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Chronic Sinus Problems: Another Role for Probiotics?


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Almost 40 million Americans suffer from chronic sinusitis. Unfortunately, most conventional treatments are not effective and don’t address the underlying cause. Find out why probiotics may represent the future of treating chronic sinus problems.

probiotics for sinuses
Sinus pressure and pain can be debilitating. b-d-s/iStock/Thinkstock

Chronic sinusitis (also known as chronic rhinosinusitis, or CRS) is one of the most common human diseases, affecting 1 in 7 American adults. And like many other modern, chronic conditions, its prevalence appears to be increasing.

CRS is a debilitating and often intractable disease. Over 20 percent of patients are unresponsive to drug therapy, and up to 40 percent of patients do not respond to surgery.

The conventional viewpoint is that CRS is caused by the presence of certain harmful species of bacteria, such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. (1) In other cases, CRS may result from an immunologic reaction to fungi that colonize the sinuses. (2) Fungal species associated with this syndrome include Bipolaris specifera and Aspergillus, Curvularia, and Fusarium.

However, in a recent paper out of the University of California, San Francisco, Dr. Susan Lynch demonstrated that the primary difference between patients with CRS and control subjects was not the presence of any particular pathogenic species (which both groups had in similar amounts), but the overall diversity of the sinus microbiome. (3)

This discovery has important implications for how we can successfully treat CRS, and I will come back to it later in the article. But first, let’s take a step back and discuss the sinus microbiome—since this may be the first time you’ve heard about it.

The Microbiome: It’s Not Just about the Gut!

If you’ve been following this blog, listening to my podcast, or have read my book, you’ll know that the gut microbiome is one of my favorite topics.

But I’m not alone. Even mainstream media outlets like The New York Times, Time, The Wall Street Journal, and FOX News have done major stories on the gut microbiome and its importance in health and disease. It’s no longer an exotic concept that only scientists and health care professionals discuss; it’s now a household term.

Could probiotics be the answer to chronic sinusitis and nasal congestion?

Yet while it’s true that the majority of microbes that comprise our microbiome live in the gut, it’s also true that we have microbes in other areas of our bodies that play similarly important roles in maintaining health and preventing disease. These areas include the skin, vagina, penis, mouth, respiratory tract, and—you guessed it—the sinus cavity.

Prior to the development of DNA/PCR technology, our ability to determine the composition of microorganisms in these various areas was extremely limited. But thanks to recent advances in technology, we now have a much better idea of what “normal” and “abnormal” microbiomes look like—not only in the gut, but also on the skin and the penis and in the mouth, respiratory tract, and sinuses.

This understanding has profound implications for how we view the pathogenesis of diseases like CRS, and in turn, what treatment options might be available to patients in the future.

It’s the Forest That’s Important, Not the Trees

As I was reading Dr. Lynch’s seminal paper, I came across the following quote, which summarizes the importance of these recent discoveries and how they will change our approach to treating conditions that are microbial in their origin:

Because of extensive use of conventional laboratory culture approaches to detect microbial species, we have been conditioned to view chronic or acute infections as exclusively due to a single pathogenic species. However, recent studies have demonstrated that the composition of the resident microbiota in a given niche can strongly influence the behavior of specific species, particularly pathogens, and, as such, represents an important contributory factor to disease etiology.

The idea here is that it isn’t the presence of a particular pathogen that matters most, but rather the environment in which the pathogen is present. If you extend this idea to thinking about treatment approaches, it follows that focusing on eradicating a particular pathogen or species may be misguided, and that a better approach is restoring microbial diversity.

This has already become evident with the gut microbiome. Clostridium difficile is a virulent infection that still kills almost 30,000 people in the U.S. each year. We’ve thrown every antibiotic we have at it, but they are often ineffective in the most severe cases.

Yet fecal microbiota transplants—which are essentially massive infusions of human probiotics—are over 90 percent effective, even in cases where patients have failed multiple courses of antibiotics. (4)

If we apply this same reasoning to the treatment of CRS, it suggests that probiotics—rather than antibiotics—may be a better solution. Antibiotics may kill harmful species of bacteria, but they are likely to further reduce microbial diversity, which would be expected to worsen CRS over time if Dr. Lynch’s theory is correct.

