Particularities and clinical applicability of saccharin transit time test

Introduction: The importance ofmucociliary clearance (MCC) for the respiratory system homeostasis is clear. Therefore, evaluating this defense mechanism is fundamental in scientific research and in the clinical practice of pulmonology and of associated areas. However, MCC evaluation has not been so usual due to the complexity ofmethods that use radiolabeled particles. Nevertheless, as an interesting alternative, there is the saccharin transit time (STT) test. This method is reproducible, simple to perform, noninvasive, does notdemand high costs, and has been widely used in studies of nasalMCC. Although the STT test is widely used, there is still lack of a detailed description of its realization. Objective: The present literature review aims to provide basic information related to the STT test andto present the findings of the previous studies that usedthismethod, discussing variations in its execution, possible influences on the obtained results and limitations of the method, as well as to relate our experience with the use of STT in researches. Data Synthesis: There are several factors that can alter the results obtained from STT tests, which would raise difficulties with proper interpretation and with the discussion of the results among different studies. Conclusions: Saccharin transit time is awidely usedmethod for the evaluation of nasal MCC, and therefore, the standardization related to the previous and concurrent to test orientations, and also its execution, become essential to improve its accuracy, and allow comparisons among different studies (AU)

Nasal mucociliary transportability of male and female smokers / Transportabilidade mucociliar nasal de homens e mulheres tabagistas

Abstract Introduction: Female smoker's present increased susceptibility to several diseases when compared to the opposite gender. However, there are no studies showing differences in nasal mucociliary transport behavior between male and female smokers. Objective: To compare the nasal mucociliary transportability in male and female smokers and non-smokers, taking into consideration age, anthropometric data, smoking load and pulmonary function. Methods: The analysis included 139 individuals (33 men and 37 women smokers and 32 men and 37 women non-smokers). All participants answered an initial interview to obtain personal data and smoking load. Anthropometric data and carbon monoxide in the exhaled air were assessed. Individuals also performed pulmonary function test and Saccharin Transit Time test. To compare saccharin transit time values between men and women, smokers and non-smokers, stratification of all independent variables was performed (sociodemographic, smoking and respiratory variables) into two categories: below and above the median values. Results: There was no difference between men and women, smokers and non-smokers, regarding nasal mucociliary transportability. Significant differences were only observed between non-smokers. Among those with less forced vital capacity values (<97.37% of predicted), women presented mucociliary transport faster than men. Moreover, it was observed influence of BMI and COex (women smokers), FCV and FEV1 (men non-smokers) and FEF25-75% (women non-smokers) on saccharin transit time values. Conclusion: Based on the findings of this study, nasal mucociliary transport in male and female adult smokers, apparently healthy, are similar.

Resumo Introdução: Mulheres tabagistas apresentam maior susceptibilidade à diversas doenças quando comparadas ao sexo masculino. No entanto, não há estudos mostrando diferenças no comportamento do transporte mucociliar nasal entre tabagistas do sexo masculino e feminino. Objetivo: Comparar a transportabilidade mucociliar nasal em homens e mulheres fumantes e não fumantes, levando em consideração idade, dados antropométricos, carga tabágica e função pulmonar. Método: A análise incluiu 139 indivíduos (33 homens e 37 mulheres fumantes e 32 homens e 37 mulheres não fumantes). Todos os participantes responderam a uma entrevista inicial para a obtenção de dados pessoais e a carga tabágica. Dados antropométricos e monóxido de carbono no ar expirado foram avaliados. Os indivíduos também fizeram teste de função pulmonar e o teste de trânsito de sacarina. Para comparar os valores do teste de trânsito de sacarina entre homens e mulheres, fumantes e não fumantes, foi feita a estratificação de todas as variáveis independentes (variáveis sociodemográficas, tabágicas e respiratórias) em duas categorias: abaixo e acima dos valores médios. Resultados: Não houve diferenças entre homens e mulheres, fumantes e não fumantes, em relação à transportabilidade mucociliar nasal. Diferenças significativas foram observadas apenas entre não fumantes. Entre os que apresentaram valores menores de capacidade vital forçada (< 97,37% do previsto), as mulheres apresentaram transporte mucociliar mais rápido do que os homens. Além disso, observou-se influência do IMC e COex (mulheres fumantes), CVF e VEF1 (homens não fumantes) e FEF25%-75% (mulheres não fumantes) sobre os valores do teste de trânsito de sacarina. Conclusão: Com base nos achados deste estudo, o transporte mucociliar nasal em tabagistas masculinos e femininos adultos, aparentemente saudáveis, são semelhantes.

