Chronic rhinosinusitis with nasal polyps（CRSwNP） represents a prevalent inflammatory disorder, which is often accompanied by nasal congestion, mucopurulent discharge, olfactory dysfunction, dizziness, and headache. Staphylococcus aureus（SA）, a predominant opportunistic pathogen within the sinonasal microenvironment, has been implicated in modulating the pathogenesis and progression of CRSwNP through multifaceted mechanisms. The physiological activities of SA-dependent quorum-sensing system and biofilm in the nasal microenvironment, including interactions with host, fungi, viruses, and other bacteria, as well as the effects of important superantigens secreted by SA on the microenvironment and immune barrier, are briefly reviewed in this article. These insights provide theoretical foundations for elucidating CRSwNP mechanisms and advancing clinical therapeutic strategies.
Humans ; Sinusitis/microbiology* ; Nasal Polyps/microbiology* ; Staphylococcus aureus ; Chronic Disease ; Rhinitis/microbiology* ; Staphylococcal Infections/microbiology* ; Quorum Sensing ; Biofilms ; Rhinosinusitis

Objective:To analyze the correlation between nasal mucosal microbiota diversity and the pathogenesis and prognosis of chronic sinusitis. Methods:A total of 80 patients with chronic sinusitis（CRS） admitted to Second Affiliated Hospital of Suzhou University were selected as the research group, and 80 patients with chronic dacryocystitis and nasal septum deviation without sinus inflammation admitted to our hospital during the same period were selected as the control group, nasal secretory specimens were collected under nasal endoscopic guidance by nasal swab, and matrix-assisted laser desorption ionization classification time mass spectrometry, anaerobic bacterial culture and common bacterial culture were performed to compare the differences in nasal mucosal flora between groups. Patients with chronic sinusitis were followed up for 6 months, and nasal secretions were collected again to detect microflora, and the patients were divided into relapse group（21 cases） and non-recurrence group（59 cases） according to whether the patients had relapse. Compare the diversity of nasal microbiota between groups. Results:There were no significant differences in mean relative abundance（MRA） between the two groups of preoperative phylum Microbacterium verrucobacterium, Cyanobacterium phylum, Phylum Laubia mlaus, Porphyromonas species, Enterococcus species, Fusobacterium species, Enterobacter species, Enterobacter species, Erythrobacterium species, Ralstonia species, Bacteroides and Streptococcus species（P>0.05）. The MRA of Acidobacterium, Proteobacteria, Actinomycetes MRA, Moraxia, Cyanobacterium, Corynebacterium and Staphylococcus were significantly lower than those of the control group（P<0.05）, and the MRA of Escher-Shigella species, Fusobacterium, Bacteroides, Firmicutes, Neisseria, Pseudomonas, Haemophilus and Lactobacillus was significantly higher than that of the control group（P<0.05）, and there was no significant difference in MRA at the level of nasal flora and genus before and after surgery in the relapsed group（P>0.05）. The MRA of Bacteroides after surgery was significantly lower in the non-recurrent group than that before surgery（P<0.05）, the MRA of Corynebacterium and Actinomycetes was higher significantly than that of preoperative（P<0.05）, and there was no significant difference in MRA of other species and phylum（P>0.05）. Conclusion:The onset of CRS is related to nasal mucosal dysbacteria, and whether the dysbacteriosis improves after surgery is correlated with the prognosis of patients.
Humans ; Chronic Disease ; Sinusitis/microbiology* ; Prognosis ; Nasal Mucosa/microbiology* ; Microbiota ; Male ; Female ; Middle Aged ; Adult ; Bacteria/isolation & purification*

