Microbiological Comparison of Maxillary Sinus Rinses in Non-Odontogenic and Odontogenic Sinusitis of Primarily Endodontic Origin.

Objectives

Odontogenic sinusitis (ODS) is common but frequently overlooked condition that differs from rhinogenic sinusitis (CRS) and should be suspected in each case of unilateral sinusitis. Clinical symptoms such as foul smell, congestion, rhinorrhea, and unilateral maxillary sinus opacification with overt dental pathology on radiological scans are more suggestive of ODS than CRS, but the distinctive microbiological flora are another clinical factor in diagnosis. The aim of this study was to compare the microbiological load of ODS and CRS and their clinical presentation for better disease recognition and its predisposing factors.

Methods

Adult patients scheduled for endoscopic sinus surgery were included in the study. Clinical data and radiological images were analyzed. The otolaryngologist assessed nasal endoscopy for mucopurulence or edema in middle meatus or sinuses, whereas dental specialist confirmed or ruled out the dental cause. Microbiological samples were collected after endoscopic maxillary antrostomy. After irrigation with 0,9% saline, the aspirated rinse was collected into sterile sets and sent for culturing.

Results

The study group consisted of 84 patients, 55 with CRS and 29 with ODS. Streptococcus spp prevailed in the CRS group, whereas Staphylococcus spp prevailed in the ODS group. Statistically significant differences between the groups were found in type of discharge, degree of edema, and presence of polyps. However, no statistical correlations were noted for presence of bacteria in the culture and endoscopic or radiological findings.

Conclusions

ODS and CRS share some common features: ODS more often presents with purulent discharge, localized maxillary involvement, and the presence of oral pathogens, and Staphylococcus spp in microbial profile.