A possible explanation for the discrepancy between high PCR-positive rate and low culture-positive rate in OME is the involvement of biofilms in the progression of this pathology [20]. Indeed, biofilms have been identified on human middle ear mucosa in children with OME and/or recurrent AOM in more than 90% of cases, but not in any control samples studied [12]. In addition to tissue surfaces, biofilms have also been identified attached to mucus [21,22] and attach in vitro to collagen gel matrix [23]. In OME, biofilms may be attached to mucus as well as mucosa, thus providing the inflammatory stimulus leading to a middle ear effusion [10,13,24].
children with OME and/or recurrent AOM
biofilms have been identified on human middle ear mucosa
more than 90%
%