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Biofilm and persistent inflammation in endoscopic sinus surgery
Christian J Hochstim1, Rizwan Masood, Dale H Rice
1Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Summary
Bacterial biofilms in chronic rhinosinusitis patients are linked to ongoing inflammation after surgery. The extent of the biofilm did not impact inflammation levels post-endoscopic sinus surgery (ESS).
Area of Science:
- Otolaryngology
- Microbiology
- Pathology
Background:
- Bacterial biofilms are implicated in chronic rhinosinusitis (CRS).
- Their precise role and clinical significance in CRS outcomes require further investigation.
- Understanding biofilm presence is crucial for managing refractory CRS cases.
Purpose of the Study:
- To investigate the association between bacterial biofilms and clinical outcomes in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery (ESS).
- To determine if biofilm presence correlates with persistent mucosal inflammation post-ESS.
Main Methods:
- Twenty-four CRS patients failing medical management underwent ESS.
- Ethmoid sinus tissue was analyzed for biofilm presence using H&E staining, FISH, and confocal microscopy.
- Biofilm status (present vs. extensive) was correlated with postoperative inflammation, blinded to surgeon.
Main Results:
- Bacterial biofilm presence was significantly associated with persistent mucosal inflammation after ESS (53% vs. 0%, P=0.009).
- The quantity of biofilm (extensive vs. present) did not correlate with inflammation levels.
- No association was found between biofilm presence and prior ESS, allergies, eosinophils, polyps, or fungal elements.
Conclusions:
- Bacterial biofilms are a significant factor associated with persistent mucosal inflammation following ESS in CRS patients.
- The presence, rather than the extent, of biofilm is linked to poorer postoperative inflammatory outcomes.
- Targeting biofilms may be a potential therapeutic strategy for refractory CRS.
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