Maxillary Sinus Aspiration Research Articles

Microbiology of Maxillary Sinus Infections: Systematic Review on the Relationship of Infectious Sinus Pathology with Oral Pathology

The main objective of this systematic review was to evaluate the microbiology of maxillary sinus infections and to determine whether an odontogenic origin of the infection can be established. The PIE question posed was the following: In patients with sinus and dental symptomatology who come for ENT or dental assessment and who undergo a microbiological study of the maxillary sinus and are found to have infectious sinus pathology, is the infectious sinus pathology related to an odontogenic origin? The literature review was carried out in PubMed, Web of Science, and the Cochrane Library. A total of 2769 articles were identified in the three databases used. Inclusion and exclusion criteria were applied, and after eliminating duplicates, 55 full-text publications were identified as suitable for inclusion. After reading this series of publications, four articles were excluded due to lack of data in the article. Finally, 51 studies were included in the qualitative analysis. In this study, the microorganisms were classified into three groups: group 1 (microorganisms of the oral microbiome related in the literature to oral pathology, namely caries and periodontal disease), group 2 (microorganisms found in the oral microbiome but not related to oral disease), and group 3 (microorganisms not identified in the microbiome). This review included 51 articles and a total of 6415 patients who underwent surgery in 7051 sinuses. Most sinus infections were caused by group 2 (63.51%) or group 1 (24.21%) bacteria. Within group 1, the most frequent bacteriological agents in sinus infections were Peptostreptococcus spp. (35.22%) and St. Viridans spp. (39.89%). In group 2, the most frequent bacteriological agents in sinus infections were H. influenzae (29%) and Streptococcus spp. (23.63%). In group 3, the most frequent cause of sinusitis of dental origin was dental caries, followed by foreign bodies (implants) and sinus elevation. Different studies have shown that certain species of bacteria isolated from maxillary sinus cultures are more frequently associated with rhinosinusitis of odontogenic origin. The results of this systemic review show that, among the bacterial species most frequently found, anaerobic species predominate over aerobic species, especially Peptostreptococcus and Staphylococcus aureus, which are part of the oral microbiome, suggesting an odontogenic origin of maxillary sinus infection. Therefore, bacterial cultures of maxillary sinus aspirate can be of great use to clinicians in the differential diagnosis of odontogenic sinusitis.

Microbiology of Acute Maxillary Sinusitis in Children.

Objectives/HypothesisAcute rhinosinusitis is a frequent common cold‐related complication in children. Despite the need for appropriate treatment, its underlying microbiology remains unclear. This study aimed to investigate the microbiology of acute rhinosinusitis in children.Study DesignProspective non controlled study.MethodsThirty‐one pediatric acute maxillary sinusitis patients with severe symptoms were assessed. The subjects were 17 males and 14 females aged 5 to 14 years (mean age, 9.1 years). Maxillary sinus aspirates were collected and cultured, with subsequent viral and bacterial polymerase chain reaction (PCR) analysis. Bacteria were analyzed using culturing and PCR, and viruses were analyzed using PCR. The PCR kits used identify 18 types of respiratory viruses and 13 types of bacteria.ResultsAt least one pathogen was detected in 30 of 31 aspirates (97%) using PCR, and none of the aspirates contained respiratory viruses alone. Ten aspirates (32%) contained both viruses and bacteria. The most common viruses detected were rhinovirus (13%) and influenza virus (10%). The most common bacteria were Haemophilus influenzae (45%), Streptococcus pneumoniae (32%), Moraxella catarrhalis (16%), and Chlamydophila pneumoniae (13%). Bacteria were found in 21 of 31 cases (68%) via bacterial culturing. Culturing revealed that H influenzae was the most common pathogen (42%).ConclusionsIn pediatric acute maxillary sinusitis, respiratory bacteria were detected in 65% of the sinus aspirates and both bacteria and viruses in 32%. The most common viruses were rhinovirus and influenza virus, and the most common bacteria were H influenzae and S pneumoniae. Viral and bacterial PCR is useful for accurately investigating the microbiology in pediatric sinusitis.Level of Evidence3 Laryngoscope, 131:E2705–E2711, 2021

The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis

This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis. 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture. A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively. The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.

This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis. 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture. A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively. The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

Diagnostic accuracy of history and physical examination in bacterial acute rhinosinusitis.

