Clin[ Otolaryn`ol[ 0887\ 23, 277285

REVIEW

Mucociliary transport and its assessment: a review

A[M[LALE\ J[D[T[MASON + N[S[JONES$
Department of Otorhinolaryn`olo`y\ Addenbrookes| Hospital\ Cambrid`e\ Department of Otorhinolaryn`olo`y\ Royal Bolton
Hospital\ Nottin`ham\ and $Department of Otorhinolaryn`olo`y\ University Hospital\ Nottin`ham\ UK
Accepted for publication 03 April 0887

The clinical assessment of nasal mucociliary

clearance
The clinician should suspect a disorder of mucociliary clear!
ance in a patient who has both rhinosinusitis and bronchi!
ectasis\ an individual with purulent rhinosinusitis who repeat!
edly fails to respond to medical treatment\ or if the nasal
airway is _lled with tenaceous secretions[ This is a review of
the various clinical tests which could be employed to assess
mucociliary clearance
Nasal mucociliary clearance is a fundamental function
required to maintain the health and defence of the nose[ Muc!
ociliary transport is disturbed in a variety of conditions which
a}ect the activity of the cilia[ Twenty to forty ml of mucus
are secreted from the normal {resting| nose each day from 059
cm1 of nasal mucosa[ Nasal mucus provides a continuous
blanket lining the nasal cavity onto which particles in the
turbulent inhaled airstream can impact and stick^ 79) of
particles larger than 01[4 mm are _ltered from the air before
it reaches the pharynx[ The blanket of mucus can be moved
by the co!ordinated waves of cilia from the front of the nose
to the nasopharynx where it can be swallowed or expectorated[
The properties of mucus are geared to ful_ll these two roles]
trapping and transporting airborne particles[
The periciliary ~uid is a lubricating layer in which the cilia
beat\0 and is functionally distinct\ but structurally continuous\
from the viscous layer of mucus above[ Soluble material such
as saccharin will dissolve and be transported through this
layer\ and it has been suggested that transport through the
periciliary layer is more e.cient than in the mucus layer[13
Cilia in isolation are sensitive to the e}ects of temperature\
working optimally at 2439 >C\ and above and below these
temperatures the natural beat frequency drops[ Mucociliary
systems are very sensitive to drying but within the usual atmo!
spheric conditions there is little alteration in nasal mucociliary
transport rate\4 and this is due to the warming and humid!
ifying functions of the nose[

Correspondence] N[S[Jones\ Department of Otorhinolaryngology\

University Hospital\ Nottingham NG6 1UH\ UK

277

Nasal mucociliary pathways

In anaesthetised animals or in fresh cadaveric specimens the
pathway of the mucus ~ow can be monitored by following
particles or drops of blood on the surface of the mucus\ or
bubbles and debris that are present in the mucus[ In the human
nasal fossa the direction of the mucus ~ow is predominantly
posteriorly towards the nasopharynx\ streaming above and
below the tubal opening5\6 and this is similar to other
primates[7 Di}erences in mucociliary transport rates between
di}erent sites in the nose depend on ciliary beat frequency\
density of the ciliary population\ length of the cilia and mucus
quality[8 The rate of mucociliary transport is 01 mm:h just
behind the anterior portion of the inferior turbinate\ and
increases to 709 mm:h on the posterior portion of the inferior
turbinate[09
In Quinlan et al[|s study on the human nose\00 radioactive
particles placed on the septum travelled posteriorly to the soft
palate\ either passing in a gentle slope to the inferior edge
of the septum\ or travelling directly posteriorly and turning
sharply down the inferior edge of the septum[ Those on the
~oor of the nose travel posteriorly\ but tend to deviate either
laterally to the inferior meatus or medially towards the inferior
edge of the nasal septum during their passage to the naso!
pharynx[ Particles placed on the medial surface of the inferior
turbinate pass laterally to the inferior meatus and then pos!
teriorly^ they then pass above or below the tubal opening[
Where there is an obstruction to the normal path of muc!
ociliary transport\ di}erent phenomena have been reported[
Where spurs on the septum or other mucosal irregularities
present large obstructions\ or are associated with alterations
in the epithelial surface such as squamous metaplasia\ the
pathway is around these obstructions[0003 If the bony spur is
small and it has retained functioning ciliated epithelium on its
surface\ and the mucus is of adequate viscosity to move up a
slope\ then the mucus blanket will travel over this obstacle[01\02
If there is a defect in the mucosal surface\ and the cohesive
properties of the mucus are preserved then the mucus carpet
can move undisturbed from one edge of intact epithelium to
the next[01\02 If there is a defect associated with pooling of the
mucus\00 or with squamous metaplasia\04 normal mucociliary
0887 Blackwell Science Ltd

Mucociliary transport and its assessment 278

transport at this site will be lost[ Andersen demonstrated areas

of the turbinate where clearance is slow and these showed
intra!individual variation in position with time[05 Quinlan sug!
gests that there is a speed gradient with the speed increasing
towards the oropharynx from the anterior parts of the nose[00

Effect of airflow on nasal mucociliary function

At a site of air~ow obstruction\ such as a septal de~ection\ or
an enlarged anterior end of the inferior turbinate there are
tissue changes\ such as hypertrophy of the subepithelial
mucosa\ mucous glands or an increase in the thickness of the
mucoperiostium[ There is also atrophy of the epithelium with
areas of metaplasia to squamous epithelium[06 In other mam!
malian mucociliary systems the initial e}ect of drying is anch!
oring of the mucus sheet to the epithelial surface\ the mucus
tending to remain plugged around its source of secretion and
not migrate to form a blanket above the periciliary ~uid and
ciliary tips[07\08

Disruption of cilia by viruses and bacteria

Haemophilus in~uenzae\ streptococcus pneumoniae\ staphy!
lococcus aureus and pseudomonas produce speci_c toxins that
disrupt epithelial cells with the loss of a con~uent ciliary _eld[
Neutrophils which gather at the sites of purulent infection
produce an elastase that is directly toxic to respiratory
epithelium[1913 Viruses responsible for the common cold dis!
rupt the ciliated cell|s microtubules and there is an increase in
mucus tethering at the sites of mucus glands making it di.cult
for the remaining cilia to transport mucus[

Chronic rhinosinusitis
In patients with chronic rhinosinusitis areas of ciliary denude!
ment have been demonstrated\ but in areas where cilia were
preserved ciliary motility appeared normal[ Prolonged sac!
charin clearance in patients with maxillary sinusitis has been
attributed to abnormalities of the mucus[ The mucosa of pat!
ients with chronic sinusitis shows changes including oedema\
shedding of epithelial cells and squamous metaplasia[ Ciliary
abnormalities have been reported including compound cilia
and deviation from the usual {81| _lament arrangement[2939

