Endoscopic Sinus Surgery for Cystic Fibrosis: Variables Influencing Sinonasal and Pulmonary Outcomes

Abstract

Background Endoscopic sinus surgery is a well-established treatment for chronic rhinosinusitis in patients with cystic fibrosis, though its benefits seem to be limited to improving sinonasal symptoms rather than affecting lung function. Objective This study aims to identify clinical and demographic factors that may influence sinonasal and pulmonary outcomes after surgery. Methods This is a six-year retrospective analysis of adult cystic fibrosis patients who underwent endoscopic sinus surgery at a tertiary care center. 22-Item Sino-Nasal Outcomes Test scores and mean forced expiratory volume data at baseline and three to six months after surgery were analyzed using t-test and stepwise regression with the following covariates: age, gender, lung transplant, revision surgery, and pseudomonas on sinus culture. Results 119 surgeries were performed on 88 patients, with 69% on patients with transplant. The overall mean (Standard Deviation) improvement in 22-Item Sino-Nasal Outcomes Test score was 9.42 (18.15) for the entire cohort ( P < .001). Pseudomonas on culture was associated with less improvement in sinonasal scores ( P = .002). There was no significant change in forced expiratory volume after surgery ( P = .94). Revision surgery ( P = .004) and older age ( P = .007) were associated with less favorable change of pulmonary function on stepwise regression ( P = .002). There was no correlation between change in sinonasal scores and pulmonary function. Conclusion Although surgery was associated with a clinically and statistically significant improvement in sinonasal scores in cystic fibrosis patients, patients with pseudomonas may experience less benefit. Revision surgery and older age may be associated with less favorable pulmonary outcomes. Awareness of such variables may help when deciding which cystic fibrosis patients should undergo surgery.

Sinus Symptoms in Cystic Fibrosis Patients and the Role of Interdisciplinary Care

“…Cystic Fibrosis (CF) is an autosomal dominant disease that occurs due to a mutation in the Cystic Fibrosis Transmembrane Regulator gene (CFTR) (1). This gene is located on chromosome7, and a defective CFTR protein causes impairment in the transport of chloride ions through mucus-producing cells (1,2).…”

“…3 In patients with functional CFTR proteins, water follows the chloride ions through these epithelial cells, and the mucus created is thin and easily cleared. 2 In patients with CF, mucus is thick, dehydrated, and cannot be easily cleared, causing increased susceptibilities to bacterial colonization and serious infections (1,2). Colonization and infections in CF patients are generally associated with their effects on the lungs, but the same mechanism occurs within the sinonasal mucosa, leading to symptoms of inflammation and rhinosinusitis (1,4).…”

Science and Research March Onward

“…An important cornerstone in the management of CRS and various other pathologies of the upper airway is surgery. Ji and colleagues aimed to identify clinical and demographic factors that influence sinonasal and pulmonary outcomes after endoscopic sinus surgery in cystic fibrosis, 9 a particularly challenging subset of CRS patients. In a retrospective analysis of 119 surgeries, they identified the presence of pseudomonas, revision surgery and older age as predictors of less favorable outcomes.…”