Acta Otolaryngol 2000; 120: 307 – 311

Capsaicin Significantly Reduces Sinonasal Polyps

TOMISLAV BAUDOIN1, LIVIJE KALOGJERA1 and JOSIP HAT2

From the Departments of 1Otorhinolaryngology/Head & Neck Surgery, and 2Radiology, Uni6ersity Hospital ‘‘Sestre milosrdnice’’, Zagreb,
Croatia

Baudoin T, Kalogjera L, Hat J. Capsaicin significantly reduces sinonasal polyps. Acta Otolaryngol 2000; 120: 307 – 311.
Some reports indicate that topical nasal treatment with capsaicin, which is usually effective in reducing symptoms of
vasomotor rhinitis, may also reduce symptoms in patients with nasal polyps. The aim of this study was to investigate the
effect of topical capsaicin treatment in severe sinonasal polyposis. Nine non-allergic, non-asthmatic patients with diffuse
eosinophilic nasal polyposis were subjected to topical capsaicin treatment: for 3 consecutive days 0.5 ml 30 mmol/l
capsaicin solution and on days 4 and 5 100 mmol/l capsaicin solution was sprayed into each nostril. Coronary computed
tomography (CT) images were made shortly before treatment. Baseline nasal lavages and a questionnaire containing
subjective symptoms and nasal endosocpy were taken just prior to the first application. Nasal lavages were performed
prior to and after the last treatment and over 4 weeks, endoscopy and subjective scores at each weekly visit, and
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correspondent CT scans 4 weeks after the treatment. CT images were analysed by computer, calculating the nose/sinuses
air volume (NSAV) from the surface of aerated parts of nasal and sinus cavities for each slice per patient prior to and
after treatment. Statistical analysis was performed comparing NSAV, subjective scores, endoscopy scores and eosinophil
cationic protein (ECP) levels in nasal lavages prior to and after treatment. Topical treatment with capsaicin significantly
increased NSAV and very significantly improved subjective and endoscopy scores, but did not significantly alter ECP
levels in nasal lavages. Key words: computed tomography scores, diffuse nasal polyposis, topical capsaicin, subjecti6e scores,
eosinophil cationic protein.

INTRODUCTION The aim of the present study was to investigate the

Despite the prevalence and long history of nasal effect of topical capsaicin treatment on the size and
polyposis, many questions still exist with respect to subjective symptoms of nasal polyps in patients with
For personal use only.

its incidence and pathogenesis. It is typically associ-
ated with perennial non-allergic rhinitis with
eosinophilia, non-allergic asthma and intolerance to
acetylsalicylic acid or other NSAIDs (1). Although
allergy has been commonly thought to be a major
cause, much compelling evidence argues against this.
Massive oedema and eosinophilic inflammation (in
more than 80% of the cases) are the main histopatho-
logical feature of nasal polyps, but it seems that
IgE-mediated allergy plays only a minor role in
eosinophil accumulation (2). Conventional therapy,
besides surgery, is a combination of long-term topical
nasal steroid treatment combined with short-term
systemic steroid treatment (3). Although surgery pro-
duces longer intervals of remission than steroid treat-
ment, the recurrence rate after polypectomy is still
high (4). The combination of surgery and topical
nasal steroids reduces the recurrence rates (5). Resis-
tance to steroid treatment leads to testing of uncon-
ventional conservative (non-steroid) treatment of
nasal polyposis (6). Some reports indicate that topical
capsaicin treatment, which is usually effective in re-
ducing symptoms of perennial non-allergic rhinitis,
may reduce nasal polyps (7). Capsaicin is a neuro-
toxin which depletes substance P with some other
neurokinins and neuropeptides, leading to long-last-
ing damage to unmyelinated axons and thinly myeli-
nated axons when repeatedly applied to the
respiratory mucosa (8).
massive sinonasal polyposis. The authors have
modified the treatment to a short-course high-dose
regimen, which has not previously been reported in
the literature.
MATERIALS AND METHODS
The patients were selected from those people referred
to the ENT Department of University Hospital ‘‘Ses-
tre milosrdnice’’, Zagreb, Croatia (a tertiary referral
centre) for surgical treatment of sinonasal polyposis
during 1998. The ethics committee of Zagreb Univer-
sity School of Medicine reviewed and approved the
study. Informed consent was offered to patients who
refused surgical and/or systemic steroid treatment
after long-term topical steroid treatment was found
to be ineffective. Inclusion criteria were: age (18–70
yrs), bilateral sinonasal polyposis, eosinophilic type
of polyps and ineffectiveness of at least 8 weeks
topical steroid treatment (except for one patient who
also refused topical steroid treatment due to glau-
coma). Patients with positive intradermal skin test to
aero-allergens, total serum IgE higher than 40 IU/ml,
bronchial asthma or positive history on any signifi-
cant cardiorespiratory disease, cystic fibrosis, signs of
sinonasal or systemic infectious disease and biopsy
indicating non-eosinophilic type of polyps or tumour
were excluded. This reduced the number to nine
patients who entered the study after obtaining in-

