Biofilms and Chronic Sinusitis

Sticky, and Slimy, and Tenaceous, Oh My.

Bacteria in “Biofilms” have properties that make them difficult to kill, both with antibiotics, and by our immune system.

These properties of biofilms help explain the clinical features of chronic rhino-sinusitis, or CRS. Here are the facts:

  • Bacteria in biofilms are difficult to grow in a Petri dish (“culture”)
  • Bacteria in biofilms are resistant to antibiotics: they may require 1,000 times the concentration that is required to kill the same bacteria that are not in a biofilm
  • Bacteria in biofilms are resistant to the immune system
  • Bacteria in biofilms are resistant to medical and surgical treatments, and difficult to cure

All of the properties in the list above are the same properties of chronic infections: they are resistant to antibiotics, resistant to our immune systems, and tenacious against our strongest medical and surgical treatments.

These Are Also The Properties of CRS

In sum – CRS is difficult to cure. And we think it is due to bacteria in biofilms.

Not all bacteria can produce the extracellular matrix of biofilms. But most bacteria can live in the biofilm that is produced by other bacteria.

They help each other. Some bacteria within the biofilm are able to make the extracellular matrix; some are able to make enzymes that destroy antibiotics; some are able to make substances that confuse our immune cells.

All of the bacteria in the biofilm benefit. It’s a team effort.

They’re just not on your team.

A lot of attention is now focused on bacterial Biofilm as the cause of many – perhaps most – chronic infections. Including CRS.

For CRS, we know that the nasopharynx and adenoid tissue are a reservoir of bacteria that produce biofilms. Once in the sinuses, these bacteria form biofilms there, too.

Biofilm Development

Stages of Biofilm Development

Image Credit:  D. Davis. Published in a Public Library of Science Journal, 2007.

What Are Biofilms Like?

If you have ever stepped across a rocky, bubbling creek and noticed the slime on the rocks in the water – that is biofilm. That is a collection of bacteria that have made an extracellular matrix for protection against the force of the running water.

If you stopped to examine it you noticed that it is slimy. It is tenacious. It is resistant to physical removal. They are different species of bacteria, but they make a similar biofilm with similar properties. The stuff causing your CRS is similar.

Some sophisticated treatments have been developed to tackle the problem of biofilms and CRS.

Tune in next time for a 5-Step Program to Cure Your CRS.

Header Image Credit of Flourescent Microscope Image:

Biofilm growing on stainless surface. From CDC, photo by Dr. Rodnay M. Donlan: “Biofilms: Microbial Life on Surfaces”, by Murga & Donlan, 2002.


Thanks for visiting.

I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (

Type in your best email address (the one you actually use).

Your email is safe – will never be shared or sold. Ever. Click here to read our Privacy Policy

When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time. How cool is that?

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)


  1. There is definitely a need for increased research on biofilms and ways in which to control them. Despite the National Institutes of Health statistic indicating that over 80 percent of microbial infections in the body are caused by biofilms, there are currently no antibiotics, disinfectants, diagnostics or regulatory standards designed specifically for biofilm-forming organisms.

    Treating a chronic infection (and therefore likely a biofilm infection) with “The right antibiotic- right from the start”, would certainly help as we fight the issue of antibiotic resistance.

    Please visit for more information.

    • Russell A. Faust, PhD, MD says:

      Hi Amanda,
      Thank you for visiting, and for taking the time to comment. Y’all have an interesting site, one that I am happy to link to.
      Please continue to visit and contribute to our community with insightful comments.
      RF (Boogs)

    • I have had a biofilm in my maxillary sinuses for 4 years producing a cough. A miracle occurred when I used anti fungus toenail treatment on my large toe nails. Since then the biofilm is gone!! harmless and worth a try.

