Gram positive bacteria (blue) within the mouse sinus mucosal epithelium at x100 magnification Image taken by Sharon Waldvogel-Thurlow
While various microorganisms have been implicated in chronic rhinosinusitis (CRS), there is little evidence for the efficacy of antibiotics. Despite this, over 90% of CRS patients in the UK are being prescribed antibiotics by their general practitioners, often with repeated courses. The over-prescription of antibiotics for CRS may predispose patients to develop an unstable commensal nasal microbiota and encourage the growth of antibiotic-resistant strains.
Previous studies by our research group found that patients receiving doxycycline or prednisone for one week had no significant change in the mucosal microbiome. In another study, when the sinus mucosa was examined 3 to 6 months after functional endoscopic sinus surgery, more Staphylococcus was detected.
Accordingly, it is important to clarify the effectiveness of antibiotic treatment for chronic rhinosinusitis and obtain local information regarding the medical management of this condition. When medical therapy fails to bring about sufficient improvement, endoscopic sinus surgery is performed to remove inflamed tissue and open up the sinus drainage pathways.
Approximately 40,000 sinus procedures are performed each year in the UK and 250,000 in the USA. Management of chronic rhinosinusitis is estimated to cost the USA about $8.6 billion each year. The incidence of chronic rhinosinusitis and its management at primary and secondary care in New Zealand has not been studied. Specifically, no temporal studies exist which examine either anterior nares or sinonasal bacterial and fungal community diversity and stability in parallel. The extent to which the bacterial and fungal members impact the temporal dynamics of the nasal microbiome is unknown.
We plan to review CRS patients undergoing routine antibiotic and surgical management monthly for one year. During each visit, middle meatus swabs will be taken using an endoscope and a clinical assessment, including a SNOT-22 score, will be performed.