Evidence of bacterial biofilms on frontal recess stents in patients with chronic rhinosinusitis

Background: Bacterial biofilms have been documented on middle ear mucosa, tonsils, and cholesteatoma. We hypothesize that bacterial biofilms are present in mucosa of patients with chronic sinusitis. We believe that frontal sinus stents may serve as a reservoir for biofilms. Experiment: We studied silicone frontal sinus stents removed,front six patients 1 to 4 weeks after FESS with scanning electron microscopy (SEM). Results: We identified evidence of bacterial biofilms on the frontal recess stents in six of six patients under SEM. Five of these patients had sinus cultures positive for Staphylococcus aureus. Bacterial biofilms were identified by evidence of glycocalyx , water channels, and three-dimensional structure. These images were similar to other images of known biofilms. Conclusions: This is evidence of the possible presence of bacterial biofilms on frontal sinus stents in patients with chronic sinusitis. Further study into the role of bacterial biofilms in perpetuating chronic sinusitis is warranted.