Fungal speciation using quantitative polymerase chain reaction (QPCR) in patients with and without chronic rhinosinusitis

OBJECTIVES/HYPOTHESIS: The objectives of this study were to determine the mycology of the middle meatus using an endoscopically guided brush sampling technique and polymerase chain reaction laboratory processing of nasal mucous; to compare the mycology of the middle meatus in patients with sinus disease with subjects without sinus disease; to compare the responses on two standardized quality-of-life survey forms between patients with and without sinusitis; and to determine whether the presence of fungi in the middle meatus correlates with responses on these data sets. STUDY DESIGN: The authors conducted a single-blind, prospective, cross-sectional study. METHODS: Patients with sinus disease and a control group without sinus disease were enrolled in the study. A disease-specific, validated Sinonasal Outcomes Test survey (SNOT-20) was completed by the subjects and a generalized validated Medical Outcomes Short Form 36 Survey (SF-36) was also completed. An endoscopically guided brush sampling of nasal mucous was obtained from the middle meatus. Fungal specific quantitative polymerase chain reaction (QPCR) was performed on the obtained sample to identify one of 82 different species of fungus in the laboratory. Statistical analysis was used to categorize the recovered fungal DNA and to crossreference this information with the outcomes surveys. RESULTS: The fungal recovery rate in the study was 45.9% in patients with sinus disease and 45.9% in control subjects. Patients with chronic rhinosinusitis had a mean SNOT-20 score of 1.80 versus the control group mean score of 0.77 (P < .0001). SF-36 data similarly showed a statistically significant difference between diseased and control populations with controls scoring a mean of 80.37 and patients with chronic rhinosinusitis scoring a mean of 69.35 for a P value of .02. However, no statistical significance could be ascribed to the presence or absence of fungi recovered, the type of fungi recovered, or the possible impact of fungi on the quality-of-life survey results. CONCLUSION: The recovery rate of fungi from the middle meatus of patients with chronic rhinosinusitis and a control population without chronic rhinosinusitis is 45.9% using QPCR techniques. No direct causation with regard to fungal species or presence was proven; however, a species grouping for future studies is proposed based on trends in this data and other reports. Disease-specific outcomes surveys revealed a statistically significant difference between the two groups.     

汉化版SNOT-22评价慢性鼻-鼻窦炎患者生存质量的初步研究

目的 探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者的健康相关生存质量(quality of life,QOL)状况.方法 采用中文版医学结局研究简表36项(medical outcome study shortform 36-items,MOS SF-36)和汉化版鼻腔鼻窦结局测试22条(sinonasal outcome test-22,SNOT-22),对2006年12月至2007年3月住院接受鼻内镜手术的64例CRS患者和20名健康志愿者进行QOL调查,并对汉化版SNOT-22量表进行考核.结果 汉化版SNOT-22量表的可行性、信度、效度和反应度等性质均通过考核(P值均＜0.01),其中影响健康最重要的5个问题依次是:鼻塞、流清鼻涕、嗅觉或味觉减退、头晕和鼻涕倒流.CRS患者术前鼻窦CT Lund-MacKay评分(10.19±6.37)与汉化版SNOT-22量表评分(33.77±14.90)的相关系数为0.233,表明二者之间有一定正相关性,但相关性不高.结论 汉化版SNOT-22量表能有效评价CRS患者的QOL.CRS患者术前鼻窦CT Lund-Mackay评分与汉化版SNOT-22量表评分有一定正相关性.     

