The Effect of Isotonic Saline Nasal Irrigation to

Mucociliary Transport Time on Traffic

Volunteer Officers in Surakarta

Mohammad Arifianto1, Donny Hendriyanto1, Sarwastuti Hendradewi1,2,

Putu Wijaya Kandhi1
1. Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine,
Sebelas Maret University/ dr. Moewardi Hospital Surakarta, Indonesia
2. Doctoral Program in Public Health, Sebelas Maret University, Surakarta, Indonesia
Corresponding Author : donny.hendriyanto@yahoo.co.id

ABSTRACT
Introduction: The traffic volunteer officer duty is to help the police officers control the
traffic congestion in Surakarta city. These officers do their work 6-8 hours every day in
contaminated and dusty air environments, therefore harmful particles can be inhaled
through the respiratory tract. Isotonic saline nasal irrigation enhances the nasal mucosa
ability to resist infectious agents, inflammatory mediators, and irritants, through direct
cleansing of irrigation, removal of inflammatory mediators and improved mucociliary
function. The study aims to investigate the effect of isotonic saline nasal irrigation on
mucociliary transport time in traffic volunteer officers.
Methods: This is pre-experimental study with a one-group pretest-posttest design that
conducted on 51 male traffic volunteer officers in Surakarta, who had met the inclusion
and exclusion criteria. The study was conducted between May 1 st - June 1st 2018 at
Surakarta police officer. Mucociliary transport time was measured with a saccharin test
before and after 2 weeks of nasal irrigation with isotonic saline solution. The data
obtained were tested for normality using the Kolmogorov-Smirnov test, then for
hypothesis test used Paired samples t-test or Wilcoxon signed-rank test.
Results: The most age group was found at 45-60 years old (49%), and the majority of the
traffic volunteer officers have a working period of 6-10 years (47,1%). Before isotonic
saline nasal irrigation, the mean mucociliary transport time in traffic volunteer officers is
10.67 + 2.63 minutes. After two weeks of isotonic saline nasal irrigation, the mean value
decreased to 7.96 + 2.16 minutes. The mucociliary transport time has found significantly
decreased after isotonic saline nasal irrigation (p<0,001).
Conclusion: Isotonic saline nasal irrigation improves mucociliary transport by decreasing
the mucociliary transport time in traffic volunteer officers.
Keywords: traffic volunteer officers; mucociliary transport time; isotonic saline nasal
irrigation
INTRODUCTION Traffic volunteer officers (Supeltas) every
The traffic volunteer officer duty is to help day spend 6 to 8 hours to help regulate traffic.
the police officers control the traffic congestion The location of work posts is spread in several
in Surakarta city. These officers do their work areas, especially on crowded streets. Protective
every day in contaminated and dusty air devices (masks) are very rarely used6.
environments, therefore harmful particles can be Nasal irrigation is an easy technique to
inhaled through respiratory tract 1. Heavy traffic maintain the hygiene of the nose and sinonasal
and a high level of industrial development, by using a saline solution. Isotonic saline nasal
causing air pollution that to be the main problem irrigation enhances the nasal mucosa ability to
of environmental health in urban areas2. resist infectious agents, inflammatory mediators
and irritants, through direct cleansing of
Air pollution in Surakarta city tends to irrigation, removal of inflammatory mediators
increase every year. In 2017, the results of and improved mucociliary function7,8,9.
measurements of air pollution by the Surakarta Is there an effect of isotonic saline nasal
City Environment Agency, with an average NO2 irrigation to mucociliary transport time in traffic
levels was 45.4 μg/Nm3, where the highest level volunteer officers.
were obtained on Jl.Adisucipto in front of the
Manahan stadium with a value of 119.56 METHODS
μg/Nm3. Pollution components especially ozone,
The study was pre-experimental with one
dust particles, and sulfur dioxide have an
group pretest-posttest design. The population of
inflammatory effect on the airway which
this study was the Traffic Volunteer Officer
increases membrane permeability, thereby
(Supeltas) in Surakarta. This research was
facilitating the penetration of allergens and
conducted between May 1st - June 1st, 2018 at
irritants in the mucous membrane and
Surakarta police officer. The sampling technique
interactions with the immune system cells2,3.
