Impact of osteitis and biofilm formation and correlation between both in diffuse sinonasal polyposis in Egyptian adults; a prospective clinical and histopathologic study

Abstract

Background: The pathogenesis of diffuse sinonasal polyposis is still not completely established, possible explanations are osteitis, aeroallergens, fungal sinusitis and biofilms. There are no reports in Egypt about osteitis and biofilms in those patients.

Purpose: To study the incidence and impact of osteitis and biofilms in Egyptian patients on diffuse sinonasal polyposis patients.

Patients and methods: Fifty patients (22 males, mean age of 30.68± 7.24 years) submitted to surgery for diffuse sinonasal polyposis. Computerized scan on sinuses ordered and scored by Lund–Mackay staging protocol, severity of Osteitis using the Global Osteitis Scoring Scale. Tissue samples were taken from diseased sinuses to be analyzed histopathologically for osteitis, and with scanning electron microscopy to detect bacterial biofilms. Another ten patients as a control scheduled for  septoplasty or turbinectomy with no evidence of sinusitis, and tissue specimens were obtained 1 cm behind the anterior end of inferior turbinate and processed in the same manner for biofilm comparison.

Study design: Contemporary prospective cross-sectional cohort study.

Results: In 70% (35/50) of the polyposis patients, histopathology was positive for osteitis. Biofilms were detected by electron microscope in 39 (78%). Two of controls (20%) were biofilm positive with a significant difference (p= 0.035). The mean Lund–Mackay was 19.08± 3.67 and mean osteitis score was 18.68± 11.99. There was a significant correlation between Lund–Mackay and osteitis score (p< 0.001) and between both and histopathologically proven osteitis (p= 0.049),  biofilms (p= 0.005) and postoperative endoscopic healing (p= 0.046) where  increased soft tissue disease and osteitis and biofilm were associated with bad healing and vice versa

Conclusion: Osteitis and bacterial biofilms underlie the majority of Polypoidal chronic rhinosinusitis and both correlated significantly. Scanning electron  microscope is a good tool for detecting bacterial biofilms. Sinus surgery with surgical ventilation, mechanical disruption of biofilms and osteitis is a mandatory therapeutic choice with prolonged treatment with antibiotics and nasal wash.