CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2019; 23(02): 229-240
DOI: 10.1055/s-0038-1676116
Update Manuscript
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Particularities and Clinical Applicability of Saccharin Transit Time Test

Fernanda Rodrigues
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Juliana Uzeloto
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Rafaella Xavier
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Juliana Ito
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Marceli Rocha
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Renata Calciolari
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Dionei Ramos
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
Ercy Ramos
1   Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho, Campus de Presidente Prudente, Presidente Prudente, SP, Brazil
› Author Affiliations
Further Information

Publication History

23 January 2018

06 October 2018

Publication Date:
15 February 2019 (online)


Introduction The importance of mucociliary clearance (MCC) for the respiratory system homeostasis is clear. Therefore, evaluating this defense mechanism is fundamental in scientific research and in the clinical practice of pulmonology and of associated areas. However, MCC evaluation has not been so usual due to the complexity of methods that use radiolabeled particles. Nevertheless, as an interesting alternative, there is the saccharin transit time (STT) test. This method is reproducible, simple to perform, noninvasive, does not demand high costs, and has been widely used in studies of nasal MCC. Although the STT test is widely used, there is still lack of a detailed description of its realization.

Objective The present literature review aims to provide basic information related to the STT test and to present the findings of the previous studies that used this method, discussing variations in its execution, possible influences on the obtained results and limitations of the method, as well as to relate our experience with the use of STT in researches.

Data Synthesis There are several factors that can alter the results obtained from STT tests, which would raise difficulties with proper interpretation and with the discussion of the results among different studies.

Conclusions Saccharin transit time is a widely used method for the evaluation of nasal MCC, and therefore, the standardization related to the previous and concurrent to test orientations, and also its execution, become essential to improve its accuracy, and allow comparisons among different studies.