再次鼻内镜手术患者生活质量调查

目的:探讨修正性鼻内镜手术(RESS)对慢性鼻-鼻窦炎鼻息肉患者(CRSwNP)健康相关生活质量(QOL)的影响。方法:采用国内现有的中文版SF-36量表(MOS SF-36)和汉化英文版SNOT-20量表(SNOT-20),分别对60例施行修正性鼻内镜手术组(RESS)的CRSwNP患者和120名健康体检者进行QOL的调查与评估,并将2组的结果进行对比。结果:通过SF-36量表评估显示:RESS组术前CRSwNP患者SF-36的维度计分均低于对照组,差异有统计学意义(P<0.05)。通过汉化SNOT-20评估显示:RESS组术前CRSwNP患者SNOT-20各条目计分和条目总分均高于对照组,差异有统计学意义(P<0.05)。RESS组CRSwNP患者术后6个月SF-36和SNOT-20量表评估得分与对照组差异无统计学意义(P>0.05)。结论:RESS可明显改善CRSw-NP患者的QOL;SF-36和汉化SNOT-20量表能有效调查评估CRSwNP患者的QOL。     

慢性鼻-鼻窦炎鼻息肉患者的生存质量调查

目的探讨慢性鼻一鼻窦炎鼻息肉（chronic rhinosinusitis with nasal polypsis，CRSwNP）患者的健康相关生存质量（quality of life，QOL）状况。方法通过国内现有的中文版医学结果研究短量36条（the Medical Outcomes Study Short Form-36，SF-36）和汉化英文版鼻腔鼻窦结果测量20条（the Sino—Nasal Outcome Test-20，SNOT-20），对随机选择的120例CRSwNP患者和200名健康体检者进行QOL的调查与评估，并对汉化后的SNOT-20量表进行临床和心理学测试。结果汉化SNOT-20量表的可行性、信度、效度和反应度等性能指标均通过考核。通过SF-36评估显示：除社会功能和情感角色外，CRSwNP患者在生理功能、生理角色、躯体疼痛、心理健康、活力和总体健康等6个维度的计分均低于对照组（P均〈0．05）；通过汉化SNOT-20评估显示：患者生理问题、功能限制和情感结果等3个维度的20个条目计分均高于对照组（P均〈0．05），其中影响健康最重要的5个问题依次为必须擤鼻涕、流黏稠鼻涕、缺乏高质量睡眠、头晕和鼻涕向后流。结论SF-36和汉化SNOT-20量表能有效调查评估CRSwNP患者的QOL；该病对患者生理功能、生理角色、躯体疼痛、心理健康、活力、总体健康和情感结果等方面有明显的负面影响，临床治疗应着重解决异常分泌物、睡眠障碍和头晕等问题。     

Impact of rhinosinusitis in health care delivery: the Quebec experience.

OBJECTIVE: Rhinosinusitis is a common disease affecting 135 per 1,000 population. The cost and the impact on quality of life of this disease are considerable. Health care delivery for a particular disease is evaluated through the health impact of the disease, outcomes of treatments, and their costs. This article reviews our experience with rhinosinusitis and its impact on health, as measured using a generic quality of life instrument, the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), in a selected patient population. Outcomes of treatments will be introduced, and the economic impact of chronic rhinosinusitis based on a U.S. study will be discussed. MATERIAL AND METHODS: One hundred and ten patients (divided into three subgroups: recurrent acute rhinosinusitis, chronic rhinosinusitis, and nasal polyposis) completed the SF-36 survey on the day of the diagnostic visit in the outpatient sinus clinics of two hospitals. RESULTS: The scores of the SF-36, in chronic rhinosinusitis, are compared with the normative values of a healthy U.S. population showing statistically significant differences in seven of eight domains. A comparison of the scores of chronic rhinosinusitis with a U.S. study on chronic rhinosinusitis shows statistically significant differences in five of eight domains. A comparison of the scores in the three diagnostic subgroups shows a statistical significance in two domains: bodily pain and vitality are more affected in recurrent acute and chronic rhinosinusitis. CONCLUSIONS: Chronic rhinosinusitis affects the quality of life of patients with rhinosinusitis and represents an important health burden. Some differences are noted with the U.S. chronic rhinosinusitis population. Recurrent acute and chronic rhinosinusitis seem to have more impact on vitality and bodily pain than nasal polyposis.     

