Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia.
Am J Rhinol Allergy. 2010 May-Jun;24(3):169-74. doi: 10.2500/ajra.2010.24.3462.
Although biofilms have been implicated in the pathogenesis of chronic rhinosinusitis (CRS), there is little evidence that their presence or absence has any effect on the outcomes of endoscopic sinus surgery (ESS). The aim of this study was to investigate the effect of biofilms on postsurgical outcomes after ESS.
A prospective, blinded study of 51 consecutive patients undergoing ESS for CRS was conducted. Preoperatively, patients assessed their symptoms using internationally accepted standardized symptom scoring systems and quality-of-life (QOL) measures, i.e., the 10-point Visual Analog Scale (VAS), Sino-Nasal-Outcome-Test 20, and global severity of CRS. Their sinonasal mucosa was graded using the Lund-Kennedy scale and the extent of radiological disease on computed tomography scans was scored using the Lund-McKay scale. Random sinonasal tissue samples were assessed for biofilm presence using confocal laser microscopy. At each postoperative visit, patients reassessed their sinus symptoms and completed QOL measures. Postsurgical state of their sinonasal mucosa was graded endoscopically.
Bacterial biofilms were found in 36 of 51 (71%) CRS patients. Patients with biofilms presented with significantly worse preoperative radiology and nasendoscopy scores (p = 0.003 and 0.01, respectively). After a median follow-up period of 16 months postsurgery, biofilm-positive patients had statistically worse sinus symptoms (VAS, p = 0.002) and worse nasendoscopy scores (p = 0.026). They also required extra postoperative visits and multiple antibiotic treatments deviating from the standard postoperative care required by biofilm-negative patients.
This study has shown that patients with biofilms have more severe disease preoperatively and persistence of postoperative symptoms, ongoing mucosal inflammation, and infections. This study strengthens the evidence for the role that biofilms may play in recalcitrant CRS.
尽管生物膜被认为与慢性鼻-鼻窦炎（CRS）的发病机制有关，但几乎没有证据表明其存在或不存在对内镜鼻窦手术（ESS）的结果有任何影响。本研究旨在探讨生物膜对 ESS 后术后结果的影响。
对 51 例连续接受 ESS 治疗的 CRS 患者进行前瞻性、盲法研究。术前，患者使用国际公认的标准化症状评分系统和生活质量（QOL）措施，即 10 分视觉模拟量表（VAS）、鼻-鼻窦-结局测试 20 和 CRS 的总体严重程度，评估他们的症状。使用 Lund-Kennedy 量表对患者的鼻黏膜进行分级，使用 Lund-McKay 量表对计算机断层扫描（CT）扫描的放射学疾病程度进行评分。使用共聚焦激光显微镜评估随机鼻组织样本中生物膜的存在。在每次术后就诊时，患者重新评估他们的鼻窦症状并完成 QOL 措施。内镜评估术后鼻黏膜状态。
在 51 例 CRS 患者中，有 36 例（71%）发现细菌生物膜。有生物膜的患者术前放射学和鼻内镜评分明显较差（p = 0.003 和 0.01，分别）。手术后中位数随访 16 个月后，生物膜阳性患者的鼻窦症状明显更差（VAS，p = 0.002）和鼻内镜评分更差（p = 0.026）。他们还需要额外的术后就诊和多次抗生素治疗，这偏离了生物膜阴性患者所需的标准术后护理。
本研究表明，有生物膜的患者术前疾病更严重，术后症状持续存在，黏膜炎症和感染持续存在。本研究加强了生物膜可能在难治性 CRS 中发挥作用的证据。
