Endoscopically directed middle meatal cultures vs computed tomographic scans in the diagnosis of bacterial sinusitis in intensive care units

The data of the present study indicated that endoscopically directed middle meatal cultures had high positive and negative predictive values and accurately diagnosed bacterial sinusitis and identified the causative bacteria with high sensitivity and specificity in comparison with the criterion standard CT scans. The procedure is simple, noninvasive, and can be easily performed at the bedside without discomfort or morbidity. Based on our data, the procedure can be considered as a trustworthy substitute to sinus CT scans in ICU patients especially when it is difficult to transport the patients for imaging. Computed tomographic scans can, therefore, be reserved for patients who do not respond to culture-specific antibiotherapy. A further advantage of this approach is avoidance of the cumulative effect of unnecessary radiation. The study also confirmed the role of nasogastric and nasotracheal intubation in the pathogenesis of ICU sinusitis.