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Mucociliary Transport and Histologic Characteristics of the Mucosa of Deviated Nasal Septum

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Mucociliary Transport and Histologic Characteristics of the Mucosa of Deviated Nasal Septum ORIGINAL ARTICLE Mucociliary Transport and Histologic Characteristics of the Mucosa of Deviated Nasal Septum Yong Ju Jang, MD, PhD; Na-Hye Myong, MD, PhD; Keun Hwan Park, MD; Tae Woo Koo, MD; Han-Gyun Kim, MD Objective: To investigate differences in mucociliary Results: The concave side showed longer saccharin clear- clearance, histologic characteristics, and surface struc- ance time than the convex side and revealed much more ture of the bilateral nasal septal mucosa in patients with severe loss of cilia. Inflammatory cells more heavily in- nasal septal deviation. filtrated the concave side, and seromucinous glands were less densely distributed. Design: Mucociliary transport was measured by sac- charin clearance time in both nasal cavities of 20 pa- Conclusion: Concave-side septal mucosae have im- tients with nasal septal deviation. Their septal mucosae paired mucociliary transport, presumably due to ciliary were taken during septoplasty, and the ciliary popula- loss, increased inflammation, and decreased density of tion was studied by scanning electron microscopy. His- the glandular acini. tologic differences in the lamina propria of septal mu- cosae were compared under a light microscope. Arch Otolaryngol Head Neck Surg. 2002;128:421-424 HE SEVERITY of septal devia- peared with increased frequency on the tions, their location, shape, side opposite the septal deviation.7 and complexity all influ- Nasal mucociliary clearance is a fun- ence airflow dynamics in damental function required to maintain the the nasal cavity. Thus, in the health and defense of the nose.8 The cli- Tbilateral nasal cavities of subjects with na- nician should suspect a disorder of mu- sal septal deviation (NSD), a difference may cociliary clearance in a patient who has rhi- occur in the amount of airflow and resis- nosinusitis. In the present study, we tance.1 In response to the difference in air- hypothesized that the nasal cavities of both flow dynamics between nasal cavities in sides in NSD have different mucociliary NSD, a compensatory hypertrophy of the clearances, and this difference may be re- nasal mucosa on the side of the nose op- sponsible for varying symptoms and in- posite the major septal deviation is often creased incidence and severity of sinus- found.2 In addition to the compensatory itis in the side opposite the septal deviation. hypertrophy, an impaired mucociliary To test this hypothesis, we investigated the clearance, higher incidence of ostiome- difference in saccharin clearance time atal complex obstruction, and increased (SCT) between nasal cavities. We also fur- incidence of sinusitis have been reported ther investigated the difference between in subjects with NSD.3-7 Interestingly, si- the concave- and convex-side mucosa with nusitis has been reported to be more se- respect to anatomical factors such as cili- vere in the concave side than in the con- ary population and the density of inflam- vex side,5 although a significant association matory cells and seromucous glands, with ethmoid sinus disease on the con- which can affect the mucociliary trans- vex side has been reported.6 Ostiomeatal port. complex obstruction and resultant sinus- itis in the direction of septal angulation From the Departments of RESULTS were attributable to nasal septal defor- Otolaryngology (Drs Jang, 7 Park, Koo, and Kim) and mity. However, contralateral ostiome- While the mean SCT of the concave-side Histopathology (Dr Myong), atal complex obstruction was suggested to septal mucosae was significantly longer Dankook University College of be related to middle-turbinate and lateral- than that of the convex nasal cavity in the Medicine, Cheonan, Korea. nasal-wall abnormalities, which ap- patients with NSD (P=.02), the SCT was (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 128, APR 2002 WWW.ARCHOTO.COM 421 ©2002 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 PATIENTS AND METHODS dorsum. Each mucosal sample was divided in 2: one for scanning electron microscopic examination and the other for light microscopic examination. For scanning electron The study was performed with the approval of the Dan- microscopic study of the surface structure, mucosal speci- kook University Hospital ethics committee, and all the sub- mens were immediately immersed in 2.5% glutaraldehyde jects gave written informed consent. From July 1999 to in 0.1M cacodyl buffer (pH 7.4) at room temperature. Af- February 2000, we observed 20 patients (12 men and 8 ter several hours of fixation, they were rinsed in 0.1M caco- women), ranging in age from 21 to 40 years (mean±SD age, dyl buffer with 0.1M sucrose and postfixed in 1% osmium 32.8±15.23 years), who underwent septoplasty for symp- tetraxide in 0.1M cacodyl buffer (pH 7.4) at 4°C. The speci- tomatic NSD, which was diagnosed by endoscopy