To evaluate the diagnostic accuracy of symptoms, the symptom progression pattern, and clinical signs in identifying bacterial acute rhinosinusitis (ARS). We conducted an inception cohort study among 50 military recruits with ARS. We collected symptoms daily from the onset of symptoms to approximately 10 days. At 9 to 10 days, standardized data on symptoms and physical findings were gathered. A positive culture of maxillary sinus aspirate was considered to be the reference standard for bacterial ARS. At 9 to 10 days, the presence or deterioration after 5 days of any of the symptoms could not be used to diagnose bacterial ARS. Toothache had an adequate positive likelihood ratio (positive likelihood ratio [LR+] 4.4) but was too rare to be used for screening. In contrast, several physical findings at 9 to 10 days were of more diagnostic use and frequent enough for screening. Moderate or profuse (vs. none/minimal) amount of secretion in nasal passage seen in anterior rhinoscopy satisfactorily either ruled in, if present (LR+ 3.2), or ruled out, if absent (negative likelihood ratio 0.2), bacterial ARS. If any secretion was seen in the posterior pharynx or middle meatus, the probability of bacterial ARS increased markedly (LR+ 5.3 and LR+ 11.0, respectively). We found symptoms or their change to be of little use in identifying bacterial ARS. In contrast, we observed several clinical findings after 9 to 10 days of symptoms to predict bacterial ARS quite accurately.

The role of microbes in the pathogenesis of acute rhinosinusitis in young adults.

Objectives/HypothesisTo provide information on the course of acute rhinosinusitis (ARS) with sequential nasal and paranasal microbiological data and their correlation with clinical outcomes.Study DesignWe conducted a prospective cohort study among 50 Finnish military recruits with clinically diagnosed ARS in spring 2012.MethodsWe collected symptom, nasal endoscopy, and cone‐beam CT (CBCT) scores during the early (2–3 days from onset) and later phases (9–10 days). We took viral samples from the nasopharynx (multiplex respiratory virus polymerase chain reaction [PCR]), bacterial culture from the middle meatus during both phases, and both viral and bacterial samples from the maxillary sinus aspirate (respiratory virus PCR, bacterial culture, broad‐range bacterial PCR) during the later phase. Cilia destruction and microbial biofilms were sought from a nasal mucosal biopsy sample.ResultsWe found that 42 (84%) of the subjects had viral nucleic acid in the nasopharynx during ARS. During the early phase, 28 (56%) of the subjects had nontypeable H. influenzae (NTHi) in the middle meatus, which was associated with wider paranasal mucosal changes in CBCT scans and increased symptoms during the study period. After 9 to 10 days from the onset, NTHi was found in the maxillary sinus in eight subjects (40%, 8/20) and led to prolonged symptoms. Bacterial biofilm was ruled out in 39 (78%) cases, and cilia destruction did not correlate with microbiological or clinical outcomes.ConclusionNasal and paranasal H. influenzae coinfection during viral infection may modify the symptoms and the extent of sinonasal mucosal disease observed in CBCT scans already from the beginning of the ARS episode.Level of EvidenceN/A. Laryngoscope, 125:E1–E7, 2015

Acute Bacterial Sinusitis in Children

On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.

Staphylococcus aureus: Is It a Pathogen of Acute Bacterial Sinusitis in Children and Adults?

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the etiologic agents of acute bacterial sinusitis (ABS). Staphylococcus aureus has been an uncommon cause of ABS despite its frequent occupancy within the anterior nares. A quantitative culture of a maxillary sinus aspirate is the gold standard for determining etiology of ABS. Cultures of the middle meatus cannot be used as a surrogate for a maxillary sinus aspirate in children with ABS, although they may be used in adults if interpretation is confined to usual sinus pathogens. Recent studies highlighting S. aureus as a major pathogen in ABS should be interpreted cautiously. Most isolates in recent pediatric studies were derived from cultures of the middle meatus. The range of reported results for the incidence of S. aureus as a cause of ABS in adults is similar to the results reported for staphylococcal colonization of the middle meatus in healthy adults.

Comparison of two minimally invasive techniques for treating chronic rhinosinusitis in the pediatric population

