Biofilms were statistically more common in patients with CSOM compared with control patients.

Bacterial biofilm in chronic suppurative otitis mediaWe were delighted to see the article by Lee et al, "Biofilm presence in humans with chronic suppurative otitis media," 1 confirming our findings of biofilm in an Aboriginal child with chronic suppurative otitis media (CSOM) in the early years of this decade. 2,3 The electron photomicrographs in the article by Vijayasekaran and Coates 3 clearly demonstrate similar appearances to those in Lee et al's article, and were presented to the National Institute on Deafness and Other Communication Disorders by our collaborators to gain a major grant for research on bacterial biofilms in otitis media with effusion. Further references to this finding are included in articles by Dohar 4 and our group's paper on intracellular cocci in children with otitis media with effusion. 5 Bacterial biofilm may represent the reason why CSOM is often recalcitrant to oral and some topical antibiotics. Considering that an estimated 106,000 Australians have CSOM, endeavors to mechanically or therapeutically ablate bacterial biofilm offer the best chance to prepare the infected ear for oto-topical antibiotics prior to surgical repair of their tympanic membranes.We look forward to further confirmation of the important role of bacterial biofilm and intracellular bacteria in diseases of the upper respiratory tract.