  2. Did you ever hear of anyone becoming chemically sensitive due to crs? I am can not go into stores because my head starts hurting. I can not take any perfume smells – cigarette smoke – anything with rubber I am becoming a freak and I do not know why. I had sinus surgery in 2000. I irrigate everyday – twice a day. Take Mucinex almost everyday just to keep the mucus thin . Any ideas??? Thanks!

    • Russell A. Faust, PhD, MD says:

      Hi Susann,
      I have not heard that link, but certainly the chronic inflammation that is associated with ANY chronic inflammatory disorder – including crs – will increase your sensitivity to chemicals, toxins, pollutants. Avoidance is your top priority. Consider adding anti-inflammatory Manuka honey to rinses (I do, it’s a great effect). Consider taking a daily supplement that contains respiratory anti-inflammatory herbs, or even a general anti-inflammatory preparation (I like Zyflamend, from NewChapter – no financial relationship).
      Thanks for visiting, and please let me know how things go.

  3. mary evans says:

    Hello, Dr. Faust! So glad to have found your site! I need some clarification on a recent issue, if you can help. I am not a child, but a young 63 year old. :o)
    Have had chronic post nasal drip for years. Assumed it was just allergies. I live in central Texas. Got pretty ill last year this time and was snarking down from my nasal passages and spitting out some really remarkable, bright green mucous. Was put on one and then another kind of antibiotic (zithro & augment.) No culture was taken. It seem to abate, but this stuff would collect just below my sphenoid sinus, dry up and finally drop down and I would spit out these yellow-green-bloody . . well. . . Managed to catch one of these on the way to the ENT in March. She did an endoscopy (the left sphenoid looked swollen, inflamed, dripping) She took a sample of what was oozing from the opening, cultured it and it came back pseudomonas a. She put me on a 10-day round of cipro and symptoms went away and I finally started feeling pretty good. I went back and she did a follow-up endo and took a sample from the nasal passage for culture. The sphenoid opening was open and clear and healthy. A week later, however, the culture results came back: pseudomonas a. My question is this: am I now colonized with this bacteria? Can I rid myself of this? Am I a danger to my grandchildren? Read I would be isolated in a hospital setting to not contaminate other patients. Is this true? I hesitate going on any fluroquinolones again as I have pretty bad osteoarthritis. While i was on the cipro, I was using a dilute solution of saline and apple cider vinegar as my ENT suggested. When I found your site, I added honey to the night time nasal wash. I know you don’t diagnose on line and would be grateful for any suggestions you might offer regarding ridding myself of this and whether I am safe for my 3 y.o. grand daughter and soon to be born grandchild. Many thanks for your terrific site and obvious compassion.
    mary evans

  4. mary evans says:

    Dr Faustus,
    An addendum to my previous post: when my ENT told me on the phone that the post-cipro culture was still pseudomonas a., she said as long as I don’t have symptoms she would not need to treat with more antibiotics. I called back for more clarification (the questions I asked you) and have not heard back.
    Thanks again,

    • Russell A. Faust, PhD, MD says:

      Hi Mary,
      First, thank you so much for your kind comments, and for visiting, but mostly for sharing your experience.
      I am usually in agreement with the policy of not treating a lab result. That is, I almost never treat someone unless they have symptoms. So your ENT is probably correct. On the other hand, it seems that you DO have ongoing symptoms and complaints. If that is the case, you may consider seeing another ENT for a second (or third) opinion. In my own practice, I always encourage patients to seek another opinion – there are many paths to wellness, and a single physician simply cannot know them all.
      In my experience, chronic rhino-sinusitis (CRS), as you describe, is best managed by a “holistic” approach. That is, a combination of remedies that include daily nasal saline rinses. For biofilm-producing bacteria (like pseudomonas a.), including Manuka honey has been shown to help eradicate those bacteria. Adding a small amount (few drops) of baby shampoo helps to dissolve the biofilm, too. That helps the rinses – and also helps our immune cells – to get at the bacteria that are protected by their biofilm. In addition, anti-inflammatory supplements (such as Quercetin/Bromolain) can help to minimize the swelling that results from CRS. Reducing the swelling can help to open the sinuses, allowing the rinses to be more effective. The book that I think is the best for following a holistic approach to sinusitis is “Sinus Relief Now” by Dr. Jordan Josephson. That link is the affiliate link to his book on Amazon (price is same as going directly to Amazon, but helps support this site).
      Thanks again for visiting and sharing, and please keep me updated!

