gms | German Medical Science

Background: The rhinologic patient represents a challenge for the ENT specialist both for diagnosis and therapy. History and physical examination are at the first place for correct diagnosis. Patient assessment includes Active Anterior Rhinomanometry, nasal provocation tests, acoustic rhinometry, analysis of the ciliary function, immunological tests (Prick Test and RAST), biochemical and radiological investigations (CT or MRI). With "traditional" test, in recent years, nasal cytology has grown in importance for a complete clinical rhinological assessment.

Nasal cytology represents a valid method to diagnose or diagnosing allergic and non allergic rhinopaties. It is simple, safe, noninvasive, easily repeatable, low cost and executable both in pediatrics and adults patients.

Aim of this study is to examine the role of nasal cytology and its importance in the assessment of a rhinological patient by reviewing the recent literature and evaluating the nasal cytological features in patients with inferior turbinates hypertrophy surgically treated.

Methods: We reviewed the International Literature (in the period) between January 2006 and June 2012 (source PubMed, Medline, Cochrane Database) using the key word Nasal Cytology, and then limiting the search field to Nasal Cytology and Rhinitis, Nasal Cytology and Rhinosinusitis, Nasal Cytology and Clinical Assessment.

The personal series is the result of an italian multicentric study (Siena-Bologna-Bari) regarding the relationship between the hypertrophy of inferior turbinates surgically treated and nasal cytology in patients with allergic and non-allergic rhinitis.

120 patients were evaluated with ENT examination and the nasal respiratory distress was subjectively evaluated using a Visual Analogue Scale (VAS). In each patient was performed a nasal cytology by the nasal scraping in the middle third of the inferior turbinate using a mucosal curette made by IR Medical Srl (Italy). The smear was then colored using May-Grünwald-Giemsa technique. Observation was performed by using optical microscope with objectives 100X, 200X, 400X and 1000X (immersion) with systematic observation of 50 microscopic fields with the count of cellular elements 1.

Results: Using keywords Nasal Cytology, 36,888 articles were found. After excluding those in which the techniques of nasal cytology did not have a leading diagnostic role, remaining 83 articles that were referenced in a particular way to nasal cytology both for research and diagnostic (7 in 2006 , 12 in 2007, 9 in 2008, 18 in 2009, 18 in 2010, 12 in 2011 and 7 until June of 2012). With keywords Nasal Cytology and Rhinitis, Nasal Cytology and Rhinosinusitis, and Nasal Citology and Clinical Assessment to restrict the research field: we were able to find 69 articles (6 in 2006, 11 in 2007, 7 in 2008, 15 in 2009, 14 in 2010, 10 in 2011 and 6 until June 2012).

The nasal cytology is used for differential diagnosis in the various types of rhinitis or to diagnose an impairment of the ciliary motility or to try to explain failures after surgical or medical therapy.

Our personal series included 120 patients with inferior turbinate hypertrophy. Some of these patients were evaluated at the ENT Clinic (Rhinological Section) of Siena University. Each patient had also to indicate the degree of subjective nasal respiratory stenosis using a Visual Analogical Scale (VAS score 1–10), before and 2-6-12 months after surgery. The base score (mean) was 9.6 (6.9–10.2), at 2 months 3.2 (1.6–4.6) at 6 months 5.3 (2.9-6.6) and at 12 months 7.6 (5–9). All patients underwent nasal cytology with the technique previously described. Nasal cytology analysis showed that 90 patients (75%) suffered from allergic rhinitis. In this group 80 patients (88.8%) had an overlap of allergic rhinitis and aspecific vasomotor rhinitis (10 NARES, 20 NARMA, 50 NARESMA), and 10 patients (11.2%) suffered for a pure allergic rhinitis. The remaining 30 patients (25%) suffered for aspecific vasomotor rhinitis (2 NARMA, 13 NARESMA, 15 NARES).

Comparing the results of nasal cytology with those of the subjective evaluation (VAS) we observed that patients suffering from NARES, with or without overlap of allergic rhinitis, had a worse result in post-operative and in some cases a true own subjective surgical failure by returning almost in pre-surgical condition of subjective nasal respiratory stenosis 12 months after surgery.

Conclusion: The nasal cytology is a simple, minimally invasive, cheap and repeatable diagnostic tool, executable even in pediatric patients. By this method it is possible to directly observe the ciliary movement and to perform a differential diagnosis between the various types of allergic and non allergic rhinitis and differentiate between the various types of infectious (bacterial, fungal 7–8) or cellular rhinitis (NARES, NARNE, NARMA, NARESMA), according to the ARIA 3 and EPOS guidelines 13.

Because prognosis and therapy success depend on rhinitis correct etiologic diagnosis, nasal cytology represents an exam with an excellent cost / benefit ratio, which should always be included in a complete rhinological assessment.