While inflammation is the direct cause of rhinosinusitis, other factors may be at work that can cause the disease to become not only chronic but difficult to permanently cure. According to a new theory, a matrix forms in the sinuses that house the fungal or bacterial infection. This matrix is called a biofilm. This biofilm anchors to the surface of the sinus and is difficult to remove. Biofilms are slimy to the touch: pond scum is an example of a biofilm found in nature. In the body, common dental plaque is considered to be a type of biofilm. The biofilms found in the sinuses appear as a yellow-green gelatinous mucus that looks like apricot jelly and/or a slimy mucus that looks like the jelly found around fish when it is refrigerated.
Biofilms have now been implicated in many infectious processes, including periodontitis, musculoskeletal infections, cystic fibrosis pneumonia, chronic sinus disease, and CAID. The latest research has begun to show that the biofilm structure creates the possibility that certain bacteria or fungi can evade antibiotic and other therapy. What’s more, biofilms can deliberately release their bacteria, causing new acute infections. Unfortunately because of the biofilm properties, the only way to resolve these infections is by mechanical removal of the biofilms in the sinuses. This can occur only by irrigation and/or debridement.