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.

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.

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 Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function

2012 ◽  
Vol 50 (4) ◽  
pp. 360-369
Author(s):  
K.I. Macdonald ◽  
A. Gipsman ◽  
A. Magit ◽  
M. Fandino ◽  
E. Massoud ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Pulmonary Function Tests ◽  
Sinus Surgery ◽  
Intravenous Antibiotics

Introduction: The role of endoscopic sinus surgery (ESS) in patients with cystic fibrosis (CF) is not clearly defined. Objective: TO perform a systematic review of subjective and objective outcomes of ESS in CF. Methods: A systematic review was performed using the keywords 'sinusitis,' 'sinus surgery,' 'nasal polyps' and 'cystic fibrosis.' The quality of papers was assessed using the NICE scoring scale. Outcomes included safety, subjective symptoms, objective endoscopy scores, days spent in hospital, courses of antibiotics, and pulmonary function tests (PFTs). Results: Nineteen studies involving 586 patients were included in the review. There were four prospective cohort trials, and three were rated as good quality. There were no major complications attributable to ESS. There was consistent evidence in four cohort studies of improved sinonasal symptoms, including nasal obstruction, facial pain, headaches, rhinorrhea and olfaction. Three studies reported conflicting results in post-operative endoscopy scores. Three studies showed a decrease in days spent in hospital, and two showed a significant decrease in courses of intravenous antibiotics. A recent study, however, did not show a difference in either days spent in hospital or courses of antibiotics. Pulmonary function tests were not improved by ESS in six cohort trials, and one small study found significant improvement. A meta-analysis of FEV1 scores confirmed no significant difference. Conclusion: THE most consistent findings of this review were that ESS in patients with CF is safe, produces symptomatic benefit, and does not consistently improve PFTs. There were more conflicting results with regards to endoscopy scores, days spent in hospital, and courses of intravenous antibiotics. Future prospective studies, utilizing validated quality of life, symptom and endoscopy scales, are needed to further elucidate the role of ESS in the management of chronic rhinosinusitis in CF patients.

scholarly journals Endoscopic Sinus Surgery in Cystic Fibrosis: Effects on Pulmonary Function and Ideal Body Weight

2004 ◽  
Vol 83 (2) ◽  
pp. 118-121 ◽  
Author(s):  
William A. Jarrett ◽  
Oleg Militsakh ◽  
Michael Anstad ◽  
Jose Manaligod
Keyword(s):  
Cystic Fibrosis ◽  
Body Weight ◽  
Pulmonary Function ◽  
Endoscopic Sinus Surgery ◽  
Ideal Body Weight ◽  
Sinus Surgery ◽  
Ideal Body

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.

Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation

2019 ◽  
Vol 33 (4) ◽  
pp. 354-358 ◽  
Author(s):  
Tracy Z. Cheng ◽  
Kevin J. Choi ◽  
Adam L. Honeybrook ◽  
Rasheedat T. Zakare-Fagbamila ◽  
Alice L. Gray ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Respiratory Tract ◽  
Pulmonary Function ◽  
Lung Transplantation ◽  
Respiratory Tract Infections ◽  
Forced Expiratory Volume ◽  
Sinus Surgery ◽  
Least Squares Regression ◽  
Antibiotic Utilization ◽  
Tract Infections

Background Patients with cystic fibrosis (CF) who have undergone lung transplantation frequently require hospitalizations and antibiotic treatments for respiratory tract infections. Although endoscopic sinus surgery (ESS) improves sinonasal quality of life in CF patients, it is unclear if ESS offers additional benefit in terms of antibiotics for pulmonary infection, hospitalization, and pulmonary function. Objective To determine whether ESS impacts antibiotic use or hospitalizations for pulmonary indications or pulmonary function in CF patients after lung transplantation. Methods This is a single-institution retrospective study of all patients who underwent lung transplantation for CF from 2005 to 2017. Patients who underwent ESS at least 1 year after transplant were included. Paired bivariate analyses were performed to determine whether there was a difference in the frequency and length of hospitalizations for pulmonary indications, number of antibiotic courses (intravenous and oral) for pulmonary exacerbations, and forced expiratory volume in 1 second (FEV1) slope in the 6 months before versus after ESS. Perioperative antibiotics and hospitalizations were not included in the analyses. Least squares regression was utilized to analyze FEV1 trends. Results A total of 20 patients underwent 36 ESS during the study period. There was significantly higher antibiotic utilization in the 6 months before ESS (0.89 ± 1.03) compared to the 6 months after ESS (0.33 ± 0.53) ( P = .002). The frequency and length of hospitalizations, FEV1 slope, and FEV1 trend before and after ESS were not significantly different. Conclusion Our results suggest that ESS is associated with a reduction in the frequency of antibiotic utilization for respiratory tract infections in lung transplant recipients with CF. A prospective study is needed to investigate these relationships further.

Improvement of Pulmonary Function in Cystic Fibrosis Patients following Endoscopic Sinus Surgery

2021 ◽  
Author(s):  
Kosuke Kawai ◽  
Natasha Dombrowski ◽  
Gregory S. Sawicki ◽  
Eelam A. Adil
Keyword(s):  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery

scholarly journals Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function

2012 ◽  
Vol 50 (4) ◽  
pp. 360-369 ◽  
Author(s):  
K.I. Macdonald ◽  
A. Gipsman ◽  
A. Magit ◽  
M. Fandino ◽  
E. Massoud ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Sinus Surgery

Effect of Endoscopic Sinus Surgery on Bronchiectasis Patients With Chronic Rhinosinusitis

2018 ◽  
Vol 32 (5) ◽  
pp. 432-439 ◽  
Author(s):  
Jesada Kanjanaumporn ◽  
Peter H. Hwang
Keyword(s):  
Pulmonary Function ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Pulmonary Function Tests ◽  
Pearson Correlation ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Sinus Surgery ◽  
Post Operation ◽  
Snot 22

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.

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