Quantitative bacteriology in adenoid tissue

Self-Defensive Antimicrobial Shape Memory Polyurethanes with Honey-Based Compounds

Infection treatment plays a crucial role in aiding the body in wound healing. To that end, we developed a library of antimicrobial polymers based on segmented shape memory polyurethanes with nondrug-based antimicrobials (i.e., honey-based phenolic acids (PAs)) using both chemical and physical incorporation approaches. The antimicrobial shape memory polymers (SMPs) have high transition temperatures (>55 °C) to enable maintenance of temporary, programmed shapes in physiological conditions unless a specific external stimulus is present. Polymers showed tunable mechanical and shape memory properties by changing the ratio, chemistry, and incorporation method of PAs. Cytocompatible (∼100% cell viability) synthesized polymers inhibited growth rates of Staphylococcus aureus (∼100% with physically incorporated PAs and >80% with chemically incorporated PAs) and Escherichia coli (∼100% for samples with cinnamic acid (physical and chemical)). Crystal violet assays showed that all formulations inhibit biofilm formation in surrounding solutions, and chemically incorporated samples showed surface antibiofilm properties with S. aureus. Molecular dynamics simulations confirm that PAs have higher levels of interactions with S. aureus cell membranes than E. coli. Long-term antimicrobial properties were measured after storage of the sample in aqueous conditions; the polymers retained their antimicrobial properties against E. coli after up to 20 days. As a proof of concept, magnetic particles were incorporated into the polymer to trigger user-defined shape recovery by applying an external magnetic field. Shape recovery disrupted preformed S. aureus biofilms on polymer surfaces. This antimicrobial biomaterial platform could enable user- or environmentally controlled shape change and/or antimicrobial release to enhance infection treatment efforts.

Relationship between bacteriology of the adenoid core and middle meatus in children with sinusitis

Objective:

To assess the correlation between bacterial pathogens in the adenoid core and the middle meatus, in children with hypertrophied adenoids and chronic or recurrent sinusitis.

Design:

The study was conducted at Alexandria University Hospitals. We included 103 children aged four to 12 years who were scheduled for adenoidectomy and who had clinical and/or radiological evidence of chronic or recurrent sinusitis. Adenoid core specimens and middle meatal swabs were obtained from every patient and were sent for bacteriological evaluation using standard qualitative and quantitative microbiological techniques. The results were statistically analysed.

Results:

The bacterial species isolated most frequently from the adenoid core were coagulase-negative staphylococci (40.8 per cent),Staphylococcus aureus(22.3 per cent),Streptococcus pneumoniae(18.4 per cent),Haemophilus influenzae(16.5 per cent) and group A streptococci (15.5 per cent). The bacterial species isolated most frequently from the middle meatus were coagulase-negative staphylococci (41.7 per cent),S aureus(32 per cent),S pneumoniae(28.1 per cent),H influenzae(21.6 per cent) and group A streptococci (19.4 per cent). The adenoid core and middle meatal cultures were both positive for at least one bacterial species in 63 cases, and were both negative in 25 cases. In six cases, a positive adenoid core culture was associated with a negative middle meatal culture. In five cases, a negative adenoid core culture was associated with a positive middle meatal culture (for one or more pathogenic species). Thus, adenoid core culture had a positive predictive value of 91.5 in forecasting the middle meatal culture result, and a negative predictive value of 84.3.

Conclusion:

Apart from its effect on nasal airway patency, adenoidal tissue may function as a bacterial reservoir initiating and maintaining sinus infection in children. These study findings support a potential role for adenoidectomy in the treatment of chronic or recurrent paediatric sinusitis.

Identification of adenoid biofilms with middle ear pathogens in otitis-prone children utilizing SEM and FISH

OBJECTIVES

Biofilms have been implicated in the development of several chronic infections. We sought to demonstrate middle ear pathogens in adenoid biofilms using scanning electron microscopy (SEM) and fluorescent in situ hybridization (FISH) with confocal laser scanning microscopy (CLSM).

