Coagulase-negative staphylococci (CoNS) as a significant etiological factor of laryngological infections: a review.

This review article shows that coagulase-negative staphylococci (CoNS) are widely responsible for laryngological diseases. General characteristics of CoNS infections are shown in the introduction, and the pathogenicity in terms of virulence determinants, biofilm formation and genetic regulation mechanisms of these bacteria is presented in the first part of the paper to better display the virulence potential of staphylococci. The PubMed search keywords were as follows: CoNS and: nares infections, nasal polyps, rhinosinusitis, necrosing sinusitis, periprosthetic joint infection, pharyngitis, osteomyelitis of skull and neck bones, tonsillitis and recurrent tonsillitis. A list of laryngological infections and those related to skull and neck bones was presented with descriptions of the following diseases: rhinosinusitis, necrotizing sinusitis, nasal polyps, nares and nasal skin infections, periprosthetic joint infections, osteomyelitis, pharyngitis, and tonsillitis. Species identification and diagnostic problems challenging for diagnosticians are presented. Concluding remarks regarding the presence of CoNS in humans and their distribution, particularly under the effect of facilitating factors, are mentioned.

Infecciones por micobacterias en otorrinolaringología: revisión de la literatura / Mycobacterial infections in otolaryngology: review

Las micobacterias constituyen un grupo de bacilos aeróbicos no capsulados y no móviles, algunos de los cuales son patógenos causantes de graves enfermedades en los mamíferos incluyendo tuberculosis y lepra. Chile, a pesar de pertenecer al grupo de países de baja prevalencia de tuberculosis en América, presentó un enlentecimiento en la curva de descenso de incidencia. Así mismo, se ha visto un aumento de micobacterias atípicas tanto en muestras pulmonares como extrapulmonares respecto a décadas anteriores. Por otra parte, las infecciones por micobacterias adquieren importancia en otorrinolaringología dado que la tuberculosis de cabeza y cuello representa alrededor del 10% a 35% de los casos de tuberculosis, siendo su localización más frecuente los ganglios linfáticos. La siguiente revisión abarcará los cuadros de infecciones por micobacterias en otorrinolaringología, sus manifestaciones clínicas, diagnóstico y tratamiento.

Mycobacteriums are a group of aerobic non-capsuled and non-mobile bacillus some of which can cause diseases in mammals such as tuberculosis and leprosy. Chile, despite belonging to the group of countries with low prevalence of tuberculosis in America, presented a slowing in the decline in incidence curve. At the same time there has been an increase in atypical mycobacterium in pulmonary and extrapulmonary samples, comparedto past decades. On the other hand infections by mycobacterium become important because the head and neck tuberculosis accounts for about 10%-35% of cases of tuberculosis, the most common site being the lymph nodes. The following review will cover mycobacterial infections in otolaryngology clinical manifestations, diagnosis and treatment.

[Infectious ENT emergencies]. / Les urgences infectieuses ORL.

Extremely serious diseases associated with very poor prognosis, especially in this context of undermedicalization and poverty. The aim of this case study was to determine the etiologies of these emergencies and to discuss their therapeutic management. Retrospective-descriptive study conducted over a 5-year period, a total of 52 clinical records were included. These infections accounted for 0.33% of our consultations. The average age of our patients was 23 years. Young age, inappropriate treatments and some ENT disorders were found to be contributing factors. The reasons for consultation were varied, depending on the site of infection; however, two clinical signs were constant: pain and fever. Adenophlegmon, peritonsillar phlegmon, cellulitis were our main etiologies together with streptococcus and staphylococcus which were the commonest causative bacteria. Empirical antibiotic therapy was used as first-line therapy, in particular third-generation cephalosporin + aminoglycoside + imidazole combination. Clinical course was marked by local and systemic complications. The evolution of diagnostic and therapeutic ENT emergencies management plans still encounters complications due to patient delay in seeking consultation.

Deep Neck Infection: A Review of 130 Cases in Southern China.