Nasal polyps
Nasal polyps are oedematous swellings of the nasal mucosa[
Their ciliated surface can undergo squamous metaplasia[
Where the mucociliary blanket is preserved the mucus is
moved in a normal fashion\ but due to the pedunculated
swelling of the mucosa the direction of the mucus ~ow may
be changed[ Patients with nasal polyposis have disturbed muc!
ociliary function as measured by saccharin clearance and
gamma scintigraphy[3034

Effect of commonly used intranasal preparations

on nasal mucociliary transport
The commonly used intranasal preparations which have ster!
oids or antihistamines as active agents have not been shown
to be detrimental to nasal mucociliary function in humans\35\36
despite reports that isolated cilia beat less e}ectively when
perfused with these drugs or the preservatives that are added
to these drugs[3742

Allergic rhinitis
Changes in ciliary structure occur in patients with long!stand!
ing allergic rhinitis and changes in secreted mucus occur at
times of acute allergen challenge[ The changes to mucus that
occur during acute allergic nasal reactions are secondary to a
variety of in~ammatory mediators[ There is likely to be an
improvement in mucociliary transport due to alterations in
the rheological properties of the mucus and an increase in
ciliary beat frequency[ Damage to nasal cilia also occurs in
patients with allergic rhinitis with absence of dynein arms\
and radial spokes\ ciliary membrane damage\ compound cilia
and disorientation of central tubules[1416 The results from
experiments on the patients with allergic rhinitis are incon!
clusive\ some suggesting there is an increase and some a
reduction in nasal mucociliary transport in response to aller!
gen challenge[ In patients with positive skin tests and a positive
response to methacholine challenge saccharin clearance times
are prolonged[17 Ciliary abnormalities have been detected in
patients described as having perennial rhinitis\ but not all
studies have found this[18
0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285

Congenital anomalies which affect nasal mucociliary function

Five to ten per cent of the cilia show abnormalities in children
and adults who have no apparent nasal disease[ In Kar!
tagener|s syndrome there is absence of the dynein arms of the
nine peripheral microtubules[ These individuals have only
39) of their ciliated cells working and they also lack co!
ordination or metachronicity[43\44 In primary ciliary dyskinesia
impaired mucociliary clearance has been shown to be due to
structural defects of the ciliary axoneme[4548
In Young|s syndrome "obstructive azoospermia with recur!
rent sinobronchial disease# there is a disorganisation of ciliary
orientation\ which is more pronounced at the cilial tip\ but
the other features of the cilia are normal[59
Nasal acilia "RothmundThomson# syndrome is an isolated
absence of cilia in the nasal mucosa[50\51 The condition presents
with chronic rhinitis[
Immunode_ciency is associated with deranged mucociliary
transport[ Patients with common variable immunode_ciency

289 A[M[Lale\ J[D[T[Mason + N[S[Jones

have slower nasal mucociliary transport and more extensive

mucosal damage than those with selective IgA de_ciency[52
In cystic _brosis the primary abnormality is not with the
cilia\ but with the production of abnormal mucus\ possibly
secondary to defective chloride transport[5355

Measurement of mucociliary function

This can be separated into three types of studies] "0# measure!
ment of ciliary form and motion^ "1# measurement of mucus
production and its chemical and physical properties^ and "2#
measurement of the e.ciency of the combined e}ects of the
mucus and ciliary systems[

MEASUREMENT OF CILIARY FORM AND MOTION

Ciliary activity has attracted a lot of interest because cilia are
relatively easy to harvest and their function is relatively easy
to measure[ Isolated\ mucus!free\ ciliary activity has been
monitored on unicellular organisms\56 and from the res!
piratory and reproductive tracts of many mammals[ When
mucociliary systems such as nasal mucosa demonstrate chan!
ges in response to a stimulus\ it is di.cult to be certain whether
the change represents alteration in ciliary activity or in the
production and properties of mucus[ Studies of mucus!free
isolated cilia permit the study of direct e}ects on cilia[ Nasal
cilia are easy to harvest] familiarity with simple anterior rhi!
noscopy allows ready access to the inferior turbinate\ the ~oor
of the nose and the anterior third of the nasal septum[ All of
these sites have been described as sources of ciliated cells by
nasal brushing with a 1!mm nylon brush[5760 A larger number
of cells that are in contact with the basal membrane can be
obtained with a curette or forceps[ It has been suggested
that a group of cells in contact with the basement membrane
should be used for ciliary beat measurements\ and that forceps
are preferable to curettes[61
The measurement of ciliary beat frequency started in 0733
with Martius who used a stroboscope to estimate frequency[
This is unreliable at frequencies around 519 Hz\62\63 because
of the phase di}erence between groups of cells and met!
achronous movement[ Nearly a century later\ in the 0829s\
the investigation of ciliary movement began in earnest with
Proetz[64
Direct observation of ciliary function can only detect the
di}erence between active and paralysed cilia[65 It is important
that methods of measurement are consistent between readings[
There is great variability in beat frequency between di}erent
cells in the same tissue sample[ Some reports only consider
the beat frequency of only the most vigorous cilia\10\66 while
other researchers suggest that beat frequency should be mea!
sured at random sites and the variability of beat frequency
within the sample should be considered[67 Diurnal rhythms
may in~uence the measurements of beat frequency\ and the

time of day should be considered[68 Intracellular calcium and

c!AMP are so in~uential in the ciliary beating that it may be
worth stating these at the same time as the beat frequency
measurements[79
Measurement of ciliary beat frequency using a photo!
sensitive cell that converts the re~ections of light from beating
cilia into an electric current and then an oscilloscope display
via an ampli_er was described in 0851\70 and this is the most
widely applied method[7173 Re~ected light from the cilia is
not the only altering light intensity that can be transduced to
an electrical signal[ Video images of beating cilia from a moni!
tor with the altering light intensities of individual pixels or
pixel groups\67\74\75 or interruptions of a light source76 or scat!
tering of a laser beam by the cilia can be utilised[77\78 All
these can be transduced to an electrical signal which can be
ampli_ed\ _ltered\ and then digitised[ A computer using fast
Fourier transformation can then be used to calculate\ and
display the ciliary beat frequency results\ and include some
statistical analysis[89
When studying preparations with beating cilia it is impor!
tant they are maintained at constant temperature\ and the pH
and the osmolality are maintained in a physiological range[61
Ciliary beat frequency shows consistent readings in the tem!
perature range 2139 >C[ Between 08 >C and 21 >C it increases
in a linear fashion\ and above 39 >C it declines[80 This is con!
sistent with studies into the temperature range of nasal tissue
in vivo[81\82 When interpreting the results of ciliary beat
measurements or the structure of cilia in a clinical setting if
abnormalities are detected they are usually secondary to other
abnormalities[ Also\ it has been shown that abnormalities of
the cilia are reversible when cultured in tissue medium[54 Cilia
obtained with a nylon brush can be examined under the elec!
tron microscope[83\84 The following features can be looked for
and measured quantitatively from electron micrographs of
transversely sectioned cilia] the incidence of compound cilia\
the incidence of central and peripheral microtubule defects\
the numbers of inner and outer dynein arms per cilium\ and
ciliary orientation[59 The ciliary beat axis is perpendicular to a
line drawn through the centres of the two central microtubules
"Figure 0#[ In a group of cilia sectioned axially and displayed
on an electromicrograph\ the angle subtended by each cilia
can be measured and the mean ciliary angle can be calculated[
From this the ciliary deviation can be calculated\ that is the
SD of the ciliary angle for the cilia sectioned can be determined[
In normal patients the ciliary angle is 03 >\ and at the tip the
ciliary deviation is 3 >[ In cilia that show disorganisation this
may be more marked at the tip than at the base\ as has been
demonstrated in Young|s syndrome[59
The biopsy of nasal cilia is straightforward\ but the equip!
ment required to measure ciliary beat frequency and measure
ciliary angles is complex and expensive and will only be avail!
able in a few centres[ The axial section of nasal cilia is not easy\
and it requires patience to section cilia cleanly and parallel to
the surface of the cell[
0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285

Mucociliary transport and its assessment 280

rheological properties of human nasal mucus has potential

value\ but a reliable test with a de_nite clinical application is
yet to be found[
MEASUREMENT OF THE COMBINED EFFECTS OF THE
MUCUS AND CILIARY SYSTEMS
It is important to distinguish between mucociliary transport
which is the movement of particles in an anatomically de_ned
location and mucociliary clearance which is the measure of
elimination of inhaled or insu/ated aerosols[

Figure 0[ The ciliary beat axis\ mean ciliary angle and the ciliary
deviation[ The ciliary axis is perpendicular to a line drawn through
the centres of the two central microtubules[ The angle subtended by
this line to an arbitrary reference point is averaged to determine the
mean ciliary angle\ and the SD gives the ciliary deviation[

MEASUREMENT OF MUCUS PRODUCTION AND ITS RHEO !

LOGICAL PROPERTIES
Measurement of the rheological properties of mucus is a well!
established _eld[85\86 The rheological properties of nasal mucus
are carefully matched to its biological function[ In the cat the
average tracheal mucus viscosity is 1372095 poises at a shear
rate of 0 s0 and recoverable shear strain 2[020[0 units at 099
dynes cm1[87 It has been suggested that these are optimum
parameters of viscosity and elasticity for mucociliary trans!
port\ but the normal levels for human nasal mucus are
unknown[ The quoted parameters for viscoelastic properties
do not have a directly comparable physiological function\ thus
it remains uncertain what changes in {spinnability|\ {shear
strain|\ {elastothixotropy|\ {pseudoplasticity|\ {creep|\ and
{adhesiveness| would have on mucociliary transport[ It is likely
that interaction of the cilia with mucus alters the dynamic
rheological properties of nasal mucus\ and thus mucus at the
cilial tips may have di}erent viscoelastic properties to that
which is carrying the mucus load[88\099
Machines have been built to measure certain properties of
mucus] the magnetic microrheometer\ the controlled stress
technique\ capillary viscometer\ the coaxial cylinder sensor
system[ From these machines\ di}erent properties of mucus
are measured\ but none correspond precisely to a de_nite
physiological function[ The harvesting of mucus samples and
their subsequent storage may well lead to alteration of their
chemical and rheological properties[ The measurement of the
0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285

Saccharin test
This involves placing a particle or solution of saccharin on
the anterior end of the inferior turbinate or nasal septum\
behind the area of slow anterior clearance[05 The method of
the test most commonly used is that described by Rutland
and Cole which is a modi_cation of Andersen|s original
description of the test[ A 0 mm diameter or quarter fragment
of a saccharin tablet is placed just behind the anterior end of
the inferior turbinate\ and the patient is asked to sit quietly
with their head forward\ not to sni}\ sneeze\ eat or drink[ The
time taken to the _rst perception of the sweet taste is the
saccharin clearance time[54
The saccharin dissolves in the mucus layer and presumably
the periciliary ~uid layer\ and is transported to the naso!
pharynx and the base of the tongue[ This is a useful screening
test\090 those with times greater than 59 min having sig!
ni_cantly disturbed mucociliary transport[ In these patients it
is necessary to con_rm their ability to taste saccharin[ The
average saccharin clearance time for an adult free from nasal
disease would be 604 min "see Table 0#[17\18\090094 In 31 pat!
ients who were starved and waiting to go to the theatre for
various non!nasal procedures and were free of any nasal dis!
ease the mean SCT was 02[2 min "range 4[221[4 min#[ From
this data it is likely that patients who have a saccharin clear!
ance time greater than 19 min have disturbed nasal muc!
ociliary transport[
It has been shown that saccharin clearance times show a

Table 0[ Saccharin clearance times for normal subjects

Author

No[
subjects

Mean SCT
"min#

Range

Corbo "0878#17
Coromina "0889#093
Yergin "0867#094
Stanley "0873#090
Stanley "0874#18
Moriarty "0880#092
Lale et al[ "0887#$

