Ciliary function and sinonasal mucosal cytology in pediatric  patients with chronic rhinosinusitis during a year after  functional endoscopic sinus surgery

Background: The objective of the study is evaluation of ciliary function and mucosal cytology after endoscopic sinus surgery in children with chronic rhinosinusitis (CRS). Methodology: A total of 132 children with CRS who underwent endoscopic sinus surgery, as well as 15 healthy controls were involved in the study. In this follow-up study patients were examined preoperatively, as well as 3, 6, 9, and 12 months after endoscopic sinus surgery. Assessment of ciliary function and sinonasal mucosal cytology was performed using high-speed videomicroscopy. Lund-Kennedy, Lund-Mackay, and sinonasal outcome test 20 (SNOT20) scores were also evaluated. Results: Total SNOT-20, Lund-Mackay, and Lund-Kennedy values significantly decreased after sinus surgery. In contrast, ciliary function and mucosal cytology only tended to improve after 6 months. 9 months after surgery the number of ciliated cells, ciliary beat frequency, cell viability, and ciliary length were significantly higher than preoperatively. The most significant improvement of ciliary function and cell height was observed 12 months after operation, whereas epithelial dystrophy and neutrophil infiltration were significantly reduced. Conclusions: Substantial improvement was observed only in a year after surgery, whereas 0 to 3 months after the surgery ciliary function was severely impaired thus predisposing to recurrent sinusitis or other complications.

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The impact of zinc supplementation on the outcome of endoscopic sinus surgery and ciliary function of the nasal mucosa in children with chronic rhinosinusitis

Nauchno-prakticheskii zhurnal «Patogenez» ◽

10.25557/2310-0435.2021.02.73-82 ◽

2021 ◽

pp. 73-82

Author(s):

С.И. Алексеенко ◽

А.В. Скальный ◽

С.А. Карпищенко ◽

С.А. Артюшкин ◽

С.В. Барашкова ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Mucosa ◽

Endoscopic Sinus Surgery ◽

Inductively Coupled Plasma ◽

Beat Frequency ◽

Ciliary Beat Frequency ◽

Sinus Surgery ◽

Ciliary Activity ◽

Ciliary Function ◽

The Impact

Несмотря на указания на роль цинка в функции реснитчатого эпителия, данные относительно влияния коррекции обмена цинка на цилиарную функцию у пациентов с хроническим риносинуситом отсутствуют. Целью настоящего исследования явилась оценка эффективности хирургического лечения, активности мукоцилиарного аппарата, а также местной воспалительной реакции слизистой оболочки носа в послеоперационном периоде у детей с хроническим риносинуситом на фоне применения цинка. Методы. Обследовано 192 ребенка с хроническим риносинуситом, в лечении которых применялась эндоскопическая риносинусохирургия. Из них 131 ребенок в послеоперационном периоде получал стандартные назначения, тогда как 61 ребенок дополнительно получал цинк в суточной дозе 10 мг в течение 90 дней. Оценка концентрации цинка в сыворотке крови осуществлялась методом ИСП-МС. Для определения функции цилий использована видеоцитоморфометрия. Определение эффективности лечения осуществлялось с использованием опросника SNOT-20, а также шкал Лунд-Кеннеди и Лунд-Маккей. Результаты. Проведение эндоскопической операции приводило к достоверному снижению значений шкал SNOT-20, Лунд-Кеннеди и Лунд-Маккей у пациентов вне зависимости от приема цинка. В то же время, пациенты, принимавшие цинк, характеризовались достоверно меньшим риском ревизионной хирургии. Цинк также оказывал значительное влияние на функционирование реснитчатого эпителия. В частности, к 12-му месяцу наблюдения количество клеток с подвижными цилиями, частота биения цилий, длина цилий и выживаемость клеток у пациентов, принимавших цинк, превышала соответствующие показатели в контрольной группе. Повышение уровня цинка в организме также сопровождалось многократным снижением количества инфильтрирующих слизистую оболочку нейтрофилов и лимфоцитов. Заключение. Предполагается, что цинк ускоряет репаративные процессы в слизистой оболочке носа и обладает противовоспалительным действием. Despite the presence of certain indications of the role of zinc in ciliated epithelium functioning, data on the potential effect of Zn supplementation in ciliary function in patients with chronic rhinosinusitis are absent. The aim of this study was to evaluate the efficiency of surgical treatment, ciliary activity, as well as local inflammation of nasal mucosa in children with chronic rhinosinusitis undergoing functional endoscopic surgery. Methods. 192 pediatric patients with chronic rhinosinusitis were examined. 131 patients received standard postoperative prescriptions, whereas 61 children received 10 mg Zn daily for 90 days. Serum Zn concentrations were measured by inductively coupled plasma mass spectrometry. Ciliary function was evaluated by video cytomorphometry. Surgery efficiency was assessed with a SNOT-20 questionnaire, as well as with Lund-Kennedy and Lund-Mackay scales. Results. Functional endoscopic sinus surgery resulted in a significant decrease in total SNOT-20, Lund-Kennedy, and Lund-Mackay scores independent of Zn supplementation. At the same time, Zn supplemented patients had a significantly lower risk of revision surgery. Zn also had a significant impact on ciliary function. Specifically, up to the 12th mo postoperatively, Zn supplementation resulted in higher number of cells with motile cilia, ciliary beat frequency, ciliary length, and cell viability as compared to controls. Increased Zn status was also associated with a manyfold decrease in mucosal neutrophil and lymphocyte infiltration. Conclusions. It is proposed that Zn enhances reparative processes in nasal mucosa and possesses anti-inflammatory activity.