With this in mind, let’s see what the research has to say about probiotics and sinus problems.

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Probiotics for Chronic Sinus Problems

As it turns out, there are several published studies suggesting that probiotics may be an effective treatment for chronic sinus problems.

One review in the Journal of Allergy found that “an emerging number of publications demonstrate beneficial effects using probiotics in clinical double-blind placebo-controlled trials in allergic rhinitis (AR).” (5) Although data on probiotics and non-allergic CRS are lacking, there are several lines of evidence to suggest that probiotics may be effective in these cases.

First, probiotics have been shown to disrupt biofilms, which are present in CRS and difficult to eradicate through other means. (6)

Second, both human and animal studies have shown that oral probiotics reduce colonization of the nose and upper respiratory tract by pathogenic bacteria (e.g., Staphylococcus aureus, Streptococcus pneumoniae, and β-hemolytic streptococci). (7, 8)

Third, upper respiratory tract infections often precede the development of CRS, and probiotics have been shown to be effective in preventing them. (9)

Finally, although this is certainly not peer-reviewed evidence, I can tell you anecdotally from my work with patients that many CRS sufferers do seem to improve with strategies aimed at restoring the microbiome—such as eating more fermentable fiber and fermented foods, and/or taking prebiotics and probiotics.

Future Directions: Nasal Probiotic Sprays for Repopulating the Sinus Microbiome?

So far we’ve been talking about the role of oral probiotics in treating CRS. But if a disruption of the sinus microbiome is the true underlying cause of CRS, wouldn’t it make more sense to address that more directly?

Dr. Lynch found that most patients with CRS are lacking in a particular species of bacteria called Lactobacillus sakei. This bacteria is a natural, protective species in our nose, but (as the name implies) it is also used to make certain fermented beverages and foods like sake and kimchi.

One might suspect that Dr. Lynch and her peers are developing a nasal spray that contains Lactobacillus sakei to be used in the treatment of CRS. Of course such a treatment will have to be developed and tested for safety and effectiveness in human clinical trials.

Given that this may take several years, some folks have decided to take matters into their own hands, er, noses.

A blog called Lacto Bacto, which is written by CRS sufferer Mara Silgailis, describes a DIY approach that appears to have helped many people with CRS. It involves putting small amounts of kimchi juice directly into the nostrils. According to Mara, she has essentially cured herself and her family of their long-term CRS, and they have been antibiotic-free for more than two years.

Along the same lines, I’ve heard anecdotal reports from patients and people online who have created DIY nasal probiotic sprays and even crushed up probiotic tablets and sniffed them, achieving somewhat miraculous results.

Of course I can’t recommend or endorse these procedures, because they haven’t been tested for safety or efficacy. It would seem that the risk is relatively low, but it’s at least possible that some of the other microbes in kimchi or other oral probiotics may not be beneficial for the sinus microbiome. We’re really just starting to scratch the surface in this area of research, and there’s still a lot that we don’t understand. So if you decide to perform these experiments at home, proceed at your own risk!

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Join the conversation

  1. Interesting concepts that you and the others, here, have mentioned. Thank you for sharing! For many years I have had chronic sinusitis, nightly accumulation of nasal congestion, as well as an all-day, every day chronic cough / mucous problem. I have tried a lot of things, including inhalers, prednisone, antibiotics, many herbal combinations meant for lung health, probiotics, raw onion, various vitamins / herbs, digestive enzymes, neti-pot, air purifiers / ionizers, getting rid of old carpeting in my house, and improving what I eat. Although, I must admit I have yet to make it through an elimination diet process. I have tried XClear, and not only did it not give me any relief, but it burns my nasal passages. I stopped using it. I also tried making my own fermented veges, and it didn’t help me, either. I have not gotten much benefit from anything but eating raw onion, eg on salad — hard to eat it straight, and the digestive enzymes, but they only mildly relieve some of it. I’ve tried Braggs apple cider vinegar, but I didn’t notice any relief, and I couldn’t stick with it. So I might just try breaking open a probiotics cap and adding it to my nasal wash bottle, or the P2 that someone mentioned. Thanks for the input, everyone !