87
19
09
24
16
5
31

7
01 "SD\ 5#
09[7 "SD\ 2[1#
03[9 "SD\ 9[8#
00[6 "SD\ 2[7#
*
02[2 "SD\ 4[4#

013
*
4[506[0
*
*
600
*

 This is the median value for the SCT\ mean not quoted[
$ Present paper[

281 A[M[Lale\ J[D[T[Mason + N[S[Jones

diurnal variation\ being at their lowest between 96[99 and

02[99\ and being longest at 93[99[095 When the saccharin test
was compared with tracking times of a 149 mm anion resin
particle labelled with 88mTc there was a signi_cant negative
correlation\096 and this correlation was maintained with the
day to day variation in saccharin clearance times[
If the times for saccharin clearance are normal there is
probably no correlation with ciliary beat frequency\ though
the log value has been reported to correlate with frequency of
ciliary beat[097
Modi_cation of the saccharin clearance test has been
described where inert tracers such as ion exchange resin par!
ticles are coated with saccharin[ The authors argue that this
would measure the movement of the particle on the mucus
layer only[098 It would seem likely that some of the saccharin
will dissolve into the mucus and the periciliary ~uid and be
transported by di}usion in this layer\ but this would not be
faster than active movement of the periciliary layer towards
the tongue[
A study compared saccharin "soluble substance# clearance
times with the time for charcoal powder "insoluble# to appear
in the nasopharynx in subjects free from nasal disease[ The
charcoal powder was reported as the most reproducible
method of assessing nasal mucociliary clearance[009 In another
study comparing saccharin with other insoluble substances\
the insoluble substances are transported more rapidly through
the nose] saccharin\ 06[3 min^ charcoal powder\ 7[2 min[000
This suggests that the mucus layer is the most e}ectively
transported layer[
When using the saccharin clearance test it must be taken in
conjunction with the patient|s symptoms and proper exam!
ination of the nasal mucosa[ If the test is prolonged beyond
59 min then there is a likelihood that there is a signi_cant
defect in cilia or mucus[ If the test is prolonged beyond 19
min and there is treatable nasal disease then there is a possi!
bility that this could be improved by the adequate treatment
of the nasal disease[
Dye
Placing a dye such as indigo carmine097 on the anterior nasal
mucosa and measuring the time taken to appear in the oro!
pharynx\ provides a measure similar to that provided by the
saccharin clearance time[5\001\002 This is time!consuming for the
investigator who has to watch the oropharynx and requires
the subject to keep his mouth open for up to 19 min[
Stained vegetable charcoal powder has been studied in chil!
dren "age 201 years#\ this gave a mean time of 8[86 min\ and
there was no di}erence between the sexes or between lying
and standing[
Trackin` of intranasal radioisotopic particles
Proctor003 describes injecting a saline solution of mic!
roaggregated albumin labelled with iodine "I020# behind the
anterior end of the inferior turbinate and onto the ~oor of the

nose[ The radioactivity is tracked using parallel slit colli!

mators[ Using this apparatus the mean mucociliary transport
rate was estimated as 5 mm:min\ and he showed that a child
with cystic _brosis had de_cient mucociliary transport[
Studies have utilized radiolabelled single non!dispersible
particles such as 9[4!mm resin particles labelled with 2 mCi
technetium!88m placed on the superior surface of the inferior
turbinate or the nasal ~oor or the nasal septum[ The course
of these particles can be tracked through the nose using a
series of collimators and a scinticounter\ or a pinhole Anger
camera[00\05\004006
Gamma scinti`raphy
This provides the most physiological information about the
deposition\ dispersion and clearance of particles in the nose[
It follows the movement of many particles once they have
been deposited in the nasal cavity\ rather than the movement
of individual particles or the passage of a substance in solution
such as saccharin[ A gamma camera is able to track the move!
ment of particles that are inhaled\ sprayed or insu/ated into
the nose[ The radiolabelling is generally achieved by the incor!
poration of 88mTc or 000I into a particle of known size[ This
permits the study of the e}ects of particle size and the method
of delivery to the nose on the deposition and clearance of the
particle by the nasal mucosa[ The equipment and a radiation
protected room are not freely available to every clinical rhi!
nologist\ and this remains a research method for the study of
intranasal drug delivery[007
The radioactivity at the tip of the nose can be measured
after placing the particle behind the anterior end of the inferior
turbinate\ the fall in detected radioactivity is proportional to
the square of the distance from the nasal tip to the moving
particle\ using this method a speed of 4[2 mm:min "range 2[2
7[1 mm:min# has been calculated[008
The type of tracer used can make a di}erence to the speed
of transport in the nose\ seroalbumin labelled with Tc88 was
transported at 7 mm:min but pertechnetate labelled with Tc88
was transported at a speed of 4 mm:min[000 Tracking the
passage of radiolabelled particles through the nose provides
useful information regarding the handling of individual
particles\ but the equipment is expensive\ the patient has to
remain in a room suitable for radioactive materials\ and the
subject is exposed to radiation[
Radio`raphic method
Movement of radiopaque 0!mm diameter discs of Te~on
mixed with bismuth trioxide can be followed with a ~uo!
roscopic image intensi_er[094 The discs were 9[97 mm thick
and had an average weight of 0[65 mg[ This is a modi_cation
of a technique described for the trachea and bronchi[019 The
movement of the discs was displayed on a monitor\ and the
distance travelled was determined from a radiopaque scale
placed on the cheek[ This provides information about the
0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285

Mucociliary transport and its assessment 282

direction of travel of these particles\ but the subject is exposed

to radiation[
The method is reproducible at 04 min intervals\ and there
was no signi_cant variation over a 01 h period[094 The results
obtained were similar to those by the radioisotopic method\05
there were no variations with sex or age\ and no correlation
with saccharin clearance times[094

Mucociliary transport on isolated human nasal

mucosa
Mason010 has described using video image analysis to measure
particle movement on the surface of isolated human inferior
turbinates[ This allows the direct measurement of the muc!
ociliary transport rate and direction of graphite particles on
the surface of isolated mucosa[ This is largely a research tool\
and has no clinical application as yet[

Summary of the clinical assessment of patients

with suspected defective mucociliary transport
rate
In patients with symptoms and signs suggestive of defective
nasal mucociliary function\ the saccharin clearance test
remains the most straightforward method of assessing nasal
clearance[ Gamma scintigraphy is the most physiological test
of mucociliary clearance but the equipment is con_ned to
research units only[ If the measured time is less than twenty
minutes then the nasal mucociliary clearance can be assumed
to be normal[ Should the time be above 39 min\ then biopsy
should be performed to study the structure and orientation of
the cilia\ and the immune status of the patient investigated[
Tests should include levels of IgG\ and total immunoglobulin[
Should the time be between 19 and 39 min then any conditions
that appear treatable should be tackled either medically or
surgically and the test repeated[ If the clearance time is below
19 min then no further assessment is required[ Should the
clearance time be prolonged beyond 19 min despite adequate
medical or surgical treatment then the patient should be inves!
tigated for abnormal cilia and immune de_ciencies[
A su.ciently sensitive and reproducible way of measuring
the rheological properties of mucus has yet to be devised[ "see
Figure 1#[

References

Figure 1[ Flow chart for the management of patients with a suspected

disorder of mucociliary transport[
0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285

