Hostname: page-component-669899f699-vbsjw Total loading time: 0 Render date: 2025-04-26T08:05:39.750Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  31 March 2023

P Fong Open the ORCID record for P Fong [Opens in a new window] ,
K Lim ,
A Gnanam  and
T Charn
P Fong
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Sengkang General Hospital, SingHealth, Singapore, Singapore
K Lim
Affiliation:
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
A Gnanam
Affiliation:
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
T Charn*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Sengkang General Hospital, SingHealth, Singapore, Singapore
*
Corresponding author: Tze Choong Charn; Email: entdrcharn@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This review evaluated the safety profile and efficacy of probiotics in chronic rhinosinusitis and was registered with Prospero (Centre for Reviews and Dissemination number: 42020193529).

Method

Literature databases were searched through inception to August 2022. Randomised, controlled trials exploring adjunctive probiotics in adult chronic rhinosinusitis patients were included. From 948 records screened, 4 randomised, controlled trials were included.

Results

Probiotics-associated adverse effects comprised epistaxis and abdominal pain. No reduction in Sino-Nasal Outcome Test values before 4 weeks (p = 0.58) or beyond 8 weeks (p = 0.08) of treatment or reduction of severe symptom frequency (p = 0.75) was observed. Symptom relapse in probiotic-treated patients was significantly lower across all timepoints (p = 0.045). Lower sinusitis relapse risks during treatment (risk ratio = 0.49; p = 0.019) and 8 months post-treatment (risk ratio = 0.56, p = 0.013) were observed. Probiotics demonstrated potential in improving Sino-Nasal Outcome Test symptom subscales, including sleep, psychological and rhinology subscales.

Conclusion

The optimal mode of probiotic administration, treatment duration and target patient subgroups requires further study to evaluate the utility of probiotics.

Keywords

Probioticsreviewrhinitissinusitis
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 12 , December 2023 , pp. 1300 - 1311
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

*

co-first author.

Tze Choong Charn takes responsibility for the integrity of the content of the paper