  • References

  • 1 Scheuch G, Kohlhäufl M, Möller W. , et al. Particle clearance from the airways of subjects with bronchial hyperresponsiveness and with chronic obstructive pulmonary disease. Exp Lung Res 2008; 34 (09) 531-549
  • 2 Nakagawa NK, Franchini ML, Driusso P, de Oliveira LR, Saldiva PH, Lorenzi-Filho G. Mucociliary clearance is impaired in acutely ill patients. Chest 2005; 128 (04) 2772-2777
  • 3 Moriarty BG, Robson AM, Smallman LA, Drake-Lee AB. Nasal mucociliary function: comparison of saccharin clearance with ciliary beat frequency. Rhinology 1991; 29 (03) 173-179
  • 4 Hasani A, Toms N, Agnew JE, Lloyd J, Dilworth JP. Mucociliary clearance in COPD can be increased by both a D2/beta2 and a standard beta2 agonists. Respir Med 2005; 99 (02) 145-151
  • 5 Ferri RG, Zonato A, Guilherme A. , et al. Análise do clearance mucociliar nasal e dos efeitos adversos do uso de CPAP. Rev Bras Otorrinolaringol 2004; 70 (02) 150-155
  • 6 Elliott MK, Sisson JH, Wyatt TA. Effects of cigarette smoke and alcohol on ciliated tracheal epithelium and inflammatory cell recruitment. Am J Respir Cell Mol Biol 2007; 36 (04) 452-459
  • 7 Smith DJ, Gaffney EA, Blake JR. Modelling mucociliary clearance. Respir Physiol Neurobiol 2008; 163 (1-3): 178-188
  • 8 Bhowmik A, Chahal K, Austin G, Chakravorty I. Improving mucociliary clearance in chronic obstructive pulmonary disease. Respir Med 2009; 103 (04) 496-502
  • 9 Mall MA. Role of cilia, mucus, and airway surface liquid in mucociliary dysfunction: lessons from mouse models. J Aerosol Med Pulm Drug Deliv 2008; 21 (01) 13-24
  • 10 Bush A, Cole P, Hariri M. , et al. Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J 1998; 12 (04) 982-988
  • 11 Ho JC, Chan KN, Hu WH. , 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 (04) 983-988
  • 12 Oozawa H, Kimura H, Noda T, Hamada K, Morimoto T, Majima Y. Effect of prehydration on nasal mucociliary clearance in low relative humidity. Auris Nasus Larynx 2012; 39 (01) 48-52
  • 13 Chilvers MA, Rutman A, O'Callaghan C. Ciliary beat pattern is associated with specific ultrastructural defects in primary ciliary dyskinesia. J Allergy Clin Immunol 2003; 112 (03) 518-524
  • 14 Macchione M, Guimarães ET, Saldiva PH, Lorenzi-Filho G. Methods for studying respiratory mucus and mucus clearance. Braz J Med Biol Res 1995; 28 (11-12): 1347-1355
  • 15 Trindade SH, de Mello Jr JFJ, Mion OdeG. , et al. Methods for studying mucociliary transport. Rev Bras Otorrinolaringol (Engl Ed) 2007; 73 (05) 704-712
  • 16 Lima Afonso J, Tambascio J, Dutra de Souza HC, Jardim JR, Baddini Martinez JA, Gastaldi AC. [Transport of mucoid mucus in healthy individuals and patients with chronic obstructive pulmonary disease and bronchiectasis]. Rev Port Pneumol 2013; 19 (05) 211-216
  • 17 Bennett WD, Laube BL, Corcoran T. , et al. Multisite comparison of mucociliary and cough clearance measures using standardized methods. J Aerosol Med Pulm Drug Deliv 2013; 26 (03) 157-164
  • 18 Stanley P, MacWilliam L, Greenstone M, Mackay I, Cole P. Efficacy of a saccharin test for screening to detect abnormal mucociliary clearance. Br J Dis Chest 1984; 78 (01) 62-65
  • 19 Puchelle E, Aug F, Pham QT, Bertrand A. Comparison of three methods for measuring nasal mucociliary clearance in man. Acta Otolaryngol 1981; 91 (3-4): 297-303
  • 20 Corbo GM, Foresi A, Bonfitto P, Mugnano A, Agabiti N, Cole PJ. Measurement of nasal mucociliary clearance. Arch Dis Child 1989; 64 (04) 546-550
  • 21 Plaza Valía P, Carrión Valero F, Marín 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) 540-545
  • 22 Proença de Oliveira-Maul J, Barbosa de Carvalho H, Goto DM. , et al. Aging, diabetes, and hypertension are associated with decreased nasal mucociliary clearance. Chest 2013; 143 (04) 1091-1097
  • 23 Proença M, Fagundes Xavier R, Ramos D, Cavalheri V, Pitta F, Cipulo Ramos EM. [Immediate and short term effects of smoking on nasal mucociliary clearance in smokers]. Rev Port Pneumol 2011; 17 (04) 172-176
  • 24 Arnaoutakis D, Collins WO. Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children. Int J Pediatr Otorhinolaryngol 2011; 75 (10) 1318-1321
