Should a culture of nasal secretions be performed for patients with signs and symptoms of sinusitis?

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In sinusitis, routine culture of nasal secretions is not performed because the nasal cavity hosts a mix of normal flora and harmless colonizers that don’t reliably reflect the actual pathogens causing sinus infection. A culture from the nose often picks up these harmless organisms rather than the bacteria actively growing in the sinuses, so the results don’t reliably guide treatment. Most acute sinusitis cases are viral, and even when bacteria are involved, empiric therapy targets the common pathogens rather than tailoring treatment to a nasal swab result. Culturing from the sinuses themselves (through aspiration) or from tissue is reserved for special situations, such as chronic or refractory cases, and is not part of routine evaluation for typical sinusitis.