Nasal Mucociliary Transport of Chronic Sinusitis in Children Yasuo
Sakakura, MD; Yuichi Majima, MD; Teruhiko Harada, MD; Masahiko
\s=b\ Nasal mucociliary function is one of the most important and indispensable mechanisms of the respiratory tract, providing protection against the atmospheric environment. We previously found mucociliary dysfunction in the noses of adult patients suffering from chronic sinusitis. In this study, using the saccharin method, we determined nasal mucociliary function in normal children and in children with chronic sinusitis. The mean (\m=+-\SD)value of saccharin transit time in the nose was 28.2\m=+-\19.9minutes in patients with chronic sinusitis, this being significantly slower than that in the control group of children. The incidence of abnormally slow nasal mucociliary transport time (>30 minutes) in patients was significantly higher than in controls of the same age. Mucociliary dysfunction may initiate a vicious cycle of self-mediated inflammation and may be important in recovery from chronic respiratory inflammation. (Arch Otolaryngol Head Neck Surg. 1992;118:1234-1237)
in inspired air blanket of the airway Foreignwithmicrobodies mucous
ported
mucus
are
entrapped on the
mucosa
and trans¬
by ciliary activity to the pharynx. No
where the microbodies are in the upper or lower respiratory tracts, they are finally eliminated into the digestive tract. This mucociliary transport function is one of the most important and indispensable protective mech¬ anisms of the airway against the atmospheric environ¬ ment. For instance, in patients with Kartagener's syn¬ drome, in which the ciliary structure is congenitally abnormal, mucociliary dysfunction inevitably follows. Se¬ rious chronic infection thus occurs in the entire airway im¬ mediately after birth, even though immunity is normal systemically and locally. We found mucociliary dysfunction in the noses of adult patients with chronic sinusitis (CS).1 We consider that mu¬ cociliary dysfunction may cause deterioration and perpet¬ uate inflammation of the nose and paranasal sinuses.2 The present study was carried out to determine nasal mucocilmatter
Accepted for publication February 20, 1992. From the Department of Otorhinolaryngology, Mie (Japan) University
School of Medicine. Presented at the Fifth International Congress of Pediatric Oto-Rhino\x=req-\
Laryngology, Ghent, Belgium, June 9, 1990. Reprint requests to Department of Otorhinolaryngology, Mie University School of Medicine, 2-176 Edobashi, Tsu, Mie 514, Japan (Dr Sakakura).
Hattori MD; Kotaro
Ukai,
MD
in children and to compare the results among normal children and those with CS.
iary transport
SUBJECTS
AND METHODS
Subjects
examination was performed as a annual health examination for schoolchildren in November 1987. Children having had no nasal symptoms for 4 weeks and children exhibiting normal findings in the nasal cav¬ ity by anterior rhinoscopy were enrolled as the control group. This group consisted of 36 children (18 boys and 18 girls) 5 to 6 years old (kindergarten pupils), 80 children (36 boys and 44 girls) 6 to 7 years old (first-grade pupils), and 77 children (41 boys and 36 girls) 10 to 11 years old (fifth-grade pupils). We defined CS as inflammation of the lining of the nose and paranasal sinuses with persistent mucous and/or purulent nasal discharge lasting more than 3 months. Chronic sinusitis was di¬ agnosed from clinical symptoms, anterior rhinoscopy, and con¬ ventional and contrast roentgenographic examinations. A total of 183 children between the ages of 5 and 15 years (Table 1) who had previously been treated at our outpatient clinic from 1980 to 1989 were studied as patients with CS (CS group). None of these pa¬ tients were given any antibiotics, steroids, or other mucolytic agents for mucopurulent nasal discharge before the examination of mucociliary transport. A
screening ear-nose-throat
part of
an
Examination of Nasal
Mucociliary Transport