  • 25 Naiboglu B, Deveci I, Kalaycik C. , et al. Effect of nasolacrimal duct obstruction on nasal mucociliary transport. J Laryngol Otol 2010; 124 (02) 166-170
  • 26 Andersen I, Camner P, Jensen PL, Philipson K, Proctor DF. A comparison of nasal and tracheobronchial clearance. Arch Environ Health 1974; 29 (05) 290-293
  • 27 Rutland J, Cole PJ. Nasal mucociliary clearance and ciliary beat frequency in cystic fibrosis compared with sinusitis and bronchiectasis. Thorax 1981; 36 (09) 654-658
  • 28 Proença M, Pitta F, Kovelis D. , et al. Mucociliary clearance and its relation with the level of physical activity in daily life in healthy smokers and nonsmokers. Rev Port Pneumol 2012; 18 (05) 233-238
  • 29 Stanley PJ, Wilson R, Greenstone MA, MacWilliam L, Cole PJ. Effect of cigarette smoking on nasal mucociliary clearance and ciliary beat frequency. Thorax 1986; 41 (07) 519-523
  • 30 Wilson R, Sykes DA, Currie D, Cole PJ. Beat frequency of cilia from sites of purulent infection. Thorax 1986; 41 (06) 453-458
  • 31 Bilgi M, Goksu S, Mizrak A. , et al. Comparison of the effects of low-flow and high-flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests. Eur J Anaesthesiol 2011; 28 (04) 279-283
  • 32 Kesimci E, Bercin S, Kutluhan A, Ural A, Yamanturk B, Kanbak O. Volatile anesthetics and mucociliary clearance. Minerva Anestesiol 2008; 74 (04) 107-111
  • 33 de Oliveira LR, Albertini Yagi CS, Figueiredo AC, Saldiva PH, Lorenzi-Filho G. Short-term effects of nCPAP on nasal mucociliary clearance and mucus transportability in healthy subjects. Respir Med 2006; 100 (01) 183-185
  • 34 Ramos EM, De Toledo AC, Xavier RF. , et al. Reversibility of impaired nasal mucociliary clearance in smokers following a smoking cessation programme. Respirology 2011; 16 (05) 849-855
  • 35 Alobid I, Enseñat J, Mariño-Sánchez F. , et al. Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery 2013; 72 (04) 540-546
  • 36 Priscilla J, Padmavathi R, Ghosh S. , et al. Evaluation of mucociliary clearance among women using biomass and clean fuel in a periurban area of Chennai: A preliminary study. Lung India 2011; 28 (01) 30-33
  • 37 Delehaye E, Dore MP, Bozzo C, Mameli L, Delitala G, Meloni F. Correlation between nasal mucociliary clearance time and gastroesophageal reflux disease: our experience on 50 patients. Auris Nasus Larynx 2009; 36 (02) 157-161
  • 38 Zhang L, Han D, Song X, Wang K, Wang H. Effect of oxymetazoline on healthy human nasal ciliary beat frequency measured with high-speed digital microscopy and mucociliary transport time. Ann Otol Rhinol Laryngol 2008; 117 (02) 127-133
  • 39 Salah B, Dinh Xuan AT, Fouilladieu JL, Lockhart A, Regnard J. Nasal mucociliary transport in healthy subjects is slower when breathing dry air. Eur Respir J 1988; 1 (09) 852-855
  • 40 Gorpelioglu C, Ozol D, Sarifakioglu E. Influence of isotretinoin on nasal mucociliary clearance and lung function in patients with acne vulgaris. Int J Dermatol 2010; 49 (01) 87-90
  • 41 Deniz M, Uslu C, Ogredik EA, Akduman D, Gursan SO. Nasal mucociliary clearance in total laryngectomized patients. Eur Arch Otorhinolaryngol 2006; 263 (12) 1099-1104
  • 42 Isaacs S, Fakhri S, Luong A, Whited C, Citardi MJ. The effect of dilute baby shampoo on nasal mucociliary clearance in healthy subjects. Am J Rhinol Allergy 2011; 25 (01) e27-e29
  • 43 Rosen EJ, Calhoun KH. Alterations of nasal mucociliary clearance in association with HIV infection and the effect of guaifenesin therapy. Laryngoscope 2005; 115 (01) 27-30
  • 44 Okuyucu S, Akoglu E, Oksuz H, Gorur H, Dagli S. The effect of dacryocystorhinostomy on mucociliary function. Otolaryngol Head Neck Surg 2009; 140 (04) 585-588
  • 45 Middleton PG, Geddes DM, Alton EW. Effect of amiloride and saline on nasal mucociliary clearance and potential difference in cystic fibrosis and normal subjects. Thorax 1993; 48 (08) 812-816
  • 46 Unal M, Oz O, Adigüzel U, Vayisoglu Y, Vatansever H, Görür K. Mucociliary clearance after external dacryocystorhinostomy. Clin Otolaryngol Allied Sci 2004; 29 (03) 264-265
