RESUMEN
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.