title: Bacterial biofilms may contribute to persistent cochlear implant infection.
abstract: OBJECTIVE
  To determine if bacterial biofilms are present on the surface of extruding or persistently infected cochlear implants.
  
  
  METHODS
  Scanning electron microscopy was performed on cochlear implants removed from two patients because of recalcitrant infection, two implants removed secondary to device failure, and two devices that had never been implanted. Preparations were examined by experienced microbiologists for the presence of bacterial biofilms.
  
  
  RESULTS
  Microorganisms and amorphous extracellular debris were found on the surface of the infected cochlear implants and the implants removed because of device failure. Biofilm formation was deemed definite in one infected device and possible in the other explanted devices. The never-implanted controls demonstrated microbial contamination without exopolymeric matrix, inconsistent with biofilms.
  
  
  CONCLUSIONS
  Bacterial biofilm formation may play a role in recalcitrant cochlear implant infections. This may have profound implications for the treatment of cochlear implant infections.
authors.affiliation: Department of Otolaryngology, University of Florida, Gainesville, Florida 32610, USA. antonpj@ent.ufl.edu
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Antonelli
authors.forename: James C
authors.initials: JC
authors.lastname: Lee
authors.forename: Robert A
authors.initials: RA
authors.lastname: Burne
mesh_terms: D000293:Adolescent; D018441:Biofilms / Q000254:growth & development*; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants / Q000009:adverse effects / Q000382:microbiology*; D003638:Deafness / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000502:physiology* / Q000648:ultrastructure