Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽  
2020 ◽  
pp. 1-4
Author(s):  
Daniel B. Spielman ◽  
David A. Gudis
Keyword(s):  
Cystic Fibrosis ◽  
Mechanical Ventilation ◽  
Chronic Rhinosinusitis ◽  
Local Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Office Setting

<b><i>Objective:</i></b> Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization. <b><i>Methods:</i></b> This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia. <b><i>Results:</i></b> Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission. <b><i>Conclusion:</i></b> This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.

Endoscopic Sinus Surgery for Cystic Fibrosis: Variables Influencing Sinonasal and Pulmonary Outcomes

2021 ◽  
pp. 194589242110596
Author(s):  
Keven S. Y. Ji ◽  
Dennis Frank-Ito ◽  
Ralph Abi Hachem ◽  
Khalil Issa ◽  
Carrie Johnson ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Revision Surgery ◽  
Endoscopic Sinus Surgery ◽  
Stepwise Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Forced Expiratory Volume ◽  
Older Age ◽  
Sinus Surgery

Background Endoscopic sinus surgery is a well-established treatment for chronic rhinosinusitis in patients with cystic fibrosis, though its benefits seem to be limited to improving sinonasal symptoms rather than affecting lung function. Objective This study aims to identify clinical and demographic factors that may influence sinonasal and pulmonary outcomes after surgery. Methods This is a six-year retrospective analysis of adult cystic fibrosis patients who underwent endoscopic sinus surgery at a tertiary care center. 22-Item Sino-Nasal Outcomes Test scores and mean forced expiratory volume data at baseline and three to six months after surgery were analyzed using t-test and stepwise regression with the following covariates: age, gender, lung transplant, revision surgery, and pseudomonas on sinus culture. Results 119 surgeries were performed on 88 patients, with 69% on patients with transplant. The overall mean (Standard Deviation) improvement in 22-Item Sino-Nasal Outcomes Test score was 9.42 (18.15) for the entire cohort ( P < .001). Pseudomonas on culture was associated with less improvement in sinonasal scores ( P = .002). There was no significant change in forced expiratory volume after surgery ( P = .94). Revision surgery ( P = .004) and older age ( P = .007) were associated with less favorable change of pulmonary function on stepwise regression ( P = .002). There was no correlation between change in sinonasal scores and pulmonary function. Conclusion Although surgery was associated with a clinically and statistically significant improvement in sinonasal scores in cystic fibrosis patients, patients with pseudomonas may experience less benefit. Revision surgery and older age may be associated with less favorable pulmonary outcomes. Awareness of such variables may help when deciding which cystic fibrosis patients should undergo surgery.

scholarly journals Outcomes of Sinus Surgery in Adults with Cystic Fibrosis

2009 ◽  
Vol 141 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Ayesha N. Khalid ◽  
Jess Mace ◽  
Timothy L. Smith
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Endoscopic Sinus Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Preoperative Ct ◽  
Nested Case Control ◽  
The Impact

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. Preoperative CT and preoperative/postoperative endoscopic findings were recorded as objective measures. Changes in two disease-specific quality-of-life (QoL) instruments were also evaluated both preoperatively and postoperatively. RESULTS: Mean postoperative follow-up was similar for cases and controls (13.1 ± 7.9 months vs 14.0 ± 6.0 months, respectively). Preoperative 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. Postoperative endoscopy scores were significantly worse for CRS patients 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 comorbid CF comparable to patients without CF.

scholarly journals Chronic rhinosinusitis in adult patients with cystic fibrosis: clinical manifestation and therapeutic approaches

2019 ◽  
Vol 29 (3) ◽  
pp. 311-320
Author(s):  
G. L. Shumkova ◽  
E. L. Amelina ◽  
V. M. Svistushkin ◽  
E. V. Sin’kov ◽  
S. A. Krasovskiy ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Markers Of Inflammation

The aim of this study was to evaluate prevalence of chronic rhinosinusitis (CRS) and nasal polyps in adult patients with cystic fibrosis (CF) in Russian Federation. Additionally, we investigated the clinical course of CRS and developed the optimal therapeutic strategy.Methods. Three hundred and forty eight CF patients were involved in the study. Physical examination, computed tomography (CT) of paranasal sinuses and audiometry, if needed, were used. CRS and bilateral nasal polyps were diagnosed in 28 patients. Nasal endoscopy, SNOT-20 questionnaire, rhinomanometry, micro - biological examination of sputum and mucus from paranasal sinuses (obtained during puncture or surgery), spirometry, and measurement of serum markers of inflammation were used. Endoscopic sinus surgery was used in 14 patients (the group 1) and others were treated non-surgically (the group 2). Both group were treated during 6 months using intranasal mometasone, mucolytics and antibiotics via PARI SINUSTM nebulizer.Results. An improvement in symptoms, CT signs, rhinomanometry parameters and endoscopic signs was seen in both groups after treatment and was more prominent in the surgical treatment group compared to the non-surgical treatment group. Bacterial load reduction in nasal sinuses, decrease in the rate of pulmonary disease exacerbations, and an improvement in oxygen blood saturation were found in the surgical treatment group only. Treatment of CRS did not affect lung function, sputum microbiology and serum inflammatory markers.Conclusion. Endoscopic sinus surgery followed by intranasal mucolytics and antibacterials is an effective and well-tolerated treatment in adult CF patients with CRS. 