References

Rosenfeld, RM, Piccirillo, JF, Chandrasekhar, SS, Brook, I, Ashok Kumar, K, Kramper, M et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015;152(suppl 2):S1–S39Google ScholarPubMed
Fokkens, W, Desrosiers, M, Harvey, R, Hopkins, C, Mullol, J, Philpott, C et al. EPOS2020: development strategy and goals for the latest European Position Paper on Rhinosinusitis. Rhinology 2019;57:162–810.4193/Rhin19.080CrossRefGoogle ScholarPubMed
Cope, EK, Lynch, SV. Novel microbiome-based therapeutics for chronic rhinosinusitis. Curr Allergy Asthma Rep 2015;15:50410.1007/s11882-014-0504-yCrossRefGoogle ScholarPubMed
Psaltis, AJ, Wormald, PJ. Therapy of sinonasal microbiome in CRS: a critical approach. Curr Allergy Asthma Rep 2017;17:5910.1007/s11882-017-0726-xCrossRefGoogle ScholarPubMed
Orlandi, RR, Kingdom, TT, Smith, TL, Bleier, B, DeConde, A, Luong, AU et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021;11:213–73910.1002/alr.22741CrossRefGoogle Scholar
Lee, VS. Topical irrigations for chronic rhinosinusitis. Immunol Allergy Clin North Am 2020;40:317–2810.1016/j.iac.2019.12.014CrossRefGoogle ScholarPubMed
Smith, A, Buchinsky, FJ, Post, JC. Eradicating chronic ear, nose, and throat infections: a systematically conducted literature review of advances in biofilm treatment. Otolaryngol Head Neck Surg 2011;144:338–4710.1177/0194599810391620CrossRefGoogle ScholarPubMed
Cleland, EJ, Drilling, A, Bassiouni, A, James, C, Vreugde, S, Wormald, PJ. Probiotic manipulation of the chronic rhinosinusitis microbiome. Int Forum Allergy Rhinol 2014;4:309–1410.1002/alr.21279CrossRefGoogle ScholarPubMed
Schwartz, JS, Peres, AG, Mfuna Endam, L, Cousineau, B, Madrenas, J, Desrosiers, M. Topical probiotics as a therapeutic alternative for chronic rhinosinusitis: a preclinical proof of concept. Am J Rhinol Allergy 2016;30:202–510.2500/ajra.2016.30.4372CrossRefGoogle ScholarPubMed
Yang, G, Liu, ZQ, Yang, PC. Treatment of allergic rhinitis with probiotics: an alternative approach. N Am J Med Sci 2013;5:465–810.4103/1947-2714.117299CrossRefGoogle ScholarPubMed
Kramer, MF, Heath, MD. Probiotics in the treatment of chronic rhinoconjunctivitis and chronic rhinosinusitis. J Allergy (Cairo) 2014;2014:983635Google ScholarPubMed
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Ioannidis, JP et al. The PRISMA statement for reporting systematic reviews and meta–analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b270010.1136/bmj.b2700CrossRefGoogle ScholarPubMed
Hill, C, Guarner, F, Reid, G, Gibson, GR, Merenstein, DJ, Pot, B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11:506–1410.1038/nrgastro.2014.66CrossRefGoogle ScholarPubMed
Higgins, JP, Altman, DG, Gotzsche, PC, Juni, P, Moher, D, Oxman, AD et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d592810.1136/bmj.d5928CrossRefGoogle ScholarPubMed
Abuzeid, WM, Girish, VM, Fastenberg, JH, Draganski, AR, Lee, AY, Nosanchuk, JD et al. Nitric oxide-releasing microparticles as a potent antimicrobial therapeutic against chronic rhinosinusitis bacterial isolates. Int Forum Allergy Rhinol 2018;8:1190–810.1002/alr.22185CrossRefGoogle ScholarPubMed
Alanin, MC. Bacteriology and treatment of infections in the upper and lower airways in patients with primary ciliary dyskinesia: addressing the paranasal sinuses. Dan Med J 2017;64:B5361Google Scholar
Nayan, S, Maby, A, Endam, LM, Desrosiers, M. Dietary modifications for refractory chronic rhinosinusitis? Manipulating diet for the modulation of inflammation. Am J Rhinol Allergy 2015;29:e170–410.2500/ajra.2015.29.4220CrossRefGoogle ScholarPubMed
Anselmo-Lima, WT, Sakano, E, Tamashiro, E, Nunes, AA, Fernandes, AM, Pereira, EA et al. Rhinosinusitis: evidence and experience: October 18 and 19, 2013 - Sao Paulo. Braz J Otorhinolaryngol 2015;81(suppl 1):1–49Google Scholar
Bernstein, JM, Haase, E, Scannapieco, F, Dryja, D, Wolf, J, Briles, D et al. Bacterial interference of penicillin-sensitive and -resistant Streptococcus pneumoniae by Streptococcus oralis in an adenoid organ culture: implications for the treatment of recurrent upper respiratory tract infections in children and adults. Ann Otol Rhinol Laryngol 2006;115:350–610.1177/000348940611500506CrossRefGoogle Scholar
Aragona, SE, Ciprandi G. Probiotics for the management of upper respiratory diseases. J Biol Regul Homeost Agents 2020;34(6 Suppl. 1):1–4Google ScholarPubMed
Endam, LM, Alromaih, S, Gonzalez, E, Madrenas, J, Cousineau, B, Renteria, AE et al. Intranasal application of lactococcus lactis w136 is safe in chronic rhinosinusitis patients with previous sinus surgery. Front Cell Infect Microbiol 2020;10:44010.3389/fcimb.2020.00440CrossRefGoogle ScholarPubMed
Lambert, PA, Gill, AL, Gill, SR, Allen, PD, Man, LX. Microbiomics of irrigation with xylitol or Lactococcus lactis in chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2021;6:64–7010.1002/lio2.524CrossRefGoogle ScholarPubMed
Abreu, NA, Nagalingam, NA, Song, Y, Roediger, FC, Pletcher, SD, Goldberg, AN et al. Sinus microbiome diversity depletion and Corynebacterium tuberculostearicum enrichment mediates rhinosinusitis. Sci Transl Med 2012;4:151ra2410.1126/scitranslmed.3003783CrossRefGoogle ScholarPubMed
