Effect of Bacterial Biofilms on Disease Severity in Chronic Rhinosinusitis

Abstract

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory disease affecting nose and para nasal sinuses for more than 12 weeks. Bacterial biofilms are emerging as an important etiological factor in CRS. The bacteria within the biofilm is resistant to treatment and adds to the severity of the disease in addition to posing difficulty in treating the disease. Objective: The aim of the present study was to compare the Severity of disease in CRS Patients with and without bacterial biofilms. Methods: Samples were taken from the patients and subjected to microbiological examination for biofilm detection. Lund Kennedy endoscopic scores and Lund Mackey CT scores were compared pre- treatment and at multiple follow ups. Results: out of 60 patients 46 (32 (69.6%) patients were biofilm positive. Median MLK endoscopic scores for biofilm positive and biofilm negative patients were calculated and compared at pre-treatment, 1 month, 3 months and 6 months post treatment respectively P <0.001. Lund Mackay CT score at pre-treatment and at 6 month post treatment follow up of biofilm positive and biofilm negative CRS patients was calculated. P value < 0.001. Percentage improvement in Modified Lund Kennedy (MLK) endoscopic score was more for biofilm negative patients compared to biofilm negative patients. Conclusion: Presence of biofilm on sinonasal mucosa is associated with more severe disease. Response to treatment is less in biofilm positive CRS patients. Presence of biofilms in CRS patients is an indication for more aggressive treatment.