title: Manuka honey sinus irrigation for the treatment of chronic rhinosinusitis: a randomized controlled trial.
abstract: Manuka honey (MH) has been shown in vitro to be effective against biofilm-producing bacteria. This study assessed the effectiveness of MH for patients with active chronic rhinosinusitis (CRS) and prior sinus surgery.
  
  
  
  This prospective single-blinded (clinician only) randomized controlled trial recruited patients with active CRS and prior sinus surgery. Patients received either MH or saline (SAL) sinus irrigations twice daily for 30 days and were offered oral antibiotics and/or oral/topical steroids as indicated. Outcomes were 22-item Sino-Nasal Outcome Test (SNOT-22) change score (primary), culture negativity, and Lund-Kennedy endoscopic change score.
  
  
  
  Forty-two patients were analyzed (MH, n = 20; SAL, n = 22). The SNOT-22 change score achieved a clinically significant improvement in both groups but was similar between MH (median [interquartile range]: -12 [-20, -1]) and SAL (-12.5 [-22, -6]) (p = 0.57). Culture negativity was better on MH (8/19, 42%) compared to SAL (4/21, 19%), nearing statistical significance (p = 0.11). Lund-Kennedy endoscopic change score improved in both groups but was not statistically better on MH (-3 [-5, 0]) compared to SAL (-1 [-2, 0]) (p = 0.20). For patients not receiving oral antibiotics/steroids, culture negativity was statistically better on MH (5/10, 50%) compared to SAL (0/6, 0%) (p = 0.04). MH was well-tolerated. No adverse events were reported.
  
  
  
  In patients with active CRS and prior sinus surgery, both MH and SAL improved outcomes, but there was no statistically significant difference between these groups. However, in the subset that did not receive oral antibiotics/steroids, culture negativity was statistically better on MH, suggesting that MH alone may be effective for acute exacerbations of CRS.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Humphreys
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Purcell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
authors.forename: Greg E
authors.initials: GE
authors.lastname: Davis
mesh_terms: D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D002908:Chronic Disease; D005260:Female; D006722:Honey; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000382:microbiology; D012220:Rhinitis / Q000382:microbiology / Q000628:therapy*; D016037:Single-Blind Method; D012852:Sinusitis / Q000382:microbiology / Q000628:therapy*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
keywords: ESS; SNOT-22; biofilm; endoscopic sinus surgery; patient reported outcome measure; quality of life; topical therapy for chronic rhinosinusitis