0 SILBERBERG A[ "0878# On mucociliary transport[ Biorheolo`y 16\

184296
1 LUCAS A[M[ + DOUGLAS L[C[ "0823# Principles underlying
activity in the respiratory tract[ II] A comparison of nasal clear!
ance in man\ monkeys and other animals[ Arch[ Otolaryn`ol[ 19\
407430
2 SAKAKURA Y[\ UKAI K[\ MAJIMA Y[ et al[ "0872# Nasal muc!
ociliary clearance under various conditions[ Acta Otolaryn`ol[
85\ 056062
3 TAKEUCHI K[\ SAKAKURA Y[\ MURAI S[ et al[ "0878# Nasal muc!
ociliary clearance in Sjogren|s syndrome[ Acta Otolaryn`ol[ 097\
015018
4 PROCTOR D[F[\ ANDERSEN I[ + LUNDQVIST G[ "0862# Clearance
of inhaled particles from the human nose[ Arch[ Int[ Med[ 020\
021028
5 HILDING A[ "0820# Ciliary activity and course of secretion cur!
rents in the nose[ Proc[ Mayo Clin[ 5\ 714727
6 YATES A[L[ "0813# Methods of estimating the activity of the
ciliated epithelium within the sinuses[ J[ Laryn`ol[ Otol[ 28\ 443
447
7 LUCAS A[M[ "0821# The nasal cavity and direction of ~uid by
ciliary movement in macacus rhesus "Desm[#[ Am[ J[ Anat[ 49\
030042
8 APP E[M[\ ZAYAS J[G[ + KING M[ "0882# Rheology of mucus and
transepithelial potential di}erence] small airway versus trachea[
Eur[ Respir[ J[ 5\ 5664
09 RUSZNAK C[\ DEVALIA J[L[\ LOZEWICZ S[ et al[ "0883# The assess!
ment of nasal mucociliary clearance and the e}ect of drugs[
Respir[ Med[ 77\ 78090
00 QUINLAN M[F[\ SALMAN S[D[\ SWIFT D[L[ et al[ "0858# Measure!

283 A[M[Lale\ J[D[T[Mason + N[S[Jones

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ment of mucociliary function in man[ Am[ Rev[ Respir[ Dis[ 88\

0212
MESSERKLINGER W[ "0855# Uber die Drainage der menscjlichen
Nebenhohlen unter normalen und pathologischen Bedingungen[
0[ Mitteilung[ Monatsschr[ Ohrenheilkd[ Laryn`ol[ Rhinol[ 090\
340345
MESSERKLINGER W[ "0856# Uber die Drainage der menschlichen
Nebenhohlen unter normalen und pathologischen Bedingungen[
1[ Mitteilun`[ Ohrenheilkd[ Laryn`ol[ Rhinol[ 090\ 202215
HILDING A[C[ "0821# Physiology of nasal mucus] experimental
work on accessory sinuses[ Am[ J[ Physiol[ 099\ 553561
INAGI K[ "0881# Histological study of mucus membranes in the
human nasal septum[ Nippon Jipiinkoka Gakai Kaiho[ 84\ 0063
0078
ANDERSEN I[\ LUNDQVIST G[R[ + PROCTOR D[F[ "0860# Human
nasal mucosal function in a controlled climate[ Arch[ Environ[
Health[ 12\ 397319
HILDING A[ "0821# Experimental surgery of the nose and sinuses[
I] Changes in the morphology of the epithelium following vari!
ations in ventilation[ Arch[ Otolaryn`ol[ 05\ 807
HIRSCH J[A[\ TOKAYER J[L[\ ROBINSON M[J[ et al[ "0864# E}ects
of dry air and subsequent humidi_cation on tracheal mucus
velocity in dogs[ J[ Appl[ Physiol[ 28\ 131135
SAKAKURA Y[ + PROCTOR D[F[ "0861# The e}ect of various
conditions on tracheal mucociliary transport in dogs[ Proc[ Soc[
Exp[ Biol[ Med[ 039\ 769768
AMITANI R[\ WILSON R[\ RUTMAN A[ et al[ "0880# E}ects of
human neutrophil elastase and Pseudomonas aeru`inosa pro!
teinases on human respiratory epithelium[ Am[ J[ Respir[ Cell
Mol[ Biol[ 3\ 1521
BERNSTEIN J[M[\ HARD R[\ CUI Z[D[ et al[ "0889# Human aden!
oidal organ culture] a model to study nontypable Haemophilus
in~uenzae "NTHI# and other bacterial interactions with naso!
pharyngeal mucosa*implications in otitis media[ Otolaryn`ol[
Head Neck Sur`[ 092\ 673680
FERGUSON J[L[\ MCCAFFREY T[V[\ KERN E[B[ et al[ "0877# The
e}ects of sinus bacteria on human ciliated nasal epithelium in
vitro[ Otolaryn`ol[ Head Neck Sur`[ 87\ 188293
SYKES D[A[\ WILSON R[\ GREENSTONE M[ et al[ "0876# Deleterious
e}ects of purulent sputum sol on human ciliary function in vitro]
at least two factors identi_ed[ Thorax 31\ 145150
WILSON R[\ ROBERTS D[ + COLE P[J[ "0874# E}ect of bacterial
products on human ciliary function in vitro[ Thorax 39\ 014020
MAURIZI M[\ PALUDETTI G[\ TODISCO T[ et al[ "0873# Ciliary
ultrastructure and nasal mucociliary clearance in chronic allergic
rhinitis[ Rhinolo`y 11\ 122139
MYGIND N[ "0871# Topical steroid treatment for allergic rhinitis
and allied conditions[ Clin[ Otolaryn`ol[ 6\ 232241
WATANABE K[ + WATANABE I[ "0872# Morphological alterations
a}ecting the microvasculature in nasal allergy[ Ann[ Otol[ Rhinol[
Laryn`ol[ 81\ 6963
CORBO G[ M[\ FORESI A[\ BONFITTO P[ et al[ "0878# Measurement
of nasal mucociliary clearance[ Arch[ Dis[ Child[ 53\ 435449
STANLEY P[J[\ WILSON R[\ GREENSTONE M[A[ et al[ "0874# Abnor!
mal nasal mucociliary clearance in patients with rhinitis and its
relationship to concomitant chest disease[ Br[ J[ Dis[ Chest[ 68\
6671
TAKASAKA T[\ SATO M[ + ONODERA A[ "0879# Atypical cilia of
the human nasal mucosa[ Ann[ Otol[ Rhinol[ Laryn`ol[ 78\ 2634
SAKAKURA Y[\ MAJIMA Y[\ SAIDA S[ et al[ "0874# Reversibility of
reduced mucociliary clearance in chronic sinusitis[ Clin[ Oto!
laryn`ol[ 09\ 6872
OHASHI Y[ + NAKAI Y[ "0872# Functional and morphological
studies on chronic sinusitis mucus membrane[ 0[ Reduced ciliary

