Microbiology of Acute, Subacute, and Chronic Rhinosinusitis in Children

Acute, subacute, and chronic rhinosinusitis may involve an infectious etiology. Knowledge of the microbiology of sinusitis is necessary because it impacts the choice of antibiotic therapy. The sinus aspirate is the most reliable source of microbiological data in sinusitis in children. However, sinus aspirates are rarely done in cases of patients with rhinosinusitis; the last time one was done in a child was in 1984. When they are done, sinus aspirate studies of children showed the presence of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae, and Moraxella catarrhalis (M. catarrhalis). Unlike sinus aspirates, nasopharyngeal and middle meatal cultures are not reliable in determining the bacteriology of children with acute sinusitis. The observation of an increase in the proportion of cases of acute otitis media caused by H. influenzae may reflect that in acute sinusitis as well. Staphylococcus aureus does not play a significant role in uncomplicated acute bacterial sinusitis. The microbiology of acute otitis media can be used as a surrogate for that of acute bacterial sinusitis in children. In contrast to bacteria, the contribution of viruses to the pathogenesis of acute bacterial sinusitis has not been studied systematically. The pathogenesis of chronic sinusitis may be related to bacterial biofilms as a stimulant of chronic inflammation.