Revista de otología y rinología

Quantitative Evidence Against Bacterial Infection Alone as a Cause of Chronic Rhinosinusitis

Neil Bhattacharyya

Quantitative Evidence Against Bacterial Infection Alone as a Cause of Chronic Rhinosinusitis

Objective: Determine if the differential presence of bacteria within individual patients with CRS supports a bacterial role in the pathogenesis of CRS.

Methods: A prospective series of adult patients with unilateral sinus disease on computed tomography undergoing primary endoscopic sinus surgery was studied. From the diseased sinus on one side and the contralateral analogous non-diseased sinus, bacterial cultures were obtained and analyzed. Quantitative assessment of bacterial burden was obtained and compared between the paired non-diseased (control) and the diseased sinuses. Results: 82 patients completed analysis with microbiological data for paired sinuses. When considering positive cultures for any bacteria excluding oral flora, 71/82 (86.6%) of the radiographically diseased sinuses were positive on culture versus 71/82 (86.6%) of the paired equivalent control sinuses on the contralateral side (p=0.999). Quantitatively similar bacterial recovery was obtained between control and diseased sinuses (1.1[1.1] versus 1.3[1.2], (serial dilution [standard deviation]) respectively, p=0.183). These results held true when coagulase negative Staphylococcus species were excluded from the analysis (p=0.333). Degree of bacterial resistance was also not different between control and diseased sinuses (p=0.851). Conclusion: Based on this prospective study with an intra‑patient control, very similar rates of quantitative bacterial recovery were found between radiographically normal (control) and diseased paranasal sinuses within patients with unilateral CRS. These data argue against a significant role for persistent bacterial infection alone in the pathogenesis of unilateral CRS. These data may also have implications for bilateral CRS.

Materials/Methods: We surveyed both NES and English-speakers (ES) before and two months after receiving voice therapy at our institution for functional dysphonia. NES received therapy via translation. The survey instrument was the 30-item Voice Handicap Index (VHI). NES subjects were provided with a professionally translated version of the VHI in their native language.

Results: Change scores were calculated for the 20 subjects (12 NES and 7 ES) who completed both pre- and post-treatment surveys, and were normalized to a maximal score of 120 to account for incomplete questionnaires. ES improved from a baseline mean of 49.1 to 30.5 (p=0.015), and NES from 56.9 to 47.3 (p=0.065). The mean for the entire group improved from 54.0 to 41.1 (p=0.002). No significant between-group difference was found.

Conclusion: Overall, this mixed population showed improvement in the VHI with voice therapy. Analyzed individually, English-speakers had significant improvement, while non-English speakers did not. Further studies of voice therapy via translation are warranted.