Effect of Endoscopic Sinus Surgery on Clinical Outcomes in Cystic Fibrosis

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.

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Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽

10.1159/000512495 ◽

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

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

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The Effects of a Practice Guideline on Endoscopic Sinus Surgery at an Academic Center

American Journal of Rhinology ◽

10.2500/105065897782537232 ◽

1997 ◽

Vol 11 (2) ◽

pp. 161-166 ◽

Cited By ~ 1

Author(s):

Michael G. Stewart ◽

Edward J. Hillman ◽

Donald T. Donovan ◽

Sarper H. Tanli

Keyword(s):

Health Care ◽

Clinical Outcomes ◽

Endoscopic Sinus Surgery ◽

Care Delivery ◽

Hospital Costs ◽

Sinus Surgery ◽

Care Process ◽

Short Term ◽

Academic Center ◽

Median Hospital

Practice guidelines (PG) (or clinical pathways) are increasingly important tools for standardizing health care delivery, improving efficiency, monitoring quality, and controlling costs. Health services researchers divide the delivery of health care into three stages: structure, process, and outcome. PGs are a technique to standardize the process of health care delivery, which may result in improved clinical outcomes or may maintain clinical outcomes while increasing process efficiency and decreasing costs. We describe the development and implementation of a PG for endoscopic sinus surgery at an academic center, and report preliminary results on the effects of the PG on the health care process. The PG was developed using a multidisciplinary combination of consensus-building and evidence-based techniques. Initially, participation in the PG was voluntary and at the attending physician's discretion. One year after implementation of the PG, 41 patients had been enrolled by members of the medical school's full-time faculty. Process and short-term outcome variables on those patients were compared to a random sample of 50 patients treated by the same physicians, but not using the PG. There was no evidence of selection bias into the PG based on demographics, severity of sinusitis, or the presence of comorbid factors. There were no differences in time spent in the operating room, postanesthesia care unit, or day surgery observation unit, between patients using the PG and not using the PG. However, patients not using the PG had a significantly higher rate of unplanned admission. Patients using the PG had significantly lower median hospital costs and charges than did patients not using the PG. In addition, median hospital costs and charges decreased steadily for all patients (not just those using the PG), simultaneous with the development and implementation of the PG. There were no differences in short-term clinical outcomes between PG and non-PG patients. In summary, the development and implementation of a PG for endoscopic sinus surgery resulted in lower hospital costs and charges while maintaining acceptable short-term clinical outcomes. PGs have important implications for improving the efficiency of the health care process.

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Paranasal Sinus Mucoceles in Cystic Fibrosis

American Journal of Rhinology ◽

10.2500/105065893781976609 ◽

1993 ◽

Vol 7 (1) ◽

pp. 31-35 ◽

Cited By ~ 12

Author(s):

William E. Davis ◽

Giulio J. Barbero ◽

William R. LaMear ◽

Jerry W. Templer ◽

Peter Konig

Keyword(s):

Cystic Fibrosis ◽

Paranasal Sinus ◽

Computerized Tomography ◽

Paranasal Sinuses ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

The Other ◽

Sinus Surgery ◽

Lateral Nasal Wall ◽

Osteomeatal Complex

Six patients between the ages of 6 and 22 years old with cystic fibrosis were found to have mucoceles of the paranasal sinuses. Four were male and two were female. They experienced nasal obstruction, purulent rhinorrhea, and anosmia, but none had fever or pain. Nasal endoscopy and coronal computerized tomography scans revealed the lateral nasal wall to be displaced medially against the septum. Functional endoscopic sinus surgery revealed large cystic spaces filled with thick yellow-green mucus. Postoperatively most patients are able to smell and breathe through their noses. The mucocele probably begins as an obstructed anterior ethmoid cell, which then enlarges and obstructs the osteomeatal complex, which further impairs drainage of the other sinuses into this area.

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

Rhinology Journal ◽

10.4193/rhino11.271 ◽

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.

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

Ear Nose & Throat Journal ◽

10.1177/014556130408300212 ◽

2004 ◽

Vol 83 (2) ◽

pp. 118-121 ◽

Cited By ~ 17

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

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Endoscopic Sinus Surgery in Patients with Cystic Fibrosis: An Analysis of Complications

American Journal of Rhinology ◽

10.2500/105065800779954338 ◽

2000 ◽

Vol 14 (6) ◽

pp. 379-385 ◽

Cited By ~ 15

Author(s):

Ford D. Albritton ◽

Todd T. Kingdom

Keyword(s):

Cystic Fibrosis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery

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

Otolaryngology ◽

10.1177/0194599820904956 ◽

2020 ◽

Vol 162 (4) ◽

pp. 572-580 ◽

Cited By ~ 1

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.

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