The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients

2019 ◽  
Vol 128 (12) ◽  
pp. 1129-1133
Author(s):  
Danny B. Jandali ◽  
Ashwin Ganti ◽  
Inna A. Husain ◽  
Pete S. Batra ◽  
Bobby A. Tajudeen
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Tertiary Care ◽  
Voice Quality ◽  
Upper Airway ◽  
Sinus Surgery ◽  
Perceptual Evaluation ◽  
Snot 22

Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

scholarly journals Role of anatomical variations in chronic rhinosinusitis on diagnostic nasal endoscopy and computed tomography scan of paranasal sinuses

2019 ◽  
Vol 6 (1) ◽  
pp. 101
Author(s):  
Falguni J. Parmar ◽  
Avani D. Patel
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Care Center ◽  
Tertiary Care ◽  
Middle Turbinate ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Nasal Endoscopy ◽  
Advantages And Disadvantages

<p class="abstract"><strong>Background:</strong> Diagnostic nasal endoscopy (DNE) and computed tomography (CT) of para nasal sinuses play an important role in the diagnosis and treatment of chronic rhinosinusitis (CRS). The aim and objective of the study is to see the anatomical variations of the sinonasal region in CRS on DNE and CT paranasal sinuses (PNS).</p><p class="abstract"><strong>Methods:</strong> A descriptive type retrospective study of 30 patients attending the ENT outpatient department of our tertiary care center clinically diagnosed as CRS with symptoms persisting for 12 weeks or more, along with previously failed medical management, including topical nasal steroids, systemic decongestant and extended courses of antibiotics and who were willing to undergo endoscopic sinus surgery are included.  </p><p class="abstract"><strong>Results:</strong> Majority of the patients had septal deviation either an anterior or posterior deviation but majority of the cases are asymptomatic for the deviation. Anatomical variations of uncinate process, middle turbinate, inferior turbinate, frontal recess, agger nasi cells, haller cells were studied as well.</p><p class="abstract"><strong>Conclusions:</strong> Prolonged duration of  rhinosinusitis symptoms (more than 8-12 weeks) is the primary reason to evaluate a patient for CRS and making the choice between CT PNS or DNE is patient and disease dependent. Understanding the advantages and disadvantages of each helps us realize that they are of synergistic in nature and not competitive.</p>

Complete versus Limited Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Cystic Fibrosis

2020 ◽  
Vol 162 (4) ◽  
pp. 572-580 ◽  
Author(s):  
Daniel J. Lee ◽  
Christopher M. K. L. Yao ◽  
Jenna Sykes ◽  
Leena Rizvi ◽  
Elizabeth Tullis ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Postoperative Period ◽  
Endoscopic Sinus Surgery ◽  
Hospital Admissions ◽  
Care Center ◽  
Sinus Surgery ◽  
Oral Antibiotic ◽  
Health Care Center ◽  
Pulmonary Exacerbations

Objective To examine the effects of the extent of endoscopic sinus surgery (ESS) on pulmonary health, including the pulmonary exacerbations and lung function in patients with cystic fibrosis (CF). Study Design Retrospective cohort study. Setting Tertiary health care center. Subjects and Methods A retrospective review of patients with CF who underwent ESS at St. Michael’s Hospital between 1999 and 2016 was performed. Two groups of patients were identified based on the surgical extent: (1) complete (maxillary antrostomy, complete ethmoidectomy, sphenoidotomy, and frontal sinusotomy) and (2) limited (any ESS that involved less than complete). Primary outcomes included the number of pulmonary exacerbations (the use of oral or intravenous [IV] antibiotics), number of hospital admissions and hospital days during a 2-year pre- and postoperative period, and pulmonary function outcomes during a 1-year pre- and postoperative period. Results There were 70 procedures (30 complete and 40 limited) among 57 patients. Baseline characteristics were similar between the groups. Complete ESS group had a significant reduction in the oral antibiotic use compared to the limited ESS group (median, –1.0 [interquartile range (IQR), –2 to 0] in complete vs 0 [IQR, –1 to 1] in limited, P = .028). There was no difference in the use of IV antibiotics, number and duration of admissions, or rate of lung function change between the 2 groups. Conclusion Complete ESS may reduce mild forms of pulmonary exacerbations as shown in the decreased use of oral antibiotics. Overall, ESS does not significantly modify pulmonary outcomes in patients with CF.

scholarly journals Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Nadim Saydy ◽  
Sami Pierre Moubayed ◽  
Martin Desrosiers
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Nasal Congestion ◽  
A Priori ◽  
Tertiary Care ◽  
Sinus Surgery ◽  
Data Set ◽  
Patient Goals ◽  
Personalized Approach ◽  
Minor Disease

Abstract Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract

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