Nasal Mucociliary Clearance Research Articles

Do Nasal Surgeries Affect Mucociliary Clearance?

The study was conducted to assess the impact of different nasal surgeries on the nasal mucociliary clearance mechanism. Mucociliary function of the nasal mucosa of patients who were undergoing various nasal surgeries was assessed by the Saccharin test by placing 5mg saccharin granule on the anterior end of the inferior turbinate 1day prior to the surgery. The time required for the test subject to experience a sweet taste was measured in minutes. Post-operatively the test was repeated 6weeks after the surgery and the test times were compared. A total of 60 patients were part of this study. Of the 60 cases, 19 cases had undergone only septoplasty, 13 cases had undergone only functional endoscopic sinus surgery (FESS), 25 cases had undergone septoplasty with FESS, 2 cases underwent septoplasty with bilateral partial inferior turbinectomy (PIT) and one case was submucous resection (SMR). Significant improvement in nasal mucociliary clearance was observed in all the patients after the procedures. Out of the 19 cases of septoplasty, 57.9% showed improvement on the right side and 47.4% on the left side. Out of the 13 cases of FESS, 61.5% showed improvement on the right side and 69.2% on the left side. Out of the 25 cases of FESS with septoplasty, 76.0% showed improvement on both sides. The case of SMR did not show improvement. The 2 cases of septoplasty with PIT showed improvement. Statistically, highly significant improvement of test time was seen postoperatively as compared to pre-operatively. Among the surgical procedures, FESS with septoplasty showed better improvement as compared to the other procedures. Based on the study, we can conclude that nasal surgeries done for correction of septal deviation and rhino sinusitis significantly improves nasal mucociliary clearance mechanism thereby improving the physiological functions of the upper airway.

Mucociliary Function: Its Variations with Disease

ABSTRACT Introduction This study compares the nasal mucociliary clearance time of patients with chronic sinusitis (pre- and postoperatively) and smokers, with controls, attending the ear, nose, and throat outpatient department at Southern Railway Headquarters Hospital, Perambur, Chennai. Materials and methods Saccharin granule was used to study mucociliary clearance as it is safe, easy, fast, and reliable. A total of 32 patients in each group were studied. In chronic rhinosinusitis patients, the test was done preoperatively and 4 weeks postoperatively. Results The average mucociliary clearance time pre- and post-operatively in chronic rhinosinusitis patients was 29.54 ± 28.68 and 12.17 ± 5.84 respectively. Cigarette smokers had a longer mucociliary clearance time (27.63 ± 21.11) compared with beedi smokers (24.04 ± 24.93). Controls had the fastest mucociliary clearance rate of 9.67 ± 4.62 among the study subjects. Conclusion Surgery for chronic rhinosinusitis improves both the overall symptoms of chronic rhinosinusitis and the protective functions of the nose and paranasal sinuses. Smokers had an impaired clearance rate compared with normals. As age advances, the mucociliary clearance rate becomes slower. How to cite this article Vamanshankar H, Kumar SC, Preetham AP, Feshan M. Mucociliary Function: Its Variations with Disease. Clin Rhinol An Int J 2016;9(2):68-73.

Effect of Deviated Nasal Septum Type on Nasal Mucociliary Clearance, Olfactory Function, Quality of Life, and Efficiency of Nasal Surgery.

