Treating Chronic Rhinosinusitis - SNOT transplant studies (Short version)

Dr. Amin Javer, MD, FRCSC, FARS, Otolaryngologist Treating Chronic Rhinosinusitis - SNOT transplant studies (Short version)

Duration: 2 minutes and 40 seconds

This is a trial that has two parts to it. The first part has just been completed and published. It is called the Sino-nasal Microbial Transplant trial or SNMT; otherwise also known as a SNOT transplant study. Most people usually laugh at that - but that's exactly what we're doing. The group of patients that are the most difficult to treat in the sinus world are patients that get chronic sinusitis that never goes away despite maximal medical and surgical management. These are patients that have had surgery and failed on maximum medical therapy. Essentially, nothing we can do works to fix their sinus problems. The reason, in our opinion, is that the chronic inflammation in their sinuses is secondary to a microbiome that has gone awry. This is what we call a “dysbiotic” microbiome. The microbiome contain the microbes that live in our bodies and on our bodies, ie within our living space – and keep things healthy for us. They amount to more than 10X the cells that make up our bodies. When this microbiome becomes dysbiotic – or loses it’s health, the body becomes unhealthy, and thereby activates inflammatory cascades resulting in inflammation.

The big question we've had so far is, what comes first: is it inflammation that damages the microbiome or does a damaged microbiome cause inflammation – a typical chicken or the egg question? We have not yet determined the answer to this question.

We noted evidence of biofilm within the sick sinuses and felt that if we could correct the microbiome, we may subsequently improve and possibly clear the inflammation. This has been done previously in fecal microbial transplants which have become very popular and have saved many lives, and continues to gain popularity worldwide. In fecal microbial transplant, what they do is take healthy fecal material and put it in the bowel that is sick. What they found is that the bowel re-gained a healthy microbiome and the patient got better. We felt that the altered or sick microbiome in the sinuses may be able to be corrected via a similar idea, ie. place healthy sino-nasal microbiome in a sick sinus and see what happens.

Presenter: Dr. Amin Javer, Otolaryngologist, Vancouver, BC

Local Practitioners: Otolaryngologist