Comparison between polymerase chain reaction and fungal culture for the detection of fungi in patients with chronic sinusitis and normal controls

CONCLUSION: PCR using panfungal gene primers is a more sensitive method for fungus detection than fungus culture, both in patients with chronic sinusitis and in normal controls. The presence of fungi alone, however, was insufficient to implicate them as pathogens in chronic sinusitis. OBJECTIVE: Previous findings have suggested that polymerase chain reaction (PCR)-based methods are more sensitive and reliable than conventional culture methods for the detection of fungal DNA. We therefore compared these methods in 82 patients with chronic sinusitis and 40 normal controls. MATERIAL AND METHODS: The noses of the subjects were irrigated with sterile saline, and the samples collected. The sediment from each irrigation was used for fungus culture and PCR analysis. RESULTS: PCR analysis using panfungal gene primers showed that 76/82 (92.5%) patients with chronic sinusitis and 39/40 (97.5%) normal controls were positive. In contrast, fungus cultures were positive in 19/82 (23.2%) patients with chronic sinusitis and 12/40 (30.0%) normal controls. We observed no significant between-group differences in the prevalence of fungus or in the fungal species detected.     

Detection of fungi in the nasal mucosa using polymerase chain reaction

HYPOTHESIS: Fungi have been increasingly recognized as important pathogens in sinusitis. However, detection of fungus with conventional culture techniques is insensitive and unreliable. Polymerase chain reaction (PCR) is an exquisitely sensitive assay that can detect the DNA of 10 or less fungal elements. The aim of this study was to compare the sensitivity of conventional culture techniques using PCR analysis. METHODS: Nasal swabs and DNA samples were collected from the nasal cavities of control subjects and patients with chronic sinusitis. Fungal-specific PCR analysis and standard cultures were performed on every sample. chi2 analysis was used to test for statistical differences between groups. RESULTS: PCR analysis detected fungal DNA in 42% and 40% of control subjects and patients with chronic sinusitis while standard cultures were positive in 7% and 0%, respectively. There was no statistically significant difference in the prevalence of fungi in the normal volunteers and patients with chronic rhinosinusitis. CONCLUSION: PCR is significantly more sensitive than nasal swab cultures in detecting the presence of fungi in nasal mucosa. In addition, our study suggests that the presence of fungi alone is insufficient to implicate it as the pathogen in chronic sinusitis.     

The role of fungi in the etiology of chronic rhinosinusitis: a prospective study

OBJECTIVES: Allergic fungal sinusitis (AFS) may represent an endpoint in a spectrum of sinonasal disease. Patients fulfilling criteria for a diagnosis of AFS have a poor prognosis often requiring multiple surgeries. The detection of 'allergic mucin' with mucus containing clusters of eosinophils and the detection of fungi by histological examination or culture is key criteria necessary for diagnosis. This study was performed to assess the strength of the association of the presence of fungi with the presence of eosinophils in a group of patients with chronic rhinosinusitis and controls. METHODS: Thirty patients with a clinical diagnosis of chronic rhinosinusitis and 10 individuals as control group were selected for the study. Total serum IgE level testing, nasal mucus cytology and fungal culture were performed in all subjects. RESULTS: Fungal spores were present in the nasal mucus in 14 patients with rhinosinusitis, and in 7 controls. The detection of eosinophils on cytology correlated significantly both with a clinical diagnosis of chronic rhinosinusitis (95% confidence intervals (CI) 0.34-0.81) and with the presence of fungal elements on cytology (p=0.02). The average serum IgE level was higher in patients with fungal spores (p=0.039). CONCLUSION: In certain susceptible individuals inhaled fungi may provoke an eosinophilic response. This response varies from simple eosinophilic inflammation to classic allergic fungal sinusitis.     