The aim of this study was to analyze the influence of deviated nasal septum (DNS) type on nasal mucociliary clearance, quality of life (QoL), olfactory function, and efficiency of nasal surgery (septoplasty with or without inferior turbinate reduction and partial middle turbinectomy). Fifty patients (20 females and 30 males) with septal deviation were included in the study and were divided into 6 groups according to deviation type after examination by nasal endoscopy and paranasal computed tomography. The saccharin clearance test to evaluate the nasal mucociliary clearance time, Connecticut Chemosensory Clinical Research Center smell test for olfactory function, and sinonasal outcome test-22 (SNOT-22) for patient satisfaction were applied preoperatively and postoperatively at the sixth week after surgery. Nasal mucociliary clearance, smell, and SNOT-22 scores were measured before surgery and at the sixth week following surgery. No significant difference was found in olfactory and SNOT-22 scores for any of the DNS types (both convex and concave sides) (P > 0.05). In addition, there was no difference in the saccharin clearance time (SCT) of the concave and convex sides (P > 0.05). According to the DNS type, the mean SCT of the convex sides showed no difference, but that of the concave sides showed a difference in types 3, 4, 5, and 6. These types had a prolonged SCT (P < 0.05). Olfactory scores revealed no difference postoperatively in types 5 and 6 but were decreased significantly in types 1 to 4 (P < 0.05). There was no significant difference in the healing of both the mucociliary clearance (MCC) and olfactory functions. SNOT-22 results showed a significant decrease in type 3. All DNS types disturb the QoL regarding nasal MCC and olfaction functions. MCC values, olfactory function, and QoL scores are similar among the DNS types. Both sides of the DNS types affect the MCC scores symmetrically. Septal surgery improves olfaction function and QoL at the sixth week following surgery but disturbs nasal MCC; thus, the sixth week is too early to assess nasal MCC.

Does oxymetazoline increase the efficacy of nasal steroids in treating nasal polyposis?

Although nasal steroids are the mainstay treatments in nasal polyposis, up to one-half of patients do not respond and need surgical treatment. This study aimed to evaluate whether oxymetazoline administration produces any additive effect on nasal steroid therapy and whether rebound congestion develops after oxymetazoline treatment. Sixty-eight patients with nasal polyposis were randomly assigned in a 1:1 ratio to receive either oxymetazoline plus mometasone furoate nasal spray (MFNS) or placebo plus MFNS, 2 sprays per nostril twice daily, with an interval of 5 minutes between each medication for 4 weeks. All the patients were then treated with MFNS, 2 sprays per nostril twice daily for 2 weeks. The nasal symptoms score, peak inspiratory flow index, nasal mucociliary clearance time (NMCCT), and total nasal polyps score were used to evaluate treatment outcomes. An intention-to-treat analysis was performed, and a worst case sensitivity analysis was applied to missing cases. Thirty-four patients were allocated to the oxymetazoline-MFNS group, and 34 to the placebo-MFNS group. One patient in each group was lost to last-visit follow-up. At 4 weeks after beginning treatment, the oxymetazoline-MFNS group showed significantly greater improvement in blocked nose, hyposmia, peak flow, NMCCT, and total nasal polyps score than the placebo-MFNS group. During the nasal steroid phase, both groups showed continuing improvement in all outcome variables. However, the oxymetazoline-MFNS group still showed significantly greater improvement in blocked nose, hyposmia, NMCCT, and total nasal polyps score, but not peak flow, than the placebo-MFNS group at the end of the study. The use of nasal steroids with oxymetazoline was more effective over 6 weeks than nasal steroids alone in improving blocked nose, hyposmia, nasal mucociliary clearance, and polyp size in treatment of nasal polyposis. There was no evidence of rebound congestion after 4 weeks of oxymetazoline treatment.

Oxygen With Cold Bubble Humidification Is No Better Than Dry Oxygen in Preventing Mucus Dehydration, Decreased Mucociliary Clearance, and Decline in Pulmonary Function

