How the heck can a barnacle stay stuck on the hull of a ship through all the tremendous currents and forces to wash it off?  And, how the heck could systemic or even topical antibiotics ever penetrate the “rubber cement” glycocalyx of snot that many of our chronic sinusitis patients have.   These two properties of biofilms (the ability to stick to a surface and the ability to form a protective glue like coating around themselves) make eradication of infection very difficult.

Infection in the upper respiratory tract is probably best described as detrimental colonization.   It seems that the presence of these bacteria stimulate a chronic inflammatory response (probably via a “superantigen” type of mechanism.  Eradication of enough “disease” is typically accomplished by the patients own defense mechanisms (cilia and immune defenses).  If this is not suffiecient then  topical and systemic antibiotics are often utilized.

Unfortunately, these previously mentioned properties of biofilms lead to a triumph of persistence for the bacteria.  We are then left with surgical options to literally “powerwash” the biofilms away and forcefully apply topical antibiotics.  In many cases, however, this is also unsuccessful.

So how do we get barnacles off a boat?  We add in soaps and surfactants and we physically scrub them off.  That has led to the development of instruments, irrigators, and topical drug administration systems.   We are also toying with the idea of using soaps, and surfactants.

Baby shampoo, bactroban, cortisporin otic suspension, surfactant, and Gentamycin irrigations have all been utilized both in the operating room and as an outpatient.