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Altered Sinonasal Ciliary Dynamics in Chronic Rhinosinusitis

American Journal of Rhinology ◽

10.2500/ajr.2006.20.2870 ◽

2006 ◽

Vol 20 (3) ◽

pp. 325-329 ◽

Cited By ~ 62

Author(s):

Bei Chen ◽

Jeffrey Shaari ◽

Steven Eau Claire ◽

James N. Palmer ◽

Alexander G. Chiu ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Adenosine Triphosphate ◽

High Speed ◽

Beat Frequency ◽

Ciliary Beat Frequency ◽

Ciliary Activity ◽

Differential Interference Contrast Microscopy ◽

Dynamic Regulation ◽

Mucus Clearance ◽

Persistent Inflammation

Background Although multiple etiologies contribute to the development of rhinosinusitis, a common pathophysiological sequelae is ineffective sinonasal mucociliary clearance, resulting in stasis of sinonasal secretions, with subsequent infection, and persistent inflammation. The respiratory cilia beat continually at a basal rate, while during times of stress, such as exercise or infection, ciliary beat frequency (CBF) increases, accelerating mucus clearance. Previous investigations have led to conflicting results with some authors reporting decreased CBF while others have found normal values of CBF in patients with chronic rhinosinusitis (CRS). Additionally, these studies have only analyzed basal CBF. The goal of this study was to compare the basal as well as the stimulated sinonasal CBF in patients with CRS versus controls. Methods A dual temperature controlled perfusion chamber, differential interference contrast microscopy, and high-speed digital video were used to analyze both basal and adenosine triphosphate (100 μM)–stimulated CBF in human sinonasal mucosal explants. Results Although no difference in basal CBF was detected between control and CRS patients, a marked difference in stimulated CBF was noted. Exogenously applied adenosine triphosphate resulted in a 50–70% increase of CBF in control tissue with a minimally observed CBF increase in explants from CRS patients. Conclusion Dynamic regulation of respiratory ciliary activity is critical for the respiratory epithelium to adapt to varying environmental situations. Thus, diminished or absent adaptation could predispose the sinonasal cavity to accumulation of inhaled infectious and noxious particulate matter resulting in infection/inflammation. Our findings suggest that CRS patients have decreased sinonasal ciliary adaptation to environmental stimuli.

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Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment

The Journal of Laryngology & Otology ◽

10.1017/s0022215100117463 ◽

1991 ◽

Vol 105 (10) ◽

pp. 832-835 ◽

Cited By ~ 102

Author(s):

Valerie J. Lund ◽

Mats Holmstrom ◽

Glenis K. Scadding

Keyword(s):

Endoscopic Sinus Surgery ◽

Clinical Success ◽

Objective Assessment ◽

Beat Frequency ◽

Ciliary Beat Frequency ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Quantitative Evidence ◽

Chronic Rhino Sinusitis ◽

Ciliary Beat

AbstractConsiderable clinical success has been claimed for functional endoscopic sinus surgery but objective assessment of prospective series is lacking in the literature. Twenty-four patients with chronic rhino-sinusitis underwent assessment of symptoms by visual analogue scoring, nasomucociliary function by ciliary beat frequency, olfaction by qualitative olfactometry and nasal airway resistance by anterior rhinomanometry pre- and post-operatively. This demonstrated a significant improvement in all symptoms examined and in ciliary beat frequency. Quantitative olfaction and anterior rhinomanometry were not improved despite diminished symptoms. These results offer quantitative evidence of clinical improvement following functional endoscopic sinus surgery which supports the pathophysiological concepts on which the technique is based.

