The Bacteriology of Chronic Rhinosinusitis With and Without Nasal Polyps

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 alpha-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 (P >. 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.