function was evaluated using the saccharin method of Andersen et al3 with minor modifications.4 A saccha¬ rin granule (2.5x0.5 mm, 5 mg) was placed on the septal mucosa corresponding to the anteroinferior tip of the middle turbinate. The time required for the subject to experience a sweet taste, ie, the time for saccharin to pass through the nasal cavity (saccharin transit time [ST]), was measured. For measurement of ST, the more severely affected side on an¬ terior rhinoscopy, or the left side if both sides were identical, was used. The children were asked to sit and were not allowed to eat or drink during the test. When after 60 minutes a subject failed to taste a sweet taste, the result was recorded as greater than 60 minutes and treated as 60 minutes in other statistical analyses. The ST values were expressed as mean±SD (minutes). The Mann-Whitney Li test was used to evaluate the null hypothesis that there is no difference in ST values in the distribution of two populations. The 2 test was used to compare the incidence of ab¬ normally slow STs for the two groups. Correlations were exam¬ ined by linear regression. A value of less than .05 was consid¬ ered significant. The normal ST range was less than 30 minutes.5 For adults, previously reported ST values were used.1
Mucociliary
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Table 1.—Age and Sex Distribution of Children With Chronic Sinusitis
Table 2.—Nasal Mucociliary Transport Time in Children With Chronic Sinusitis
Sex
Mean (±SD)
Mucociliary Transport
Total
Age,
3
2
0
2
5
20.0±16.1
4
0
0
0
6
27.1 ±1 7.6
5
9
3
12
7
24.6±19.3
6
15
8
23
8
22.2±17.2
7
13
3
16
9
23.5±21.2
8
8
10
18
10
25.5±19.9
Age,
M
y
y
Time, min
9
10
3
13
11
33.4±19.1
10
12
5
17
12
35.6±17.1
11
8
3
11
13
34.1 ±21.2
12
11
7
18
14
31.5±21.5
13
20
11
31
15
29.4±17.3
14
14
4
18
15
Total
30
3
1
4
125
58
183
Table 2 gives the ST for children with CS from each age group. There was no significant difference between boys and girls in mean ST, but the mean ST significantly increased with age CR2=.046, P
Sakakura, MD; Yuichi Majima, MD; Teruhiko Harada, MD; Masahiko
\s=b\ Nasal mucociliary function is one of the most important and indispensable mechanisms of the respiratory tract, providing protection against the atmospheric environment. We previously found mucociliary dysfunction in the noses of adult patients suffering from chronic sinusitis. In this study, using the saccharin method, we determined nasal mucociliary function in normal children and in children with chronic sinusitis. The mean (\m=+-\SD)value of saccharin transit time in the nose was 28.2\m=+-\19.9minutes in patients with chronic sinusitis, this being significantly slower than that in the control group of children. The incidence of abnormally slow nasal mucociliary transport time (>30 minutes) in patients was significantly higher than in controls of the same age. Mucociliary dysfunction may initiate a vicious cycle of self-mediated inflammation and may be important in recovery from chronic respiratory inflammation. (Arch Otolaryngol Head Neck Surg. 1992;118:1234-1237)
in inspired air blanket of the airway Foreignwithmicrobodies mucous
ported
mucus
are
entrapped on the
mucosa
and trans¬
by ciliary activity to the pharynx. No
where the microbodies are in the upper or lower respiratory tracts, they are finally eliminated into the digestive tract. This mucociliary transport function is one of the most important and indispensable protective mech¬ anisms of the airway against the atmospheric environ¬ ment. For instance, in patients with Kartagener's syn¬ drome, in which the ciliary structure is congenitally abnormal, mucociliary dysfunction inevitably follows. Se¬ rious chronic infection thus occurs in the entire airway im¬ mediately after birth, even though immunity is normal systemically and locally. We found mucociliary dysfunction in the noses of adult patients with chronic sinusitis (CS).1 We consider that mu¬ cociliary dysfunction may cause deterioration and perpet¬ uate inflammation of the nose and paranasal sinuses.2 The present study was carried out to determine nasal mucocilmatter
Accepted for publication February 20, 1992. From the Department of Otorhinolaryngology, Mie (Japan) University
School of Medicine. Presented at the Fifth International Congress of Pediatric Oto-Rhino\x=req-\
Laryngology, Ghent, Belgium, June 9, 1990. Reprint requests to Department of Otorhinolaryngology, Mie University School of Medicine, 2-176 Edobashi, Tsu, Mie 514, Japan (Dr Sakakura).
