title: Biofilm density in the pediatric nasopharynx: recurrent acute otitis media versus obstructive sleep apnea.
abstract: OBJECTIVE
  We compared the biofilm surface density of adenoids removed from children with recurrent acute otitis media (RAOM) to that of adenoids removed from children with a diagnosis of obstructive sleep apnea (OSA).
  
  
  METHODS
  We performed a comparative microanatomic study of adenoid mucosa using scanning electron microscopy in patients with diagnoses of RAOM and OSA (27 female and 41 male; age range, 3 months to 15 years).
  
  
  RESULTS
  The adenoids removed from patients with RAOM had dense, mature biofilms covering nearly their entire mucosal surfaces. More specifically, the adenoids removed from patients with RAOM had an average of 93.53% of their mucosal surface covered, versus an average of 1.01% coverage on the adenoids removed from patients with OSA. These differences were statistically significant (p < 0.0001).
  
  
  CONCLUSIONS
  The adenoids removed from patients with RAOM had almost their entire mucosal surface covered with biofilms, versus scant coverage for patients with OSA. Recurrent acute otitis media is notoriously resistant to antibiotic treatment, and aspirates of middle ear fluid repeatedly yield negative cultures. It is these properties that have led biofilms to become increasingly implicated in the pathogenesis of RAOM. Thus, the resistance of biofilms to antimicrobials, together with their planktonic shedding of organisms, may be an important mechanism in the development of RAOM.
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zuliani
authors.forename: Michael
authors.initials: M
authors.lastname: Carlisle
authors.forename: Aaron
authors.initials: A
authors.lastname: Duberstein
authors.forename: Michael
authors.initials: M
authors.lastname: Haupert
authors.forename: Mausumi
authors.initials: M
authors.lastname: Syamal
authors.forename: Richard
authors.initials: R
authors.lastname: Berk
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: James
authors.initials: J
authors.lastname: Coticchia
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000382:microbiology* / Q000648:ultrastructure; D000293:Adolescent; D018441:Biofilms / Q000254:growth & development*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008855:Microscopy, Electron, Scanning; D010033:Otitis Media / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D020545:Respiratory Mucosa / Q000382:microbiology / Q000648:ultrastructure; D020181:Sleep Apnea, Obstructive / Q000382:microbiology* / Q000473:pathology / Q000601:surgery