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Comparative Analysis of Mucociliary Clearance and Mucosal Morphology Using High-Speed Videomicroscopy in Children With Acute and Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420988804 ◽

2021 ◽

pp. 194589242098880

Author(s):

Svetlana Alekseenko ◽

Sergey Karpischenko ◽

Svetlana Barashkova

Keyword(s):

Chronic Rhinosinusitis ◽

Disease Severity ◽

High Speed ◽

Mucociliary Clearance ◽

Neutrophil Infiltration ◽

Healthy Children ◽

Significant Group ◽

Ciliary Function ◽

Mucosal Morphology ◽

Ciliary Beat

Objective evaluation of mucociliary clearance and mucosal morphology using high-speed videomicroscopy, and their association with markers of disease severity in children with acute (ARS) and chronic rhinosinusitis (CRS). Methods A total of 67 children aged from 6 to 17 years including 15 healthy children, 20 pediatric patients with acute rhinosinusitis, and 32 cases with chronic rhinosinusitis were enrolled in the present study. SNOT20, Lund-Kennedy, and Lund-Mackay scores were also evaluated. Results Children with rhinosinusitis were characterized by significantly lower number of cells with motile cilia, ciliary beat frequency, cilia length, and cell viability, as well as ciliary beat asynchrony, epithelia dystrophy and reduced epithelial cell height, being more severe in ARS group. Neutrophil infiltration of sinonasal mucosa was more profound in children with ARS, whereas the number of lymphocytes was significantly reduced. Markers of ciliary function were characterized by a significant correlation with epithelia dystrophia and neutrophil infiltration. Discriminant analysis demonstrated significant group separation based on the parameters of mucociliary clearance and mucosal morphology. In regression models mucociliary function was also associated with SNOT20, Lund-Kennedy, and Lund-Mackay scores. Conclusion The results of the present study demonstrate significant alteration of mucociliary clearance and mucosal morphology and its association with sinonasal inflammation and disease severity in patients with rhinosinusitis. Given a tight association between altered mucociliary clearance and severity of the disease, modulation of inflammation and ciliary function both in acute and chronic rhinosinusitis may be considered as the potential tool in therapeutic and surgical management of the disease.

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Reference Ranges for Respiratory Ciliary Function for Chinese Children May Not Be Extrapolated From European Data

10.21203/rs.3.rs-34578/v1 ◽

2020 ◽

Author(s):

So-Lun LEE ◽

Christopher O'Callaghan ◽

Yu-Lung Lau ◽

Chun-Wai Davy Lee

Keyword(s):

High Speed ◽

Beat Frequency ◽

Ciliary Beat Frequency ◽

Chinese Children ◽

Second Hand Smoke ◽

Reference Ranges ◽

Ciliary Function ◽

Age Related ◽

Beat Pattern ◽

Healthy Chinese

Abstract Background:To aid in the diagnosis of Primary Ciliary Dyskinesia (PCD) and to evaluate the respiratory epithelium in respiratory disease, normal age related reference ranges are needed for ciliary beat frequency (CBF), beat pattern and ultrastructure. These reference data are not available for Asian or Chinese children. Our aim was to establish reference ranges for healthy Chinese children.Methods:Ciliated epithelial samples were obtained from 135 health Chinese children aged below 18 years by brushing the inferior nasal turbinate. CBF and beat pattern were analysedfrom high speed video recordings. Epithelial integrity and ciliary ultrastructure were assessed using transmission electronic microscopy. Results:The mean CBF from 135 children studied was 10.1 Hz (95% CI 9.8 to 10.4). Approximately 20% (ranged 18.0-24.2 %) of ciliated epithelial edges were found to have areas of dyskinetically beating cilia. Normal beat pattern was observed in ciliated epithelium from all subjects. We did not find any effect of exposure to second hand smoke on CBF in our subjects. Microtubular defects were found in 9.3% of all of the cilia counted in these children while other ciliary ultrastructural defects were found in less than 3%.Conclusions: We established the reference range for CBF, beat pattern and ultrastructure in healthy Chinese children. Using similar methodology, we found a lower overall mean CBF than previously obtained European values. This study highlights the need to establish normative data for ciliary function in different populations.

