Middle Meatal Research Articles

Bacteriology of Chronic Sinusitis in Relation to Middle Meatal Secretion

The bacteriology of chronic sinusitis has been studied widely, but some factors may affect the results, such as sample sources and sampling techniques. However, whether the presence of secretion in the middle meatus affects the culture result has been studied rarely. When patients with chronic sinusitis underwent functional endoscopic sinus surgery, swab specimens were taken from the ipsilateral middle meatuses and ethmoid sinuses under endoscopic guidance. While taking specimens from the middle meatuses, we observed the presence of secretions in the middle meatuses. The severity of chronic sinusitis was evaluated by preoperative computed tomography, which was scored by the Lund-Mackay system. The scores of the frontal, anterior ethmoid, maxillary sinus, and ostiomeatal complex were cumulated. Between March 2001 and February 2004, 210 pairs of specimens were collected. The secretion was present in 82 middle meatuses and was absent in the other 128 middle meatuses. The culture rates of middle meatus and ethmoid sinus specimens were 70.7 and 51.2%, respectively, for patients with secretions in the middle meatuses and 53.1 and 44.5%, respectively, for patients without secretions in the middle meatuses. The culture rate was significantly different for middle meatus specimens (p = 0.011) and the mean cumulated computed tomography score also was significantly higher in patients with secretions in the middle meatuses than in patients without secretions in the middle meatuses (p < 0.001). The results of this study suggest that the presence of secretion in the middle meatus indicates more severe disease in the anterior group of paranasal sinuses.

Commentary on “Endoscopically Directed Middle Meatal Cultures versus Maxillary Sinus Taps in Acute Bacterial Maxillary Rhinosinusitis: A Meta‐Analysis”

The following commentary refers to the above-named article by Benninger, Payne, Ferguson, et al, which appeared in the January 2006 edition of this Journal. See vol. 134, no. 1, pp. 3–9.

Endoscopically Directed Middle Meatal Cultures Versus Maxillary Sinus Taps in Acute Bacterial Maxillary Rhinosinusitis: A Meta-Analysis

The aim of this study was to verify the correlation of endoscopically directed middle meatal (EDMM) cultures with maxillary sinus tap and culture (MST) in acute bacterial rhinosinusitis (ABRS). Meta-analysis of the previous literature, unpublished data, and a prospective trial supported by the Sinus & Allergy Health Partnership. EDMM and MST cultures were obtained and their results compared. Inclusion for both the unpublished and prospective trial as well as prior published literature in the meta-analysis required the studies to compare EDMM versus MST in the acute setting of bacterial rhinosinusitis with both symptomatic and radiologic evidence of ABRS. Three articles and 1 national presentation were identified for inclusion. Additional data from unpublished studies and the prospective trial were combined. The pooled data consisted of 126 patients with 131 culture pairs. For known pathogenic bacteria for ABRS and in comparison to MST, EDMM had a sensitivity of 80.9%, a specificity of 90.5%, a positive predictive value of 82.6%, a negative predictive value of 89.4%, and an overall accuracy of 87.0% (95% confidence interval, 81.3%-92.8%); 70.5% (12/17) of false positive culture pairs were of known pathogens for ABRS that would not be expected to be contaminants. This meta-analysis shows that EDMM is a highly sensitive and accurate culture method for acute ABRS and may be more sensitive than MST given the presence of pathogenic bacteria not found on antral lavage. EDMM is a viable, and possibly preferred, culture method for determining antimicrobial efficacy and bacterial resistance patterns. A-1a.

Microbiology of Sinus Puncture versus Middle Meatal Aspiration in Acute Bacterial Maxillary Sinusitis

Maxillary sinus puncture is considered the gold standard for diagnosing acute bacterial maxillary sinusitis (ABMS) and for identifying bacterial pathogens in antimicrobial trials of ABMS. However, sinus puncture and aspiration is all invasive, time-consuming procedure that is limited by discomfort to the patient and possible complications. Therefore, the diagnostic usefulness in clinical practice and patient enrollment in studies of ABMS is hindered and alternatives for maxillary sinus puncture are being investigated. We designed a prospective clinical and microbiological outpatient study. Cultures obtained by endoscopically guided middle meatal aspiration were compared with those from sinus puncture and aspiration in 24 patients with ABMS. Considering puncture and aspiration as the gold standard, endoscopy cultures provided a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78.6%, and correlation of 88.5%. In our study, endoscopic sampling compared favorably with sinus puncture and aspiration.

Evaluation of middle meatal stenting after minimally invasive sinus techniques (mist)

In this study, we compared postoperative synechia rates and morbidity for different middle meatal (MM) stents after minimally invasive sinus techniques (MIST). In a prospective study, we included 100 patients with bilateral chronic sinusitis undergoing MIST at a tertiary care facility with a single surgeon. For all patients, MeroGel stents were placed in the right MM, Gelfilm stents were placed in the left MM. Follow-up consisted of 3 postoperative visits between weeks 1 and 12 with endoscopic evaluation for synechia, granulation tissue, stent retention, nasal obstruction, headache, and infection. Synechia developed in 4 patients on the left and in none on the right (P = 0.04). There were no significant side-specific differences regarding postoperative nasal congestion, headache, or sinusitis. Mean stent retention time was 7.9 days for MeroGel and 5.6 days for Gelfilm (P = 0.0004). Compared with Gelfilm, Merogel MM stents produced less synechia; Merogel retains its position in the MM longer than Gelfilm; and the incidence of postoperative MM synechia can be reduced when absorbable MM stents are used in conjunction with MIST.