Tratamiento del dorso nasal por vía submucosa / Treatment of nasal dorsum through submucous

Para acceder al dorso nasal, los autores utilizan, como vía de abordaje submucosa o extramucosa, la incisión transcartilaginosa alar, que permite disecar más extensamente el área y conservar la integridad de la anatomía y la fisiología endonasal. Remarcan la importancia de mantener ilesas las válvulas vestibulares y la mucosa nasal, con el objeto de preservar su funcionalidad.

For resection of the osteocartilaginous hump, the authors use the transcartilaginous incision by submucous approach. It safeguards the anatomical integrity and preserves the physiologic mechanism of the nasal ventilation. They emphasize about importance to keep harmless the vestibule valve and mucous membrane.

Válvula nasal: anatomia e fisiologia: [revisão] / Nasal valve: anatomy and physiology: [review]

A porção anterior das cavidades nasais, da narina à válvula nasal (VN), é a região de maior resistência nasal ao fluxo aerífero, de suma importância para a fisiologia nasal. Na literatura existem terminologias diferentes para se referir às mesmas estruturas anatômicas e, ainda, o mesmo termo se referindo a estruturas anatômicas diferentes. OBJETIVO: Realizamos este trabalho com o objetivo de revisarmos o funcionamento da VN e definirmos com mais clareza estruturas anatômicas da porção anterior das cavidades nasais, principalmente a região da VN. CONCLUSÃO: Existe controvérsia na literatura quanto à nomenclatura das estruturas da VN. Neste trabalho definimos VN como uma estrutura tridimensional compreendida anteriormente pelo ostium internum e posteriormente pelo isthmus nasi.

The anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), is the place of highest nasal resistance to airflow, paramount to nasal physiology. There are different terminologies for the same anatomic structures in the literature. AIM: The aim of this paper was to study the NV function and define clearly the structures of the anterior portion of the nasal cavities, mainly the region of the NV. CONCLUSION: Internum ostium is the anterior segment and isthmus nasi is the posterior segment of the NV region.

Ação do estrógeno e progesterona na mucosa nasal humana: avaliação do transporte mucociliar nasal de sacarina e pesquisa de receptores hormonais através de método imuno-histoquímico / Estrogen and progesterone influence in human nasal mucosa: evaluation of nasal saccharin mucociliary transport and test for hormone receptors with immunohistochemical staining

Apesar do estudo exaustivo do transporte mucociliar nasal, ainda há dados controversos sobre a influência direta dos hormônios sexuais femininos nesse mecanismo. O presente estudo teve por objetivos: 1. avaliar o transporte mucociliar nasal de sacarina nos sexos masculino e feminino, comparando-o nas fases folicular, periovulatória e lútea de ciclos ovarianos consecutivos e 2. identificar a expressão e a localização dos receptores para estrógeno e progesterona na mucosa nasal humana em conchas nasais inferiores de indivíduos dos sexos masculino e feminino na idade reprodutiva. O transporte mucociliar nasal de sacarina foi avaliado prospectivamente em 14 voluntários não fumantes, sem queixas nasais, com idades entre 15 e 30 anos (7 homens e 7 mulheres, com média de idade 23,5 anos). Nas mulheres, o transporte mucociliar nasal de sacarina foi medido nas fases folicular, periovulatória e lútea durante dois ciclos ovarianos consecutivos (em cinco casos) ou três ciclos consecutivos (em dois casos). Nos homens, o transporte mucociliar nasal de sacarina foi avaliado em medidas repetidas aleatoriamente três vezes (em dois casos) ou seis vezes (em cinco casos). A expressão dos receptores para estrógeno e progesterona na mucosa nasal humana foi avaliada por método imunohistoquímico, de modo retrospectivo, em conchas nasais inferiores conservadas em formaldeído e fixadas na parafina, arquivadas após a cirurgia de turbinectomia parcial da concha inferior a que foram submetidos 20 pacientes da mesma faixa etária dos voluntários (10 pacientes do sexo masculino e 10 do sexo feminino, com idades entre 15 e 33 anos, média de idade 22,1 anos). Para a imuno-histoquímica utilizaram-se anticorpos monoclonais de camundongo contra receptores para estrógeno (clone 6F11, Novocastra) e para progesterona (clone 16, Novocastra) separadamente. Não houve diferenças significativas no transporte mucociliar nasal de sacarina entre as fases folicular...

