The Bacteriology of Chronic Rhinosinusitis With and Without Nasal Polyps | Infectious Diseases | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Fokkens  WLund  VMullol  JEuropean Position Paper on Rhinosinusitis and Nasal Polyps Group, European position paper on rhinosinusitis and nasal polyps 2007 [review].  Rhinol Suppl 2007; (20) 1- 136PubMedGoogle Scholar
Lund  VJ Impact of chronic rhinosinusitis on quality of life and health care expenditure.  Clin Allergy Immunol 2007;2015- 24PubMedGoogle Scholar
Brook  I Acute and chronic bacterial sinusitis.  Infect Dis Clin North Am 2007;21 (2) 427- 448,viiPubMedGoogle ScholarCrossref
Doyle  PWWoodham  JD Evaluation of the microbiology of chronic ethmoid sinusitis.  J Clin Microbiol 1991;29 (11) 2396- 2400PubMedGoogle Scholar
Bachert  CZhang  Nvan Zele  TGevaert  PPatou  Jvan Cauwenberge  P Staphylococcus aureus enterotoxins as immune stimulants in chronic rhinosinusitis.  Clin Allergy Immunol 2007;20163- 175PubMedGoogle Scholar
Polzehl  DWeschta  MPodbielski  ARiechelmann  HRimek  D Fungus culture and PCR in nasal lavage samples of patients with chronic rhinosinusitis.  J Med Microbiol 2005;54 (pt 1) 31- 37PubMedGoogle ScholarCrossref
Clement  SVaudaux  PFrancois  P  et al.  Evidence of an intracellular reservoir in the nasal mucosa of patients with recurrent Staphylococcus aureus rhinosinusitis.  J Infect Dis 2005;192 (6) 1023- 1028PubMedGoogle ScholarCrossref
Plouin-Gaudon  IClement  SHuggler  E  et al.  Intracellular residency is frequently associated with recurrent Staphylococcus aureus rhinosinusitis.  Rhinology 2006;44 (4) 249- 254PubMedGoogle Scholar
Weschta  MRimek  DFormanek  MPolzehl  DPodbielski  ARiechelmann  H Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial.  J Allergy Clin Immunol 2004;113 (6) 1122- 1128PubMedGoogle ScholarCrossref
Malm  L Assessment and staging of nasal polyposis.  Acta Otolaryngol 1997;117 (4) 465- 467PubMedGoogle ScholarCrossref
Riechelmann  HEssig  ADeutschle  TRau  ARothermel  BWeschta  M Nasal carriage of Staphylococcus aureus in house dust mite allergic patients and healthy controls.  Allergy 2005;60 (11) 1418- 1423PubMedGoogle ScholarCrossref
Jiang  RSHsu  CYJang  JW Bacteriology of the maxillary and ethmoid sinuses in chronic sinusitis.  J Laryngol Otol 1998;112 (9) 845- 848PubMedGoogle ScholarCrossref
Kremer  BJacobs  JASoudijn  ERvan der Ven  AJ Clinical value of bacteriological examinations of nasal and paranasal mucosa in patients with chronic sinusitis.  Eur Arch Otorhinolaryngol 2001;258 (5) 220- 225PubMedGoogle ScholarCrossref
Busaba  NYSiegel  NSSalman  SD Microbiology of chronic ethmoid sinusitis: is this a bacterial disease?  Am J Otolaryngol 2004;25 (6) 379- 384PubMedGoogle ScholarCrossref
Brook  I Bacteriology of acute and chronic ethmoid sinusitis.  J Clin Microbiol 2005;43 (7) 3479- 3480PubMedGoogle ScholarCrossref
Brook  I Bacteriology of chronic sinusitis and acute exacerbation of chronic sinusitis.  Arch Otolaryngol Head Neck Surg 2006;132 (10) 1099- 1101PubMedGoogle ScholarCrossref
Nigro  JFNigro  CEMarone  SAVoegels  RL Microbiology of the maxillary and ethmoid sinuses in patients with chronic rhinosinusitis submitted to functional endoscopic sinus surgery [in Portuguese].  Braz J Otorhinolaryngol 2006;72 (2) 217- 222PubMedGoogle Scholar
Cervin  AWallwork  B Macrolide therapy of chronic rhinosinusitis.  Rhinology 2007;45 (4) 259- 267PubMedGoogle Scholar
Jenkins  SGBrown  SDFarrell  DJ Trends in antibacterial resistance among Streptococcus pneumoniae isolated in the USA: update from PROTEKT US Years 1-4.  Ann Clin Microbiol Antimicrob 2008;71PubMedGoogle ScholarCrossref
Original Article
February 16, 2009

The Bacteriology of Chronic Rhinosinusitis With and Without Nasal Polyps

Author Affiliations

Author Affiliations: Department of Otorhinolaryngology (Ms Niederfuhr and Dr Kirsche) and Institute of Medical Microbiology and Hygiene (Dr Wellinghausen), University Hospital of Ulm, Ulm, Germany; and Department of Otorhinolaryngology, University Hospital of Innsbruck, Innsbruck, Austria (Dr Reichelmann).

Arch Otolaryngol Head Neck Surg. 2009;135(2):131-136. doi:10.1001/archoto.2008.531

Objective  To compare the bacteriologic findings in ethmoidal biopsy specimens and nasal lavage samples from healthy control patients and from patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSNP+) and without nasal polyps (CRSNP−).

Design  Comparative microbiologic investigation.

Setting  University hospital.

Patients  The study included 31 CRSNP+ patients, 13 CRSNP− patients, and 21 control patients.

Intervention  Aerobe and anaerobe bacterial culture of nasal lavage samples and biopsy specimens of anterior ethmoidal mucosa.

Main Outcome Measure  Analysis of biopsy specimens from 65 patients and nasal lavage samples from 63 patients.

Results  Mixed cultures of aerobe and anaerobe bacteria were mainly detected in the biopsy specimens. The most common aerobe bacteria found in the biopsy specimens were coagulase-negative staphylococci, Corynebacterium species, Staphylococcus aureus, and α-hemolytic streptococci. Propionibacterium and Peptostreptococcus species were the most common anaerobes. Pathogenic bacteria such as S aureus, Enterobacteriaceae, and Haemophilus influenzae were detected in biopsy specimens from 16 of 31 CRSNP+ patients (52%), 4 of 13 CRSNP− patients (31%), and 10 of 21 control patients (48%). There were no significant differences in the bacterial cultures of the biopsy specimens between the 3 patient groups (>.30). The majority of bacteria detected in the biopsy specimens were also detected in the corresponding lavage samples; however, in 35% of patients, pathogenic bacteria were found only in nasal lavage samples and not in corresponding biopsy specimens.

Conclusions  There are no significant differences in the bacteriologic features of ethmoidal biopsy specimens between CRSNP+, CRSNP−, and control patients. Therefore, a bacteriologic pathogenesis of the polyps in CRSNP+ patients seems unlikely. The general use of antibiotics in patients with CRS appears questionable. Investigation of nasal lavage samples is not suitable for predicting the bacteriologic features of inflamed sinuses of patients with CRS.