Bacteriological and immunological studies of chronic maxillary sinusitis in adults

ABSTRACT

The bacterial finding of 83 maxillary sinuses in 60 patients with chronic maxillary sinusitis. Together with 9 non-inflamed sinuses. Were reported Employing an intraoperative techniqne and simultaneous collection of 3 different types of specimens in the present intevtigation made possible comparison of their bacterial characteristics. The results indicated that intraoperative culture of antral mucosa seems to provide the most reliable finding of bacterial flora in chronic maxillary sinusitis. The anaerobic bacteria were never found in the mucosal culture of non-inflamed sinus. The anaerobes appeared to invade the sinus cavity following the sealing of the ostium through the lymphtic or venous system and maintain the inflammatory process. Microbiological analysis of the results between the infected and non-inflamed sinuses established anaerobic bacteria as the most important pathogen in chronic maxillary sinusitis. The predominant anaerobes recovered in descending order of frequency were propionibacterium acnes. Bacteroides melaninogenicus. Veillonella parvula. Peptostreptococcus magnus and Bacteroides intermedius. There was a lower frequency of anaerobic culture in sinus secretion samples when compared to high frequency demonstrated in sinus mucosa samples when compared to high frequency demonstrated in sinus mucosa samples [14% and 75% respectively]. Statistical analysis of the results of mucosal culture of inflamed and control materials demonstrated that those aerobic and facultative bacteria recovered in the inflamed sinus appeared to be the normal inhabitants of non-inflamed sinus mucosa. The presence of normal flora in the normal healthy sinus mucosa may explain the chain of events that follows the occlusion of the ostium. These aerobic bacteria may become pathogenic and play a role in the pathogenesis of sinusitis. The mean level of secretory IgA was elevated in patients with purulent sinus wash. Than in patients with mucopurulent and serous wash. This means that as the inflammatory process in the maxillary sinus is advanced towards the purulent type with sinus mucosal damage. There is a concomitant increase of secretory IgA