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It is generally understood that administering substances containing live microbiologically active micro-organisms (probiotics) enhances the treatment of chronic rhinosinusitis. Probiotics manipulate and rebalance the alterations occurring in the local microbiome in chronic rhinosinusitis patients. This results in propagation of healthy commensals, limitation of pathogenic colonisation and possible eradication of biofilms. In this review, 948 records were screened, and four randomised controlled studies were included for meta-analysis. Data was extracted from RCT characteristics, sample design comprising different arms, intervention methods and outcome measures. These were based on (SNOT)-22 and SNOT-20 scores, microbiological profiles and inflammatory product changes. Three parallel RCTs and one crossover RCT were included, altogether comprising 318 chronic rhinosinusitis patients. Bacterial strains belonging to the lactobacillus family was used in three RCT’s and bacterial strain belonging to enterococcus in one. One study showed an early reduction in SNOT-20 and SNOT-22 scores in four weeks, but this was not sustained at eight weeks. However, probiotics showed a potential in improving sleep, psychological and rhinological subscales. In patients treated with probiotics, the symptom relapse rate was lower at all times compared to those who did not receive this as an adjuvant. The main side effects were gastro-intestinal disturbance and epistaxis regardless of the method of delivery used for the probiotics, namely nasal spray and drops, chewable tablet and oral nutraceutical stick. The study has several limitations but encourages further research in the mode of administration, treatment duration and target patient subgroups.

Role of probiotics in chronic rhinosinusitis: a systematic review of randomised controlled trials.
Fong P, Lim K, Gnanam A, Charn T.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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