Noninvasive <i>in vivo</i> Observation of Sinonasal Ciliary Activity by Endomicroscopy-a Pilot Study in Human Subjects

Ciliary activity is vital to mucosal health, but practical methods to evaluate ciliary activity in the outpatient setting are lacking. This study developed a method for the in vivo clinical observation of sinonasal ciliary activity by nasal endoscopy during/after endoscopic sinusitis surgery. An endomicroscope has been developed in which one NTSC pixel of the screen is 2.4x2.6 μm in size, by equipping a conventional rigid nasal endoscope with a newly developed zoom attachment. The device was used to observe mucous fluid wave reflections (MFWRs), namely specular reflections of the endoscopic light by waves produced by cilia beating on the nasal mucosa, in ten subjects who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis at an outpatient clinic. MFWRs were videorecorded, and the endomicroscopic images were used to subjectively evaluate the intensity of MFWRs on a scale of 0 to 5 during ESS and during a follow-up period of up to six months after surgery. MFWRs were observable in three patients on the surface of edematous mucosa and in four patients on the polypoid mucosa. MFWR intensity did not consistently increase after surgery. In conclusion, we developed an endomicroscope which allows noninvasive observation and videorecording of MFWR patterns indicative of ciliary activity on human nasal mucosa. This device is compatible with other rigid endoscopes and represents a potentially useful tool for routine outpatient examination.