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action in chronic sinusitis[ Acta Otolaryn`ol[ "Stockh[# 286

"Suppl[#\ 28
OHASHI Y[ + NAKAI Y[ "0872# Functional and morphological
studies on chronic sinusitis mucus membrane[ 1[ Functional and
morphological pathology of chronic sinusitis mucus membrane[
Acta Otolaryn`ol[ "Stockh[# 286"Suppl[#\ 0037
OHASHI Y[ + NAKAI Y[ "0872# Reduced ciliary action in chronic
sinusitis[ Acta Otolaryn`ol[ "Stockh[# 286"Suppl[#\ 28
MAJIMA Y[\ SAKAKURA Y[ + MATSUBARA T[ "0875# Possible
mechanisms of reduction of nasal mucociliary clearance in
chronic sinusitis[ Clin[ Otolaryn`ol[ 00\ 4459
NUUTINEN J[\ RAUCH!TOSKALA E[ + SAANO V[ "0882# Ciliary
beating frequency in chronic sinusitis[ Arch[ Otolaryn`ol[ Head
Neck Sur`[ 008\ 534536
MAJIMA Y[\ SAKAKURA Y[\ MATSUBARA T[ et al[ "0872# Muc!
ociliary clearance in chronic sinusitis] related nasal clearance and
in vitro bullfrog palate clearance[ Biorheolo`y 19\ 140151
HINNI M[L[\ MCCAFFREY T[V[ + KASPERBAUER J[L[ "0881# Early
mucosal changes in experimental sinusitis[ Otolaryn`ol[ Head
Neck Sur`[ 096\ 426437
FONTOLLIET C[ + TERRIER G[ "0876# Abnormalities of cilia and
chronic sinusitis[ Rhinolo`y 14\ 4651
BURGERSDIJK F[J[A[\ DE GROOT J[C[M[J[\ GRAAMANS K[ et al[
"0875# Testing ciliary activity in patients with chronic and recur!
rent infections of the upper airways] experience in 57 cases[ Lar!
yn`oscope 85\ 09180922
BERNSTEIN J[M[\ CROPP J[M[\ NATHANSON F[ et al[ "0889# Bio!
electric properties of cultured nasal polyps and turbinate epithelial
cells[ Am[ J[ Rhinol[ 3\ 3438
CAUNA N[\ HINDERER K[H[\ MANZETTI G[W[ et al[ "0861# Fine
structure of nasal polyps[ Ann[ Otol[ 70\ 3047
DJUKANOVIC R[ "0884# Nasal polyps] a model for chronic mucosal
in~ammation[ Clin[ Exp[ Aller`y 14\ 471474
LEE S[W[\ HARDY J[G[\ WILSON C[G[ et al[ "0873# Nasal sprays
and polyps[ Nucl[ Med[ 4\ 586692
WLADISLAVOSKY!WASERMAN P[\ KERN E[B[\ HOLLEY K[E[ et al[
"0873# Epithelial damage in nasal polyps[ Clin[ Aller`y 03\ 130
136
SCADDING G[K[\ LUND V[J[\ HOLMSTROM M[ et al[ "0880# Clinical
and physiological e}ects of ~uticasone propionate aqueous nasal
spray in the treatment of perennial rhinitis[ Rhinolo`y 00"Suppl[#\
2632
STANLEY P[J[\ GRIFFIN W[M[\ WILSON R[ et al[ "0874# E}ect of
betametasone and betametasone with neomycin nasal drops on
human nasal mucociliary clearance and ciliary beat frequency[
Thorax 39\ 596501
STAFANGER G[ "0876# In vitro e}ect of beclomethasone dipro!
pionate and ~unisolide on the mobility of human nasal cilia[
Aller`y 31\ 496400
VAN DE DONK H[J[M[\ MULLER!PLANTEM\ I[P[\ ZUIDEMA J[ et al[
"0879# The e}ects of preservatives on the ciliary beat frequency
of chicken embryo tracheas[ Rhinolo`y 07\ 008022
VAN DE DONCK H[J[M[ + MERKUS F[W[H[M[ "0870# Nasal
drops] do they damage ciliary movement< Pharmacy Int[ 1\ 046
047
VAN DE DONK H[J[\ ZUIDEMA J[ + MERKUS F[W[ "0870# The
e}ects of nasal drops on the ciliary beat frequency of chicken
embryo tracheas[ Rhinolo`y 08\ 104129
VAN DE DONK H[J[ + MERKUS F[W[ "0871# Decreases in ciliary
beat frequency due to intranasal administration of propanolol[
J[ Pharm[ Sci[ 60\ 484485
VAN DE DONK H[J[M[\ VAN DEN HEUVEL A[G[M[\ ZUIDEMA J[ et
al[ "0872# The e}ects of nasal drops and their additives on human
nasal mucociliary clearance[ Rhinolo`y 19\ 016026
PEDERSEN H[ + MYGIND N[ "0865# Absence of axonemal arms in

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the nasal mucosal cilia in Kartagener|s syndrome[ Nature 151\

