The microbiology of paranasal sinus infections: diagnosis and management.

Study of the bacteriology of sinusitis and its diagnosis and treatment has been difficult. One problem is the anatomy of the paranasal sinuses; all communicate with a bacteriologically contaminated cavity. Access to all but the frontal sinus involves traversing either the nasal or oral cavity, both of which are teeming with aerobic and anaerobic bacteria. The criteria used to establish the diagnosis of sinusitis has varied widely. There are a number of examination techniques available, but none are foolproof. Therefore, patient populations may not be comparable. The absolute elimination of the possibility of contamination of culture specimens is impossible. Investigators have taken cultures in several ways: of the purulent secretions within the nose, of the contents lavaged from the sinus into the nose, of material aspirated from the sinus, and of tissue removed from the sinus. In most studies prior to 1974, anaerobic cultures were not performed. Studies of various treatment programs have used differing criteria to monitor the progress of treatment. No single method is completely reliable. Clinical signs and symptoms, radiologic appearance, the results of irrigation, and thermography have been used to follow patients. Many studies have used multiple therapeutic maneuvers concurrently, for example, antibiotics, lavage, and a decongestant. In some there were no controls. Because of these problems, as is true in many clinical areas of investigation, meaningful comparisons of various studies are difficult. Despite this, there are some areas of consensus in the literature.