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The effect of endoscopic sinus surgery on the bacterial microbiome in chronic rhinosinusitis.
Ravi Jain1, Michael Hoggard2, Kristi Biswas1, Melissa Zoing1, Yannan Jiang3, Richard Douglas1.
1. Department of Surgery, The University of Auckland, Auckland, New Zealand
2. School of Biological Sciences, The University of Auckland, Auckland, New Zealand
3. Department of Statistics, The University of Auckland, Auckland, New Zealand
Abstract:
Introduction: Endoscopic sinus surgery (ESS) improves symptoms for many chronic rhinosinusitis (CRS) patients by enlarging the size of sinus ostia, improving mucociliary clearance and facilitating access for topical therapies. However, the effect of surgery on the sinonasal microbiota remains poorly understood. This study examined changes in bacterial communities in CRS patients before and after surgery.
Methods:
Swab samples were taken from the middle meatus of 23 patients undergoing endoscopic sinus surgery. Follow up swabs were taken in clinic (mean 120 days post surgery). Symptom scores and antibiotic use were recorded. Bacterial communities were characterized using 16s rRNA gene-targeted amplicon sequencing and bacterial abundance was measured using quantitative PCR. Co-existing asthma, aspirin sensitivity, antibiotic use and presence of polyps were noted.
Results:
Unpredictable shifts in bacterial community composition were seen postoperatively. ESS was associated with increased bacterial richness. Many taxa had changes in average relative abundance and prevalence. Staphylococcus was the only dominant taxa to increase significantly in abundance (P=0.002). Changes in bacterial communities were driven more by inter-subject variability (P=0.007) than other study factors. Finegoldia was associated with a reduction in abundance following ESS, increases in patients with higher symptoms scores and reductions in patients with reduced total bacterial burden.
Conclusions:
This study has documented changes in bacterial composition and abundance in the middle meatus following ESS. The complexity of these changes reflects the variability between patients. Modern molecular techniques highlight the currently limited knowledge of the impact of therapies on the microbiology of CRS.
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