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    Biofilms in chronic rhinosinusitis with polyps: is eradication possible?
    (Springer, 2014) Korkmaz, Hakan; Ocal, Bulent; Tatar, Emel Cadalli; Tatar, Ilkan; Ozdek, Ali; Saylam, Guleser; Celik, Hakan Hamdi
    The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps. The study is a randomized controlled trial in a tertiary referral hospital. Thirty-four patients with chronic rhinosinusitis completed the study. In the first group, 19 patients received mometasone furoate nasal spray 200 mu g once daily for 8 weeks. In the second group, 15 patients received oral clarithromycin 500 mg twice daily for 2 weeks and continued once daily 250 mg tablet for subsequent 6 weeks, plus mometasone furoate. Scanning electron microscopy was the primary outcome measure. Secondary outcome measures included computerized tomography and sinonasal outcome test-20 items. Mucosal biofilms were detected in 23 of 34 (68 %) patients on pretreatment polyp samples. After the treatment, biofilms disappeared in 1 of 11 patients in the first group, whereas the eradication of biofilms was evident in 6 of 12 (50 %) patients in the second group. Tomography scores improved in eight patients of each group (42.1 and 53.4 %, respectively). The comparison of improvements did not reveal significant difference between the groups. The overall symptom scores improved compared to the baseline levels. The mean changes of -8.8421 and -11.4000 in the first and second group, respectively, were not statistically different. Adding long-term low-dose oral macrolides to nasal steroids was effective in the eradication of biofilm. However, we were not able to demonstrate that combined therapy was superior in terms of the improvement in tomography and symptom scores.
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    Prevalence of Biofilms and Their Response to Medical Treatment in Chronic Rhinosinusitis without Polyps
    (Sage Publications Ltd, 2012) Tatar, Emel Cadalli; Tatar, Ilkan; Ocal, Bulent; Korkmaz, Hakan; Saylam, Guleser; Ozdek, Ali; Celik, Hakan Hamdi
    Objective. The aim of this study was to investigate the prevalence of biofilms and the effects of medical treatment modalities in chronic rhinosinusitis (CRS) patients without nasal polyps. Study Design. Randomized controlled trial. Settings. Tertiary referral hospital. Subjects and Methods. The authors randomly divided 32 adult patients with CRS without nasal polyps into 2 groups. In the first group (n = 16), oral clarithromycin was administered 500 mg/bid for 2 weeks and then 250 mg/d for the following 6 weeks. In the second group (n = 16), an 8-week course of 200-mcg/d topical mometasone furoate was added to the clarithromycin regimen, identical to the first group. The pre-and posttreatment nasal tissue samples were evaluated by scanning electron microscopy for biofilm prevalence and graded from 0 to 3 according to density and extension. Results. Biofilms were detected in 24 of 32 patients (75%) before the treatment (grades 1-3). Biofilms were detected in 14 of 32 patients (43.8%) after the treatment (grades 12). When each group was evaluated independently, there was a significant improvement after the treatment in both groups I and II. When the biofilm grades of group I were compared to those of group II, there was no significant difference both in the pre-and posttreatment evaluation. Conclusion. The prevalence of biofilms in CRS without polyps was 75% in our study. Regression of biofilms to 43% was observed under medical treatment. Adding nasal steroids to macrolides gave no further benefit.