Bacteriology of normal frontal sinuses

Purpose

The aim of this cross-sectional trial was to identify the bacterial flora and to quantify the level of bacterial presence in healthy adult frontal sinus cavities.

Materials and methods

Ninety five consecutive patients undergoing craniotomy of the anterior cranial fossa were enrolled. All patients were evaluated preoperatively by a sino-nasal questionnaire, nasal endoscopy and CT scan. Exclusion criteria were patients with sinus tumours, presenting a cold in the past 8 weeks, having signs or symptoms suggestive of sinus disease, history suggestive of allergic rhinitis and/or asthma, having undergone hospitalization or an outpatient clinic visit within the past 12 months, patients with known systemic disease, having previous sinus or nose surgery, history of trauma of the sino-nasal region, or having used systemic antibiotics, steroids, or nasal spray in the past 8 weeks. Lavages were obtained from frontal sinuses before craniotomy through trephination of the anterior wall. The sinus was irrigated with sterile saline followed by aspiration. Specimens were inoculated for aerobic and anaerobic organisms.

Results

After applying the exclusion criteria, 42 patients (84 sinuses) were finally included in the study. Bacterial organisms were recovered in 12 of 84 (14.28%) sinuses. However, 85.72% of the sinuses were found to be sterile. Bacteria recovered included three different coagulase-negative staphylococci, one Citrobacter diversus and two Micrococcus spp. No anaerobic organism was isolated.

Conclusions

This study demonstrated that the majority of frontal sinuses of asymptomatic adults with normal CT and endoscopic appearance are sterile.     

Bacteriology of chronic maxillary sinusitis and normal maxillary sinuses: using culture and multiplex polymerase chain reaction

BACKGROUND: Although many investigations have been performed on bacteriology of chronic sinusitis and normal sinuses, there still is much discussion. Also a new bacterial agent, Alloiococcus otitidis determined in the nasopharynx and middle ear specimens can be thought as a causative agent of sinusitis. METHODS: The bacteriology of chronic maxillary sinusitis and maxillary sinuses with normal radiogram and endoscopic findings were studied by culture methods for aerobic and anaerobic bacteria. Multiplex polymerase chain reaction (PCR) was used to investigate four bacteria in study and control groups. There were 27 specimens in the study group and 28 specimens in the control group. RESULTS: In the study group, the bacteria commonly isolated were Staphylococcus aureus (11.1%), alpha-hemolytic streptococci (11.1%), Streptococcus pneumoniae (11.1%), Haemophilus influenzae (7.4%), coagulase-negative staphylococci (7.4%), and anaerobes (33.3%). Coagulase-negative staphylococci (14.3%), alpha-hemolytic streptococci (10.7%), and anaerobes (35.7%) were isolated also in the control group. PCR was used to investigate S. pneumoniae, H. influenzae, Moraxella catarrhalis, and A. otitidis in the study and control groups. None of these bacteria was determined in the control group whereas detection rates of these bacteria in the study group were 11.1, 11.1, 3.7, and 7.4%, respectively. It should be considered that PCR yielded faint amplification band for A. otitidis. CONCLUSION: Using multiplex PCR can help to increase detection rates of bacterial etiology. Healthy sinuses are not sterile. A. otitidis may be one of the pathogens causing sinusitis.     

Aerobic and anaerobic bacterial flora of normal maxillary sinuses

The bacterial flora of non-inflamed maxillary sinuses were studied in 12 adults. Patients' median age was 35 years (range 25 to 53 years): 8 were females and 4 were males. Aseptic aspiration of the sinus was made when the patients were under general anaesthesia for corrective plastic surgery of the nasal septum. All aspirates were cultured for aerobes and anaerobes. Anaerobes were isolated in all 12 specimen patients; in 5 patients (42%), they were the only organisms isolated, and in 7 (58%), they were recovered mixed with aerobes. There were 33 anaerobic isolates (2.75 pr specimen) and the predominant ones were: 11 Bacteroides sp. (including 6 B. melaninogenicus), 10 anaerobic gram-positive cocci and 5 Fusobacterium sp. There were 16 aerobic isolates (1.3 per specimen) and the predominant ones were: 5 beta hemolytic streptococci, 3 alpha hemolytic streptococci, and 2 each of S. pneumoniae and hemophilus parainfluenzae. Beta lactamase production was noted in 4 isolates recovered from 3 patients. These included all isolates of S. aureus (2) and 2 of 6 isolates of B. melaninogenicus. The presence of aerobic and anaerobic organisms in the non-inflamed sinus demonstrates the non-sterility of the sinus cavity. In the events that follow closure of the sinus ostium, these bacteria may become pathogenic.     

