Enhancement of ciliary action by a beta-adrenergic stimulant

Experience in Counting Ciliary Beat Frequency from Vital Cytologic Sampling

From a viable cytologic brush biopsy of the respiratory epithelium you can get an insight into the functional state of the epithelial cell layer, especially of the ciliated cells. We report on our experience of several hundred sampling procedures from the nasal and bronchial mucosa. The technique of the method is described, including the microphotometric apparatus to determine the ciliary beat frequency. We stress the importance of checking the ciliary beat frequency of the 10 most active cells of one preparation to get representative results. Futhermore it is decisive to watch them over a period of 10 seconds, considering the time shift of the ciliary beat frequency. Putting the cell solution into a counting chamber gives the possibility of differentiating viable and dead ciliated cells as well as squamous cells in the sample. These results proved to yield a good picture of the functional state of the sampled respiratory mucosal site.

Cryopreservation of Human Nasal Ciliated Epithelium

The purpose of this study was to compare the effects on human nasal cilia of various freezing and thawing methods in order to determine a reliable method of cryopreservation. Ten samples each were preserved by a slow freezing and a fast freezing method. All samples were stored in liquid nitrogen (–196°C) for 1 week. The frozen samples were thawed by one of two methods: 1) rapid thawing—37°C water bath for 3–4 minutes; and 2) slow thawing—room temperature for 15 minutes. Prefreeze and postthaw ciliary beat frequency (CBF) was measured. The slow freezing and fast thawing method (SFFT) resulted in the best viability. An additional 10 samples preserved using the SFFT method stored at –70°C to –90°C did not retain ciliary function. Thirty ciliated samples preserved by the SFFT method were examined after freezing in liquid nitrogen (–196°C) for 1 week, 2 weeks, and 1 month. There was no significant decrease in CBF after cryopreservation at –196°C for 1 week or 2 weeks (P> 0.05). As the storage time increased to 1 month, postthaw CBF decreased 7.25 ± 0.87% when compared to the prefreeze CBF (P < 0.05). We conclude that human nasal cilia preserved by SFFT at –196°C retain activity for up to 1 month.

Long-Term Follow-Up for Children Treated With Surgical Intervention for Chronic Rhinosinusitis

OBJECTIVES/HYPOTHESIS

The goal of this study is to retrospectively compare the long-term, 10 year, outcomes of surgical versus medical management of young children with chronic rhinosinusitis.

STUDY DESIGN

This is a retrospective, age-matched, cohort outcome study performed at a tertiary-care hospital.

METHODS

Two groups of young children (2-5 yr old) with chronic rhinosinusitis were treated with endoscopic sinus surgery or medically managed and evaluated 10 years after their initial therapy. Of the 131 eligible patients, 67 could be located and consented to participate in the study. Six symptoms (day cough, night cough, irritability or crankiness, headaches, nasal airway obstruction, and purulent rhinorrhea) were used to assess the outcome of their treatment.

RESULTS

Children undergoing endoscopic sinus surgery had more significant disease as noted on the computed tomography (CT) scans. Their symptom severity, however, was similar. When individual symptoms were compared, there were no statistically significant differences between the surgically and medically managed groups. When the mean was controlled for baseline symptom severity and CT severity, there was statistical improvement in nasal airway obstruction and decreased rhinorrhea. There was a trend toward improvement in cough, but this was not statistically significant. Parenteral assessment of improvement (change) in symptoms (P = .001) and their degree of satisfaction with treatment (P = .005) was significantly higher in the surgically managed group.

CONCLUSIONS

Children who have chronic rhinosinusitis improve in their symptoms of nasal airway obstruction and purulent discharge if they undergo surgery. Parents of young children with chronic rhinosinusitis appear to be more satisfied with the outcome of surgical management than medical management when assessed 10 years later.

Improvement of mucosal pathology of the sinuses after exposure to sulfur dioxide by nebulization of S-carboxymethylcysteine

Since s-carboxymethylcysteine (S-CMC) can directly enhance the ciliary activity in the maxillary sinus mucosa of patients with chronic sinusitis in the absence of significant organic changes of ciliated cells, the nebulization therapy using this medicine might be more effective in the treatment of chronic sinusitis than oral administration of the medicine. The safety of using 0.5-10% of S-SMC as a medicine for nebulization has been experimentally established. The present study was designed to experimentally examine the effectiveness of nebulization using 0.5-10% of S-CMC solution in the treatment of experimental chronic sinusitis in rabbits recurrently exposed to 20 ppm of sulfur dioxide. Thirty-three healthy rabbits were used; 3 of them were used as controls. The remaining 30 were exposed to 20 ppm of sulfur dioxide for 4 h a day for 4 successive weeks. Twelve animals were not treated with any medication during the post-exposure period, and sacrificed at 24 h or 15 days after completion of the final exposure to sulfur dioxide. The remaining 18 animals were treated with nebulization using 10%, 5% or 0.5% of S-CMC solution for 20 min a day for 14 successive days after the final exposure to sulfur dioxide, and they were sacrificed at 24 h after the final nebulization using S-CMC. At the time of sacrifice, the ciliary activity and the morphology of the sinus mucosa were observed to assess the effectiveness of S-CMC nebulization. In the animals sacrificed 24 h after the final exposure, the mucosa of the sinus demonstrated marked epithelial cell injuries, and the ciliary activity was extremely reduced. Complete recovery of the epithelium and the ciliary activity was not recognized in the animals sacrificed 15 days after completion of the exposure. By contrast, epithelial recovery was more accelerated in the animals treated with S-CMC nebulization during the 14 days after the exposure. In the animals treated with 0.5% of S-CMC, the ciliary activity was inferior to that of the control animals, and the epithelial repair was not complete. In the animals treated with 10% of S-CMC, however, ciliary activity and epithelial morphology were completely recovered. In conclusion, our study suggests that clinical application of 10% of S-CMC nebulization may provide otolaryngologists with a new tool in the treatment of sinus diseases such as chronic sinusitis.

