| Objective:(1)The purpose of this study was to investigate the morphological characteristics of bacterial biofilm(BBF)in surgical specimeans of patients with choronic rhinosinusitis(CRS)using confocal scanning laser microscopy(CSLM),to investigate the express of biofilms in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)compared to patients with chronic rhinosinusitis without nasal polyps(CRSsNP)and controls,to investigate the prevalence of biofilms in different anatomical localizations,and to evaluate the role of biofilms in the clinical correlation of CRS.(2)The ethmoid sinusitis was evaluated by CT imaging(GOSS)scoring and histopathological scoring.The expression of osteitis in the chronic rhinosinusitis group(CRS)and the control group was compared.The GOSS score and histopathological score were analyzed.To evaluate the clinical value of osteitis and chronic rhinosinusitis.(3)To investigate the relationship between BBF and osteitis in CRS patients.Methods:(1)We selected 82 patients with endoscopic surgical treatment,including 34 patients with CRSwNP,33 patients with CRSsNP,and 15 controls patients with no clinical or radiological evidence of sinus disease such as sinus osteoma,optic nerve decompression,and cerebrospinal fluid leak repair.Clinical information was recorded from each patient,including symptom score,endoscopy score,CT score etal.We collected sinus mucosal specimens from the middle turbinate,the uncinate process,and the ethmoid bulla intraoperatively and determined the existence of BBF with BacLight/CSLM detection.The differences between the experimental group and the control group and the differences between different anatomical localizations were judged,the presence of bacterial biofilms and some clinical parameters were analyzed.(2)We selected 82 patients underwent endoscopic sinus surgery,including 67 patients with chronic sinusitis(CRS)and 15 patients in the control group.All patients underwent preoperative sinus CT analysis,and patients with osteitis were scored by GOSS scale.All patients underwent sinus bone specimens during the operation,and were stained by HE and scored according to Biedlingmaier JF pathological grade.The differences between the experimental group and the control group were analyzed,and the correlation between the presence of osteitis and some clinical indicators was analyzed.(3)Statistical analysis was performed using statistical software to analyze the correlation between bacterial biofilm and osteitis in patients with chronic rhinosinusitis.Results:(1)Biofilms were studied in 27/34(79.41%)CRSwNP,18/33(54.55%)CRSsNP,and0/15(0%)controls.The difference in point prevalence between patients with CRSwNP vs Controls(?~2=26.531,P(27)0.001),CRSsNP vs controls(?~2=13.091,P(27)0.001),and CRSwNP vs CRSsNP(?~2=4.695,P(27)0.05)were all significant.Biofilms were found in 20/67(29.85%)middle turbinate,32/67(47.76%)uncinate process,and 42/67(62.69%)ethmoid bulla.The difference between the ethmoid bulla and the middle turbinate locations(?~2=14.529,P(27)0.001),and the difference between the middle turbinate and the uncinate process were significant.The preoperative VAS scores,the preoperative Lund-Kennedy scores and CT scores of the CRS patients with biofilms were higer than those biofilm-negative patients(P<0.05).There was no significant difference in the history of nasal surgery,duration between the two groups.The biofilm score was positively correlated with the VAS score,the Lund-Kennedy score,and the Lund-Mackay score.The P values were 0.001,0.011,and0.025,and the P values were all<0.05.The difference was statistically significant.