Endoscopic detection of fast mucociliary pathways in endoscopic sinus surgery: a marker for local mucociliary function

Abstract

Abstract Introduction The mucociliary transport velocity is heterogenous showing areas of slow and fast pathways. The aim of this study was to assess fast mucociliary pathways (FMP) in the maxillary sinus in chronic rhinosinusitis. Patients and Methods Endoscopic recording of mucociliary clearance (MCC) and FMP was performed on the posterior wall of the maxillary sinus in 22 chronic rhinosinusitis patients subjected to endoscopic sinus surgery and 12 normal volunteers undergoing septal or turbinate surgery. MCC was assessed intraoperatively using methylene blue over 20 min. MCC was designated as complete, incomplete, or absent. For all patients and controls, the preoperative and postoperative sinonasal outcome scores (SNOT 20) were determined, and the transnasal and transmaxillary saccharin test, and preoperative computed tomography radiological staging were performed. Results FMP were more frequent in the controls (75%) than the patients (40%), with no statistical significance. Delay, direction, site, and duration of FMP were not statistically different in both groups. Six patients with no FMP (absent MMC in five and partial in one) had extremely prolonged transmaxillary saccharin times, with no postoperative improvement. Otherwise, SNOT 20, transnasal, and transmaxillary saccharin times improved significantly in the patients. Controls showed a significant improvement in the SNOT 20 and transmaxillary sacchrin time. FMP correlated significantly with MCC (r=0.636; P<0.01), transnasal (r=−0.7, P<0.05), and transmaxillary (r=−0.553; P<0.05) saccharin times. In a discriminant model, the only predictive variables of FMP detection were MCC (positive) and transnasal saccharin time (negative) with total correction classification (91.2%). This study describes the different characteristics of FMP. Our results suggest that FMP can be used as a marker of local MCC.