J Rhinol.  2016 May;23(1):55-59. 10.18787/jr.2016.23.1.55.

Bioballs Causing Asymptomatic or Recurrent Acute Rhinosinusitis: Two Cases

  • 1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea. shcho@hanyang.ac.kr
  • 2Department of Pathology, College of Medicine, Hanyang University, Seoul, Korea.


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.


Biofilm; Bacteria; Pseudomonas; Rhinosinusitis; Maxillary sinus
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