Efficacy of Topical Manuka Honey for Chronic Rhinosinusitis After Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis

Background and Objectives: The aim of this study was to perform a systematic review and meta-analysis evaluating the efficacy of topical manuka honey in the postoperative management of chronic rhinosinusitis following endoscopic sinus surgery.Methods: A systematic search was conducted using PubMed, Embase, OVID, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials. Data were extracted from the randomized trials identified for meta-analysis. Outcome measures—including visual analogue scales, quality of life assessed by the Sinonasal Outcome Test-22, the Philpott-Javer endoscopic score or Lund-Kennedy endoscopic score, post-treatment culture negativity, and adverse effects—were compared between the manuka honey treatment and control groups. Heterogeneity was assessed within subgroups.Results: Four studies including 134 patients were incorporated into the meta-analysis. All subgroup analyses exhibited low heterogeneity. Visual analogue scale scores showed no significant differences, indicating that manuka honey did not cause definite discomfort (standardized mean difference [SMD], -0.46; 95% confidence interval [CI], -1.02 to 0.10). Similarly, improvement in the Sinonasal Outcome Test-22 score was not statistically significant (SMD, -0.03; 95% CI, -0.58 to 0.52). Although the Philpott-Javer score was slightly better in the manuka honey group, the difference was not statistically significant (SMD, 0.13; 95% CI, -0.26 to 0.52), and changes in the Lund-Kennedy endoscopic score from baseline were comparable (SMD, 0.59; 95% CI, -0.03 to 1.21). Culture negativity following manuka honey treatment was marginally improved compared to saline, yet without statistical significance (risk ratio, 0.43; 95% CI, 0.16 to 1.15). No serious adverse effects were reported in any study.Conclusion: Although topical manuka honey appears to have no serious adverse effects, its efficacy should be reconsidered given the lack of statistically significant improvement in sinus mucosal status and post-treatment culture negativity. Further well-designed trials are warranted to clarify its potential benefits.