BACKGROUND: The indications for surgical management of chronic rhinosinusitis (CRS) in patients with cystic fibrosis (CF) are poorly defined. In this study we compare outcomes of medical versus surgical treatment and examine trends associated with the transition from medical to surgical therapy in CF patients. METHODS: One hundred thirty-six patients with CF referred to a tertiary rhinology practice were retrospectively divided into 3 cohorts: Medical, Upfront Surgery, or Crossover, if they converted from medical to surgical management. The 22-item Sino-Nasal Outcome Test (SNOT-22) and pulmonary function test (PFT) data were assessed up to 48 months. RESULTS: Compared to patients initially managed medically (n = 90), those who pursued upfront surgery (n = 46) had a greater incidence of nasal polyposis (p = 0.0011), prior sinus surgery (p = 0.0025), lower percent-predicted forced expiratory volume in 1 second (%FEV1 ) (p = 0.0063), and higher Lund-Mackay (p = 0.0025) and SNOT-22 (p = 0.0229) scores. Within the medical group, 35.5% converted to surgery after a mean of 14.3 months. Crossover (n = 32) was associated with a 6.1-point increase in SNOT-22 and a 4.5% deterioration in %FEV1 . Despite worsened symptom severity, the Crossover cohort ultimately achieved similar postoperative SNOT-22 scores (p = 0.831) and %FEV1 (p = 0.114) as those who underwent upfront surgery. Although the Medical cohort had the lowest baseline SNOT-22 scores (p < 0.001), surgery at any time normalized scores to the same baseline level (p = 0.652). Neither medical therapy nor surgery improved PFTs. CONCLUSIONS: Surgery effectively reduces CRS-related symptoms in CF patients but may not improve pulmonary function. In patients who first pursue medical therapy, symptomatic decline may prompt eventual conversion to surgery. Patients who delay surgery may achieve similar outcomes as those who pursue surgery upfront.
BACKGROUND: The indications for surgical management of chronic rhinosinusitis (CRS) in patients with cystic fibrosis (CF) are poorly defined. In this study we compare outcomes of medical versus surgical treatment and examine trends associated with the transition from medical to surgical therapy in CFpatients. METHODS: One hundred thirty-six patients with CF referred to a tertiary rhinology practice were retrospectively divided into 3 cohorts: Medical, Upfront Surgery, or Crossover, if they converted from medical to surgical management. The 22-item Sino-Nasal Outcome Test (SNOT-22) and pulmonary function test (PFT) data were assessed up to 48 months. RESULTS: Compared to patients initially managed medically (n = 90), those who pursued upfront surgery (n = 46) had a greater incidence of nasal polyposis (p = 0.0011), prior sinus surgery (p = 0.0025), lower percent-predicted forced expiratory volume in 1 second (%FEV1 ) (p = 0.0063), and higher Lund-Mackay (p = 0.0025) and SNOT-22 (p = 0.0229) scores. Within the medical group, 35.5% converted to surgery after a mean of 14.3 months. Crossover (n = 32) was associated with a 6.1-point increase in SNOT-22 and a 4.5% deterioration in %FEV1 . Despite worsened symptom severity, the Crossover cohort ultimately achieved similar postoperative SNOT-22 scores (p = 0.831) and %FEV1 (p = 0.114) as those who underwent upfront surgery. Although the Medical cohort had the lowest baseline SNOT-22 scores (p < 0.001), surgery at any time normalized scores to the same baseline level (p = 0.652). Neither medical therapy nor surgery improved PFTs. CONCLUSIONS: Surgery effectively reduces CRS-related symptoms in CFpatients but may not improve pulmonary function. In patients who first pursue medical therapy, symptomatic decline may prompt eventual conversion to surgery. Patients who delay surgery may achieve similar outcomes as those who pursue surgery upfront.
Authors: Zainab Farzal; Kelly M Dean; Satyan B Sreenath; Sarah E Hodge; Brian D Thorp; Charles S Ebert; Adam M Zanation; Brent A Senior; Adam J Kimple Journal: Int Forum Allergy Rhinol Date: 2020-01-17 Impact factor: 3.858
Authors: Daniel M Beswick; Stephen M Humphries; Connor D Balkissoon; Matthew Strand; Eszter K Vladar; David A Lynch; Jennifer L Taylor-Cousar Journal: Ann Am Thorac Soc Date: 2022-01
Authors: Adam J Kimple; Brent A Senior; Edward T Naureckas; David A Gudis; Ted Meyer; Sarah E Hempstead; Helaine E Resnick; Dana Albon; Wayne Barfield; Margo McKenna Benoit; Daniel M Beswick; Eliza Callard; Shelagh Cofer; Veronica Downer; E Claire Elson; Angela Garinis; Ashleigh Halderman; Lisa Hamburger; Meagan Helmick; Michael McCown; Cameron J McKinzie; Hanna Phan; Kenneth Rodriguez; Ronald C Rubenstein; Ashley Severin; Gopi Shah; Ambika Shenoy; Brittney Sprouse; Frank Virgin; Bradford A Woodworth; Stella E Lee Journal: Int Forum Allergy Rhinol Date: 2022-02-22 Impact factor: 5.426