Mucociliary Clearance In Patients Research Articles

Histopathology of Recalcitrant Maxillary Sinusitis Necessitating Endoscopic Medial Maxillectomy.

Endoscopic medial maxillectomy (EMM) is an effective intervention for patients with recalcitrant maxillary sinusitis after previous middle meatal antrostomy. The pathophysiology of refractory maxillary sinusitis is incompletely understood. We aim to identify trends in structured histopathology (SHP) to better understand how tissue architecture changes contribute to refractory sinusitis and impaired mucociliary clearance. All patients who underwent EMM or standard maxillary antrostomy for recalcitrant maxillary sinusitis of various forms were included. Retrospective chart review was conducted to collect information on demographics, disease characteristics, comorbid conditions, culture data, and SHP reports. Chi-squared and logistic regression analyses were performed for SHP variables. Forty-one patients who underwent EMM and 464 patients who underwent maxillary antrostomy were included. On average, the EMM cohort was 10 years older (60.9 years vs. 51.1 years; p = 0.001) and more often had a history of prior sinus procedures (73.2% vs. 40.9%; p < 0.001). EMM patients had higher rates of fibrosis (34.1% vs. 15.1%, p = 0.002), and this remained statistically significant when controlling for prior sinus procedures and nasal polyposis (p = 0.001). Cultures positive for pseudomonas aeruginosa (38.2% vs. 5.6%, p < 0.001) and coagulase negative staphylococcus (47.1% vs. 23.5%, p = 0.003) were more prevalent in the EMM group. Fibrosis and bacterial infections with Pseudomonas and coagulase negative Staphylococcus were more prevalent in patients requiring EMM. This may contribute to the multifactorial etiology of impaired mucociliary clearance in patients with recalcitrant maxillary sinusitis. 3 Laryngoscope, 134:2646-2652, 2024.

THE CONDITION OF MUCOCILIARY CLEARANCE IN PATIENTS WITH NASAL SEPTUM DEVIATION AND POSTNASAL DRIP SYNDROME

Introduction. Mucociliary clearance is a vital defense mechanism in the human upper respiratory tract that safeguards the body against inhaled harmful substances. Ciliary activity was first discovered by Sharpey in 1835, and it took nearly a century for this function to be recognized as a central component in the physiology of the sinuses.&#x0D; The aim of this study is to investigate the status of mucociliary clearance in patients with a nasal septum deviation and concomitant postnasal drip syndrome.&#x0D; Materials and Methods: A total of 54 patients, aged between 23 and 55 years, were enrolled in the study. All participants underwent a saccharin test and an assessment of the motor activity of the ciliated epithelium. Exclusion criteria included the presence of infectious and inflammatory diseases of the upper respiratory tract within the last month.&#x0D; Results: In the control group of patients, no significant difference was observed in the speed of saccharin test passage, both in the right and left parts of the nasal cavity, with test times ranging from 8.35 to 14.52 minutes. However, in the second clinical group comprising patients with nasal septum deviation, the average time for the saccharin test on the mucous membrane of the concave side of the nasal septum was significantly longer than on the convex side, measuring 21.52 ± 3.04 minutes and 12.36 ± 2.73 minutes, respectively (P = 0.02). When assessing the data from patients in the third clinical group based on the curvature side, a significant difference (P &lt; 0.05) was observed in the reduction of saccharin test speed compared to the control group.&#x0D; Conclusions: The data obtained indicate a significant influence of nasal septum deviation on subsequent changes in nasal cavity physiology, resulting in a slowdown of mucociliary clearance. This can lead to excessive mucus stagnation in the nasal cavity and, consequently, the development of postnasal drip syndrome.

Endoscopic trans-sphenoidal pituitary surgery does not impact postoperative nasal quality of life