in this study is total sampling. The study sample
There is a first body defense mechanism on
was all Traffic Volunteer Officers who working
the airway in the nose, called a mucociliary
help regulate traffic. The independent variable is
transport system. The mucociliary transport
nasal irrigation of isotonic saline solution, while
system is very important, because it functions to
the dependent variable is the time of mucociliary
keep the upper airways clean by carrying inhaled
transport.
particles such as dust, bacteria, viruses, allergens
The following are the operational definitions
and other toxins that are caught in the mucous
of the research : Nasal irrigation with isotonic
layer to the nasopharynx to be swallowed or
saline solution is the act of flowing a solution
coughed. Disruption of the mucociliary transport
that has a concentration of solute which is equal
system will cause disruption to the cleaning of
to the concentration in the cell into the nose. The
the particles, so that the contact of the particles
solution used is 0.9% NaCl. The measurement
with the nasal mucosa becomes longer. This
results are categorized into 2, namely pretest and
condition can cause inflammation or ulceration
posttest. Measuring scale is nominal.
of the nasal mucosa directly1,4.
Mucociliary transport is the movement of
The mucociliary transport time of
cilia to move the mucous component of the
motorcycle riders who drive for 8-12 hours a day
mucus towards the nasopharynx. The time of
has an extension of the normal value
mucociliary transport measured by saccharin
(> 12 minutes) in 32% of samples and
testing was recorded from the start of saccharin
occupations that have a high risk of exposure to
placed under the inferior turbinate until it felt
traffic pollution taxi drivers and bus drivers who
sweet. Measuring instrument using stop watch.
work in the environment with air pollution for a
long time5.
The measurement results are minutes. Measuring normally distributed, the Wilcoxon test is
scale is numeric. performed to test the hypothesis. Data processing
Sample included in the study were those is done by using computer program SPSS version
who meets the inclusion criteria and exclusion 22.0 for Windows.
criteria. Criteria inclusion is all Traffic Volunteer
Officers and willing as research subject. Patients RESULT
with septum deviation grade III, diabetes This research has been conducted on
mellitus, mass in the nose, history of nose and 54 respondents of Traffic Control Volunteers
sinus surgery in the short term (less than 3 (Supeltas) in the Surakarta City area. Found
months), and patient immunocompromized, to be 3 respondents dropped out so the number of
excluded from this study. samples until the end of the study was
Phone number of samples are recorded and 51 people. Three respondents who dropped out
recorded to control sample compliance. The were due to 2 respondents not attending the
saccharin test after nasal irrigation and
Characteristics Frequency Percentage
1 respondent refused to undergo a second
Age
saccharin test (after 14 days of nasal irrigation).
20 - 35 yo 8 15.7%
35 - 45 yo 16 31.4% Table 1. Overview of Basic Characteristics of
Research Subjects
45 - 60 yo 25 49.0%
> 60 yo 2 3.9% Based on table 1, it is known that the
Gender majority of Traffic Control Volunteers (Supeltas)
Male 51 100.0% are 45-60 years old, namely 25 people (49.0%),
Female 0 0.0% and at least> 60 years of age are 2 people (3.9%).
The results of this study also showed that Traffic
Length of work
Control Volunteers were all male. The majority
0-5 y 17 33.3%
of respondents were Traffic Control Volunteers
6-10 y 24 47.1% with a working period of 6-10 years, namely 24
11-15 y 10 19.6% people (47.1%), and at least 11-15 years of work.
sample is examined by the nose and throat and a The normality test in this study is used to
saccharin test is performed. Saccharin is placed determine the statistical test used because the
at the bottom of the inferior turbinate until it data is on a numerical scale if the data is
feels sweet. normally distributed then the different test pairs
After that, the sample was taught how to do using the paired sample t-test. If the data is not
nasal irrigation with a pot containing 0.9% NaCl. normally distributed using the Wilcoxon test.
