September 23, 2012

How is Sinusitis Like Diarrhea, Germs and All?

A normal human body is composed of more "bacteria" cells than "human" cells. Indeed, the bacteria collectively living inside a normal healthy person would fill a half-gallon jug; numerically, there are probably 10 times more bacterial cells in the body than human cells.

Though the majority of these bacteria have no known effect on the human body (good or bad), some of these organisms perform tasks that participate in maintaining health and are deemed necessary members of the normal human flora.

When such "good" bacteria is wiped out through medical intervention (most commonly antibiotics), human diseases like clostridium difficile manifested by massive diarrhea occurs. Treatment (gross as it sounds) may include fecal bacteriotherapy which involves transplanting poop from a healthy individual into the patient.

So How is Diarrhea Related to Sinusitis?

Well, it seems when it comes to chronic sinus infections, the same phenomenon may be happening whereby chronic antibiotic usage leads to a situation where all the "good" bacteria has been killed off leading to a situation where "bad" bacteria constantly re-colonizes the sinus cavities causing mayhem.

"Good" bacteria needs to be present to prevent "bad" bacteria from reforming.

It is possible that simply giving more antibiotics may only reinforce the elimination of not only the bad bacteria, but also all the good ones leading to a chronic and repetitive state of sinusitis especially when biofilms develop.

But... is this true???

Apparently... it's possible!

Researchers have determined that there IS a relationship between sinus bacterial composition (microflora) and chronic sinusitis and that it differs from normal healthy sinuses.

The sinus microflora of chronic sinusitis patients exhibited significantly reduced bacterial diversity compared with that of healthy individuals. At least in the sinusitis population investigated, they found relative abundance of a single species, Corynebacterium tuberculostearicum. When mouse sinuses were populated with this bacteria, sinusitis occurred. Having a normal healthy microflora protected AGAINST this bacteria.

In healthy sinuses, Lactobacillus sakei was identified as a potentially protective species and defended against C. tuberculostearicum sinus infections, even when the sinus cavities were wiped of all bacteria.

This study demonstrated that sinus mucosal health may potentially be highly dependent on the sinus microflora and that "good" bacteria presence is necessary in maintaining healthy sinuses.

Now, I'm not advocating that we take poop from healthy people and fill the sinus cavities of chronic sinusitis patients... but it may influence a fundamental change in the way physicians treat patients suffering from sinus infections that just won't go away no matter what treatment has been pursued whether numerous antibiotics, saline flushes, sinus surgery, etc.

In such sinus cripples, perhaps saline flushes containing "healthy" bacteria would be beneficial??? Hopefully, it won't stink like poop, otherwise I think patient compliance may be an issue.

What about a gel containing good bacteria injected into the sinus cavities???

I should mention that taking probiotics would help the gut, but not the sinus cavities as I can't really see how the elements contained within the probiotic pill can get absorbed into the blood and land in the sinus cavities intact.

Pretty cool area of research which I'm looking forward to hopefully seeing more of in the near future!

Humans Carry More Bacterial Cells than Human Ones. Scientific American 10/30/07

Sinus Microbiome Diversity Depletion and Corynebacterium tuberculostearicum Enrichment Mediates Rhinosinusitis. Sci Transl Med. 2012 Sep 12;4(151):151ra124.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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