Although nasal mucociliary clearance has been thoroughly studied, there is controversial evidence that it is directly influenced by female sex hormones. This study focused on: 1. evaluating saccharin nasal mucociliary transport in both sexes and during the follicular, periovulatory and luteal phases of consecutive ovarian cycles, and 2. identifying the expression and localisation of estrogen and progesterone receptors in human nasal mucosa from inferior turbinates of patients in reproductive age. Saccharin nasal mucociliary transport was prospectively evaluated in 14 nonsmoking healthy volunteers aged 15 to 30 years (7 males and 7 females, mean age 23.5 years) who had no nasal complaints. In females, saccharin nasal mucociliary transport was measured in the follicular, periovulatory and luteal phases during two consecutive ovarian cycles (five cases) or three consecutive cycles (two cases). In males, the saccharin nasal mucociliary transport was randomly repeated three times (two cases) or six times (five cases). Estrogen and progesterone receptor expression in human nasal mucosa was retrospectively assessed by immunohistochemistry in archival, formalin-fixed, paraffin-embedded inferior nasal conchae from 20 patients submitted to partial inferior turbinectomy whose ages were matched to their of the volunteers (10 male and 10 female patients aged 15 to 33 years, mean age 22.1 years). Immunohistochemistry used mouse monoclonal antibodies against estrogen receptor (6F11 clone, Novocastra) and progesterone receptor (16 clone, Novocastra) separately. There were no significant differences in saccharin nasal mucociliary transport among follicular, periovulatory and luteal phases in consecutive ovarian cycles, nor between sexes (p=.08). Even though, considering the first ovarian cycle only, saccharin nasal mucociliary transport was faster during the follicular phase (p=.03). Estrogen and progesterone receptors were found in the cytoplasm of serous...

Tiempo de tránsito nasal de sacarina en escolares sanos / Nasal transit time determined with the saccharine test in healthy children

Introducción. La prueba de tránsito nasal de sacarina es un medio simple, no invasivo e indoloro para evaluar la depuración mucociliar nasal. Ha sido empleada en varias condiciones como en la evaluación de los efectos de intervenciónes quirúrgicas y medicamentosas directas en la región aérea nasal y también de aquéllas que sin estar directamente relacionadas alternan la depuración mucociliar nasal. Sin embargo, existe muy poca información acerca de los valores de dicha prueba en la edad pediátrica. El objetivo de este estudio fue determinar los valores de tiempo de tránsito nasal de sacarina en escolares sanos. Material y métodos. Este estudio se realizó en escolares sanos. La sacarina sódica en polvo fue colocada en el cornete inferior y se computó el tiempo transcurrido hasta que los niños relataban la aparición de un sabor dulce en la lengua. El análisis estadístico de los tiempos de tránsito nasal de sacarina, según edad y sexo, se realizó mediante pruebas no paramétricas (ANOVA), chi cuadrada y la regresión lineal. Resultados. Se estudiaron 84 niños, con edades entre 4 y 14 años. El tiempo promedio de tránsito nasal de sacarina fue de 16.7 ñ 9.2 min y se observó una tendencia significativa del tiempo de sacarina a ser mayor con el aumento de la edad y en niñas (P< 0.05). Conclusión. Los valores descritos en el presente estudio se encuentran dentro del límite referido en publicaciones de otros países y contribuyen a aumentar la escasa información disponible aceraca de los valores de tiempo de tránsito nasal de sacarina en escolares sanos

Nasal mucociliary function and pH of tympanal secretions in patients with secretory otitis media

In this study, using the saccharine method, nasal mucociliary function was determined in three groups of subjects who were not suffering from any significant nasal problems: Group I consisted of normal volunteers [n = 40], group II consisted of patients suffering from bilateral secretory otitis media [n = 30] and group III consisted of patients suffering from unilateral secretory otitis media [n = 10]. The mean +SD value of saccharine transport time was 17.8 + 4.5 in group I and 47.8 + 8 in group II, but in group III, there was a difference in saccharine transport time between right and left sides being slower at the side of the affected ears and normal at the side of the non affected ears. The pH of tympanal secretions in group II and III [n = 70] and that of the saliva of group I [n = 40] were done. The pH of the tympanal secretions varied from 7.3 to 8.8 with a mean of 8.2 + 0.4 and the pH of the saliva of the control persons varied from 6.2 to 8.0 with a mean of 7.0 + 0.6 with a significant difference

Svara (nostril dominance) and bilateral volar GSR.

The Svara yoga concept of Ida, Pingala and Susumna svara representing rest, active and turbulent states was examined in this study by recording nostril dominance (svara) and bilateral volar GSR (galvanic skin resistance) as an indicator of sympathetic activity under field and laboratory conditions. The sympathetic activity was low in Ida svara, followed by Pingala svara and was maximum in Susumna svara group of subjects under both field and laboratory conditions which agreed with the traditional Svara yoga description. The volar GSR on the right side more readily varied with svara, particularly so in the physically relaxed subjects of laboratory condition than the left volar GSR. The latter observation was worth noting because the subjects were right handed. The right side could be recommended as the standard site for recording volar GSR to closely reflect the sympathetic activity, particularly so when physical rest was given to subjects.