ObjectiveTo compare two minimally invasive techniques for the treatment of chronic rhinosinusitis in young children. BackgroundChronic rhinosinusitis (CRS) is a common diagnosis in young children. Maxillary sinus aspiration & irrigation with adenoidectomy (MSI) followed by an extended course of oral antibiotics has been shown to be an alternative to functional endoscopic sinus surgery. However, since MSI is not performed under direct visualization, it has inherent risk. This study analyzes the techniques of MSI and endoscopically guided middle meatus cultures & antral biopsy with adenoidectomy (EGC) in the (1) diagnosis of bacterial infection by culture, (2) time to resolution using double antibiotic therapy, and (3) associated morbidity of the two procedures. MethodsThe medical records at Wayne State University, Department of Otolaryngology Head & Neck Surgery were reviewed from 2004 to 2010. All children who presented with CRS who underwent MSI or EGC were included in this retrospective case series. ResultsPatients presented with a history of cough, nasal discharge, and congestion. The mean age was 3.7 years. Symptom duration prior to treatment was 7.4 months in the 64 patients who underwent MSI and 9.1 months in the 46 patients who underwent EGC. MSI identified bacteria in 80% of patients compared to 73% in EGC patients (p=0.45). The MSI group underwent antibiotic treatment for 8.7 weeks and achieved symptom resolution in 8.7 weeks compared to 6.9 weeks and 4.9 weeks respectively in the EGC group (p=0.08 and 0.01). However, if patients presented with snoring or cough, time to resolution of symptoms was significantly lower in patients undergoing EGC versus MSI (p=0.02 and p=0.01, respectively). One patient who underwent MSI experienced epistaxis requiring nasal packing, and two patients had pseudoproptosis following irrigation that resolved spontaneously shortly thereafter. No complications were reported in the EGC group. ConclusionEGC is an effective treatment for young children with CRS. EGC and MSI are equally effective in obtaining diagnostic cultures. EGC decreases time to symptom resolution, and it lowers the risk of complication when compared to MSI.

Bacteria and Viruses in Maxillary Sinuses of Patients With Primary Hypogammaglobulinemia

To study bacteria and viruses in maxillary sinuses of patients with primary hypogammaglobulinemia receiving immunoglobulin therapy. Prospective cross-sectional study during 6 months. Tertiary care university hospital. Seventeen patients with primary hypogammaglobulinemia (10 males and 7 females; mean age, 39 years [age range, 11-71 years]). Sixteen patients had common variable immunodeficiency, and 1 patient had X-linked agammaglobulinemia. Magnetic resonance imaging and x-ray imaging of paranasal sinuses when patients did not have signs of acute infection and reevaluation 6 months later. Maxillary sinus aspiration and lavage were performed at a follow-up visit. Sinus fluid analysis for bacteria and viruses was performed by culture and by polymerase chain reaction. A questionnaire on symptoms related to sinusitis was administered during the follow-up period. Among 17 patients, 9 (53%) had radiologically defined sinusitis without subjective symptoms at study enrollment. At reevaluation 6 months later, radiological findings remained unchanged in two thirds of the patients. Among 15 patients, bacteria were found in sinus lavage samples from 13 patients, and viruses were found in samples from 7 patients. Eight patients had 2 pathogens or more on bacterial culture. Rhinovirus was identified from sinus lavage samples in 5 patients (33%), enterovirus in 3 patients (20%), and respiratory syncytial virus in 1 patient (7%). Pathogenic bacteria were found in maxillary sinuses of all patients who tested positive for rhinovirus and enterovirus. No fungi were found. During the follow-up period, 6 patients reported mucopurulent drainage. Bacteria and viruses were commonly found in maxillary sinuses of patients with primary hypogammaglobulinemia. Yearly evaluation by an ear, nose, and throat surgeon is recommended.

Bacteriological findings and antimicrobial susceptibility in chronic sinusitis with nasal polyp

Conclusions. We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results. Objective. To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea. Materials and methods. The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated. Results. Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.

Concordance of Middle Meatal Swab and Maxillary Sinus Aspirate in Acute and Chronic Sinusitis: A Meta-Analysis

The medical management of acute and chronic sinusitis is a therapeutic challenge. The use of endoscopic middle meatal cultures as a noninvasive method to determine the bacteriology of the maxillary sinus has not accurately been established. The aim of this study was to review the literature that compares cultures obtained by endoscopic middle meatal swabs with those obtained from maxillary sinus aspirates (MSAs). We reviewed studies published between January 1966 and October 2003 that were identified from searches of multiple databases, bibliographies, and original articles. Studies were included for analysis if they compared the results of endoscopic middle meatal cultures to aspirate cultures. All clinical variables and test performances were independently extracted by two reviewers. Middle meatal culture had a per isolate accuracy of 82% (95% confidence interval, 0.64, 0.92) compared with MSA (excluding coagulase negative staphylococcus and fungal cultures). Endoscopic middle meatal cultures have a high concordance with MSAs.