Delayed Reocclusion of a Middle Meatal Antrostomy

Delayed Reocclusion of a Middle Meatal Antrostomy

Air-exposed Tissue Culture of Human Middle Ear Epithelium and Meatal Epidermis: a Method to Study the Advancing Front of Cholesteatoma

The suitability of an air-exposed culture model consisting of a collagen matrix was investigated for constructing an advancing front (AF) of human middle ear epithelium (MEE) and meatal epidermis (ME). Three different culture settings were used: ( i ) MEE; ( ii ) ME; and ( iii ) AF (MEE+ME). Small tissue biopsies were placed on a fibroblast-populated collagen matrix and grown at the air-liquid interface. After 3 weeks of culture, the MEE and ME outgrowth was differentiated. Light, scanning electron and transmission electron microscopy showed no visible differences compared to native MEE and ME. Cytokeratin 8 and cytokeratin 10 expressions were comparable to the expression seen in the native MEE and ME tissues. Proliferation, which was demonstrated by the expression of Ki-67, was present in the basal layers of cultured MEE and ME. A double layer of cells in which the ME covered the MEE formed the AF. In the AF, the MEE and ME showed the same morphological and immunohistochemical characteristics as in their native tissues. The results of the study show that this in vitro system is a well-defined model system offering the possibility to study the effects of external stimuli on the different epithelia of the AF involved in the pathogenesis of cholesteatoma.

Sparfloxacin in the treatment of purulent sinusitis-a multicentric study in Indian patients.

Sparfloxacin, a new quinolone antibacterial was used to treat one hundred and thirty two patients with acute purulent sinusitis, at a dosage of 400 mg on the first day followed by 200 mg once daily for a further four days. A clinically successful outcome (defined as disappearance of nasal discharge, fever, pain, tenderness over the sinuses and headache) was recorded in 122 ( 95.3%) patients. Sparfloxacin was well tolerated. Fourteen adverse experiences were reported in 7 patients ( 5.3%); they were mainly gastrointestinal and mild. No phototoxic or cardiological adverse events occurred. An unusual feature was that Staphylococcus aureus and Pseudomonas spp. were the most common bacterial species isolated from middle meatal was of patients in this study.

Endoscopic View of Mucociliary Transport following Middle Meatal Antrostomy

Endoscopic View of Mucociliary Transport following Middle Meatal Antrostomy

Correlation of Middle Meatal and Maxillary Sinus Cultures in Acute Maxillary Sinusitis

Cultures obtained from the middle meatus have been used frequently in the past to direct therapy in patients with acute maxillary sinusitis. However, no convincing data have been published to indicate that middle meatal cultures accurately represent the bacterial flora within the maxillary sinus. The hypothesis of this experiment is that bacteria obtained by directed middle meatal cultures qualitatively and quantitatively correlate with cultures taken by maxillary sinus puncture. Acute sinusitis was induced by injecting 10(8) colony-forming units of bacteria directly into the maxillary sinuses of rabbits in which the ostia were occluded with cotton packs. Eight animals were injected with Staphylococcus aureus, eight with Haemophilus influenzae, and eight with Streptococcus pneumoniae. The packs were removed after 3 days, and specimens were obtained from the middle meatus in the region of the maxillary sinus ostium, and from the maxillary sinus, 1 day later. The contralateral maxillary sinuses of six of the animals were injected with normal saline and served as controls. There was a 100% correlation rate between cultures of specimens obtained from the maxillary sinus and from the middle meatus in all 24 animals. In addition, the quantitative counts from the middle meatus and the maxillary sinus correlated. Control animals showed no bacterial growth from either the middle meatus or the maxillary sinus. These results show that, in an animal model of acute sinusitis, cultures of specimens from the middle meatus reflect the contents of the maxillary sinus.

Middle Meatal Antrostomy Stenting following Pediatric Endoscopic Sinus Surgery

Functional endoscopic sinus surgery in the pediatric population is similar to surgery in adults, yet different in many ways. The smaller size of the surgical field, the lesser extent of pneumatization of the sinuses, and the rapidity of the healing process in children result in a higher occurrence of synechiae and of closure of the middle meatal antrostomy. In addition, a second general anesthesia is often necessary, as children do not tolerate the pain of suctioning in the office. An ostiomeatal stent that has previously proved effective in adults is evaluated in 40 children who underwent bilateral ethmoidectomy and maxillary antrostomy. The stent appears to be effective in preventing synechiae and maintaining patency of the middle meatal antrostomy and ventilation of the maxillary sinuses. In addition, once it is removed, the maxillary and ethmoid cavities are relatively cleaner than control, and require minimal postoperative debridement. In the group of children where the stent was placed bilaterally, there was no need for a second general anesthesia for the purpose of suctioning.

Combined approach middle meatal antrostomy.

Combined approach middle meatal antrostomy.