Nasal rinsing with probiotics in rhinosinusitis – analysis of symptoms and safety assessment

<b>Introduction:</b> In the pathophysiology of chronic upper respiratory tract inflammation, an important role is attributed to the disturbances of the patient's microbiome in terms of diversity and functioning, to the decreased abundance of commensal bacteria and the increase of pathogenic bacteria. In recent years, there has been growing scientific interest in the role of probiotics - administered both locally and orally - in the management of various diseases, particularly inflammatory conditions such as chronic rhinosinusitis. <br><br><b>Aim:</b> To assess the use of nasal rinsing with probiotics in patients with rhinitis and rhinosinusitis (primary and secondary). <br><br><b>Material and methods:</b> A total of 51 patients (31 women and 20 men) were included in the study, including 24 patients with granulomatosis with polyangiitis during immunosuppressive therapy (12 women and 12 men) and 27 patients (19 women and 8 men) with rhinitis (chronic rhinosinusitis with polyps, chronic rhinosinusitis without nasal polyps, atrophic rhinitis with nasal septum perforation, and allergic rhinitis). Exclusion criteria were: cystic fibrosis, primary ciliary dyskinesia, pregnancy, severe lung, heart, kidney disease, use of oral probiotics, use of intranasal probiotics in the last 6 months, sinus surgery in the last 6 months, lack of consent to participate in the study, antibiotic therapy in the last 2 months. Patients were scheduled to undergo nasal rinsing with a probiotic solution, with the following parameters assessed before and after the procedure: SNOT-22 scores and the severity of nasal lesions according to the Lund-Kennedy scale. In the group of patients with rhinitis, the ENS-6 questionnaire was also conducted and symptoms assessed on the VAS scale (visual analogue scale): nasal discharge, nasal obstruction, facial pain, impaired sense of smell, nasal irritation, nasal itching, and severity of crusting. <br><br><b>Results:</b> The study showed that nasal rinsing with a probiotic solution is well tolerated and does not cause any adverse effects. In both groups, a reduction in symptoms was observed based on the SNOT-22 questionnaire (p = 0.002 in GPA, ns - in rhinitis/ rhinosinusitis). According to the Lund-Kennedy scale, the reduction in the intensity of changes in both groups was statistically significant. In addition, patients with primary rhinitis or rhinosinusitis also experienced a reduction in nasal mucosa irritation and crusting intranasal (p<0.05). <br><br><b>Conclusions:</b> Probiotic nasal rinsing appears to have a beneficial effect on the condition of the nasal mucosa in patients with both primary and secondary (GPA-related) rhinosinusitis and is generally well tolerated.