Objective To analyze the risk factors of multidrug-resistant bacterial infections in patients with chronic rhinosinusitis.Methods The clinical data of 221 patients with chronic rhinosinusitis who were treated in our center from January 2010 to January 2017 were collected retrospectively. Specimens were collected for bacterial culture and antibiotic susceptibility testing. The risk factors for multidrug-resistant bacterial infections were analyzed.Results Univariate analysis showed that combined use of 3 or more antibiotics,high visual analogue scale score,high Lund-Kennedy score,long disease course(>5 years),high frequency of acute infections(more than 3 times a year),long duration of acute infection(>7 days),recurrent upper respiratory tract infections(>3 times per year),chronic otitis media,smoking history,allergic rhinitis,poor drainage,high frequency of antimicrobial use(≥3 times/year),use of multiple antibiotics(more than 3 types),aged over 60 years,and use of antibacterial drugs for over 7 days were the risk factors for production of multi-drug-resistant organism(MDRO) in patients with chronic sinusitis(all P<0.05). After adjusting for other factors,combined use of 3 or more antibiotics,high frequency of acute infections(more than 3 times a year),recurrent upper respiratory tract infections(>3 times per year),smoking history,allergic rhinitis,poor drainage,and high frequency of antimicrobial use(≥3 times/year) remained the risk factors for MDRO in patients with chronic sinusitis(all P<0.05).Conclusions Multidrug-resistant bacterial infections in patients with chronic sinusitis can be caused by a variety of factors. In the clinical practice,by focusing on the major risk factors,a comprehensive management strategy should be adopted to reduce the production of MDRO and improve the therapeutic outcomes.
Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; complications ; Chronic Disease ; Drug Resistance, Multiple, Bacterial ; Humans ; Logistic Models ; Middle Aged ; Retrospective Studies ; Rhinitis ; microbiology ; Risk Factors ; Sinusitis ; microbiology

OBJECTIVETo evaluate the photodynamic therapy (PDT) against multi-antibiotic-resistant Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S.epidermidis) obtained from patients with chronic rhinosinusitis (CRS).

METHODSForty-five CRS patients who had been given medical treatment but still needed endoscopic surgery were included in this study. The mucus from middle meatus was collected from these patients during surgery, followed by separation of S. aureus and S. epidermidis and drug sensitive test. The strains which could form biofilm were selected. Light emitting diode (LED) array with a major wavelength of (633±10) nm was used as light source and 5-Aminolevulinic acid (ALA) was used as photosensitizer in this PDT experiment. The safe range of LED dose and ALA concentration which were not toxic to bacteria by themselves were confirmed, and then did PDT experiment on S. aureus and S. epidermidis. The data of bacterial colony forming unit were transformed to lgCFU before statistical analysis.The Graph Pad Prism 5 software was used to analyzed the data.

RESULTSThirteen S. aureus and 16 S. epidermidis were included in this experiment(from 45 patients), all of them were multi-antibiotic-resistant bacteria, and four of S. aureus and five of S. epidermidis could form biofilm in each group. In planktonic S. aureus experiment, the mean lgCFU was 8.32±0.31 in control group whereas the experiment group was 6.47±0.67 (t=9.01, P<0.01), and in planktonic S. epidermidis experiment the final data was 8.34±0.20 (control group) and 6.97±0.59 (experiment group) (t=8.84, P<0.01). In biofilm S. aureus experiment, the mean lgCFU was 8.68±0.05 (control group), 6.90±0.96(experiment group) (t=3.68, P<0.05); and in biofilm S. epidermidis experiment the data was 8.67±0.05 (control group), 7.29±0.61 (experiment group, t=5.07, P<0.01).

CONCLUSIONOur results demonstrated that ALA-mediated PDT on multi-antibiotic-resistant S. aureus and S. epidermidis from CRS patients was effective in vitro. Additional work defining if the PDT treatment would damage the nasal mucosa and further checking the effectiveness of PDT in vivo is still needed.

Aminolevulinic Acid ; therapeutic use ; Anti-Bacterial Agents ; Biofilms ; Drug Resistance, Multiple, Bacterial ; Humans ; Light ; Photochemotherapy ; Photosensitizing Agents ; therapeutic use ; Rhinitis ; drug therapy ; microbiology ; Sinusitis ; drug therapy ; microbiology ; Staphylococcal Infections ; complications ; drug therapy ; Staphylococcus

