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The objective of our studies was to document the presence of bacterial biofilms in recurrent and chronic infectious diseases of the upper airways (UA) (adenoiditis, tonsillitis, chronic rhinosinusitis) and to assess the association between the presence of biofilm and the maintenance of a chronic inflammation. Methods: 16 surgical samples of tonsils and adenoids from patients with UA infections and 24 samples of ethmoid mucosa from patients who underwent endoscopic sinus surgery for chronic rhinosinusitis (CRS) were cultured using conventional methods and subjected to scanning electron microscopy (SEM) to detect evidence of biofilm. Results: Bacterial biofilms were observed in 57.5% of chronically infected UA mucosa; in 41.7% of ethmoid mucosa of CRS patients they were significantly (p < 0.001) associated with a marked destruction of ciliated epithelium. Discussion: Our studies confirm that biofilm formation plays a role in UA infections, it not only explains the resistance of these infections to antibiotic therapy, but also represents an important element that contributes to the maintenance of a chronic inflammatory reaction.
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