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Nasal secretory eosinophilia was evaluated in inflammatory chronic rhinitis by a cytometric method. Thirteen control subjects and 97 patients (nasal polyps = 44; chronic sinusitis = 26; chronic rhinitis = 27) took part in this study. Secretory eosinophilia was low in the control group (0.3 +/- 0.2 to 1.3 + 0.8%), compared to: 13.8 +/- 8.2 to 15 +/- 7.6% in idiopathic chronic rhinitis, 16.3 +/- 7.3 to 22.7 +/- 10.2% in perennial allergic rhinitis, 18.5 +/- 6 to 25.3 +/- 6.1% in nasal polyps, 23.1 +/- 1.1 to 25.9 +/- 8.6% in nasal polyps with asthma, 27.3 +/- 7.1 to 30.3 +/- 7.8% in aspirin triad. The NARES syndrome was clearly individualized with a secretory eosinophilia between 48 +/- 16.9 and 58.8 +/- 10.7%. Nasal cytometry is a new method that confirms the role of secretory eosinophilia as an interesting marker in the study of inflammatory chronic rhinitis. Nevertheless reference values would be established only after a better knowledge of cell kinetics in nasal secretion under normal and pathological conditions.

The mucus membranes of the nasal chambers may be compared to a local immune system which has been called the NALT. The submucosa contains a lymphoid infiltration of T-helpers, T-suppressors and a set of plasma cells capable of synthetizing four IgG subgroups, IgM, IgA and IgD. The IgA plasma cells are most numerous. There is no local synthesis of IgE. Macrophages and langerhans' giant cells are present. The epithelium is an immunological entity which is composed, in addition to secretory cells, of uliated cells, lymphocytes, and M cells. The epithelium is able to synthesize secretory component and allows the transport of IgA and IgM into the secretions. The NALT has multiple immunological functions: antigenic information, humoral immune response, and expression of local cellular immunity. Modifications in T lymphocyte subpopulations are observed in allergic rhinitis. Secreted interleukins modify the local efflux and affluence of effector cells (mastocytes and eosinophils). Abnormalities of the NALT are characteristic of deficiency in humoral IgA and IgG subgroups. The possible presence of alterations of cellular immunity in chronic rhinosinusitis has been suggested.

The authors propose a method, simple and practical, for quantitative cytological analysis of nasal secretions. A representative sample of secretions was collected in each nasal cavity by the washing-blowing technic. Homogenization using mucolytics was the first step in the laboratory. After cytocentrifugation and May-Grundwald-Giemsa staining, the light microscope (x 100) was used for the differential leukocyte count. The two factors Friedman's test (sample and experimentation) showed no analytic variability of the measure (p less than 0.05) for the analysed parameters. 534 specimens were obtained on 254 patients and 13 control subjects. All the parameters could be analysed for the two nasal cavities on 127 patients (47.6%), for only one nasal cavity on 62 patients (23.2%), at all 189 positive results (70.8%). The mean volume collected after a 7 ml washing-blowing test was 5 ml. The total leukocyte count varied between 6,833 +/- 1,424 and 44,638 +/- 31,226 per ml in the control group, between 125,246 +/- 36,108 and 498,245 +/- 367,328 per ml in the patient group. The mean eosinophil count varied between 0.3 +/- 0.2% and 1.3 +/- 0.8% in the control group, between 15.1 +/- 2.4% and 18.2 +/- 2.6% in the patient group. The neutrophil count was over 90% in the control group, between 75 and 80% in the patient group. The mean lymphocyte count was about 5% in the two groups, the monocyte count about 1%. So the washing-blowing technic enables a quantitative analysis of nasal secretions. Nasal cytometry seems to be an interesting method for studying the inflammatory secretory cells compartment.(ABSTRACT TRUNCATED AT 250 WORDS)

Nose and sinus pathology is frequently related to a chronic inflammation, the mechanisms of which involve different cell types that form the MALT, or effector cells. B-lymphocytes are three times more numerous than the T-lymphocytes, where the CD4+ cells predominate over the CD8+ cells. IgA's are mainly secreted by the plasmocytes. In IgA deficiency, a relative increase in IgG or IgD plasmocytes has been recorded. Antigenic information is obtained from cells presenting the antigen. Langerhans-like cells have been described. Two different populations of mast cells have been identified, whilst on the contrary eosinophilic cells are normally absent. The particularities of capillary vascularization and the extent of the nerve fibre network contribute to the creation of a micro-environment interacting with the lymphocytes. The phenomena of cellular interaction are described through the dynamic evolution of the IgE-dependent response in allergic rhinitis.

The authors propose a method for the investigation of the muco-ciliary function of the nasal mucosa: they record the motion of radioactive particles, which are put by sonic nebulisation on nasal mucosa. The average speed is calculated by means of the analysis of sequential images and by the study of the variation of activity in relation to time in several main zones. A half-clearing time of the initial activity is also measured. The average speed is 8.33 mm/minute for normal persons and 2.36 mm/minute for a group of patients. This simple, accurate, non aggressive method is used for pharmacodynamic tests.

Immunohistological investigations were performed on a series of samples from 37 patients with nasal polyps, 22 with chronic sinusitis, and 15 controls with healthy nasal and sinusal mucosa. Mean numbers of plasma- and mast cells were not different in the various groups. Immunoglobulin isotypes were always predominantly IgA and IgM; IgE were scarce. Deposited immune complexes were always absent. A statistically significant difference, however, was observed in the number of eosinophils within the mucosa. Patients with nasal polyps had up to ten times more eosinophils per surface unit than patients with sinusitis or healthy mucosa.