  • 47 Cmejrek RC, Gutman MT, Torres AJ, Keen KJ, Houser SM. The effect of injection immunotherapy on mucociliary clearance in allergic patients. Otolaryngol Head Neck Surg 2005; 133 (01) 9-15
  • 48 Boatsman JE, Calhoun KH, Ryan MW. Relationship between rhinosinusitis symptoms and mucociliary clearance time. Otolaryngol Head Neck Surg 2006; 134 (03) 491-493
  • 49 Xavier RF, Ramos D, Ito JT. , et al. Effects of cigarette smoking intensity on the mucociliary clearance of active smokers. Respiration 2013; 86 (06) 479-485
  • 50 Altuntaş EE, Kaya A, Uysal IO, Cevit Ö, Içağasioğlu D, Müderris S. Anterior rhinomanometry and determination of nasal mucociliary clearance time with the saccharin test in children with Crimean-Congo hemorrhagic fever. J Craniofac Surg 2013; 24 (03) e239-e242
  • 51 Develioglu ON, Sirazi S, Topak M, Purisa S, Kulekci M. Differences in Mucociliary activity of volunteers undergoing Ramadan versus Nineveh fasting. Eur Arch Otorhinolaryngol 2013; 270 (05) 1655-1659
  • 52 Bercin S, Ural A, Kutluhan A. Effects of topical drops and sprays on mucociliary transport time and nasal air flow. Acta Otolaryngol 2009; 129 (11) 1257-1261
  • 53 Yoruk O, Ates O, Araz O. , et al. The effects of silica exposure on upper airways and eyes in denim sandblasters. Rhinology 2008; 46 (04) 328-333
  • 54 Wolff RK, Dolovich MB, Obminski G, Newhouse MT. Effects of exercise and eucapnic hyperventilation on bronchial clearance in man. J Appl Physiol 1977; 43 (01) 46-50
  • 55 Svartengren M, Falk R, Philipson K. Long-term clearance from small airways decreases with age. Eur Respir J 2005; 26 (04) 609-615
  • 56 Kamani T, Yilmaz T, Surucu S, Turan E, Brent KA. Scanning electron microscopy of ciliae and saccharine test for ciliary function in septal deviations. Laryngoscope 2006; 116 (04) 586-590
  • 57 Rubin AS, Cavalazzi AC, Viegas CAA. , et al. Diretrizes para testes de funçao pulmonar. J Bras Pneumol 2002; 28 (03) 237
  • 58 Koop CE, Luoto J. “The Health Consequences of Smoking: Cancer,” overview of a report of the Surgeon General. Public Health Rep 1982; 97 (04) 318-324
  • 59 Wattenberg EV. Noncarcinogenic effects of cigarette smoke on the respiratory tract. Environment Health Sci 2012; 8: 10
  • 60 Comandini A, Rogliani P, Nunziata A, Cazzola M, Curradi G, Saltini C. Biomarkers of lung damage associated with tobacco smoke in induced sputum. Respir Med 2009; 103 (11) 1592-1613
  • 61 Cannon JG, Meydani SN, Fielding RA. , et al. Acute phase response in exercise. II. Associations between vitamin E, cytokines, and muscle proteolysis. Am J Physiol 1991; 260 (6 Pt 2): R1235-R1240
  • 62 Nieman DC, Nehlsen-Cannarella SL. The immune response to exercise. Semin Hematol 1994; 31 (02) 166-179
  • 63 Holmqvist N, Secher NH, Sander-Jensen K, Knigge U, Warberg J, Schwartz TW. Sympathoadrenal and parasympathetic responses to exercise. J Sports Sci 1986; 4 (02) 123-128
  • 64 Devalia JL, Sapsford RJ, Rusznak C, Toumbis MJ, Davies RJ. The effects of salmeterol and salbutamol on ciliary beat frequency of cultured human bronchial epithelial cells, in vitro. Pulm Pharmacol 1992; 5 (04) 257-263
  • 65 Sisson JH. Alcohol and airways function in health and disease. Alcohol 2007; 41 (05) 293-307
  • 66 Monda M, Viggiano A, Vicidomini C. , et al. Espresso coffee increases parasympathetic activity in young, healthy people. Nutr Neurosci 2009; 12 (01) 43-48
  • 67 Yeragani VK, Krishnan S, Engels HJ, Gretebeck R. Effects of caffeine on linear and nonlinear measures of heart rate variability before and after exercise. Depress Anxiety 2005; 21 (03) 130-134
  • 68 Yeates DB, Aspin N, Levison H, Jones MT, Bryan AC. Mucociliary tracheal transport rates in man. J Appl Physiol 1975; 39 (03) 487-495
  • 69 Cammer P, Strandberg K, Philipson K. Increased mucociliary transport by cholinergic stimulation. Arch Environ Health 1974; 29 (04) 220-224
  • 70 Foster WM, Bergofsky EH, Bohning DE, Lippmann M, Albert RE. Effect of adrenergic agents and their mode of action on mucociliary clearance in man. J Appl Physiol 1976; 41 (02) 146-152
