Assessing the role of adenoid biofilm on children in different ENT diseases. A state-of-the-art systematic review

Introduction Adenoid hypertrophy (AH) and recurrent or persistent adenoiditis are common pediatric conditions linked to complications such as obstructive sleep apnea (OSA), otitis media (OM), and sinusitis. Adenoidectomy is a standard treatment, potentially effective through mechanical removal of biofilms, which acts as infection reservoirs. This state of the art review systematically assesses the role of adenoidal biofilms in pediatric upper airway diseases. Methods Databases searched included PubMed, Cochrane Library, EMBASE, and SciELO. Inclusion criteria encompassed studies on adenoidal biofilms in children (<18 years). Data were summarized in 8 research questions. Results Of 18 studies (706 patients, 392 controls), evidence suggests a potential role of biofilms in recurrent acute otitis media (RAOM) and chronic otitis media (COM), with some studies indicating associations with otitis media with effusion (OME) and sinusitis. No correlation was found between biofilm presence and adenoid size. Evidence on diagnostic methods (swabs) and non-surgical treatments for biofilm remains inconclusive. Conclusion Biofilms likely contribute to RAOM and COM, albeit with weak evidence due to cross-sectional study designs. Associations with OME and sinusitis are suggested but unproven, and biofilm relevance to adenoid size is unsupported. Future research should focus on biofilm-targeted diagnostics and therapies to refine clinical management.