Abstract
Nasal mucociliary clearance (NMC) plays an important role in removal of inhaled particles. The aim of this study was to assess the normal nasal mucociliary clearance time in Indian adult population in age group 18–60 years. A cross sectional, descriptive, observational study was performed. Two hundred participants in the age group 18–60 years were included in this study. Saccharin transit test was performed in these subjects. Saccharin particle was placed 0.5 cm away from the inferior turbinate from its anterior part. The participants were asked to inform the appearance of sweet taste. Duration between placement of particle and the appearance of taste was noted in minutes. Mean saccharin transit time was 9.44?2.73 minutes. There was no statistically significant difference in saccharin transit time between males & females. Nasal mucociliary clearance time between < 40 years & ≥40 years was compared and there was no significant difference between the 2 groups. The normal mucociliary clearance value in healthy adult Indian population-based on saccharin transit time is 9.44 ± 2.73 min. The earliest change in respiratory defense mechanism is change in nasal mucociliary clearance time and saccharin test is a simple, easy test to detect this.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12070-023-03915-x.
Keywords: Saccharin transit time, Nasal mucociliary clearance, Adult, Respiratory disease
Introduction
It is a known fact that nasal mucociliary system is an important defense system in the respiratory tract. The large epithelial surface from the nose up to alveoli is exposed to pathogens, chemicals, particulates everyday which has the potential to cause harm to the respiratory tract. The defense mechanisms include sneezing, coughing and rhinitis. It is a known fact that the clearance time in lower respiratory tract is same as that in nares [1].
Impairment of mucociliary clearance can be both due to aquired [2] cause and due to genetically determined causes [3, 4] This can further lead to infections in the nose, paranasal sinus and rest of respiratory tract.
The tests that are available to test mucociliary clearance are vague, tests like clearance of radiolabelled particles are time consuming and expensive. Saccharin test is a low cost, simple and safe test with results similar to that obtained using a radiolabeled substance [5]. In the recent times this test is recommended as a test to scrutinize divergent mucociliary clearance time [6].
It is imperative to have a normative data of mucociliary clearance so that abnormal can be known and person can be treated before respiratory disease progresses. This information of normative data is limited and is different amongst different ethnicities as per previous studies [7–9]. Establishing normative values of mucociliary clearance time across different populations is the need of the hour in these testing times of climate change and also change in habits of smoking ad vaping addictions. The aim of this study is to set up a standard range of mucociliary clearance time in healthy Indian adult population of 18–60 years and add knowledge to the existing data.
Methods and Materials
This study was conducted on healthy adults at a tertiary care hospital over a period of 6 months. Two hundred subjects between twenty one and sixty years of age were included in this study. A cross sectional, descriptive, observational study was performed. Exclusion criteria consisted of subjects with chronic lung pathologies including asthma other COPD, smokers and those having any nasal pathology. Individuals who had history of nasal trauma, nasal surgery, using any nasal drops or sprays and those taking antihistamines were also excluded. A written informed consent was obtained from all the participants. A detailed clinical history was obtained from the participants, Otorhinolaryngeal examination was carried out to rule out accompanying nasal pathologies which is otherwise asymptomatic.
Nasal mucociliary clearance time was assessed by performing the Saccharin test. This test was performed in morning hours between 9 and 11 am. The test was repeated twice to have exact value. This test was performed as described by Anderson et al.[[1] ,] and later improvised by Rutland and Cole [10, 11]. Participant was asked to be seated erect, head bent slightly. Under endoscopic guidance 0.5 mm of saccharin molecule was kept half cm behind the anterior border of the inferior turbinate. Subjects were told not to sniff, eat, drink talk, or cough. If the patient sneezed then the test was repeated after half an hour. The participants were asked to inform immediately when they got the sweet taste. This duration between placement of particle and the appearance of taste was noted in minutes.
Result
Two hundred participants were included in this study. 54.5% (109) were male and 45.5% (91%) were female. The maximal participants were in the age group of 18–30 years age (60.5%) (Fig. 1). Mean age of the participants was 29.76 ± 10.67 years. Mean saccharin transit time was 9.44 ± 2.73 min (Table 1). Nasal mucociliary clearance time in males was found to be 9.46 ± 2.63 min whereas in females was 9.43 ± 2.87 min. There was no significant difference in saccharin transit time between males & females (p: 0.95) (Table 2). Saccharin transit time between < 40 years & ≥40 years subjects were compared. The mean saccharin transit time in < 40 years age group was 9.48 ± 2.70 min and of age ≥ 40 years was 9.31 ± 2.9 min. This difference too was not significant (p-0.74)(Table 3).
Fig. 1.
Age distribution
Table 1.
Age and Saccharin transit time descriptive data
| Descriptive Statistics | |||||
|---|---|---|---|---|---|
| N | Minimum | Maximum | Mean | SD | |
| Age | 200 | 20 | 57 | 29.76 | 10.67 |
| Saccharin transit time in minutes | 200 | 2.00 | 20.00 | 9.44 | 2.73 |
Table 2.
Comparison of saccharin transit time between males and females
| Independent-t-test | ||||||
|---|---|---|---|---|---|---|
| Sex | N | Mean | SD | t-value | p-value | |
| Saccharin transit time in minutes | Male | 109 | 9.46 | 2.63 | 0.06 | 0.95 |
| Female | 91 | 9.43 | 2.87 | |||
Table 3.
Comparison of saccharin transit time between age group < 40 years and ≥ 40 years
| Independent-t-test | ||||||
|---|---|---|---|---|---|---|
| Age category | N | Mean | SD | t-value | p-value | |
| Saccharin transit time in minutes | < 40 | 160 | 9.48 | 2.70 | 0.34 | 0.74 |
| ≥ 40 | 40 | 9.31 | 2.90 | |||
Discussion
The saccharin test is easy, reliable, low-cost technique for evaluation of nasal mucociliary clearance. Saccharin test reflects lower respiratory tract clearance as well [12].
