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Erwin L. van der Veen, MD; Maroeska M. Rovers, MSc, PhD; Maurine A. Leverstein-van Hall, MD, PhD; Elisabeth A. M. Sanders, MD, PhD; Anne G. M. Schilder, MD, PhD

Arch Otolaryngol Head Neck Surg. 2006;132:752-755.

Objectives  To determine the optimal approach for nasopharyngeal culture and to establish which approach children tolerate best.

Design  Cross-sectional study.

Setting  A pediatric otolaryngology department of a Dutch tertiary care hospital.

Patients  A cohort of 42 children with chronic suppurative otitis media.

Intervention  Paired nasopharyngeal samples were collected transorally and transnasally and cultured for potential aerobic pathogens.

Main Outcome Measures  The isolation rate of both samples and the amount of discomfort measured by the visual analog scale.

Results  Forty-six (87%) of 53 samples obtained transnasally were culture positive vs 40 (75%) of 53 samples obtained transorally (P = .20). Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus were found more frequently with the transnasal than with the transoral approach: 34% vs 13% (P = .003), 62% vs 51% (P = .20), 30% vs 19% (P = .15), and 21% vs 11% (P = .18), respectively. Mean (SD) visual analog scale scores were 5.3 (1.0) and 3.4 (1.7) (P<.001) for the transnasal and transoral approaches, respectively.

Conclusions  Although the transoral approach is better tolerated in children, the isolation rate of the transnasal approach is higher, especially for S pneumoniae. The transnasal sampling technique should therefore be the preferred approach for detection of potential pathogens in the nasopharynx in children.

Author Affiliations: Departments of Otorhinolaryngology (Drs van der Veen, Rovers, and Schilder) and Pediatric Immunology (Drs Rovers and Sanders), Wilhelmina Children's Hospital, Julius Center for Health Sciences and Primary Care (Dr Rovers), and Department of Medical Microbiology (Dr Leverstein-van Hall), University Medical Center Utrecht, Utrecht, the Netherlands.