  • 71 Begrow F, Böckenholt C, Ehmen M, Wittig T, Verspohl EJ. Effect of myrtol standardized and other substances on the respiratory tract: ciliary beat frequency and mucociliary clearance as parameters. Adv Ther 2012; 29 (04) 350-358
  • 72 Boek WM, Graamans K, Natzijl H, van Rijk PP, Huizing EH. Nasal mucociliary transport: new evidence for a key role of ciliary beat frequency. Laryngoscope 2002; 112 (03) 570-573
  • 73 Houtmeyers E, Gosselink R, Gayan-Ramirez G, Decramer M. Effects of drugs on mucus clearance. Eur Respir J 1999; 14 (02) 452-467
  • 74 Moore RY. Circadian rhythms: basic neurobiology and clinical applications. Annu Rev Med 1997; 48: 253-266
  • 75 Stephenson R. Do circadian rhythms in respiratory control contribute to sleep-related breathing disorders?. Sleep Med Rev 2003; 7 (06) 475-490
  • 76 Mortola JP. Breathing around the clock: an overview of the circadian pattern of respiration. Eur J Appl Physiol 2004; 91 (2-3): 119-129
  • 77 McFadden Jr ER. Circadian rhythms. Am J Med 1988; 85 (1B): 2-5
  • 78 Sahin-Yilmaz A, Naclerio RM. Anatomy and physiology of the upper airway. Proc Am Thorac Soc 2011; 8 (01) 31-39
  • 79 Cruz AA, Togias A. Upper airways reactions to cold air. Curr Allergy Asthma Rep 2008; 8 (02) 111-117
  • 80 Kilgour E, Rankin N, Ryan S, Pack R. Mucociliary function deteriorates in the clinical range of inspired air temperature and humidity. Intensive Care Med 2004; 30 (07) 1491-1494
  • 81 Proctor DF, Andersen I, Lundqvist GR. Human nasal mucosal function at controlled temperatures. Respir Physiol 1977; 30 (1-2): 109-124
  • 82 Jorissen M, Bessems A. Influence of culture duration and ciliogenesis on the relationship between ciliary beat frequency and temperature in nasal epithelial cells. Eur Arch Otorhinolaryngol 1995; 252 (08) 451-454
  • 83 Smith CM, Hirst RA, Bankart MJ. , et al. Cooling of cilia allows functional analysis of the beat pattern for diagnostic testing. Chest 2011; 140 (01) 186-190
  • 84 Rodway GW, Windsor JS. Airway mucociliary function at high altitude. Wilderness Environ Med 2006; 17 (04) 271-275
  • 85 Fokkens WJ, Scheeren RA. Upper airway defence mechanisms. Paediatr Respir Rev 2000; 1 (04) 336-341
  • 86 Deniz M, Gultekin E, Ciftci Z. , et al. Nasal mucociliary clearance in obstructive sleep apnea syndrome patients. Am J Rhinol Allergy 2014; 28 (05) 178-180
  • 87 Baby MK, Muthu PK, Johnson P, Kannan S. Effect of cigarette smoking on nasal mucociliary clearance: A comparative analysis using saccharin test. Lung India 2014; 31 (01) 39-42
  • 88 Janic T, Niedzielska I. Mucociliary clearance impairment after zygomaticomaxillary-orbital fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115 (06) e6-e12
  • 89 Kirtsreesakul V, Somjareonwattana P, Ruttanaphol S. The correlation between nasal symptom and mucociliary clearance in allergic rhinitis. Laryngoscope 2009; 119 (08) 1458-1462
  • 90 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 (06) 349-355
  • 91 Philpott CM, Conboy P, Al-Azzawi F, Murty G. Nasal physiological changes during pregnancy. Clin Otolaryngol Allied Sci 2004; 29 (04) 343-351
  • 92 Ferreira-Ceccato AD, Ramos EM, de Carvalho Jr LCJ. , et al. Short-term effects of air pollution from biomass burning in mucociliary clearance of Brazilian sugarcane cutters. Respir Med 2011; 105 (11) 1766-1768
  • 93 Cinar F, Beder L. Nasal mucociliary clearance in coal mine workers. Otolaryngol Head Neck Surg 2004; 130 (06) 767-769
  • 94 Oysu C, Tosun A, Yilmaz HB, Sahin-Yilmaz A, Korkmaz D, Karaaslan A. Topical Nigella Sativa for nasal symptoms in elderly. Auris Nasus Larynx 2014; 41 (03) 269-272
  • 95 Gelardi M, Guglielmi AV, De Candia N, Maffezzoni E, Berardi P, Quaranta N. Effect of sodium hyaluronate on mucociliary clearance after functional endoscopic sinus surgery. Eur Ann Allergy Clin Immunol 2013; 45 (03) 103-108
  • 96 Riechelmann H, Rettinger G, Weschta M, Keck T, Deutschle T. Effects of low-toxicity particulate matter on human nasal function. J Occup Environ Med 2003; 45 (01) 54-60
