BioFilms in Chronic Rhino Sinusitis

You might be wondering why antibiotics and antifungal drugs are ineffective for chronic sinus infections.  It's because of the Bio-Film formation.  Biofilms are colonies of microbes that form a mass which is resistant to drug therapy.

A Syndrome Which is Quite Common

Chronic Sinusitis, nasal polyposis, asthma and eosinophilia are quite common and may co-exist as a syndrome.    Chronic bacterial or fungal sinus infection with Bio-Film formation has been implicated in this syndrome.  Many of these patients have been on multiple courses of antibiotics and/or antifungal drugs which are completely ineffective because of bio-film formation.    Many of these patients have undergone repeated nasal sinus surgeries, and are commonly steroid dependent from chronic use of prednisone.

Below is a link to a useful Slide Show presentation which discusses BioFilm formation, and newer treatment methods for BioFilm eradication such as baby shampoo surfactant irrigation, light therapy, low level ultrasound, manuka honey irrigation etc,  Additionally, some users feel that Xylitol nasal irrigation is superior to saline, and pulsed Irrigation systems may be superior to the squeeze bottle type systems.  Proteolytic enzymes such as serra-peptidase may be of use in digesting the bio-film.  Probiotics must also be added whenever anti-microbial remedies are used.

Above Left image of biofilm courtesy of U Penn, Below Image CAT Scan showing sinusitis courtesy of Family Practice Notebook.

Slide Show explaining BioFilms: GRAND ROUNDS FEB 19, 2014, Angela Natili, MD  U. of Texas Dept. of Otolaryngology: Click Here: 2014-02-pic-biofilm-and-crs.

Click Here for: Russell Faust MD,  Five step program to eliminate Sinusitis.

NASAL- Sinus  Irrigation

This is a Case Report by Dr Russell Faust showing serial CAT Scans of clearing of sinus cavities over time using simple saline irrigation: 3 Year Old Boy Hospitalized For Severe Sinusitis: Simple Cure.
Buy on Amazon: NasoPure Irrigation System by Dr. Hana R. Solomon, M.D

Xylitol Nasal Irrigation

General info on nasal xylitol from A. H. 'Lon' Jones D.O.  Nasal Xylitol.com
Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study Joshua D. Weissman MD, Francisca Fernandez MD and Peter H. Hwang MD* The Laryngoscope  Volume 121, Issue 11, pages 2468–2472, November 2011

Buy XClear (Xylitol Irrigation) on Amazon: Xlear Nasal Spray, 1.5 fl oz liquid
Buy Pulsed Nasal Irrigation System on Amazon
Nasal Irrigation Protocol Heidi Peterson ND
Hydro-Pulse Irrigation System Dr Murray Grossan
Enzyme Therapy to Dissolve Bio-Film - InterFase Plus
Buy on Amazon: Specialized enzymes and EDTA disrupt biofilm matrix embedding potential gastrointestinal pathogens. InterFase Plus and Probiotics.

Klaire Labs - Interfase Enzyme Supplement - 120 Veg Caps
Add on probiotics: Prescript-Assist Broad Spectrum Probiotic Prebiotic Complex (60 Caps)

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Sublingal Immunotherapy Drops for Allergies: This is a useful book on Amazon for treating underlying Allergies as a cause of asthma: Dr. Dean Mitchell's Allergy and Asthma Solution:  Sublingual Immunotherapy, Allergy Drops. 
Articles with related interest:  More on Oregano as anti microbial
References:
Nasal Irrigation:
Nasal_Irrigation_Tomooka_Laryngoscope_2000
Clinical Study and Literature Review of Nasal Irrigation. Lance T. Tomooka, Claire Murphy PhD and Terence M. Davidson MD
The Laryngoscope Volume 110, Issue 7, pages 1189–1193, 2000
Buy on Amazon: NasoPure Irrigation System by Dr. Hana R. Solomon, M.D
Web Site for Hana R. Solomon, M.D Nasal Saline Rinse System  (Nasopure),  Dr. Hana’s Nasopure.
Videos on You Tube: How to Use NasoPure Nasal Irrigation System
Buy on Amazon: Water Pic Nasal Sinus  Irrigation System
Eosinophilia is poor prognostic sign:
1) Significance of eosinophilia in chronic rhinosinusitis. American Journal of Rhinology, 2002, Vol 16, Iss 6, pp 313-317. MH Zadeh, V Banthia, VK Anand, C Huang. Anand VK, 205 E 64th St, New York,NY 10021 USA.
2) Eosinophilic inflammation in sputum of poorly controlled asthmatics. European Respiratory Journal, 2002, Vol 20, Iss 6, pp 1370-1377. M Romagnoli, I Vachier, PT delaFuente, H Meziane, C Chavis, J Bousquet, P Godard, P Chanez. Chanez P, Ctr Hosp Univ Montpellier, Hop Arnaud Villeneuve, Clin Malad Resp, Inst Natl Sante & Rech Med, U454, F-34295 Montpellier 5, FRANCE.
3) Clinical factors influencing the eosinophil infiltration of nasal polyps. Rhinology, 2002, Vol 40, Iss 4, pp 173-178. R Jankowski, F Bouchoua, L Coffinet, JM Vignaud. Jankowski R, Henri Poincare Univ, Serv ORL, CHU Cent Hosp, Dept Otorhinolaryngol, 29 Ave Lattre Tassigny, CO 34, F-54035 Nancy, FRANCE

In Testing for Allergies, a Single Shot May Suffice
By LAURIE TARKAN Published: March 20, 2007
Broward Center for Allegy and Sinus Dr Callari : Sublingual Immunotherapy
Richard H. Callari, MD,

Broward Sinus & Allergy Center
1625 S.E. 3rd Avenue, Suite 717
Fort Lauderdale, FL 33316
Phone: (954) 760-7836
Fax: (954) 760-7869
www.browardsinusandallergy.com
Angela Natili, MD  THE UNIVERSITY OF TEXAS DEPARTMENT OF OTOLARYNGOLOGY.  GRAND ROUNDS FEB 19, 2014  Francis B. Quinn, Jr., MD, FACS,  Melinda Stoner Quinn, MSICS  2014-02-pic-biofilm-and-crs
Xylitol Nasal Irrigation
Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study Joshua D. Weissman MD, Francisca Fernandez MD and Peter H. Hwang MD* The Laryngoscope  Volume 121, Issue 11, pages 2468–2472, November 2011
Buy XClear on Amazon: Xlear Nasal Spray, 1.5 fl oz liquid

Link to this article:http://wp.me/p3gFbV-2na

Jeffrey Dach MD
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