© 2000 Taylor & Francis. ISSN 0001-6489

 308 T. Baudoin et al.
Table I. Nose/sinuses air 6olume (NSAV), subjecti6e and endoscopy scores and ECP in nasal la6age during the
obser6ation period. Visit 1: before the treatment; 6isit 2: after the last treatment (day 5); 6isit 3: a week after the
last treatment; 6isit 4: 2 weeks after the last treatment; 6isit 5: 4 weeks after the last treatment, ECP: eosinophil
cationic protein; ND: not done
Parameter Visit 1 Visit 2
NSAV (cm3) 27.16917.87 ND
Symptom score 30.62n 912.91 16.759 7.38*
Endoscopy score 5.2591.16 4.591.07*
ECP (mg/l) 90.869 73.68 115.959 101.1
* pB0.05.
formed consent. Five were male, four female, age
range 37–67 years, 6 previously operated (1 – 6 opera-
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tions per patient).
All of the patients had had computed tomography
(CT) scans and biopsies shortly before the treatment
(5 mm thick coronal images, from the anterior wall of
the frontal sinus to the posterior end of the sphe-
noid). Nasal endoscopy, baseline nasal lavages (5 ml
saline per nostril) and a questionnaire were carried
out just before the first application. The question-
naire considered intensity and frequency of nasal
symptoms (obstruction, rhinorrhea, postnasal drip,
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olfaction, sneezing, itching, headache, cough, eyelid
or facial swelling; scores range: 0 – 3 for intensity and
0 –4 for frequency of each symptom). Total subjective
symptom score was the sum of the intensity and
frequency scores for each symptom. Nasal endoscopy
results were scored for each side: 0= no polyps;
1 = polyps confined to middle meatus; 2= larger than
the middle turbinate; 3= larger than the lower tur-
binate (total score range 0 – 6) (9).
The patients were subjected to the following topical
capsaicin treatment: for 3 consecutive days patients
received 0.5 ml 30 mmol/l capsaicin solution sprayed
into each nostril, and 100 mmol/l of capsaicin solu-
tion on days 4 and 5, respectively, receiving topical
anaesthesia only before the first treatment. Nasal
lavages were repeated after the last treatment and in
4 weeks, while subjective and endoscopy scores were
taken at each visit (Table I). Nasal lavages were
analysed for eosinophil cationic protein (ECP) con-
tent using standard radioimmunoassay (RIA) kit
(Pharmacia, Uppsala, Sweden), as described else-
where (10). CT scans were repeated 4 weeks after the
treatment, according to the calibration and position
at the first visit, so the corresponding images could be
analysed. The surface of the aerated parts in the nasal
and sinus cavities was measured from each image
using diagnostic viewing station of PACK RIS-ISSA
(VAMS, Zagreb, Croatia). The nose/sinuses air vol-
Acta Otolaryngol 120
Visit 3 Visit 4 Visit 5
ND ND 36.92 9 23.02*
13.62 96.78* 14.259 8.08* 159 13.86*
3.5 9 1.19* 2.759 1.16* 3.75 9 1.75*
ND ND 102.379 98.15
ume (NSAV) in the nasal and sinus cavities was
calculated (sum of all surfaces in cm2 × 0.5 cm) for
each patient prior to and after the treatment.
Statistical analysis was performed comparing
NSAV (Student’s paired t-test), subjective and en-
doscopy scores (Mann-Whitney-Wilcoxon test), and
ECP levels (Student’s paired t-test) in nasal lavages
prior to and after the treatment. Differences\0.05
were considered significant.
RESULTS
All of the patients completed the study, except for
one who refused to have control CT images made.
Some patients had minor complaints at the moment
of the first application, mostly itching and irritation
in the nose. The reduction of major symptom scores
during the observation period of 4 weeks is demon-
strated in Fig. 1. The most pronounced symptom was
obstruction, followed by rhinorrhea and loss of smell.
While obstruction and rhinorrhea scores were
markedly reduced during the observation period, ol-
faction score was improved for less than 20%. Previ-
ously unoperated patients had quicker and stronger
response during the observation period. The number
of polypectomies did not influence the response.
Fig. 1. Mean symptom scores. Each score is the sum of
intensity and frequency scores for each symptom. Score
ranges: 0 – 3 for intensity and 0 – 4 for frequency of each
symptom.
 Acta Otolaryngol 120
Fig. 2. Nose/sinuses air volume (NSAV) before and after
topical capsaicin treatment.
The results of mean NSAV, subjective and en-
doscopy scores and ECP in nasal lavages are summa-
rized in Table I. Mean NSAV increased from 27.16
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cm3 to 36.92 cm3 in 4 weeks after the treatment. Only
one patient had a decrease in the NSAV following
treatment, although she had improved subjective
scores (Fig. 2). Percentile increase was more pro-
nounced in those with baseline value lower than 20
cm3. Improvement in subjective scores was highly
significant at each visit during the 4-week observation
period, mostly pronounced at 1 week after treatment
(p B0.002). Endoscopy scores were mostly improved
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at 2 weeks (pB0.0004). ECP levels in nasal lavages
insignificantly increased from 90.86 mg/l baseline to
115.95 mg/l after the last application. There is no
correlation between subjective and endoscopy scores
(r=0.05). The correlation between and nose/sinus air
volume and endoscopy scores prior to (r = 0.75) and
after the treatment (r = 0.77) is highly significant.
ECP values do not correlate with subjective and
endoscopy scores respectively, but they correlated
moderately with nose/sinus air volume before (r= −
