The most striking feature in these NPs was the presence of neutrophils in 4 of 10 samples — something that we almost never observe in idiopathic NPs of non-CF patients. The presence of neutrophils likely reflects trafficking of the cells in response to chemotactic stimuli different from those found in the NPs of non-CF patients. The distinguishing feature of CF lower airway disease is the almost universal colonization with bacteria — typically, gram-negative organisms. Although this is not the focus of the present study, it is reasonable to argue that CF similarly predisposes patients to colonization of the sinuses with bacteria and biofilm formation. Neutrophilia would then reflect the migration of these cells from the vasculature in response to this process. A role for PMNs is further supported by our studies regarding granulocyte biomarker expression in sinus secretions. As sinus secretions were obtained during routine clinic visits and not as a part of the polypectomy, we cannot directly correlate expression of mediators in mucus samples with polyp histology. Despite this caveat, as with the NPs, markedly elevated concentrations of myeloperoxidase were seen in half of these specimens, and again, this is something not routinely observed in non-CF chronic sinus disease. Van Zele et al found elevated levels of myeloperoxidase (as well as CXCL8 [IL-8]) in CF-derived sinus secretions, also pointing to a prominent role for PMNs. Even more impressive were our extracellular DNA concentrations, which were elevated in all of the CF specimens and to an extent higher than those we have observed in non-CF disease. Extracellular DNA is primarily derived from granulocytes, secreted as a component of neutrophils and eosinophils (mitochondrial-derived and nuclear-derived DNA nets, respectively) as part of their antibacterial response., In addition, extracellular DNA reflects cellular necrosis and the presence of inhibitors of phagocytosis of apoptotic bodies. These striking elevations in DNA content contribute to the viscosity of secretions and the inability to clear them (even with surgery and postsurgical irrigations) and will thereby contribute to the infection-remodeling-infection process. Elevations in DNA content are also consistent with reports that in attempts to reduce viscosity in the lung, CF secretions respond best to DNase.- This approach is being tested as a therapeutic option following sinus surgery. Administration of dornase alpha between 4 weeks and 12 months after surgery was associated with improved nasal symptoms and rhinoscopic findings. A recent double-blind placebo-controlled study found that dornase alpha improved quality-of-life outcome measures in subjects who had previously undergone sinus surgery., Other symptoms include a runny nose, facial pain, loss of sense of smell, and, rarely, nose bleeds. The thick mucus created by cystic fibrosis leads to chronic (constant, long-term) sinus congestion and frequent sinus infections, which doctors believe cause nasal polyps to develop., Nasal polyps are common in patients with cystic fibrosis (CF), affecting between 6% and 48% of this population. This study aimed to investigate the implications (symptoms, endoscopic findings, laboratory correlations) of nasal polyps in CF patients and their impact on overall health..