and acous- mens were dehydrated in graded ethanol series and then tic rhinometry. Thirteen patients showed deviation to the dried in a critical point drier (HCP-2; Hitachi Co, Tokyo, left side, and the remaining 7 patients showed deviation Japan). Samples were coated with gold in a sputter coater to the right. All patients had C-shaped anteroposterior de- (E 106; Hitachi Co) with 2.5-kV acceleration voltage in an viation and C-shaped cephalocaudal septal deviation on en- argon atmosphere with a current of 20 mA for 1 minute. doscopic examination. Patients who had minor spurs or se- Samples were examined under a scanning electron micro- vere S-shaped septal deviation were excluded. In acoustic scope (S-2500; Hitachi Co) at 15.0 kV in a random man- rhinometric examination, all patients revealed a differ- ner. The degree of ciliary population was graded as 1 (no ence of greater than 0.4 cm2 between nasal cavities in the cilia), 2 (ciliated mucosa occupying less than 30% of the nondecongested minimal cross-sectional area. Each mem- epithelial surface), 3 (ciliated mucosa occupying 30% to ber of the control group demonstrated a straight septum 60% of the surface), or 4 (ciliated mucosa occupying more on endoscopic examination and showed a difference in mini- than 60% of the epithelial surface). To evaluate the degree mal cross-sectional area of less than 0.2 cm2, as deter- of ciliary population, the proportional area of the ciliated mined by acoustic rhinometry. The study population had epithelial surface was estimated by 2 separate investiga- not experienced upper respiratory tract infection in the pre- tors on 5 randomly selected mucosal surfaces for each speci- vious 2 months, and showed normal sinus radiography char- men under ϫ1500 magnification. acterized by the absence of sinus opacity, mucosal thick- For light microscopic examination, the remaining mu- ening, and air-fluid level in the posteroanterior view and cosal pieces were fixed in 10% formalin, embedded in par- the Water view. They showed negative results in a skin- affin, and stained with hematoxylin-eosin. The histologic prick test using 40 common inhalant allergens, as deter- characteristics observed included the distribution of the na- mined by a mean wheal size smaller than 2 mm in diam- sal glands and infiltration of inflammatory cells. The num- eter and an area less than 25% that of a reference histamine ber of all types of inflammatory cells was noted in 5 ran- reaction. domly selected areas of both the subepithelial layer and the During the preoperative evaluation, saccharin tests of interglandular connective tissue at ϫ400 magnification. The both nasal cavities were conducted separately on consecu- distribution of nasal glandular tissues was evaluated in the tive days. A 1-mm-diameter or quarter fragment of a sac- portions of lamina propria deeper than the subepithelial charin tablet was placed on the anterior end of the septal layer by counting the number of glandular acini on the ran- mucosa, just medial to the anterior end of the inferior tur- domly selected 5 areas at ϫ400 magnification. The glan- binate. The patient was asked to sit quietly, head forward, dular acini were also classified into serous and mucinous and not to sniff, sneeze, eat, or drink. The time taken to types. The serous and mucinous glands were character- the first perception of the sweet taste was recorded. As a ized by their amphophilic granular cytoplasms and pale blue control, the saccharin test was also performed in 15 healthy or clear cytoplasms, respectively. Light microscopic ex- volunteers (aged 19-38 years). The control population also amination was also conducted in a blind manner by 2 in- had a normal sinus radiograph, negative results in the skin- vestigators. The difference in SCT was statistically tested prick test, and no history of recent upper respiratory tract by 1-way analysis of variance using the PC-SAS statistical infection. package, version 6.04 (SAS Institute, Cary, NC). The dif- During the septoplasty, samples of septal mucosae ference in the degree of ciliary population, number of in- approximately 0.5ϫ0.5 cm were taken from the point 2 flammatory cells, and number of glandular acini was sta- cm posterior to the nostril and 1.5 cm inferior to the nasal tistically tested using the t test. those of the septal mucosa of the right and left side of Table 1. Mean ± SD Saccharin Clearance Time (SCT) the normal group, respectively (PϾ.05) (Table 1). in Bilateral Nasal Mucosa of Patients With Nasal Septal Deviation (NSD) and Control Subjects In scanning electron micrographic examination, the concave-side nasal mucosa (Figure 1A) showed less Patient Group Nasal Cavity Mean SCT, min dense ciliary population than the contralateral septal mu- cosa (Figure 1B). The average score in the grading of cili- NSD (n = 20) Concave side 16.52 ± 8.06 ary population was significantly lower in the concave sides, Convex side 12.36 ± 4.83 Control (n = 15) Right side 11.36 ± 4.33 indicating more severe loss of cilia (P=.005) (Table 2).
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