Outcomes of sinus surgery in adults with cystic fibrosis

Abstract

Objectives: Adults with cystic fibrosis (CF) represent a challenging subset of patients with chronic rhinosinusitis (CRS). While data suggest that endoscopic sinus surgery (ESS) may benefit pediatric CF patients, there remains a paucity of data regarding the impact of endoscopic sinus surgery on adult CF patients with CRS. Our purpose was to evaluate objective and quality of life measures in adult CF patients with CRS following ESS.Study Design: Nested case-control study. Setting: Tertiary care centerMethods: Twenty patients with CF were evaluated and matched to 20 controls without concomitant CF. Pre-operative computed tomography (CT) and pre-/post-operative endoscopic findings were recorded as objective measures. Changes in two disease-specific quality of life (QoL) instruments were also evaluated both pre-and post-operatively. Results:Mean post-operative follow-up was similar for cases and controls (13.1 ± 7.9 months vs. 14.0 ± 6.0 months, respectively). Pre-operative CT scores (16.9±4.5 vs. 10.9±5.9, p = 0.001) and endoscopy scores (9.3±5.8 vs. 5.7±4.6, p = 0.049) were significantly worse in CF patients. Postoperative endoscopy scores were significantly worse for CRS patient with CF (p=0.001), although the degree of improvement on endoscopy within each group was no different (p =0.071). Additionally, both groups experienced similar improvement in QoL after ESS (all p ≥ 0.134). Conclusions:While baseline measures of disease-severity are worse in the CF population, our data support objective and QoL improvements for adult patients with co-morbid CF comparable to patients without CF.

Sinonasal Manifestations in Cystic Fibrosis

“…ESS has been proven to be a safe and effective treatment of sinus disease in CF (grade B-C evididence). [11, 37–43] Unfortunately, a high proportion of CF patients will eventually require revision surgery because of recurrence or persistence of sinus disease (grade C evidence) [51]. The identification of factors associated with an increased likelihood of need for revision sinus surgery has been aimed at by many studies, with equivocal outcomes (grade B-C evidence) [51–53].…”

“…The introduction of more advanced sinus surgery techniques in recent years has fuelled hopes for successful and less invasive surgical management of sinusitis in CF. Endoscopic sinus surgery (ESS) has been shown to be safe and effective for the treatment of sinus disease in patients with CF in many studies [11, 37–43]. Some studies have shown a significant improvement in both sinonasal symptoms and quality of life following ESS, [30, 42, 43] whereas others have shown a reduced need for revision surgery following ESS as compared to conventional surgery [44].…”

Surgical Management of Chronic Rhinosinusitis in Cystic Fibrosis

“…Large systematic reviews have demonstrated a definitive benefit of ESS on patient-reported quality of life (QoL) outcomes, while the effect of sinus surgery on pulmonary function tests (PFTs) have yielded conflicting results to date. Khalid et al demonstrated significant improvement in QoL as measured by the Rhinosinusitis Disability Index (RSDI) in CF patients after ESS that was comparable to control patients, even though CF patients had worse pre-operative CT and endoscopic findings [20]. In one systematic review, Macdonald et al found that ESS consistently improved sinonasal symptoms in CF patients, and some evidence existed for reduced days of hospitalization for pulmonary exacerbations and usage of intravenous antibiotic therapy.…”

What is the role of endoscopic sinus surgery in adult patients with cystic fibrosis?

“…The last study is a prospective, nested case‐control study comparing 20 patients with CF to 20 control patients without CF . The objective measures that were compared included preoperative computed tomography (CT) findings, preoperative and postoperative endoscopic findings, and two disease‐specific QoL instruments examined preoperatively and postoperatively.…”