Update on the Role of the Microbiome in Chronic Rhinosinusitis

Abstract

Abstract Purpose of Review Chronic rhinosinusitis (CRS) is a common yet complex and heterogeneous inflammatory condition of the paranasal sinuses that is likely caused by a combination of infectious and inflammatory factors. The role of the microbiome in the pathogenesis of CRS remains poorly defined. The purpose of this review is to examine the role of the microbiome in CRS and evaluate current and emerging therapies that may alter the sinonasal microbiome. Recent Findings There are complex interactions among the various microorganisms that make up the sinonasal microbiome with a growing body of evidence that increased microbial biodiversity may be protective against the development of CRS and patients with improved biodiversity may have better treatment outcomes. Topical and systemic antimicrobials, intranasal corticosteroids, and surgery have demonstrated transient changes to the microbiome without significant change in symptoms. The use of probiotics and bacteriophages remain areas of active investigation regarding alterations to the sinonasal microbiome. Summary CRS seems to be associated with decreased sinonasal microbial diversity, but whether this is the cause of CRS or a downstream effect remains unclear. Additional evaluation into the role of the microbiome on CRS and the impact of therapies that may yet alter the microbiome are necessary.