Endoscopically guided sinus cultures in normal subjects.

The study of healthy sinus flora has been pursued with Caldwell-Luc, antral puncture, and anterior rhinoscopy. Increasingly, nasal endoscopy has been used to obtain cultures, yet the significance of findings using this technique remains uncertain. Our ability to interpret the growing number of these cultures will be greatly enhanced by determining the results of this technique in patients without sinusitis. The goal of this study is to identify the bacterial flora of the sinuses in 25 healthy volunteers. Gram stain, aerobic, and anaerobic cultures were performed on swabs taken from the middle meatus and sphenoethmoid recesses. Eighteen cultures were sterile for aerobic organisms. Of the remaining 32 cultures, 41 isolates were retrieved. Predominant aerobes were S. aureus, Staphylococcus coagulase-negative, and diphtheroids; P. acnes was the predominant anaerobe.

Endoscopically guided cultures in chronic sinusitis.

In chronic sinusitis, culture-directed antibiotics are often recommended as a cornerstone of treatment. The significance of Gram-negative rods (GNRs), coagulase-negative Staphylococci (SCN), and Staphylococcus aureus has been controversial. In an effort to determine host factors which correlate with culture results, 507 endoscopically-guided cultures are reviewed from 265 patients. A history of asthma, allergic rhinitis, prior sinus surgery, and the concurrent use of antibiotics, steroids, and irrigations were some of the host factors compared by X2. The results were compared to a control group of 50 cultures from healthy volunteers. SCN, S. aureus, P. aeruginosa, and Streptococcus were the most common isolates. GNRs were present in 27% of cultures and were more common in patients who had prior sinus surgery or were using irrigations. P. aeruginosa was more common in patients taking systemic steroids. SCN occurred with the same incidence in patients and control subjects but was more prevalent in cultures obtained intraoperatively and in patients taking systemic steroids. No identifiable host factor was associated with S. aureus. S. aureus occurred at similar rates in patients and control subjects but grew heavily in patients and exhibited only light growth in controls. Topical nasal steroids appear to have no statistically significant effect on bacterial cultures. Findings from this study further our understanding of chronic sinusitis and may help guide practitioners in the treatment of this disease.

A new prosthesis for reconstructing the incudostapedial joint.

OBJECTIVE: This study aimed to evaluate the hearing results obtained using the Silverstein Incus-Stapes Connection in ossicular reconstruction among patients with chronic ear disease. STUDY DESIGN: The study was performed as a retrospective review. A control group consisted of patients undergoing similar surgery but in which no prosthesis was used. SETTING: The Florida Ear and Sinus Center outpatient offices of the senior author. PATIENTS: Forty-seven patients with a mean age of 48 years comprised the treatment group. Thirty-eight patients (mean age, 49.4 years) acted as control subjects. INTERVENTION: All patients underwent surgery for chronic ear disease. Reconstruction surgery for patients requiring separation of the incudostapedial was performed with a Silverstein Incus-Stapes Connection or by reapproximating the joint capsule to allow primary healing. MAIN OUTCOME MEASURE: The patients were categorized according to how the prosthesis was used. Results comparing the preoperative air-bone gap and postoperative air-bone gap were evaluated. The change in air-bone gap was reported according to the guidelines set forth by the Committee on Hearing and Equilibrium. RESULTS: The mean postoperative air-bone gap for reconstruction with the prosthesis was 17.6 dB compared to a mean of 11.8 dB among control subjects. An air-bone gap of 16.5 dB was achieved when the prosthesis was used to bridge an area of lenticular resorption. When a composite prosthesis, made by adding cartilage to the disk, was used to bridge larger defects, an air-bone gap of 14.3 dB was seen. Finally, when the prosthesis was used as a partial ossicular replacement prosthesis and directly contacted the tympanic membrane, the air-bone gap was 9 dB. The prosthesis was found to be stable when re-exploration was required and modification of the prosthesis with cartilage was accomplished easily intraoperatively. CONCLUSION: The Silverstein Incus-Stapes Connection is a middle ear prosthesis that can provide a mechanism for overcoming incus resorption in selected cases. In addition, the prosthesis can be modified easily with the addition of cartilage when needed.

Imaging of granulomatous neck masses in children.

Non-tuberculous mycobacterial (NTM) infection is the most common cause of granulomatous inflammation in pediatric neck masses. Diagnosis relies upon culture, acid-fast bacilli (AFB) staining, chest radiograph, purified protein derivative (PPD) test, and clinical features. Computed tomography (CT) and magnetic resonance (MR) imaging may provide valuable information in the work-up of children with cervical masses. We reviewed 11 CT and 5 MR studies of children with a clinical diagnosis of NTM infection. Specific findings included stranding of the subcutaneous fat, thickening and enhancement of the overlying skin, obliteration of the tissue palnes, and multichambered masses. One patient had calcifications within the mass. MR with contrast better demonstrated the soft tissues and is our recommended imaging modality, although CT is more likely to detect calcifications within the neck mass.