Sinus microbiota varies among chronic rhinosinusitis phenotypes and predicts surgical outcome

J Allergy Clin Immunol. 2015 Aug;136(2):334-42.e1. doi: 10.1016/j.jaci.2015.02.008. Epub 2015 Mar 26.


Background: Chronic rhinosinusitis (CRS) is a prevalent multifactorial disease process in which bacteria are believed to play a role in the propagation of inflammation. Multiple subtypes of CRS have been described based on clinical and pathologic features, but a detailed examination of the sinus microbiota in patients with CRS and its clinical subtypes has yet to be performed.

Objective: We sought to examine the resident microbiota of CRS subtypes and determine whether bacterial diversity is a predictor of disease outcomes.

Methods: Sinus swabs from patients with CRS and healthy subjects collected during endoscopic sinus surgery were analyzed by means of molecular phylogenetic analysis of 16S rDNA pyrosequences.

Results: Fifty-six patients with CRS and 26 control subjects were studied. Biodiversity was similar between the CRS and control groups. Among the CRS subtypes examined, only 2 conditions (presence of purulence and comorbid condition of asthma) were associated with significant alterations in microbial community composition. In 27 patients with CRS who were followed postoperatively, those with better outcomes had more diverse bacterial communities present at the time of surgery, along with higher relative abundances of Actinobacteria.

Conclusion: Analysis of microbiota in a large cohort reveals that particular CRS phenotypes (asthma and purulence) are characterized by distinct compositions of resident bacterial communities. We found that bacterial diversity and composition are predictors of surgical outcome, promoting the concept of community ecology in patients with CRS.

Keywords: 16S rDNA; 16S rRNA; Sinusitis; bacteria; chronic rhinosinusitis; microbiome; pyrosequencing; sinus surgery outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / complications
  • Asthma / drug therapy
  • Asthma / microbiology
  • Asthma / surgery*
  • Bacteria / classification*
  • Bacteria / drug effects
  • Bacteria / genetics
  • Biodiversity
  • Case-Control Studies
  • Chronic Disease
  • Cross-Sectional Studies
  • Female
  • Genes, rRNA*
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Male
  • Microbiota / drug effects
  • Microbiota / genetics
  • Middle Aged
  • Paranasal Sinuses / drug effects
  • Paranasal Sinuses / immunology
  • Paranasal Sinuses / microbiology
  • Paranasal Sinuses / surgery*
  • Phenotype
  • RNA, Ribosomal, 16S / genetics
  • Rhinitis / complications
  • Rhinitis / drug therapy
  • Rhinitis / microbiology
  • Rhinitis / surgery*
  • Sinusitis / complications
  • Sinusitis / drug therapy
  • Sinusitis / microbiology
  • Sinusitis / surgery*
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • RNA, Ribosomal, 16S