With computer fans, the smaller they are, the more noise they make in order to move air. Larger is typically better as they move more air at less rpms meaning much quieter.
I don't know your situation, however I have used adapters successfully in some situations to increase flow while decreasing noise, albeit only as a last resort.
This is an example of 80mm or 92mm to 120mm:
Fan adapterWith that said there is basically 2 types of computer fans, air flow and static pressure, with static pressure fans used when you are blowing through a radiator/heat sink (or even a screen or filter as dust is enemy to all things electronic) and an air flow fan when there is minimal obstruction. Static pressure fans have a more focused flow.
In the reviews that I have read, the static pressure fans blowing through a radiator or heat sink, were typically 1-2 degrees cooler.
As far as which is better, positive or negative air pressure, usually positive air pressure is better. (Positive pressure is more intake than exhaust).
I found a link that can explain why better than I can as I don't like typing:
Positive or Negative air pressureI agree with Landy, that it is better to push air through obstructions than pulling. However with screens or filters, you really don't have much choice.
Again, filtering out dust is very important unless you plan on cleaning the inside often as dust is an insulator, thus lowering the cooling effects.
I typically design computers with positive air pressure. YMMV