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December 12, 2013

The Nose is a Jungle of Germs (even in Normal Healthy People)!

A fascinating study was conducted by Stanford researchers on the amount and types of germs found inside the nose in normal healthy individuals, whether they are staph carriers or not.

In a typical nose in a healthy individual without any symptoms, the following "germs" can be found. Keep in mind that ALL these germs have the potential to cause a pathological sinus infection:

• Corynebacterium
• Propionibacterium
• Escherichia-Shigella
• Staphylococcus aureus (including MRSA)
• Staphylococcus (other species)
• Dolosigranulum
• Tomitella
• Moraxella
• Actinobacteria
• beta-Proteobacteria
• Prevotella
• Anaerococcus
• Streptococcus
• Peptoniphilus
• Variovorax

These germs were found not just in the nostril, but also on the middle turbinate located about 1-2 inches into the nose and the sphenoid recess located in the very back upper part of the nose (about 3+ inches into the nose).

The top 2 most common germs found in healthy individuals were corynebacterium and propionibacterium. When these bacterial populations decrease, the presence of staphylococcus increases.

Staphylococcus was also found not just at the nostril where cultures are most commonly obtained, but in both much deeper locations within the nose.

This may explain why in spite of aggressive whole body MRSA body hygiene management and use of bactroban ointment to the nares not uncommonly fails to eradicate staph/MRSA in susceptible patients.

Clearly, more research is needed, especially in how to minimize/eradiacate staph colonization beyond the nostril (but allow for normal, healthy bacteria to remain).

Source:
Staph Germs Hide Out In The Hidden Recesses Of Your Nose. NPR 12/11/13

Reference:
Nasal Microenvironments and Interspecific Interactions Influence Nasal Microbiota Complexity and S. aureus Carriage. Cell Host & Microbe, Volume 14, Issue 6, 631-640, 11 December 2013
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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