Skip to main content

Advertisement

SpringerLink
Log in

The Effect of Spray Cryotherapy on Microbial Biofilms in Chronic Rhinosinusitis

  • Respiratory Infections (F Arnold, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Microbial biofilms seem to play an active role in the pathogenesis of chronic rhinosinusitis (CRS). They represent an adaptive defense resource enabling resistance to antibiotics and host defense mechanisms. Biofilms are thought to be accountable for refractory cases of sinusitis by perpetuating local inflammation. The objective of this study was to assess the effectiveness of spray cryotherapy as a biofilm disruption agent in CRS in an in vitro model.

Recent Findings

A total of 23 patients with CRS undergoing endoscopic sinus surgery (ESS) were included. Rhinosinusal mucosa samples were harvested. Half of sample was left intact while the other half was treated with spray cryotherapy, so patients served as their own witnesses. Subsequently, they were processed to hematoxylin-eosin (HE) and toluidine blue (TB) staining and analyzed by light microscopy. Biofilms were detected in 17 of 23 patients with CRS. Staining by HE showed strong correlation with the results of TB staining protocol. The in vitro CRS study demonstrated that spray cryotherapy removed polymicrobial biofilms from the mucosa surface in 70.6% of cases and induced important structural changes in the remaining samples.

Summary

Thus far, cryotherapy has proven to be a reliable method for the disruption of microbial biofilms in CRS with nasal polyps, in vitro conditions. Spray cryotherapy could be a considerable benefit in the management of recalcitrant CRS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CRS :

chronic rhinosinusitis

ESS :

endoscopic sinus surgery

HE :

hematoxylin-eosin (HE) and

TB :

toluidine blue

FESS :

functional endoscopic sinus surgery

CT :

computerized tomography

ENT surgeon :

Ears-Nose-Throat surgeon

TM :

Massons’ trichrome

CLSM :

confocal laser scanning microscopy

LPC :

lymphocytic

PMN :

polymorphonuclear

TH2 :

T helper 2 lymphocytes

SEM :

scanning electron microscopy

TEM :

transmission electron microscopy

FISH :

fluorescent in situ hybridization

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Copeland E, Leonard K, Carney R, Kong J, Forer M, Naidoo Y, Oliver BGG, Seymour JR, Woodcock S, Burke CM et al: Chronic rhinosinusitis: potential role of microbial dysbiosis and recommendations for sampling sites. Front Cell Infect Microbiol 2018, 8:57. The present paper presents an in depth picture of the microbiome present in chronic rhinosinusitis using high-throughput 16S rRNA gene sequencing together with the chalanges related to the correct sampling procedure for an accurate diagnosis. According to this study the middle meatus is not an effective representative sampling site given the small changes in variation across groups.

  2. •• Gocea A, Taulescu M, Trombitas V, Albu S. Effects of cryotherapy on the maxillary antrostomy patency in a rabbit model of chronic rhinosinusitis. Biomed Res Int. 2013;2013:101534. The authors of this study conducted an animal based controled, randomized, double-blind study showing that intraoperative low-pressure spray cryotherapy increases the patency of the maxillary antrostomy 4 weeks after surgery without other significant histological side effects prooving that this technique could also be a safe and effective technique in human subjects, representing the basis for the current research.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rudmik L: Chronic rhinosinusitis: an under-researched epidemic. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2015, 44:11.

  4. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital and health statistics series 10. Data Natl Health Surv. 2014(260):1–161.

  5. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012, 23:3. preceding table of contents, 1–298

  6. Schlosser RJ, Gage SE, Kohli P, Soler ZM. Burden of illness: a systematic review of depression in chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30(4):250–6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tomoum MO, Klattcromwell C, DelSignore A, Ebert C, Senior BA. Depression and anxiety in chronic rhinosinusitis. Intl Forum Allergy Rhinol. 2015;5(8):674–81.

    Article  Google Scholar 

  8. Nanayakkara JP, Igwe C, Roberts D, Hopkins C. The impact of mental health on chronic rhinosinusitis symptom scores. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2013, 270(4):1361–1364.

  9. Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otology Rhinology Laryngol Suppl. 2004;193:3–5.

    Article  Google Scholar 

  10. • Arild Danielsen K, Eskeland O, Fridrich-Aas K, Cecilie Orszagh V, Bachmann-Harildstad G. Burum-Auensen E: Bacterial biofilms in chronic rhinosinusitis; distribution and prevalence. Acta Otolaryngol. 2016;136(1):109–12. This paper demonstrates that there was a higher biofilm prevalence in the ethmoid bulla compared to other locations examined, supporting the biofilm-related pathogenesis of chronic rhinosinusitis deeper into the sinonasal cavity where due local conditions biofilms have excelent conditions for their development.

