Open Access Highly Accessed Open Badges Research article

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection

Sam Boase1, Andrew Foreman1, Edward Cleland1, Lorwai Tan1, Rachel Melton-Kreft2, Harshita Pant1, Fen Z Hu2, Garth D Ehrlich2 and Peter-John Wormald13*

Author Affiliations

1 Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia

2 Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, PA, USA

3 Department of Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, 28, Woodville Road, Woodville SA 5011, Australia

For all author emails, please log on.

BMC Infectious Diseases 2013, 13:210  doi:10.1186/1471-2334-13-210

Published: 8 May 2013



Bacteria and fungi are believed to influence mucosal inflammation in chronic rhinosinusitis (CRS). However their presence and relationship to disease is debated. This study used multiple detection methods to compare microbial diversity and microbial abundance in healthy and diseased sinonasal mucosa. The utility of contemporary detection methods is also examined.


Sinonasal mucosa was analyzed from 38 CRS and 6 controls. Bacterial and fungal analysis was performed using conventional culture, molecular diagnostics (polymerase chain reaction coupled with electrospray ionization time-of-flight mass spectrometry) and fluorescence in situ hybridization.


Microbes were detected in all samples, including controls, and were often polymicrobial. 33 different bacterial species were detected in CRS, 5 in control patients, with frequent recovery of anaerobes. Staphylococcus aureus and Propionibacterium acnes were the most common organisms in CRS and controls, respectively. Using a model organism, FISH had a sensitivity of 78%, and a specificity of 93%. Many species were detected in both CRS and controls however, microbial abundance was associated with disease manifestation.


This study highlights some cornerstones of microbial variations in healthy and diseased paranasal sinuses. Whilst the healthy sinus is clearly not sterile, it appears prevalence and abundance of organisms is critical in determining disease. Evidence from high-sensitivity techniques, limits the role of fungi in CRS to a small group of patients. Comparison with molecular analysis suggests that the detection threshold of FISH and culture is related to organism abundance and, furthermore, culture tends to select for rapidly growing organisms.