INCs effect on the Quality of Life and Local Microbiome in Children with CRS

Intranasal corticosteroids (INCs) are the first-line treatment for chronic rhinosinusitis (CRS) in adults and children, despite scarce evidence regarding their efficacy in the pediatric population. Similarly, there needs to be more literature on their effect on the sinonasal microbiome.

The present study assessed the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS. It enrolled children aged 4 to 8 years with CRS and randomized them to receive intranasal mometasone in an atomizer for 12 weeks (1 application/nostril, once daily) and supplemental 3-mL sodium chloride (NaCl), 0.9% solution in a nasal nebulizer once daily for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nasal nebulizer once daily for 12 weeks (control group).

Before and after treatment, the participants underwent the Sinus and Nasal Quality of Life Survey (SN-5), a nasopharynx swab for microbiome analysis by next-generation sequencing methods, and nasal mucosa sampling for the occurrence of innate lymphoid cells (ILCs).

The study observed-

• Study completion by 63 participants among 66 children enrolled. 
• The mean (SD) age of the cohort as 6.1 (1.3) years, with 60.3% being male and 39.7% being female. 
• Significantly greater clinical improvement reflected by a reduction in SN-5 score in the INC group compared with the control group.
• Greater increase in nasopharyngeal microbiome richness and a larger decrease in nasal ILC3 abundance in the INC group compared with the control group. 
• A significant interaction between alterations in microbiome richness and the INC intervention on the prediction of significant clinical improvement.

This study shows that treatment with an INC greatly enhances the quality of life of children with CRS and markedly increases sinonasal biodiversity. Although further investigation on the long-term efficacy and safety of INCs is warranted, these data may support the recommendation of using INCs as a first-line treatment of CRS in children.

Latek M, Łacwik P, Molińska K, et al. Effect of an Intranasal Corticosteroid on Quality of Life and Local Microbiome in Young Children With Chronic Rhinosinusitis: A Randomized Clinical Trial. JAMA Pediatr. Published online February 27, 2023. doi:10.1001/jamapediatrics.2022.6172