Sinoscopic Guided Correlation Between Microbiology of Chronic Rhinosinusitis and Its Related Chest Diseases in Adults

Abstract

In this prospective study 25 CRS adult patients were enrolle<!. All patients were scheduled for functional endoscopic sinus surgery (FESS) after failure of medical treatment. The study population included 18 males and 7 females with an age raging between 25-66 y and a mean of 34.1 y. The diagnosis of chronic rhinosinusitis in these patients was done according to the definition of the consensus report of rhinosinusitis task force group (Lanza et al., 1997). Eligibility criteria for the study included: complaints, symptoms and signs of rhinosinusitis lasting for at least 3 months with typical nasal endoscopic findings confirmed with soft tissue involvement of the paranasal sinuses on the CT scan. No patients with cystic fibrosis, primary ciliary dyskinesia, recognised immunodeficiency or other systemic diseases were included. Also no medications were allowed one month before the study except for local lower airways asthma medications. Preoperative CRS assessment, examinations and CT assessments were performed using standard

scoring systems. Also pulmonary assessments using pulmonary function tests and bronchial provocation tests were done. Intraoperative specimens collections under aseptic precautions were performed before FESS. BALs were performed for bacteriological, mycological and cellular examinations. Also middle meatal swabs ancl lavages were obtained for bacteriological, mycological and cellular examinations. On the other hand mycological examinations of the nasal vestibular swabs and nasal cavity lavages were obtained. FESS was performed with recording of the surgical scores and all the pathological specimens were subjected to H&E and GMS staining for fungal detection. In this study lower airways involvement was identified in 60% of our adult chronic rhinosinusitis

patients. Different kinds of lower airways involvement were present in chronic rhinosinusitis. Some are manifest such as asthma others are non-manifest such as SAD and bronchial hyperactivity. In 92% of our CRS patients n() associated lower airways bacterial cultures could be identified.

Aerobic gram positive bacteria were the most common cultured bacteria in CRS. Coagulase negative staph were the most common cultured bacteria in lower airways involvement subgroups. In SAD mixed infection of gram positive and anaerobic bacteria with associated neutrophilic inflammation were the main findings.Conversely in asthma the role of bacterial colonisation without neutrophilic inflammation were more apparent.ln asihma the bacterial culture correlated to CT scan scoring system .So they may act as a disease modifier in these subgroup. •