A study of the photoelectrical signal from human nasal cilia under several conditions

The movement of normal human nasal cilia was analyzed. Ciliary beat was recorded by means of a phase-contrast microscope equipped with a photodetector. The electrical signal was analyzed as follows: i) a power spectrum was calculated in order to measure ciliary beat frequency (CBF), ii) the beat cycles were averaged and the standard deviation of the waveform was computed to determine signal consistency (SC), and iii) the ratio of the duration of the smooth to that of the steep part of the cycles was measured. This was done under three different conditions: 1) normal or "initial", 2) after induction of "function loss", and 3) after "salbutamol stimulation". At "function loss," the cilia beat slower and with less harmony. CBF decreased from an average of 9.0 Hz in the "initial" condition to 5.8 Hz. SC decreased from an average of 5.7 to 1.9. After "salbutamol stimulation", average CBF was partially restored to 7.7 Hz, while average SC increased to 4.4. These findings indicate that in ciliary function studies, SC, as a measure for ciliary beat harmony, may be introduced alongside CBF as a second valuable parameter. In this study we were not able to identify different phases in the signal that might be used as a third parameter to indicate the effective and the recovery stroke.

Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis

Klebsiella ozaenae is a gram-negative rod that has been isolated with relative frequency from patients with atrophic rhinitis. The relationship of this bacterium to the pathogenesis of atrophic rhinitis is not understood, and whether this bacterium is simply an opportunistic colonizer of the injured nose or the etiologic agent of the disease is unclear. This study was designed to investigate a potential role for bacterially produced cilioinhibition as a mechanism for the pathogenesis of atrophic rhinitis.

Increased ciliary beating frequency of nasal mucosa following immunotherapy for allergy

The present study was designed to elucidate the effect of immunotherapy on the beating frequency of nasal cilia in patients with nasal allergy. Of 40 patients with nasal allergy due to Dermatophagoides farinae, 20 were treated with immunotherapy by the use of D farinae extracts, and 20 control patients were treated with antihistamine tablets. Mucosal pieces were taken from the right inferior turbinate before and 1 year after the initiation of treatment, and the ciliary beating frequency (CBF) was examined by a photoelectric method. The use of antihistamine tablets did not increase CBF even when it relieved the nasal symptoms. Immunotherapy, on the other hand, increased CBF in 66.7% of patients when it alleviated their nasal symptoms. The CBF before immunotherapy of patients who showed an increase CBF after treatment was statistically higher than that of patients who did not.

Reversibility of reduced ciliary activity on adenoids of patients with otitis media with effusion following culture

We have studied the ciliary activity of the pharyngeal epithelium on adenoids obtained from patients with recurrent otitis media with effusion to assess indirectly the ciliary activity in the Eustachian tube. In conclusion, the following has been speculated from the present study: (1) middle ear effusions depress the ciliary activity; and (2) recovery of the reduced ciliary activity can be achieved in an effusion-free environment inasmuch as the ciliated cells have not undergone organic changes. Prompt elimination of the effusion, if present, is of critical importance for the recuperation of tubotympanic drainage, because a positive therapeutic effect resulting from elimination of the effusion can only be possible in early phase of the disease, before irreversible morphological lesions have occurred.

Pharyngeal ciliary activity in guinea pigs with otitis media

The function of cilia present in the tubotympanum plays an important role in the pathogenesis and chronicity of otitis media with effusion (OME). We used a photoelectric method to examine the ciliary activity in the eustachian tube, in the central pharynx, as well as the nasal cavity of normal animals and animals with otitis media. In normal animals, the ciliary activity in the nasal cavity was not different from that in the eustachian tube. In some animals with otitis media, however, there was a significant difference between the ciliary activity in the nasal cavity and that in the eustachian tube. On the other hand, no significant differences were recognized in any given group of animals examined between the level of the ciliary activity in the central pharynx and that in the eustachian tube. Our findings show that the function of the cilia present in the pharynx is a valid index of that in the eustachian tube. Our study further indicates that it may be possible to clinically assess the ciliary activity in the pharyngeal mucosa biopsied from patients with OME to determine objectively the effects of medical treatments of the disease.