METHODS

Comparative micro-anatomic investigation of adenoid mucosa using SEM and FISH with confocal scanning laser microscopic (CLSM) imaging from patients with recurrent acute otitis media (RAOM).

RESULTS

All otitis-prone children demonstrated biofilm surface area presence greater than 85% by SEM. FISH accompanied by CLSM imaging also demonstrated patchy biofilms All biofilms contained middle ear pathogens and were frequent in polymicrobial distributions: 4 of 6, 4 of 6 and 3 of 6 samples contained Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, respectively.

CONCLUSIONS

Dense adenoid biofilms may act as a reservoir for reinfection of the tubotympanum. Aspiration of planktonic middle ear pathogens existing in resistant adenoid biofilms during a viral upper respiratory tract infection may be an important event in the development of RAOM.

Resistant bacteria in the adenoid tissues of children with otitis media with effusion

OBJECTIVE

To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME).

METHODS

This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy.

RESULTS

In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures.

CONCLUSION

The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.

Effectiveness of adenoidectomy and laser tympanic membrane fenestration

OBJECTIVE

Adenoidectomy alone or with tonsillectomy (A+/-T) is an effective surgical intervention in the management of otitis media in children, especially when it is performed in conjunction with insertion of pressure equalization tubes (PETs). Otorrhea and persistent tympanic membrane (TM) perforation are frequent complications. This study evaluates the effectiveness of intermediate duration middle ear ventilation using laser tympanic membrane fenestration (LTMF) without tube insertion and as an adjunct to adenoidectomy in resolving middle ear disease within the first 90 days after surgery.

STUDY DESIGN

This pilot study was a multicenter, prospective clinical cohort trial. Institutional review board approval and informed consent were obtained. The study involved four tertiary care pediatric otolaryngology departments. Fifty children (96 ears) were treated with LTMF in conjunction with A+/-T from June 1, 1998, through March 30, 1999. Ages ranged from 9 months to 12 years. Patients undergoing A+/-T who would have been recommended for PET insertion instead underwent middle ear ventilation with LTMF using the Oto-LAM device (ESC/Sharplan, Yokneam, Israel). Patients were seen at 30, 60, and 90 days postoperatively. Resolution of otitis media with effusion was determined by clinical examination, which included pneumatic otoscopy, audiometry, and tympanometry.

RESULTS

Of the treated ears, 88%, 86%, and 83% had clinical resolution of middle ear disease at 30, 60, and 90 days, respectively. Preoperatively, 45% (n = 85) of ears had normal hearing; 92% (n = 49) had normal hearing at 90 days. Eighty-nine percent (n = 92) had type C2 or B tympanograms preoperatively, and 12% (n = 60) had type C2 or B at 90 days.

CONCLUSION

Laser tympanic membrane fenestration in conjunction with adenoidectomy was effective in restoring normal middle ear function at 90 days post-treatment in greater than 80% of children who otherwise may have had placement of PETs.

Microbiology of healthy and diseased adenoids

OBJECTIVE

To determine the qualitative and quantitative microbiology of core adenoid tissue obtained from four groups of 15 children each, with recurrent otitis media (ROM), recurrent adenotonsillitis (RAT), obstructive adenoid hypertrophy (OAH), and occlusion or speech abnormalities (controls).

METHODS

Core cultures of surgically removed diseased adenoids and of healthy controls were cultured for aerobic and anaerobic bacteria.

RESULTS

Polymicrobial aerobic-anaerobic flora were present in all instances. Ninety-four organisms were isolated from control specimens, and 148 from ROM, 142 from RAT, and 149 from OAH specimens. The predominant aerobes in all groups were alpha-hemolytic and gamma-hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A beta-hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium species. The number, concentration and distribution of types of most organisms did not vary among the three groups of diseased adenoids. However, the number of those that are potential pathogens and those that produced beta-lactamase was lower in the control than the diseased adenoids (P < .001).

CONCLUSION

The study highlights the importance of the bacterial load in the adenoids in contributing to the etiology of ROM, RAT, and OAH.

