ORIGINAL RESEARCH
Evaluation of Nasal Mucociliary Clearance in COVID-19 Patients
COVID-19 Hastalarında Nazal Mukosilier Klirensin Değerlendirilmesi
Received Date : 12 Oct 2020
Accepted Date : 21 Dec 2020
Available Online : 09 Feb 2021
Burak Numan UĞURLUa, Hüseyin Serdar YERLİKAYAa, Gülay AKTAR UĞURLUa,
Sevim ASLAN FELEKa
aDepartment of Otolaryngology, Hitit University Erol Olçok Training and Research Hospital, Çorum, TURKEY
Doi: 10.24179/kbbbbc.2020-79556 - Makale Dili: EN
KBB ve BBC Dergisi. 2021;29(2):95-9
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: There is no information about the relationship between
coronavirus disease-2019 (COVID-19) and nasal mucociliary clearance
(NMC). To investigate whether the severe acute respiratory
syndrome-CoV-2 has an effect on NMC. Material and Methods: Thirty-two
patients hospitalized in our hospital with the diagnosis of COVID-19 and confirmed
by rt-PCR test were included in the study. Smokers and patients with
chronic upper respiratory tract infection were excluded from the study. The
saccharin test was performed to evaluate NMC. Patients over 50 and under 50
years of age were examined in two groups as the reference values change with
age. Patients with and without pulmonary symptoms were compared in terms
of NMC. In addition, patients with and without cough were compared in terms
of NMC in their age groups. Results: The study included a total of 32 patients,
18 (56%) males and 14 (44%) females, with a mean age of 50.8 years
(range, 17-81 years). The mean clearance time of the patients over 50 years
of age (n=15) was 14.20±4.80 min, while under 50 years of age (n=17) was
11.94±3.61 min. When compared with the reference values in the literature,
no significant difference was observed in both age groups (p>0.05). There
was no significant difference in the patients over 50 years of age compared to
the patients with lung involvement (n=11, mean=14.64, SD=5.26) and without
lung involvement (n=4, mean=13, SD=3.56) (p>0.05). There was no significant
difference in the patients under 50 years of age compared to the
patients with lung involvement (n=7, mean=12.86, SD=4.78) and without lung
involvement (n=10, mean=11.3, SD=2.63) (p>0.05). When the patients with
and without cough complaint were compared between their age groups, no
significant difference was observed (p>0.05). Conclusion: NMC has been
preserved in COVID-19 patients. There is no significant difference in terms
of lung involvement and cough complaints in NMC times.
Keywords: COVID-19; SARS-CoV-2; mucociliary clearance
ÖZET
Amaç: Koronavirüs hastalığı-2019’da [coronavirus disease-2019
(COVID-19)], nazal mukosilier klirensin (NMK) etkilenip etkilenmediÄŸi
bilinmemektedir. Çalışmamızda, şiddetli akut solunum sendromu-CoV-
2’nin, NMK üzerinde bir etkisinin olup olmadığı araştırılmak istenmiştir.
Gereç ve Yöntemler: Çalışmaya, hastanemize COVID-19 nedeni ile yatırılmış
ve tanısı rt-PCR ile kesinleşmiş 32 hasta dâhil edildi. Sigara içen ve
kronik üst solunum yolu enfeksiyonu olan hastalar hariç tutuldu. Tüm hastalara,
NMK süresi ölçümü için sakkarin testi uygulandı. Referans değerlerinin
farklılık gösterebilmesi nedeniyle 50 yaş altı ve 50 yaş üzeri hastalar
2 gruba ayrılarak incelendi. Her iki grupta da akciğer tutulumu olan ve olmayan
hastalar, NMK süreleri açısından kıyaslandı. Ayrıca öksürük şikâyeti
olan ve olmayan hastalar da kendi yaş gruplarında NMK açısından kıyaslandı.
Bulgular: Çalışmaya, 18 (%56)’i erkek, 14 (%44)’ü kadın olmak
üzere 32 hasta dâhil edildi. Ortalama yaş 50,8 idi (aralık 17-81). Elli yaş
üstü hastaların (n=15) ortalama klirens süresi 14,20±4,80 dk iken, 50 yaşın
altındaki hastaların (n=17) ortalama klirens süresi 11,94±3,61 dk idi. Literatürdeki
referans değerler ile kıyaslandığında, her iki yaş grubunda da anlamlı
farklılık izlenmedi (p>0,05). Elli yaş üzeri olup, akciğer tutulumu olan
(n=11; ortalama=14,64; SS=5,26) ve akciÄŸer tutulumu olmayan (n=4; ortalama=
13; SS=3,56) hastalar kıyaslandığında, NMK süresinde anlamlı farklılık
izlenmedi (p>0,05). Elli yaş altı hastalarda akciğer tutulumu olan (n=7;
ortalama=12,86; SS=4,78) ve akciÄŸer tutulumu olmayan (n=10; ortalama=
11,3; SS=2,63) hastalarda NMK süresi arasında anlamlı farklılık izlenmedi
(p>0,05). Öksürük şikâyeti olan ve olmayan hastalar, kendi yaş
gruplarında kıyaslandığında anlamlı farklılık izlenmedi (p>0,05). Sonuç:
NMK, COVID-19 hastalarında korunmuştur. NMK sürelerinde akciğer tutulumu
ve öksürük şikâyeti açısından anlamlı farklılık yoktur.
