Sinusitis, mucociliary clearance

Direct toxic effects such as irritation, inflammation, or increased permeability will bring about symptoms such as the sneeze reflex, nasal discomfort, and hypersecretion with the possibility of underlying pathological changes such as squamous metaplasia, cilia erosion, plasma exudation, epithelial necrosis, inflammatory remodeling, or neutrophil accumulation. Indirect adverse effects can also occur and any alteration to normal nasal homeostasis should be avoided. For example, a reduction in mucociliary clearance can cause rhinitis, sinusitis, and an increased susceptibility to airway infections, and consequently ciliary movement should not be altered by any nasal medication. In the context of absorption enhancers, the rate and extent of recovery of normal nasal epithelial function after nasal administration is a prime consideration. 

Chronic diseases include cystic fibrosis in which nasal mucus is thick and viscous as a result of abnormal chloride transport across the membrane of the epithelial cells, leading to reduced water secretion. Similarly, chronic sinusitis also reduces nasal mucociliary clearance due to an increase in the rheological properties of mucus. 

The rate of mucociliary clearance can be affected by the pathophysiological condition of the nasal cavity and this will also affect the rate of clearance of administered drag. Such conditions include rhinitis, the common cold, hayfever, sinusitis, asthma, nasal polyposis, Sjogren s and Kartagener s syndromes. In addition, environmental factors such as humidity, temperature and pollution can also affect the rate of nasal clearance. 

Affected individuals manifest bronchiectasis and chronic sinusitis. Because the cilia of the respiratory epithelium are defective, mucociliary clearance is reduced... 

Normal physiological functioning of the sinuses depends on ostial patency, mucociliary function, and the quantity and quality of secretions. Retention of sinus secretions may result if ostial diameter is compromised if cilia are damaged, impairing mucociliary clearance of secretions or if increased viscosity or volume of secretions exceeds the clearing capacity of the sinus mucociliary drainage system. 

The osteopathic treatment of sinusitis has several goals to relieve obstruction and pain to improve venous and lymphatic flow from the area to affect reflex changes and to improve mucociliary clearance. Several manual techniques have been designed to aid in achieving these goals. Although only one set of sinuses may produce pain, the entire series of techniques should be performed to assist drainage of all the sinus areas. 

Nasal decongestant sprays such as phenylephrine and oxymetazoline that reduce inflammation by vasoconstriction are often used in sinusitis. Use should be limited to the recommended duration of the product to prevent rebound congestion. Oral decongestants may also aid in nasal or sinus patency. To reduce mucociliary function, irrigation of the nasal cavity with saline and steam inhalation may be used to increase mucosal moisture, and mucolytics (e.g., guaifenesin) maybe used to decrease the viscosity of nasal secretions. Antihistamines should not be used for acute bacterial sinusitis in view of their anticholinergic effects that can dry mucosa and disturb clearance of mucosal secretions. 

The goal in treatment of sinusitis is eradication of infection with clearance of the infected material from the sinuses. While the use of an appropriate antibiotic is necessary, the use of ancillary therapy is also of utmost importance. Steam and nasal saline, decongestants, topical corticosteroids, and mucoevacuants are given in an attempt to reduce nasal obstruction, increase sinus ostia size, promote improved mucociliary function, decrease mucosal inflammation, and thin secretions. In selected patients who fail to respond to aggressive medical therapy, functional endoscopic surgery can often provide relief. In patients with poorly controlled asthma, treatment of underlying sinusitis has been shown to dramatically improve the asthmatic state. 

---