Biofilms in chronic rhinosinusitis: a review.
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.
Cohen
Michael
M
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. cohenn@uphs.upenn.edu
Kofonow
Jennifer
J
Nayak
Jayakar V
JV
Palmer
James N
JN
Chiu
Alexander G
AG
Leid
Jeff G
JG
Cohen
Noam A
NA
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*