Little is known about the effects of long-term nasal low-flow oxygen (NLFO) on mucus and symptoms and how this variable is affected by dry or cold humidified gas. The aim of this study was to investigate the effects of dry-NLFO and cold bubble humidified-NLFO on nasal mucociliary clearance (MCC), mucus properties, inflammation, and symptoms in subjects with chronic hypoxemia requiring long-term domiciliary oxygen therapy. Eighteen subjects (mean age, 68 years; 7 male; 66%with COPD) initiating NLFO were randomized to receive dry-NLFO (n= 10) or humidified-NLFO (n= 8). Subjects were assessed at baseline, 12 h, 7days, 30days, 12months, and 24months by measuring nasal MCC using the saccharin transit test, mucus contact angle (surface tension), inflammation (cells and cytokine concentration in nasal lavage), and symptoms according to the Sino-Nasal Outcome Test-20. Nasal MCC decreased significantly (40%longer saccharin transit times) and similarly in both groups over the study period. There was a significant association between impaired nasal MCC and decline in lung function. Nasal lavage revealed an increased proportion of macrophages, interleukin-8, and epidermal growth factor concentrations with decreased interleukin-10 during the study. No changes in the proportion of ciliated cells or contact angle were observed. Coughing and sleep symptoms decreased similarly in both groups. There were no outcome differences comparing dry vscold bubble humidified NLFO. In subjects receiving chronic NLFO, cold bubble humidification does not adequately humidify inspired oxygen to prevent deterioration of MCC, mucus hydration, and pulmonary function. The unheated bubble humidification performed no better than no humidification. ClinicalTrials.gov; No.: NCT02515786; URL: www.clinicaltrials.gov.

Mucociliary Clearance in Bronchiectasis

ABSTRACT Bronchiectasis is a chronic lung disease, defined pathologically as irreversible dilatation of the bronchi. There is ineffective clearance of pulmonary secretions because of damage to the cilia. The nasal mucociliary clearance was studied using the saccharine method in 75 patients of bronchiectasis and the results were compared with those of 25 healthy controls. The nasal mucociliary clearance was significantly prolonged in patients with bronchiectasis. How to cite this article Yadav J, Ranga RK, Goel AK, Gupta KB. Mucociliary Clearance in Bronchiectasis. Clin Rhinol An Int J 2016;9(1):37-39.

Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy.

To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored. Prospective, single-group, pretest-posttest design. Academic tertiary care medical center. This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility. Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up. The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.

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.

Fluticasone furoate verses fluticasone propionate: a comparative study by assessment of nasal mucociliary clearance time on patients with allergic rhinitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Allergic diseases in India have been on an uprising trend. 3.5% of the population in INDIA is suffering from Allergic Rhinitis. This study aims to compare the effectiveness of two commonly used intranasal steroids- Fluticasone Furoate (FF) and Fluticasone Propionate (FP) using the nasal mucociliary clearance time (NMCT).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a prospective study on 70 patients. 35 each on FF and FP. Pretreatment and Post treatment Nasal was assessed by Saccharin Test. Patients were then put on either FF or FP for a period of one month. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Average improvement of NMCT post treatment with steroids sprays is 2-3 minutes.(Average Pretreatment time is 17.92 and Average Post treatment time 15.55 minutes).&lt;/p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both drugs are equally efficacious and well tolerated by the patients. Compliance of Fluticasone Furoate was better because of its once daily dosage. Disadvantages of FP are its twice daily dosage and after taste.

The effects of smoking and smoking cessation on nasal mucociliary clearance, mucus properties and inflammation

OBJECTIVE:The aim of the present study was to assess nasal mucociliary clearance, mucus properties and inflammation in smokers and subjects enrolled in a Smoking Cessation Program (referred to as quitters).METHOD:A total of 33 subjects with a median (IQR) smoking history of 34 (20-58) pack years were examined for nasal mucociliary clearance using a saccharine transit test, mucus properties using contact angle and sneeze clearability tests, and quantification of inflammatory and epithelial cells, IL-6 and IL-8 concentrations in nasal lavage fluid. Twenty quitters (mean age: 51 years, 9 male) were assessed at baseline, 1 month, 3 months and 12 months after smoking cessation, and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and after 12 months. Clinicaltrials.gov: NCT02136550.RESULTS:Smokers and quitters showed similar demographic characteristics and morbidities. At baseline, all subjects showed impaired nasal mucociliary clearance (mean 17.6 min), although 63% and 85% of the quitters demonstrated significant nasal mucociliary clearance improvement at 1 month and 12 months, respectively. At 12 months, quitters also showed mucus sneeze clearability improvement (∼26%), an increased number of macrophages (2-fold) and no changes in mucus contact angle or cytokine concentrations.CONCLUSION:This study showed that smoking cessation induced early improvements in nasal mucociliary clearance independent of mucus properties and inflammation. Changes in mucus properties were observed after only 12 months of smoking cessation.

