potent bronchocnstrictors yet studied in
human subjects, being up to 10000 times more potent than methacoline in
some normal subjects and with a longer duration of action than inhaled
histamine . Leukotriene levels have also been shown to be elevated in
patients with asthma as well as in those with sinonasal polypi (Parnes
and Chums ,1979)
Leukotriene-receptor antagonists are an important new class of
orally active non-steroidal antiasthma drugs which are effective over a ,
wide range of asthma severity with a high therapeutic index. They are a
hybrid between a preventer of inflanunation (antagonism of
pro inflammatory activities of leukotrienes) and a bronchodilating releaver
(antagonism of leukotriene-induced smooth-muscle bronchoconstriction).
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The use of leukotriene antagonists dose not alter the smooth-muscle
response to B2·agonists (Stephen et 0£,2000).
This study directly compared montelukast (Singulair) , an oral
leukotriene receptor antagonist, and beclomthasone (Beconase), a
commonly used inhaled corticosteroid.
The study population (antileukortiene group) was 40 patients (15
female and 25 male ) age range from 17 years to 67 years with a mean
age 32.4 years . The control population (bec1omethasone group) was 20
patients (6 female and 14 male ) age range 17 years to 57 years with a
mean age 33.5 years . Treatment was started two weeks after
polypectomy and FESS surgery and continued for one year, (study
period). During the whole treatment .period, patients seen and follow up
monthly, symptoms and signs recorded in doctor’s follow up sheet.
Although beclomethasone had a better effect on some end points
(post nasal discharge, headache and smell affection) , both agents
significantly improved nasal symptoms and prevented the recurrence of
nasal polypi .However, montelukast had better improvement in nasal
symptoms than beclomethasone, we are strongly favor the lise or intra
nasal beclomethasone over oral montelukast in the control of recurrence
of polypi after polypectomy. Beclomethasone inhaler easily in
administration. and financially more beneficial especially with long term
course of treatment . However, some patients may needs the Use of oral
montelukast according to majority of symptoms (nasal obstr,uction,
sneezing, rhinorrea and nasal itching ).-we recommend further studies as a
combination of both drugs or by extending the duration of the study .