title: Biofilms in chronic rhinosinusitis: a review.
abstract: BACKGROUND
  Bacterial biofilms consist of a complex, organized community of bacteria that anchor to both biotic and abiotic surfaces. They are composed of layers of embedded, live bacteria within extruded exopolymeric matrix. This configuration allows for evasion of host defenses and decreased susceptibility to antibiotic therapy while maintaining the ability to deliberately release planktonic bacteria, resulting in recurrent acute infections. Thus, bacterial biofilms were hypothesized to contribute to the progression and persistence of chronic rhinosinusitis.
  
  
  METHODS
  This review summarizes several of the seminal papers supporting this hypothesis.
  
  
  RESULTS
  Multiple reports using various imaging modalities have demonstrated the presence of biofilms in sinonasal mucosa of patients with chronic rhinosinusitis. More recently, several studies have correlated the presence of biofilms with poor clinical outcomes in the disease process. Early therapeutic interventions have generated mixed results.
  
  
  CONCLUSIONS
  Bacterial biofilms appear to contribute to the progression of chronic rhinosinusitis in a subset of patients, although substantial effort toward therapeutic intervention is still necessary.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. cohenn@uphs.upenn.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kofonow
authors.forename: Jayakar V
authors.initials: JV
authors.lastname: Nayak
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
authors.forename: Jeff G
authors.initials: JG
authors.lastname: Leid
authors.forename: Noam A
authors.initials: NA
authors.lastname: Cohen
mesh_terms: D000818:Animals; D001419:Bacteria / Q000302:isolation & purification*; D018441:Biofilms; D002908:Chronic Disease; D006801:Humans; D012220:Rhinitis / Q000188:drug therapy / Q000382:microbiology*; D012852:Sinusitis / Q000188:drug therapy / Q000382:microbiology*