Anderson et al. [1] concluded thirty minutes as the limit that differentiates impaired and the normal saccharin transit time. A study by Plaza Valia et al. [13] found that among 249 nonsmokers saccharin transit time was 17.17 ± 8.43 min, men and women had similar transit time but there they found increase in nasal mucociliary clearance duration with age. Study by James C Ho [14] et al. of healthy 90 subjects age 11–90 years showed mean saccharin transit time of 12.86 ± 5.6 min, with men and women having similar transit time, however with increasing age transit time increased. In present study the mean saccharin transit time was 9.44 ± 2.73 min. There was no significant difference in clearance time between the genders or with age. This could be because the range in the results in the 2 groups i.e. <40 years and ≥ 40 years was wide to pick small differences. Also the participant number in ≥ 40 was less (n = 40) in comparison to < 40 years group (n = 160).
The limitation of this study is that the Saccharin transit time test is a subjective test and some bias may happen due to this. However objective test of clearance of radiolabelled particles is time consuming and expensive test so saccharin transit time test remains a widely accepted method to evaluate nasal mucociliary clearance. With availability of normative data this test should be done routinely to detect pathology at early stage.
Conclusion
The normal mucociliary clearance value in healthy adult Indian population-based on saccharin transit time is 9.44 ± 2.73 min.
In this present scenario of climate change and change in habits which can have deleterious effect on human respiratory system, careful monitoring of the respiratory system and mucociliary clearance is a must. The earliest change in respiratory defense mechanism is change in nasal mucociliary clearance time and saccharin test is a simple, easy test to detect this. This test can be incorporated in day-to-day practice and help educate the population about various respiratory illnesses, also help to preventing/stop smoking in individuals and educate people about climate change. This data can be used in making strict policies to prevent air pollution. Also nasal mucociliary clearance time can be used to measure the burden of disease attributable to air pollution, for which a normative data base is the need of hour.
Through this study we tried to establish a database of the normative values of mucociliary clearance time in adult population in order to help professionals’ to use this simple yet reliable test in day to day practice and for further research and practical purpose.
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Funding
Self.
Data Availability
Yes available on request.
Conflict of Interest
None.
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References
- 1.1. Andersen I, Proctor DF. Measurement of nasal mucociliary clearance. Eur J respiratory Dis Supplement. 1983;127:37–40. [PubMed] [Google Scholar]
- 2.Afzelius BA, Camner P, Mossberg B Acquired ciliary defects compared to those seen in the immotile-cilia syndrome. Eur J Respiratory Dis Supplement 1983 Jan 1;127:5–10 [PubMed]
- 3.Sleigh MA. Primary ciliary dyskinesia. Lancet. 1981;ii:476. doi: 10.1016/S0140-6736(81)90811-4. [DOI] [PubMed] [Google Scholar]
- 4.Eliasson R, Mossberg B, Camner P, Afzelius BA. The immotile cilia syndrome. A congenital abnormality as an etiologic factor in chronic airway infections and male sterility. N Engl J Med. 1977;297:1–7. doi: 10.1056/NEJM197707072970101. [DOI] [PubMed] [Google Scholar]
- 5.Andersen IB, Camner P, Jensen PL, Philipson K, Proctor DF (1974 Sep) Nasal clearance in monozygotic twins. American review of respiratory disease. 110(3):301–305 [DOI] [PubMed]
- 6.Stanley P, MacWilliam L, Greenstone M, Mackay I, Cole P (1984) Efficacy of a saccharin test for screening to detect abnormal mucociliary clearance. British journal of diseases of the chest. Jan 1;78:62 – 5 [PubMed]
- 7.Ewert G. On the mucus flow rate in the human nose. Acta Otolaryngol Suppl. 1965;200:1–62. [PubMed] [Google Scholar]
- 8.Kärjä J, Nuutinen J, Karjalainen P Mucocillary Functlon in Children with Secretory Otitis Media. Acta oto-laryngologica. 1983 Jan 1;95(5–6):544–6 [DOI] [PubMed]
- 9.Drettner B, Falck B, Simon H Measurements of the air conditioning capacity of the nose during normal and pathological conditions and pharmacological influence. Acta oto-laryngologica. 1977 Jan 1;84(1–6):266–77 [DOI] [PubMed]
- 10.Andersen IB, Camner P, Jensen PL, Philipson K, Proctor DF (1974) A comparison of nasal and tracheobronchial clearance. Archives of Environmental Health: An International Journal. Nov 1;29(5):290-3 [DOI] [PubMed]
- 11.Rutland J, Cole P (1980 Sep) Non-invasive sampling of nasal cilia for measurement of beat frequency and study of ultrastructure. The Lancet 13(8194):564–565 [DOI] [PubMed]
- 12.Rutland J, Cole PJ (1981) Nasal mucociliary clearance and ciliary beat frequency in cystic fibrosis compared with sinusitis and bronchiectasis. Thorax. Sep 1;36(9):654-8 [DOI] [PMC free article] [PubMed]
- 13.Valía PP, Valero FC, Pardo JM, Rentero DB, Monte CG (2008) Saccharin test for the study of mucociliary clearance: reference values for a Spanish population. Archivos de Bronconeumología ((English Edition)). Jan 1;44(10):540-5 [PubMed]
- 14.Ho JC, Chan KN, Hu WH, Lam WK, Zheng L, Tipoe GL, Sun J, Leung R, Tsang KW The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. American journal of respiratory and critical care medicine. 2001 Mar 15;163(4):983–8 [DOI] [PubMed]
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Data Availability Statement
Yes available on request.