In their own unpublished research, Dr. Pinto and his collaborators have produced data suggesting that sinusitis patients with polyps, those without polyps and healthy controls all differ in their microbiome patterns. “We’re also seeing that other forms of upper airway disease may have environmental differences in their microbiome depending on what exposures people have, particularly what they breathe in,” he said.
Explore This IssueDecember 2012
As independent labs seek to verify and expand on the newest findings, Dr. Kern expects more pathogens to join Corynebacterium as potential instigators in patient subgroups. In fact, he suspects the observed decrease in potentially protective bacteria among CRS patients could prove more relevant, both therapeutically and etiologically. “It may be that the Corynebacterium is really a bystander, and it’s really the loss of the other bugs, the protective organisms, that are more important,” he said. “That’s more likely to me, intuitively.”
Multiple clinicians are already experimenting with therapies intended to return patients’ microbiomes to more protective states. In one early but promising study cited by Dr. Pinto, doctors administered probiotics to ward off necrotizing colitis in the guts of neonates; in another, clinicians gave probiotics to intubated patients with ventilator-associated pneumonia to prevent lower airway pathogens. And, of course, there’s the anecdotal success of the self-administered earwax transplant for chronic otitis.
“There are no current applications of that in the nose,” Dr. Pinto said, “but this study provides a nice justification for trying to develop such therapies, to either prevent or cure chronic sinusitis, which is pretty exciting.”