Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.

Although many investigations on the bacteriology of chronic sinusitis have been reported, there is still much discussion about the physiological flora of the nose and paranasal sinuses, the role of the various aerobic and anaerobic "pathogenic" bacteria, and the influence of the anatomical location from which samples for bacteriology are taken. We conducted a qualitative and semi-quantitative bacteriological examination of patients with chronic sinusitis undergoing a transnasal sinus operation (patient group), and of patients without chronic sinusitis undergoing a septoplasty (control group). In both groups brush smears of the inferior nasal turbinate and biopsies of the middle nasal turbinate were taken, with additional biopsies of the maxillary sinus and ethmoidal bulla in the chronic sinusitis group. In both groups coagulase-negative staphylococci were identified in almost all samples. Staphylococcus aureus was found in 22% (middle turbinate) to 33% (inferior turbinate) of the samples from the control group and in 33% (maxillary sinus, middle turbinate) to 50% (inferior turbinate) of the samples from the patient group. Other (pathogenic) aerobic bacteria were found much more rarely and only slight distinctions between control and patient group were observed. The concentrations of the different bacterial species (colony-forming units) were comparable in both groups. Strictly anaerobic bacteria and fungi were not identified. Only small discrepancies between the various methods and/or locations of sampling were found. Based on our bacteriological findings a differentiation between patients with and without chronic sinusitis was not possible. These results shed doubt on the clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.