This interesting European cross-sectional study demonstrates a link between occupational dust exposure and the presence of nasal polyposis. A random sample of textile workers (215) and retail store employees (101) in Portugal was taken, with clinical data gathered through a systematic interview, including RhinoQOL and CAT questionnaires, endoscopic nasal examination and Lund-Kennedy score. Workers were chosen at random from their employee number in the personnel database, selected from a total of 509 employees who worked in various parts of the process and all had a minimum of one year’s work. The factory manufactured mainly wool fabrics. The retail employees were selected from two nearby retail stores. Exclusion criteria included previous jobs in the textile industry at any time or jobs/hobbies with dust exposure in the previous 10 years. Systematic interviews collected information on demographics, occupational history, domestic or hobby dust exposure, smoking, alcohol, comorbidities and nasal symptoms and surgeries. Atopy, lower airway disease and obstructive sleep apnoea (OSA) were only included with formal specialist diagnosis. Endoscopic evaluation of the nose was undertaken by a single surgeon; polyps were classified according to the Lund criteria and the Lund-Kennedy endoscopic score was determined. Exclusions included antrochoanal polyp, malignancy and papillomas. A total of 316 individuals were recruited; between the exposed and control groups, no difference existed in exposure to domestic fumes or history of previous nasal surgery. Retail workers had significantly more domestic pets. Textile groups reported more sinonasal symptoms over the preceding three months, with significantly higher rates of hyposmia, headache, facial pressure, sneezing, snoring and nasal pruritus. Other, perhaps more important, symptoms such as nasal blockage, discharge and epistaxis were not different between the two groups. The rate of septal deviation was the same between the two groups. Nasal polyps were found in 19 subjects in the textile group (9%), nine grade I and nine grade II. Twenty four (11%) had polypoid change around the middle turbinate. No patient in the retail sector had nasal polyps although one had an antrochoanal lesion and another had polypoid change around the middle turbinate. Prevalence rates in textile workers were significantly higher than two referenced population-based studies done previously in Sweden and Portugal. The authors remind us of the importance of personal protective equipment and appropriate exhaust systems in the workplace. This study seems to suggest that occupational dust exposure may be one of the factors responsible for polypoid change and recalcitrant CRS, and highlights the need for a larger endoscopically-controlled epidemiological study.

Higher prevalence of nasal polyposis among textile workers: an endoscopic based and controlled study.
Veloso-Teles R, Cerejeira R, Roque-Farinha R, von Buchwald C.
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Suki Ahluwalia

Cairns Hospital / James Cook University, Queensland, Australia.

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