The study aims to present our experience of the clinical course and management of deep neck infection and try to determine if the characteristics of this kind of infection were similar between the children and adults in southern China.Patients diagnosed with deep neck infection in the Division of Otolaryngology in the First Affiliated Hospital of Sun Yat-sen University between January 2002 and December 2011 were screened retrospectively for demographic characteristics, presenting symptoms, antibiotic therapy before admission, the history of antibiotics abuse, leucocyte count, etiology, bacteriology, disease comorbidity, imaging, treatment, complications, and outcomes.One hundred thirty patients were included and 44 (33.8%) were younger than 18 years old (the children group), 86 patients (66.2%) were older than 18 years old (the adults group). Fever, trismus, neck pain, and odynophagia were the most common symptoms in both groups. Forty children (90.9%) and 49 adults (57.0%) had been treated with broad-spectrum antibiotic therapy before admission. Thirty one children (70.5%) and 24 adults (27.9%) had a history of antibiotics abuse. In children group, the site most commonly involved was the parapharyngeal space (18 patients, 40.9%). In adults group, the site most commonly involved was multispace (30 patients, 34.9%). In children group, the most common cause was branchial cleft cyst (5 patients, 11.4%) and the cause remained unknown in 31 patients (70.5%). In adults group, the most common cause was pharyngeal infection (19 patients, 22.2%). All of the 27 patients with associated disease comorbidity were adults and 17 were diabetes mellitus (DM). Streptococcus viridans was the most common pathogen in both children and adults groups. Eighty six (66.2%) underwent surgical drainage and complications were found in 31 patients (4 children, 27 adults).Deep neck infection in adults is easier to have multispace involvement and lead to complications and appears to be more serious than that in children. Understanding the different characteristics between the children and adults with deep neck infection may be helpful in accurate evaluation and proper management.

In defence of 'dye therapy'.

Worldwide, healthcare is facing enormous problems with the continuing rise of drug-resistant infectious diseases. In view of the scarcity of new antimicrobial agents and the withdrawal of many pharmaceutical houses from the fray, alternative approaches are required. One of these is photoantimicrobial chemotherapy, which is highly effective across the range of microbial pathogens and does not suffer from resistance. However, there is a lack of uptake of this approach by healthcare providers and the pharmaceutical industry alike. It is seldom recalled that, unlike anticancer photodynamic therapy, the development of photoantimicrobial agents has evolved from the antiseptic 'dye therapy' in common use until the widespread introduction of the penicillin class in the mid-1940s. Cationic biological dyes such as methylene blue, crystal violet and acriflavine were effective in local wound therapy and today provide a sound basis for light-activated antimicrobial therapeutics. It is proposed that such 'safe' dyes are introduced as locally administered photoantimicrobials, especially in order to conserve valuable conventional antibacterial drugs.

Determination of the biofilm formation capacity of bacterial pathogens associated with otorhinolaryngologic diseases in the Malaysian population.

This study aims to assess the association between microbial composition, biofilm formation and chronic otorhinolaryngologic disorders in Malaysia. A total of 45 patients with chronic rhinosinusitis, chronic tonsillitis and chronic suppurative otitis media and 15 asymptomatic control patients were studied. Swab samples were obtained from these subjects. Samples were studied by conventional microbiological culturing, PCR-based microbial detection and Confocal Laser Scanning Microscopy (CLSM). Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci (CoNS) and other Streptococcus species were detected in subjects of both patient and control groups. Biofilm was observed in approximately half of the smear prepared from swab samples obtained from subjects of the patient group. Most of these were polymicrobial biofilms. S. aureus biofilm was most prevalent among nasal samples while H. influenzae biofilm was more common among ear and throat samples. Results from this study supported the hypothesis that chronic otorhinolaryngologic diseases may be biofilm related. Due to the presence of unculturable bacteria in biofilms present in specimens from ear, nose and throat, the use of molecular methods in combination with conventional microbiological culturing has demonstrated an improvement in the detection of bacteria from such specimens in this study.

The role of the human microbiome in otolaryngology-head and neck surgery: a contemporary review.

OBJECTIVES/HYPOTHESIS: The human microbiome represents the collective genomes and gene products of microbes living within and on humans. The objective of this review is to provide a summary of the current microbiome literature pertaining to otolaryngology-head and neck surgery. DATA SOURCE: Ovid MEDLINE. METHODS: Scientific publications with clinical correlates. RESULTS: Human microbiome studies have been facilitated by culture-independent, high-throughput sequencing methods. Data from the Human Microbiome Project has shown that the composition of the human microbiome is specific to each body site and that each individual has a unique microbiome. Alterations in the human microbiome are associated with some disease states; thus, novel therapeutic strategies are being developed based on concepts and findings stemming from microbiome research. CONCLUSIONS: Although a growing body of research shows potential significance of the human microbiome for human health and disease, there is a paucity of microbiome studies in otolaryngology. More studies are required to increase our understanding of the indigenous microbiota and their effects on diseases of the head and neck.