内镜鼻窦手术治疗慢性鼻-鼻窦炎临床结局的主客观评估

目的评估内镜鼻窦手术治疗慢性鼻．鼻窦炎的主客观临床结局并构建临床实用性的主客观结局评估体系。方法通过前瞻性队列研究，对120例慢性鼻-鼻窦炎患者术前和术后12个月的临床结局进行视觉模拟量表（visual analog scale，VAS）、医学结局研究简表36项（medical outcome study short-form 36-items，SF-36）和鼻腔鼻窦结局测试20条（sino-nasal outcome test-20，SNOT-20）等症状与生存质量的主观评估，以及内镜下黏膜形态、纤毛功能与组织病理学等客观评估。数据统计采用t检验、Х^2检验和Spearman相关分析处理手术前后主客观结局的变化及其相互关系。结果①术后12个月，VAS、SF-36和SNOT-20整体评分较术前明显改善（P〈0．01），其中85．96％、77．19％和83．33％的个体三项主观指标评分分别较术前改善，同时改善的比例为72．28％；手术前后各个时期，三种主观指标评分均具相关性（P值均〈0．01），其中SNOT-20兼性作用最大。②术后12个月，内镜下黏膜形态、纤毛功能和组织病理学整体评分较术前明显改善（P值均〈0．05），其中86．84％、86．81％和75．57％的个体三种客观指标评分分别较术前改善，同时改善的比例为71．85％；手术前后各个时期，三种客观指标评分均具相关性（P值均〈0．05），其中内镜下黏膜形态兼性作用最大。③SNOT-20与内镜下黏膜形态同时评估显示：术后12个月74．56％的患者主客观评分升降结局一致，而25．44％的患者主客观结局不一致，其中伴发鼻息肉患者更容易出现这种差异性（P〈0．05）。④手术前后不同时期，SNOT-20与内镜下黏膜形态评分均无相关性（P〉0．05），但前10位条目总分与内镜下黏膜形态评分具有相关性（0．18≤r≤0．42，P〈0．05），而后10位条目总分与之不相关（P〉0．05）。结论①内镜鼻窦手术可有效改善慢性鼻-鼻窦炎患者术后的症状、生存质量、内镜下黏膜形态、纤毛功能及组织状态等临床结局；②构建以SNOT-20和内镜下黏膜形态评估为主体的主客观结局评估体系，简约可靠，合理有效，具有临床实用性。     

‘Eosinophilic Fungal Rhinosinusitis’: A Common Disorder in Europe?

OBJECTIVES/HYPOTHESIS: The traditional criteria for the diagnosis of allergic fungal sinusitis include chronic rhinosinusitis, "allergic mucin" (mucus containing clusters of eosinophils), and detection of fungi by means of histological examination or culture. In 1999, a group of Mayo Clinic researchers, with a novel method of mucus collection and fungal culturing technique, were able to find fungi in 96% of patients with chronic rhinosinusitis. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of their patients. Because the presence of eosinophils in the allergic mucin, not a type I hypersensitivity, is probably the common denominator in the pathophysiology of allergic fungal sinusitis, the Mayo Clinic group proposed a change in terminology from allergic fungal sinusitis to eosinophilic fungal rhinosinusitis. Using new techniques of culturing fungi from nasal secretion, as well as preservation and histological examination of mucus, we investigated the incidence of "eosinophilic fungal rhinosinusitis" in our patient population. STUDY DESIGN METHODS: In an open prospective study nasal mucus from patients with chronic rhinosinusitis as well as from healthy volunteers was cultured for fungi. In patients, who underwent functional endoscopic sinus surgery, nasal mucus was investigated histologically to detect fungi and eosinophils within the mucus. RESULTS: Fungal cultures were positive in 84 of 92 patients with chronic rhinosinusitis (91.3%). In all, 290 positive cultures grew 33 different genera, with 3.2 species per patient, on average. Fungal cultures from a control group of healthy volunteers yielded positive results in 21 of 23 (91.3%). Histologically, fungal elements were found in 28 of 37 patients (75.5%) and eosinophilic mucin in 35 of 37 patients (94.6%). Neither fungi nor eosinophils were present in 2 of 37 patients (5.4%). CONCLUSIONS: Our data show that the postulated criteria of allergic fungal sinusitis are present in the majority of patients with chronic rhinosinusitis. Either those criteria will be found to be invalid and need to be changed or, indeed, "eosinophilic fungal rhinosinusitis" exists in the majority of patients with chronic rhinosinusitis. Based on our results, fungi and eosinophilic mucin appear to be a standard component of nasal mucus in patients with chronic rhinosinusitis.     

