Abstract
Objectives: Chronic rhinosinusitis (CRS) is prevalent in the Cystic
Fibrosis (CF) population. CRS exacerbations in CF are thought to
contribute to pulmonary exacerbations. Literature regarding the impact
of endoscopic sinus surgery (ESS) is inconclusive. This study examines
rates of lung function decline and pulmonary exacerbation in CF patients
who have undergone ESS. Design: Retrospective review of medical records.
Setting: Academic Hospital. Participants: 40 adult CF patients. Main
outcome measures: Rate of lung function decline (Forced Expiratory
Volume1(FEV1) % predicted), number of pulmonary exacerbations (IV/oral
antibiotic therapy +/- hospital admission) and total number days
hospitalized 2 years post-operatively was collected. CRS patients
undergoing ESS were matched to those without ESS by gender, age, and
F508del genotype. Results: Forty patients (mean age 37.4, 60% male)
were reviewed. No significant difference was found between the surgical
group and controls in baseline FEV1(72.5% vs. 72.7%, p=0.98), 2-year
pre-operative number of pulmonary exacerbations (3.05 vs. 1.65, p=0.10),
or Lund-Mackay scores (12.25 vs. 11.55, p=0.71). No significant
difference was found in 1-year (70.5% vs. 72.8%, p=0.84) or 2-year
(70.4% vs. 72.6% p=0.80) post-operative FEV1 and 2-year post-operative
pulmonary exacerbations (1.7 vs. 1.45, p=0.87). A significant increase
was identified in total number days hospitalized post-operatively (4.85,
p=0.02). In the surgical group, no significant difference was identified
between preoperative and postoperative FEV1, 1 -year (-2.51%, p=0.32)
and 2-years after ESS (-3.10%, p=0.51), postoperative rate of pulmonary
exacerbations (-1.28, p=0.11), or in total number days hospitalized
(3.74, p=0.14). Conclusions: In this study, ESS does not appear to
significantly improve FEV1 or decrease the number of pulmonary
exacerbations post-operatively.