A 70 years old male patient complained a sense of swelling on right facial, mild pain, and the obstruction of right nasal, no complain of facial numbness and toothache. Physical examination showed the slight bulging on right facial with mild tenderness, purulent nasal secretions on the right middle nasal meatus, and no significant neoplasm. CT scan showed that soft density tissue in the right maxillary sinus,and the high density tissue in some period. Postoperative diagnosis: carcinoma of maxillary sinus with fungal sinusitis.
Aged ; Carcinoma ; complications ; diagnosis ; Humans ; Male ; Maxillary Sinus ; microbiology ; pathology ; Mycoses ; complications ; Nose Neoplasms ; complications ; diagnosis ; Sinusitis ; microbiology

OBJECTIVE: To study the distribution and drug sensitivity test of bacteria of patients on chronic rhinosinusitis with or without nasal polyps. METHOD: The purulent discharges were collected from sinus of 175 patients with chronic rhinosinusitis with or without nasal polyps during endoscopic sinus surgery. The results of germiculture and drug sensitivity test were analyzed. RESULT: From 175 specimens, 118 (67%) showed positive results in germiculture. Among them, 79 strains of gram positive bacteria and 39 strains of gram negative bacteria were detected. Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus were the most common pathogens in gram positive bacteria. The most common pathogens of gram negative bacteria were P. Aeruginosa, Enterobacter aerogenes, Enterobacter cloacae. The sensitive antibiotic on gram positive bacteria were amikacin, Daptomycin, Linezolid, vancomycin, teicoplanin, amoxicillin and clavulanate potassium, cefuroxime, respectively. The sensitive antibiotics on Gram negative bacteria were amikacin, Cefoperazone/sulbactam and imipenem, ceftazidime ceftazidime, aztreonam, levofloxacin, respectively. CONCLUSION Bacterial infection was common happened in the sinus cavity of patients with chronic rhinosinusitis with or without nasal polyps. Gram positive bacteria were the main pathogenic bacteria and gram positive bacteria and gram negative bacteria have great differences in the sensitivity of antibiotics. For patients with chronic rhinosinusitis, the using of antibiotics should depend on the drug sensitivity test.
Bacterial Infections ; complications ; drug therapy ; Gram-Negative Bacteria ; drug effects ; Gram-Positive Bacteria ; drug effects ; Humans ; Microbial Sensitivity Tests ; Nasal Polyps ; microbiology ; Rhinitis ; microbiology ; Sinusitis ; microbiology

OBJECTIVE: To investigate the clinical features of fungal rhino-sinusitis. METHOD: Clinical data of 189 patients suffering from fungal rhino-sinusitis treated by functional endoscopic sinus surgery was analyzed retrospectively. The analyzed data included clinical type, age of onset, predilectionsite, reason, and surgical outcome. RESULT: Among the 189 patients with fungal rhino-sinusitis,181 cases were fungal ball,6 cases were allergic fungal rhino-sinusitis, 1 case was acute invasive fungnal rhino-sinusitis, 1 case was chronic invasive fungnal rhino-sinusitis. One hundred and twenty-eight cases were in the maxillary sinus (123 cases were unilateral, 5 cases were bilateral). Nineteen cases were in the ethmoid sinus. 31 cases were in the sphenoid sinus. Two cases were both in the maxillary sinus and ethmoid sinus, 1 case was both in the maxillary sinus and sphenoid sinus. Two cases invasive fungnal rhino-sinusitis had diabetes history. All the patients treated by functional endoscopic sinus surgery, 184 cases without recurrence, 5 cases suffered re-operation. CONCLUSION The incidence of fungal rhinosinusitis is showing a rising trend, fungal ball is the highest. The sinusitis patients whom we highly doubt for fungal infection should be confirmed by using sinonasal secretion smear, cultivation and histopathological examination. Surgical treatment should completely remove the fungal masses, to avoid reoperation.
Chronic Disease ; Emotions ; Ethmoid Sinus ; pathology ; Fungi ; Humans ; Maxillary Sinus ; pathology ; Mycoses ; pathology ; surgery ; Recurrence ; Retrospective Studies ; Rhinitis ; microbiology ; surgery ; Sinusitis ; microbiology ; surgery ; Sphenoid Sinus ; pathology