The nasal saline was administered with isotonic Data is said to be normally distributed if the
saline (0.9% NaCl) for 2 weeks, two days a day value is p> 0.05. The results of the normality test
time. After 2 weeks a repeat mucociliary can be seen in the Kolmogorov-Smirnov test as
transport examination was performed with the follows.
saccharin test. Then data collection and data The Kolmogorov-Smirnov test results
analysis were carried out. obtained p value = <0.001, which means that in
The data normality test was carried out by a this study the distribution of mucociliary
Kolmogorov-Smirnov test. If the test results are transport data for the pretest and posttest nose
obtained p-value <0.05, then the data is said to was not normally distributed, so the hypothesis
have an abnormal distribution. Conversely, if the test used was the Wilcoxon test.
value of p> 0.05, then the data has a normal
distribution. If the data is normally distributed, Table 2. The effect length of work with
the hypothesis test used is t-paired. If data is not mucocilliary transport time
 Lenght of Mucocilliary Transport Time Table 4. Impact Using Nasal Irrigation with
p
work (Mean+SD) Mucociliary Transport Time on Lenght of Work
0-5 y 9,65 + 2,45 minutes 0,007
Mucociliary Transport
6-10 y 10,46 + 2,48 minutes Lenght of Time (minutes) p
11-15 y 12,90 + 2,08 minutes work
Pretest Posttest
NB : Kruskal Wallistest
0-5 y* 9,65 +2,45 7,35 +2,12 <0,001
Based on table 2, it is known that 6-10 y* 10,46 +2,48 7,75 +2,07 <0,001
respondents with 0-5 years of work obtained
11-15 y** 12,90 +2,08 9,50 +1,90 <0,001
an average mucociliary transport time of
9.65 ± 2.45 minutes. Then respondents with NB : * Wilcoxon Rank Test
** Paired t test
a working period of 6-10 years had
an average mucociliary transport time of
Based on table 4, it is known that the
10.46 ± 2.48 minutes, and respondents with a
respondents with a working period of 0-5 years,
working period of 11-15 years with an average
6-10 years and 11-15 years experienced
mucociliary transport time of 12.90 ± 2.08
a decrease in mucociliary transport time with
minutes, with thus it can be seen that the longer
a value of p <0.001, which means that the
exposure to smoke of vehicles that are assessed
treatment using nasal wash with isotonic saline
with a long working period can extend the time
solution has an effect on decreasing transport
of mucociliary transport. The results of the
time mucociliary is good for respondents with a
statistical test get a value of p = 0.007 which
working period of 0-5 years, 6-10 years and
means that the effect of length of work on
11-15 years.
mucociliary transport time is statistically
significant. DISCUSSION
Table 3. The effect of Using Nasal Irrigation with
Mucociliary transport is a mechanism of
Isotonic Saline Solution at Mucociliary
Transport Time
ciliary movement to drain secretions from the
nasal cavity to the nasopharynx. The duration at
Mucociliary Transport which particle matter travels along the surface of
Saccharine Time (minutes) p the nasal cavity through mucociliary transport is
Pretest Postest called the mucociliary transport time10,11.
Mean+SD 10,67 + 2,63 7,96 + 2,16 <0,001 The speed of mucociliary transport varies
greatly. In healthy people the particles in the
mucous palate are removed by active cilia at a
Before being given the treatment of using
speed of 3-25 mm/minute and on average
nasal wash with isotonic saline solution, the time
6 mm/minute. According to Maul J. et al (2013),
of nasal mucociliary transport obtained an
the mucociliary transport time in healthy adults is
average value of 10.67 ± 2.63 minutes with a
<12 minutes on the saccharin test.
minimum value of 7 and a maximum value of 16,
In this study, 16 respondents (31.4%)
after being treated using nasal wash with isotonic
experienced impaired mucociliary transport time
saline during transport nasal mucociliary values
before nasal irrigation. Brant et al (2014),
averaged 7.96 ± 2.16 minutes, with a minimum
conveyed the time of nasal mucociliary transport
value of 5 and a maximum value of 13, thus
in motorcyclists who drive for 8-12 hours a day,
reducing the mean nasal mucociliary transport
5 days a week experiencing elongation from
time by 25.4%. The Wilcoxon test results
normal values (>12 minutes) in 32% of samples
obtained p value = <0.001 statistically
examined5. The time of mucociliary transport in
significant.
most respondents (68.6%) at the pretest (before
nasal irrigation with isotonic saline fluid) was
obtained within normal limits. This is probably
because in the Supeltas postal area, the
parameters of air pollution are still below the
normal threshold, so that it has not caused a
disturbance of mucociliary transport.