Infecciones por Streptococcus anginosusen otorrinolaringología: revisión de 9 casos clínicos / Infections caused by Streptococcus anginosusin otolaryngology: review of 9 clinical cases

Introducción: El Streptococcus anginosus (SA) es un habitante común de la cavidad oral y tracto gastrointestinal, y puede ser un patógeno agresivo causante de abscesos en varios sitios del cuerpo. Aparentemente, su rol en infecciones de cabeza y cuello está adquiriendo cierta notoriedad y no está claramente reportado en la literatura. Objetivo: El objetivo del presente estudio fue evaluar las implicancias clínicas de estas infecciones en otorrinolaringología. Material y método: Estudio retrospectivo de todos los pacientes diagnosticados microbiológicamente con infecciones causadas por Streptococcus anginosus, tratados en el Servicio de Otorrinolaringología del Hospital Barros Luco-Trudeau entre los años 2007 a 2012. Se describen las características clínicas, microbiológicas y el manejo de los pacientes. Resultados: La muestra estuvo constituida por 9 casos, 3 hombres y 6 mujeres, con una mediana de edad de 52 años (rango 6-70). Los sitios de infección fueron: absceso periamigdalino (2 casos), un absceso peritraqueostoma, un absceso submandibular, un absceso submentoniano, un absceso parafaríngeo con extensión retrofaríngea y mediastino, un caso de absceso cerebral frontal secundario a sinusitis frontal complicada, un caso de otitis media crónica activa, y un caso de sinusitis maxilar crónica. Discusión: El SA ha sido reportado como un agente causal de infecciones potencialmente graves en cabeza y cuello. Su identificación requiere de consideraciones especiales para el cultivo, y al ser un microorganismo común puede ser confundido e informado como S viridans o Streptococcus anaeróbico. Es importante reconocer al SA como un patógeno a considerar en infecciones de cabeza y cuello.

Introduction: Streptococcus anginosus (SA) is a common inhabitant of the oral cavity and gastrointestinal tract, and can be an aggressive pathogen causing abscesses in various body sites. Apparently, its role in head and neck infections is gaining some notoriety that it is not clearly reported in the literature. Aim: The aim of this study was to evaluate the clinical implications of this infections in otolaryngology. Material and method: A retrospective case series study of all patients diagnosed microbiologically with Streptococcus anginosus infections treated at the Department of Otolaryngology, HospitalBarros Luco-Trudeau from 2007 to 2012. We describe the clinical and microbiological features, and treatment of each patient. Results: The sample consisted of 9 patients, 3 men and 6 women, with a median age of 52 years (range 6-70). The sites of infection were: peritonsillar abscess (2 cases), peritracheostomy abscess, submandibular abscess, submental abscess, parapharyngeal abscess with retropharyngeal and mediastinal extension, a case of frontal brain abscess secondary to frontal sinusitis, a case of otitis chronic active half, and one case of chronic maxillary sinusitis. Discussion: SA has been reported as a causative agent ofpotentially serious infections in the head and neck region. Their identification requires special considerations for growing, and because of being a common microorganism may be confused and informed as Streptococcus viridans or anaerobic streptococcus. It is important to recognize SA as a relevant pathogen in head and neck infections.

[Primary mucosal tuberculosis of head and neck region: a clinicopathologic analysis of 47 cases].

OBJECTIVE: To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region. METHODS: Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature. RESULTS: The patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients. CONCLUSIONS: Primary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.

[Head and neck tuberculosis - still current problem in ENT practice]. / Gruzlica narzadów glowy i szyi - wciaz aktualny problem w praktyce laryngologicznej.