    Article  PubMed  Google Scholar 

  11. Lam K, Schleimer R, Kern RC. The etiology and pathogenesis of chronic rhinosinusitis: a review of current hypotheses. Curr Allergy Asthma Rep. 2015;15(7):41.

    Article  PubMed  PubMed Central  Google Scholar 

  12. •• Dlugaszewska J, Leszczynska M, Lenkowski M, Tatarska A, Pastusiak T, Szyfter W. The pathophysiological role of bacterial biofilms in chronic sinusitis. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2016, 273(8):1989–1994. The present study utilizes various experimental techniques in characterizing the heterogenous microbiota found in chronic rhinosinusitis patients and the various degrees of distruction of normal epithelial structures providind evidence towards the discrepancies generated by each detection method and the possible role of biofilm in the pathogenesis or resiliance of chronic rhinosinusitis.

  13. Ramakrishnan Y, Shields RC, Elbadawey MR, Wilson JA. Biofilms in chronic rhinosinusitis: what is new and where next? J Laryngol Otol. 2015;129(8):744–51.

    Article  PubMed  CAS  Google Scholar 

  14. Hayes SM, Howlin R, Johnston DA, Webb JS, Clarke SC, Stoodley P, et al. Intracellular residency of Staphylococcus aureus within mast cells in nasal polyps: a novel observation. J Allergy Clin Immunol. 2015;135(6):1648–51.

    Article  PubMed  Google Scholar 

  15. Garapati C, Clarke B, Zadora S, Burney C, Cameron BD, Fournier R, et al. Development and characterization of erythrosine nanoparticles with potential for treating sinusitis using photodynamic therapy. Photodiagn Photodyn Ther. 2015;12(1):9–18.

    Article  CAS  Google Scholar 

  16. Singh P, Mehta R, Agarwal S, Mishra P. Bacterial biofilm on the sinus mucosa of healthy subjects and patients with chronic rhinosinusitis (with or without nasal polyposis). J Laryngol Otol. 2015;129(1):46–9.

    Article  PubMed  CAS  Google Scholar 

  17. Goggin R, Jardeleza C, Wormald PJ, Vreugde S. Corticosteroids directly reduce Staphylococcus aureus biofilm growth: an in vitro study. Laryngoscope. 2014;124(3):602–7.

    Article  PubMed  CAS  Google Scholar 

  18. Das S, Rosas LE, Jurcisek JA, Novotny LA, Green KB, Bakaletz LO. Improving patient care via development of a protein-based diagnostic test for microbe-specific detection of chronic rhinosinusitis. Laryngoscope. 2014;124(3):608–15.

    Article  PubMed  CAS  Google Scholar 

  19. Suh JD, Ramakrishnan V, Palmer JN. Biofilms. Otolaryngol Clin N Am. 2010;43(3):521–30. viii

    Article  Google Scholar 

  20. Healy DY, Leid JG, Sanderson AR, Hunsaker DH. Biofilms with fungi in chronic rhinosinusitis. Otolaryngol—Head Neck Surg. 2008;138(5):641–7.

    Article  PubMed  Google Scholar 

  21. Foreman A, Psaltis AJ, Tan LW, Wormald PJ. Characterization of bacterial and fungal biofilms in chronic rhinosinusitis. Am J Rhinol Allergy. 2009;23(6):556–61.

    PubMed  Google Scholar 

  22. Fastenberg JH, Hsueh WD, Mustafa A, Akbar NA, Abuzeid WM. Biofilms in chronic rhinosinusitis: pathophysiology and therapeutic strategies. World J Otorhinolaryngol—Head Neck Surg. 2016;2(4):219–29.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Galli J, Calo L, Ardito F, Imperiali M, Bassotti E, Passali GC, et al. Damage to ciliated epithelium in chronic rhinosinusitis: what is the role of bacterial biofilms? Ann Otology Rhinol Laryngology. 2008;117(12):902–8.

    Article  Google Scholar 

  24. Psaltis AJ, Weitzel EK, Ha KR, Wormald PJ. The effect of bacterial biofilms on post-sinus surgical outcomes. Am J Rhinol. 2008;22(1):1–6.

    Article  PubMed  Google Scholar 

  25. • Tajudeen BA, Schwartz JS, Palmer JN. Understanding biofilms in chronic sinusitis. Curr Allergy Asthma Rep. 2016;16(2):10. Authors of this paper have provided an overview for the role of biofilms in chronic rhinosinusitis, highlighting the current understanding of biofilm pathogeneis and providing a rationale for the current therapeutic approach and future research strategies together with an insight in the role bitter taste receptors could play in the host’s innate immune response.