Workers who work outdoors and are
exposed to high air pollution, based on several
studies, can cause nasal complaints due to
reduced mucociliary transport function.
According to Brant et al (2014), jobs that have
the same risk of being exposed to high air
pollution in addition to motorbike riders are
traffic controllers, taxi drivers and motorists 5.
Traffic volunteers officers (Supeltas) spend
6-8 hours every day to help regulate traffic at the
location of work posts spread in several areas,
especially on crowded and crowded streets. Dust
and pollutant particles are automatically inhaled
and enter the nose and airway. Protective devices
(masks) are also very rarely used. Exposure to
dust, irritants and pollutants that occur
continuously and in the long term can lead to
health problems6,12,13.
Nasal irrigation is an easy technique to
maintain the hygiene of the nose and sinonasal
by using saline solution. Saline solution is widely
used in nasal irrigation according to the
physiological nasal mucosa and paranasal
sinuses. This is done to enhance the nasal
mucosa ability to resist infectious agents,
inflammatory mediators and irritants, through
direct cleansing of irrigation, removal of
inflammatory mediators and improved
7,8,9
mucociliary function .
The results showed that before being treated
with nasal saline with isotonic saline solution,
nasal mucociliary transport received an average
value of 10.67 ± 2.63 minutes, after being treated
with nasal irrigation with isotonic saline
mucociliary transport of the nose obtained an
average value 7.96 ± 2.16 minutes, thus reducing
the mean nasal mucociliary transport by 25.4%.
Thus there is a significant effect on the use of
nasal wash with isotonic saline solution at the
time of mucociliary transport of the supeltas
officer.
Nasal irrigation with isotonic saline solution
can improve sinonasal mucosal function through
several physiological effects, namely direct
washing of colonies of pathogenic
microorganisms and irritants on the nasal
mucosal surface, reduction of inflammatory
mediators, reduction of mucosal edema,
reduction of mucin secretion, increased
mucociliary transport by increasing the
frequency of movement cilia14,15,16.
Nasal irrigation began to be used and
research was carried out on its role as an adjunct
therapy since 1988. Most of the studies aimed at
cases of rhinosinusitis and allergic rhinitis17,18.
Research on nasal irrigation of workers with
polluted and dusty air environments is still
rare. Research on polluted or dusty air
environment workers has been done by Sofyan
and Tami, 2017 who researched street vendors
on the edge of Medan city main road with the
result that there was an increase in pH after nasal
irrigation with isotonic saline solution 19.
Respondents with a working period of
0-5 years found the mucociliary transport time an
average of 9.65 ± 2.45 minutes. Then
respondents with a working duration of
6-10 years obtained an average mucociliary
transport time of 10.46 ± 2.48 minutes, and
respondents with a working period of
11-15 years found an average mucociliary
transport time of 12.90 ± 2.08 minutes. Thus it
can be seen that the longer exposure to smoke of
vehicles that are assessed with long working
hours can extend the time of mucociliary
transport.
The limitation in this study is that pollutant
levels were not measured in all Supeltas posts.
The content of air pollutants at each point in the
city of Surakarta has different parameters that
can affect the difference in mucociliary transport
time. This study also did not use controls due to
the limited number of samples.
CONCLUSION
The effect isotonic saline nasal irrigation
improve mucociliary transport by decreasing the
mucociliary transport time in traffic volunteer
officers. The need for further research by
measuring the level of air pollution in each
traffic volunteer officers (Supeltas) post to know
objectively the level of air pollution in each post.
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