383384
VEVAINA J[R[\ TEICHBERG S[ + BUSCHMAN D[ "0876# Correlation
of absent inner dynein arms and mucociliary clearance in a pati!
ent with Kartagener|s syndrome[ Chest 80\ 8084
AFZELIUS B[A[ "0865# A human syndrome caused by immotile
cilia[ Science 082\ 206208
ELIASSON R[\ MOSSBERG B[\ CAMNER P[ et al[ "0866# The immotile
cilia syndrome] a congenital abnormality as an etiologic factor
in chronic airways infections and male sterility[ N[ En`l[ J[ Med[
186\ 06
STURGESS J[M[\ CHAO J[\ WONG J[ et al[ "0868# Cilia with defective
radial spokes] a cause of impaired ciliary motility[ N[ En`l[ J[
Med[ 299\ 4245
STURGESS J[M[\ CHAO J[ + TURNER J[A[P[ "0879# Transposition
of ciliary microtubules] another cause of impaired ciliary motion[
N[ En`l[ J[ Med[ 292\ 207211
DE IONGH R[\ ING A[ + RUTLAND J[ "0881# Mucociliary function\
ciliary ultrastructure\ and ciliary orientation in Young|s
syndrome[ Thorax 36\ 073076
DUDLEY J[P[\ WELCH M[J[\ STIEHM E[R[ et al[ "0871# Scanning
and transmission electron microscopic aspects of the nasal acilia
syndrome[ Laryn`oscope 81\ 186188
WELCH M[J[\ STIEHM E[R[ + DUDLEY J[P[ "0873# Isolated absence
of nasal cilia\ a case report[ Ann[ Aller`y 41\ 2123
KARLSSON G[\ HANSSON H[A[\ PETRUSON B[ et al[ "0874# The nasal
mucosa in immunode_ciency] surface morphology\ mucociliary
function and bacteriology _ndings in adult patients with common
variable immunode_ciency or selective IgA de_ciency[ Acta Oto!
Laryn`olo`ica 099\ 345358
KNOWLES M[R[\ STUTT M[J[\ SPOCK A[ et al[ "0872# Abnormal
permeation through cystic _brosis respiratory epithelium[ Sci!
ence 110\ 09560969
RUTLAND J[ + COLE P[J[ "0870# Nasal mucociliary clearance and
ciliary beat frequency in cystic _brosis compared with sinusitis
and bronchiectasis[ Thorax 25\ 543547
RUTLAND J[\ PENKETH A[ + GRIFN W[M[ "0872# Cystic _brosis
serum does not inhibit human ciliary beat frequency[ Am[ Rev[
Respir[ Dis[ 017\ 09290923
KINOSITA H[ "0841# Response of a single cilium] stimulating e}ect
of isotonic KCl solution on a large abfrontal cilium of Mytilus[
Annot[ Zool[ Japon[ 14\ 703
HAN L[Y[\ WILSON R[ + SLATER S[ "0889# In vitro and in vivo
e}ects of ribavirin on human respiratory epithelium[ Thorax 34\
099093
DOLOVICH M[B[\ MAHONY J[B[\ CHAMBERS C[ et al[ "0881# Ciliary
function\ cell viability\ and in vitro e}ect of ribavirin on nasal
epithelial cells in acute rhinorrhoea[ Chest 091\ 173176
BONIN S[R[\ PHILLIPS P[P[ + MCCAFFREY T[V[ "0880# The e}ect
of arachidonic acid metabolites on ciliary beat frequency of
human nasal mucosa in vitro[ Acta Otolaryn`ol[ 001\ 586691
RUTLAND J[\ GRIFFIN W[ + COLE P[ "0870# Nasal brushings and
measurement of ciliary beat frequency[ Chest 79"Suppl[#\ 754
756
INGELS K[J[\ KORTMANN M[J[\ NIJZIEL M[R[ et al[ "0880# Factors
in~uencing ciliary beat measurements[ Rhinolo`y 18\ 0615
TORREMALM N[G[\ MERCKE U[ + REIMER A[ "0864# The muc!
ociliary activity of the upper respiratory tract[ Rhinolo`y 02\ 002
019
BLEEKER J[D[ + HOEKSEMA P[E[ "0860# A simple method to
measure the ciliary beat rate of respiratory epithelium[ Acta
Otolaryn`ol[ 60\ 315318
PROETZ A[W[ "0821# Motion picture demonstration of ciliary
action and other factors of nasal physiology[ Trans[ Am[ Laryn!
`ol[ Assoc[ 43\ 153162

0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285

65 IRAVANI J[ + MELVILLE G[N[ "0865# Mucociliary function in

the respiratory tract as in~uenced by physiochemical factors[
Pharmacol[ Ther[ B[ 01\ 360381
66 DEITMER T[\ BROER E[ + DURWEILER\ B[ "0878# Is inhalational
therapy noxious to the ciliated nasal epithelium< Rhinolo`y 16\
044048
67 DEVALIA J[L[\ SAPSFORD R[J[\ WELLS C[ et al[ "0889# Culture and
comparison of human bronchial and nasal epithelial cells in vitro[
Respir[ Med[ 73\ 292201
68 RUSZNAK C[\ DEVALIA J[L[\ SAPSFORD R[J[ et al[ "0882# In~uence
of circadian rhythms on ciliary beat frequency "CBF# of human
bronchial epithelial cells "HBEC#\ in vitro[ Thorax 37\ 345
79 DI BENDETTO G[\ MAGNUS C[J[\ GRAY P[T[ et al[ "0880# Calcium
regulation of ciliary beat frequency in human respiratory epi!
thelium in vitro[ J[ Physiol[ 328\ 092000
70 DALHAMN T[ + RYLANDER R[ "0851# Frequency of ciliary beat
measured with a photosensitive cell[ Nature 085\ 481482
71 VAN DE DONK H[J[M[\ ZUIDEMA J[ + MERKUS F[W[H[M[ "0879#
The in~uence of pH and osmotic pressure upon tracheal ciliary
beat frequency as determined with a new photo!electric regis!
tration device[ Rhinolo`y 07\ 82093
72 RUTLAND J[ + COLE P[J[ "0879# Noninvasive sampling of nasal
cilia for measurement of beat frequency and the study of ultra!
structure[ Lancet 1\ 453454
73 YAGER J[\ CHEN T[M[ + DULFANO M[J[ "0867# Measurement of
frequency of ciliary beats of human respiratory epithelium[ Chest
62\ 516522
74 KENNEDY J[R[ + RANYARD J[R[ "0872# Morphology and quan!
titation of ciliated outgrowths from cultured rabbit tracheal
explants[ Eur[ J[ Cell Biol[ 18\ 199197
75 TEICHTAL H[\ WRIGHT P[L[ + KIRSNER R[L[G[ "0875# Measure!
ment of in vitro ciliary beat frequency] a television video modi!
_cation of the transmitted light technique[ Med[ Biol[ En`[
Comput[ 13\ 082085
76 KENNEDY J[R[ + DUCKETT K[E[ "0870# The study of ciliary
frequencies with an optical spectrum analysis system[ Exp[ Cell[
Res[ 024\ 036045
77 LEE W[I[ + VERDUGO P[ "0866# Ciliary activity by laser light
scattering spectroscopy[ Ann[ Biomed[ En`[ 4\ 137148
78 VERDUGO P[\ HINDS T[R[ + VINCENZI F[F[ "0868# Laser light
scattering spectroscopy] preliminary results on bioassay of cystic
_brosis factors[ Paediatr[ Res[ 02\ 020024
89 ROMET S[\ SCHOEVAERT D[ + MARANO F[ "0880# Dynamic image
analysis applied to the study of ciliary beat on cultured ciliated
epithelial cells from rabbit trachea[ Biol!Cell[ 60\ 072089
80 GREEN A[\ SMALLMAN L[A[\ LOGAN A[C[M[ et al[ "0884# The
e}ect of temperature on nasal ciliary beat frequency[ Clin[ Oto!
laryn`ol[ 19\ 067079
81 COLE P[ "0842# Some aspects of temperature\ moisture and heat
relationships in the upper respiratory tract[ J[ Laryn`ol[ Otol[ 56\
338345
82 INGELSTEDT S[ "0845# Studies on conditioning of air in the res!
piratory tract[ Acta Otolaryn`ol[ 020"Suppl[#\ 079
83 RUTLAND J[\ DEWAR A[\ COX T[ et al[ "0871# Nasal brushing for
the study of ciliary ultrastructure[ J[ Clin[ Pathol[ 24\ 245248
84 DE IONGH R[ + RUTLAND J[ "0878# Orientation of respiratory
tract cilia in patients with primary ciliary dyskinesia\ bron!
chieotasis and in normal subjects[ J[ Clin[ Pathol[ 31\ 502508
85 AIACHE J[M[ + MOLINA C[ "0863# Methodes d|etude de la rheo!
logie des expectorations[ Biorheolo`y 00\ 264272
86 DAVIS S[S[ "0862# Techniques for the measurement of the rheo!
logical properties of sputum[ Bull[ Physiopathol[ Respir[ 8\ 3689
87 ADLER K[B[\ WOOTEN O[ + DULFANO M[J[ "0862# Mammalian
respiratory mucociliary clearance Arch[ Environ[ Health[ 16\ 253
258

