The role of nasal cavity disinfection in the bacteriology of chronic sinusitis.
OBJECTIVE
Several factors may influence the results of bacteriological studies in chronic rhinosinusitis. We investigated the potential role of nasal cavity disinfection in the bacteriology of the bulla ethmoidalis in patients suffering from chronic sinusitis.


METHODS
Bacteriology of the bulla ethmoidalis was studied in 176 consecutive adult patients presenting a chronic sinusitis refractory to standard medical treatment who underwent functional endoscopic sinus surgery. Two different techniques were used: (A) a technique with nasal vestibule and facial disinfection with chlorhexedin (N = 89 patients and 165 samples) vs. (B) a technique with facial, nasal vestibule and nasal cavity disinfection with a povidone-iodine solution followed by a cleansing of the nasal cavity (N = 87 patients and 166 samples).


RESULTS
Culture rate was 89.6% (183 bacterial isolates) for technique (A) vs 76.5% (164 bacterial isolates) for technique (B) (p < 0.001). Major bacteria encountered in the (A) group and in the (B) group were respectively: Coagulase Negative Staphylococcus: 77 vs 40 isolates (p < 0.001); Coagulase positive Staphylococcus: 44 vs 30 isolates (p = 0.061); Streptococcus pneumoniae: 4 vs 5 isolates; Others: Streptococcus sp.: 12 vs 16 isolates; Haemophilus influenzae: 8 vs 6 isolates; Enterobacteriacea: 33 vs 53 isolates (p = 0.013) and others Gram Negative Bacilli: 3 vs 7 isolates.


CONCLUSIONS
The standard (A) technique to study the bacteriology of the bulla ethmoidalis in patients with chronic sinusitis yielded a higher percentage of positive culture and of bacterial isolates than a more advanced (B) technique. This is mainly due to the higher percentage of contaminant bacteria such as Coagulase Negative Staphylococcus recovered with the standard technique. Enterobacteriacea and others Gram Negative Bacilli were more often encountered into the bulla ethmoidalis with the technique where disinfection of the nasal cavity was performed.
Rombaux
Ph
P
Department of Otorhinolaryngology, Cliniques Universitaires Saint Luc, Brussels, Belgium. philippe.rombaux@orlo.ucl.ac.be
Collet
S
S
Hamoir
M
M
Eloy
Ph
P
Bertrand
B
B
Jamart
F
F
Gigi
J
J
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use; D002908:Chronic Disease; D003030:Coagulase / Q000032:analysis; D004203:Disinfection / Q000379:methods*; D004724:Endoscopy; D004755:Enterobacteriaceae / Q000302:isolation & purification; D005005:Ethmoid Sinus / Q000382:microbiology / Q000601:surgery; D015521:Ethmoid Sinusitis / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000187:drug effects / Q000382:microbiology*; D011206:Povidone-Iodine / Q000627:therapeutic use; D011300:Preoperative Care; D011446:Prospective Studies; D013210:Staphylococcus / Q000145:classification / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013291:Streptococcus / Q000145:classification / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
D000891:Anti-Infective Agents, Local; D003030:Coagulase; D011206:Povidone-Iodine; D002710:Chlorhexidine