NASAL CELL SMEARS 



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NASAL CELL SMEARS 



condition. Hansel, F. K., St. Louis: 

 C. V. Mosby Co., 1936, gives a useful 

 scheme on page 380 for recording the 

 cytology of nasal secretions similar to 

 that used in the recording of skin tests. 

 In view of the irregularitj- of distribu- 

 tion of the cells and the amount and 

 type of secretions, it is difficult to de- 

 termine the cells in percentages. Long 

 personal experience in the observation 

 of smears and in the correlation of them 

 with clinical symptoms is of the utmost 

 value. The smears should be repeated 

 in the same patient in order to obtain 

 a complete picture of the sequence of 

 events. In estimating the numbers of 

 neutrophiles in the secretion, it must be 

 realized that when acute or chronic in- 

 fections complicate allergic responses, 

 the neutrophiles outnumber the eosino- 

 philes in the secretion about 10 to 1. 

 In seasonal hay fever, however, un- 

 complicated by infection, there may be 

 a few neutrophiles along with squamous 

 epithelial cells, but the major cellular 

 response will be eosinophilic. Some 

 cases of hay fever show a response of 

 mononuclears with coarse blue granules 

 filling the cell and nearly obscuring the 

 nucleus. Their actual significance is 

 still unknown. A criticism of Hansel's 

 scheme is that it does not take into con- 

 sideration the other cellular elements 

 besides eosinophiles and neutrophiles. 

 The type, color, quantity and consist- 

 ency of the secretion should be included 

 and correlated with clinical symptoms, 

 but the macroscopic appearance cannot 

 be relied upon as an indication of the 

 microscopic cellular contents of the se- 

 cretion. The smears must also be ex- 

 amined for the presence of microorgan- 

 isms and the tj'pes of epithelial cells 

 should be carefully studied. 



Smears from normal noses may or 

 may not show a few scattered neutro- 

 philes. A small amount of thin mucus 

 is usualljr present with some squamous 

 epithelial cells. Ciliated cells are seen 

 if they have been wiped from the nose 

 with the applicator. In the normal 

 nose they are rarely exfoliated. 



In cases of nasal polyps, eosinophiles 

 usually are predominant; but repeated 

 studies of the secretions are necessary 

 to determine whether or not complicat- 

 ing acute or chronic infection is present. 

 If a marked predominance of neutro- 

 philes persists, a chronic infection is 

 present. The cytology of nasal polypi 

 is fully discussed by Walsh, T. E., and 

 Lindsay, J. R. (Arch. Otolaryng., 1934, 

 20, 649). Stagnation and secondary 

 infection are frequently present inthese 

 cases, since polypi cause obstruction in 

 the nose and a resultant neutrophilic 



response. A single failure to find eosin- 

 ophiles in a smear does not rule out the 

 existence of an allergic condition, but 

 repeated failures to demonstrate eosin- 

 ophiles usually means that an active 

 nasal allergy is not present. 



The differentiation of an allergic 

 rhinitis from a common cold may at 

 times be difficult clinicall3^ In these 

 cases microscopic examination of the 

 secretions is helpful; but nevertheless, 

 even with cases of acute upper respira- 

 tory infections in non-allergic patients, 

 the eosinophilic response is so marked 

 that it may closely approach the num- 

 ber found in allergic individuals during 

 an infection. In the non-allergic per- 

 sons the eosinophiles may disappear 

 before the neutrophiles but not in many 

 of them. In allergic persons, the eosin- 

 ophiles often increase as the neutro- 

 philes disappear, but these differences 

 are uncertain. Acute allergic exacer- 

 bations may so closely resemble com- 

 mon colds that in numerous intances, 

 even microscopically, it is difficult to 

 distinguish between them unless re- 

 peated consecutive smears are examined 

 throughout the course of the condition. 

 Hilding, A. C. (Tran. Amer. Laryngol. 

 Assoc, 1934, 253-271) carefully studied 

 fresh unstained nasal secretions from 

 common colds in adults and noted that 

 ciliated columnar cells were shed in the 

 exudates during the first few days of the 

 infection. More recently Bryan, W. 

 T. K. and Brvan, M. P. (The Larvngo- 

 scope, 1950, 60, 523-531) applied the 

 staining technique of Papanicolaou to 

 nasal secretions. In a series of upper 

 respiratory infections, in which the 

 secretions were examined at timed 

 intervals during the course of the in- 

 fection, it was possible to chart a de- 

 generative pattern of change exhibited 

 by the ciliated columnar epithelial cells. 

 These changes suggest virus etiology. 

 In seasonal allergic hay fever the ex- 

 foliation of the ciliated columnar cells 

 and their degenerative patterns of 

 change have thus far not been observed. 

 Smears from these cases reveal that 

 large numbers of clumped or grouped 

 eosinophiles are significant when they 

 are not complicated bj^ infection. 

 Ciliated epithelial cells are of rare 

 occurrence, but some basal and squa- 

 mous epithelial cells are frequently 

 encountered. Consequently exfoliation 

 of the ciliated columnar epithelial cells 

 in acute upper respiratory infections 

 may have diagnostic value. 



Within the last few years cytological 

 studies of nasal diseases have been ex- 

 tended by use of the smear technique to 

 include diagnostic information in regard 