Efficacy and Safety of a Novel, Single-dose Azithromycin Microsphere Formulation Versus 10 Days of Levofloxacin for the Treatment of Acute Bacterial Sinusitis in Adults

To compare the efficacy and safety of a single 2.0-g dose of a novel azithromycin microsphere formulation with that of 10 days of levofloxacin, 500 mg/d, when used to treat adults with uncomplicated acute bacterial maxillary sinusitis (ABS). An international, multicenter, randomized, double-blind, double-dummy trial. Eligible outpatients > or =18 years of age with clinical and radiographic evidence of ABS underwent maxillary sinus aspiration before randomization. Primary endpoint was clinical efficacy at the test-of-cure visit (day 17-24). Clinical success rates were 94.5% (242/256) in azithromycin-microspheres-treated patients and 92.8% (233/251) in the levofloxacin group. In patients with documented Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, clinical cure rates were 97.3% (36/37), 96.3% (26/27), and 100% (8/8), respectively, for the azithromycin group and 92.3% (36/39), 100% (30/30), and 90.9% (10/11), respectively, for the levofloxacin group. Single-dose azithromycin microspheres provided clinical and bacteriologic efficacy and safety comparable to 10 days of levofloxacin. A novel microsphere formulation of azithromycin given as a single dose was safe and effective for the treatment of ABS.

Microbiology of sinusitis and the predictive value of throat culture for the aetiology of sinusitis

A prospective study of throat cultures and maxillary sinus aspirates from children with chronic sinusitis (n = 21), acute sinusitis (n = 28) or a clinical diagnosis of chronic adenoiditis (n = 41) was performed. Seventy-two bacterial pathogens were isolated from sinus aspirates from 52% of the study population. Haemophilus influenzae was most common pathogen, followed by Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococci. Quantitative throat cultures had positive predictive values of 41%, 53% and 75% for H. influenzae, Strep. pneumoniae and M. catarrhalis, respectively, while negative predictive values were 93-98%, indicating that these three pathogens do not cause sinusitis when absent from the throat.

Pediatric sinusitis: when do we operate?

The role of surgery in the treatment of pediatric sinusitis is still in evolution. This review of recent literature highlights developments in the study of pediatric sinusitis, particularly as it pertains to surgical intervention. There is growing support in the literature for adenoidectomy as a first-line surgical intervention for chronic rhinosinusitis in children when maximal medical management fails. Maxillary sinus aspiration or middle meatal culture can be performed at the same sitting to facilitate directed antibiotic therapy. Intravenous antibiotics seem to be a promising alternative to functional endoscopic sinus surgery (FESS), especially in younger children. Current literature continues to support FESS as a safe and effective treatment for pediatric sinus disease. Previous notions that FESS may inhibit midfacial growth have been challenged by several recent studies. There is no clear consensus regarding timing of FESS for chronic rhinosinusitis. However, the current literature seems to support FESS when maximal medical therapy, adenoidectomy, and culture-directed systemic antibiotics have all failed with persistence of sinonasal disease, when anatomic abnormalities predispose to chronic rhinosinusitis by obstructing normal sinonasal drainage pathways, in sinonasal polyposis to facilitate application of topical steroids, as an adjunct to desensitization in aspirin-sensitive patients, when orbital or intracranial complications of sinonasal disease occur, and in selected cystic fibrosis patients to improve quality of life and facilitate application of topical antibiotics with activity against Pseudomonas aeruginosa. Although the current literature lends some additional clarity to the indications for surgical intervention in pediatric chronic rhinosinusitis, additional research is still needed to elucidate appropriate timing for surgery and more specific indications.

Profile of aerobic bacteria isolated in chronic maxillary sinusitis patients

To determine the pattern of aerobic bacteria isolated in patients with chronic maxillary sinusitis at the Ear, Nose and Throat Clinic of the University of Nigeria Teaching Hospital, Enugu, and the antibiotics sensitivity pattern of these organisms. A prospective hospital-based clinical study. Fifty - four patients with clinical diagnosis of chronic maxillary sinusitis were evaluated. Out of 54 maxillary sinus aspirate specimens studied, 31 yielded bacterial growths and 32 no bacterial growth. The common aerobic bacteria isolated were Staphylococcus aureus (32.3% ), Pseudomonas aeruginosa and Escherichia coli were 16.1% each. Staphylococcus aureus was sensitive to Erythromycin, and the gram-negative organisms to Gentamicin. Bacteria isolated in chronic maxillary sinusitis and their sensitivity patterns varied. Bacteriologic study of the antral washings / aspirates should be done in every patient with chronic maxillary sinusitis. Combination chemotherapy that included Erythromycin and Gentamicin was recommended.

