As we keep fighting a losing battle with bacteria and antibiotics, it becomes clear that it is not about killing bacteria, not even diminishing the bacterial load, but rather about shifting the different types of bacteria that colonise and live in our sinuses. This study adds to the growing corpus of knowledge that points to the importance of microbiome diversity in the development of disease and health rather that the absolute number and type of bacteria. The authors used the format of a true prospective study and collected swabs from the middle meatus of 23 patients undergoing sinus surgery, both before and a mean of four-months post-surgery. Quantitative real-time PCR was used for microbiome analysis. Surgery resulted (as is by now well known) in an increase of the different subtypes of bacteria present and in colonisation. Patients analysed in this study were on average dominated in both prevalence and relative abundance by Staphylococcus, Streptococcus, and Corynebacterium.
The relative abundance of Staphylococcus increased following surgery, while Streptococcus and Corynebacterium both reduced postoperatively.
However, overall, bacterial richness was found to increase postoperatively. This study does not aim (nor does it succeed!) to prove the futility of endoscopic sinus surgery for CRS – rather, it shows, in a very elegant way that all is not what it seems. In the same way that chronic rhinosinusitis is not a simple infective condition, the very real benefits of ESS are not related to reduction in a bacterial load.
