Histologic evaluation of nasal epithelium of the middle turbinate in untreated OSAS patients and during nCPAP therapy.

OSAS-patients complain about nasal disorders. Irritation of the nasal mucosa often leads to termination of nCPAP treatment. The aim of this study is to evaluate whether symptoms are related to histologic changes of the nasal mucosa of the head of the middle turbinate in OSAS-patients. Semi-thin sections of epon-embedded middle turbinate biopsy samples from 35 male patients (age 51-75 yr) with OSAS were compared with those of 10 healthy men (age 51-75 yr). In untreated OSAS-patients atrophic epithelium is common whereas ciliated epithelial types are rare. After short-time nCPAP therapy (mean 581h) patches of ciliated epithelium and squamous metaplasia reappear. Short-term nCPAP leads to a partially restoration of the mucosal architecture. During long-time nCPAP therapy (mean 6.737h) squamous metaplasia with conspicuous intraepithelial connective tissue papillae predominates whereas pseudostratified ciliated epithelium is missing. Dense round cell infiltrates in the lamina propria are frequently found. Rhinitic symptoms in OSAS-patients are correlated with marked histological changes of the respiratory epithelium of the head of the middle turbinate. Histological changes in untreated OSAS differ from those of patients during nCPAP-treatment.

Histological evaluation of age-related changes in human respiratory mucosa of the middle turbinate.

Though the lining of the healthy human nose is subject of numerous investigations, age-related changes have attracted little attention. Furthermore, varying sampling sites complicate the evaluation of the available information. Reference is needed for evaluation of abnormal conditions, e.g. in persons with sleep apnea. Biopsy samples from the middle turbinate of 40 healthy humans aged 5 to 75 years were examined. Tissue samples were fixed immediately in glutaraldehyde and embedded in Epon for semi-thin sectioning and blind histological evaluation. In all age groups, patchy arrangement of different epithelial types were found. Ciliated epithelium decrease with age. Stratified and atrophic epithelial types show striking changes. Thin atrophic epithelium with conspicuously thickened basement membranes is only seen above the age of 40 years and is frequently found in older subjects. Stratified epithelial types initially increase with age, but decrease above 50 years. In the middle aged group (26 to 50 years) we found a remarkably high amount of squamous metaplasia, resulting in overall thicker epithelium becoming thinner in older subjects. In contrast, basement membranes are thinnest in the middle aged group. In conclusion, evaluating the histology of nasal respiratory epithelium must take pronounced age-related physiological changes into account.