Bioballs Causing Asymptomatic or Recurrent Acute Rhinosinusitis: Two Cases

Hong Dae Kim; Dong Won Lee; Ju Yeon Pyo; Young-Ha Oh; Seok Hyun Cho

doi:10.18787/jr.2016.23.1.55

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Kim, Lee, Pyo, Oh, and Cho: Bioballs Causing Asymptomatic or Recurrent Acute Rhinosinusitis: Two Cases

Case Report

J Rhinol 2016;23(1):55-59.

Published online: 10 January 2016

DOI: https://doi.org/10.18787/jr.2016.23.1.55

Bioballs Causing Asymptomatic or Recurrent Acute Rhinosinusitis: Two Cases

Hong Dae Kim, MS¹, Dong Won Lee, MD¹, Ju Yeon Pyo, MD², Young-Ha Oh, MD, PhD², Seok Hyun Cho, MD, PhD^1,

¹ Departments of Otolaryngology-Head and Neck Surgery

² Pathology, College of Medicine, Hanyang University, Seoul, Korea

교신저자：조석현, 04763 서울시 성동구 왕십리로 222-1 한양대학교 의과대학 이비인후-두경부외과학교실 Tel: +82-2-2290-8591, Fax: +82-2-2293-3335, E-mail: shcho@hanyang.ac.kr

Received 22 August 2015 Revised 16 November 2015 Accepted 29 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A variety of intrinsic and extrinsic factors have been studied to explain the pathogenesis of rhinosinusitis. Recently biofilms are emerging as an important cause. Biofilms are highly organized structures composed of a protective extracellular matrix and bacterial colonies, and provide the means for bacterial survival and virulence. Biofilms are known to be associated with intractable cases of rhinosinusitis and antibiotic resistance. Patients diagnosed with biofilm-related rhinosinusitis tend to suffer more severe disease that those without biofilms. Biofilm severity can also influence the prognosis of rhinosinusitis. We present two cases of pseudomonas-induced macroscopic biofilms (bioballs) of the maxillary sinuses. These bioballs cause intractable chronic rhinosinusitis as well, but unlike traditional biofilms, they can be surgically removed by endoscopy, and thus have a better prognosis than traditional biofilms. This is the first report of visible biofilms (bioballs) found in the maxillary sinuses.

Keywords: Biofilm, Bacteria, Pseudomonas, Rhinosinusitis, Maxillary sinus.

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Fig. 1.

Preoperative paranasal CT scans of two cases of bioballs. Symptomatic maxillary sinusitis was located at the left side in case 1 (A) and the right side in case 2 (B). However, incidental maxillary sinusitis was also found at the opposite sides for each cases (bioballs).

Fig. 2.

Intraoperative findings of bioballs (macroscopic biofilm) obtained from case 1 (A-D) and case 2 (E-H). Dark brown colored fungal balls were found at the left maxillary sinus of case 1 (B and D) and right maxillary sinus of case 2 (E and G). However, green or gray colored gel-like materials were found at the right maxillary sinus of case 1 (A and B) and the left maxillary sinuses of case 2 (F and H).

Fig. 3.

Microscopic findings of case 1. Greenish gel-like material (A, H-E stain, original magnification ×40) from the right maxillary sinus reveals a bioball consisting of thick acellular mucous material and peripherally arranged bacterial colonies (arrow) with acute inflammatory cell infiltrates (B, H-E stain, original magnification ×400). Most of bacterial colonies show gram negativity (C, Gram stain, original magnification ×400).

Fig. 4.

Microscopic findings of the case 2. Gel-like materials obtained from left maxillary sinus reveals a friable necrotic acellular mucoid material (A, H-E stain, ×40) with dispersed bacterial colonies (B, H-E stain, ×200).

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