Effect of N- Acetylcysteine on Nasal Mucociliary Clearance in Chronic Sinusitis

Abstract Chronic sinusitis is a common health problem that causes loss of productivity throughout the world, which is treated by variety of means. Aim: To evaluate the effect of N- acetylcysteine on nasal mucociliary clearance by Andersen, saccharine method. Materials and method: Study was conducted in thirty normal adult subjects and sixty patients in age group of 19- 55 years of chronic sinusitis diagnosed on the basis of major & minor criteria of sinusitis and substantiated by radiology. The nasal mucociliary clearance was evaluated before and after the treatment with N- acetylcysteine and levofloxacin with Andersen’s method, in which a saccharin particle of 1.5mm diameter was used. Result: Nasal mucociliary clearance time in 30 healthy controls was 8.37 ± 1.54, 30 chronic sinusitis patients before treatment 18.4 ± 2.73 minutes and 11.24 ± 2.51 minutes after treatment with levofloxacin & N- acetylcysteine respectively. In group C, it was 19.52 ± 2.26 minutes before treatment and 13.37 ± 2.58 minutes after treatment with levofloxacin. The difference in mean value of two samples after treatment was statistically significant. Conclusion: N – acetylcysteine mucolytic agent in combination of antibiotic is helpful for the treatment of chronic sinusitis, which not only helps in removal of stagnated mucus by improving nasal mucociliary clearance but also help the antibiotic to be more effective.

Potassium titanyl phosphate laser turbinate reduction in the management of allergic inferior turbinate hypertrophy: Our experience.

Background:Allergic inferior turbinate hypertrophy is one of the most common causes of nasal obstruction. Several surgical methods can be used for the reduction of allergic inferior turbinate hypertrophy refractory to medical management. Herein, we share our experience with a potassium titanyl phosphate (KTP) laser, which is a relatively novel technique for turbinate reduction.Objectives:To evaluate the efficacy of KTP laser turbinate reduction in terms of symptomatic improvement and its effect on nasal mucociliary clearance.Methods:This study was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from November 2012 to July 2013. Thirty patients with inferior turbinate hypertrophy refractory to medical management were selected. A KTP laser was used at 6 W in continuous mode, with a spot size of 0.6–1 mm, and energy delivered through a 400-μm optical fiber. A follow-up was done at 1 week, 1 month, and 3 months. All the values (both by the Sino Nasal Outcome Test scoring system and saccharine transit time) were assessed before surgery and at each follow-up visit.Results:The patients showed significant differences in the symptoms (p < 0.0001) at each follow-up. The mean saccharin transit time showed significant prolongation during the first week and first month after surgery, which indicated adverse effects on the mucociliary system (p < 0.0001). This, however, was a temporary effect, and the mean saccharin time returned to normal limits (17.96 minutes) at the third postoperative month. The mean operative time was 11.62 minutes. The procedure was not associated with any serious intra- or postoperative complications.Conclusion:KTP laser turbinate reduction is a safe, effective, and minimally invasive procedure in the treatment of allergic inferior turbinate hypertrophy, with a minimal effect on the nasal mucosa. It can be done as an office procedure, with minimal complications.

Nasal mucociliary clearance in chronic renal failure: comparision of pre-dialysis and dialysis stages

Nasal mucociliary clearance in chronic renal failure: comparision of pre-dialysis and dialysis stages

The use of preparation sinupret in post-operative period after rhinoseptoplasty

The authors studied clinical efficacy of the preparation Sinupret in the treatment of post­surgical inflammation after rhinosurgery interventions. The study embraced 64 patients after surgical correction of the deviated nasal septum. The symptoms dynamics was assessed based on the data of endoscopic examination and the change of nasal mucociliary clearance time determined by saccharin test. The study displayed the advisability Sinupret prescription in the early post­surgery period after nasal septum surgery.

Nasal Mucociliary Clearance in Adenoid Hypertrophy and Otitis Media with Effusion.

Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.

