Biofilms

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Curr Opin Otolaryngol Head Neck Surg. 2009 Nov 24. [Epub ahead of print]Biofilms in chronic rhinosinusitis.Suh JD, Cohen NA, Palmer JN.Division of Rhinology, Department of ORL:HNS, University of Pennsylvania, Pennsylvania, USA.PURPOSE

OF REVIEW: Rhinosinusitis is one of the most common medical complaints

in the United States, affecting up to 16% of the population. It is

associated with over 13 million physician visits per year and an

estimated aggregated cost of over $6 billion annually. Patients with

chronic rhinosinusitis (CRS) demonstrate worse quality-of-life scores

than those suffering from chronic obstructive pulmonary disease,

congestive heart failure, back pain, or angina. Despite the large

societal impact and economic burden, the pathophysiology of CRS remains

largely unsolved. One possible mechanism for the chronic nature of this

disease is the involvement of bacterial biofilms, which represent a

phenotypic change in bacteria that make them resistant to conventional

treatment strategies. We will discuss these changes as well as emerging

treatment options. RECENT FINDINGS: New research involving topical

antimicrobials, surfactants, loop diuretics, and macrolide antibiotics

can be used as adjuvant therapies to treat biofilm-associated CRS. All

have shown some promise in laboratory or small patient studies, but all

need further evaluation SUMMARY: Bacterial biofilms are highly

organized structures composed of communities of bacteria encased within

a protective extracellular matrix. If bacterial biofilms are the cause

of certain cases of CRS, then the treatment paradigms will have to be

changed. Novel nonantimicrobial therapies may have clinical

applications to prevent and destabilize biofilms. We believe that

ultimately methods to reduce sinonasal inflammation and protect cilia

will be the first step in blocking the attachment and aggregation of

bacteria that would otherwise start biofilm formation. Once more is

known about the role of biofilms in CRS, new therapies will undoubtedly

play a greater role and change our treatment paradigms.