Impact of Biofilms on Quality of Life of Rhinosinusitis Patients after Endoscopic Sinus Surgery

Introduction: The chronic and recalcitrant nature of rhinosinusitis has been known from many years. Many reasons for this have been implicated and biofilms have now been established as one of the cause for its recurrent and persistent nature. Little literature and studies exist confirming this effect. This study presents analysis of sinonasal mucosal samples and correlates presence of biofilms with surgical outcomes. Materials and methods: An analysis of mucosal samples collected during endoscopic sinus surgery from 40 patients of chronic rhinosinusitis (CRS) was done. Preoperative symptoms, endoscopic and radiological scores were documented and mucosal samples collected intraoperatively were sent for biofilm detection. Biofilm detection was performed using microtiter plate method. Postoperatively patients were followed up for minimum of 3 months with endoscopic evaluation and presence of ongoing symptoms was also recorded. Results: Thirteen patients out of 40 patients showed positive bacterial culture. Eight out of 13, i.e. 61.53% bacteria produced biofilms and five out of 13, i.e. 38.46% bacteria did not produce biofilms. Patients with biofilms had significantly worse preoperative and postoperative symptom and endoscopic scores. Thus, presence of biofilms was related to poor outcomes. Conclusion: This study showed that the presence of biofilms was correlated with higher symptom scores and poorer surgical outcomes. Also, more recurrences were found in patients with positive biofilms. This strengthens the belief that biofilms may play an active role in persisting mucosal inflammation and persistent symptoms in some patients of CRS. Treatment modalities aiming removal of biofilms may be important in management of CRS.