In addition, occlusion of the sinuses can cause niche-specific differences in the microbiota. However, in CRS, the drainage from the sinuses to the MM is frequently impaired.
After the introduction of endoscopes, it replaced the maxillary sinus puncture as the new “gold standard”. Traditionally, the middle nasal meatus (MM) was presumed to be optimal for this purpose. The determination of the optimal sampling site for patients with CRS is nontrivial. Similarly, isolation of viable bacteria is a prerequisite for in vitro testing of novel antimicrobial therapies such as bacteriophage typing. Nucleic acid-based studies provide extensive information for microbiome research, but the culture remains irreplaceable for the majority of practical purposes, including pathogen identification and testing for antibiotic resistance. īacterial identification techniques used in patients with CRS include conventional culture and molecular methods. Inadequate use of antibiotics for rhinosinusitis is an important factor contributing to the global increase of antibiotic resistance. Nevertheless, antibiotics are frequently prescribed to patients with CRS disregarding these recommendations. In selected cases, macrolides or doxycycline seem to be beneficial, probably due to their anti-inflammatory properties. Antibiotics are currently recommended mainly during exacerbations and in these cases culture directed therapy is most reasonable. The mainstay of therapy in CRS is anti-inflammatory treatment followed by surgery in refractory cases. The role of bacteria in chronic rhinosinusitis (CRS) is unclear, but growing evidence links the disease to bacterial dysbiosis and biofilm formation.
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