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.
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?
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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I have had sinusitis throughout my 56 years, even as a child. I am able to manage it via Claritin. I stay on Claritin almost daily, but do try and wean myself from it periodically but usually come running back when I feel symptoms returning. I hate taking maintenance medicine and would love to be Claritin Free. Does this meet the CRS criterial?
Cheryl, I took Claritin-D and then Allegra-D for maybe 15 years before a cardiologist told me to lay off the Sudafed since it was likely the cause of my occasional heart palpitations. (Family doctor prescribed allergy meds plus decongestants without ever testing me for allergies…). I stayed on plain allergy medicine for another 10 years and finally underwent allergy testing and then immunotherapy, which has helped a lot. They have been helped further by fixing up my diet (which is what Chris’s books and blog and dietary programs are all about). I’ve begun getting acupuncture and herbal treatments as well, which help open my sinuses and heal my gut.
So, there are many many things you can try to get off the allergy medicine! Try eliminating foods like Chris or other paleo nutritionists recommend, and immunotherapy too.
thanks for the article
Not sure what to do but did hear sinus problems and sinus polyps are due to fungal issues. Son has constant blocked nostril and realized there are polyps growing in there. Of course the Doctor type cure was drugs, i.e. Prednisone, which does get rid of them but they come back. Since then read that fungus/yeast issue could be the cause. If he takes probiotics which type should be used and should a person follow a ‘candida’ diet to eliminate yeast. Sure hope there is some type of procedure because his condition is pretty bad and constant all year round (and of course, naturopaths are too expensive for him to go to. Sure hope there’s help out there.
Check out this biotech company finally dealing with the microbiome. Seres Therapeutics. Kind of exciting mainstream is finally catching up.
Check out SYN, they are developing a product that will prevent C. Diff in the first place
What about adding ACV to warm water along with/instead of salt, baking soda for nasal irrigation?
After years of five kids suffering CRS, I decided to try Sarah Pope’s method a try. At bedtime, after teeth are brushed and the last drink of water has been drunk, take one bio-kult capsule and empty it on the tongue. Swish around the mouth for one minute and swallow, then to bed. The kids wake up with clearer heads in the morning and it takes between 4-6 days to completely alleviate the symptoms.
Had bronchitis over the winter. Did not take antibiotics, but used natural remedies. A month later, developed a sinus infection. I’d never had one before. (pain in upper molars which turned out to not be teeth related, pain when leaning over, sinus headache, etc). I took antibiotics for 10 days. I rarely take them, but decided to when sinus rinsing and other remedies didn’t work.
The sinus symptoms went away with the antibiotics, then returned a month later. Doing salt water rinses, which used to feel great, started causing more pain.
Realizing I can’t live on antibiotics, I tried grating fresh garlic and sniffing the fumes at least 4 times a day, crushing or grating each time to release fumes (especially in early morning and before bed). It worked immediately and I’ve been doing it ever since. It’s also done wonders for my elderly mom who was suffering from vasomotor rhinitis, which was driving her crazy.
I was concerned the garlic fumes would be irritating, but for my mom and I, they were not.
I realize this is not getting way down to the root cause, but it totally keeps the symptoms at bay without resorting to drugs.
Maybe this could help someone else.
Thanks for your post; My story is very similar to yours. I have been eating raw garlic, but, after reading your post, I just put a pea sized chunk in my nostril, which goes to the infected (pseudomonas) & occluded sinus. Among other things my naturopath has me taking a good probiotic 2X/day–I think it helps, along with a LOT of other things she’s got me doing!
I am trying to clear this without resorting to the Cipro that is waiting for me at the pharmacy 🙂
I’ve had three sinus surgeries and the last one seemed to do the trick, at least for awhile. Eventually, and for the past 2 years, I’ve had a constant runny nose, post-nasal drip, etc. The most curious thing that happens, however, is whenever I eliminate (#2 – and I mean EVERY time) my nose runs and sometimes I even feel nauseous. Usually I sneeze. This article brings a little inkling of light to what it could possibly be but my doctor simply shrugs her shoulders. Huh. A good friend who is totally homeopathic suggested it might be the vagus nerve. Ever the mysteries … thanks for the article.
