Effect of Endoscopic Sinus Surgery on Pulmonary Function and Microbial Pathogens in a Pediatric Population With Cystic Fibrosis

Osborn, Alexander J.; Leung, Randy; Ratjen, Félix; James, Adrian L.

doi:10.1001/archoto.2011.68

Cited by 41 publications

(48 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The study selection process is illustrated in Figure . The search strategy retrieved 416 abstracts, and 24 pertinent articles were selected for this systematic review (Table ) . The systematic review included 680 patients, including both children and adults.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review

Liang

Higgins

Ishman

et al. 2013

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

For adult and pediatric CF sinusitis, ESS yielded clinical improvement as measured primarily by sinonasal symptoms and endoscopic findings. It is unclear if surgical intervention modifies lower airway disease. Future prospective studies with predetermined, objective, and validated outcome measures are needed to determine the effectiveness of surgical intervention for CF-related CRS. Overall evidence Grade B/C.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Table shows the eight studies that examined PFT as an outcome measure for the effectiveness of surgical therapy for CRS in CF . Spirometry measurements included forced expiratory volume in 1 minute (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow 25% to 75% (FEF25–75).…”

Section: Resultsmentioning

confidence: 99%

Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review

Liang

Higgins

Ishman

et al. 2013

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

show abstract

“…Special attention should be attributed to the eradication of bacteria in the sinuses, which requires endoscopic sinus surgery and daily nasal douching with isotonic saline solution. The authors who did not include daily nasal care in their protocol observed no significant reduction in bacteria type or bacterial recolonization [17,18]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

Vital¹,

Höfer

Benden

et al. 2012

Respiration

View full text Add to dashboard Cite

Background: Lung transplantation (LTx) is a therapy for patients with cystic fibrosis (CF) end-stage lung disease. Pseudomonal airway colonization (PAC) is common in CF. Objectives: We investigated the influence of post-transplant sinus surgery and daily nasal douching on PAC after LTx and the influence of PAC on survival and bronchiolitis obliterans syndrome (BOS). Methods: CF patients transplanted at our centre were included (November 1992 to December 2009). Clinical data, including microbiological data before and after LTx were collected. Survival and BOS following LTx were compared for CF recipients with and without PAC by Kaplan-Meier statistics and Cox regression analysis. Results: Ninety-four CF patients were transplanted, of whom 82 (87%) underwent sinus surgery after transplantation, and 65% of 66 patients with pre-transplant PAC had persistent PAC after transplantation. Upper and lower PAC is related. Patients without PAC after transplantation had a significantly better survival rate, and BOS was less frequent with a later onset. PAC was the only significant parameter for the development of BOS stage 2 in the multivariate analysis for cytomegalovirus infection, acute rejection and PAC. Conclusions: Sinus surgery and daily nasal douching reduced PAC in LTx recipients. Absence of post-transplant PAC had a positive impact on post-transplant survival and the development of BOS.

show abstract

“…Since it is generally (and perhaps incorrectly) assumed that any bacterium found in the upper airways is present in the lungs (33), antibiotics are empirically prescribed for sinus infections based on sputum culture. Patient response to this CF-CRS treatment approach is largely ineffective, and patients who fail medical management ultimately require surgical intervention (10, 34, 35). Therefore, a deeper understanding of the ecological relationships between the sinuses and lungs is needed to improve upon treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

16S rRNA gene sequencing reveals site-specific signatures of the upper and lower airways of cystic fibrosis patients

Yang

Dunitz

et al. 2017

Preprint

View full text Add to dashboard Cite

RationaleChronic rhinosinusitis (CRS) is an inflammatory disorder of the sinonasal mucosa associated with microbial colonization. Metastasis of sinus microbiota into the lower airways is thought have significant implications in the development of chronic respiratory disease. However, this dynamic has not been thoroughly investigated in cystic fibrosis (CF) patients, where lower airway infections are the primary driver of patient mortality. Given the high prevalence of CRS in CF patients and the proposed infection dynamic between the upper and lower airways, a better understanding of sinus-lung continuum is warranted.ObjectiveTo compare the microbiome of matched sinus mucus and lung sputum samples from CF subjects undergoing functional endoscopic sinus surgery (FESS) for treatment of CRS.MethodsMucus was isolated from the sinuses and lungs of twelve CF patients undergoing FESS. 16S ribosomal RNA gene sequencing was then performed to compare bacterial communities of the CF lung and sinus niches. Finally, functional profiling was performed to predict bacterial metagenomes from the 16S dataset, and was used to compare pathogenic bacterial phenotypes between the upper and lower airways.Measurements and Main ResultsBacterial richness was comparable between airway sites, though sinus and lung environments differed in community evenness, with the sinuses harboring a higher prevalence of dominant microorganisms. Beta diversity metrics also revealed that samples clustered more consistently by airway niche rather than by individual. Finally, predicted metagenomes showed that anaerobic metabolism was enriched in the lung environment, while genes associated with both biofilm formation and Gram identity were not variable between sites.ConclusionsSinus and lung microbiomes are distinct with respect to richness and evenness, while sinus communities have a higher incidence of a dominant taxon. Additionally, ordination analyses point to sinus and lung environments as being stronger determinants of microbial community structure than the individual patient. Finally, BugBase-predicted metagenomes revealed anaerobic phenotypes to be in higher abundance in the lung relative to the sinuses. Our findings indicate that while the paranasal sinuses and lungs may still comprise a unified airway in which lower airways are seeded by sinus microbiota, these discrete airway microenvironments harbor distinct bacterial communities.

show abstract

Effect of Endoscopic Sinus Surgery on Pulmonary Function and Microbial Pathogens in a Pediatric Population With Cystic Fibrosis

Abstract: The lack of effect of endoscopic sinus surgery on pulmonary function test results and respiratory tract microbial pathogens in our study highlights the need for prospective assessments of postoperative quality-of-life improvement and of adjunct medical therapy efficacy.

Cited by 41 publications

References 27 publications

Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review

Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review

Impact of Sinus Surgery on Pseudomonal Airway Colonization, Bronchiolitis Obliterans Syndrome and Survival in Cystic Fibrosis Lung Transplant Recipients

16S rRNA gene sequencing reveals site-specific signatures of the upper and lower airways of cystic fibrosis patients

Contact Info

Product

Resources

About