Anahtar Kelimeler: COVID-19; SARS-CoV-2; mukosilier klirens
KAYNAKLAR
- Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10(2):102-8. [Crossref] [PubMed] [PMC]
- Cingi C, Bayar Muluk N. All Around the Nose: Basic Science, Diseases and Surgical Management. 1st ed. Cham, Switzerland: Springer; 2020. [Crossref]
- Xu L, Jiang Y. Mathematical modeling of mucociliary clearance: a mini-review. Cells. 2019;8(7):736. [Crossref] [PubMed] [PMC]
- Andersen I, Lundqvist GR, Proctor DF. Human nasal mucosal function in a controlled climate. Arch Environ Health. 1971;23(6):408-20. [Crossref] [PubMed]
- Antunes MB, Cohen NA. Mucociliary clearance--a critical upper airway host defense mechanism and methods of assessment. Curr Opin Allergy Clin Immunol. 2007;7(1):5-10. [Crossref] [PubMed]
- Uchida Y, Nohara K, Tanaka N, Fujii N, Fukatsu H, Kaneko N, et al. Comparison of saccharin time in nursing home residents with and without pneumonia: a preliminary study. In Vivo. 2020;34(2):845-8. [Crossref] [PubMed] [PMC]
- Deniz M, Gultekin E, Ciftci Z, Alp R, Ozdemir DN, Isik A, et al. Nasal mucociliary clearance in obstructive sleep apnea syndrome patients. Am J Rhinol Allergy. 2014;28(5):178-80. [Crossref] [PubMed]
- Rosen EJ, Calhoun KH. Alterations of nasal mucociliary clearance in association with HIV infection and the effect of guaifenesin therapy. Laryngoscope. 2005;115(1):27-30. [Crossref] [PubMed]
- Cinar F, Beder L. Nasal mucociliary clearance in coal mine workers. Otolaryngol Head Neck Surg. 2004;130(6):767-9. [Crossref] [PubMed]
- Plaza ValÃa P, Carrión Valero F, MarÃn Pardo J, Bautista Rentero D, González Monte C. [Saccharin test for the study of mucociliary clearance: reference values for a Spanish population]. Arch Bronconeumol. 2008;44(10):540-5. [Crossref] [PubMed]
- Ho JC, Chan KN, Hu WH, Lam WK, Zheng L, Tipoe GL, et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med. 2001;163(4):983-8. [Crossref] [PubMed]
- Alho OP. Nasal airflow, mucociliary clearance, and sinus functioning during viral colds: effects of allergic rhinitis and susceptibility to recurrent sinusitis. Am J Rhinol. 2004;18(6):349-55. [Crossref] [PubMed]
- Lovato A, de Filippis C. Clinical presentation of COVID-19: a systematic review focusing on upper airway symptoms. Ear Nose Throat J. 2020;99(9):569-76. [Crossref] [PubMed]
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. [PubMed] [PMC]
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. [Crossref] [PubMed] [PMC]
- Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study. Infectious Diseases (except HIV/AIDS); 2020 Feb. Available from: [Crossref]
- Vaira LA, Salzano G, Deiana G, De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020; 130(7):1787. [Crossref] [PubMed] [PMC]
- Sakakura Y, Ukai K, Majima Y, Murai S, Harada T, Miyoshi Y. Nasal mucociliary clearance under various conditions. Acta Otolaryngol. 1983;96(1-2):167-73. [Crossref] [PubMed]
- Xie J, Hungerford D, Chen H, Abrams ST, Li S, Wang G, et al. Development and external validation of a prognostic multivariable model on admission for hospitalized patients with COVID-19. SSRN Electron J. 2020. [Crossref]
- Knowles MR, Boucher RC. Mucus clearance as a primary innate defense mechanism for mammalian airways. J Clin Invest. 2002;109(5):571-7. [Crossref] [PubMed] [PMC]
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Erratum in: Lancet. 2020;395(10229):1038. Erratum in: Lancet. 2020;395(10229):1038. [Crossref] [PubMed] [PMC]
- Bhowmik A, Chahal K, Austin G, Chakravorty I. Improving mucociliary clearance in chronic obstructive pulmonary disease. Respir Med. 2009;103(4):496-502. [Crossref] [PubMed]
- Conrad C. Application of N-Acetylcysteine in pulmonary disorders. In: Frye RE, Berk M, eds. The Therapeutic Use of N-Acetylcysteine (NAC) in Medicine. Singapore: Springer Singapore; 2019. p.255-76. [Crossref]
- Zhang Q, Ju Y, Ma Y, Wang T. N-acetylcysteine improves oxidative stress and inflammatory response in patients with community acquired pneumonia: a randomized controlled trial. Medicine (Baltimore). 2018;97(45): e13087. [Crossref] [PubMed] [PMC]
- McPhail GL, Acton JD, Fenchel MC, Amin RS, Seid M. Improvements in lung function outcomes in children with cystic fibrosis are associated with better nutrition, fewer chronic pseudomonas aeruginosa infections, and dornase alfa use. J Pediatr. 2008;153(6):752-7. [Crossref] [PubMed]