Moderator: Dr. N.JANARDHAN Presenter: Dr.R.

RAGHAVENDRA REDDY

The microbiology of chronic maxillary sinusitis is polymicrobial, consisting of both aerobic and anaerobic bacteria. Chronic sinusitis is suspected of being caused by impaired paranasal sinus ventilation and drainage disorders. Several studies have shown that in the majority of cases of chronic sinusitis, bacterial culters are negative.

Even PCR techniques have failed to demonstrate bacterial infection in most of cases. However none of these techniques employed adequate methods for the recovery of anaerobic bacteria. This study is aimed to summarize their experience in recovery of micro organisms in adults.

Study center: microbiology and ENT department , S.Nijalingappa medical college, Bagalkot, Karnataka. 50 patients ( 32 men, 18 women) were included. Age range : 18-60 yrs. All patients had obstructive or subobstructive chronic hyperplastic sinusitis, had failed medical therapy and required surgical intervention. Cultures of sinus contets were done by either inferior or middle meatal antrostomy.

Judging the presence of sinusitis: waters view or lateral view or CT scan nose and paranasal sinuses taken. mucosal thickening, air fluid level, or complete opacification of maxillary sinus is taken as criteria. mucosal thickening was evaluated by noting the nearest distance b/w the air mucosal interface and the lateral part of the sinus wall.

mucosal thickening was defined as a mucosal width of 5mm or more. patients had atleast one of the following complaints facial pain, head ache, purulent nasal discharge, fever or malaise. chronic sinusitis was defined based on the clinical records as an infection of atleast 12 weeks duration.

Collection and transport of specimen: specimens are collected using sinus puncture through the inferior meatus or by the middle meatal antrostomy while doing endoscopic sinus surgery. specimens were transported to the laboratory in a thioglycollate broth. the time b/w the collection and inoculation of the specimen did not exceed 30 minutes.

Inoculation of specimens: specimens were inoculated on to 5% sheeps blood, chacolate and Mac-conkeys agar plates for aerobic and facultative organisms. The plates were incubated at 37degree.C. aerobically (Mc conkey) or under 5% co2 (5% sheep and chacolate agars) and examined at 24 and 48 hours. For anaerobes the material is pasted on to prereduced vit.K1enriched Brucella blood agar, an anaerobic blood agar plate containing Kanamycin and Vancomycin hydrochloride an anaerobic blood plate containing Colistin sulfate and Nalidixic acid. The anaerobic plates are incubated in jars (gaspak) and examined at 48 and 96 hours. Aerobic and anaerobic bacteria were identified using conventional techniques. Antibiotic sensitivity testing was done by Kirby Bauer disk diffusion method using standard antibiotic disks on all aerobic/facultative organisms.