285 A[M[Lale\ J[D[T[Mason + N[S[Jones

88 SLEIGH M[A[ "0889# Ciliary adaptations for the propulsion of

mucus[ Biorheolo`y 16\ 416421
099 SLEIGH M[A[\ BLAKE J[R[ + LIRON N[ "0877# The propulsion of
mucus by cilia[ Am[ Rev[ Res[ Dis[ 026\ 615630
090 STANLEY P[J[\ MACWILLIAM L[\ GREENSTONE M[A[ et al[ "0873#
E.cacy of a saccharin test for screening to detect abnormal
mucociliary clearance[ Br[ J[ Dis[ Chest 67\ 5154
091 ANDERSEN I[ + PROCTOR D[F[ "0872# Measurement of nasal
mucociliary clearance[ Eur[ J[ Respir[ Dis[ 53"Suppl[#\ 2639
092 MORIARTY B[G[\ ROBSON A[M[\ SMALLMAN L[A[ et al[ "0880#
Nasal mucociliary function] comparison of saccharin clearance
with ciliary beat frequency[ Rhinolo`y 18\ 062068
093 COROMINA J[ + SAURET J[ "0889# Nasal mucociliary clearance in
patients with nasal polyposis[ J[ Otolaryn`ol[ Relat[ Spec[ 41\
200204
094 YERGIN B[M[\ SAKETKHOO K[\ MICHAELSON E[D[ et al[ "0867# A
roentgenographic method for measuring nasal mucus velocity[
J[ Appl[ Physiol[ 33\ 853857
095 PASALLI D[\ BELLUSI L[ + LAURIELLO M[ "0889# Diurnal activity
of the nasal mucosa[ Acta Otolaryn`ol[ 009\ 326331
096 PUCHELLE E[\ AUG F[\ PHAM Q[T[ et al[ "0870# Comparison of
three methods for measuring nasal mucociliary clearance in man[
Acta Otolyn`ol[ 80\ 186292
097 DUCHATEAU G[S[M[J[E[\ GRAAMANS K[\ ZUIDEMA J[ et al[ "0874#
Correlation between nasal ciliary beat frequency and mucus
transport rate in volunteers[ Laryn`oscope 84\ 743748
098 DEITMER\ T[ "0875# A modi_cation of the saccharin clearance test
for nasal mucociliary clearance[ Rhinolo`y 13\ 126139
009 PASSALI D[\ BELLUSI L[\ BIANCHINI CIAMPOLI M[ et al[ "0873#
Experiences in determination of nasal mucociliary transport
times[ Acta Otolaryn`ol[ "Stockh[# 86\ 208212

000 ARMENGOT M[\ BASTERRA J[ + GARIN L[ "0889# Normal values

of nasal mucociliary clearance] comparison of various techniques
and substances[ Acta Otorrinolarin`ol[ Espanola 30\ 222225
001 EWART G[ "0854# On the mucus ~ow rate in the human nose[
Acta Otolaryn`ol[ 199"Suppl[#\ 0943
002 TREMBLE G[E[ "0837# Clinical observations in the movement of
nasal cilia[ Laryn`oscope 17\ 195109
003 PROCTOR D[F[ + WAGNER H[N[ "0854# Clearance of particles
from the human nose[ Arch[ Environ[ Health[ 00\ 255260
004 ANDERSEN I[B[\ LUNDQVIST G[R[ + PROCTOR D[F[ "0861# Human
nasal mucosal function under four controlled humidities[ Am[
Rev[ Respir[ Dis[ 095\ 327338
005 ANDERSEN I[\ CAMNER P[\ JENSEN P[L[ et al[ "0863# Nasal clear!
ance in monozygotic twins[ Am[ Rev[ Respir[ Dis[ 009\ 290294
006 ANDERSEN I[\ CAMNER P[\ JENSEN P[L[ et al[ "0863# A comparison
of nasal and tracheobronchial clearance[ Arch[ Environ[ Health[
18\ 189182
007 DAVIS S[S[\ HARDY J[G[\ NEWMAN S[P[ et al[ "0881# Gamma
scintigraphy in the evaluation of pharmaceutical dosage forms[
Eur[ J[ Nucl[ Med[ 08\ 860875
008 DE ESPANA R[\ FRANCH M[\ GARCIA A[ et al[ "0875# Measurement
of nasal mucociliary transport rate in normal man[ Rhinolo`y 13\
130136
019 FRIEDMAN M[\ STOTT F[D[\ POOLE D[O[ et al[ "0866# A new
roentgenographic method for estimation mucus velocity in
airways[ Am[ Rev[ Respir[ Dis[ 004\ 5661
010 MASON J[D[T[\ ASPDEN T[J[\ ADLER J[ et al[ "0884# Measurement
of nasal mucociliary transport rates on the isolated human
inferior turbinate[ Clin[ Otolaryn`ol[ 19\ 429424

0887 Blackwell Science Ltd\ Clinical Otolaryn`olo`y\ 12\ 277285