INTRODUCTION: It is estimated that between XVI and XIX century one fourth of European population died of tuberculosis. Nowadays tuberculosis is still one of the most important infectious diseases. In 2009 estimately 9 million new cases were registered worldwide, mortality due tuberculosis reached 1.5 million. In Poland extrapulmonary tuberculosis is rare (7% of overall morbidity) and most commonly affects pleura, lymph nodes, bones, joints and genitourinary system. Head and neck tuberculosis is rare and causes many diagnostics problems. METHODS: Retrospective analysis of case histories of patients admitted to ENT Department of Silesian Medical University in Katowice. RESULTS: Between 1993 and 2010 four cases of head and neck tuberculosis were diagnosed in our Clinic. Two of patients were admitted to the hospital with symptoms of laryngeal tumor such as difficulty in swallowing. During direct laryngoscopy tissue specimens were taken. Examination of the third patient showed tumor located below left angle of mandibule. During superficial parotidectomy tumor was removed. In the fourth registered case tuberculosis manifested as tumor of nasopharynx. In every case which is mentioned above pathology reports revealed epithelioid cell granulomas with caseous necrosis typical for tuberculosis. Patients underwent tuberculostatic treatment. CONCLUSION: Rare occurrence and lack of characteristic symptoms of head and neck tuberculosis often lead to misdiagnosis. Histopathological examination is the most important diagnostic procedure. Microbiological examination is difficult in extrapulmonary tuberculosis, because of low concentration of pathogens in specimens. Tuberculostatic therapy is the leading method of treatment in every case of tuberculosis.

Tuberculosis presenting as bilateral vocal fold palsy: case report and review of otolaryngological manifestations of tuberculosis.

OBJECTIVE: We report a rare case of tuberculosis presenting with bilateral vocal fold palsy. METHOD: Case report and discussion of ENT manifestations of tuberculosis. CASE REPORT: A 39-year-old man presented with stridor and bilateral vocal fold palsies, and underwent an emergency tracheostomy. Intra-operatively, a mass was identified overlying the thyroid cartilage. Fine needle aspiration cytology of this mass showed well formed granulomas but negative Ziehl-Nielsen staining. Computed tomography showed the mass to be surrounding the thyroid cartilage, causing airway occlusion; pulmonary infiltrates were also seen. The patient was commenced on tuberculosis treatment. Subsequent sputum samples from the tracheostomy confirmed the diagnosis. The patient responded very well to treatment, and was successfully decannulated after one week. CONCLUSION: The incidence of tuberculosis in the UK is increasing, particularly in urban areas. The otolaryngologist may encounter a wide variety of presentations. Diagnosis requires a high index of clinical suspicion.

Eradicating chronic ear, nose, and throat infections: a systematically conducted literature review of advances in biofilm treatment.

OBJECTIVE: Bacteria can grow as individual, planktonic organisms or as complex biofilm communities that are more resistant to treatment. This review was designed to systematically search to identify recent laboratory studies on eradication of biofilms in otolaryngologic infections to highlight promising advances in biofilm treatment. DATA SOURCES: A systematic electronic literature search of Medline/PubMed, CINHAL, and Web of Science was conducted for articles describing the treatment of biofilm infections in ear, nose, and throat (ENT) diseases through March 2010. English-language articles and articles with an English abstract that focused on biofilm treatment were considered for review. REVIEW METHODS: Each included article was reviewed by one of the authors for study design, treatment intervention, and outcome. Data from in vitro and animal studies were considered separately from human studies. RESULTS: A total of 30 articles were identified for this review, including 5 studies that included a human treatment component. In general, antibiotics were relatively ineffective for eradicating biofilm infections. Markedly higher antibiotic dosages were required to reduce biofilm presence compared with doses that were effective in eradicating planktonic bacteria. Mupirocin irrigation, gentian violet, and thiamphenicol glycinate acetylcysteine effectively eradicated biofilms. Physical disruption, surfactants, and probiotics were also shown to be beneficial in both nonhuman and human studies. CONCLUSION: Eradicating ENT biofilms is difficult when treating single-organism or mixed flora biofilms. Antibiotic therapy is often ineffective against biofilms, and clinical treatment may need to focus on nonantibiotic therapies that reduce, disrupt, or eradicate ENT biofilms.

Diagnosis of tuberculosis in the head and neck.