  • 97 Bencova A, Vidan J, Rozborilova E, Kocan I. The impact of hypertonic saline inhalation on mucociliary clearance and nasal nitric oxide. J Physiol Pharmacol 2012; 63 (03) 309-313
  • 98 Cingi C, Unlu HH, Songu M. , et al. Seawater gel in allergic rhinitis: entrapment effect and mucociliary clearance compared with saline. Ther Adv Respir Dis 2010; 4 (01) 13-18
  • 99 Fooanant S, Chaiyasate S, Roongrotwattanasiri K. Comparison on the efficacy of dexpanthenol in sea water and saline in postoperative endoscopic sinus surgery. J Med Assoc Thai 2008; 91 (10) 1558-1563
  • 100 Unsal Tuna EE, Ozbek C, Koç C, Ozdem C. Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid. Am J Otolaryngol 2008; 29 (01) 37-41
  • 101 Kim ST, Gang IG, Cha HE, Ha JS, Chung YS. Effect of mitomycin C on the size of antrostomy after endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2006; 115 (09) 673-678
  • 102 Saieed WN, Alpachachi IA, Almashhadani WM. The effect of montelukast on nasal mucociliary clearance. J Clin Pharmacol 2006; 46 (05) 588-590
  • 103 Riechelmann H, Deutschle T, Stuhlmiller A, Gronau S, Bürner H. Nasal toxicity of benzalkonium chloride. Am J Rhinol 2004; 18 (05) 291-299
  • 104 Yazici H, Soy FK, Kulduk E. , et al. Comparison of nasal mucociliary clearance in adenoid hypertrophy with or without otitis media with effusion. Int J Pediatr Otorhinolaryngol 2014; 78 (07) 1143-1146
  • 105 Ozkul HM, Balikci HH, Karakas M, Bayram O, Bayram AA, Kara N. Repair of symptomatic nasoseptal perforations using mucosal regeneration technique with interpositional grafts. J Craniofac Surg 2014; 25 (01) 98-102
  • 106 Parida PK, Surianarayanan G, Alexander A, Saxena SK, Santhosh K. Diode laser turbinate reduction in the treatment of symptomatic inferior turbinate hypertrophy. Indian J Otolaryngol Head Neck Surg 2013; 65 (Suppl. 02) 350-355
  • 107 Miwa M, Miwa M, Watanabe K. Changes in intramaxillary sinus pressure following antrostomy, draining tubes, and YAMIK procedures in 25 patients treated for chronic paranasal sinusitis. Ear Nose Throat J 2011; 90 (08) 368-381
  • 108 Yigit O, Kirgezen T, Taskin U, Yener M. Endoscopic dacryocystorhinostomy appears to impair nasal mucociliary clearance. Ear Nose Throat J 2011; 90 (09) E23-E27
  • 109 Chen YL, Tan CT, Huang HM. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope 2008; 118 (07) 1270-1274
  • 110 Hu KH, Tan CT, Lin KN, Cheng YJ, Huang HM. Effect of endoscopic sinus surgery on irradiation-induced rhinosinusitis in patients with nasopharyngeal carcinoma. Otolaryngol Head Neck Surg 2008; 139 (04) 575-579
  • 111 Sakthikumar KR, Ravikumar A, Mohanty S, Senthil K, Somu L, Kuruvilla S. Functional study of nasal mucosa in endoscopic sinus surgery and its correlation to electron microscopy of cilia. Indian J Otolaryngol Head Neck Surg 2008; 60 (01) 1-6
  • 112 Chen YL, Liu CM, Huang HM. Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates. Int J Pediatr Otorhinolaryngol 2007; 71 (06) 921-927
  • 113 Clayman MA, Clayman LZ. Twenty year follow-up of ciliary mobility after bilateral inferior turbinectomy for allergic rhinitis using saccharin. Otolaryngol Head Neck Surg 2006; 134 (04) 703-704
  • 114 Huang HM, Cheng JJ, Liu CM, Lin KN. Mucosal healing and mucociliary transport change after endoscopic sinus surgery in children with chronic maxillary sinusitis. Int J Pediatr Otorhinolaryngol 2006; 70 (08) 1361-1367
  • 115 Bhardwaj A, Sharma MK, Gupta M. Endoscopic evaluation of therapeutic effects of “Anuloma-Viloma Pranayama” in Pratishyaya w.s.r. to mucociliary clearance mechanism and Bernoulli's principle. Ayu 2013; 34 (04) 361-367
  • 116 Parida PK, Santhosh K, Ganesan S, Surianarayanan G, Saxena SK. The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in allergic rhinitis. Indian J Med Sci 2011; 65 (07) 269-277
  • 117 Gupta SC, Chandra S, Singh M. Effects of irradiation on nasal mucociliary clearance in head and neck cancer patients. Indian J Otolaryngol Head Neck Surg 2006; 58 (01) 46-50
  • 118 Kamel R, Al-Badawy S, Khairy A, Kandil T, Sabry A. Nasal and paranasal sinus changes after radiotherapy for nasopharyngeal carcinoma. Acta Otolaryngol 2004; 124 (04) 532-535