Biopsy and specimen collection in chronic rhinosinusitis

Biopsy, aspiration, swab, and irrigation of the nose and sinuses are methods used in specimen collection and culture when chronic rhinosinusitis is suspected. Biopsy may be indicated to identify the presence of fungal elements in the mucus or tissues, suspected neoplasm, or inflamed bone. Aspiration directly from the maxillary sinus is considered to be the gold standard for culture, but it is painful. Direct endoscopic-guided culture of the middle meatus appears to be a viable substitute, with swab and suction methods having similar rates of microbiological contamination. Topical delivery methods for irrigating sinus cavities may utilize spray bottles, nebulizers, or a bulb syringe; these have various degrees of efficacy in dispersing materials to the sinuses. Use of the bulb syringe appears to offer broad distribution with limited risk of sample contamination. Specimens must be handled carefully to avoid loss of fungal elements. Advantages and indications of various methods are reviewed.