OBJECTIVES: To establish the features of Mycobacterium tuberculosis infection in the head and neck region, and to determine which investigations have the greatest diagnostic accuracy. STUDY DESIGN: Region-based, retrospective cohort study. METHOD: The study included 148 patients with tuberculosis of the head and neck treated in the Greater Glasgow and Clyde region between 2000 and 2007. RESULTS: The following diagnostic sensitivities were calculated: 53 per cent for fine needle aspiration, 95 per cent for core biopsy and 91 per cent for lymph node excision biopsy. There was a statistically significant difference between the sensitivity results for fine needle aspiration versus core biopsy (p = 0.0003) and fine needle aspiration versus excision biopsy (p < 0.0001). There was no statistically significant difference between the sensitivity results for core biopsy and excision biopsy. CONCLUSION: Core biopsy has equivalent diagnostic accuracy to excision biopsy in the investigation of head and neck tuberculosis. We suggest that core biopsy should be used in preference to lymph node excision, as it can be performed under local anaesthetic outside the operating theatre. A proposed algorithm for diagnostic management is included.

Treatment of methicillin-resistant Staphylococcus aureus pediatric head and neck infections: results of a national survey of otolaryngologists in the United States.

OBJECTIVE: Little information is available concerning the treatment of pediatric head and neck infections caused by methicillin-resistant Staphylococcus aureus (MRSA), which is resistant to antimicrobial agents such as cephalosporins. The objective of this investigation is to describe clinical characteristics of pediatric MRSA head and neck infections in the United States and how they are treated. DESIGN: National survey. SETTING: United States. METHODS: Practicing members of the American Academy of Otolaryngology-Head and Neck Surgery were surveyed regarding patients aged < 18 years with MRSA head and neck infections during 2006. MAIN OUTCOME MEASURES: Clinical characteristics and treatment of pediatric MRSA infections. RESULTS: Of 701 surveys sent, 201 were completed (adjusted response rate 30%). Otolaryngologists responding to the survey reported treating a total of 1123 pediatric MRSA head and neck infections in 2006. Forty-seven percent reported treating pediatric patients with MRSA infections in the otologic region, 39% in the oropharyngeal/neck region, and 17% in the sinonasal region. The antimicrobials most frequently used to treat these infections were clindamycin, trimethoprim-sulfamethoxazole, and vancomycin. Cephalosporins and fluoroquinolones were also commonly prescribed. CONCLUSIONS: Otolaryngologists in the United States reported treating a broad range of MRSA head and neck infections in pediatric patients. Although most were treated with appropriate antimicrobials, some were treated with agents not active against MRSA.

Microbiology in complicated head and neck infections.

OBJECTIVE: To identify the pathogens associated with complicated ear, throat and sinus infections and to link the relevant susceptibility patterns to the empirical therapy currently advised in the Dutch guidelines. STUDY DESIGN: Retrospective, descriptive study of consecutive cases. SETTING: Tertiary referral centre. PATIENTS: All consecutive patients with a complicated ear, nose and throat infection who underwent surgery at a tertiary referral centre during a six-year period. The term 'complicated' was used to define infections that had spread outside the primary region of infection (middle ear cavity, pharyngeal mucosa, or paranasal sinus) and which therefore, under our policy, required surgical intervention. MAIN OUTCOME MEASURE: Microbiological culture and susceptibility pattern RESULTS: A total of 96 patients were included in this study. The predominant causative organisms for the infections were Streptococcus pneumonia, beta hemolytic streptococci and Streptococcus milleri for ear, throat, and sinus infections, respectively. These were all susceptible to the recommended empirical therapy. Cultures from 6 patients yielded coagulase-negative staphylococci resistant to frequently used antibiotics. The mortality rate in our series was 13% for ear infections. This was caused by complicated infections in young children and patients with cholesteatoma. Ten per cent of the ear infections in adults yielded Pseudomonas aeruginosa and 25% yielded anaerobes. CONCLUSIONS: Ear infections in young children and in patients with cholesteatoma should be treated aggressively. Our results suggest that patients with intracranial complications stemming from ear infections should preferably be treated with a combination therapy including antibiotics targeting gram negatives and anaerobes. The role of coagulase-negative staphylococci, especially in neck abscesses, may be more important than has been thought until now.

Nationwide trends in pediatric Staphylococcus aureus head and neck infections.

