When and how should we treat biofilms in chronic sinusitis?

PURPOSE OF REVIEW: Biofilms have been observed on the sinus mucosa of patients with chronic rhinosinusitis and are associated with poor clinical outcomes after surgery. This article summarizes the recent studies which describe the efficacy of treating biofilms in chronic rhinosinusitis. RECENT FINDINGS: Biofilms are polymicrobial communities comprised of bacteria that tend to be more antibiotic-resistant than when in planktonic forms. Antibiotic therapy against biofilms is usually associated with relapse following cessation of treatment and may also have an adverse effect on normal commensal microflora. Surfactants can improve clinical symptoms, but their use has been limited by side effects. Other treatment modalities that physically remove or disrupt biofilms, such as ultrasound, have shown some efficacy in small trials. The impact of surgery on biofilms has not been extensively investigated. SUMMARY: The nature of biofilms makes their removal difficult. No currently available treatment directed against them has demonstrated lasting efficacy.