Impact of saline irrigation and topical corticosteroids on the postsurgical sinonasal microbiota

Abstract

Introduction Topical treatments with nasal saline irrigation, topical steroid sprays, or corticosteroid rinses can improve sinonasal symptoms in chronic rhinosinusitis (CRS). However, the impact of these therapies on commensals (Corynebacterium) and on biofilm pathogens associated with CRS (Staphylococcus aureus and Pseudomonas) is not well characterized. Methods Paired nasal and sinus swabs were collected endoscopically from 28 controls and 14 CRS patients with nasal polyposis (CRSwNP) who had not received systemic antibiotics or corticosteroids in the previous eight weeks. Total DNA from swab eluents were extracted and analyzed by 16S rRNA gene-based pyrosequencing. A total 359,077 reads were obtained and classified taxonomically. The association of use of topical therapies with sinonasal microbiota composition was assessed by factor and vector-fitting. The proportional abundances of sinonasal bacteria between topical therapy users and non-users were further compared by two-tailed Kolmogorov-Smirnov test among controls and among CRSwNP participants. Result Nasal saline irrigation, with or without added budesonide, was not associated with significantly distinct sinonasal microbiota composition or significantly decreased Pseudomonas or S. aureus abundances among either controls or CRSwNP participants. Corynebacterium was slightly lower in controls that reported using saline irrigation than those who did not. No significant association was found between nasal saline irrigation and the proportional abundances of Pseudomonas, S. aureus, and Corynebacterium in CRSwNP participants. However, male CRSwNP patients were noted to have significantly higher Corynebacterium proportional abundances than their female counterparts. The use of topical steroid sprays was associated with a distinct microbiota in control subjects, characterized by higher proportional abundances of Dolosigranulum and Simonsiella and a lower proportional abundance of Campylobacter. Conclusion Nasal saline irrigation is not associated with a distinct alteration in the proportional abundance of commensal bacteria or biofilm-forming pathogens in CRSwNP patients. However, use of topical intranasal corticosteroid sprays in control subjects is associated with a distinct sinonasal microbiota.

The sinonasal bacterial microbiome in health and disease

“…Interestingly, in the first study, a number of patient-specific factors were examined, and the use of topical saline or topical intranasal steroids, or the presence of nasal polyps was not a predictor of altered microbiome composition. Similar findings were noted in a cross-sectional cohort of postoperative CRS with polyp patients, where the use of saline irrigations with or without budesonide was not found to influence the sinus microbiome [35]. To date, properly designed studies to evaluate for the effect of topical therapies on the microbiome have not been performed, so no real conclusions can be made.…”

Post‐operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta‐analysis

“…Clinical trials and meta‐analyses have shown that saline alone irrigation is effective for reducing CRS symptoms and improving QOL in both pre‐operative and post‐operative periods . We compared the effects of saline irrigation with steroid treatment with saline irrigation alone.…”

“…Clinical trials and meta-analyses have shown that saline alone irrigation is effective for reducing CRS symptoms and improving QOL in both pre-operative and post-operative periods. 23 We compared the effects of saline irrigation with steroid treatment with saline irrigation alone. Steroid irrigation was not associated with significant improvements in the measurements, compared to saline irrigation, which could be explained by several reasons.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…449,450 Observed alterations in local microbiota in CRS may result from repeated and prolonged medical therapies. 439,451 In the Feazel et al 439 study, prior sinus surgery and the presence of S. aureus were also associated with less diversity, but this observation requires further exploration to determine if this is a disease-association or a result of the extensive medical and surgical therapies used in recalcitrant CRS.…”