OBJECTIVE: A retrospective analysis of the clinical efficacy on the surgery of maxillary sinus diseases via the endoscopic lateral nasal wall incision, and a discussion on the clinical application of this approach. METHOD: Eighteen cases of the maxillary sinus diseases diagnosed on the basis of the preoperative nasal endoscopy, CT scan or MRI, and pathologic finding. Among 13 patients underwent routine lateral nasal wall incision approach, including 4 of maxillary sinus hemorrhagic and necrotic polyps, 4 of maxillary sinus cyst, and 3 of the maxillary sinus fungal infection. Five patients underwent lateral nasal wall resection approach and thorough maxillary sinus lesions resection by nasal endoscope, including 3 of inverted maxillary sinus papilloma, a nasal sinus bone giant cell tumor and a spindle cell tumor. Patients were followed up for more than half a year, and the postoperative efficacy were observed. RESULT: The surgical cavity of the lateral nasal wall incision approach have luminal epithelium, well shapes of inferior turbinate, no recurrence of the lesion, and the lateral nasal wall resection patients with well luminal epithelium, without recurrence. All patients had no complications such as numbness, tears, etc. CONCLUSION Endoscopic incision of lateral nasal wall keep the nasolacrimal duct and inferior turbinate, help remove the entire sinus cavity lesion and retain the physiological function of the nasal cavity. Resection of the lateral nasal wall can reveal an ideal vision approach, which perform certain clinical value for the treatment of the inverted maxillary sinus papilloma and sinus cancer.
Cysts ; surgery ; Dissection ; methods ; Endoscopy ; Humans ; Magnetic Resonance Imaging ; Maxillary Sinus ; surgery ; Maxillary Sinus Neoplasms ; surgery ; Maxillary Sinusitis ; microbiology ; surgery ; Nasal Cavity ; surgery ; Papilloma, Inverted ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

A young female complained repeated nasal discharge for over three months with discomfort of right cheek, and oral antibiotics had less effect. She has a history of "root canal therapy" five years before. Physical examination found purulent secretion in the right middle nasal meatus, and light tenderness in the right side of the maxillary sinus area. The CT scan of paranasal sinus shown possible fungal infection of right maxillary sinus. Finally the nasal endoscopic surgery confirmed the fungus ball of right maxillary sinus with foreign body (the root canal filling material).
Endoscopy ; Female ; Foreign Bodies ; diagnosis ; Humans ; Maxillary Sinus ; microbiology ; Maxillary Sinusitis ; microbiology ; Mycoses ; diagnosis ; Respiratory Tract Infections ; microbiology ; Tomography, X-Ray Computed

OBJECTIVE: To determine the distribution of bacteria in patients with chronic rhinosinusitis, and to compare the bacteriologic features in middle meatus specimens between patients with nasal polyps (CRSwNP) and patients without nasal polyps (CRSsNP). 
 METHODS: We retrospectively analyzed the positive rate and types of bacterial culture in middle meatus specimens from 40 controls, 65 patients with CRSwNP, and 72 patients of CRSsNP. The specimens from the middle meatus were obtained during endoscopic sinus surgery.
 RESULTS: The positive rates of bacteria for CRSwNP, CRSsNP and the controls 81.9%, 80.0% and 82.5%, respectively, with no significant difference among the 3 groups. The common aerobe bacteria found in the specimens was Coagulase-negative staphylococci, Staphylococcus aureus, Streptococcus and Corynebacterium. The common anaerobe was Fusobacterium. The positive rates for aerobic and anaerobic bacteria showed no significant differences among the 3 groups.
 CONCLUSION The distribution of bacteria in middle meatus specimens is not significantly different among CRSwNP, CRSsNP and the controls. Therefore, bacterial infection may not play a key role in the pathogenesis of CRS patients with and without nasal polyos.
Bacterial Infections ; diagnosis ; Case-Control Studies ; Chronic Disease ; Corynebacterium ; isolation & purification ; Endoscopy ; Fusobacterium ; isolation & purification ; Humans ; Nasal Polyps ; microbiology ; Retrospective Studies ; Rhinitis ; microbiology ; Sinusitis ; microbiology ; Staphylococcus aureus ; isolation & purification ; Streptococcus ; isolation & purification