Bacterial Biofilms in Chronic Rhinosinusitis and Their Implications for Clinical Management

  • Abhilasha Karunasagar
  • Santosh S. Garag
  • Suma B. Appannavar
  • Raghavendra D. Kulkarni
  • Ashok S. Naik
Original Article


To study the microbiological profile in patients with chronic rhino-sinusitis. To correlate disease severity with the presence of biofilms and host risk factors. To assess outcome of Sinus Surgery 2 weeks post operatively in terms of presence of bacteria and their ability to form biofilm. Prospective study. 50 cases of chronic rhino-sinusitis requiring Functional Endoscopic Sinus Surgery admitted in SDM Hospital, Dharwad, Karnataka were studied using intra-operative mucosal samples for microbiological analysis. The organisms isolated were tested for biofilm forming ability using three in vitro tests. Severity of disease was assessed using SNOT 22 scoring system. Of 50 cases studied, 66% showed presence of chronic rhino-sinusitis with polyposis and had higher SNOT scores compared to those without polyps. Bacterial isolates were obtained from only 17 samples. Staphylococcus species was isolated from 16 samples and Klebsiella pneumoniae from one. 11 Staph spp. isolates showed biofilm forming ability in vitro. Postoperative events in 3 cases yielded biofilm-forming Staphylococcus. Staphylococcus was the most dominant organism isolated and 11 isolates were biofilm formers. Thus the detection of biofilm forming organisms can be considered as a negative prognostic indicator and should forewarn the surgeon about the risk of recurrence.


Chronic rhinosinusitis Bacterial biofilm Staphylococcus Nasal polyposis 


Compliance with Ethical Standards

Conflict of interest

Authors declare that they have no conflict of interest. No external funding was used for the study.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Fokkens WJ, Lund VJ, Mullol J et al (2012) The European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:1–299Google Scholar
  2. 2.
    Kennedy DW, Ramakrishnan VR (2015) Functional endoscopic sinus surgery: concepts, surgical indications and techniques. In: Kennedy DW, Hwang PH (eds) Rhinology diseases of the nose, sinuses, and skull base, 1st edn. Thieme, New York, pp 308–335Google Scholar
  3. 3.
    Hopkins C, Gillett S, Slack R et al (2009) Psychometric validity of the 22-item sinonasal outcome test. Clin Otolaryngol 34:447–454CrossRefPubMedGoogle Scholar
  4. 4.
    Gonz′alez-Castro J, Pascual J, Busquets J (2013) National survey on the use of preoperative systemic steroids in endoscopic sinus surgery. Int Forum Allergy Rhinol 3(6):497–503CrossRefGoogle Scholar
  5. 5.
    Bauer AW, Kirby WMM, Sherris JC et al (1966) Antibiotic susceptibility testing by standardized single disc method. Am J Clin Pathol 45:493–496PubMedGoogle Scholar
  6. 6.
    Christensen GD, Bisno AL, Simpsom WA, Beachey EH (1982) Adherence of slime producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 7:318–326Google Scholar
  7. 7.
    Freeman DJ, Falkiner FR, Keane CT (1989) New method for detecting slime production by coagulase negative staphylococci. J ClinPathol 42:872–874Google Scholar
  8. 8.
    Mathur T, Singhal S, Khan S et al (2006) Detection of biofilm formation among isolates of staphylococci: an evaluation of three different screening methods. Indian J Med Microbiol 24(1):25–29CrossRefPubMedGoogle Scholar
  9. 9.
    Senior BA, Kennedy DW, Tanabodee J et al (1998) Long-term results of functional endoscopic sinus surgery. Laryngoscope 108:151–157CrossRefPubMedGoogle Scholar
  10. 10.
    Sanclement JA, Webster P, Thomas J, Ramadan HH (2005) Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis. Laryngoscope 115:578–582CrossRefPubMedGoogle Scholar
  11. 11.
    Psaltis AJ, Weitzel EK, Ha KR, Wormald PJ (2008) The effect of bacterial biofilms on post-sinus surgical outcomes. Am J Rhinol 22:1–6CrossRefPubMedGoogle Scholar
  12. 12.
    Krouse JH (2005) Allergy and chronic rhinosinusitis. Otolaryngol Clin North Am 38:1257–1266 (ix–x) CrossRefPubMedGoogle Scholar
  13. 13.
    Prince AA, Steiger JD, Khalid AN et al (2008) Prevalence of biofilm-forming bacteria in chronic rhinosinusitis. Am J Rhinol 22:239–245CrossRefPubMedGoogle Scholar
  14. 14.
    Perloff JR, Palmer JN (2004) Evidence of bacterial biofilms on frontal recess stents in patients with chronic rhinosinusitis. Am J Rhinol 18(6):377–380PubMedGoogle Scholar
  15. 15.
    Niederfuhr A, Kirsche H, Riechelmann H, Wellinghausen N (2009) The bacteriology of chronic rhinosinusitis with and without nasal polyps. Arch Otolaryngol Head Neck Surg 135:131–136CrossRefPubMedGoogle Scholar
  16. 16.
    Conley DB, Tripathi A, Seiberling KA et al (2006) Superantigens and chronic rhinosinusitis II: analysis of T-cell receptor V beta domains in nasal polyps. Am J Rhinol 20(4):451–455CrossRefPubMedGoogle Scholar
  17. 17.
    Bhattacharyya N, Kepnes LJ (2008) Assessment of trends in antimicrobial resistance in chronic rhinosinusitis. Ann Otol Rhinol Laryngol 117:448–452CrossRefPubMedGoogle Scholar
  18. 18.
    Oliveira A, Cunha MLRS (2010) Comparison of methods for the detection of biofilm production in coagulase-negative staphylococci. BMC Res Notes 3:260CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  1. 1.Department of ENTSDM College of Medical Sciences and HospitalDharwadIndia
  2. 2.Department of MicrobiologySDM College of Medical Sciences and HospitalDharwadIndia

Personalised recommendations