0.33) and after (r = −0.49) the treatment.
DISCUSSION
This study tested the effect of topical nasal capsaicin
treatment on sinonasal polyposis of the eosinophilic
type. Patient selection included only a part of group
IIA according to nasal polyps classification by Setti-
pane (1) (asthmatic patients excluded), and the most
advanced stage of the disease according to Kennedy
(11). Although the authors supposed the polyps to be
resistant to topical steroids, according to failure of
the last course, it should be stated that 6 out of 9
patients (previously operated) have been controlling
their disease with topical steroids from 2 to 18 years
(with intermittent operations). The only relevant
study in the literature, which reported a good re-
sponse to capsaicin treatment for sinonasal polyposis
has recorded the increased eosinophils count in nasal
smears following treatment. Although we have
Capsaicin reduces sinonasal polyps 309
recorded the increase of ECP in nasal lavage, it was
statistically insignificant. ECP levels moderately still
correlated with NSAV prior to and after the treat-
ment. On the other hand, the authors have previously
reported neurogenic inflammation characterized by
marked vasodilatation eosinophil extravasation, ob-
served in nasal polyp tissue 15 min after 100 mmol/l
capsaicin provocation (12). As eosinophils activity is
supposed to play an important role in the pathogene-
sis and inflammation in nasal polyps (2), beneficial
effect of the substance that increases their activity is
not expected. However, some of these data indicate
an increase in eosinophils activity following capsaicin
challenge, which makes further research even more
interesting. We have modified the previously reported
capsaicin treatment regimen for nasal polyposis (7),
which used 30 mmol/l solution weekly without usual
increasing-dose, and tested the short-course high-dose
regimen.
The nose/sinus air volume is a good objective
parameter in the analysis of the treatment effect, but
it is more time-consuming than other staging proce-
dures (13). Although in this study it was not precisely
measured (due to thick scans), this method was more
informing than subjective CT scoring. We used 5 mm
scans to reduce radiation dose. In this study NSAV
correlated significantly with the endoscopy scores,
and moderately with the ECP levels in nasal lavages,
but not with subjective symptoms scores. The treat-
ment effect could have been analysed with acoustic
rhinometry, which has the advantage of no radiation
applied, but does not stage the sinus disease.
At present, the mode of action of capsaicin in nasal
polyposis can be explained only by neurotoxic effect
and blocking the neurogenic inflammation in the nose
after repeated applications. A single application may
induce neurogenic inflammation in the nasal mucosa
of patients with allergic rhinitis (14), but such an
effect was not demonstrated in several studies with
patients suffering from non-infectious non-allergic
rhinitis (NINAR) (14, 15). Research into the capsa-
icin effect on inflammatory mediators, cytokines and
immune cells response in patients with NINAR (de-
spite improvement in subjective scores), has not un-
covered any significant changes, even when using a
high-dose regimen (15, 16). However, neurogenic infl-
ammation was demonstrated following capsaicin ap-
plication to the nasal polyp tissue of non-allergic
patients with nasal polyposis (12). The presence of
neurokinins in the nasal polyps was established, but
their role in pathogenesis remains unclear (17).
Although long-term results are beyond the scope of
this article, it should be stated that only three patients
needed treatment for longer than six months. Two
patients have received a second course of treatment
 310 T. Baudoin et al.
following the same regimen 3 months after the first
application with even better results than after the first
course (one of those is the patient with an NSAV
increase following treatment). Other patients had sig-
nificant recurrences, but are still not willing to be
operated. One of those had a good response to
furosemide inhalation treatment, and the others are
treated with topical steroids with poor response.
This study has demonstrated a significant beneficial
effect of capsaicin treatment in nasal polyposis, al-
though the effect on CT images (Fig. 3) is not com-
parable to polypectomy combined with functional
endoscopic sinus surgery (FESS) or systemic steroid
treatment. However, the results of subjective scores
indicate that capsaicin treatment may have a place in
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combined treatment, especially if the effect of steroids
is not satisfactory, or side-effects are present. On the
other hand, further immunohistochemical research,
especially into neuropeptide and neurokinin activity
in nasal polyps following capsaicin treatment, should
offer new data on their pathogenesis.
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Fig. 3. Corresponding CT slices of the same patient (A)
before and (B) after topical capsaicin treatment.
Acta Otolaryngol 120
ACKNOWLEDGMENTS
This research is in part supported by the grant of Ministry
of Science and Technology of Croatia (610001). We would
like to thank Professor Džubur (VAMS, Zagreb, Croatia)
for assistance with the image analysing process and Mr
Z& eljka Bukovec for the biochemical analysis. Special thanks
to Roland Barić, BSc Geol, for his expert help in statistical
consulting and editing this article.
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