OBJECTIVES: To evaluate the epidemiologic manifestations of pediatric Staphylococcus aureus head and neck infections nationwide and to identify possible trends in the antibiotic drug susceptibility of S aureus during a 6-year period. DESIGN: Retrospective review of microbiologic data from a peer-reviewed national database. SETTING: More than 300 hospitals nationwide. PATIENTS: All pediatric patients with head and neck infections involving S aureus. MAIN OUTCOME MEASURES: Anatomic sites were divided into oropharynx/neck, sinonasal, and otologic infection categories. Demographic and antimicrobial drug susceptibility patterns were reviewed. RESULTS: A total of 21,009 pediatric head and neck S aureus infections that occurred between January 2001 and December 31, 2006 were gathered from the database. Predominance was observed in the oropharyngeal/neck category (60.3%). For all sites, the mean patient age was 6.7 years (range, 0-18 years), with a 51.7% male predominance. There was a high occurrence in the North East Central region of the United States. Overall, methicillin-resistant S aureus was seen in 21.6% of all patient isolates (n = 4534), with rates of 11.8%, 12.5%, 18.1%, 27.2%, 25.5%, and 28.1% for 2001 through 2006, respectively. This represents a 16.3% increase in methicillin-resistant S aureus during these 6 years for all pediatric head and neck S aureus infections. CONCLUSIONS: There is an alarming nationwide increase in the prevalence of pediatric methicillin-resistant S aureus head and neck infections. Disparities in the treatment of various head and neck infections nationwide may contribute to the regional differences in the prevalence of such infections. Judicious use of antibiotic agents and increased effectiveness in diagnosis and treatment are warranted to reduce further antimicrobial drug resistance in pediatric head and neck infections.

[Fungal infection in the otorinolaryngologic area].

Recent trends of fungal infections of the ear and nose were introduced from the viewpoint of otolaryngologic practice. Aspergillus terreus was the most common pathogen of otomycosis followed by A. niger and A.flavus. Aspergillosis is the most common fungal disease in the paranasal sinuses. Unilateral opacity of the maxillary sinus which contains flecks of calcification was specifically found by CT-study. These two fungal infections are easily treated surgical removal of the fungus ball and establishment of a drainage route to the nasal passage by endoscopic sinus surgery are effective to manage aspergillomas in paranasal sinuses. These two fungal infections usually occurred in immunocompetent patients and the relationship between diabetes mellitus as the underlying disease is not established.

Antibacterial activity of mometasone furoate.

OBJECTIVE: To test the antibacterial properties of the topical corticoid mometasone furoate, which is used as a nasal spray. DESIGN: The activity of mometasone (0.01%, 0.1%, and 0.5%) in buffer solution against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Streptococcus pyogenes, and Streptococcus milleri was tested by quantitative killing assays. SETTING: In vitro study. MAIN OUTCOME MEASURE: Reduction of viable bacteria and fungi in quantitative killing assays. RESULTS: Mometasone (0.5%) reduced viable counts of S pyogenes and S milleri by 99.99% and 99.00%, respectively, after 24 hours of incubation, whereas colony-forming units (CFUs) of S aureus, P aeruginosa, and E coli were not affected by the corticoid. Mometasone (0.1%) caused a decrease in CFUs of S pyogenes of 99.90% to 99.99%, while it led to a 99.00% reduction in CFUs of S milleri, but only if low bacterial counts of 1 x 10(4) CFUs/mL were incubated. By contrast, the use of mometasone at a low concentration (0.01%) demonstrated an increase in CFUs of S milleri if the baseline bacterial count was low (1 x 10(4) CFUs/mL). CONCLUSION: Mometasone demonstrates antimicrobial activity against streptococci.

Biofilms and their role in otorhinolaryngological disease.

OBJECTIVE: To describe the pathophysiology of biofilm communities and their role in otorhinolaryngological disease, with reference to the published literature. DESIGN: Review of relevant literature, using Medline and the combined search terms 'biofilms' and 'otorhinolaryngology', and also various related keywords such as 'tonsil' and 'adenoid'. RESULTS: Description of biofilm pathophysiology and of published reports of biofilms in otorhinolaryngological disease. CONCLUSION: Virtually all microbes live in biofilm communities. Within these communities, the microbes assume differing specialised roles which confer survival advantages on the community. These communities cause chronic and device-associated infections. Within the specialist field of otorhinolaryngology, biofilms have been shown to play a role in many infections, including: chronic otitis media, cholesteatoma, chronic tonsillitis, chronic sinusitis, and infections of tracheostomies, endotracheal tubes and cochlear implants.