Bacteriology of chronic maxillary sinusitis]

132 patients with chronic maxillary sinusitis were included in this bacteriological study of the intrasinus exudate obtained by a radical antrostomy or antral puncture. We found 78.3% aerobes, 21.7% anaerobes, 51.5% gram positive and 48.5% gram negative micro-organisms, but no fungi in 120 cultures. The commonest aerobic species was Haemophylus (20%), whereas Peptococcus and Bacteroides were the commonest anaerobes (10%).     

Mycosis of the maxillary sinuses

Fungus infection of the maxillary sinus has been considered a rare disorder; recently, however, such cases have been reported in increasing number. The authors have recently observed five cases of mycosis of the paranasal sinuses. Three of these cases showed the clinical symptoms and signs of swelling and pain in the cheek area and epistaxis and aroused suspicion of maxillary cancer. Of the remaining two cases one was misdiagnosed as maxillary cancer with pulmonary metastasis and radiation therapy without preliminary tissue diagnosis given because of the poor general condition of the patient. On improvement of the patient's condition exploratory maxillotomy and mucosal biopsy revealed mycotic invasion; in the other, chronic bacterial maxillary sinusitis was suspected, but exploratory sin-usostomy showed mycosis. The authors emphasize an apparent increasing frequency of mycosis of the paranasal sinuses and the fact that the symptoms and signs of mycotic invasion may duplicate those of early malignancy of this area.     

Bacteriology of chronic maxillary sinusitis in adults

Aspirates of 72 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. Bacterial growth was present in 66 of the 72 specimens (92%). Anaerobic bacteria were isolated in 58 of the 66 culture-positive specimens (88%). Anaerobes only were recovered in 37 cases (56%) and in 21 (32%) they were mixed with aerobic or facultative bacteria. Aerobic or facultative bacteria were present in eight cases (12%). A total of 185 isolates (2.8 per specimen)--131 (2.0 per specimen) anaerobes and 54 (0.8 per specimen) aerobes or facultatives--were isolated. The predominant anaerobic organisms were anaerobic cocci and Bacteroides sp, and the predominant aerobes or facultatives were Streptococcus sp and Staphylococcus aureus. Twelve of the 27 Bacteroides sp that were tested for beta-lactamase (44%) produced the enzyme. These findings indicate the major role of anaerobic organisms in chronic sinusitis.     

上颌窦浆细胞肉芽肿(附3例报告)

目的 :探讨上颌窦浆细胞肉芽肿的临床特征及治疗方法。方法 :结合文献复习 ,报告 3例上颌窦浆细胞肉芽肿患者的临床资料。结果 :3例经 Caldwell- L uc手术 ,术后结合类固醇激素及抗变态反应药物治疗 ,疗效良好 ,随访 0 .5～ 2年未见复发。结论 :上颌窦浆细胞肉芽肿是一种炎症反应性病变 ;CT检查多见上颌窦骨壁侵犯 ,有类似恶性肿瘤的影像学表现。本病患者预后大多良好。     

Gaucher's disease involving the maxillary sinuses

A 46-year-old man with a long history of Gaucher's disease involving the spleen, bone marrow, and multiple bones presented with apparent sinusitis. He had radiologic opacification and histologically documented involvement by Gaucher's disease of the maxillary antra. Bony involvement of the mandible and maxilla has rarely been reported. To the best of our knowledge, this represents the first reported case of paranasal sinus involvement by Gaucher's disease.     

