The importance of biofilms in chronic rhinosinusitis

There is mounting evidence that bacterial and possibly fungal biofilms play an important role in the etiology and persistence of Chronic Rhinosinusitis (CRS). CRS affects nearly 16-25% of the US population each year, with billions of dollars of annual healthcare expenditures dedicated to its treatment (Gliklich and Metson 1995). Unfortunately, the recalcitrant nature of the disease, which often exhibits a chronic relapsing course, significantly contributes to these healthcare costs. The reasons for the persistent nature of the disease are likely secondary to a number of underlying pathophysiologic mechanisms. Asthma, allergic rhinitis, Gram-positive and Gram-negative infections, aspirin-sensitive asthma, fungus, osteitis, nasal polyposis, superantigens, and other factors have been implicated as etiologies contributing to the development of CRS.