    • Have you ever heard of ‘fire cider’? Rosemary Gladstone, well known herbalist has videos online on how to make it, and we’ve found it helpful for both sinus issues and just as an all around tonic during the winter months. It sounds disgusting, made with ginger, onions, garlic, horseradish, and various other herbs as you wish, but it actually is palatable once you get used to it. (mixed w/ honey before use).
      If you don’t wish to try making this, even just grated horseradish held in the side of your cheek for a few minutes can promote sinus drainage and at least help with the discomfort temporarily.

    • I’m wondering the same thing. Instead of sniffing up the powder contents of a pro-biotic capsule, why not mix the pro-biotic powder with water, salt and baking soda for use with a neti pot or nasal rinse squeeze bottle? Has anyone tried this?

  2. I had chronic sinusitis since I was a small child. I never went to doctors for this as I thought it was just “normal”. The headaches were rare but i had continuing–all day–all night– post-nasal drip. Once I switched to raw goat milk and raw goat milk kefir, the problem disappeared. I was shocked since the reason I started raw dairy was for digestive issues. These cleared up too.

  3. I began to suffer from Sinus congestion when I turned 50 and found a wonderful nasal spray made from grapefruit seed extract. It is absolutely amazing and worked wonders for me and my children. I use it as soon as I feel a sinus headache or any congestion. Here is a link if you want to check it out http://www.amazon.com/Nutribiotic-Nasal-Spray-Fluid-Ounce/dp/B00012NGHG
    One thing to be aware with Grapefruit of course is its interaction with other medicines http://www.drugs.com/article/grapefruit-drug-interactions.html So please be aware of that if you are on other medications. Hope this helps!

  4. Kimchi juice up the nose sounds… painful. Very painful. Question though, is it normal to always have one nostril plugged? I can breathe fine and have no other difficulties.

    • I was like this through adolescence and early adulthood until I elected to have a turbinate reduction surgery. The right side of my sinuses was so constricted (and my sinuses in general are small to begin with) that stuff would just get trapped up there even though nothing else was wrong. If the air was dry or I was even slightly dehydrated, I could only breathe out of the left side, and my colds lasted far, far longer than anyone else I know. Just an idea…it’s a little costly but if you have the ability it might be worth it, as it was for me to reduce number and severity of colds 🙂

    • No, it’s not normal to always have one nostril plugged. I thought it was for most of my life and 3 days after starting paleo I could breathe freely through both nostrils. That was a great feeling.

    • No, that is not normal. Have you had your nose scoped to see if there is a physical reason for the blockage of one side of your nose. There are times I am fully impacted on one side of my head/nose, and feel I can breathe fine too but know I have a sinus infection.

  5. The *only* time I’ve **not** had to use otc nasal spray (Afrin, etc) is when I was in ketosis for a few months. Menopause and (?) have made it nigh unto impossible to get back into much less sustain.

    Totally agree with this article’s direction.

    • Hi Monica,

      Sounds like you’re pretty miserable with your sinus symptoms!

      Afrin nasal spray should not be used for more than two-three days and then, only occasionally. One of the problems is that it creates what is known as rebound congestion which basically means the sinus passages will be remain congested as a result of chronic use of the Afrin, and you will feel like you need to use the spray all the time in order to breath. Not a good situation.

      I love this article because I have felt that probiotics are essential to break any cycle of recurring infection and recurring sinus infections are something I see all the time in my practice.

      I also think it is important to be on a highly nutritious, anti-inflammatory diet. If anything, stop all dairy for awhile to see if that helps.

      I have also seen that the xylitol spray, Xlear, seems to be helpful and is safe – definitely a better option than Afrin!

