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

  • 2025-11-27
  • Journal of rhinology : official journal of the Korean Rhinologic Society 32(3)
    • Yun Jin Kang
    • Min Ju Kang
    • Sung Won Kim
    • Soo Hwan Kim
    • Yong Jin Park

Study Design

Type
Review
Sample size
n = 134
Population
four studies including 134 patients
Methods
systematic review and meta-analysis; systematic search using PubMed, Embase, OVID, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials; data extracted from randomized trials

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.

Research Insights

  • Manuka Honey→Improved Lund-Kennedy Score

    Changes in the Lund-Kennedy endoscopic score from baseline were comparable (SMD, 0.59; 95% CI, -0.03 to 1.21).

    Effect
    Neutral
    Effect size
    Small
  • Manuka Honey→Improved Sinonasal Outcome Test Score

    Improvement in the Sinonasal Outcome Test-22 score was not statistically significant (SMD, -0.03; 95% CI, -0.58 to 0.52).

    Effect
    Neutral
    Effect size
    Small
  • Manuka Honey→Improved Sinus Score

    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)

    Effect
    Neutral
    Effect size
    Small
  • Manuka Honey→Reduced Infection Rate

    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).

    Effect
    Neutral
    Effect size
    Small
  • Manuka Honey→Reduced Pain Severity

    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).

    Effect
    Neutral
    Effect size
    Small

Adverse Events Reported

  • Manuka Honey→discomfort

    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).

    Finding
    No significant difference
    Magnitude
    SMD -0.46 (95% CI -1.02 to 0.10)
    Significant
    No
  • Manuka Honey→Overall tolerability

    No serious adverse effects were reported in any study.

    Finding
    Reported
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