Identification of adenoid biofilms with middle ear pathogens in otitis-prone children utilizing SEM and FISH.
OBJECTIVE
Biofilms have been implicated in the development of several chronic infections. We sought to demonstrate middle ear pathogens in adenoid biofilms using scanning electron microscopy (SEM) and fluorescent in situ hybridization (FISH) with confocal laser scanning microscopy (CLSM).


METHODS
Comparative micro-anatomic investigation of adenoid mucosa using SEM and FISH with confocal scanning laser microscopic (CLSM) imaging from patients with recurrent acute otitis media (RAOM).


RESULTS
All otitis-prone children demonstrated biofilm surface area presence greater than 85% by SEM. FISH accompanied by CLSM imaging also demonstrated patchy biofilms All biofilms contained middle ear pathogens and were frequent in polymicrobial distributions: 4 of 6, 4 of 6 and 3 of 6 samples contained Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, respectively.


CONCLUSIONS
Dense adenoid biofilms may act as a reservoir for reinfection of the tubotympanum. Aspiration of planktonic middle ear pathogens existing in resistant adenoid biofilms during a viral upper respiratory tract infection may be an important event in the development of RAOM.
Hoa
Michael
M
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
Tomovic
Senja
S
Nistico
Laura
L
Hall-Stoodley
Luanne
L
Stoodley
Paul
P
Sachdeva
Livjot
L
Berk
Richard
R
Coticchia
James M
JM
D000233:Adenoidectomy; D000234:Adenoids / Q000382:microbiology* / Q000601:surgery / Q000648:ultrastructure; D018441:Biofilms; D002648:Child; D002675:Child, Preschool; D006193:Haemophilus influenzae / Q000502:physiology; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007223:Infant; D008297:Male; D008855:Microscopy, Electron, Scanning; D001936:Moraxella catarrhalis / Q000502:physiology; D010033:Otitis Media / Q000382:microbiology* / Q000473:pathology / Q000517:prevention & control; D055502:Secondary Prevention; D013211:Staphylococcus aureus / Q000502:physiology; D013296:Streptococcus pneumoniae / Q000502:physiology