Amy,
When you started eating Paelo did you give up dairy? My son had chronic sinititus for years . A care giver suggested trying giving up dairy for a month. When he did his sinisus cleared for the first time in 4 years. Unfortunately he decided he’d rather be stuffed up than give up dairy. So for the last 15 years he has been stuffed up, always. He’ll stay away from dairy to clear up when he has a gig coming up where he needs to sing, then go right back to dairy, mostly cheese, after.
Debra … Just wonder if your son might benefit from switching to A2 dairy? This has made a huge difference to me as I too didn’t want to stop dairy altogether … But A2 milk and cream and switched to goats cheese and coconut yogurt don’t seem to give me the same sinus problems
Deb R,
Excuse my ignorance, but I’ve never heard of A2milk and cream, what is it?
Does goats milk cheese taste as bad as goats milk?
Hi,
I’m sorry for witting this comment here but I keep on reading how bad Goat milk is and just the other day I got myself some Goat milk from Walmart and it actually taste very similar to regular milk. It was very expensive. Now, I have not tasted goat cheese or know what a2 milk is. ;-(
All my family suffer from sinus infection. We are positive for Staphylococcus aureus in our eyes, noses and mouth. We tried antibiotics, xclear, probiotics, grapefruit seed extract and some of that was helpful but nothing really solved the problem. The best result was after xclear but when we stopped everything started again. It seems like all of that can control infection but does not solve it. Now I am going to try honey.
My husband has tested positive for Staphylococcus. He only has the pimples on his face and scalp. We haven’t tried the xclear, how did you like it?
Hi
We had success with a probiotic called saccharomyces boulardii. It turned out that my child born by Caesar section suffered lowered immunity, sleep aponea and terrible upper respiratory tract infections, one after the other, was also insulin sensitive due to tremendous stress in the womb, caused by my elevated cortisol levels, during pregnancy, which affected his growth hormones and have him insulin sensitivity. It seems both can be treated by this probiotic, so after giving him a broad spectrum children’s probiotic, with great success with regard to curing his recurring ear infections and improving his general immunity. His sleep aponea remained. So I tried the afore mentioned probiotic and his upper respiratory infections went, as did his sleep aponea and sinus problems. He is now a happy little boy and sleeps through the night. It has taken us from hell to heaven, in one very easy step. I hope this helps you.
Kindest regards
After three decades of near-constant sinus infections, paleo eating cured me. No idea why. And my sinuses are my early warning signal, if I get too liberal with the diet, I get excess mucus in my sinuses.
After sinus infections my whole life along with IBS problems, going gluten free solved all the issues. I do have to stay away from certain FODMAPs (sorbitol, stone fruits, onions, etc.) but a small price to pay for feeling well for the last 2 years! Plus, lost 15-20 lbs of extra weight I could never get rid of. I do eat sauerkraut once in awhile and various probiotics but not daily. None of these things helped: sinus surgery, 3-4 doses a year of antibiotics, horrid prescription sprays for asthma which I didn’t have. Got so bad I ended up with pneumonia.
Hi Beth, I know you wrote a while ago, but I am just seeing this. I had the same experience going gluten free. I had very severe sinus problems some which improved when a spur was removed, but the infections continued. It seemed that my sinuses woudl not heal well. And now, within a couple of weeks of going gluten-free, my sinuses healed themselves without any medications, neti-pot or otherwise. I am still eating grains, just not gluten-containing ones. If this improvement is because of celiac disease I wonder if the extracellular matrix of the nasal passages could have been leaky due to autoantibodies against the transglutaminase. This might make it easier for bugs to take hold. Anyway, I don’t know what the mechanisms is, but it is making all the difference for me!
Paleo works wonders for many people because all grains are very high in sugar and therefore inflammatory. Get off the treat foods, avoid added sugar to natural food (nothing packaged or processed) and consume healthy fats, primarily olive oil, first cold press, extra virgin and consider coconut oil. Best wishes.
I used to get regualer sinus infections and would snort garlic powder to get rid of them so I would think kimchi wouldn’t be any worse and would help more. Though I haven’t had a sinus infection since I started consuming more fermented foods and drinks. I believe in fermented foods and have some simple recipes for making your own in my book found on my website. I regularly make and eat kimchi, kombucha, and beet kvass all for pennies on the dollar compared to store bought options.