Hattori MD; Kotaro
Ukai,
MD
in children and to compare the results among normal children and those with CS.
iary transport
SUBJECTS
AND METHODS
Subjects
examination was performed as a annual health examination for schoolchildren in November 1987. Children having had no nasal symptoms for 4 weeks and children exhibiting normal findings in the nasal cav¬ ity by anterior rhinoscopy were enrolled as the control group. This group consisted of 36 children (18 boys and 18 girls) 5 to 6 years old (kindergarten pupils), 80 children (36 boys and 44 girls) 6 to 7 years old (first-grade pupils), and 77 children (41 boys and 36 girls) 10 to 11 years old (fifth-grade pupils). We defined CS as inflammation of the lining of the nose and paranasal sinuses with persistent mucous and/or purulent nasal discharge lasting more than 3 months. Chronic sinusitis was di¬ agnosed from clinical symptoms, anterior rhinoscopy, and con¬ ventional and contrast roentgenographic examinations. A total of 183 children between the ages of 5 and 15 years (Table 1) who had previously been treated at our outpatient clinic from 1980 to 1989 were studied as patients with CS (CS group). None of these pa¬ tients were given any antibiotics, steroids, or other mucolytic agents for mucopurulent nasal discharge before the examination of mucociliary transport. A
screening ear-nose-throat
part of
an
Examination of Nasal
Mucociliary Transport
function was evaluated using the saccharin method of Andersen et al3 with minor modifications.4 A saccha¬ rin granule (2.5x0.5 mm, 5 mg) was placed on the septal mucosa corresponding to the anteroinferior tip of the middle turbinate. The time required for the subject to experience a sweet taste, ie, the time for saccharin to pass through the nasal cavity (saccharin transit time [ST]), was measured. For measurement of ST, the more severely affected side on an¬ terior rhinoscopy, or the left side if both sides were identical, was used. The children were asked to sit and were not allowed to eat or drink during the test. When after 60 minutes a subject failed to taste a sweet taste, the result was recorded as greater than 60 minutes and treated as 60 minutes in other statistical analyses. The ST values were expressed as mean±SD (minutes). The Mann-Whitney Li test was used to evaluate the null hypothesis that there is no difference in ST values in the distribution of two populations. The 2 test was used to compare the incidence of ab¬ normally slow STs for the two groups. Correlations were exam¬ ined by linear regression. A value of less than .05 was consid¬ ered significant. The normal ST range was less than 30 minutes.5 For adults, previously reported ST values were used.1
Mucociliary
Downloaded From: http://archotol.jamanetwork.com/ by a University of Calgary User on 05/27/2015
Table 1.—Age and Sex Distribution of Children With Chronic Sinusitis
Table 2.—Nasal Mucociliary Transport Time in Children With Chronic Sinusitis
Sex
Mean (±SD)
Mucociliary Transport
Total
Age,
3
2
0
2
5
20.0±16.1
4
0
0
0
6
27.1 ±1 7.6
5
9
3
12
7
24.6±19.3
6
15
8
23
8
22.2±17.2
7
13
3
16
9
23.5±21.2
8
8
10
18
10
25.5±19.9
Age,
M
y
y
Time, min
9
10
3
13
11
33.4±19.1
10
12
5
17
12
35.6±17.1
11
8
3
11
13
34.1 ±21.2
12
11
7
18
14
31.5±21.5
13
20
11
31
15
29.4±17.3
14
14
4
18
15
Total
30
3
1
4
125
58
183
Table 2 gives the ST for children with CS from each age group. There was no significant difference between boys and girls in mean ST, but the mean ST significantly increased with age CR2=.046, P
