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Adenoid bacteriology and sinonasal symptoms in children
1Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, 11201, USA.
Insights
Pediatric sinonasal symptoms correlate significantly with bacterial pathogens in adenoid tissue. This finding supports adenoidectomy for managing persistent sinusitis in children.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Sinonasal symptoms are common in children.
- Bacterial pathogens in adenoid tissue may contribute to these symptoms.
- The relationship between symptom severity and bacterial load is not well understood.
Purpose of the Study:
- To investigate the correlation between sinonasal symptoms in children and the presence and quantity of bacterial pathogens in the adenoid core.
- To determine if adenoid size influences this correlation.
Main Methods:
- A prospective cross-sectional survey of 84 children (aged 2-12) undergoing adenoidectomy.
- Caregiver-completed quality-of-life surveys assessed sinonasal and related symptoms.
- Standard microbiologic techniques analyzed adenoid core bacteriology for pathogen identification and quantification.
Main Results:
- All adenoid core samples harbored bacterial pathogens.
- A significant correlation (R2 = 0.48, p < 0.0001) was found between sinonasal infection symptom scores and the concentration of adenoid core pathogens.
- This correlation remained significant after adjusting for nasal obstruction and adenoid size.
Conclusions:
- Sinonasal infectious symptoms account for 48% of the variability in adenoid core bacteriology, independent of adenoid size.
- Results suggest a potential role for adenoidectomy in managing pediatric sinusitis.
- Further longitudinal studies are warranted.
Objective:
To study the correlation between sinonasal symptoms in children and the prevalence of bacterial pathogens in the adenoid core.
Design:
Prospective cross-sectional survey.
Setting:
Tertiary referral center.
Patients:
Consecutive sample of 84 children, aged 2 to 12 years, scheduled for adenoidectomy between July 1995 and November 1995. A blocked recruitment scheme was used to ensure a balanced distribution of sinonasal symptoms in the study sample.
Methods:
A caregiver-completed quality-of-life survey was used to measure the frequency and severity of baseline sinonasal, ear, obstructive, and behavioral symptoms. Standard microbiologic techniques were used for qualitative and quantitative adenoid bacteriology.
Outcome Measures:
Pathogenic and nonpathogenic bacteria isolated, percentage of specimens with no growth, colony-forming units of pathogens per gram of adenoid tissue, dominant bacterial organism, and number of pathogenic species per adenoid with concentration greater than 10(5) colony-forming units.
Results:
One or more bacterial pathogens were recovered from core samples of all adenoids, with a concentration greater than 10(5) colony-forming units in 31 specimens (26%). Haemophilus influenzae, group A beta-hemolytic streptococcus, and Staphylococcus aureus were encountered most often. Multivariate analysis revealed a significant correlation of sinonasal infection symptom scores with colony-forming units of adenoid core pathogens (R2 = 0.48, p < 0.0001), adjusted for the confounding effects of nasal obstructive symptoms and adenoid size (specimen weight).
Conclusions:
Sinonasal infectious symptoms explain 48% of the variability in quantitative bacteriology of the adenoid core, independent of adenoid size. Although longitudinal studies are required, our results support a potential role for adenoidectomy in the management of refractory pediatric sinusitis.