The Sinonasal Microbiome and Its Role in the Pathogenesis and Progression of Chronic Rhinosinusitis

Abstract

Chronic rhinosinusitis is a multifactorial inflammatory disease of the nasal cavity and paranasal sinuses that significantly impacts patients' quality of life and represents an important public health concern. In recent years, advances in molecular sequencing techniques have improved the understanding of the sinonasal microbiome and its potential role in the pathophysiology of the disease. This study aimed to analyze the available scientific evidence regarding the influence of the sinonasal microbiome on the development, progression, and management of chronic rhinosinusitis. A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in national and international scientific databases, identifying 47 potentially relevant studies. After applying the eligibility criteria, 11 studies were included in the final analysis. The findings demonstrated that patients with chronic rhinosinusitis frequently exhibit reduced bacterial diversity, alterations in microbiota composition, and imbalance between potentially protective microorganisms and species associated with persistent inflammation. Associations were also observed between specific microbial profiles and clinical outcomes, including disease recurrence and treatment response. Recent evidence additionally suggests the involvement of the gut–sinus axis as a complementary mechanism in the pathophysiology of chronic rhinosinusitis. It is concluded that sinonasal microbiome dysbiosis plays an important role in maintaining chronic inflammation and may represent a promising target for future diagnostic and therapeutic strategies. However, methodological heterogeneity among studies highlights the need for further research to better understand host–microbiome interactions.