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Oxidative Stress

Oxidative stress (OS) is a term used to describe the diseases caused by reactive oxygen species (ROS), which have a destructive and pathogenic character. The tissues of the sinonasal mucosa are inevitably subjected to OS causing injuries.

Inflammation is considered to play an increasingly important role in chronic sinusitis with nasal polyps (CRSwNP). The causes that determine the persistence of chronic inflammation in CRSwNP have not yet been fully established. Reactive oxygen species are produced by immune cells and eosinophils in patient sinuses.

Current treatment, mostly corticosteroids and antibiotics, is deficient due to side effects and failing to adress the core issues and do not address the OS connection.

Histological changes go with infiltration of inflammatory cells in CRSwNP. As a result of the inflammation, activated neutrophils migrate to the inflammatory site, where they exert bactericidal function by producing ROS. At the same time, ROS trigger cellular and intracellular disturbances at the sinonasal mucosa level.

Tissue damage related to free radicals occurs in cases of nasal polyps. High malondialdehyde (MDA) levels were found in patients with nasal polyps compared healthy subjects. The source of free radicals produced in patients with nasal polyps are different from those released by inflammatory cells. In patients with nasal polyps, low retinol, beta-carotene, vitamin E, vitamin C and glutathione were also found. There is a high level of MDA in nasal polyps, and this could be caused by free-radical damage in nasal polyps.

Excess MDA, as a by-product of free radicals, can be related to decreased blood and tissue antioxidant levels. Patients with nasal polyposis have significantly lower blood and tissue antioxidant levels. Thus, high free-radical levels in the patient group can be related to decreased antioxidant level or consumption of antioxidants by excess free radicals.

The OS stress can also be related to the alcohol-associated symptoms with chronic sinusitis. Alcohol congeners that are present along with ethanol, namely toxic aldehyde and ketone bodies, cause OS that needs to be addressed by cells and organs, along with dehydration, explaining a large part hangover symptoms as well.

Thus, supplementation of various antixoxidants such as Vitamins C and E and replenishing glutathione pools, in addition to controling the inflammation in the nasal mucosa stemming from free radicals liberated by immune cells, will help quench free radicals associated with nasal polyps and alcohol consumption.

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