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Updated: Jun 20, 2026

Oral Biofilm Sampling for Microbiome Analysis in Healthy Children
Published on: December 31, 2017
Biofilm density in the pediatric nasopharynx: recurrent acute otitis media versus obstructive sleep apnea
Giancarlo Zuliani1, Michael Carlisle, Aaron Duberstein
1Division of Pediatric Otolaryngology, Department of Otolaryngology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Insights
Children with recurrent acute otitis media (RAOM) have significantly more biofilm on their adenoids than those with obstructive sleep apnea (OSA). Biofilms may play a key role in RAOM development and antibiotic resistance.
Area of Science:
- Microbiology
- Otolaryngology
- Pediatrics
Background:
- Biofilms are microbial communities resistant to antibiotics.
- Recurrent acute otitis media (RAOM) is often antibiotic-resistant.
- The role of biofilms in RAOM pathogenesis is under investigation.
Purpose of the Study:
- To compare biofilm surface density on adenoids from children with RAOM versus obstructive sleep apnea (OSA).
Main Methods:
- Scanning electron microscopy was used for comparative microanatomic study.
- Adenoid tissues from 68 children (RAOM and OSA groups) were analyzed.
- Patient age ranged from 3 months to 15 years.
Main Results:
- Adenoids from RAOM patients showed extensive biofilm coverage (average 93.53%).
- Adenoids from OSA patients had minimal biofilm coverage (average 1.01%).
- The difference in biofilm coverage was statistically significant (p < 0.0001).
Conclusions:
- Adenoids in RAOM patients are heavily colonized by biofilms.
- Biofilms may contribute to antibiotic resistance and pathogenesis in RAOM.
- Scant biofilm coverage was observed in OSA patients.
Objectives:
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.
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