title: Biofilms in chronic rhinosinusitis: what is new and where next?
abstract: BACKGROUND
  Chronic rhinosinusitis is a common, heterogeneous condition. An effective means of mitigating disease in chronic rhinosinusitis patients remains elusive. A variety of causes have been implicated, with the biofilm theory gaining increasing prominence.
  
  
  OBJECTIVE
  This article reviews the literature on the role of biofilms in chronic rhinosinusitis, in terms of pathophysiology and with regard to avenues for future treatment.
  
  
  METHODS
  A systematic review of case series was performed using databases with independently developed search strategies, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, and Zetoc, in addition to conference proceedings and a manual search of literature, with the last search conducted on 18 January 2014. The search terms included the following, used in various combinations to maximise the yield of articles identified: 'biofilms', 'chronic rhinosinusitis', 'DNase', 'extracellular DNA' and 'biofilm dispersal'.
  
  
  RESULTS
  The existing evidence lends further support for the role of biofilms (particularly the Staphylococcus aureus phenotype) in more severe, recalcitrant disease and poorer surgical outcomes.
  
  
  CONCLUSIONS
  Multimodality treatment, with a shift in paradigm to incorporate anti-biofilm strategies, is likely to form the mainstay of future recalcitrant chronic rhinosinusitis management.
authors.affiliation: Department of Otolaryngology,Freeman Hospital,Newcastle upon Tyne,UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Ramakrishnan
authors.affiliation: School of Dental Sciences,Newcastle University,UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Shields
authors.affiliation: Department of Otolaryngology,Freeman Hospital,Newcastle upon Tyne,UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Elbadawey
authors.affiliation: Department of Otolaryngology,Freeman Hospital,Newcastle upon Tyne,UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Wilson
mesh_terms: D018441:Biofilms; D002908:Chronic Disease; D003131:Combined Modality Therapy; D006801:Humans; D012220:Rhinitis / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D012852:Sinusitis / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D013203:Staphylococcal Infections / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D013211:Staphylococcus aureus / Q000502:physiology
keywords: Biofilm; Deoxyribonucleases; Sinusitis