Biofilm surface area in the pediatric nasopharynx: Chronic rhinosinusitis vs obstructive sleep apnea.

OBJECTIVE To compare the percentage of mucosal surface area of adenoids infected with biofilms removed from children with chronic rhinosinusitis (CRS) vs children with obstructive sleep apnea (OSA). DESIGN Comparative microanatomical investigation of adenoid mucosa from patients with CRS and OSA using scanning electron microscopy. SETTING University-affiliated hospitals and ambulatory surgery center. PATIENTS Four girls and 12 boys ranging in age from 3 months to 10 years. MAIN OUTCOME MEASURE Measurements of biofilm coverage of the entire adenoidal surface. RESULTS Adenoids removed from patients with CRS had dense mature biofilms covering the mucosal surface; they had a mean of 94.9% of their mucosal surface covered with mature biofilms, compared with a mean of 1.9% coverage on the adenoids removed from patients with OSA. This difference was statistically significant at P < .001. CONCLUSIONS Adenoids removed from patients with CRS had almost their entire mucosal surface covered with biofilms vs scant coverage for patients with OSA. Biofilms in the nasopharynx of children with CRS may act as a chronic reservoir for bacterial pathogens resistant to standard antibiotics. The mechanical debridement of the nasopharyngeal biofilms may explain the observed clinical benefit associated with adenoidectomy in this subset of pediatric patients.