Chronic Rhinosinusitis: Potential Role of Microbial Dysbiosis and Recommendations for Sampling Sites.

Elizabeth Copeland,Brian G G Oliver,Richard Carney,Catherine M Burke,Yuresh Naidoo,Justin R Seymour,Stephen Woodcock,Justin Kong,Nicholas W Stow,Martin Forer,Katherine Leonard

doi:10.3389/fcimb.2018.00057

Abstract

Chronic rhinosinusitis (CRS) is an inflammatory condition that affects up to 12% of the human population in developed countries. Previous studies examining the potential role of the sinus bacterial microbiota within CRS infections have found inconsistent results, possibly because of inconsistencies in sampling strategies. The aim of this study was to determine whether the sinus microbiome is altered in CRS and additionally if the middle meatus is a suitable representative site for sampling the sinus microbiome. Swab samples were collected from 12 healthy controls and 21 CRS patients, including all eight sinuses for CRS patients and between one and five sinuses for control subjects. The left and right middle meatus and nostril swabs were also collected. Significant differences in the sinus microbiomes between CRS and control samples were revealed using high-throughput 16S rRNA gene sequencing. The genus Escherichia was over-represented in CRS sinuses, and associations between control patients and Corynebacterium and Dolosigranulum were also identified. Comparisons of the middle meatuses between groups did not reflect these differences, and the abundance of the genus Escherichia was significantly lower at this location. Additionally, intra-patient variation was lower between sinuses than between sinus and middle meatus, which together with the above results suggests that the middle meatus is not an effective representative sampling site.

Highlights

Chronic rhinosinusitis (CRS) is characterized by persistent inflammation of the nose and the paranasal sinuses with symptoms including nasal obstruction or nasal discharge, in addition to facial pain or pressure and a reduction in the sense of smell (Fokkens et al, 2012)
A total of 31 subjects were included in the study, including 12 healthy controls and 21 CRS patients. 57% (n = 12) of CRS patients had nasal polyps
Coverage of three PCR and DNA extraction process negative controls was low (329, 542, and 3,255 sequences after quality filtering) and these sequences were dominated by the common skin bacterial genera Corynebacterium and Staphylococcus

Summary

Introduction

Chronic rhinosinusitis (CRS) is characterized by persistent inflammation of the nose and the paranasal sinuses with symptoms including nasal obstruction or nasal discharge, in addition to facial pain or pressure and a reduction in the sense of smell (Fokkens et al, 2012). Patients who have an inadequate response to medical treatment may be offered functional endoscopic sinus surgery (FESS), a surgical procedure aiming to restore sinus ventilation and function by widening the ostia of sinus cavities (Khalil and Nunez, 2006; Patel et al, 2017) and reducing inflammatory load (Bassiouni et al, 2012). In a quality of life study, surgical intervention in patients with high symptom scores was a more effective treatment strategy than ongoing medical treatment (Patel et al, 2017). Improved understanding of the pathophysiology of CRS should lead to more targeted treatment options

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