      • mary evans says:

        Dr Faust,
        Many thanks for your reply. I will be adding a Quercetin/Bromolain suppliment to my routine and honey/baby shampoo to my rinses. Would or can you address my question regarding whether or not I am Pseudomonas “contagious” around other people, esp. my grandchildren or is the positive culture (as long as I am asymptomatic) not indicative of a contagious infection? Would hate to be known as Pseudomonas Mary . . .
        Thanks again,

        • Russell A. Faust, PhD, MD says:

          Sorry to say, Mary, but pseudomonas a. is VERY contagious!

          • mary evans says:

            So, I should not be around a newborn? I have a grandchild who is due to arrive in the world in September. Any suggestions on how I can handle this?

          • Russell A. Faust, PhD, MD says:

            Again, pseudomonas is very contagious. Ask your grandchild’s pediatrician.

          • mary evans says:

            Dr Faust,
            Do you have a referral list for other like-minded ENT docs around the country, specifically San Antonio, Texas?

          • Russell A. Faust, PhD, MD says:

            The best source for holistic docs is the American Board of Integrative Holistic Medicine. The ABIHM is an organization that educates physicians on the best evidence-based remedies, regardless of the source of the remedy (Ayurveda, Naturopathy, etc). You can search for an ABIHM Board-Certified physician, in any specialty, at their site:

          • mary evans says:

            Thanks, for all your information!

  5. Valerie Milo says:

    Hello again, I have commented before on your post about Manuka honey. I have chronic sinusitis & have tried everything under the sun; hydropulse nasal irrigation adding manuka & baby shampoo & tons of supplements, when desperate antibiotics which either do not work at all or seem to work temporarily & then infection recurs soon after I finish the antibiotics. I have 2 little boys who are often sick with colds but they get over it & I’m stuck another sinus infection as usual. Allergy test showed no allergies, so my ENT thinks biofilm. She wants to do balloon sinuplasty since antibiotics are not working. She said she’ll clean my sinuses in this procedure as well. What are your views of balloon rhinoplasty & cleaning away biofilm? Does it usually work? I felt like manuka rinse helped a few months ago but after a month I switched back to saline & infection geared up again. I’m doing the manuka rinse again now & taking supplements. I’m just so sick of being sick.

  6. Valerie Milo says:

    I am also looking for a doctor who practices integrative medicine and maybe chiropractor since my sinus headaches hurt all the way down my neck & back. Maybe acupuncture as well.

  7. Valerie Milo says:

    Also, I eat a healthy diet, I exercise, we use air purifiers & try to keep our home as chemical free as possible. I have eliminated dairy & gluten to see if this helps at all.

  8. Valerie Milo says:

    Oh, one more thing! Kind of interesting, allergist recommended I get the Pneumovax vaccine because the sample from my sinus showed strep…I did get it a few weeks ago but I still have sinus infection. So far it’s not full blown but we’ll see. Apparently in a blood test it showed I did not have immunity to strep bacteria. Although I’m still not exactly clear about what all the results meant. I have to go back in a week to have my blood checked again to see if anything changed. Just thought I’d add that because I’d never heard of this vaccine before! And was hoping it might help!

    • Russell A. Faust, PhD, MD says:

      Hi Valerie,
      Sounds frustrating!
      Getting rid of biofilm-related sinusitis can take a long time. It took me nearly a year of concentrated effort to eradicate my own chronic sinusitis. I used hypertonic saline rinses, eventually adding Manuka honey, and finally baby shampoo. I was considering balloon sinuplasty, and I would have tried that if these other remedies had not worked; grateful that they did work.
      Have you considered visiting a Doctor of Naturopathy? They can often figure out complicated challenges like yours. My own ND helped me considerably.
      Thanks for sharing, and please keep me updated.