PurposeThe aim of this prospective longitudinal study was to assess both subjective quality of life using questionnaires and objective examination of nasal function with regard to olfaction, nasal air flow and mucociliary clearance in patients after minimally invasive, turbinate-preserving endoscopic transnasal trans-sphenoidal pituitary surgery.MethodsPatients undergoing endoscopic transnasal pituitary surgery were recruited prospectively and examined during three study visits, preoperatively and 3 and 6 months postoperatively. We examined nasal function using sniffin' sticks test, rhinomanometry, saccharin transit time test, and endoscopic and radiological scores. In addition, the influence on subjective quality of life and mental health was recorded using the Sinonasal-Outcome-Test-20 (SNOT-20) and the Hospital-Anxiety-and-Depression-Scale (HADS).Results20 patients undergoing endoscopic pituitary tumor resections were included. No significant changes in olfaction or mucociliary clearance were noted. Nasal air flow showed a tendency to increase in the postoperative course lacking significance. Both the endoscopy and the radiological scores showed a significant deterioration, especially after 3 months, with a trend towards improvement over time. However, neither the SNOT-20 nor the HADS showed significant changes compared to baseline.ConclusionsOur concept of minimally invasive endoscopic tumor resections on the pituitary gland with preservation of nasal turbinates shows low morbidity for the patient. Despite objectifiable surgery-associated changes in the nose, nasal physiology in terms of smell, airflow and mucociliary clearance can be preserved and the subjective quality of life of our patients remains stable.

Hypertonic saline induces inflammation in human macrophages through the NLRP1 inflammasome.

Nebulized hypertonic saline (3-7%) is commonly used to increase mucociliary clearance in patients with chronic airway disease and/or virus infections. However, altered salt concentrations may contribute to inflammatory responses. The aim of this study was to investigate whether 500 mM NaCl (3%) triggers inflammation in human macrophages and identify the molecular mechanisms involved. NaCl-induced pyroptosis, IL-1β, IL-18 and ASC speck release were measured in primary human monocyte-derived macrophages. Treatment with the recombinant IL-1 receptor antagonist anakinra or the NLRP3 inhibitor MCC950 did not affect NaCl-mediated inflammasome assembly. Knock-down of NLRP1 expression, but not of NLRP3 and NLRC4, reduced NaCl-induced pyroptosis, pro-inflammatory cytokine and ASC speck release from human THP-1-derived macrophages. Data from this study suggest that 3% NaCl-induced inflammatory responses in human macrophages depend on NLRP1 and inflammasome assembly. Targeting inflammation in addition to inhalation with hypertonic saline may benefit patients with inflammatory airway disease.

Upper Airway Mucociliary Clearance is Impaired in Dyspneic COVID-19 Patients.

Covid-19 is transmitted mainly by respiratory droplets and as the upper airway mucosa is the first innate immune barrier, it is crucial to understand the effects of SARS-CoV-2 on this system. In the current study, we aimed to evaluate the nasal mucociliary clearance in patients with SARS-CoV-2 infection and their symptom development. Observational cross-sectional study. The nasal mucociliary clearance (NMC) time was evaluated by the saccharin test and the results were compared between patients with SARS-CoV-2 infection (group 1) and controls (group 2, asymptomatic patients with a negative polymerase chain reaction test). We also compared the NMC time for each specific symptom suffered by participants in group 1 with the NMC time of the control group as well as with the patients in group 1 who were asymptomatic. There was a significant increase in NMC time in group 1with dyspnea when compared to the control group (p = 0.032) and also when compared to patients who were infected were not dyspneic (p = 0.04). There were no differences in the clearance times when considering other symptoms. COVID-19 patients with dyspnea present with altered nasal mucociliary clearance.

Molecular mechanisms of altered mucociliary clearance in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)

Molecular mechanisms of altered mucociliary clearance in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)

LONG-TERM USE OF INHALED HYPERTONIC SALINE IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS: EXPERIENCE FROM A TERTIARY CARE CENTER IN A LOW AND MIDDLE INCOME COUNTRY

Long term hypertonic saline use has been found to improve mucus transport, airway hydration, and mucociliary clearance in patients with cystic fibrosis. However, the effect of hypertonic saline on the outcomes of patients with cystic fibrosis is not well established. The aim of our study was to determine the long-term use of hypertonic saline in reducing pulmonary exacerbations, length of hospital stay and pseudomonas colonization in patients with cystic fibrosis admitted for treatment at a tertiary care referral center. Retrospective cohort study was conducted on 71 patients with cystic fibrosis. Patients ranged in age between 3-18 years. All patients with two to five pulmonary exacerbations in the preceding six months were included in the study. Those who received regular inhaled 3-7% hypertonic saline twice daily during their admission and till 6 months after discharge from hospital were categorized as hypertonic saline (HTS) group. Patients who did not receive regular hypertonic saline for 6 months were included in the non-hypertonic saline (NHTS) group. Data was analyzed at the end of one year. The HTS group had 37 patients whereas, the NHTS group had 34 patients. Mean number of exacerbation episodes was significantly lower in HTS group (2.18±0.84) as compared to NHTS group (3.67±0.91) (p<0.01) whereas, length of hospital stays and frequency of pseudomonas colonization did not significantly differ between the two groups (p=0.78 and p=0.12 respectively). The mean number of pulmonary exacerbations also significantly reduced from 3.11±1.07 to 2.18±0.84 p-value <0.01 in the HTS group over the follow-up period of one year. : Long term hypertonic saline therapy is beneficial in patients with cystic fibrosis in preventing pulmonary exacerbations and subsequently reducing morbidity.

