Rhinocytology Analysis for Chronic Rhinitis in Children: An Allergist’s Perspective

Nasal mucus cytology (rhinocytology) is a simple and non-invasive diagnostic method that can help doctors identify rhinitis phenotypes and clarify the diagnosis in patients with protracted rhinitis (runny nose and/or nasal congestion for more than 3 weeks). Aim of the work is to evaluate rhinocytology data in children referred by otolaryngologists to an allergist-immunologist to clarify the causes of protracted rhinitis. Study design and conditions: a one-time retrospective study of children with protracted rhinitis observed in Moscow Children’s Clinic No. 94 in the period 2022—2023. The analysis of rhinocytology results was carried out based on the data from the EMIS database. Material and methods. The study included data from 344 rhinocytograms obtained from patients aged 2—18 years with persistent rhinitis (runny nose/nasal congestion for more than 3 weeks) referred by otolaryngologists for consultation with an allergist-immunologist in the period from October 1, 2022 to June 30, 2023. Exclusion criteria: acute respiratory inflammatory diseases; acute inflammatory process in the paranasal sinuses; nasal polyps; curvature of the nasal septum; previously undiagnosed (not confirmed by allergological examination) diagnoses of seasonal, episodic or year-round allergic rhinitis in the patient; grade 2—3 adenoids, as well as acute or chronic rhinosinusitis according to examination and X-ray examination (or computed tomography of the paranasal sinuses). Results. Analysis of rhinocytograms in children with symptoms of prolonged rhinitis allowed us to identify two main types of changes in the cellular composition of nasal mucus: 1). cytological profile of non-allergic rhinitis, characterized by an increase in the number of inflammatory cells: neutrophils and / or lymphocytes (from a moderate amount to — completely in the field of vision with a normal level of eosinophils) — in 56.6% of cases; 2). cytological profile of mixed rhinitis with an increase in the level of inflammatory cells in combination with hypereosinophilia of more than 15% in the field of vision — in 10.6%. From the mixed rhinitis group (n=36), 2 patients had large accumulations of flora (bacteria) in the rhinocytogram in combination with an increased number of eosinophils. In 28.4% of children, significant changes in the rhinocytogram were not found. In 4.4% of cases, the material for research was insufficient. Overall, infectious-type pathological changes were significantly more common among the examined patients (59.3% 95% CI: 54.0—64.6), while mixed-type changes were 5 times less common (10.9% 7.6—14.3%, p<0.001). Conclusions. According to rhinocytograms, the majority of children with persistent rhinitis referred by otolaryngologists to an allergist-immunologist had infectious-type inflammation, while mixed-type cytological changes were less common. Rhinocytograms can assist physicians in diagnosing allergic and non-allergic rhinitis, clarifying the type of inflammatory changes in the nasal cavity, and optimizing treatment for children with persistent rhinitis.