Adenoid bacteriology in sinonasal symptoms in children

One of the most common reasons that pediatric patients are brought to emergency facilities is because of upper respiratory tract infections. In some of these cases, they are complicated by development of acute bacterial sinusitis. Recurrent sinusitis is also seen as a common disorder of childhood. Previous studies have shown that improvement of sinusitis symptoms occur with adenoidectomy; possibly because of removal of the adenoid pad as the reservoir for pathogenic bacteria. The purpose of this study was to evaluate the correlation between sinusitis and the prevalence of bacterial pathogens in the adenoids. A positive correlation would be suggestive of the role of the adenoids as a bacterial reservoir. This was a prospective study of all children ages 2-12 years old who were undergoing adenoidectomy alone or in combination with tympanostomy tube insertion or tonsillectomy. A questionnaire was used to assess the possibility of sinonasal infections. A blocked recruitment scheme was used to be sure that a representative spectrum of sinonasal symptoms occurs in this study. The questionnaire was supposed to evaluate important quality-of-life domains, including the sinonasal infection symptoms, ear infections, nasal obstruction, and behavioral symptoms. Following filling out the questionnaire, an adenoidectomy was performed, a core sample was evaluated to analyze deep tissue infection rather than surface colonization. Pathogens that were highly likely to be associated with infection were evaluated. Eighty-four subjects participated in the study. Surgeries were primarily performed for sinusitis and nasal obstruction. Adenoidectomy was performed alone in 23%, along with tympanostomy tubes in 21% and tonsillectomy in 40%. The most common sinonasal symptoms were congestion, rhinorrhea, nighttime cough, postnasal drip, and fetor oris. Ear symptoms were also fairly common. One or more bacterial pathogens were recovered from the core samples of all the adenoids. The severity and level of sinonasal symptoms evaluated as either low, medium, or high were significantly associated with quantitative bacteriologic results. The number of pathogens and CPUs per gram of adenoid tissue were also correlated with increased symptoms. Multivariate analysis showed a strong correlation between sinonasal symptoms and quantitative bacteriology. In the discussion, the authors describe the significant positive correlation between the sinonasal symptoms and the quantitative studies of the adenoid core for bacteriology. This would suggest that the adenoid tissue may serve as a reservoir of bacteria and may play a role in the development of sinonasal symptoms and sinusitis. This is a very well done study evaluating the potential correlation of adenoid bacteriology and sinonasal symptoms in children. The questionnaire that was utilized is described as fulfilling many of the requirements for objective outcomes testing. However, there is no discussion either by the authors in the paper, or a reference that shows that the instrument truly had been validated. Although this may or may not have impacted the results, if this validation of the outcomes instrument did not occur, then the correlation between a nonvalidated instrument and the bacteriology of the adenoids may be less significant. Because certain nasal sinus symptoms are common even in validated instruments, it is likely that this correlation would persist. Ongoing evaluation and research related to the role of the adenoids in chronic nasal symptoms and sinusitis in children may play a great role in helping the clinician to manage this complicated and difficult disorder.