上颌窦腺样囊性癌14例临床分析

目的：探讨上颌窦腺样囊性癌(ACC)的诊断及手术加术后放疗的治疗效果，并分析与预后有关的因素。方法：回顾性分析1992～1999年14例上颌窦ACC患者的临床资料，用Kaplan-Meier法计算5年及10年无瘤生存率。结果：随访3～10年，平均67．2个月。T2N0M0 2例，健在，无复发及转移；T3N0M0 4例，其中1例术后57个月复发，3例健在，无复发及转移；T4N0M0 8例，其中2例术后分别于36个月、40个月因局部复发、颅内侵犯死亡，1例术后39个月复发，1例术后96个月全身转移，4例健在，无复发及转移。5年无瘤生存率为72．5％，10年无瘤生存率为54．4％。结论：上颌窦ACC早期症状不典型，容易误诊和漏诊；彻底的手术切除加术后放疗可以降低术后复发的机会，提高治愈率。肿瘤临床分期及手术切缘情况与预后有关。     

Bacteriology of nontraumatic maxillary sinus mucoceles versus chronic sinusitis

OBJECTIVE: To compare the bacteriology of maxillary sinus mucoceles to chronic sinusitis and understand the pathogenesis of nontraumatic maxillary sinus mucoceles (NTMSM). STUDY DESIGN: Retrospective review. METHODS: Review of intraoperative bacteriology culture results obtained in patients with NTMSM. Patients with history of facial trauma or previous paranasal sinus surgery were not included in the study. The results were compared to intraoperative cultures obtained from patients with chronic sinusitis (CS). RESULTS: The study groups consisted of 16 patients with NTMSM (9 male and 7 female patients) and 211 patients with CS (86 male and 125 female patients). Cultures in the NTMSM group were positive in 7 of 16 patients (44%) (four cultures had more than one isolate). There was no growth in cultures of 9 patients (56%). On the other hand, cultures in 176 patients with CS (83%) grew organisms (42 cultures had more than one isolate); there was no growth in 35 of 211 patients (17%) (P = .0007). The cultures grew aerobic bacteria in 7 of 16 (44%) and 160 of 211 (76%) patients of the NTMSM and CS groups, respectively. Anaerobic bacteria were detected in cultures of 2 of 16 patients (12.5%) with NTMSM compared with 13 of 211 patients (6.2%) in the CS group (P = .286). The most common pathogenic aerobe in the NTMSM group was alpha-hemolytic Streptococcus, while Staphylococcus aureus was the most common in the CS group. CONCLUSION: The bacteriology of maxillary sinus mucoceles is different from that of CS. The majority of patients with mucoceles have sterile intraoperative cultures. The data do not support infection as the main origin of NTMSM.     

Bacteriology of antrum in adults with chronic maxillary sinusitis

Swabs of 126 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria during endoscopy. Bacterial growth was present in 113 of 126 specimens (90%). Anaerobic bacteria were isolated in 100 of 113 culture-positive specimens (88%). Anaerobes only were recovered in 59 cases (52%) and, in 41 (36%), they were mixed with aerobic or facultative bacteria. Aerobic or facultative bacteria were present in 13 cases (12%). A total of 323 isolates (2.8 per specimen), 228 (2.3 per specimen) anaerobes and 95 (1.7 per specimen) aerobes or facultatives, were isolated. The predominant anaerobic organisms were anaerobic cocci and Bacteroides species; the predominant aerobes or facultative bacteria were Streptococcus species and Staphylococcus aureus. These findings indicate the major role of anaerobic organisms in chronic sinusitis.     

Studies of the gas exchange and pressure in the maxillary sinuses in normal and infected humans

The total gas pressure in experimentally occluded maxillary sinus was continuously recorded during 90 minutes on 7 healthy human subjects. PO2 and PCO2 were measured before and after the total pressure recording. In 3 cases the volume changes in the sinus were measured. The total gas pressure after an initial increase to about 35 mm H2O decreased to a steady state of about 70 mm H2O below atmospheric pressure. The volume changes in sinus showed a corresponding alteration. The gas measurements showed a decrease of PO2 of 25 mm Hg and a rise of PCO2 of 21 mm Hg. In 3 patients with acute purulent sinusitis there was seen a pressure of about 10 cm H2O above the atmospheric pressure.