Biofilms in chronic rhinosinusitis.

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.