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 center Methods: 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. Post-operative 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.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…1467,1468 ESS for CF-associated CRS improves both QoL and endoscopic scores. 1469 However, ESS in the CF population often has high rates of revision surgery and persistent radiographic abnormalities. In addition, despite radiographic evidence of RS by CT imaging, only a small proportion (10-20%) will have self-reported CRS symptoms/complaints.…”

“…1471 Outside of the transplant literature, pulmonary outcomes for CF patients are mixed despite improved QoL. 1469,1472 Because of the pooling of maxillary sinus secretions seen in CF patients and the frequent need for revision ESS procedures, emerging literature suggests that a widened/inferiorly-extended maxillary sinus antrostomy surgery may permit improved drainage and larger volume irrigant delivery. 1473 …”

Rhinosinusitis and Comorbidities

“…Interestingly, CF patients with CRS experience the same quality-of-life improvements as other polypoid CRS patients after ESS [27].…”

Current views on chronic rhinosinusitis in patients with cystic fibrosis

“…В исследовании с дизайном случай-контроль были оценены исходы эндоскопической синусото-мии у взрослых пациентов с МВ в сравнении с боль-ными без него [27]. До-и послеоперационно оцени-вались данные компьютерной томографии, резуль-таты эндоскопического исследования и данные, полученные при анкетировании с помощью двух опросников в отношении качества жизни.…”