  9. I’ve seen 5 ENT’s and I’ve been to dozens of specialist the past 4 years for a cough that produces tons of mucus and infections. I’ve had 2 sinus surgeries and followed through with all the nasal rinses until that turned into a nightmare – generating water based bacteria infections. Be careful if you folks are using equipment that is not sterilized before use every time!!! I believe my biofilm is part fungus related because oddly enough my maxillary sinuses cleared up once I used an anti fungal toenail ointment on my feet. Sounds strange but true. I have one sinus cavity to go which is way in the back of my throat. It cleared up only temporarily with the anti fungal toe medicine use but came back. My maxillary’s are still clear. I’m determined to find a cure rather than accept Drs throwing antibiotics, drugs, rinses, etc.. At me because they don’t want to take the time. It would be nice to just find someone who actually cares and would do the research after hearing my symptoms. I now have a vast amount of allergies to candle scents, food, perfume, laundry soap, etc. it’s just not acceptable. I won’t give up until I find the cure for this!!!

    • Russell A. Faust, PhD, MD says:

      Hi Kathy,

      I can see from your IP Address that you are in Michigan. Note that there are some outstanding Naturopathic Doctors in Michigan. (My own personal physician is an ND). The advantage that they offer is that they don’t simply treat a diagnosis; they care for the whole person; they look beneath the symptoms for the underlying cause and help you restore a healthy balance. You might consider asking around for a qualified ND to help avoid yet another prescription for antibiotics, drugs, etc. In my opinion, saline rinses are very benign, and also powerfully effective in eliminating chronic rhino-sinusitis.

      Thanks for sharing, and best success!

  10. Hi,
    I have had a pseudomonas sinus infections for. . .17 years! Yes, the first culture was treated with IV Fortaz. I am allergic to Cipro and Levaquin. 2 years later…it was back, with a vengeance. IV antibiotics again. I’ve had so many endoscopic cultures (maybe 30+? or more) and had 2 surgeries (did not cure me) in 1990s. I drain well now, however, seem to have colonized pseudomonas. Now, I HURT horribly. I have been on IV antibiotics (different ones more recently) 14+ times, and do saline rinses, steam inhalation, take loads of vit C and zinc (even tried IV C), and as a nurse, no longer work (was a school nurse). I have horrible L head/face pain, constant sinus drip of bright green+blood at times…last culture was May. We all know what it is, and nothing gets rid of it. I have been to 5-6 ENTs, 4 IDs, and now…am resolved to this “draining” diagnosis. I love my current infectious disease doctor, who is much more holistic (encourages rinses) and listen to my symptoms, and does complete exams, without making me get cultures nonstop, as did the previous doctor. I am under constant care. Problem is….how contagious am I? I go out in public (to the store) and do not work at all any more (too sick) but, my son has cancer, and I am concerned. I am a cautious nurse who washes often. He knows my diagnosis too. Since his cancer diagnosis, I have been around him many times without any problems. But reading this blog, I see maybe there is another precaution to take (aside from wearing a mask). I do not leak any fluids when I talk…. I have 4 grandchildren too (all his). Frustrating. And, tired of being sick for so long… but I won’t stop seeing my son and his family. Honestly, please tell me, just HOW CONTAGIOUS IS PSEUDOMONAS? I always have it, just at times chronic and times acute.

    • Russell A. Faust, PhD, MD says:

      Hi Susan:

      The person to answer the “contagion” question is, of course, your Infectious Disease Specialist, not an online boogordoctor. I’m flattered that you ask my opinion, but please ask your ID Doc. And then let me know! Thanks.


  1. […] role of biofilms in chronic rhino-sinusitis (CRS) was recently reviewed on this […]

Speak Your Mind