An experimental study on the respiratory toxicity of isopropyl alcohol

Guinea-pigs were exposed to 400 ppm or 5500 ppm of isopropyl alcohol (IPA) for 24 successive hours, and they were killed immediately after the exposure period. The ciliary activities of the nose and trachea were examined. In addition, the epithelium of the nose and trachea was observed by scanning and transmission electron microscopy. The present study showed that exposure to 400 or 5500 ppm of IPA vapor caused deterioration of the ciliary activity and also some pathological changes. Although our study revealed that exposure to 400 ppm of IPA vapor can affect the mucosa of the nose and trachea, the ciliary activity of the 400-ppm exposure group was not too poor and morphological changes were rather mild. Recovery from such degeneration might be rapid. Therefore, our study supports the justification of the allowable IPA level recommended by ACGIH.

The influence of drugs on nasal ciliary movement

Drugs in nasal preparations, for local use as well as for systemic use, should not interfere with the self-cleaning capacity of the nose, effectuated by the ciliary epithelium. Many drugs and additives, however, have a negative effect on nasal ciliary function. Examples of ciliotoxic agents are lipophilic and mercuric preservatives, local anesthetics, antihistamines, propranolol, and absorption enhancers such as the bile salts. Cholinergic drugs and beta-adrenergic drugs exert a ciliostimulatory effect. It is the purpose of this review to summarize the present knowledge of ciliotoxicity of drugs and additives and to give recommendations for the use of ciliofriendly drugs in nasal preparations.

Effects of bacterial endotoxin on the ciliary activity in the in vitro middle ear mucosa

In the present study, we have examined the hitherto unknown effects of long-term exposure to lipopolysaccharide (LPS), possessing the major parts of biological activity of endotoxin, on ciliary activity in the middle ear. Our results show that LPS can affect the ciliary activity in a dose-response fashion: 1) LPS does not impair the ciliary activity up to 168 h if the concentration is 1 ng/ml or less; 2) 10 ng/ml of LPS does not impair ciliary activity in the middle ear close to the tympanic orifice up to 168 h, but can cause reduced activity distal to the orifice after extended exposure (more than 96 h); 3) 100 ng/ml or more of LPS can cause dysfunction of cilia in the tympanic cavity, and in particular 1 microgram/ml or more of LPS can quickly disable the ciliary activity in the middle ear distal to the orifice.

Effects of Staphylococcus aureus on the ciliary activity of the middle ear lining

Our previous investigation using normal guinea pigs disclosed that, like respiratory mucosa, the middle ear lining has ciliary activity, and that this ciliary activity becomes more active as the location becomes more distal to the eustachian tube. In this experimental study, the effects of Staphylococcus aureus on the middle ear lining was examined from functional and morphological viewpoints. In conclusion, the ciliary activity at the entrance to the eustachian tube and that more distal to the tube present a similar pattern of reaction to S aureus in an in vitro system. On the other hand, the ciliary activity of the middle ear lining displays a varying pattern of reaction according to the locations within the tympanic cavity.

Degeneration and regeneration of respiratory mucosa of rats after exposure to styrene

The recovery process of pathological changes in the respiratory mucosa following exposure to styrene were experimentally studied to improve the understanding of the respiratory toxicity of styrene. Thirty male SD rats were exposed to 150 ppm or 1000 ppm of styrene for 4 h a day over 3 weeks (5 days a week). They were killed for examination at 1 day or 12 weeks after completion of the exposure sequence. Bilateral mucosal samples from the nasal septum and the trachea of the animals were examined for ciliary activity and subjected to electron microscopy. Complete functional and morphological recovery of the nasal and tracheal mucosa was observed at the 12th week post-exposure to 150 ppm of styrene. After exposure to 1000 ppm of styrene, almost normal function and morphology of the tracheal mucosa was found at the 12th week post-exposure, but the nasal mucosa continued to show decreased ciliary activity and an affected morphology.

Ciliary activity in patients with nasal allergies

Nasal allergy is a disease ensuing from type-I allergic reactions in the nasal cavity. A correct understanding of this process requires further investigation of the non-allergic pathology present. In the allergic state, the function of the nasal cilia is considered to be involved in the invasion of allergens into the nasal mucosa, and may also be involved with the manifestation and progression of the disease produced. In the present study, we examined the ciliary activity of the nasal mucosa of 35 patients with nasal allergies by using the photo-electric method of Ohashi and Nakai to better understand the non-allergic pathologies present. The nasal cilia of four healthy volunteers served as controls. In addition, a multivalent analysis was made according to quantifying theory I in order to define the effects of various factors on ciliary activity in the nasal mucosa during the allergic state. The following results were found in our present study. Ciliary activity was observed in 32 of 35 patients with nasal allergy. The mean value of the ciliary activity in these patients was 498 +/- 195 beats/min, while that of the normal controls was 753 +/- 46 beats/min. The ciliary activity in the nasal mucosa in the allergic state declined as the morbid period was prolonged; this decline in ciliary activity was relatively great in cases of perennial allergies aggravated by season-specific allergens.