The Relationship Between Bacterial Biofilms And Chronic Rhinosinusitis By Morphological SEM Studies

Objective:To determine the presence and the morphological features of bacterial biofilms in surgical specimens of patients with Chronic Rhinosinusitis(CRS)compared with control patients without CRS by scanning electron microscopy(SEM),and to evaluate the role of biofilm on the pathogenisis of CRS.Methods:15 patients of CRS undergoing endoscopic sinus surgery and 11 control patients with fracture of nasal bone were enrolled in this study.Clinical information was recorded from each patient.All patients underwent a otolaryngological examination, preoperative paranasal sinus computerized tomography(CT)scanning which were evaluated according to the Lund-McKay CT scoring system.All the samples including uncinate process,ethmoid cavity mucosa from CRS group and uncinate process, ethmoid bulla from control group were prepared using standard methods for SEM.The presence of bacterial biofilms on the samples of two groups was observed by SEM. Statistical analysis was performed using SPSS 13.0.Continuous data was analyzed by Student t test and dichotomous data was analyzed by x~2 or Fisher's exact test.P was considered to be significant at a level of 0.05. Results:1.9(60%)of the 15 patients were found to have evidence of biofilms.In control group,only 1(9.1%)of 11 patients had biofilm.The difference was statistical significent (p＜0.01).2.All controls except one had healthy appearing cilia and goblet cells without biofilms.All the 16 CRS patients showed aberrant findings of the mucosal surface with variation in degrees of severity from disarrayed cilia to complete absence of cilia and goblet cells.Among them the typical morphologic feather such as water channels,3-D structure,and matrix-embedding spherical or elliptical bodies were noted in 9 cases. Five samples including one case from control had been shown cilia aggregation.3.The preoperative CT scores of the CRS patients with biofilms(n=9)were significantly higher than those without biofilms(n=6,p＜0.05).Conclusion:1.The typical morphologic feather of BF such as water channels,3-D structure, and matrix-embedding spherical or elliptical bodies were noted in sinus mucosa of patients with CRS by the SEM.2.The positive rate of bacterial biofilms in CRS group was significantly higher compared to control group,which indicated bacterial biofilms may play a important role in the pathogenesis of CRS.3.Besides the typical bacterial biofilm features,cilia aggregation was found in five cases of CRS patients.We consider cilia aggregation can be regarded as one morphologic feather of bacterial biofilm in nasal mucosa,which need further study.4.The presence of bacterial biofilms in CRS patients is associated with paranasal CT scores,which indicates bacterial biofilm is correlated with the severity of CRS.