Evidence of bacterial biofilms in chronic rhinosinusitis: factors affecting and the impact on prognosis

Vivek Gogia, Lakshmi Vaid, P. P. Singh, Rumpa Saha


Background: The aim of the study was to study the evidence of bacterial biofilms in chronic rhinosinusitis (CRS) and its effect on disease prognosis by correlating between symptom score, computed tomography (CT) score and endoscopy score.

Methods: 40 samples of bacteriologically positive CRS patients were studied and data analyzed using SNOT-20 questionnaire, nasal endoscopy scores and CT grading. Functional endoscopic sinus surgery was done in all CRS patients to clear blockage and ensures patency of osteomeatal complex. Postoperative evaluation continued at 2 weeks, 1 month and 3 months. A comparison made between preoperative and postoperative SNOT-20 and endoscopy scores of patients with and without biofilms.  

Results: Patients with biofilm forming bacteria have significantly poor preoperative and postoperative SNOT-20 score and endoscopy score as compared to bio-film negative patients; however the quality of life improved in both the groups.

Conclusions: Biofilms play a potential role in postoperative prognosis of patients undergoing FESS. Further studies and research is required for assigning them as a definite proprietor for CRS.


Bacterial biofilms, Chronic rhinosinusitis, SNOT-20

Full Text:



Rubin MA, Gonzales R, Sande MA. Infections of the upper respiratory tract. In: Kasper DL, Braunbald E, Fuaci AS, et al, eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005: 185-201.

Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997;117(3):1-7.

Otto BA, Wenzel SE. The role of cytokines in chronic rhinosinusitis with nasal polyps. Curr Opin Otolaryngol Head Neck Surg. 2008;16(3):270-4.

Harvey RJ, Lund VJ. Biofilms and chronic rhinosinusitis: systematic review of evidence, current concepts and directions for research. Rhinology. 2007;45(1):3-13.

Ferguson BJ, Stolz DB. Demonstration of biofilm in human bacterial chronic rhinosinusitis. Am J Rhinol. 2005;19:452-7.

Foreman A, Singhal D, Psaltis AJ, Wormald PJ. Targeted imaging modality selection for bacterial biofilms in chronic rhinosinusitis. Laryngoscope. 2010;120:427-31.

Hall-Stoodley L, Hu FZ, Gieseke A. Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA. 2006;296:202-11.

Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;114(6):155-212.

Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg. 1997;7:535-540.

CLSI 2006 performance standards for antimicrobials susceptability testing. Sixteenth Information Supplement. CLSI document M-100-516 (M7). Wayne PA; Clinical and Laboratory Standard Institute 26 (3).

Mathur T, Singhal S, Khan S, Upadhyay DJ, Fatima T, Rattan A. Detection of biofilm formation among the clinical isolates of staphylococci: An evaluation of three different screening methods. Indian J Med Microbiol. 2006;24(1):25-9.

Singhal D, Psaltis AJ, Foreman A, Wormald PJ. The impact of biofilms on outcomes after endoscopic sinus surgery. Am J Rhinol Allergy. 2010;24(3):169-74.

Bendouah Z, Barbeau J, Hamad WA, Desrosiers M. Use of an in vitro assay for determination of biofilm-forming capacity of bacteria in chronic rhinosinusitis. Am J Rhinol. 2006;20(5):434-8.