The expansion of autologous adipose-derived stem cells in vitro for the functional reconstruction of nasal mucosal tissue.

BackgroundI t is established that adipose-derived stem cells (ADSCs) produce and secrete cytokines/growth factors that antagonize mucosal injury. However, the exact molecular basis underlying the treatment effects exerted by ADSCs is ill understood, and whether ADSCs cooperate with adipose tissue particles to improve mucosal function in patients with empty nose syndrome (ENS) has not been explored. We investigated the impact of ADSCs on nasal mucosa, the associated mechanisms, and their use in the treatment of patients with ENS.Results The nasal endoscope and mucociliary clearance assessments were significantly improved (P < 0.05) in patients with (n = 28) and without (n = 2) a rudimentary turbinate that received ADSCs combined with fat granules transplantation. Patients experienced a significant improvement in nasal obstruction and nasal mucociliary clearance after nasal turbinate angioplasty (P < 0.05). H&E staining, Masson’s staining, and AB-PAS staining confirmed that inflammation was significantly reduced, collagenous fibers became aligned, fewer deposits were observed, and the mucosal proteins generated from caliciform cells increased following treatment. After a 14-day incubation period, ADSCs developed a polygonal cobblestone shape characteristic of human epithelial cells. Furthermore, immunohistochemical analysis revealed the presence of epithelial markers such as cytokeratin-7, and cytokeratin-19. Western blot analysis showed the presence of specific epithelial cell markers including cytokeratin-7, cytokeratin-14 and cytokeratin-19 in these epithelial like cells (ELC); these markers had low expression levels of ADSCs.ConclusionsThe reconstruction of mucosal function by nasal turbinate angioplasty combined with ADSCs and autologous adipose tissue particle transplantation significantly improved the symptoms of patients with ENS. This is a new procedure that will improve mucosal restoration treatment options in patients with ENS. Furthermore, we undertook preliminary explorations of the underlying mechanisms involved, and found that transplantation of ADSCs could induce epithelial cells to improve mucosa function in patients with ENS in the micro-environment of injection areas.

Clinical efficacy of nasal steroids on nonallergic rhinitis and the associated inflammatory cell phenotypes.

Although good response to nasal steroid therapy has been documented in allergic rhinitis (AR), the efficacy of this treatment in non-AR, and the associated inflammatory cell phenotypes has not been fully investigated. To compare the response to steroids in non-AR versus AR and to assess the impact of inflammatory cell phenotypes on non-AR treatment outcomes. A total of 149 patients with rhinitis were divided into non-AR and AR groups by using the allergy skin-prick test. Based on nasal cytology, the non-AR group was further divided into inflammatory non-AR (INAR) and noninflammatory non-AR (NINAR) groups, and the INAR groups were further subdivided into four phenotypes according to inflammatory cell type: non-AR with eosinophils (NARES), non-AR with mast cells (NARMA), non-AR with neutrophils (NARNE), and NARES and mast cells (NARESMA). All the patients were treated over 28 days with 220 μg of nasal triamcinolone acetonide once daily. Nasal symptom score, peak inspiratory flow index, and nasal mucociliary clearance time (NMCCT) were used to evaluate treatment outcomes. The initial screening found 67 patients with non-AR and 82 patients with AR. At 28 days after nasal steroid treatment, all nasal symptom score, peak inspiratory flow indexes, and NMCCTs were significantly improved within each group; however, the non-AR group recorded significantly lower levels of improvement in blocked nose, rhinorrhea, sneezing, nasal itching, peak flows, and NMCCTs than the AR group. The NINAR group overall indicated lower levels of improvement than the INAR group. Among the INAR subgroups, the NARESMA, NARES, and NARMA phenotypes had similar outcome improvements, all better than the NARNE phenotype. Although both patients with non-AR and those with AR had good steroid response, the patients with non-AR had less improvement than the patients with AR. Patients with NINAR had the worst treatment outcome among the non-AR phenotypes.

Evaluation of nasal mucociliary activity in patients with chronic renal failure.

