CILIARY ULTRASTRUCTURE IN NASAL BRUSHINGS

Normal ciliary ultrastructure is thought to be necessary for effective function. There has been little or no attempt to quantify ultrastruct ural abnormalities in nasal disease and assess their significance. In this study we measured nasal ciliary function and examined ciliary ult rastructure in nasal brushings from 35 patients with perennial nasal s ymptoms refractory to treatment. Ultrastructural defects included micr otubular abnormalities, compound cilia and ciliary 'blebs'. The incide nce of abnormal cilia was 16.7%, compared with 9% in controls, but the re was only a poor correlation between ultrastructural defects and cil iary beat frequency. One patient had primary ciliary dyskinesia (PCD) with a typical clinical history and immotile cilia. However, only seco ndary ultrastructural abnormalities were seen. We have been unable to show that ciliary ultrastructural defects form the basis of impaired f unction. In patients with suspected PCD, nasal brushings should be tak en for functional and ultrastructural studies; ideally, a further samp le should be obtained for examination of possible primary ultrastructu ral abnormalities.