title: A new horizon in the treatment of biofilm-associated tonsillitis.
abstract: To demonstrate the efficacy of tonsil brushing in patients with chronic tonsillitis to remove the microbial biofilm on the tonsil surface using an in vitro model.
  
  
  
  Specimens from patients undergoing tonsillectomy were evaluated prior to and following surface cleaning methods, including rinsing and brushing, using scanning electron microscopy (SEM).
  
  
  
  The study population consisted of 25 randomly selected patients with chronic tonsillitis.
  
  
  
  Specimens were collected and divided into four portions. Each portion received distinct surface cleaning methods and was immediately fixed for SEM examination.
  
  
  
  The biofilm layer on the surface of the tonsils was examined using SEM. The density of the biofilm layer and the degree of persistence of the biofilm after rinsing and brushing were measured.
  
  
  
  The surface biofilm of the tonsils in the first group, which were neither brushed nor rinsed, revealed a thick layer of biofilm on the mucosal surface. The second group of tonsils, which were only rinsed, also showed a thick layer of biofilm. The third group of tonsils, which were rinsed following gentle brushing using a soft toothbrush, showed a reduction in the thickness of the biofilm layer. The fourth group of tonsils, which were brushed with a hard brush, was almost devoid of a biofilm layer.
  
  
  
  Our results demonstrate that rinsing does not effectively remove the biofilm layer on the tonsil surface. The use of a harder brush was identified as a more powerful means of removing biofilm compared with a soft brush.
authors.affiliation: Namik Kemal University School of Medicine, Department of Otorhinolaryngology, Namik Kemal Mah. 59100 Tekirdag/Turkey zciftci@nku.edu.tr.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Ciftci
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Taksim Training and Research Hospital, Istanbul, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Develioglu
authors.affiliation: Department of Histology and Embryology, Acibadem University School Of Medicine, Istanbul, Turkey.
authors.forename: Serap
authors.initials: S
authors.lastname: Arbak
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Near East University, Girne, Cyprus.
authors.forename: Tunis
authors.initials: T
authors.lastname: Ozdoganoglu
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Namik Kemal University, Medical Faculty, Tekirdag, Turkey.
authors.forename: Erdogan
authors.initials: E
authors.lastname: Gultekin
keywords: biofilm; brushing; chronic tonsillitis; scanning electron microscopy; treatment