Chronic rhinosinusitis (CRS) is a complex, heterogenous condition that is likely associated with infectious and inflammatory causative factors. Renewed interest in the role that microbes play in this condition has stemmed from advancements in microbe identification and parallel research implicating the microbiome as having a role in other chronic inflammatory conditions. This clinical commentary provides a review of the current literature relevant to chronic rhinosinusitis. Particular focus is placed on factors specific to investigation of the sinonasal microbiome, evidence for the role of dysbiosis in the disease state, and influences that may affect the microbiome. Possible mechanisms of disease and therapeutic implications through microbial manipulation are also reviewed, as are deficiencies and limitations of the current body of research. Chronic rhinosinusitis (CRS) is a complex, heterogenous condition that is likely associated with infectious and inflammatory causative factors. Renewed interest in the role that microbes play in this condition has stemmed from advancements in microbe identification and parallel research implicating the microbiome as having a role in other chronic inflammatory conditions. This clinical commentary provides a review of the current literature relevant to chronic rhinosinusitis. Particular focus is placed on factors specific to investigation of the sinonasal microbiome, evidence for the role of dysbiosis in the disease state, and influences that may affect the microbiome. Possible mechanisms of disease and therapeutic implications through microbial manipulation are also reviewed, as are deficiencies and limitations of the current body of research. 

http://manuscript.elsevier.com/S0091674922002913/pdf/S0091674922002913.pdf

Unravelling the role of the microbiome in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease phenotypically classified by the absence (CRSsNP) or presence of nasal polyps (CRSwNP). The latter may also be associated with asthma and hypersensitivity towards non-steroidal anti-inflammatory drugs (NSAID) as a triad termed NSAID-exacerbated respiratory disease (N-ERD). The role of the microbiome in these different disease entities with regard to the underlying inflammatory process and disease burden is yet not fully understood. To address this question, we measured clinical parameters and collected nasal samples (nasal mucosal fluids, microbiome swabs from middle meatus and anterior naris) of patients suffering from CRSsNP (n=20), CRSwNP (n=20) or N-ERD (n=20) as well as from patients without CRS (=disease controls, n=20). Importantly, all subjects refrained from taking local or systemic corticosteroids or immunosuppressants for at least two weeks prior to sampling. The nasal microbiome was analyzed using 16S rRNA gene amplicon sequencing, and levels of 33 inflammatory cytokines were determined in nasal mucosal fluids using the MSD platform. Patients suffering from N-ERD and CRSwNP showed significantly worse smell perception and significantly higher levels of type 2 associated cytokines IL-5, IL-9, Eotaxin and CCL17. Across all 4 patient groups, Corynebacteria and Staphylococci showed the highest relative abundances. Although no significant difference in alpha and beta diversity was observed between the control and the CRS groups, pairwise testing revealed a higher relative abundance of Staphylococci in the middle meatus in N-ERD patients as compared to CRSwNP (p<0.001), CRSsNP (p<0.01) and disease controls (p<0.05) and of Lawsonella in patients suffering from CRSwNP in middle meatus and anterior naris in comparison to CRSsNP (p<0.0001 for both locations) and disease controls (p<0.01 and p<0.0001). Furthermore, we observed a positive correlation of Staphylococci with IL-5 (Pearson r=0.548) and a negative correlation for Corynebacteria and Eotaxin-3 (r=-0.540). Thus, in patients refraining from oral and nasal corticosteroid therapy for at least two weeks known to alter microbiome composition, we did not observe differences in microbiome alpha or beta diversity between various CRS entities and disease controls. However, our data suggest a close association between increased bacterial colonization with Staphylococci and decreased colonization by Corynebacteria as well as increased type 2 inflammation.

The nasal microbiome in patients suffering from non-steroidal anti-inflammatory drugs-exacerbated respiratory disease in absence of corticosteroids

The year 2021 was a dynamic year. During this year, the International Forum of Allergy and Rhinology (IFAR) published a diverse set of high-quality articles generated by dedicated researchers, otolaryngologists, rhinologists, and allergists who were navigating the second year of the coronavirus disease 2019 (COVID-19) pandemic. At its core, IFAR prioritizes top manuscripts across the gamut of rhinologic and allergic arenas, and aims to champion the highest quality and level of evidence in the understanding of rhinologic-related diseases. Although this past year’s issues included timely and highly cited publications that encompassed international consensus statements and reports related to the ongoing pandemic, the content of IFAR remains diverse in breadth. The Research Note and Clinical Letter article formats were recently introduced, enabling succinct and rapid communication of important findings. In 2021, authors continued to provide valuable contributions regarding unique subsets of rhinologic and allergicassociated diseases, ranging from clinical and molecular disease characterization to novel treatment strategies for challenging pathology such as aspirin-exacerbated respiratory disease (AERD) and cystic fibrosis. This year also included multiple unique investigations relating to anterior skull-base pathology, and neoplasms of the sinonasal cavity and orbit. Furthermore, 2021′s publications exemplify the expanding interest in chemosensory function, centered mainly on olfaction, and a continued robust reporting on quality-of-life (QoL) outcomes in the diverse group of patients that we treat. Additionally, important work highlighted gender disparities in our field’s authorship and room for improvement in this arena.1 Although this report is by no means a comprehensive substitute for the novel individual reports, we have highlighted a subset of the journal’s content from 2021.

Alain Domissy

Papers

Dysbiosis in aspirin‐exacerbated respiratory disease