(2)Among 67 patients with chronic sinusitis,36 patients(53.7%)had osteitis with GOSS score(at least one sinus had bone hyperplasia)and 31 patients(46.3%)had no osteitis.There were 28 patients(41.8%)with meaningful osteitis above grade 1.In the control group,there were 3 cases of grade 1 osteitis(20.0%)without significant osteoarthritis.The incidence of sinus:the incidence of ethmoid sinus in the maxillary sinus group was higher in the patient.The incidence rate of the right maxillary sinus was 31.3%(21/52),and the incidence rate of the left maxillary sinus was 28.4%(19/52).The incidence of the right anterior ethmoid sinus was 29.9%(20/52),and the incidence of the left anterior ethmoid sinus was 25.4%(17/52).The incidence of ethmoid sinus in the posterior group was slightly lower than that in the anterior group.Among 67 patients with chronic sinusitis,43 patients(64.2%)had pathological grade osteitis(Biedlingmaier JF grade?II),and 24 patients(35.8%)had no osteitis.There were 22 cases of grade II osteitis(32.8%),19 cases of grade III osteitis(28.4%),and 2 cases of grade IV osteitis(3.0%).There were 13 patients(86.7%)without osteitis in the control group and 2 patients(13.3%)with grade II osteitis.The positive rate of osteitis in the CRS group was significantly higher than that in the control group.The positive rate of osteitis in histopathological examination was 43/67(64.2%)in the CRS group and 2/15(13.3%)in the control group(?~2=12.796,P<0.001).The positive rate of imaging osteitis(total GOSS?5)was 28/67(41.8%)in the CRS group and 0/22(0%)in the control group(?~2=9.519,P=0.002).VAS scores in the sinusitis group with GOSS scores in the osteitis-positive and negative groups(t=5.03,P<0.001),Lund-Mackay scores(t=7.03,P<0.001),and Lund-Kennedy scores(t=6.47,P<0.001),the differences were statistically significant.VAS scores(t=2.172,P=0.019),Lund-Mackay scores(t=10.873,P<0.001),and Lund-Kennedy scores(t=6.367,P<0.001)in the sinusitis group,the differences were statistically significant.GOSS scores were positively correlated with VAS scores in patients with osteitis(r=0.514,P<0.001),and GOSS scores were positively correlated with Lund-Mackay scores(r=0.291,P=0.027);There was also a positive correlation trend between GOSS scores and Lund-Kennedy scores(r=0.698,P<0.001).The VAS score increased significantly with the increase of pathological grade of osteitis,and there was a positive correlation between them(r=0.541,P<0.001).The Lund-Mackay score increased significantly with the increase of pathological grade,and there was a positive correlation between them(r=0.909,P<0.001).Lund-Kennedy score increased significantly with the increase of pathological grade,and there was a positive correlation between them(r=0.822,P<0.001).The GOSS score was significantly increased with the increase of pathological grade of ethmoid sinus bone,and there was a positive correlation between them(r=0.647,P<0.001.(3)Pathological osteitis was present in 35(77.8%)patients with positive biofilm.26(57.8%)patients with positive biofilm were positive for imaging osteitis.Bacterial biofilm and osteitis were present in 35 patients(52.2%)in the sinusitis group.There was a significant difference in the positive rate of pathological osteitis between the biofilm positive group and the negative group(?~2=11.024,P<0.001).There was a significant difference in the positive rate of imaging osteitis between the biofilm positive group and the negative group(?~2=14.398,P<0.001).As the biofilm score increased,the bone pathological grade increased significantly(r=0.412,P=0.001).As the biofilm score increased,the grade of GOSS increased significantly(r=0.602,P<0.001).Conclusions:(1)Bacterial biofilms were demonstrated to be present in the sinus mucosa of patients with choronic sinusitis and BBF are more likely to be located deeper into the sinonasal cavity.The bacterial biofilms may be related to the CRSwNP.Bacterial biofilms are associated with the severity of CRS.(2)Chronic rhinosinusitis patients have pathological changes in bone that reflect the severity of the disease to some extent.The GOSS score can objectively and accurately reflect the degree of osteitis in patients with chronic rhinosinusitis and is convenient for clinical application.(3)Bacterial biofilm positive patients are more prone to osteitis in submucosal bone tissue.More than half of patients with chronic sinusitis have bacterial biofilm and osteitis.There may be a correlation between the volume of BBF and the severity of osteitis. |
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