Biofilm production by otitis isolates of P. aeruginosa is common and may play a role in the pathogenesis of disease. The MICs for biofilm-embedded bacteria differ from their planktonic counterparts, potentially leading to a lack of response to treatment. If polymyxin B, gentamicin, neomycin or enrofloxacin is to be used for topical treatment of a Pseudomonas otitis, the concentration of the medication should be increased, in particular if addressing chronic otitis, because biofilms may have developed.

Triz-EDTA(®) may be a useful adjunctive treatment for chronic cases of Pseudomonas otitis where biofilms may have developed, if gentamicin or neomycin is to be used as a topical treatment. In vivo study is required to confirm this effect.

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