2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

M. TURAN ET AL.

percentages for categorical variables. One-way ANOVA was used to compare group means. Chi-square test was performed to determine the relationship between categorical variables. Statistical significance level was considered as 5%, and SPSS (ver: 13) statistical program was used for all the statistical computations. Results The demographic characteristics of the patient and control groups are presented in Table 1 . No significant difference was present between the groups with regard to age and gender. Micro-organismic growth from vallecular, pharyngeal, and laryngeal smears in patient and control groups are shown in Table 2 . Coagulase-negative staphylococci (CNS), Streptococcus viridians (VGS), and candida albicans were detected to grow significantly more in the patient group in all three anatomic localizations compared with the control group. Neisseria spp , basillus spp and Non-viridans alpha-hemolytic streptococcus were detected to grow significantly more in the control group in all three anatomic localizations compared with the patient group. Klebsiella spp , escherichia coli , Lactobacillus , acidovor- ans , enterococcus spp , and parapsilosis growth showed no difference between the control and patient groups. Comparison of the growth according to anatomic localiza- tions in the patient group is shown in Table 3 . No significant difference was observed between the growths in different anatomic localizations in the patient group. Discussion Upper air way soft tissue infections are not observed frequently under normal circumstances; however, endogenous oral bac- teria may overcome the immune resistance of the host and cause infection in especially the immunologically suppressed [ 5 ]. Bacterial infections or colonization can influence the chronicity or severity of chronic airway diseases such as asthma [ 6 ]. When the mechanical airway defense mechanisms are impaired, the micro-organisms that migrate through the upper airway mucosa are colonized within the distal air ways. In the study of Kirkpatrick et al. [ 6 ], 25% micro-organismic growth was demonstrated in the distal airways. In patients who used ICS, detection of the laryngeal infection may be an important problem for the clinician when the clinical symptom and findings are insufficient. Thus, the precise diagnosis and proper treatment of the disease may be difficult. In our study, we investigated the changes in pharynx vallecula, and larynx microflora in patients using ICS and compared them to each other. Inhaled corticosteroids are well identified common agents used for localized anti-inflammatory responses when admin- istered topically to the respiratory tract mucosa. It is known that this application causes microflora changes due to Table 1. Demographic characteristics of the patient and control groups. Control ( n ¼ 27) Case ( n ¼ 39) p Age 43.07 13.23 45.56 12.76 0.449 Gender (F/M) 13/14 22/17 0.508

Exclusion criteria Patients with a history of antibiotic usage in the last month, additional known chronic disease, respiratory distress that necessitates mechanical ventilation, hospitalization within the last month, smoking, systemic steroid and/or any immuno- suppressive drug usage within the last 3 months were excluded. Sampling and culturing Culture samples were obtained from the posterior pharyngeal wall, the vallecular, and the laryngeal surface of the epiglottis in the supraglottic region of the larynx. The oral cavity was cleaned for possible food debris by gargling with water before sample collection. We used xylocaine spray 10% (100 mg/mL lidocaine, 10 mg lidocaine per puff of spray) for topical local anesthetics to avoid gag reflex and nausea during sample collection. Sterile culture swabs were used for the pharynx. Length of the sterile culture swap was adjusted by cutting with sterile scissors and gloves and afterward it was placed at the end of the sterile laryngeal punch device and the swab samples were obtained. Samples were collected from vallecular and laryngeal surface of the epiglottis with a 90 laryngeal punch biopsy device with guidance of a 70 rigid laryngeal telescope ( Figure 1 ). Contamination from the pharynx and oral cavity during sample collection was avoided. Sample collection was repeated in cases that were suspicious about contamination. Samples were placed in sterile gel tubes and transferred to the microbiology laboratory in a maximum of 10 min. The samples collected were inoculated into 5% sheep blood agar, Eosin Methylene Blue, and Saboraud Dextrose agar, and incubated in 37 incubators for 18–24 h. Gram staining and catalase tests were performed in order to define the micro-organismic growth. They were named by the same microbiologist blinded against the study according to the basic micro-organism classification method.

Statistical analysis Descriptive statistics for the continuous variables were pre- sented as Mean; Standard deviation values with count and

Figure 1. Sterile culture swap placed at the end of the sterile laryngeal punch device has been shown.

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