Biofilms Correlate with T_H1 Inflammation in ihe Sinonasal Tissue of Patients with Chronic Rhinosinusitis

OBJECTIVE Determine the prevalence of bacterial biofilms in surgical chronic rhinosinusitis (CRS) patients and characterize the inflammatory response associated with biofilm CRS. STUDY DESIGN Cross‐sectional. SETTING Tertiary care academic center. SUBJECTS AND METHODS Sinonasal mucosa and peripheral blood were collected from 60 CRS patients. Mucosal biofilms were demonstrated by scanning electron microscopy. Leukocyte subpopulations were determined by flow cytometry. Cytokines were identified with a luminex‐based assay on the lysate of homogenized tissue or plasma. RESULTS Of the 60 samples, 17 were determined to be positive for the presence of biofilms. Oral steroid‐naive CRS patients with biofilm demonstrated a local T H 1 inflammatory response with significantly elevated levels of interferon‐γ (INF‐γ), granulocyte colony‐stimulating factor, macrophage inflammatory protein‐1 β, and neutrophils in the sinonasal mucosa. No differences were present at the systemic level. CONCLUSION Sinonasal bacterial biofilms correlate to a T H 1 skewed local but not systemic inflammatory response in CRS. This difference is abrogated by the use of oral steroids.