Chronic rhinosinusitis in children—Bacteriological analysis in terms of cytological examination

Abstract

IntroductionThe mechanisms of inflammatory response occurring in chronic rhinosinusitis in children are multifactorial. Besides the history and a physical examination, amongst diagnostic tools there are cytological and bacteriological examinations. Objectives1Determining the nature of the bacterial flora present in the nasal cavities and paranasal sinuses in children with chronic rhinosinusitis amongst patients of The Department of Paediatric Otolaryngology, Warsaw Medical University.2Determining the relation between bacterial strains and cytological examination of nasal mucosa in children with chronic rhinosinusitis. Materials and methodsThe study group included 64 patients with chronic rhinosinusitis without polyps. The control group included 30 randomly chosen children. Diagnostic tests performed in both groups were: middle meatal culture and cytological examination from the inferior nasal concha and middle meatus. Statistical analysis was accomplished with Statistica 8.0. Results1The most common strains of bacteria found in patients with chronic rhinosinusitis are gram-positive bacteria such as coagulase-negative staphylococci and Staphylococcus aureus, and gram-negative bacteria such as: Haemophilus influenzae and Moraxella catarrhalis.2The analysis of relation between bacterial strains and nasal cytology revealed:(a)The presence of the coagulase-negative staphylococci was correlated with less severe inflammatory changes, expressed by a higher count of epithelial columnar cells and lower count of neutrophils in the cytology results.(b)The presence of S. aureus was associated with a significantly higher percentage of squamous cells in cytology obtained from the middle nasal turbinate (for S. aureus found in the maxillary sinus). This observation suggests drawing attention to the transformation of mucosa into squamous, as a possible risk factor for colonisation of S. aureus in the maxillary sinus.(c)Occurrence of H. influenzae and M. catarrhalis in the smear correlated with a greater potential for infection, expressed by a significantly higher count of neutrophils. ConclusionsDamage to the respiratory epithelial surface is understood as damage to the innate immune barrier, and repeated antibiotic therapy with the subsequent repopulation of the epithelium accidentally by various bacteria can become responsible for the pathogenic effect of bacteria in chronic rhinosinusitis.