*2.1.1 Sampling*

*Rhinosinusitis*

the underlying tonaca propria by a basal membrane. In the context of the tonaca propria, we can find three layers. At the beginning, just below the basement membrane, we can find the lymphoid layer, which is characterized by the richness of lymphocytes (nasal-associated lymphoid tissue (NALT)). Then we have the glandular layer, characterized by glands that have a significant immune function producing secretions rich in lysozyme and IgA. Last, we can find the vascular layer, characterized by important

This brief description of microscopic anatomy of the nasal mucosa allows us to

The pathology of the rhinosinusal district appears to be varied and diversified [2], and it is characterized by many different types of clinical entities that sometimes are present individually, sometimes they overlap: this creates, in our opinion, classification difficulties. Another critical aspect for clinicians is to understand the real extent of rhinosinus disease, that is, if we are dealing with an exclusively nasal

Our experience has led us to use in diagnosis of a rhinosinusopathy both a cytological examination of the nasal mucosa that will allow us to identify the problem and a radiological study (better if using cone beam CT) to define the real extent of the problem. In this discussion we will explain how to perform a cytological examination and how to interpret it, and we will try to define a systematic classification of rhinopathies relying on the analysis of cytological compartments of patients affected by

For about 10 years, we have been analyzing cytological samples from the lower turbinate mucosa in patients with chronic rhinopathies. This type of evaluation allowed us to study the microscopic characteristics of the healthy nasal mucosa and to identify the characteristic aspects of the different forms of rhinopathy. Performing a cytological examination is simple, rapid, and minimally invasive. It is

From October 2013 to September 2018, we performed cytological sampling and subsequent microscopic analysis on the sample obtained from 300 patients with chronic rhinopathy. These patients reported suffering from several months or even years of nasal respiratory obstruction, rhinorrhea, in some cases complaining of

The cytological examination of each patient was performed according to the Italian Academy of Nasal Cytology (AICNA) procedures. We briefly summarized

recurrent headache or hyposmia or sneezing and nasal itching.

First of all, in the respiratory epithelium, the mucociliary clearing action is carried out thanks to the cooperation of ciliated and muciparous cells. This process is fundamental in determining the circulation of mucus, and therefore it performs a nasal cleaning with immuno-protective tasks [3]. At the level of the superficial mucous layer (thanks to the presence of lymphatic tissue) and at the level of the intermediate glandular layer (thanks to the secretion of lysozyme and IgA), immunocompetence functions are also performed. At last, the vascular layer, thanks to the presence of cavernous tissue, allows to change the physical-chemical characteristics of the air inhaled before its passage in the middle and lower respiratory tract [2]. With the passage of air through the nasal cavities, water vapor is transferred through the mucosa of the inferior turbinates with consequent lowering of oxygen partial pressures [4]. Furthermore, due to the contact between the mucosal surface

vascular representation, especially in the mucosa of the inferior turbinate [2].

highlight the many important physiological functions it performs.

of the turbinate and the air, the heating of the same is ensured [5].

or sinus involvement or an involvement of both districts.

rhinopathy from our Center in the last 5 years.

**2. Materials and methods**

also a cost-effective investigation.

the modalities in the following paragraph.

**30**

Through a small spoon called Rhino-Probe®, we collect mucous material joined to cells of the nasal mucosa, exerting a slight pressure on the body of the inferior turbinate. This technique is called nasal scraping (there are other sampling techniques such as brushing, nasal swab, and the washing that we report but of which we have no experience).
