Effect of Endoscope Sinus Surgery on Pulmonary Function in Cystic Fibrosis Patients: A Meta‐Analysis

Abstract

Objective: The objective of this study was to quantify the effect of endoscopic sinus surgery on pulmonary function in patients with cystic fibrosis and chronic rhinosinusitis. Methods: The PubMed, MEDLINE, Cochrane Library, and Embase databases were searched for studies published in English, without any language and time restrictions from their inception to March 1, 2020. Studies examining pulmonary function outcomes in patients with cystic fibrosis and chronic rhinosinusitis following endoscopic sinus surgery were included. Primary outcomes were pulmonary function tests, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow between 25% and 75% of vital capacity (FEF 25-75). Results: A total of 12 studies with 570 patients were included for data extraction and meta-analysis. For FEV 1 (%), the summarized mean difference (MD) was −6.92 (95% confidence interval [CI] = −19.67 to 5.83, P = .29) and 0.70 (95% CI = −3.81 to 5.21, P = .76) for the postoperative results after 6 months and 12 months, respectively. The pooled MDs for FVC (%) and FEV1/FVC ratio (%) for the postoperative results after 6 months were 0.60 (95% CI = −4.12 to 5.31, P = .80) and −1.29 (95% CI = −6.14 to 3.55, P = .60). Conclusion: Endoscopic sinus surgery in chronic rhinosinusitis patients with cystic fibrosis did not improve the pulmonary function in chronic rhinosinusitis patients with cystic fibrosis. More prospective studies and meta-analyses addressing the same topic are needed in the future.

The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study

“…The goals of surgery are to reduce sinonasal symptoms and remove bacterial reservoirs that are believed to contribute to acute pulmonary exacerbations and decline in lung function 5,6,22,38 . However, the published results are somehow conflicting, 21,38–40 and a recently published meta‐analysis that included 570 patients did not find any improvement in pulmonary function after ESS 41 …”

“…5,6,22,38 However, the published results are somehow conflicting, 21,[38][39][40] and a recently published meta-analysis that included 570 patients did not find any improvement in pulmonary function after ESS. 41 The reduced sinus pneumatization was experimentally induced in animal studies through the alteration of the CFTR gene and with the fundamental contribution of chronic infection and inflammation that begin since birth. 42,43 In agreement with our results, there is a large number of papers reporting detailed anatomical description of sinonasal development in CF patients that are known to more frequently display sinus hypoplasia or aplasia than non-CF patients, 35,44 but a normal pneumatization of mastoid cells and temporal bone.…”

Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis

“…There is correlation between pulmonary and sinus disease in CF, as both lower airways (lungs) and upper airways (sinuses) are colonized with similar organisms . In people with CF and progressive sinonasal involvement, sinus surgery may affect pulmonary exacerbations, though the direct relationship remains unclear . The effect of CFTR modulator therapy on CRS in people with CF is not well defined.…”

“…8 In people with CF and progressive sinonasal involvement, sinus surgery may affect pulmonary exacerbations, though the direct relationship remains unclear. [9][10][11][12][13] The effect of CFTR modulator therapy on CRS in people with CF is not well defined. The role of ivacaftor in improving clinical symptoms, increasing scores on the validated 20-item Sino-Nasal Outcome Test (SNOT-20), and improving computed tomography (CT) findings of sinus disease has been reported.…”