Effect of Endoscopic Sinus Surgery on Bronchiectasis Patients With Chronic Rhinosinusitis

Abstract

Background The concept of unified airway disease has linked bronchiectasis with chronic rhinosinusitis (CRS), much in the same way as in asthma and CRS. Although the outcomes of endoscopic sinus surgery (ESS) on comorbid asthma have been relatively well studied, the outcomes of ESS on comorbid bronchiectasis have rarely been examined. Objective We sought to determine sinonasal and pulmonary clinical outcomes of ESS in bronchiectasis patients with CRS. Method We reviewed all bronchiectasis patients who had ESS for CRS at our institution from 2006 to present. The sinonasal outcome test 22 (SNOT-22) was administered preoperatively and at 3 months, 1 year, and 3 years postoperatively. Pulmonary function tests (PFTs) were measured preoperatively and at 6 months and 1 year post operation to assess the forced expiratory volume in 1 s (FEV1), forced viral capacity (FVC), and FEV1/FVC values. Paired t test and Pearson correlation were used to compare pre- and postsurgical results. Results A total of 141 bronchiectasis patients who had ESS for CRS were studied. The most common cause of bronchiectasis was cystic fibrosis (CF) (42.55%). SNOT-22 scores improved at 3 months post operation and were maintained at 1 year and 3 years post operation ( P < .001). All SNOT sub-domains showed a significant improvement after surgery ( P < .01). However, PFTs did not change at 6 months post operation and 1 year post operation ( P > .05). There were significant differences in the outcomes in CF versus non-CF patients ( P < .05) but not by sex or age. Conclusion ESS is effective in improving long-term sinonasal outcomes in bronchiectasis patients with CRS. However, ESS does not appear to improve the pulmonary function.

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

“…Subsequently, 314 abstracts that described outcomes associated with ESS in CRS patients with CF were reviewed. Based on the inclusion and exclusion criteria, 12 studies [13][14][15][16][17][18][19][20][21][22][23][24] were finally included for data extraction and meta-analysis after retrieving 28 full-text manuscripts.…”

“…The majority of studies reported at least 6 months follow-up post-operation. Most of the included studies were conducted in the United States 13,14,[16][17][18][21][22][23][24] (n = 9), while the others were conducted in Canada 15,20 (n = 2) and Israel 19 (n = 1). Only one study was a prospective cohort study.…”

“…12 However, limited quantifiable data for pulmonary function and smaller sample sizes did not permit stratified analyses in the meta-analysis, which could not draw a detailed conclusion. Recent studies [13][14][15] provided new evidence and facilitated a new, well-conducted systematic review and metaanalysis, with more power of persuasion. Therefore, we conducted a systematic review and meta-analysis with the latest available data to investigate the effects of ESS on PFTs in CRS patients with CF.…”

Prevalence of chronic rhinosinusitis in bronchiectasis patients suspected of ciliary dyskinesia

“…Interestingly, the incidence of chronic rhinosinusitis (CRS) is increased in idiopathic bronchiectasis patients . Between 50% and 70% of patients with bronchiectasis will have both subjective and objective findings of CRS . The close association between upper and lower airway disease has led to exploration of potential common pathophysiologic mechanisms.…”

Editorial

“…12 In another article, Kanjanaumporn and Hwang assessed how patients with bronchiectasis responded to ESS from both sinonasal and pulmonary standpoints. 13 In summary, the September 2018 issue of AJRA offers insight into the evolving scientific understanding of various aspects of the immune system and showcases the potential for translation of this work into the clinical realm. Further, historic concepts are revisited, rethought, and modernized for updated use in the current clinical practice.…”