      Good luck,

      • Many thanks Dawn. In total agreement. One complication besides menopause is simultaneously being treated for chronic lyme-silver, samento, banderol-all of which purportedly destroy gut flora.
        I’m looking upon this as a temporary situation-definitely will work on getting my gut right. Stool test showed cryptosporidium which entailed anti-parasitic supps. Trying to get to the root of the issues vs the symptoms. This will take time-appreciate you taking the time to offer counsel. 🙂
        Many thanks 🙂

    • Most OTC nasal sprays have a terrible rebound effect – the more you use them, the more stuffed up you get. Takes days of being unable to breathe at all to get over the rebound congestion. For some, like me, only one day of use can trigger this. You might want to see your doctor to get off of them. You may find that you no longer have a problem. And if it disappears in ketosis, maybe it involves an overgrowth of fungal organisms. That’s been my experience.

      • You’re right Amy. Not happy with our family’s current situation. I’ve got 2-3 kids who use the Afrin too. 🙁 Just ordered 3 bottles of Xclear and hopefully we can get off it. I did use Oregaspray which is quite effective-need to keep on it and watch the intake of sugars. Thanks for your concern. In Total Agreement.

  6. Chris, I wonder how effective xylitol nasal spray would be as it’s also a biofilm distrupter. I imagine it would be easy to obtain and possibly provide some relief along with oral probiotics?

      • Chris-
        Please look into oregano oil for your readers. It has CHANGED my life!!! I was told by my allergist because I was a woman, because I developed allergies later in life, – that I would never grow out of it. That I would just have to deal with always having at least 2 severe sinus infections a year. Maybe the balloon inflation surgery might help.
        I was at my wits end. And constantly being prescribed antibiotics for my sinus infections – and never feeling well because of the antibiotic gut imbalance. Oregano oil has changed my life. I have been allergy free for 4 years now. And I only take oregano oil when I feel a bit phemy or have that feel a bit of allergy signs coming on. Which is almost never.

      • But doesn’t xylitol kill both good and bad bacteria? And also increase oxalate production?

      • xlcear just created more inflammation, Its way more ideal to get the right anti-iflammation speices of mircobes in the sinus, L-rhamonous, casei, etc

    • But you have to then get the right critters in once the film is cleared out. Perhaps, do Xlear for a period of time and then try this kimchi approach. Plus, as with everything, a healthy probiotic rich diet containing some or all of fermented foods like sauerkraut, kimchi, kefir, and kombucha should be a daily routine. When junk foods (refined sugars in particular) are not consumed, along with adding in fermented foods and plenty of fibers, it’s probable beneficial bacteria and yeasts automatically start to repopulate the gut and other areas as well.

  7. For almost four years now I’m struggling with this problem. I even tried the Neti-pot, but it only gave me a splitting headache extra. The AIP diet helped a lot, but not all the way. Yesterday I went to see the specialist for the result of a scan and he had two options: a combination of something like prednison and anti biotics. If that wouldn’t do the trick he suggested operation. prefer the probiotics approach. 🙂

    • Hi Margot,

      The options you were given are pretty standard in conventional medicine and pretty risky. I too would prefer to give probiotics a try.

      Follow a nutritious, anti-inflammatory diet and consider complete elimination of dairy for awhile and see how it goes.

      Best wishes.


  8. Hi Chris,

    Articles like these give me hope! Now I find it somewhat difficult to believe that a single strain of lactobacillus would really be the end all be all. I’m going to experiment with some home made kefir, even if it doesn’t contain L. sakei

    Best, Palva

  9. My wife suffered from sinus infections for years, overtime she went in the ocean it would re-occur. As the owner of windsurfing business this was problematic. Anyway, since she solved the problem, we have been rec. others to use Apple Cider Vinegar – spoonful orally each day – very strong taste and I have not idea why this seams to work. Brags is the brand I think. Hope it helps… and would like to know why is seams to work.

