Correlation of Middle Meatal and Maxillary Sinus Cultures in Acute Maxillary Sinusitis

Abstract

Cultures obtained from the middle meatus have been used frequently in the past to direct therapy in patients with acute maxillary sinusitis. However, no convincing data have been published to indicate that middle meatal cultures accurately represent the bacterial flora within the maxillary sinus. The hypothesis of this experiment is that bacteria obtained by directed middle meatal cultures qualitatively and quantitatively correlate with cultures taken by maxillary sinus puncture. Acute sinusitis was induced by injecting 10(8) colony-forming units of bacteria directly into the maxillary sinuses of rabbits in which the ostia were occluded with cotton packs. Eight animals were injected with Staphylococcus aureus, eight with Haemophilus influenzae, and eight with Streptococcus pneumoniae. The packs were removed after 3 days, and specimens were obtained from the middle meatus in the region of the maxillary sinus ostium, and from the maxillary sinus, 1 day later. The contralateral maxillary sinuses of six of the animals were injected with normal saline and served as controls. There was a 100% correlation rate between cultures of specimens obtained from the maxillary sinus and from the middle meatus in all 24 animals. In addition, the quantitative counts from the middle meatus and the maxillary sinus correlated. Control animals showed no bacterial growth from either the middle meatus or the maxillary sinus. These results show that, in an animal model of acute sinusitis, cultures of specimens from the middle meatus reflect the contents of the maxillary sinus.

Rigid Nasal Endoscopy versus Sinus Puncture and Aspiration for Microbiologic Documentation of Acute Bacterial Maxillary Sinusitis

“…There were no complications from either endoscopy or puncture, but it was noted that patients reported that the latter was more painful. The findings in these 3 studies [11,32,33] are consistent with observations of concordance between middle meatal and maxillary sinus cultures in a rabbit model of ABMS [34]. The current study confirms, in a larger population, the concordance between puncture and aspiration culture results and endoscopy culture results for patients with ABMS.…”

Role of Middle Meatus Aspiration Culture in the Diagnosis of Chronic Sinusitis

“…Orobello et al 13 found a strong correlation between middle meatal cultures and both maxillary and ethmoid sinus cultures in children, even though gross purulence was rarely encountered in their patients. Finally, Valdya et al 16 induced acute sinusitis in 24 rabbits and demonstrated a 100% correlation between middle meatal and maxillary sinus cultures in those animals. They concluded that middle meatal cultures accurately reflect maxillary sinus pathogens and could be used to direct antimicrobial therapy.…”

Does methicillin-resistantStaphylococcus aureushave a significant role in the peri-operative course of patients undergoing rhinological surgery?

“…A recent study on the effects of septoplasty on the nasal flora found that 16 per cent of patients had coagulase negative S aureus cultured postoperatively; 37 again, this would appear to represent colonisation only. 30,40,41 Other organisms grown readily from nasal swabs and mucosal specimens include Citrobacter diversus, Streptococcus viridans and Staphylococcus epidermidis. 38,39 (Middle meatal swabs would appear to be equally as valid as antral aspirates for determining the microbiological population of the maxillary antrum.)…”