Effect of Functional Endoscopic Sinus Surgery on Mucociliary Clearance in Patients of Chronic Rhinosinusitis

Effect of Functional Endoscopic Sinus Surgery on Mucociliary Clearance in Patients of Chronic Rhinosinusitis

Correlation between severity of diabetes mellitus, polyneuropathy and nasal mucociliary clearance

Objective: To examine the relationship between the severity of polyneuropathy and nasal mucociliary clearance times in patients with polyneuropathy and investigate how the presence and severity of electrophysiological polyneuropathy might affect mucociliary clearance in patients with diabetes mellitus.&#x0D; Material and Methods: This prospective cross-sectional study was carried out in the Neurol-ogy and Ear, Nose and Throat (ENT) clinics in a tertiary hospital. The study included three groups of patients with 20 participants in each group (Group 1, patients with diabetic poly-neuropathy; Group 2, patients with non-diabetic polyneuropathy; and Group 3, diabetes melli-tus patients with a normal nerve conduction study) Nasal saccharin test was performed on all patients.&#x0D; Results: There was a statistically significant difference in the duration of nasal mucociliary clearance among the groups (p= 0.001). There was a positive, statistically significant (p = 0.007) correlation between the nasal mucociliary clearance duration and the severity of poly-neuropathy. The nasal mucociliary clearance duration increased with the severity of polyneuropathy.&#x0D; Conclusion: Patients with diabetes mellitus are a special group, and preventable problems should be taken into consideration when examining nasal pathologies. It should be kept in mind that nasal mucociliary clearance dysfunction can be both a cause and a result in management of diabetes mellitus patients, and thus it should be evaluated carefully.

First clinical trials of the inhaled epithelial sodium channel inhibitor BI 1265162 in healthy volunteers.

BackgroundInhibition of the epithelial sodium channel (ENaC) represents a mutation-agnostic therapeutic approach to restore airway surface liquid hydration and mucociliary clearance in patients with cystic fibrosis. BI 1265162 is an inhaled ENaC inhibitor with demonstrated preclinical efficacy.MethodsThree phase I trials of BI 1265162 in healthy male subjects are presented: NCT03349723 (single-rising-dose trial evaluating safety, tolerability and pharmacokinetics (PK)); NCT03576144 (multiple-rising-dose trial evaluating safety, tolerability and PK); and NCT03907280 (absolute bioavailability trial).ResultsBI 1265162 single doses ≤1200 µg and multiple doses of 600 µg were well tolerated. Adverse events were balanced across treatment groups, were of mainly mild or moderate intensity and resolved by trial-end. One subject discontinued from trial medication on day 7 (asymptomatic hyperkalaemia adverse event; recovered day 8). One subject experienced a serious adverse event (neuropathia vestibularis) leading to hospitalisation and missed one of the four dosing periods. Both events were not considered to be drug-related and subjects recovered. BI 1265162 displayed dose-proportional, time-independent PK; maximum accumulation was 1.6-fold; calculated effective elimination half-life was 3.6–8.7 h over the dose ranges tested. Renal excretion was not a major drug elimination route. Oral and inhaled dosing (±activated oral charcoal) absolute bioavailability was 0.50% and ∼40%, respectively.ConclusionBI 1265162 single or multiple doses up to 6.5 days were well tolerated. Systemic exposures mainly represent drug absorbed through the lungs and not the gastrointestinal tract, with ∼40% of the inhaled dose reaching the systemic circulation. Accumulation was minimal. Twice-daily dosing is supported for future development.

Chemical cautery versus anterior inferior turbinectomy: Which is the better modality of treatment in nasal allergy?

