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.

Impact of mucosal biofilm and bony osteitis on chronic rhinosinusitis with nasal polyps

“…The positive rate of BBF in our study was in line with some of the other studies using SEM [25][26][27]; the high odds ratio and wide confidence interval in our study suggest that there is a statistically significant association between biofilm formation and CRSwNP.…”

“…Besides, the presented pathological features of bony osteitis in our study that included thickening of the periosteum, new formation of unorganized woven bone, and fibrosis were also similar to previous studies [23,26,[29][30][31]. For additional correlation assessment, we used the histopathological bony grade of Biedlingmaier, which was proposed as the most beneficial system for histopathological grading by Videler et al [24].…”

“…In our study, biofilms were also found in 4 (40%) of the 10 patients in the control group; they were also detected on the nasal mucosae of normal controls in some studies [25][26][27][28], assuming that biofilms may be normal colonies of bacteria. Mladina et al detected BBF on healthy sinus mucosa and suggested that BBF could be normal respiratory mucosal blankets that contain lots of bacteria and part of the mucociliary system [27].…”