Chronic rhinosinusitis and adenoid hypertrophy in children

Purpose The purpose of this study was to investigate the relationship between adenoid microbiology, adenoid size, and maxillary sinus microbiology in children with both chronic rhinosinusitis and adenoid hypertrophy. Methods The children with both chronic rhinosinusitis and adenoid hypertrophy were admitted to this prospective study. The study included 30 children. The diagnosis of chronic rhinosinusitis was based on clinical and radiologic examinations. Adenoid hypertrophy was classified as medium and large based on the preoperative flexible fiberoptic endoscopy and nasal endoscopy during surgery. Maxillary sinus aspiration and adenoidectomy was performed in all patients. Sinus aspirate and adenoid tissue specimens were cultured. The correlation of culture results was investigated. The relationship between adenoid size and maxillary sinus culture results was analyzed by using chi-square test. Results Adenoid sizes were medium in 12 (40%) and large in 18 (60%) cases. Bacterial growth was found on 14 of 30 (47%) sinus aspirate, and all adenoid specimen cultures showed bacterial growth (100%). There was no statistical correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus. The relationship between adenoid size and maxillary sinus culture results was not found statistically significant (χ 2 = 0.96, P = 1.0). Conclusion The reason that there was no correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus is that it seems possible that the adenoids act as a barrier causing mechanical obstruction rather than a nidus for chronic sinus infection. However, there is no relationship between adenoid size and maxillary sinus culture positivity. Medium adenoids causing partial obstruction may lead to changes in the microenvironment and may start bacterial growth in children with positive maxillary culture. Further investigation is needed to explain the association between adenoid hypertrophy and rhinosinusitis. Adenoidectomy helps to resolve the symptoms of chronic rhinosinusitis in the children with both chronic rhinosinusitis and adenoid hypertrophy.

The role of Chlamydia pneumoniae infection in children with chronic sinusitis.

Chlamydia pneumoniae infection is a frequent cause of lower respiratory disease in both adults and children. However, its role in upper respiratory disease, including sinusitis, is less clear. To determine the role of infection with C. pneumoniae in chronic sinusitis in children. Prospective collection of specimens. Tertiary care academic medical center. Children with clinical and radiologic evidence of chronic sinusitis unresponsive to medical management undergoing adenoidectomy, maxillary sinus lavage, or endoscopic sinus surgery for treatment. Intervention Nasopharyngeal and middle meatal swabs and portions of surgical specimens were obtained and cultured for C. pneumoniae. Specimens were obtained from 20 children (14 boys and 6 girls) aged 3 through 16 years. Thirteen bilateral endoscopic ethmoidectomies with maxillary antrostomies, 10 adenoidectomies, and 3 bilateral maxillary sinus lavages were performed. Chlamydia pneumoniae was isolated from the nasopharyngeal swab and adenoid tissue of 1 child (aged 6 years); however, his middle meatal swabs and maxillary sinus aspirates were negative. After 10 days of treatment with clarithromycin, repeat nasopharyngeal cultures were negative for C. pneumoniae. With the use of sensitive culture methods, C. pneumoniae was not isolated from sinus specimens of children enrolled in this study. This preliminary study suggests that C. pneumoniae does not play a significant role in chronic sinusitis in children.

Bacteriologic findings in Patients with Chronic Sinusitis

We studied the bacteriology of maxillary sinus aspirates obtained from patients diagnosed with chronic sinusitis. We recovered 659 strains from 510 aspirates; of these, 572 (86.8%) were aerobes and 87 (13.2%) were anaerobes. Aerobes only were recovered from 310 of the 510 specimens (60.8%) and anaerobes only from 31 (6.1%). Among the 572 aerobic bacteria, the most prevalent organisms were Streptococcus viridans (158 strains [27.6%]), Streptococcus pneumoniae (67 [11.7%]), Corynebacterium species (66 [11.5%]), Staphylococcus aureus (54 [9.4%]), Moraxella catarrhalis (38 [6.6%]), Hemophilus parainfluenzae (33 [5.8%]), and group C beta-hemolytic streptococci (26 [4.5%]). Among the 87 recovered anaerobes were species of Peptostreptococcus (32 strains [36.8%]), Prevotella (22 [25.3%]), Actinomyces (13 [14.9%]), Propionibacterium (11 [12.6%]), Fusobacterium (8 [9.2%]), and Veillonella (1 [1.1%]). Beta-lactamase production was detected in 115 of the 572 aerobic strains (20.1%) and in 10 of the 87 anaerobic strains (11.5%). We found that the prevalence and type of organisms we identified in chronic sinusitis did not differ substantially from those reported in previous studies. Our study is one of the more extensive reports on the type and prevalence of pathogens in chronic sinusitis that has been published to date.

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis

Purpose: To investigate aerob-anearob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. Patients and Methods: The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4±14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. Results: Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (−) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. Conclusions: This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.