慢性上颌窦炎鼻内镜下开窗方式的选择与疗效观察

目的观察鼻内镜下上颌窦开放术治疗慢性上颌窦炎,不同开窗方式的选择与疗效分析。方法 56例单侧慢性筛、上颌窦炎伴鼻息肉患者,术前Lund-Mackay CT评分,CT评分=2者纳入研究对象,术中随机分为A组28例、B组28例,分别行中鼻道开窗和中下鼻道联合开窗,以鼻腔鼻窦结局测试-20（sino-nasal outcome test-20,SNOT-20）量表中文版、Lund-Kennedy评分及糖精试验黏液纤毛传输时间（mucociliary transport time,MTT）对比术后疗效,另外,用亚甲蓝染色观察黏液纤毛传输途径。结果术后6个月时,A、B两组SNOT评分、Lund-Kennedy评分及MTT值差异均有统计学意义（P〈0.05）;50例亚甲蓝从上颌窦口下缘流出,5例亚甲蓝从上颌窦口前缘流出。结论①对于慢性上颌窦炎Lund-Mackay CT评分=2的病例,行中、下鼻道联合开窗可取得更好的疗效;②上颌窦口下缘黏膜是黏液纤毛传输的重要途径,对上颌窦的引流起着极为重要的作用。     

鼻内镜手术对慢性鼻-鼻窦炎鼻息肉患者临床症状和生活质量的影响

目的探讨鼻内镜手术方式对慢性鼻-鼻窦炎鼻息肉患者症状和生活质量（quality of life, QOL）的影响。方法通过医学结局研究简表36项健康调查(medical outcome study short-form 36-items healt 和 survey, MOS SF-36,简称 SF-36)和鼻腔鼻窦结局测量20条(sino-nasal outcome test-20, SNOT-20)对60例慢性鼻-鼻窦炎鼻息肉患者术前、术后1个月和术后6个月进行随访调查与评估,并从中选取多组鼻窦炎鼻息肉的患者采取不同范围的手术来评估手术方式对改善患者症状和生活质量的影响。结果经鼻内镜手术治疗,患者术后一个月SF-36量表的生理角色、心理健康、情感角色、总体健康等部分维度以及SNOT-20量表的20个条目总分与5大条目总分等指标均开始出现明显好转(P＜0．05),术后2～6个月上述指标则无显著提高(P＞0．05)。术后6个月症状与QOL状态较术前均全面改善,而手术方式对患者症状和QOL状态影响则无统计学意义（P＞0.05）。结论慢性鼻-鼻窦炎鼻息肉患者鼻内镜手术后6个月内症状基本缓解,生活质量基本恢复常态,改良鼻内镜手术对慢性鼻-鼻窦炎鼻息肉患者症状和生活质量的改善与传统鼻内镜手术基本相同。     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦手术前后症状与生存质量的评估

