From: anonymous@washington.xtn.net
Subject: nose cultures for sinus infection
Posted-By: xx108 (ENT Clinic Moderator)
Organization: Organization For Community Networks
Date: Thu, 24 Apr 1997 21:23:29 -0700
Newsgroups: ofcn.clinic.ent

I am an RN with a un-named sinus problem. I have had multiple sinus surgeries the odd finding during the last surgery was the fact I have no nasal cilia, it has been replaced with squamous metaplasia. I had a MRSA infection from the hospital where I worked(matched by DNA). During the infection I would a neg then positive. I have had grossly purlent nasal drainage out of one side which was symptomtic and have had the other side that had no drainage or symptoms. When culturing my nose they would culture both sides with the same culturette. My results would say 3+ staph, but normal flora so it is neg. or would come back normal flora. After seeing this my doctor and I would both be shocked. My question is this: Could the normal flora from the good side be the cause of the culture to be read wrong? Should I do culture on separate culturettes?? I have always had a good side and a bad side. These were not anterior cultures but deep cultures on infected purlent drainage.

Reply: ------------------------

I am not sure I understand - obtaining any coag positive staph on a culture from the nose would be considered a positive culture for infection in my opinion, even if there also was found normal flora. I am also not clear why one would use the same culturette in both nostrils - it would seem to me to increase the possibility of contamination. When culturing the nose, it is important to use a thin wire type culture swab and avoid touching the skin of the nasal vestibule on the way into the nasal passage. I also would certainly use separate culturettes for culturing both nasal passages.

As an aside, in situations such as yours where there has been prior surgery, and chronic or recurrent purulent sinusitis continues to occur, pulsatile sinus irrigation with dilute salt water on a daily basis using a Grossan nasal irrigator device attached to a Water-pik is frequently recommended. Besides the obvious mechanical cleansing affect, the pulsatile action is thought to help stimulate the nasal cilia back to normal function (one of main principles of contemporary sinus surgery is to preserve any and all normal respiratory mucosa as is possible so as to prevent subsequent cilia-related sinus problems). An additional advantage of this irrigation technique is that topical antibiotic solutions such as gentamicin can be used to treat infection, which in cases such as yours can often be primarily superficial or surface infection.

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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis

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