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When and how should we treat biofilms in chronic sinusitis?

Jain, Ravi; Douglas, Richard

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2014 - Volume 22 - Issue 1 - p 16–21
doi: 10.1097/MOO.0000000000000010
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa

Purpose of review Biofilms have been observed on the sinus mucosa of patients with chronic rhinosinusitis and are associated with poor clinical outcomes after surgery. This article summarizes the recent studies which describe the efficacy of treating biofilms in chronic rhinosinusitis.

Recent findings Biofilms are polymicrobial communities comprised of bacteria that tend to be more antibiotic-resistant than when in planktonic forms. Antibiotic therapy against biofilms is usually associated with relapse following cessation of treatment and may also have an adverse effect on normal commensal microflora. Surfactants can improve clinical symptoms, but their use has been limited by side effects. Other treatment modalities that physically remove or disrupt biofilms, such as ultrasound, have shown some efficacy in small trials. The impact of surgery on biofilms has not been extensively investigated.

Summary The nature of biofilms makes their removal difficult. No currently available treatment directed against them has demonstrated lasting efficacy.

Department of Surgery, The University of Auckland, Auckland, New Zealand

Correspondence to Richard Douglas, MD, Department of Surgery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Tel: +64 9 923 9820; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins