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- Bacteriology of chronic sinusitis less well defined than acute sinusitis [Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis] although flares of chronic sinusitis may be cause be the usual acute pathogens just noted.
- Polymicrobial flora typically, increased Gram negative organisms and possibly anaerobes.
- Pseudomonas aeruginosa, Staphylococcus aureus more common in nosocomial and immunocompromised infections.
- Controversy exists over role of fungi in chronic sinusitis. Suggestion that fungal elements may be inciting an eosinophil-mediated immune response in sinonasal mucosa.