Exploring the Link Between Bacterial Biofilm and Disease Severity in Cholesteatoma-Associated CSOM

Chronic suppurative otitis media (CSOM) with cholesteatoma is a potentially dangerous condition that can lead to extracranial and intracranial complications. Bacteria associated with CSOM cholesteatoma frequently produce biofilms, which contribute to antibiotic resistance and accelerate disease progression.

This cross-sectional study was conducted at the tertiary teaching hospital of Hasanuddin University, its affiliated hospitals, and the Hasanuddin University Medical Research Center (HUM-RC) between March 2024 and April 2025. Patients diagnosed with CSOM cholesteatoma who underwent mastoidectomy were enrolled. Bacterial isolates obtained from cholesteatoma tissue were evaluated for biofilm formation using crystal violet staining. Data were analyzed using SPSS software.

A total of 49 patients were included: 46.9% male and 53.1% female; age range 9-66 years. Of the bacterial isolates, 40 demonstrated biofilm formation. Pseudomonas aeruginosa was the most frequently identified species (42.5%), followed by 12 other species, all of which exhibited weak to moderate biofilm production. Based on the Telmesani grading system, 47% of patients presented with severe disease. However, the limited sample size restricted the ability to establish a statistically significant correlation between biofilm presence and clinical severity.

Biofilm formation was detected in the majority of bacterial isolates, with Pseudomonas aeruginosa emerging as the predominant species. Although nearly half of the patients presented with severe disease, most isolates demonstrated only weak to moderate biofilm production. The limited sample size restricted the ability to establish a statistically significant correlation between biofilm presence and clinical severity. Nevertheless, these findings highlight the importance of biofilm in the pathogenesis of CSOM and underscore the need for larger multicenter studies to clarify its role and inform the development of biofilm-targeted therapeutic strategies.