Relationship between bacterial biofilm and clinical features of patients with chronic rhinosinusitis

The purpose of this study was to investigate the incidence of bacterial biofilm (BBF) in patients with chronic rhinosinusitis (CRS) using confocal scanning laser microscopy (CSLM), and to assess the relationship between BBF and clinical features of CRS. This was a prospective observational study of the sinus mucosa of 27 CRS patients and 10 controls undergoing endoscopic sinus surgery (ESS). Clinical information was recorded preoperatively and sinus mucosal specimens were collected intraoperatively. We determined the existence of BBF with BacLight/CSLM detection, and proposed a BBF scoring system based on its morphologic features. Clinical parameters, including symptom score, endoscopy score, CT score and symptom duration, were compared between CRS patients with and without BBF, and among CRS patients with different BBF score. BBF was found in 16/27 (59.26%) CRS patients and none in 10 controls. SNOT-20 symptom score and individual symptoms including need to blow nose, cough and postnasal discharge were significantly more severe in CRS patients with BBF than those without. BBF score was better correlated than BBF existence with SNOT-20 score (r = 0.811, P < 0.001 vs. r = 0.604, P = 0.001), and correlated with both endoscopy score (r = 0.490, P = 0.009) and symptom duration (r = 0.487, P = 0.010), neither was correlated with BBF (P = 0.824; P = 0.263). BBF score is likely to guide anti-BBF therapy in CRS patients.