Microbiomics of irrigation with xylitol or Lactococcus lactis in chronic rhinosinusitis

Abstract

Objective Topical sinonasal rinse therapies may alter the local microbiome and improve disease control in chronic rhinosinusitis (CRS). The objective of this study was to examine microbiome changes in post‐surgical CRS patients when rinsing with commercially available products containing xylitol or Lactococcus lactis. Methods A crossover‐type protocol with a washout period was designed. Swab samples from anterior ethmoid cavities of CRS patients were collected prospectively at baseline. Subjects were provided packets containing either L. lactis W136 or xylitol in non‐blinded fashion and instructed to add it to their rinse bottles daily for 28 days, after which another swab was taken. A saline wash‐out period was completed and a third swab taken. A final 28‐day regimen of the opposite product was followed by a final swab. DNA extraction and sequencing of the 16S rRNA gene allowed for global microbiome analysis. Results We enrolled 25 subjects with CRS and 10 controls resulting in 70 adequate samples. Increased detection of Lactococcus was observed after use of L. lactis. No significant trends in alpha or beta diversity as a result of treatment were observed. SNOT‐22 score did not change significantly following treatment with xylitol, L. lactis, or saline. Conclusion We did not detect any major clinical or microbiome‐level effect due to treatment with two topical rinse products. Further research is needed to elucidate their clinical utility and possible probiotic effect. Level of Evidence 3.

Role of probiotics in chronic rhinosinusitis: a systematic review of randomised, controlled trials

“…After screening the titles and abstracts, 217 duplicates and 836 irrelevant records were excluded (Figure 1). Twenty-seven potentially relevant studies were further examined, with 23 articles excluded for the following reasons: 10 were not RCTs, [15][16][17][18][19][20][21][22][23][24] 2 did not employ probiotics as the intervention for chronic rhinosinusitis, 25,26 5 did not recruit chronic rhinosinusitis patients as their participants [27][28][29][30] 1 explored the use of probiotics in paediatric chronic rhinosinusitis patients only, 31 2 were conference abstracts on self-administered topical probiotics for refractory chronic rhinosinusitis and antimicrobial photodynamic therapy, and 1 was a clinical trial protocol tied to an excluded full text. 32 The remaining four studies were included in our qualitative synthesis, [33][34][35][36] 2 of the RCTs were included in our meta-analysis for SNOT-20 or SNOT-22 scores 33,35 and 2 RCTs were evaluated for their incidence of side effects using Fisher's exact tests.…”

Effects of Probiotic Supplementation during Chronic Rhinosinusitis on the Microbiome

“…Various treatment options exist for CRS, but there is a lack of broadly applicable and effective treatment approaches [ 1 ]. Saline nasal irrigations, systemic and/or topical corticosteroid therapy, antibiotic medication (typically macrolides because they also have anti-inflammatory properties), and functional endoscopic sinus surgery are the main treatment options now available [ 1 , 9 , 10 , 11 ]. Patients do not always react to available treatments though, and symptoms frequently return even after surgery.…”

“…Pathogens or medications, such as frequent antibiotic courses, can disrupt this natural microbiota, resulting in an imbalance in the microbiome that favours the emergence of CRS [ 11 , 16 , 17 ]. Following surgery and frequent antibiotic administrations, the microbiome’s composition continues to alter, and antibiotic resistance increases [ 11 , 17 ]. This results in uncontrolled repopulation of empty niches, which may interfere with the restoration of the “optimal” microbial community [ 17 ].…”