Adenoid bacteriology and sinonasal symptoms in children

OBJECTIVE: To study the correlation between sinonasal symptoms in children and the prevalence of bacterial pathogens in the adenoid core. DESIGN: Prospective cross-sectional survey. SETTING: Tertiary referral center. PATIENTS: Consecutive sample of 84 children, aged 2 to 12 years, scheduled for adenoidectomy between July 1995 and November 1995. A blocked recruitment scheme was used to ensure a balanced distribution of sinonasal symptoms in the study sample. METHODS: A caregiver-completed quality-of-life survey was used to measure the frequency and severity of baseline sinonasal, ear, obstructive, and behavioral symptoms. Standard microbiologic techniques were used for qualitative and quantitative adenoid bacteriology, OUTCOME MEASURES: Pathogenic and nonpathogenic bacteria isolated, percentage of specimens with no growth, colony-forming units of pathogens per gram of adenoid tissue, dominant bacterial organism, and number of pathogenic species per adenoid with concentration greater than 10(5) colony-forming units. RESULTS: One or more bacterial pathogens were recovered from core samples of all adenoids, with a concentration greater than 105 colony-forming units in 31 specimens (26%). Haemophilus influenzae, group A beta-hemolytic streptococcus, and Staphylococcus aureus were encountered most often. Multivariate analysis revealed a significant correlation of sinonasal infection symptom scores with colony-forming units of adenoid core pathogens (R(2) = 0.48, p < 0.0001), adjusted for the confounding effects of nasal obstructive symptoms and adenoid size (specimen weight). CONCLUSIONS: Sinonasal infectious symptoms explain 48% of the variability in quantitative bacteriology of the adenoid core, independent of adenoid size. Although longitudinal studies are required, our results support a potential role for adenoidectomy in the management of refractory pediatric sinusitis.