目的探讨内镜鼻窦手术治疗对慢性鼻-鼻窦炎鼻息肉患者症状与生存质量（quality of life，QOL）的有效作用及其转变规律。方法通过视觉模拟量表（visual analog scale，VAS）、医学结局研究简表36项健康调查（medical outcome study short-form 36-items health survey，MOS SF-36，简称SF-36）和鼻腔鼻窦结局测量20条（sino-nasal outcome test-20，SNOT-20）等症状与QOL量表，对120例慢性鼻．鼻窦炎鼻息肉患者术前、术后3个月和术后6个月进行前瞻性随访调查与评估，并与200名健康体检者的QOL状况进行对比。结果经内镜鼻窦手术治疗，患者术后3个月VAS量表的单个症状总分与总体症状、SF-36量表的生理角色与总体健康等部分维度以及SNOT-20量表的20个条目总分与5大条目总分等指标均开始出现明显好转（P〈0．05），术后3～6个月上述指标则无显著提高（P〉0．05），术后6个月症状与QOL状态较术前均全面改善。SF-36量表显示慢性鼻-鼻窦炎鼻息肉患者与健康体检者差异无统计学意义（P〉0．05），但VAS量表提示患者嗅觉减退和异常鼻漏等症状依然存在。SNOT-20量表提示慢性鼻-鼻窦炎鼻息肉患者睡眠障碍和异常鼻漏等重要问题仍未解决，与健康体检者相比差异有统计学意义（P〈0．05）。结论慢性鼻-鼻窦炎鼻息肉患者内镜鼻窦手术治疗后6个月症状总体上得到解决，生存质量基本恢复常态，但嗅觉减退、异常鼻漏和睡眠障碍等重要问题仍明显存在，有待进一步解决。     

Characterization of fungi in chronic rhinosinusitis using polymerase chain reaction and sequencing

The role of fungi in chronic rhinosinusitis (CRS) remains unknown. Fungi were also determined as one of the responsible agents in the etio-pathogenesis, while several studies found fungi in 6–93% of the cases. The aim of this study is to test the presence of fungi in samples taken from the middle meatus of patients with CRS, using traditional culture methods and polymerase chain reaction (PCR), and to compare the efficacy of these methods. Thirty patients diagnosed with CRS, with or without nasal polyposis, undergoing an operation in the Otorhinolaryngology Clinic, were prospectively included in the study. Nasal mucosa samples from ten patients, who were operated for pathologic evaluation, and without CRS, were used as controls. Nasal samples were taken from each patient by swabbing with a cytology brush. Middle meatus culture samples were taken by using nasal cotton swab, and the polyp and/or sinus mucosa samples were taken during endoscopic sinus surgery. Fungal specific PCR, using 18S rRNA primers and standard cultures, were performed on every sample. All amplicons were sequenced. There was no fungal growth in the Sabouraud dextrose agar (SDA) medium from middle meatus samples and tissue parts. Of 30 tissue and brush samples, 3 and 2 were positive for fungal DNA, respectively. Sequence analysis showed that four amplicons were homologus to Cladosporium herbarum and one to Aspergillus amstelodami. We concluded that fungal etiology is overestimated and fungi rarely play a role in patients with CRS. Large-scale studies should be done using molecular methods.     