Role of adenoids in the pathogenesis of otitis media: a bacteriologic and immunohistochemical analysis

Adenoidectomy is frequently performed in children suffering from recurrent or chronic otitis media with effusion and is thought to produce a long-term effect in preventing further episodes of otitis media. Bacteriologic analysis of adenoids from 60 patients revealed a significantly elevated colonization rate of middle ear pathogens in children with a present or previous history of ear disease compared to children with adenoidal hypertrophy only. The predominant pathogen was nontypeable Haemophilus influenzae, followed by Streptococcus pneumoniae and Moraxella catarrhalis. Quantitative analysis did not demonstrate a bacterial overload in the otitis group. Lectin histochemical analysis of the adenoids revealed no significant differences between the three groups; nevertheless, colonization with S pneumoniae demonstrated an increased labeling pattern with succinylated wheat germ agglutinin, indicating the exposure of N-acetyl-glucosamine as part of its own receptor structure. On the basis of these results, we support the concept of adenoidectomy in order to remove a bacterial focus; however, we could not verify the hypothesis of bacterial overgrowth in the nasopharynx.

Microbiology of recurrent parotitis

BACKGROUND

Infantile chronic recurrent parotitis (ICRP) is characterized by episodes of recurrent swelling of the parotid gland with decreased salivary flow and purulent secretion. The etiology of this little unknown clinical condition has been attributed to multiple causes such as canalicular system malformations, ascending bacterial infection, hyposialia, parotitis sequelae, viral infections and immunologic disorders, among others.

METHODS

We studied the types (with counts) of microorganisms involved in ICRP. Saliva samples were obtained from 56 patients and 20 controls, inoculated onto enriched media and incubated under aerobic and anaerobic conditions. Antimicrobial susceptibility and serotyping of the isolated organisms isolated were performed.

RESULTS

Of 57 saliva samples from ICRP patients, 52 (91%) were culture-positive. The most frequently isolated microorganisms were Streptococcus pneumoniae and Haemophilus influenzae. Thirteen of twenty (65%) samples were also culture-positive, mostly for viridans streptococci. However, colony counts were lower than in clinical samples (P < 0.004). Approximately one-third of S. pneumoniae strains resistant or moderately resistant to penicillin, and all H. influenzae strains were susceptible to all of the antimicrobials tested.

CONCLUSIONS

S. pneumoniae or H. influenzae were isolated in high concentrations in IRCP cases but not in controls, suggesting that these microorganisms may have a role in the development of this clinical entity. Quantitative cultures are very important in assessment of the pathogenic role of these microorganisms in patients but not in controls.

Adenoid bacteriology and sinonasal symptoms in children

OBJECTIVE

To study the correlation between sinonasal symptoms in children and the prevalence of bacterial pathogens in the adenoid core.

DESIGN

Prospective cross-sectional survey.

SETTING

Tertiary referral center.

PATIENTS

Consecutive sample of 84 children, aged 2 to 12 years, scheduled for adenoidectomy between July 1995 and November 1995. A blocked recruitment scheme was used to ensure a balanced distribution of sinonasal symptoms in the study sample.

METHODS

A caregiver-completed quality-of-life survey was used to measure the frequency and severity of baseline sinonasal, ear, obstructive, and behavioral symptoms. Standard microbiologic techniques were used for qualitative and quantitative adenoid bacteriology.

OUTCOME MEASURES

Pathogenic and nonpathogenic bacteria isolated, percentage of specimens with no growth, colony-forming units of pathogens per gram of adenoid tissue, dominant bacterial organism, and number of pathogenic species per adenoid with concentration greater than 10(5) colony-forming units.

RESULTS

One or more bacterial pathogens were recovered from core samples of all adenoids, with a concentration greater than 10(5) colony-forming units in 31 specimens (26%). Haemophilus influenzae, group A beta-hemolytic streptococcus, and Staphylococcus aureus were encountered most often. Multivariate analysis revealed a significant correlation of sinonasal infection symptom scores with colony-forming units of adenoid core pathogens (R2 = 0.48, p < 0.0001), adjusted for the confounding effects of nasal obstructive symptoms and adenoid size (specimen weight).