Colloidal Silver nose spray is helping me alot but I will try nasal probiotics too. Thanks all!
My husband suffered from chronic sinus infections for years. His turned out to be caused by an allergy to his contact lens solution. Once he went to glasses he stopped getting them. Maybe this might help someone. I also read recently that we have a biome on our eyes and that contact lenses damage that. It contributes to chronic dry eye which I have – haven’t been able to wear contact lenses for 10 years. I’d be happy to put probiotics in my eye if that would help but I imagine they are different strains than the ones in your gut.
I’ve never had a sinus infection but have been stuffed up for my entire life. One allergist remarked that it was amazing I could even breathe through my nose.
I’ve been on a grain-free, sugar-free, dairy-free diet for over a decade. I’ve also been taking probiotics for longer than that. Furthermore, I’ve been seeing a Naturopath for the past 5 years. There has been no improvement in my stuffiness from anything I’ve tried other than OTC decongestants such as Sudafed.
I guess I’ll have to try snorting probiotic powder, even though I find the idea of snorting anything revolting.
I suffered much most of my life from sinus. Nothing helped except humidity. Air conditioners added to my misery. Then a in the last couple of years the pain is all gone. I am 76 and retired 3 years ago after 50+ years driving trucks. I suppose the cab air conditioners exasperated the problem, but that doesn’t explain why I had the problem for many years before we had A/C
I use a probiotic called Flora-Sinus from Nutri-Health supplements it helps me throughout the entire year. I also use eucalyptus oil (5-10 drops) in a small metal bowl full of hot water. Put a small towel over your head to keep the steam in and breathe deeply over the eucalypuis and hot water for about 15 minute once or twice a day.
hope this is a help to someone.
Thank you for sharing the product name. I ordered some and am looking forward to seeing if they help!
I have had sinus issues for many years, I started taking an oral probiotic about 4 months ago and all of my sinus issues as well as other gut issues are gone.
What’s the name if the probiotic you take?
I have the same sinus problem from time to time and
I read it somewhere that sesame oil is very helpful. Twice or three times a day apply into the nose. I use this method and it helps a lot! The other helpful method is hot steam with sea salt and water. 10- 20 minutes under a towel and it clears up the sinus infection in a few days! Garlic and onion are very good to eat and honey. So far these are my remedies! You can try them and see which one helps! Apple sider vinegar is a good idea! I will try that, as well!
Hi,
I was diagnosed with chronic sinusitis 2 years ago. Never really had any symptoms until 2 years ago. I also was diagnosed with HBP, High Cholesterol and reflux/gasritis. The day after I started to take medication for all 4 of these conditions including antibiotics and nasal spray my belly got really hard and it remained like that until I started to read and look for answers on the internet because Docs after doing MRI’s, Endoscopy and Colonoscopy did not have an answer. My GI said it was IBS so she also game me medication for this. Well, sinus still the same and Belly still the same so I started to take probiotics because I read antibiotics kills the good ones and I needed to replace it with probiotics Yes, 75% of the pain and the pressure on my abdomen, belly area was gone. Yes, it helped right away. Now, as for my chronic sinusitis problem it did continue but much better than before. What actually did the final trick for me besides the probiotic which I take every single day was a product called Simple Saline which is cheap and very easy to use. Now, I still use the nasal spray and sometimes the medication for the congestion just in case but not on a daily basis. I actually think I don’t need it . As for my HBP, IBS, High Cholesterol and reflux/gastritis I started to eat better and now I don’t have HBP, IBS or High Cholesterol and have been medication free for these 3 conditions for 6 months or more. btw, they also said I had nerve damage on hands and feet and put me on medication for 4 months, 1 year ago I stopped taking them because I had a reaction to one of them and have not used any medication for this and is like I never had nerve damage. Yes, a Neuro Doc did all the test and said I had these nerve damages conditions. Now I have no burning on my arms and legs and no numbness on hands and feet as well. So if you ask me, for sure probiotics will help and in many ways so giving it a try won’t hurt. Sure, I have not tried to use it on the nose and for now I will stay with the regular pill until further study is done. But yes, buy and get some is for sure a miracle pill. 😉 Sorry if I violated any terms by adding the name of a product. Please remove if I did. 😉