The cytology and microbiology of persistent paranasal sinus secretions after endoscopic sinus surgery: a controlled study.

OBJECTIVE

To determine the cellular composition and influence of microbiology on persistent paranasal sinus secretions after endoscopic sinus surgery (ESS).

METHODS

Persistent sinus secretions from a consecutive series of patients after ESS were studied with cytopathology and cultures for aerobic, anaerobic, and fungal organisms. A control group consisting of patients without persistent secretions after ESS was also studied. Epithelial, neutrophil, and eosinophil cell presence was semiquantitatively assessed on a 4-point scale and compared between control and diseased groups. Cellular composition was then stratified and analyzed according to the presence of microorganisms.

RESULTS

A total of 50 diseased and 24 control patients were studied. Both diseased and control patients demonstrated sloughed epithelial cells in secretions (53.1% and 66.7%, respectively, P = .131). The diseased group exhibited significantly higher eosinophilic or eosinophilic/neutrophilic cellularity than the controls (P = .048). The average neutrophil infiltration score was 0.82 versus 0.54 for the controls (P = .104). For the diseased group, the mean eosinophil score was 1.56 versus 0.96 in the control group (P = .035). Pathogenic bacteria were identified in 64% of the diseased group patients versus 54.2% in controls (P = .454). Only two fungal cultures were positive (diseased group). Microbiological analysis indicated that in the absence of bacteria, diseased group patients mainly manifested an eosinophilic presence, whereas in the presence of bacteria, the neutrophil response was enhanced in diseased patients and eosinophil response was enhanced in controls.

CONCLUSIONS

Persistent sinus secretions after ESS are primarily driven by an eosinophilic presence. Patients without inflammatory exudate after ESS respond to bacteria with increased eosinophilia, whereas hypersecretory patients demonstrate both increased neutrophil and eosinophil presence.