Nasal ciliary studies in children with chronic respiratory tract symptoms

Ciliary abnormalities include a range of morphological dysfunctions resulting in dysmotility. These typically manifest with upper and lower respiratory symptoms later in the infancy and early childhood. The diagnosis is based on ciliary studies i.e. measurement of ciliary beat frequency (CBF). We present a series of 67 children who had nasal biopsy and ciliary studies done between 1993-2002. There were 44 boys and 23 girls of age between 1 to 17 years. In 49 (73%) cases indication of ciliary studies was chest symptoms. There were six diagnostic categories: asthma, recurrent chest infections, bronchiectasis, rhinosinusitis, dextrocardia and prematurity. Fourteen patients (20%) had dextrocardia and of these 9 had no measurable beating cilia. In the rest 5 CBF ranged 8-12.7 Hz. If the patients with dextrocardia are excluded, 5 of the 53 (10%) did not have any ciliary activity and in remaining CBF ranged 5.3-19.7 Hz. Our results showed a significant number of children with immotile cilia had associated dextrocardia. In the absence of situs inversus index of suspicion should be very high to detect these cases early. Otolaryngologists can play a key role in diagnosis because of an easy access for nasal biopsy, which is much simple than bronchial biopsies.