Diseases of the tonsils are becoming more resistant to antibiotics due to the persistence of bacteria through the formation of biofilms. Therefore, understanding the microbiology and pathophysiology of such diseases represent an important step in the management of biofilm-related infections. We have isolated the microorganisms, evaluated their antimicrobial susceptibility, and detected the presence of bacterial biofilms in tonsillar specimens in correlation with the clinical manifestations of tonsillar diseases. Therefore, a total of 140 palatine tonsils were collected from 70 patients undergoing tonsillectomy at University Malaya Medical Centre. The most recovered isolate was Staphylococcus aureus (39.65%) followed by Haemophilus influenzae (18.53%). There was high susceptibility against all selected antibiotics except for cotrimoxazole. Bacterial biofilms were detected in 60% of patients and a significant percentage of patients demonstrated infection manifestation rather than obstruction. In addition, an association between clinical symptoms like snore, apnea, nasal obstruction, and tonsillar hypertrophy was found to be related to the microbiology of tonsils particularly to the presence of biofilms. In conclusion, evidence of biofilms in tonsils in correlation with the demonstrated clinical symptoms explains the recalcitrant nature of tonsillar diseases and highlights the importance of biofilm’s early detection and prevention towards better therapeutic management of biofilm-related infections. 1. Introduction The ear, nose, and throat (ENT) represent a natural habitat for a broad range of microorganisms such as commensal bacteria as well as potential pathogens . However, these bacteria can sometimes find their way to overcome the defense barriers of such locations and establish chronic infections that poses a challenge to both medical practice and healthcare system . Infections of the ENT such as tonsillitis are diseases that occur with high frequency . During the past decades, efforts have been made to manage the infectious diseases of tonsils . It has been reported that the impact of tonsillar diseases may not only affect the tonsils alone but it can reach other related anatomic structures like the paranasal sinus, upper aerodigestive tract, and Eustachian tube-middle ear complex . Thus understanding the microbiology and pathophysiology of such diseases represents an important step in the management of biofilm-related infections. Chronic infections of the ear, nose, and throat are becoming more resistant to common antimicrobial
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