Comparison between polymerase chain reaction and fungal culture for the detection of fungi in patients with chronic sinusitis and normal controls.

CONCLUSION: PCR using panfungal gene primers is a more sensitive method for fungus detection than fungus culture, both in patients with chronic sinusitis and in normal controls. The presence of fungi alone, however, was insufficient to implicate them as pathogens in chronic sinusitis. OBJECTIVE: Previous findings have suggested that polymerase chain reaction (PCR)-based methods are more sensitive and reliable than conventional culture methods for the detection of fungal DNA. We therefore compared these methods in 82 patients with chronic sinusitis and 40 normal controls. MATERIAL AND METHODS: The noses of the subjects were irrigated with sterile saline, and the samples collected. The sediment from each irrigation was used for fungus culture and PCR analysis. RESULTS: PCR analysis using panfungal gene primers showed that 76/82 (92.5%) patients with chronic sinusitis and 39/40 (97.5%) normal controls were positive. In contrast, fungus cultures were positive in 19/82 (23.2%) patients with chronic sinusitis and 12/40 (30.0%) normal controls. We observed no significant between-group differences in the prevalence of fungus or in the fungal species detected.

Polysomnographic effects of nasal surgery for snoring and obstructive sleep apnea.

OBJECTIVE: It has been hypothesized that nasal obstruction causes an increase in negative pressure in the upper airway and induces an inspiratory collapse at the pharyngeal level. We used portable polysomnography (PSG) to assess the efficacy of nasal surgery for snoring and obstructive sleep apnea (OSA). MATERIAL AND METHODS: We reviewed 21 patients who presented with nasal obstruction and snoring. Septal surgery with or without inferior turbinectomy was performed. Each patient was assessed pre- and postoperatively using PSG. We measured the respiratory distress index (RDI), apnea index (AI), oxygen saturation index (OSI) and the duration of snoring. Selection criteria were an RDI of > 15 as determined by PSG and clinical nasal obstruction and a deviated nasal septum as determined by physical examination. RESULTS: Nasal surgery had the following effects: RDI decreased from 39 to 29 (p = 0.0001), AI decreased from 19 to 16 (p = 0.0209), OSI decreased from 48 to 32 (p = 0.0001) and the duration of snoring decreased from 44% to 39% (p = 0.1595). Snoring and OSA were completely relieved in 4 patients (19%) who did not require any additional surgical therapy. CONCLUSION: Snoring and OSA may be corrected merely by septal surgery in some patients, and secondary surgery (uvulopalatoplasty) may be considered after a thorough evaluation by means of postoperative PSG.