title: Identification of adenoid biofilms with middle ear pathogens in otitis-prone children utilizing SEM and FISH.
abstract: 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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoa
authors.forename: Senja
authors.initials: S
authors.lastname: Tomovic
authors.forename: Laura
authors.initials: L
authors.lastname: Nistico
authors.forename: Luanne
authors.initials: L
authors.lastname: Hall-Stoodley
authors.forename: Paul
authors.initials: P
authors.lastname: Stoodley
authors.forename: Livjot
authors.initials: L
authors.lastname: Sachdeva
authors.forename: Richard
authors.initials: R
authors.lastname: Berk
authors.forename: James M
authors.initials: JM
authors.lastname: Coticchia
mesh_terms: 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