Sinus microbiota varies among chronic rhinosinusitis phenotypes and predicts surgical outcome.

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent multifactorial disease process in which bacteria are believed to play a role in the propagation of inflammation. Multiple subtypes of CRS have been described based on clinical and pathologic features, but a detailed examination of the sinus microbiota in patients with CRS and its clinical subtypes has yet to be performed. OBJECTIVE: We sought to examine the resident microbiota of CRS subtypes and determine whether bacterial diversity is a predictor of disease outcomes. METHODS: Sinus swabs from patients with CRS and healthy subjects collected during endoscopic sinus surgery were analyzed by means of molecular phylogenetic analysis of 16S rDNA pyrosequences. RESULTS: Fifty-six patients with CRS and 26 control subjects were studied. Biodiversity was similar between the CRS and control groups. Among the CRS subtypes examined, only 2 conditions (presence of purulence and comorbid condition of asthma) were associated with significant alterations in microbial community composition. In 27 patients with CRS who were followed postoperatively, those with better outcomes had more diverse bacterial communities present at the time of surgery, along with higher relative abundances of Actinobacteria. CONCLUSION: Analysis of microbiota in a large cohort reveals that particular CRS phenotypes (asthma and purulence) are characterized by distinct compositions of resident bacterial communities. We found that bacterial diversity and composition are predictors of surgical outcome, promoting the concept of community ecology in patients with CRS.

Clinical significance of middle turbinate lateralization after endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: To investigate the clinical significance of middle turbinate lateralization (MTL) occurrence postendoscopic sinus surgery (ESS) for chronic rhinosinusitis, namely, association with postoperative symptoms and eventual need for undergoing revision surgery. STUDY DESIGN: Retrospective chart review of consecutive postoperative follow-up appointments (November 2009-May 2011) for patients who had had full-house ESS (post hoc analysis). METHODS: Endoscopic video recordings were reviewed by a blinded reviewer to determine occurrence of MTL (any portion of the middle turbinate touching the lateral nasal wall). Postoperative symptom questionnaires using the Adelaide scoring system were collected. Records were reviewed to determine the need for revision surgeries during follow-up. RESULTS: A total of 151 patients had follow-up with video endoscopy from 2009 to 2011. No statistically significant association between MTL and symptoms was found (P > .05). Of the patients with MTL, 21% required revision versus 9% in those who had no MTL (P = .07). Log-rank test showed that there was a statistically significant difference between the revision surgery survival curves for the MTL and no-MTL groups (P = .03). Controlling for the inability to examine the frontal sinus, the difference between the two survival functions increased (P = .005). CONCLUSIONS: MTL was not associated with patient-reported symptoms, but may be associated with a more rapid need for future revision surgery. We hypothesize that this effect is related to interference with the frontal sinus.

Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis.

OBJECTIVES/HYPOTHESIS: To analyze the differences between biodegradable and nondegradable nasal dressings with regard to their effects on wound healing in the short and medium term and on surgical outcomes in the long term, after endoscopic sinus surgery (ESS). STUDY DESIGN: A prospective, randomized, partly blinded, controlled trial. METHODS: A total of 56 patients undergoing bilateral ESS for chronic rhinosinusitis with polyposis were enrolled and randomized to receive biodegradable (Nasopore; Stryker, Hamilton, ON, Canada) on one side and nondegradable packing (Merocel; Medtronic Xomed, Minneapolis, MN) on the opposite side. Postoperative morbidities (pain, bleeding, facial edema, nasal blockage) related to dressings were assessed on postoperative day 6. Wound healing (edema, crusting, secretions, synechia, granulation tissue formation, and percentage re-epithelialization) were evaluated at 2 weeks, 1 month, 3 months, and 6 months using modified Lund-Kennedy scores. Long-term assessment at 12 months was done using validated Lund-Kennedy scores. RESULTS: Morbidities related to nondegradable packing were significantly higher than with degradable packing (Wilcoxon signed rank test, P<.01). Pain, bleeding, nasal blockage, and facial edema were significantly less with absorbable packing. No statistically significant difference was found between sinonasal cavities packed with biodegradable or nondegradable materials with regard to healing scores and percentage of re-epithelialization at 2 weeks, 1 month, 3 months, 6 months, and surgical outcomes at 1 year (P>.05). However, healing at 6 months was correlated with the preoperative Lund-Mackay radiology and surgery scores (Spearman's rho correlation test, P<.05 and P<.01, respectively). CONCLUSIONS: No significant healing or surgical outcome differences were found between biodegradable and nondegradable packing. However pain, bleeding, nasal blockage, and facial edema were lower with biodegradable packing. LEVEL OF EVIDENCE: 1b.