Learning Objectives: To describe: 1. the existence of biofilms in otitis 2. the role of biofilms in the pathogenesis of otitis media 3. the potential targets of treatment.

Biofilms are multicellular network of bacteria encased in a matrix and are noticeably resistant to both antibiotics and host defenses. Biofilms exist in otitis media, cholesteatoma, chronic otitis media, onto protheses and in adenoids. Demonstration of biofilms in otitis media has shown different mechanisms of persistence of bacteria into the middle ear. Substantial effort in understanding the biologic nature of biofilms has resulted in evidence supporting their importance in otitis media and adenoids. The predominant role played by in biofilms is important, both from the perspective how pathogens develop viable communities in the middle ear as well as how this structure impedes successful antibiotic therapy. Understanding the nature of the biofilm component in the pathogenesis of chronic otitis media will likely have a meaningful influence on the development of novel strategies of treatment.