Bacteriological aetiology of chronic rhinosinusitis in children; a study from the pediatric otolaryngology clinic of the warsaw medical university

Magdalena Frąckiewicz¹, *Lidia Zawadzka-Głos¹, Elżbieta Podsiadły², Lechosław P. Chmielik¹, Joanna Rogulska²

Summary
Introduction. Chronic rhinosinusitis (CRS) is a long-lasting inflammation whose aetiology is multifactorial. In the majority of patients, the disease develops from an existing impaired patency of the nose or ostia of paranasal sinuses. Such patients require surgical treatment, however almost always the disease is accompanied by bacterial infection of this region.
Aim. To identify and estimate the sensitivity of pathogens to drugs through bacteriological testing of samples from children surgically treated for chronic rhinosinusitis or those where preliminary treatment of such diseases has been proposed.
Material and methods. The study was performed on children who had undergone the initial stage of conservative treatment at the Department of Paediatric Otolaryngology, Warsaw Medical University between 2007 and 2010. Samples for bacteriological examination were collected during the endoscopic sinus surgery from under the middle nasal turbinates and maxillary sinuses.
Results. Pathogens that either most frequently caused or co-existed with chronic rhinosinusitis were determined in samples taken from the maxillary sinuses and from under the middle nasal turbinates. Staphylococcus aureus was found to be the most frequently cultured.
Discussion. Chronic rhinosinusitis develops as a result of composite and multistage inflammatory process. At least one component of the CRS pathogenesis is through chronic or recurrent bacterial infection. Our study demonstrated in many cases a lack of correlation between the results from under the nasal turbinates and maxillary sinuses.
Conclusions. 1. Our screening tests have a different bacterial aetiology for rhinosinusitis than those patients seen by their family doctor. 2. In most cases results from under the middle nasal turbinate differ from the lumen of maxillary sinuses. 3. Examining samples taken from under the middle nasal turbinates and maxillary sinuses plays a vital role in establishing the aetiology of rhinosinusitis and in choosing the appropriate treatment if a recurrence of rhinosinusitis occurs. 4. On basis of this study, the authors suggest amoxicillin and amoxicillin with clavulanate acid be used as first line treatment agents in cases of exacerbated chronic rhinosinusitis.

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