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Relationship between bacteriology of the adenoid core and middle meatus in children with sinusitis
S Elwany1, A N El-Dine, A El-Medany
1Department of Otolaryngology, Alexandria Medical School, Alexandria, Egypt. samyelwany@msn.com
Insights
Bacterial pathogens found in the adenoid core correlate with those in the middle meatus in children with sinusitis. These findings suggest adenoidectomy may help treat chronic or recurrent pediatric sinusitis.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Hypertrophied adenoids are common in children and can be associated with chronic or recurrent sinusitis.
- The role of adenoidal tissue as a potential reservoir for bacterial pathogens in pediatric sinusitis requires further investigation.
Purpose of the Study:
- To determine the correlation between bacterial pathogens in the adenoid core and the middle meatus.
- To evaluate the diagnostic value of adenoid core cultures in predicting middle meatal cultures in children with sinusitis.
Main Methods:
- A study involving 103 children (aged 4-12) with chronic or recurrent sinusitis undergoing adenoidectomy.
- Bacteriological evaluation of adenoid core specimens and middle meatal swabs using standard microbiological techniques.
- Statistical analysis of culture results to assess correlations and predictive values.
Main Results:
- Coagulase-negative staphylococci, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and group A streptococci were the most frequent isolates from both sites.
- A high concordance was observed between adenoid core and middle meatal cultures, with positive predictive values of 91.5% and negative predictive values of 84.3% for adenoid core cultures.
- Adenoid core cultures were positive in 63 cases when middle meatal cultures were also positive, and negative in 25 cases when both were negative.
Conclusions:
- Adenoidal tissue may serve as a bacterial reservoir, contributing to the initiation and persistence of sinus infections in children.
- The findings support the potential efficacy of adenoidectomy in managing chronic or recurrent pediatric sinusitis.
- Correlation between adenoid core and middle meatus bacterial flora suggests a link between adenoid hypertrophy and sinonasal infections.
Objective:
To assess the correlation between bacterial pathogens in the adenoid core and the middle meatus, in children with hypertrophied adenoids and chronic or recurrent sinusitis.
Design:
The study was conducted at Alexandria University Hospitals. We included 103 children aged four to 12 years who were scheduled for adenoidectomy and who had clinical and/or radiological evidence of chronic or recurrent sinusitis. Adenoid core specimens and middle meatal swabs were obtained from every patient and were sent for bacteriological evaluation using standard qualitative and quantitative microbiological techniques. The results were statistically analysed.
Results:
The bacterial species isolated most frequently from the adenoid core were coagulase-negative staphylococci (40.8 per cent), Staphylococcus aureus (22.3 per cent), Streptococcus pneumoniae (18.4 per cent), Haemophilus influenzae (16.5 per cent) and group A streptococci (15.5 per cent). The bacterial species isolated most frequently from the middle meatus were coagulase-negative staphylococci (41.7 per cent), S aureus (32 per cent), S pneumoniae (28.1 per cent), H influenzae (21.6 per cent) and group A streptococci (19.4 per cent). The adenoid core and middle meatal cultures were both positive for at least one bacterial species in 63 cases, and were both negative in 25 cases. In six cases, a positive adenoid core culture was associated with a negative middle meatal culture. In five cases, a negative adenoid core culture was associated with a positive middle meatal culture (for one or more pathogenic species). Thus, adenoid core culture had a positive predictive value of 91.5 in forecasting the middle meatal culture result, and a negative predictive value of 84.3.
Conclusion:
Apart from its effect on nasal airway patency, adenoidal tissue may function as a bacterial reservoir initiating and maintaining sinus infection in children. These study findings support a potential role for adenoidectomy in the treatment of chronic or recurrent paediatric sinusitis.
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