The effect of intraoperative mupirocin irrigation on Staphylococcus aureus within the maxillary sinus.

BACKGROUND: Antibiotic irrigations are occasionally used during endoscopic sinus surgery when gross mucosal infection is present. These irrigations are thought to flush out pathogenic bacteria and decrease the bacterial load within the mucosal surfaces. This treatment, however, has not been studied in vivo and it is unknown whether antibiotic rinses produce a quantitative reduction in pathologic bacteria within the sinus mucosa. The objective of this study was to determine the relative abundance of Staphylococcus aureus within the maxillary sinus and to evaluate the impact of intraoperative mupirocin irrigation on bacterial burden. METHODS: Sixteen patients with symmetric maxillary chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa on both sides. In each patient, the right side was irrigated with 240 mL of normal saline (NS) and the left side was irrigated with 240 mL of NS mixed with 60 mg mupirocin. Repeat maxillary sinus mucosal biopsies were taken from each side 7 to 10 days postsurgery. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and relative amount of S. aureus. RESULTS: Mupirocin irrigations were found to significantly reduce the amount of S. aureus found within the maxillary sinus mucosa compared to NS alone. The average fold change between the pre- and posttreatment biopsies on the right and left was 9.05 and 97.42, respectively (p < 0.01). CONCLUSION: Intraoperative mupirocin irrigations significantly reduce the amount of S. aureus detected within the diseased sinus mucosa at up to 10 days postoperatively.

Upregulation of Bcl-2 in nasal polyps from patients with cystic fibrosis.

BACKGROUND: Nasal polyps in patients with cystic fibrosis (CF) are believed to be phenotypically different than polyps affecting non-CF patients. The aim of this study was to investigate differences in cell cycle regulatory mechanisms between these 2 groups. In this prospective study at a tertiary care academic medical center, multiple techniques were used to confirm the upregulation of antiapoptotic Bcl-2 family proteins in CF polyps. METHODS: Nasal polyps were prospectively obtained from CF and non-CF patients. The Sigma Panorama Protein Microarray for Cell Signaling was used to identify differences in protein expression between the 2 polyp groups. Western blot analysis confirmed altered expression of a subset of these proteins. Immunohistochemical staining was performed on archived tissue to further investigate B-cell lymphoma 2 protein (Bcl-2) expression. Following review by a pathologist, slides were digitized using an Aperio™ ScanScope XT system and staining intensity was quantified with the Positive Pixel Count algorithm. The mean staining intensity for each polyp group was compared. RESULTS: The protein microarray suggested a greater than 2-fold upregulation of Bcl-xl in CF polyps relative to non-CF polyps. Western blot analysis confirmed the upregulation in CF polyps of Bcl-2, a more commonly studied protein analog of Bcl-xl. The CF polyp group was noted to have a higher quantitative intensity of immunohistochemical staining for Bcl-2 compared to the non-CF group (p < 0.05). CONCLUSION: Through multiple modalities of protein investigation, we have demonstrated an upregulation of Bcl-2 family proteins in CF polyps relative to polyps from non-CF patients.

Upregulation of RANTES in nasal polyps from patients with cystic fibrosis.

BACKGROUND: Nasal polyps in patients with cystic fibrosis (CF) are believed to be phenotypically different than polyps affecting non-CF patients. The objective of this study was to characterize the expression of inflammatory cytokines within nasal polyps from CF and non-CF, aspirin-tolerant patients. "Regulated on activation, normal T-cell expressed and secreted" (RANTES) is a chemotactic cytokine involved in the recruitment and activation of eosinophils. Multiple molecular studies of non-CF polyps have established that RANTES may play an important role in nasal polyposis. Our study suggests RANTES may be upregulated in CF polyps relative to non-CF polyps. METHODS: Nasal polyps were prospectively obtained from CF and non-CF, aspirin-tolerant patients. The Quantibody™ Human Cytokine Array I from RayBiotech, Inc., was used to identify differences in cytokine expression between protein extracts of two polyp groups. Four CF polyp extracts and 4 non-CF, aspirin-tolerant polyp extracts were each incubated on identical antibody subarrays, each containing 20 human cytokines in quadruplicate. Western blot analysis confirmed expression of RANTES. RESULTS: The protein microarray suggests a greater than 4-fold upregulation of RANTES in CF polyps relative to non-CF polyps. Western blot analysis confirmed expression of RANTES in CF polyps. CONCLUSION: Chemokines such as RANTES are responsible for the activation of inflammatory cells within the lamina propria of nasal polyps. We have demonstrated that RANTES may be an important cytokine associated with CF polyps.

Protein microarray analysis of nasal polyps from aspirin-sensitive and aspirin-tolerant patients with chronic rhinosinusitis.

BACKGROUND: The purpose of this study was to apply protein microarray technology to the study of sinonasal tissue and to identify differential protein expression in nasal polyps from aspirin-sensitive (AS) versus aspirin-tolerant (AT) patients with chronic rhinosinusitis (CRS) and CRS with nasal polyps (CRSwNPs). METHODS: Nasal polyp specimens were prospectively obtained from two groups of patients with CRSwNP. The test group (AS) consisted of five patients that were diagnosed with CRSwNP and intolerance to aspirin based on medical history and physical exam. The control group (AT) consisted of four AT patients with CRSwNP. Protein was extracted and labeled from harvested polyps and the Sigma Panorama Antibody Microarray-Cell Signaling Kit was used to identify differences in protein expression between the two polyp groups. Western blot analysis was used to validate the results of the protein microarray. RESULTS: The protein microarray showed a greater than twofold change in expression of both beta-adaptin and heat shock protein 70 (HSP70). Western blot analysis confirmed up-regulation of beta-adaptin and HSP70 in nasal polyp tissue from AS patients. CONCLUSION: Pooled samples of AS and AT nasal polyps evaluated by protein microarray show distinct protein expression profiles in the stress response and receptor-mediated endocytosis pathways. This study establishes the successful application of protein microarray technology to study nasal polyposis, which in turn can be validated by Western blot analysis.

Recurrent sudden sensorineural hearing loss sensitive to transtympanic and systemic steroid treatment: case report.

Sudden sensorineural hearing loss (SSNHL) is a rare otologic emergency. Recurrence of this pathology is extremely rare, and its incidence remains unknown. We report the case of a previously healthy 28-year-old man with normal findings on bilateral ear examination who presented with severe unilateral SSNHL. Audiometry demonstrated a pure-tone average of 70 dB and a speech discrimination score of 0% in the affected ear. The patient was treated within hours of the onset of symptoms with an intratympanic injection of dexamethasone and then started on a tapered course of oral prednisone. He experienced a full recovery based on repeat audiometric testing 7 days later. However, 1 year later, the patient experienced a repeat episode of SSNHL in the same ear. Management again included an intratympanic injection and an oral steroid course with good results. A complete metabolic and radiographic evaluation failed to identify a cause of the hearing loss. This case represents a highly unusual instance of recurrent SSNHL of unknown etiology.