Evaluation of Manuka honey in the management of allergic fungal rhinosinusitis.

C hronic rhinosinusitis (CRS) is one of the most expensive chronic disorders experienced by the North American population. It is estimated to affect nearly 15% of the US population. Its prevalence is reported to be increasing, thereby attributing to the rise in today’s health care costs. Allergic fungal rhinosinusitis (AFRS), a subtype of CRS, accounts for approximately 7% of all CRS patients requiring surgery. Many AFRS patients who have undergone functional endoscopic sinus surgery (FESS) continue to develop sinus disease and depend on long-term medical management with either steroids or antifungals, or both, for relief. Unfortunately, the side effects of these medications ultimately lead to their discontinuation and poor control of the disease. We present two patients (Table 1) diagnosed with AFRS based on Bent and Kuhn’s criteria. Both patients underwent FESS and close follow-up with maximal medical management. Both patients were treated with manuka honey irrigation for a 12-week period after failing maximal medical management. Each patient used the manuka honey preparation as provided in the Manuka honey sinus rinse bottles (Honeydoc Products Inc, Montreal, QC) and irrigated each nasal cavity twice a day (120 cc per side twice a day). Both patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22) before and after the 12-week treatment course. Patients had pretreatment and follow-up appointments at 6 and 12 weeks for endoscopic examination of their sinuses. Case Reports