title: Biofilm surface area in the pediatric nasopharynx: Chronic rhinosinusitis vs obstructive sleep apnea.
abstract: OBJECTIVE
  To compare the percentage of mucosal surface area of adenoids infected with biofilms removed from children with chronic rhinosinusitis (CRS) vs children with obstructive sleep apnea (OSA).
  
  
  METHODS
  Comparative microanatomical investigation of adenoid mucosa from patients with CRS and OSA using scanning electron microscopy.
  
  
  METHODS
  University-affiliated hospitals and ambulatory surgery center.
  
  
  METHODS
  Four girls and 12 boys ranging in age from 3 months to 10 years.
  
  
  METHODS
  Measurements of biofilm coverage of the entire adenoidal surface.
  
  
  RESULTS
  Adenoids removed from patients with CRS had dense mature biofilms covering the mucosal surface; they had a mean of 94.9% of their mucosal surface covered with mature biofilms, compared with a mean of 1.9% coverage on the adenoids removed from patients with OSA. This difference was statistically significant at P < .001.
  
  
  CONCLUSIONS
  Adenoids removed from patients with CRS had almost their entire mucosal surface covered with biofilms vs scant coverage for patients with OSA. Biofilms in the nasopharynx of children with CRS may act as a chronic reservoir for bacterial pathogens resistant to standard antibiotics. The mechanical debridement of the nasopharyngeal biofilms may explain the observed clinical benefit associated with adenoidectomy in this subset of pediatric patients.
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology, Wayne State University, Children's Hospital of Michigan, Detroit 48201, USA. jcoticch@med.wayne.edu
authors.forename: James
authors.initials: J
authors.lastname: Coticchia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zuliani
authors.forename: Crystal
authors.initials: C
authors.lastname: Coleman
authors.forename: Michael
authors.initials: M
authors.lastname: Carron
authors.forename: Jose
authors.initials: J
authors.lastname: Gurrola
authors.forename: Michael
authors.initials: M
authors.lastname: Haupert
authors.forename: Richard
authors.initials: R
authors.lastname: Berk
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000382:microbiology* / Q000648:ultrastructure; D018441:Biofilms; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008855:Microscopy, Electron, Scanning; D009305:Nasopharynx / Q000382:microbiology*; D012220:Rhinitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D012852:Sinusitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000382:microbiology*