The ability of respiratory mucosal surfaces to eliminate foreign particles and pathogens and to keep mucosal surfaces moist and fresh depends on mucociliary activity. Chronic renal failure (CRF) is an irreversible medical condition that may result in important extrarenal systemic consequences, such as cardiovascular, metabolic, and respiratory system abnormalities. Although there are studies describing nasal manifestations of CRF, data are lacking concerning the effects of the condition on nasal mucosa. The goal of the current study was to evaluate nasal mucociliary clearance (NMC) time in patients with CRF. This prospective cohort study conducted in a tertiary referral center included 32 non-diabetic end-stage CRF patients and 30 control individuals. The control group consisted of voluntary participants who had been referred to our clinic for symptoms other than rhinological diseases. The mean NMC times in CRF patients and control individuals were 12.51 ± 3.74 min (range 7-22 min) and 8.97 ± 1.83 min (range 6-13 min), respectively. The mean NMC time in patients with CRF was significantly longer than that in control individuals (p < 0.001). Clinicians must keep in mind that NMC time in CRF patients is prolonged and must follow-up these patients more closely for sinonasal and middle ear infections.

Effects of rapid maxillary expansion on nasal mucociliary clearance.

To evaluate the changes in nasal mucociliary clearance in orthodontic patients after rapid maxillary expansion (RME) therapy. Forty-two children (25 boys and 17 girls) participated in this study. The RME group consisted of 21 patients (mean age, 13.8 years), who had undergone RME at the initiation of orthodontic treatment. The control group consisted of 21 subjects (mean age, 13.6 years), who were attending the department of orthodontics for active orthodontic treatment. The nasal mucociliary clearance was assessed by the saccharin test. Saccharin transit times (STTs) were measured for each treated subject before expansion (T1), after RME (T2), and after a 3-month retention period (T3). Records were obtained at the same time intervals for each group. The STT decreased significantly in the RME group after expansion and retention (P < .05). A statistically significant difference was found when the STTs of the control and RME groups were compared after expansion and retention (P < .05). The STTs of young orthodontic patients with maxillary narrowness and without any history of nasal or systemic disease were within normal limits. However, RME increased the mucociliary clearance in patients who had maxillary narrowness, having positive effects on nasal physiology and increasing nasal cavity volume.

Analysis of mucociliar clearance: a new diagnostic method and a therapeutical proposal

Mucociliary clearance is a key defence mechanism in human upper and lower airways and its impairment predisposes to chronic infections of the nose, paranasal sinuses and respiratory tract. Nasal mucociliary clearance is a first-line physiological function of nasal cavity, that helps protecting the lower respiratory tract from undesirable organic and inorganic matter, including microorganisms. On one hand, multiple investigations have demonstrated a marked decrease in nasal mucociliary clearance in patients with rhinitis or chronic rhinosinusitis. Ciliary motility analysis allows us to have an index of our defense mechanisms functionality and of our ability to react to microorganisms. The ciliary motility can be evaluated with a light microscope using phase contrast. Sampling should be performed through a brushing at the level of the middle third of the inferior turbinate and the sample must be analyzed immediately after collection. Through the analysis of the sample, it is possible to evaluate the presence of ciliated cells with a functional edge, to calculate the length of the ciliary motilia, to assess the direction of movement and to evaluate the coordination of the lashes. The time needed for this examination is short, it only takes 5 to 10 minutes, and it appears to be not invasive, repeatable and not painful. The ciliary function may also be influenced by the use of certain medications, such as anti-histamines, whereas it may be stimulated and improved by the use of topical hyaluronic acid. HA may be an important regulator of the inflammatory process. During nasal inflammation, high-molecular weight HA breaks down under the influence of free radicals and enzymes. Low-molecular weight fragments deliver signals regarding tissue damage and mobilize immune cells, while the high molecular weight form suppresses immune cells function and prevents excessive exacerbation of inflammation. Based on the known background of the effects of HA in the regulation of vasomotor tone, mucous gland secretion and in the modulation of the inflammatory process, it is suggested that HA may improve ciliary motility, nasal mucosa cellularity and inflammatory status.