Endoscopically guided sinonasal cultures: A direct comparison with maxillary sinus aspirate cultures

Sinusitis is a common medical problem that can at times be challenging to t reat. Although most cases respond to empiric therapy, success is not achiev ed universally. If empiric therapy fails, if is important to identify the c ausative bacterial pathogen. Antral puncture is the traditional diagnostic method to recover and identify pathogens in sinusitis; however, it remains a painful, invasive test with potential complications. In contrast, rigid s inonasal endoscopy permits recovery of mucopus emanating from the sinus ost ia with little pain and few possible complications. Endoscopy also affords important visual information that can confirm or refute a historical/clinic al diagnosis of sinusitis. Although previous studies have shown poor correl ation between nasal cavity swab cultures and maxillary sinus aspiration cul tures, few investigations have compared endoscopically guided middle meatal cultures with cultures obtained from maxillary sinus aspiration. Thirteen patients with maxillary sinusitis in one or both sinuses underwent endoscop ically guided culture of the middle meatus and maxillary sinus puncture wit h aspiration and culture (16 total study samples). Results from the microbi ologic analysis were compared. Endoscopically guided middle meatal cultures accurately identified the predominant bacterial pathogen and correlated wi th the cultures from maxillary sinus aspiration in more than 90% of infecti ons. These preliminary results suggest that endoscopically guided sino-nasa l cultures hold promise as a viable alternative to maxillary sinus aspirati on. Endoscopically guided cultures appear to be an effective, noninvasive d iagnostic tool for otolaryngologists managing sinusitis.