The impact of intraoperative saline irrigations on bacterial load within the maxillary sinus

Abstract

Background Saline irrigations are routinely employed during endoscopic sinus surgery to remove mucous and debris from the sinus cavities. What is unknown is whether this results in a quantitative reduction in pathologic bacteria within the sinus mucosa. The objectives of this study were to quantify the amount of 5 different bacteria (Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, coagulase-negative Staphylococcus (CNS), and Streptococcus pneumoniae) within the maxillary sinus and to determine the impact of saline irrigations on bacterial counts. Methods Twenty patients with chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa prior to any irrigation. In each patient, the left maxillary sinus was then irrigated with 250 cc of normal saline (NS) with a pressurized pulse-irrigation device and the right side was irrigated with 250 cc of NS using a 30-cc syringe attached to a curved suction tip. Repeat maxillary sinus mucosal biopsies were then taken from each side. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and amount of each of the bacteria. Results Saline irrigations were found to significantly reduce the amount of S. aureus, P. aeruginosa, and S. pneumoniae found within the maxillary sinus mucosa. No difference was found for H. influenzae or CNS. No difference in bacterial load reduction was able to be shown between the pressurized saline flushes and manual saline rinse methods. Conclusion Intraoperative saline irrigations are able to significantly reduce the amount of potentially pathogenic bacteria within the diseased sinus mucosa.

Investigation of bacterial repopulation after sinus surgery and perioperative antibiotics

“…Postoperatively, patients were routinely placed on sinus irrigations and a 2‐week course of oral antibiotics (amoxicillin‐clavulanate, or clarithromycin if penicillin‐allergic). Bacterial load was hypothesized to be the lowest after treatment (FESS with irrigation at completion of surgery, followed by 2 weeks of postoperative antibiotics and saline rinses), and then bacterial repopulation was expected to subsequently occur in the following weeks. As such, we compared microbiota present at the time of surgery, 2 weeks postoperatively, and 6 weeks postoperatively.…”

Modified Two-Handed Transnasal Endoscopic Surgery: Innovative Instrument Design and an Experimental Canine Study

“…Moreover, Seiberling et al verified that intraoperative saline irrigation can significantly reduce the amount of potentially pathogenic bacteria within diseased sinus mucosa. 14…”

The effect of intraoperative mupirocin irrigation on Staphylococcus aureus within the maxillary sinus

“…We have previously established that intraoperative saline irrigations are effective in reducing the load of pathogenic bacteria within the maxillary sinus . Although it is unclear whether this will have a clinical impact, it is assumed that healing may be improved due to the decrease in bacterial load within the sinus mucosa.…”

“…There is a gap in knowledge regarding whether intraoperative rinses of mupirocin are effective in reducing the load of S. aureus in patients with CRS. In a previous study we reported that intraoperative saline rinses effectively reduce bacterial load within the treated sinus . In this study, our goal is to determine: (1) if mupirocin rinses reduce the bacterial load of S. aureus within the maxillary sinus; and (2) if the antibiotic rinse is more effective than saline irrigations alone.…”