    Article  PubMed  Google Scholar 

  26. •• Koo H, Allan RN, Howlin RP, Stoodley P, Hall-Stoodley L. Targeting microbial biofilms: current and prospective therapeutic strategies. Nat Rev Microbiol. 2017;15(12):740–55. This up to date review presents the multifactorial development of biofilms and their hallmarks of resilience together with the current and under development therapeutic strategies to overcome resistance that target it’s various components, providing a rationale for a multifaceted approach.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Albu S, Trombitas V, Vlad D, Emanuelli E. The influence of spray cryotherapy on wound healing following endoscopic sinus surgery in chronic rhinosinusitis. Laryngoscope. 2016;126(1):25–32.

    Article  PubMed  Google Scholar 

  28. Nadel DM, Lanza DC, Kennedy DW. Endoscopically guided cultures in chronic sinusitis. Am J Rhinol. 1998;12(4):233–41.

    Article  PubMed  CAS  Google Scholar 

  29. Caselli M, Tosini D, Gafa R, Gasbarrini A, Lanza G. Segmented filamentous bacteria-like organisms in histological slides of ileo-cecal valves in patients with ulcerative colitis. Am J Gastroenterol. 2013;108(5):860–1.

    Article  PubMed  Google Scholar 

  30. Sridharan G, Shankar AA. Toluidine blue: a review of its chemistry and clinical utility. J Oral Maxillofac Pathol. 2012;16(2):251–5.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Biel MA, Sievert C, Usacheva M, Teichert M, Balcom J. Antimicrobial photodynamic therapy treatment of chronic recurrent sinusitis biofilms. Intl Forum Allergy Rhinol. 2011;1(5):329–34.

    Article  Google Scholar 

  32. • Hamilos DL. Host-microbial interactions in patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2014;133(3):640–653.e644. The current paper focuses on critical interactions between host and pathogens that could provide a better understanding for the pathogenesis of this disease, notably the local downregulated immune response as a consequence of dysregulated pattern recognition receptor pathways, in the presence of normal systemic imune function.

    Article  PubMed  CAS  Google Scholar 

  33. Ramadan HH, Sanclement JA, Thomas JG. Chronic rhinosinusitis and biofilms. Otolaryngol Head Neck Surg. 2005;132(3):414–7.

    Article  PubMed  Google Scholar 

  34. Ramadan HH. Chronic rhinosinusitis and bacterial biofilms. Curr Opin Otolaryngol Head Neck Surg. 2006;14(3):183–6.

    PubMed  Google Scholar 

  35. Ragab A, Essa N, El-Raghy N, Zahran W, El Borolsy A. Evaluation of bacterial adherence and biofilm arrangements as new targets in treatment of chronic rhinosinusitis. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2012;269(2):537–44.

    Google Scholar 

  36. Sanderson AR, Leid JG, Hunsaker D. Bacterial biofilms on the sinus mucosa of human subjects with chronic rhinosinusitis. Laryngoscope. 2006;116(7):1121–6.

    Article  PubMed  Google Scholar 

  37. Toth L, Csomor P, Sziklai I, Karosi T. Biofilm detection in chronic rhinosinusitis by combined application of hematoxylin-eosin and gram staining, European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2011;268(10):1455–62.

  38. •• Moore RF, Lile DJ, Abbas AE: Current status of spray cryotherapy for airway disease. J Thorac Dis 2017, 9(Suppl 2):S122-s129. This article reviews the current use of spray cryotherapy in various benign or malignant settings providing evidence towards the feasability of this method even in an outpatient setting with minimal side effects for airway disease given a proper protocol and provides the basic biological principles supporting this technique.

  39. Browning R, Turner JF Jr, Parrish S. Spray cryotherapy (SCT): institutional evolution of techniques and clinical practice from early experience in the treatment of malignant airway disease. J Thorac Dis. 2015;7(Suppl 4):S405–14.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This paper was published under the frame of the University of Medicine and Pharmacy Cluj-Napoca, Romania, Internal Grants 2016, project no. 4994/5/08.03.2016.

Author information

Authors and Affiliations

  1. Second Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Str. Republicii no. 18, 3400, Cluj-Napoca, Romania

    Diana Vlad, Alina Dutu, Anda Apostol, Veronica Trombitas, Adrian Mihalca & Silviu Albu

Authors
  1. Diana Vlad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alina Dutu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anda Apostol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Veronica Trombitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adrian Mihalca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Silviu Albu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diana Vlad.

Ethics declarations

Conflict of Interest

None to be declared.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Respiratory Infections

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vlad, D., Dutu, A., Apostol, A. et al. The Effect of Spray Cryotherapy on Microbial Biofilms in Chronic Rhinosinusitis. Curr Infect Dis Rep 20, 41 (2018). https://doi.org/10.1007/s11908-018-0647-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-018-0647-4

Keywords

Search

Navigation