    • Apple cider vinegar is made from a symbiotic culture of bacteria and yeast similar in process to brewing Kombucha Tea. The below article on how to brew Kombucha makes it easy to understand how apple cider vinegar is made. I am not trying to promote Kombucha. Just found this article which by chance answered the same question I’d also had for a long time about how is apple cider vinegar made.
      “What Is Kombucha Tea?
      Kombucha starts out as a sugary tea, which is then fermented with the help of a scoby. “SCOBY” is actually an acronym for “symbiotic culture of bacteria and yeast.” It’s very close cousins to the mother used to make vinegar. Sounds like a plausible reason why it’s helping your chronic sinus problems. 🙂 Here’s the article: http://www.thekitchn.com/how-to-make-kombucha-tea-at-home-cooking-lessons-from-the-kitchn-173858
      Probiotics whether capsules, apple cider vinegar, kombucha seem to be one positive solution to a complex situation towards wellness.

    • It’s slightly antifungal and also constricts the blood vessels. But too much can increase histamine levels.

  10. I have not been formally diagnosed with CRS but i have the symptoms since several years and they are not recurring but are constant. CT and MRIs have indicated nasal polyps and inflammations, but my ENTs haven’t yet given any solution.

    I had not ever got this thought of what Chris is pointing at. It seems very interesting and i don’t see any harm in it.

    In India, recently i see advertising of Nasal drops which are made as per age old Ayurved science. The drops mainly contain ‘cow ghee’ (ghee is clarified butter, but should be made only by principles well laid since thousands of years, otherwise it doesn’t give medicinal effects)
    This drops are fortified with medicinal herbs and they directly address the site of discomfort, i.e. Nasal passage, sinuses, brain.. There is one Dr. Santosh Jalukar who claims to have fantastic results from this ancient remedy.
    Cow ghee from various breeds in US or Europe is not recommended bcoz of hybridization and use of hormones. Only Indian organic fed breed’s product have the claimed medical values, specially the ‘GIR’ cows whose milk is proven to have similar composition as human breast milk.

    There are various things available in world other than the chemical pharma products, time has come to explore the ancient wisdom.

  11. I couldn’t find the references to which you referred in your article. Could you please send them to me?

    • Throughout the article you’ll see numbers at the end of sentences that link to references. They look like this: (3).

  12. I have been suffering for almost 5 years now with swelling in my nose and sinus. I’ve had to mouth breath so many times for so long and it’s caused secondary emotional stress. is there ANYbody out there that can direct me to someone who can run any tests that could help nail down the problem?? my nose is extremely sensitive …and on good days I only have one open nostril. I live in fear of colds and flu because of how complicated things get when this happens. Please direct me to help…thank you!

    • I have extremely stuffed sinuses all winter…which sounds a lot like what you are going through. I need help also as I do not want surgery. I do take probiotics, but it doesn’t seem to help the sinus. I believe mine come from extremely dry air and I can’t get enough moisture in the air in the winter, even with 3 humidifiers. Help! 🙂

    • Hi Emily,

      You may want to see a functional medicine practitioner who can help you get to the root of why you’ve been having so many problems with your sinuses.

      Our sinuses are very sensitive tissues and will let us know if we are dealing with excess inflammation.

      Meanwhile, I think this article is right on and that taking a good probiotic may be very helpful. I would also recommend a nutritious, anti-inflammatory diet, and eliminating dairy for a month or two and see how you feel.

      Good luck,

    • Emily, I’m so sorry you are having this problem. I’m taking an on-line class right now that I think will help you. Chris K knows the team leader, Christa O. Everyone is having great results. If you go to the info site: http://www.gutthrivein5.com you will read a huge amount of information. As of last night’s webinar. They are opening a new class THIS year in October, instead of waiting until until Spring 2016. You do not have to do lab tests bc Dr. jack Tips’ developmental research. Dr. Tom O’Bryan is on the team, also. The class and the supplements cost about $1000, and I did buy about $100 extra items from Amazon and mountainroseherbs.com. I’ve been sick for 20 years and it has helped me greatly. You get lifetime access with updates, lifetime access to the staff to ask questions with a 72 hour turn around. Lifetime access to the Private Forums who are/have been I the program. This 10 week class has been the most thorough, methodical, comprehensive approach out there. You can also see Christa O. On her website at http://www.thewholejourney.com. Lots of good info there too. Blessings. Janice

    • Emily,
      Google: functional health practitioner + where you live. They can run tests to check all of you & find out what’s stuffing you up. Best of luck.
      PS I had very similar symptoms to yours since I was a teen, so about 25+yrs. I got complete relief by simply dropping grains from my diet (which I had done for digestive issues). Took about 1 week.