CONCLUSIONS

Sinonasal infectious symptoms explain 48% of the variability in quantitative bacteriology of the adenoid core, independent of adenoid size. Although longitudinal studies are required, our results support a potential role for adenoidectomy in the management of refractory pediatric sinusitis.

Adenoidectomy for otitis media with effusion

The efficacy of adenoidectomy in the surgical treatment of children with otitis media with effusion (OME) persisting after adequate medical therapy has been established in three independent randomized clinical trials. Although each of these studies used a different experimental design, all showed significant reductions in morbidity from OME after adenoidectomy as compared to the control groups. Subsequent application of these findings in formulating clinical guidelines for the use of adenoidectomy has yet to be realized, and recommendations to parents for or against the procedure appear to vary more with the surgeon's philosophy than with the condition of the child. This discussion examines the effectiveness and cost of adenoidectomy for the treatment of children with chronic OME and addresses the question of whether adenoidectomy should be used as a primary or a secondary surgical therapy. The argument is made to use adenoidectomy as a primary therapy in selected cases on the basis of patient age, type of OME, and patient preference, and to base the decision not on the size of the adenoid, but on its known pathophysiology.

Mycoplasma and Chlamydia in adenoids and tonsils of children undergoing adenoidectomy or tonsillectomy

The prevalence of mycoplasmal and chlamydial infection was assessed in 83 children undergoing adenoidectomy, tonsillectomy, or both procedures for recurrent adenotonsillitis or obstructive symptoms. Throat smears (surface specimens) and minced adenoids and tonsils (core specimens) were cultured for Mycoplasma spp and for Chlamydia spp. Isolation rates in adenoidal specimens were as follows: Mycoplasma hominis, surface 7.1% core 2.9%; and Ureaplasma urealyticum, surface 1.4%, core 2.9%. Mycoplasma hominis was also found in tonsillar specimens: surface 14.3%, core 20%. Chlamydia trachomatis was isolated only from a single core adenoidal specimen. The rate of mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%). Our findings document colonization of genital mycoplasmas in adenoids and tonsils of children with recurrent adenotonsillitis. Further studies are needed to evaluate the possible pathogenetic role of these microorganisms in adenotonsillar infection.

Adenoidectomy and otitis media

Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence. Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx. Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media. In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy. Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over 2 years in the two adenoidectomy groups. The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion. All three studies showed that the effect of adenoidectomy was independent of adenoid size. This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure.

Modern assessment of tonsils and adenoids

Modern assessment of the tonsils and adenoids is based on an appreciation of new concepts pertaining to the pathogenesis of tonsil and adenoid disease. Recognition of the emergence of beta-lactamase-producing and encapsulated anaerobic bacteria in the tonsils and adenoids should lead to a reconsideration of present therapeutic recommendations for antibiotic therapy in infectious tonsil and adenoid disease. The performance of a precise history, use of a standardized physical examination, and judicious use of laboratory evaluation are all necessary for appropriate patient management and improved communication between the pediatrician and otolaryngologist. Thus, appropriate recommendation for tonsillectomy and adenoidectomy will enhance their benefits, and the result will be happier and healthier children.

Nasopharyngeal culture with quantitative analysis of pathogenes in chronic otitis media with effusion. Effects on pathogen yield of different swabs and transport methods

The influence of different swabs and transport media on nasopharyngeal culture pathogen recovery has been studied in patients with chronic otitis media with effusion. Transport times of less than two hours have been used. Protecting the cotton wire swab with a polyethylene shealth to prevent contamination by nasal flora did not have any significant influence either on the recovery of potential pathogens or on the contaminating nasal flora. Facilitating a quantitative analysis of the nasopharyngeal culture by transporting the specimen in empty tubes gave a pathogen recovery rate similar to that with transport in Stuart medium, whereas an attempt at transporting in sodium chloride or prereduced PY broth led to significantly lower yields of Branhamella catarrhalis (p less than 0.01) and in PY broth on Haemophilus influenzae as well (p less than 0.01).

Chronic secretory otitis media: effects of surgical management

To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p less than .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p less than .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p less than .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p less than .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p less than .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p less than .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.