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Ciliary function of the nose in patients with Osler`s disease and the effect of topically applied estrogens as a nose ointment

Rhinology Journal ◽

10.4193/rhino11.046 ◽

2011 ◽

Vol 49 (4) ◽

pp. 407-412

Author(s):

J.U. Sommer ◽

B.A. Stuck ◽

C. Heiser ◽

S.S. Kassner ◽

K. Hormann ◽

...

Keyword(s):

High Speed ◽

Beat Frequency ◽

Digital Camera ◽

Ciliary Beat Frequency ◽

Control Group ◽

Mucus Clearance ◽

Ciliary Function ◽

The Mean ◽

Positive Effect ◽

Ciliary Beat

Background: In recent years, the positive effect of topically applied estriol nose ointment in the adjuvant therapy of Morbus-Rendu-Osler (HHT) has been proven. Due to the induced metaplasia, a complete destruction of the ciliated cells may be expected. However, data regarding the ciliary function of HHT patients with and without the use of topical estriol application are currently lacking. Methodology/principal: Ciliated samples were obtained by gently brushing the inferior nasal turbinate of 19 healthy volunteers and 15 patients with known HHT (8 of them regularly using 0.1% estriol nose ointment for 2 years (HHTwE) and 7 of them not using the ointment in the last 12 months (HHTwoE)). Analysis was done with an inverted phase contrast microscope connected to a high-speed digital camera. Recorded parameters were the visual integrity (VI) of the ciliary beat and its frequency (CBF) in Hz. Results: The VI index of all samples showed an undisrupted, even beating pattern with a difference between the three groups. The mean CBF in all HHT patients was reduced compared to the control group`s mean CBF. Within the HHT group itself, the mean CBF was reduced in the HHTwE group compared to the HHTwoE group. Conclusions: The ciliary beat frequency of HHT patients is impaired compared to the control group and even more so if the HHT patients topically apply estriol more than 6 months. An undisrupted beating pattern is found in the HHTwE group despite the fact that estrogens induce a transformation of the ciliated columnar into a keratinizing squamous epithelium. This data may justify the adjuvant application of estriol as a nose ointment in the treatment of epistaxis in HHT patients without the fear of damage to the nose`s mucus clearance.

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Ciliary Beat Frequency, Olfaction and Endoscopic Sinus Surgery

ORL ◽

10.1159/000027594 ◽

1998 ◽

Vol 60 (4) ◽

pp. 202-205 ◽

Cited By ~ 19

Author(s):

Balegh Abdel-Hak ◽

Andreas Gunkel ◽

Georg Kanonier ◽

Anneliese Schrott-Fischer ◽

Hanno Ulmer ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Beat Frequency ◽

Ciliary Beat Frequency ◽

Sinus Surgery ◽

Ciliary Beat

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Objective assessment of endoscopic sinus surgery in the management of chronic rhinosinusitis: an update

The Journal of Laryngology & Otology ◽

10.1017/s0022215100128014 ◽

1994 ◽

Vol 108 (9) ◽

pp. 749-753 ◽

Cited By ~ 51

Author(s):

Valerie J. Lund ◽

Glenis K. Scadding

Keyword(s):

Chronic Rhinosinusitis ◽

Clinical Success ◽

Subjective Evaluation ◽

Objective Assessment ◽

Beat Frequency ◽

Ciliary Beat Frequency ◽

Acoustic Rhinometry ◽

Sinus Surgery ◽

Ostiomeatal Complex ◽

Ciliary Beat

AbstractWhilst clinical success of endoscopic surgery for chronic rhinosinusitis has necessarily depended primarily upon subjective evaluation, a range of objective techniques are now available which may facilitate our interpretation of results. A group of 200 patients underwent assessment of symptoms by sequential visual analogue scoring, olfaction by qualitative and quantitative testing, nasal airflow by forced inspiratory peak flow, anterior rhinomanometry, nasomucociliary function by ciliary beat frequency and nasal topography by acoustic rhinometry performed pre- and post-operatively. Significant improvement was demonstrated in all symptoms examined, olfactory tests and ciliary beat frequency whilst acoustic rhinometry provided an attempt to quantify the surgical cavities. These results offer an interesting perspective on the pathology of rhinosinusitis and the rationale for surgery within the ostiomeatal complex.

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What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00519-9 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Nadim Saydy ◽

Sami P. Moubayed ◽

Marie Bussières ◽

Arif Janjua ◽

Shaun Kilty ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Patient Reported Outcome ◽

Sinus Surgery ◽

Structured Interviews ◽

Subjective Data ◽

Operative Outcomes ◽

Patient Reported ◽

Definition Of Success ◽

Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

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