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Low-frequency ultrasound for biofilm disruption in chronic rhinosinusitis with nasal polyposis: in vitro pilot study
Tamás Karosi1, István Sziklai, Péter Csomor
1Department of Otolaryngology and Head and Neck Surgery, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary. karositamas@gmail.com
Objectives/Hypothesis:
Microbial biofilms have been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyposis (CRSwNP). Although biofilms are characterized by an extremely high resistance against chemical and physical agents, low-frequency ultrasound (LFU) treatment has been suspected to be an efficient and safe method for biofilm disruption.
Study Design:
Basic science experimental study.
Methods:
A total of 10 patients with CRSwNP undergoing endoscopic sinus surgery were analyzed. Two series of identical nasal polyps (n = 20) were processed to hematoxylin-eosin (HE) and Gram staining and to continuous-wave LFU treatment (5 minutes, 0.4 MHz, 37°C), respectively.
Results:
Presence of microbial biofilms was confirmed in all patients with CRSwNP. HE staining showed a strong correlation with the results of Gram protocol in biofilm detection. In the LFU-treated group (n = 10), a significantly decreased inflammatory cell count was found in the subepithelial layer of nasal polyps (P < .001). In addition, bacterial biofilms were completely removed from the surface of the epithelial layer. Microscopic tissue injuries or significant temperature changes were not detected due to LFU treatment.
Conclusions:
Between in vitro conditions, LFU treatment appeared to be a reliable and microscopically safe method for the disruption of microbial biofilms in CRSwNP. These results may provide a basis for a prospective human study investigating the efficacy and safety of this therapeutic modality alone or in combination with antibiotics or topical steroids in biofilm-positive cases of CRSwNP.
Insights
Low-frequency ultrasound (LFU) effectively disrupted microbial biofilms in chronic rhinosinusitis with nasal polyposis (CRSwNP) patients. This safe, in vitro method reduced inflammation and removed biofilms without tissue damage, paving the way for clinical trials.
Area of Science:
- Otorhinolaryngology
- Microbiology
- Biophysics
Background:
- Microbial biofilms are key in chronic rhinosinusitis with nasal polyposis (CRSwNP) pathogenesis.
- Biofilms exhibit high resistance to conventional treatments.
- Low-frequency ultrasound (LFU) shows potential for biofilm disruption.
Purpose of the Study:
- To evaluate the efficacy and safety of LFU for disrupting microbial biofilms in CRSwNP.
- To assess LFU's impact on inflammation and tissue integrity in nasal polyps.
Main Methods:
- Basic science experimental study involving 10 CRSwNP patients.
- Nasal polyps were stained (HE, Gram) and treated with LFU (0.4 MHz, 5 min, 37°C).
- Comparison of LFU-treated and untreated polyp samples.
Main Results:
- Microbial biofilms confirmed in all CRSwNP patients.
- LFU treatment significantly reduced subepithelial inflammatory cell counts (P < .001).
- Complete removal of bacterial biofilms from the epithelial surface; no significant tissue injury or temperature change observed.
Conclusions:
- LFU is a reliable and microscopically safe in vitro method for disrupting CRSwNP biofilms.
- Results support further human studies on LFU as a standalone or adjunctive therapy.
- LFU may be a valuable therapeutic option for biofilm-positive CRSwNP.
