Manuka honey sinus irrigation for the treatment of chronic rhinosinusitis: a randomized controlled trial

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: ESS; SNOT-22; biofilm; endoscopic sinus surgery; patient reported outcome measure; quality of life; topical therapy for chronic rhinosinusitis.

Conflict of interest statement

Potential conflict of interest: None provided.

© 2016 ARS-AAOA, LLC.

Figures

FIGURE 1.

Participant flow. MH = manuka honey; SAL = saline.

FIGURE 2.

Box plot comparison of SNOT-22 score change from baseline (p = 0.57). Dotted line indicates change of −9, considered a clinically significant improvement. Missing outcome data related to difficulty with clinic logistics and inability to collect data: post-SNOT-22 score in MH group (n = 1). MH = manuka honey; SAL = saline; SNOT-22 = 22-item Sino-Nasal Outcome Test.

FIGURE 3.

Bar plot comparison of posttreatment culture negativity (p = 0.11). Proportion of negative posttreatment cultures is provided for each treatment group above the respective bar. Missing outcome data related to difficulty with clinic logistics and inability to collect data: pretreatment culture in MH group (n = 1), posttreatment culture in SAL group (n = 1). MH = manuka honey, SAL = saline.

FIGURE 4.

Box plot comparison of Lund-Kennedy endoscopic score change from baseline (p = 0.20). Dotted line indicates change of 0, below which is considered an improvement. MH = manuka honey, SAL = saline.