INTRODUCTION: Nasal allergy is one of the most common forms of allergy seen in practice. Although medical treatment is the most commonly accepted modality of treatment, surgery also has a role. This study was aimed at the assessment of nasal symptoms and mucociliary clearance in patients with nasal allergy, before and following chemical cautery with trichloroacetic acid (TCA) in one group and anterior–inferior turbinectomy in another group and to study advantages and disadvantages of each procedure. MATERIALS AND METHODS: This was a prospective, randomized, single-blind, controlled clinical trial conducted at a tertiary care hospital on a sample of fifty patients with a history of allergic rhinitis without a satisfactory response to medical line of treatment. Preoperative nasal airflow was assessed both subjectively and objectively using the nasal symptom score and the mucociliary clearance, respectively. One group was subjected to undergo anterior–inferior turbinectomy and the other group chemical cautery with 50% TCA. Postoperative nasal airflow was also assessed by similar methods after a duration of 1 month. RESULTS: All the patients had significant relief from their symptoms at the end of 1 month postprocedure, irrespective of the procedure done. However, patients who underwent anterior–inferior turbinectomy had more symptomatic relief compared to the other group. DISCUSSION: Debulking the inferior turbinate either with surgery or with cautery relives the nasal obstruction in patients with allergic rhinitis. The other symptoms of nasal allergy are also found to be less severe in these cases. CONCLUSION: Surgical line of treatment can be used as an effective intervention to satisfactorily alleviate patient's allergic symptoms. Anterior–inferior turbinectomy is preferred for the longer symptom-free life of the patients.

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis

IntroductionMucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. ObjectiveThe aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. MethodsForty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. ResultsPatient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p<0.05). ConclusionsUnique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis

IntroductionMucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. ObjectiveThe aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. MethodsForty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. ResultsPatient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p<0.05). ConclusionsUnique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.

The evaluation of nasal mucociliary clearance in patients with Helicobacter pylori infection.

This study aimed to examine nasal mucociliary clearance time in patients with Helicobacter pylori infection. Fifty patients who were newly diagnosed with H pylori infection using gastric biopsy in the gastroenterology out-patient clinic, and 50 age- and gender-matched healthy adults who were admitted to the otorhinolaryngology out-patient clinic, were included in this study. After an otorhinolaryngological examination (anterior rhinoscopy and nasal endoscopic examination), the nasal mucociliary clearance time of each subject was calculated using the saccharine test. The mean mucociliary clearance time was 06:29 ± 3:31 minutes (range, 00:55-15:19 minutes) in the control group and 10:12 ± 06:09 minutes (range, 01:28-32:00 minutes) in the study group. Comparisons of the two groups revealed a statistically significant difference (p = 0.002). Nasal mucociliary clearance time was significantly increased in patients with H pylori infection. The results suggest that H pylori infection may have an unfavourable effect on nasal mucociliary clearance.

Evaluation of allergic rhinitis with nasal symptoms and nasal mucociliary clearance in patients with fibromyalgia syndrome.

The exact etiopathogenesis of fibromyalgia syndrome (FM) is still unclear but the pathogenesis of FM is associated with neurogenic inflammation. Allergic rhinitis (AR) is a common inflammatory and immunological disease of the nasal mucosa. As a result, it is known that neurogenic inflammation has a role in the pathophysiology of both FM and AR. The aim of this study was to evaluate AR and nasal allergic inflammation using nasal mucociliary clearance time (NMC) in FM patients. Forty-five FM patients and fifty healthy controls were included in the study. In both groups, AR was evaluated by total nasal symptom scoring (TNSS) and NMC was measured using saccharine transit time test (STT). TNSS was positive in 9 patients (20%) in the FM group and no positivity in the control group. In FM group, the mean value of TNSS was higher than that of the control group (p= 0.0001). The average value of STT of FM patients was statistically significantly longer when compared to the control group (p= 0.0001). The results we obtained suggest that there is a high possibility of coexistence of FM and AR. As a result, the coexistence of AR and FM cannot be denied but we believe that comprehensive clinical studies should be conducted on this subject.

Repurposing excipients as active inhalation agents: The mannitol story.