  13. I appreciate the anecdotal information about kimchi. You never know what may help someone else. Is there a commercially available spray that contains whatever kimchi is made from?

    • I used sinus rinses for about 2 years in an effort to clear up my nasal drip and sinus headaches, with mixed results. It supposedly adds moisture back into the irritated nasal passages, and the salt helps heal inflammation. I’ve now been trying to reduce dairy as it contributes to thicker mucus. I’ve never heard of “sniffing” probiotics, but the XLear brand sinus spray with xylatol does help clear up immediate clogs in my passages. I’m trying to stay clear of cortosteroid histamine blockers unless my asthma gets too bad!

    • I have had good luck with the Xlear neti solution packets. Not cheap though – I’m thinking $0.50 per packet. Maybe the standard salts have some anti-microbial action. I’m not sure if that is good or bad. I’m inclined to use a neti-pot for a few weeks, and then, give it a rest. Perhaps, in principle, consider the steps used for clearing SIBO.


  14. Hi,

    I used to suffer from sinus infections at least twice a year, usually with changes in the weather. I live in the humid South, in Alabama. They were terrible to go through. Headaches, constant mucous, etc. I could not sleep or sit directly in front of a fan without getting one of these infections. They were always bacterial, according to the doctor, not viral, but antibiotics never really helped. I was still fighting the infections, usually for 2-3 weeks.

    About two years ago, I started making my own sauerkraut, simply because I love it, and thought it would be good for me. It soon became apparent that I was no longer getting these sinus infections like I used to. I eat sauerkraut, Bulgarian yogurt, or kim-chi almost ever day, and usually at least a half a cup or more.

    I read about how gut health could affect other problems in the body, and I’ve wondered for a while if the fermented/pro-biotic foods I was eating had anything to do with it. I now believe that they do. I have been sleeping with a fan blowing on me at night this summer, and although there have been a couple of times where it felt like I had an infection coming on, it never manifested itself and the familiar feelings dissipated by the next day.

    I realize this is just anecdotal evidence, but this seems to support in theory what Chris is saying here.

    • Joseph,

      It’s so good to hear of your success!

      I agree with this article and think probiotics can be very helpful. Great to hear it’s worked for you.

      Take care,


  15. As a lifetime allergy sufferer with sinus and upper-respiratory infection patterns, I was thrilled to be rid of a sinus infection in less than 24 hours on a recent international trip. I attribute the rapid healing to assistance from sniffed Bio-Kult probiotic powder removed from the gel-cap it came in. All symptoms(splitting headache, nasal congestion, sore-throat, fatigue) were eliminated with two applications; they were 4 hours apart and each consisted of half the contents of one gel-cap split between both nostrils. Thank you for continuing to share your knowledge and understanding, Chris. Much LOVE

  16. We use an aerosol spray product from P2 Probiotics called I Help You Breathe. I don’t know what strains of bacteria they use, but it has significantly helped the respiratory symptoms in one family member with multiple allergies.

    • Erin – I am thinking about ordering this spray product you mentioned and wondered if your family member uses it sprayed directly in his/her nose/mouth. I can’t find a lot of reviews about the product, and am not sure if it is worth the price, etc. Do you think it has made a significant difference? Have you sprayed it in your nose during a cold to see if it helps as well? Thanks for any info!

      • It is a very fine mist, so we just spray it in the air and inhale. The affected family member was getting symptoms at night (itchy/runny/stuffy nose, itchy/watery eyes, lots of sneezing). I suspect she may be allergic to dust mites so perhaps the spray breaks down the allergen. She notices a big difference when she goes without the spray. I have not been sick since starting to use it so I can’t say if it’s effective during a cold or not.

        P2 has periodic sales, so check their Facebook page or sign up for their emails to save some money.