Manejo quirúrgico endoscópico de la poliposis nasosinusal / Endoscopic surgical management of nasosinusal polyposis

El objetivo de este trabajo fue valorar el manejo con cirugía endoscópica de pacientes con poliposis nasosinusal diseminada, haciendo una revisión retrospectiva de 29 casos tratados y observados por lo menos durante un año, de noviembre de 1993 a mayo de 1995. Los pacientes fueron estudiados con tomografía computada y examen endoscópico; fueron tratados con resección de pólipos con cirugía endoscópica, habiendo dos complicaciones: un paciente desarrolló fistula de líquido cefalorraquídeo que cedió con tratamiento médico y otro tuvo hemorragia de 1000 ml. A 12 meses de seguimiento postquirúrgico, 61 por ciento de los pacientes tuvieron recurrencias, 8 pacientes en estadio Friedman III y 10 en estadio Friedman IV. Se concluye que la cirugía endoscópica en la poliposis nasosinusal diseminada es un tratamiento coadyuvante y no definitivo; se requiere seguimiento a largo plazo y éste seguimiento debe de ser endoscópico

Nasal mucus clearance in chronic smokers.

Smokers were observed to have grossly prolonged nasal mucus clearance. It was also inferred that the persons smoking bidi/unfiltered cigarettes had significant depression of ciliary activity. The clearance was prolonged as the number of cigarettes smoked and the duration of smoking increased. It was greater among those who gave a history of nasal exhalation of inhaled smoke. Nasal mucociliary clearance measurement is easy to measure and can be a useful index in evaluating the effect of smoking on the ciliary activity of the mucosa of the respiratory tract.

Anatomía, fisiología y imágenes de las fosas nasales y senos paranasales / Paranasal sinuses: anatomy, physiology and imaging

La reciente incorporación de la cirugía funcional endoscópica de los senos paranasales ha modificado criterios quirúrgicos en la patología sinusonasal. La cirugía endoscópica requiere gran entrenamiento técnico y un profundo conocimiento de la anatomía regional. La TC de alta resolución del macizo craneofacial es el método complementario de elección. El motivo de nuestro trabajo es presentar la anatomía y la fisiología de las fosas nasales correlacionándolas con la TC de manera que el radiólogo ofrezca un examen tomográfico adecuado para la aplicación de este tipo de cirugía. Para el estudio anatómico se examinaron 8 preparados anatómicos de cráneos secos y una cabeza fijada en formol que luego fue seccionada en planos paralelos frontales. El examen tomográfico incluyó cortes multiplanares de la cabeza fijada en formol y el estudio de 10 pacientes sin patología sinusal. El complejo ostiomeatal, que incluye el meato medio, la apófisis unciforme y las vías de drenaje de las celdillas etmoidales anteriores y de los senos frontales y maxilares son elementos de reparo fundamentales para la cirugía endoscópica y el área clave para entender las rinosinusopatías inflamatorias. La TC con cortes coronales es el método complementario indispensable para entender una anatomía que ofrece múltiples variaciones individuales

Arachidonic acid and prostaglandin E2 in allergic nasal tissues

This study was carried out on 60 persons, 40 of them were suffering from allergic rhinitis, while 20 were normal [control group]. Arachidonic acid and PGE2 levels were estimated in the nasal tissues by gas chromatography and radioimmunoassay methods. There was a marked increase in arachidonic acid and PGE2 levels in nasal tissues in cases of allergic rhinitis. There was significant positive correlation between arachidonic acid and PGE2 [r = 0.92]. In the allergic group, there was no sex variation in arachidonic acid and PGE2 levels. The increase in both arachidonic acid and PGE2 in nasal tissues of allergic rhinitis patients was explained by excessive nasal tissue uptake of arachidonic acid or excessive synthesis from linoleic acid, but not due to the decrease in the degradation of PGE2. These findings can help in the study and management of allergic rhinitis

Effect of inspiratory and expiratory air flow on congestion and decongestion in the nasal cycle.

The role of the inspiratory and expiratory airflow through nostrils during the process of breathing in the reflex reciprocal congestion and decongestion of the nasal cycle was examined in this study. Air flow through each nostril was measured separately in male subjects before and after four types of breathing practices for 15 min each consisting of (1) inspiration through the patent nostril and expiration through the congested nostril, (2) inspiration through congested nostril and expiration through patent nostril, (3) inspiration through both nostrils and expiration through mouth and (4) inspiration through mouth and expiration through both nostrils. The breathing practices had no effect on the congested nostril but caused decrease in air flow through the patent nostril, indicating congestion. It is suggested that the inspiratory and expiratory air flow through the nostrils caused reflex congestion of the patent nostril. The stimuli arising from the nasal mucosa due to air flow during breathing may form the basis for the reflex reciprocal congestion and decongestion of nostrils in the nasal cycle.