title: Bacteriology of recurrent exacerbation of postoperative course in chronic rhinosinusitis in relation to asthma.
abstract: OBJECTIVE
  Co-mobidity of asthma is known to result in a poor prognosis of post-endoscopic sinus surgery (post-ESS). Bacterial infection may play a key role in recurrent pathophysiology of sinusitis in post-ESS.
  
  
  METHODS
  Forty-two patients with CRS associated with asthma undergoing ESS were enrolled. Bacterial culture was performed from the sinus cavity at the time of acute infectious episodes. Recurrence of sinonasal disease was analyzed in terms of steroid responsiveness and peak expiratory flow (PEF).
  
  
  RESULTS
  Totally 75 aspirates were obtained during post-ESS; 2 repeat aspirates from 10 patients, 3 from 5 patients, and 4 from 2 patients. Only 6 specimens (8.0%) obtained from 5 patients (11.9%) showed no growth whereas 83 isolates were recovered from 69 specimens. Sixteen patients had at least one episode of a significant decline of PEF. All except one patient complained of symptoms and signs of upper respiratory infections prior to a depression of PEF. Positive culture was obtained in 10 out of 11 patients examined at the time of acute exacerbation of CRS.
  
  
  CONCLUSIONS
  Bacterial infection may play a critical role of recurrent polyps and refractory symptoms during post-ESS follow-up. Moreover, worsening of sinusitis accompanies asthma exacerbation.
authors.affiliation: Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan. ike@juntendo.ac.jp
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Ikeda
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yokoi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kusunoki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Saitoh
authors.forename: Toru
authors.initials: T
authors.lastname: Yao
authors.forename: Kaori
authors.initials: K
authors.lastname: Kase
authors.forename: Akira
authors.initials: A
authors.lastname: Minekawa
authors.forename: Ayako
authors.initials: A
authors.lastname: Inoshita
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawano
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications* / Q000503:physiopathology; D001424:Bacterial Infections / Q000188:drug therapy; D002648:Child; D002908:Chronic Disease; D024881:Drug Resistance, Bacterial; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000209:etiology; D010254:Paranasal Sinus Diseases / Q000209:etiology; D010256:Paranasal Sinuses / Q000382:microbiology / Q000601:surgery; D010366:Peak Expiratory Flow Rate; D011127:Polyps / Q000209:etiology; D011183:Postoperative Complications; D011184:Postoperative Period; D012008:Recurrence; D012220:Rhinitis / Q000150:complications / Q000382:microbiology* / Q000503:physiopathology; D012852:Sinusitis / Q000150:complications / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult