Prevalence of Pus in Radiologically Diseased Sinuses in Patients Undergoing Surgery For

OBJECTIVE: To establish the prevalence of pus in radiologi-cally diseased sinuses in patients undergoing sinus surgery and to correlate this with the bacterial load in the sinuses. STUDY DEIGN AND SETTING: A prospective study per-formed on adult patients with the diagnosis of chronic sinusitis undergoing endoscopic sinus surgery at an Adelaide group of academic hospitals. In 45 consecutive and unselected patients, a radiologically diseased sinus was surgically opened, and a spe-cially designed suction aspirator was placed into the sinus under endoscopic control. These aspirates were Gram stained and cul-tured to quantify the polymorphonuclear neutrophil count, bacte-rial flora, and bacterial colony count. The CT scans of all patients were graded by using the Lund-Mackay scoring system. RESULTS: A variety of bacteria, most commonly staphylococci, were cultured from a radiologically diseased sinus in 88 % of patients. There was no correlation between the bacterial colony count and presence of pus, and only 11 % of patients had microscopic evidence of inflammation in sinus aspirates. There was no correlation between the Lund-Mackay CT score and the presence of pus in the sinus. CONCLUSIONS: The majority of patients undergoing surgery for chronic sinusitis did not have a purulent exudate, and there was no correlation with the bacterial load. The usefulness of antibiotics in the treatment of chronic rhinosinusitis, in the absence of mac-roscopic pus, is questionable