Changes in the Microbiome During Chronic Rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with a yet unknown etiology. As studies continue to elucidate the disease's heterogeneity inflammatory profile and presentation, there is a growing interest in the influence of the nasal microbiome on disease pathogenesis and chronicity. The sinus microbiota appear dominated by the Staphylococcus and Corynebacterium genera; known upper airway pathogens, such as Haemophilus influenza, are present in the upper airways of healthy individuals, though at relatively lower abundances than in CRS patients. Viral culprits may induce an unhindered local immune response that contributes to the recurrence and chronicity of inverted papillomas-benign mucosal lesions with the propensity for local destruction and malignant transformation that can be found in patients with a history of nasal infection. The persistence of inverted papillomas warrants investigation into their pathogenesis and how they may contribute to a nasal landscape promoting the chronicity of CRS. Further investigation is needed to uncover the interplay between resident microbiota and viral, fungal, and immunological influence. Discerning between 'healthy' and 'diseased' sinonasal microbiomes and 'keystone' species could shed light on CRS etiology and provide the opportunity for CRS treatment tailored to an individual's microbiome. This review aims to explore the interrelation of microbial residents in the pathogenesis and chronicity of the diseased sinonasal environment.

Keywords: chronic rhinosinusitis (CRS); dysbiosis; inverted papilloma; microbiome; nasal polyps; otolaryngology; upper airway.

Figure 1

(Left) Coronal CT of allergic fungal rhinosinusitis, with opacification and expansion of paranasal sinuses. (Right) Coronal CT scan of paranasal sinuses with features consistent with chronic rhinosinusitis, with opacification and possible bony erosion consistent with invasive infections. Images courtesy of the Otolaryngological and Radiological Departments of Heliodor Święcicki Hospital.

Figure 2

In the sinuses of healthy individuals, Staphylococcus spp., Corynebacterium spp., Propionibacterium spp., and Achromobacter spp. are dominant [13,19,27]. The most common and abundant species are Staphylococcus epidermidis, Staphylococcus aureus, and Propionibacterium acnes. Opportunistic bacteria, such as Streptococcus pneumoniae, Neisseria meningiditis, Haemophilus influenzae and Moraxella catarrhalis, occur less abundantly [13]. In the sinuses of CRSwNP patients, the most prevalent are Staphylococcus spp., Lactobacillus spp., and Corynebacterium spp. [27]. Although the amount of bacteria in the sinuses of healthy individuals is similar to that of CRSwNP patients, significant reduction of diversity of bacterial species was observed when compared to the sinuses of healthy individuals [40]. Figure created on NIAID Visual & Medical Arts. 11/15/2024. CRS. NIAID BIOART Source. bioart.niaid.nih.gov/bioart.