Feazel, LM, Robertson, CE, Ramakrishnan, VR, Frank, DN. Microbiome complexity and Staphylococcus aureus in chronic rhinosinusitis. Laryngoscope 2012;122:467–7210.1002/lary.22398CrossRefGoogle ScholarPubMed
Zheng, XL, Zhao, YX, Xu, M. Efficacy and safety of 3 nasal packing materials used after functional endoscopic sinus surgery for chronic rhinosinusitis: a comparative study in China. Med Sci Monit 2017;23:1992–810.12659/MSM.899553CrossRefGoogle ScholarPubMed
Jiang, R-S, Liang, K-L, Wu, S-H, Lin, J-F, Tsai, C-C. The influence of Jia Wei Cang Er San on the postoperative bacteriology of chronic rhinosinusitis: a randomized, placebo-controlled, double-blind study. Open J Med Microbiol 2013;3:3201810.4236/ojmm.2013.32018CrossRefGoogle Scholar
Mårtensson, A, Greiff, L, Lamei, SS, Lindstedt, M, Olofsson, TC, Vasquez, A et al. Effects of a honeybee lactic acid bacterial microbiome on human nasal symptoms, commensals, and biomarkers. Int Forum Allergy Rhinol 2016;6:956–6310.1002/alr.21762CrossRefGoogle ScholarPubMed
Kalima, K, Lehtoranta, L, He, L, Pitkaniemi, J, Lundell, R, Julkunen, I et al. Probiotics and respiratory and gastrointestinal tract infections in Finnish military conscripts - a randomised placebo-controlled double-blinded study. Benef Microbes 2016;7:463–7110.3920/BM2015.0172CrossRefGoogle ScholarPubMed
Berggren, A, Lazou Ahren, I, Larsson, N, Onning, G. Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infections. Eur J Nutr 2011;50:203–1010.1007/s00394-010-0127-6CrossRefGoogle ScholarPubMed
Guillemard, E, Tondu, F, Lacoin, F, Schrezenmeir, J. Consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114001 reduces the duration of respiratory infections in the elderly in a randomised controlled trial. Br J Nutr 2010;103:58–6810.1017/S0007114509991395CrossRefGoogle Scholar
Maestroni, GJ, Losa, GA. Clinical and immunobiological effects of an orally administered bacterial extract. Int J Immunopharmacol 1984;6:111–1710.1016/0192-0561(84)90005-5CrossRefGoogle ScholarPubMed
JE, T. Use of probiotics as adjunctive treatment for chronic rhinosinusitis. In: https://classic.clinicaltrials.gov/ct2/show/NCT00396162 [11 September 2023]Google Scholar
Mukerji, SS, Pynnonen, MA, Kim, HM, Singer, A, Tabor, M, Terrell, JE. Probiotics as adjunctive treatment for chronic rhinosinusitis: a randomized controlled trial. Otolaryngol Head Neck Surg 2009;140:202–810.1016/j.otohns.2008.11.020CrossRefGoogle ScholarPubMed
Habermann, W, Zimmermann, K, Skarabis, H, Kunze, R, Rusch, V. Reduction of acute recurrence in patients with chronic recurrent hypertrophic sinusitis by treatment with a bacterial immunostimulant (Enterococcus faecalis Bacteriae of human origin). Arzneimittelforschung 2002;52:622–7Google ScholarPubMed
Mårtensson, A, Abolhalaj, M, Lindstedt, M, Mårtensson, A, Olofsson, TC, Vasquez, A et al. Clinical efficacy of a topical lactic acid bacterial microbiome in chronic rhinosinusitis: a randomized controlled trial. Laryngoscope Investig Otolaryngol 2017;2:410–1610.1002/lio2.93CrossRefGoogle ScholarPubMed
La Mantia, I, Gelardi, M, Drago, L, Aragona, SE, Cupido, G, Vicini, C et al. Probiotics in the add-on treatment of rhinosinusitis: a clinical experience. J Biol Regul Homeost Agents. 2020;34(suppl 1):27–34Google ScholarPubMed
Wu, Y, Pei, C, Wang, X, Wang, M, Huang, D, Wang, F et al. Effect of probiotics on nasal and intestinal microbiota in people with high exposure to particulate matter </= 2.5 mum (PM2.5): a randomized, double-blind, placebo-controlled clinical study. Trials 2020;21:85010.1186/s13063-020-04759-4CrossRefGoogle ScholarPubMed
Gluck, U, Gebbers, JO. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci). Am J Clin Nutr 2003;77:517–2010.1093/ajcn/77.2.517CrossRefGoogle ScholarPubMed
Macias-Valle, L, Psaltis, AJ. A Scholarly review of the safety and efficacy of intranasal corticosteroids preparations in the treatment of chronic rhinosinusitis. Ear Nose Throat J 2021;100:295–30110.1177/0145561320967727CrossRefGoogle ScholarPubMed
Chowdhury, NI, Mace, JC, Bodner, TE, Alt, JA, Deconde, AS, Levy, JM et al. Does medical therapy improve sinonasal outcomes test-22 domain scores? an analysis of clinically important differences. Laryngoscope 2019;129:31–610.1002/lary.27470CrossRefGoogle ScholarPubMed
Vitetta, L, Coulson, S, Thomsen, M, Nguyen, T, Hall, S. Probiotics, D-lactic acidosis, oxidative stress and strain specificity. Gut Microbes 2017;8:311–2210.1080/19490976.2017.1279379CrossRefGoogle ScholarPubMed
Cervin, AU. The potential for topical probiotic treatment of chronic rhinosinusitis, a personal perspective. Front Cell Infect Microbiol 2017;7:53010.3389/fcimb.2017.00530CrossRefGoogle ScholarPubMed
Cho, DY, Skinner, D, Lim, DJ, McLemore, JG, Koch, CG, Zhang, S et al. The impact of Lactococcus lactis (probiotic nasal rinse) co-culture on growth of patient-derived strains of Pseudomonas aeruginosa. Int Forum Allergy Rhinol 2020;10:444–910.1002/alr.22521CrossRefGoogle Scholar