The story of how we came to use inhaled mannitol to diagnose asthma and to treat cystic fibrosis began when we were looking for a surrogate for exercise as a stimulus to identify asthma. We had proposed that exercise-induced asthma was caused by an increase in osmolarity of the periciliary fluid. We found hypertonic saline to be a surrogate for exercise but an ultrasonic nebuliser was required. We produced a dry powder of sodium chloride but it proved unstable. We developed a spray dried preparation of mannitol and found that bronchial responsiveness to inhaling mannitol identified people with currently active asthma. We reasoned that mannitol had potential to replace the 'osmotic' benefits of exercise and could be used as a treatment to enhance mucociliary clearance in patients with cystic fibrosis. These discoveries were the start of a journey to develop several registered products that are in clinical use globally today.

Effects of Septoplasty on Nasal Mucociliary Clearance in Patients Suffering from the Deviated Nasal Septum

Effects of Septoplasty on Nasal Mucociliary Clearance in Patients Suffering from the Deviated Nasal Septum

CFTR pharmacology.

CFTR protein is an ion channel regulated by cAMP-dependent phosphorylation and expressed in many types of epithelial cells. CFTR-mediated chloride and bicarbonate secretion play an important role in the respiratory and gastrointestinal systems. Pharmacological modulators of CFTR represent promising drugs for a variety of diseases. In particular, correctors and potentiators may restore the activity of CFTR in cystic fibrosis patients. Potentiators are also potentially useful to improve mucociliary clearance in patients with chronic obstructive pulmonary disease. On the other hand, CFTR inhibitors may be useful to block fluid and electrolyte loss in secretory diarrhea and slow down the progression of polycystic kidney disease.

Pilot Randomized Controlled Trial Evaluating the Effect of Hypertonic Saline With and Without Hyaluronic Acid in Reducing Inflammation in Cystic Fibrosis

Hypertonic saline (HS) has been established as a therapy aimed at restoring the surface liquid of airways liquid and enhancing mucociliary clearance in patients with cystic fibrosis (CF). A formula containing 7% HS and 0.1% hyaluronic acid (HA) is also available, basing its use on the protective effects of HA against elastin injury and on its greater ease of administration (i.e., the perceived acceptability of inhalation). This study explores the effect of HA+HS in reducing the inflammation of airways, by measuring cytokine levels in sputum, its safety profile, and the prevalence of commonly reported symptoms like cough, throat irritation, and saltiness. In a pilot, double-blind, randomized controlled, parallel-group, 1:1 trial, clinically stable CF patients older than 6 years of age and with a FEV1pred. >40% were randomized to one of the treatment arms, HS or HS+HA, to be administered twice a day at home. Clinical data, inflammatory markers (IL-1β, IL-6, IL-8, IL-10, TNF-α, VEGF) in sputum, and judgments on the tolerability and pleasantness were collected at the beginning and after 28 days. HA+HS had no significant effect on inflammatory markers versus HS alone, as shown by broad confidence intervals. In the HS+HA group, the highest decrement from baseline values was observed for IL-1β (-58.8%) followed by VEGF (-49.9%), whereas in the HS group a significant increment of IL-10 levels (+83.0%; p = 0.011) was the only significant finding. Prevalence of unfavorable scores was 36.8% in HA+HS versus 55% in HS group (p = 0.207); no significant differences were detected in the prevalence of moderate/severe symptoms of cough, saltiness, and throat irritation in pulmonary functions tests after 28 days. HS+HA administration in CF patients does not show any significant effects on lung inflammation and function as compared to HS alone.

Assessment of nasal mucociliary activity in patients with Behçet's disease.

To investigate nasal mucociliary clearance in patients with Behçet's disease. Thirty patients with Behçet's disease, diagnosed on the basis of criteria defined by the International Study Group for Behçet's Disease, and 30 healthy individuals were recruited. In both groups, individuals with conditions that could affect nasal mucociliary clearance were excluded. Nasal mucociliary clearance time was evaluated using saccharin tests. The time between placement of a saccharin tablet and the tasting of the saccharin was measured and recorded as the saccharin clearance time. The mean nasal mucociliary clearance time was significantly longer in the Behçet's disease patients than in the control subjects (p < 0.001). Furthermore, there was a positive correlation between Behçet's disease duration and nasal mucociliary clearance time (p < 0.001, r = 0.882). The results suggest that nasal mucociliary clearance time is longer in Behçet's disease patients than in control subjects, and is positively correlated with disease duration.