慢性鼻-鼻窦炎主观调查量表与CT评估相关性分析

目的 研究慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)主观调查量表与CT评估之间的相关性.方法 收集121例CRS患者的鼻腔鼻窦结局测量20条(sino-nasal outcome test-20,SNOT-20)、医学结局研究简表36项(medical outcome study short-form 36 items,SF-36)、视觉模拟量表(visual analogue scale,VAS)以及Lund-Mackay CT评分数据.在总体未分组情况下,分别进行主观量表之间、Lund-Mackey CT评分与主观量表之间的相关性分析.再按照CRS伴或不伴鼻息肉、性别、病史、文化程度等因素分组后进行主观量表之间、Lund-Mackey CT评分与主观量表之间的相关性分析和组间比较.结果 在总体未分组情况下,SNOT-20与SF-36呈负相关(r=-0.561,P＜0.01),SNOT-20与VAS呈正相关(r=0.743,P＜0.01),SF-36与VAS呈负相关(r=-0.504,P＜0.01),而Lund-Mackey CT评分与主观量表之间在统计学上无相关性(P＞0.05).在分组情况下,仅有CRS伴鼻息肉组的主客观评估之间存在相关性:Lund-Mackey CT评分与SNOT-20呈正相关(r、0.318,P=0.005);Lund-Mackey CT评分与SF-36呈负相关(r=-0.358,P=0.002);Lund-Mackey CT评分与VAS评分呈正相关(r=0.358,P=0.002).Lund-Mackay CT评分、SNOT-20以及VAS评分在CRS伴和不伴鼻息肉两组患者间差异有统计学意义(t值分别为3.249、-2.409、-2.957,P值均＜0.05).结论 CRS患者以其自测为基础的主观调查量表之间有着较好的相关性,而Lund-Mackey CT评分与主观量表之间仅在CRS伴鼻息肉组有相关性,且相关系数较弱.CRS患者是否伴鼻息肉与生活质量的高低并无必然联系.

Abstract：

Objective To investigate the relationship between the patient-based questionnaires and the computed tomography (CT) staging in patients with chronic rhinosinusitis (CRS). Methods Quantitative data of 121 preoperative recruits with CRS were collected by using the Lund-Mackay CT staging system, a visual analogue scale ( VAS), sino-nasal outcome test-20 ( SNOT-20), and the medical outcome study short-form 36 items (SF-36). The patients were classified into several subgroups according to whether CRS was associated with nasal polyps (NP) or not, sex, duration of disease, and educational background.Correlation between the patient-based questionnaires and the CT staging were analyzed in the total cohort patients and subgroups. Results In the total cohort patients, there were significant correlations between SNOT-20 and SF-36 ( r = -0. 561, P ＜ 0. 01 ), SNOT-20 and VAS ( r = 0. 743, P ＜ 0. 0l ), and SF-36 and VAS ( r = - 0. 504, P ＜ 0. 01 ), however, the CT staging did not correlate with the patient-based questionnaires (P ＞ 0. 05 ). Significant but weak correlations were found between the CT staging and the patient-based questionnaires in the C RS with NP subgroup (CT vs SNOT-20, r = 0. 318, P = 0. 005; CT vs SF-36, r = - 0. 358, P = 0. 002; CT vs VAS, r = 0. 358, P = 0. 002). Compared between CRS with NP and without NP subgroup, there were statistic differences on the Lund-Mackay CT stage and the SNOT-20 and VAS scores (t value was 3.249, -2.409, -2.957, respectively, all P＜0.05). Conclusions The patient-based questionnaires correlate well with each other, but CT staging correlated significantly but weakly with the patient-based questionnaires only in the CRS with NP subgroup. Nasal polyps do not appear to be responsible for the adverse effects of CRS on quality of life.     

Microbiology of middle meatus in chronic rhinosinusitis

BACKGROUND: Nasal endoscopy allows the collection of middle meatus secretion samples and is an alternative method for determining microorganisms in rhinosinusitis. This study assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with ipsilateral maxillary sinus aspirates and microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 114 CRS patients for aerobic, anaerobic, and fungal cultures; maxillary sinus secretions were collected from 13 of these patients. Twenty-three healthy volunteers served as controls. RESULTS: Aerobes were isolated in 86% of CRS patients, anaerobes were isolated in 8% of CRS patients, and fungi were isolated in 11% of CRS patients; the most frequent microorganisms were Staphylococcus aureus (36%), coagulase-negative Staphylococcus (20%), and Streptococcus pneumoniae (17%). Middle meatus and maxillary sinus cultures presented the same pathogens in 80% of cases. In healthy individuals, coagulase-negative Staphylococcus (56%), S. aureus (39%), and S. pneumoniae (9%) were the most frequent isolates. CONCLUSION: The culture of endoscopically collected middle meatus secretions is effective in identifying microorganisms in CRS patients.