title: Is biofilm the cause of chronic otitis externa?
abstract: OBJECTIVE
  This study was undertaken in two phases. In the first phase, we considered patients affected by chronic external otitis treated either by chemical ear peeling (CEP) or by antibiotic/steroid treatment to compare the clinical and microbiological outcomes. In the second phase, we compared the microscopic findings observed in the CEP samples of patients affected by chronic otitis externa's acute exacerbation or by acute otitis externa to demonstrate the role of biofilm in the pathogenesis of chronic otitis externa.
  
  
  METHODS
  Prospective, double-blind, controlled study.
  
  
  METHODS
  In phase 1 we compared clinical and microbiological data collected from two groups of 25 patients with chronic otitis externa treated by CEP or by conventional antibiotic/steroid treatment. In phase 2 we compared the results of the optical and electron microscopic analysis of specimens obtained by performing CEP in two groups of patients (25 with chronic otitis externa exacerbation and 15 with acute otitis externa).
  
  
  RESULTS
  In phase 1 the disease control rate yielded markedly better results when treated with CEP. In phase 2 biofilms were identified in 23 of the 25 patients with chronic otitis externa exacerbation (92%) and in only three acute external otitis cases (20%).
  
  
  CONCLUSIONS
  CEP is a simple and effective method for the treatment of chronic external otitis. The removal of the bacterial biofilm has a high correlation with a long-term clinical remission.
authors: Department of Otorhinolaryngology, Audiology and Phoniatrics G. Ferreri ,University Sapienza, Rome, Italy.
authors: Massimo
authors: M
authors: Fusconi
authors: Vincenzo
authors: V
authors: Petrozza
authors: Anna Rita
authors: AR
authors: Taddei
authors: Vittorio
authors: V
authors: Vinciguerra
authors: Armando
authors: A
authors: De Virgilio
authors: Fernanda
authors: F
authors: Chiarini
authors: Mirko
authors: M
authors: Cirenza
authors: Carmen
authors: C
authors: Gallinelli
authors: Michela
authors: M
authors: Conte
authors: Marco
authors: M
authors: de Vincentiis
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects; D002908:Chronic Disease; D016001:Confidence Intervals; D003646:Debridement / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000502:physiology / Q000648:ultrastructure; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000502:physiology / Q000648:ultrastructure; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008854:Microscopy, Electron; D010032:Otitis Externa / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids