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Barouh A, Nadoushan MJ, Soltanipur M. Comparison of Proliferating Cell Nuclear Antigen (PCNA) Expression among Nasal Polyp and Chronic Rhinosinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024:S2173-5735(24)00048-6. [PMID: 38723777 DOI: 10.1016/j.otoeng.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND OBJECTIVE Chronic rhinosinusitis is a common inflammatory disorder in sinonasal mucosa that could be developed with or without nasal polyps. Cellular proliferation is suggested as a possible mechanism of nasal polyp development. However, conducted studies in this context are limited. So, the present study's aim is the comparison of Proliferating cell nuclear antigen (PCNA) expression in nasal polyps and chronic rhinosinusitis. MATERIALS AND METHODS In this cross-sectional study, 70 nasal polyp and 60 chronic rhinosinusitis samples from patients referred to Mostafa Khomeini Hospital, Tehran from 2017 to 2022 were immunohistochemically stained by PCNA marker. The percentage of PCNA nuclear expression was determined in two groups and its association with the type of pathological lesion and the patient's age and sex was analyzed by SPSS statistic software version 24 statistical software (IBM Statistics, USA). RESULTS The mean expression of PCNA in nasal polyp and chronic rhinosinusitis samples was 16.55% ± 13.66 and 17.58% ± 12.68 respectively (ranging from 0 to 57% in both groups) however, there was no significant statistical difference between the two groups (p = 0.479). No relationship was found between PCNA expression with age and sex in none of the chronic rhinosinusitis and nasal polyp groups. CONCLUSION Proliferative activity of the nasal epithelial cell is similar in chronic rhinosinusitis with and without nasal polyps and it is considered that the increase of epithelial cell proliferative activity probably has no role in nasal polyp development in patients with chronic rhinosinusitis.
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Affiliation(s)
- Alireza Barouh
- Medical Students Research Committee, Shahed University, Tehran, Iran.
| | | | - Masood Soltanipur
- Medical Students Research Committee, Shahed University, Tehran, Iran; Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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2
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Yılmaz Topçuoğlu M, Sommerburg O, Wielpütz MO, Wucherpfennig L, Hackenberg S, Mainz JG, Baumann I. [Chronic rhinosinusitis in people with cystic fibrosis-an up-to-date review from the perspective of otorhinolaryngology]. HNO 2024:10.1007/s00106-024-01428-9. [PMID: 38363326 DOI: 10.1007/s00106-024-01428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Cystic fibrosis (CF) is a complex systemic disease involving numerous organ systems. With improved treatment options and increasing life expectancy of persons with CF (PwCF), extrapulmonary manifestations are coming increasingly into the focus. From birth, almost all PwCF have radiologically detectable pathologies in the upper airways attributable to CF-associated chronic rhinosinusitis (CF-CRS). OBJECTIVE The aim of this work is to provide an up-to-date overview of CF-CRS from the otorhinolaryngology perspective and to provide the reader with background knowledge and current developments. PATHOPHYSIOLOGY The cystic fibrosis transmembrane conductance regulator (CFTR) gene defect leads to increased viscosity of sinonasal secretions and reduced mucociliary clearance, causing chronic infection and inflammation in the upper airway segment and, consequently, to CF-CRS. CLINICAL PICTURE AND DIAGNOSTICS The clinical picture of CF-CRS comprises a wide spectrum from asymptomatic to symptomatic courses. CF-CRS is diagnosed clinically and radiologically. THERAPY Sinonasal saline irrigation is recommended as a conservative treatment measure. Topical corticosteroids are also commonly used. Surgical therapy is reserved for highly symptomatic treatment-refractory patients without a sufficient response to conservative treatment including CFTR modulator (CFTRm) therapies. Depending on the CFTR mutation, CFTRm therapies are the treatment of choice. They not only improve the pulmonary and gastrointestinal manifestations in PwCF, but also have positive effects on CF-CRS. CONCLUSION The ENT specialist is part of the interdisciplinary team caring for PwCF. Depending on symptom burden and treatment responsiveness, CF-CRS should be treated conservatively and/or surgically. Modern CFTRm have a positive effect on the clinical course of CF-CRS.
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Affiliation(s)
- M Yılmaz Topçuoğlu
- Hals-Nasen-Ohrenklinik der Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - O Sommerburg
- Sektion für Pädiatrische Pneumologie & Allergologie und Mukoviszidosezentrum, Zentrum für Kinder- und Jugendmedizin, Klinik III, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - M O Wielpütz
- Klinik für Diagnostische und Interventionelle Radiologie, der Universitätsklinik Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - L Wucherpfennig
- Klinik für Diagnostische und Interventionelle Radiologie, der Universitätsklinik Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - S Hackenberg
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J G Mainz
- Pädiatrische Pneumologie, Allergologie, Mukoviszidosezentrum Medizinische Hochschule Brandenburg (MHB) Theodor Fontane, Klinikum Westbrandenburg, Brandenburg an der Havel, Deutschland
| | - I Baumann
- Hals-Nasen-Ohrenklinik der Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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Almeida PRL, Person OC, Puga ME, Atallah ÁN, Trevisani VF. Surgery for nasal polyposis in cystic fibrosis. Cochrane Database Syst Rev 2023; 12:CD014084. [PMID: 38063253 PMCID: PMC10704557 DOI: 10.1002/14651858.cd014084.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-shortening, autosomal recessive disease that leads to abnormal electrolyte concentration in exocrine secretions. Secretion stasis in paranasal sinuses determines chronic rhinosinusitis (CRS) and nasal polyposis. Endoscopic sinus surgery is used to open the sinuses and allow medical treatment to work properly. OBJECTIVES To determine the effects of sinus surgery alone or in combination with medical treatment (non-surgical) compared to medical treatment (non-surgical) alone on both nasal and pulmonary function in people with CF diagnosed with CRS with nasal polyposis. Further, to evaluate the impact of sinus surgery (with or without medical treatment) on hospitalization rates, use of antibiotics and pulmonary exacerbation rates. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search: 4 July 2022. We also searched other databases (Pubmed, Embase, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Virtual Health Library and ClinicalTrials.gov). Date of last search: 18 September 2022. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing groups who underwent endoscopic sinus surgery and groups with medical treatment alone. DATA COLLECTION AND ANALYSIS The review authors independently selected studies, extracted data, assessed the risk of bias and evaluated the certainty of the evidence using GRADE. They contacted the authors of the included study for additional information. MAIN RESULTS We identified 66 publications relating to 50 studies from electronic searches. Only one study fulfilled the inclusion criteria, and only limited information was available. In this study, 28 participants aged 19 to 28 years were randomized in equal numbers to either nasal irrigation alone or nasal irrigation with surgery (endoscopic polypectomy with extended sinusotomy). The certainty of the evidence was very low according to the GRADE approach. We are uncertain whether, compared to medical treatment alone, the addition of surgical intervention improves nasal symptoms, or reduces bacterial colonization, the use of antibiotics and pulmonary exacerbations. We are also uncertain whether the addition of surgery to medical treatment leads to changes in pulmonary function. There was one episode of bleeding during surgery that was corrected during the procedure with no further consequences. The study did not report on survival. AUTHORS' CONCLUSIONS Very low-certainty evidence means we are not certain if endoscopic sinus surgery to treat chronic rhinosinusitis with nasal polyposis in cystic fibrosis is effective. Future research should be multicentric to increase the number of participants and increase statistical power. Adequate randomization and allocation concealment are important to guarantee that the groups are similar. Blinding, however, may not be possible in an ethical trial; even without blinding, results can achieve high-level evidence if the outcomes used are objective parameters. Future research should follow participants of all ages for at least 12 months to evaluate the evolution of nasal polyposis, its recurrence and how symptoms may return. We also consider mortality an important outcome to be assessed. Future clinical research should consider the effects of cystic fibrosis transmembrane conductance regulators, a new group of drugs that may affect the development of nasal polyps.
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Affiliation(s)
- Paula Ribeiro Lopes Almeida
- Collaborator of the Department of Otorhinolaryngology at Mario Covas State Hospital, School of Medicine ABC, Santo André - São Paulo, Brazil
- Postgraduate student at the Department of Emergency Medicine and Evidence-Based Medicine of the Federal Universitiy of São Paulo - UNIFESP, São Paulo, Brazil
| | - Osmar C Person
- Collaborator of the Department of Otorhinolaryngology at Mario Covas State Hospital, School of Medicine ABC, Santo André - São Paulo, Brazil
| | - Maria Es Puga
- Cochrane Brazil, Center for Studies in Evidence-Based Medicine and Health Technology Assessment, São Paulo, Brazil
| | - Álvaro N Atallah
- Cochrane Brazil, Center for Studies in Evidence-Based Medicine and Health Technology Assessment, São Paulo, Brazil
| | - Virginia Fm Trevisani
- Cochrane Brazil, Center for Studies in Evidence-Based Medicine and Health Technology Assessment, São Paulo, Brazil
- Head Professor at the Department of Rheumatology, University of Santo Amaro, São Paulo, Brazil
- Assistant Professor at the Department of Emergency Medicine and Evidence-Based Medicine, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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Eischen E, Gliksman MF, Segarra D, Murtagh RD, Ryan LE, Parasher AK, Tabor MH. Correlation between CT imaging and symptom scores in cystic fibrosis associated chronic sinusitis. Am J Otolaryngol 2023; 44:103858. [DOI: 10.1016/j.amjoto.2023.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
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Cascio F, Gazia F, D'Alcontres FS, Felippu AWD, Migliorato A, Rizzo G, Palmeri S, Felippu AWD, Lucanto MC, Costa S, Cascio F. The centripetal endoscopic sinus surgery in patients with cystic fibrosis: A preliminary study. Am J Otolaryngol 2023; 44:103912. [PMID: 37167857 DOI: 10.1016/j.amjoto.2023.103912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The main aim of this study is to analyze the possible differences between clinical, demographic or genetic characteristics, in Cystic Fibrosis (CF) patients with chronic rhinosinusitis (CRS) with different phenotype. The secondary objective is to describe the possible benefit of surgery with Centripetal Endoscopic Sinus Surgery (CESS). METHODS The study includes 56 who performed CT scan of the paranasal sinuses. They were divided in 3 group according to phenotype: CRS without Nasal Polyps (NP); CRS with NP; CRS complicated with Mucocele. The clinical symptoms, age, gender, genotype, microbial colonization and pulmonary disease stage were collected and analyzed to assess possible statistically significant differences. Regarding the 7 patients who performed CESS surgery, the number of hospitalizations, intravenous (iv) antibiotic courses, respiratory exacerbations, the FEV1, the Lund-Mackay Score (LMS) and the SNOT 22 were evaluated before and 1 year after surgery. RESULTS No statistically significant differences regarding clinical symptoms between the 3 groups were identified (p > 0.05). Furthermore, there were no differences in age, gender, genotype, microbial colonization and pulmonary disease stage (p > 0.05). Regarding the patients who performed CESS, no significative difference in FEV1 progression was found. A reduction in hospitalization, pulmonary exacerbation and in the number of iv antibiotic courses resulted statistically significant different (p = 0.004; <0.001 and <0.001 respectively). A significant improvement in SNOT-22 and LMS (p < 0.001) was obtained. CONCLUSION Radiological monitoring of the rhinosinus disease is necessary regardless of the clinical expression of the disease. The presence of CRS with NP complicated by mucocele is frequent and independent of the patient's age and clinical manifestations. An extensive surgical approach could represent the gold standard for patients with CF in consideration of the potential important advantages to perform a total toilet of all the sinuses and nasal cavities and at the same time eliminating a potential microbiological reservoir.
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Affiliation(s)
| | | | | | | | - Alba Migliorato
- Department of Biomedical, Dental and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giuseppina Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Serenella Palmeri
- Department of Otorhinolaryngology, San Vincenzo Hospital, ASP Messina, Taormina, Italy
| | | | | | - Stefano Costa
- Unit of Fibrosis Cystic, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Felice Cascio
- AO Papardo, Unit of Otorhinolaryngology, Messina, Italy
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Jones G, Hemmerich C, Rucker B, Wise A, Kee M, Johnson A, Brame L, Hamilton T, Vassar M. Harms reporting by systematic reviews for functional endoscopic sinus surgery: a cross-sectional analysis. Eur Arch Otorhinolaryngol 2023; 280:2805-2819. [PMID: 36595047 DOI: 10.1007/s00405-022-07803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate the completeness of harms reporting in systematic reviews (SRs) pertaining to functional endoscopic sinus surgery (FESS). METHODS Using a cross-sectional study design, we performed a comprehensive search using MEDLINE (PubMed and Ovid), EMBASE, Epistemonikos, and the Cochrane Database of Systematic Reviews databases for SRs regarding FESS on May 15th, 2022. Returns were screened and data were extracted in a masked, duplicate manner. Following established methodology, we extracted general study characteristics, harms items, and overall methodological quality for each SR in our sample. Corrected covered area (CCA) was calculated for SR dyads. For data analysis, using Stata 16.1 we performed a bivariate analysis between variables. RESULTS Fifty-five SR's were included in our sample after excluding 375 studies that did not meet our inclusion criteria. Of the included SRs, 19 (19/55, 34.5%) did not report harms and 39 (39/55, 70.9%) reported half of the harms items or fewer. Our study found that 23 (23/55, 41.8%) of SRs demonstrated a method of harms data collection, 26 (26/55, 47.3%) of SRs had patients available for harms analysis in their results, and 25 (25/55, 45.5%) of SRs had a balanced discussion of harms and benefits of FESS. Fifty-two SRs were appraised as "critically low" quality using AMSTAR-2. A significant association was found between completeness of harms reporting (Mahady) and whether harms were listed as a primary outcome. No other associations were statistically significant. Two SR dyads had CCAs between 20% and 50% overlap and were compared for unique and shared harms. CONCLUSIONS Our study demonstrates gaps in harms reporting regarding FESS in SRs. We recommend future studies implement guidelines such as the STROCCS guidelines or the harms extension of the PRISMA guidelines to improve harms reporting. Accurate harms reporting may advance patient safety and promote a more objective risk-benefit analysis for physicians and patients.
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Affiliation(s)
- Garrett Jones
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA.
| | - Christian Hemmerich
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Brayden Rucker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Audrey Wise
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Austin Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Lacy Brame
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Tom Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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7
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Kimple AJ, Senior BA, Naureckas ET, Gudis DA, Meyer T, Hempstead SE, Resnick HE, Albon D, Barfield W, Benoit MM, Beswick DM, Callard E, Cofer S, Downer V, Elson EC, Garinis A, Halderman A, Hamburger L, Helmick M, McCown M, McKinzie CJ, Phan H, Rodriguez K, Rubenstein RC, Severin A, Shah G, Shenoy A, Sprouse B, Virgin F, Woodworth BA, Lee SE. Cystic Fibrosis Foundation otolaryngology care multidisciplinary consensus recommendations. Int Forum Allergy Rhinol 2022; 12:1089-1103. [PMID: 35089650 PMCID: PMC9545592 DOI: 10.1002/alr.22974] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a multisystem disease that often requires otolaryngology care. Individuals with CF commonly have chronic rhinosinusitis but also present with hearing loss and dysphonia. Given these manifestations of CF, otolaryngologists are frequently involved in the care of patients with CF; however, there is limited consensus on optimal management of sinonasal, otologic, and laryngologic symptoms. METHODS The Cystic Fibrosis Foundation convened a multidisciplinary team of otolaryngologists, pulmonologists, audiologists, pharmacists, a social worker, a nurse coordinator, a respiratory therapist, two adults with CF, and a caregiver of a child with CF to develop consensus recommendations. Workgroups developed draft recommendation statements based on a systematic literature review, and a ≥80% consensus was required for acceptance of each recommendation statement. RESULTS The committee voted on 25 statements. Eleven statements were adopted recommending a treatment or intervention, while five statements were formulated recommending against a specific treatment or intervention. The committee recommended eight statements as an option for select patients in certain circumstances, and one statement did not reach consensus. CONCLUSION These multidisciplinary consensus recommendations will help providers navigate decisions related to otolaryngology consultation, medical and surgical management of CF-CRS, hearing, and voice in individuals with CF. A collaborative and multidisciplinary approach is advocated to best care for our patients with CF. Future clinical research is needed utilizing standardized, validated outcomes with comprehensive reporting of patient outcome, effects of modulator therapies, and genetic characteristics to help continue to advance care, decrease morbidity, and improve the quality of life for individuals with CF.
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Affiliation(s)
- Adam J. Kimple
- Department of Otolaryngology/Head & Neck SurgeryThe University of North CarolinaChapel HillNorth CarolinaUSA
| | - Brent A. Senior
- Department of Otolaryngology/Head & Neck SurgeryThe University of North CarolinaChapel HillNorth CarolinaUSA
| | - Edward T. Naureckas
- Department of Pulmonary MedicineCritical Care MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - David A. Gudis
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center/New York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Ted Meyer
- Department of Otolaryngology/Head & Neck SurgeryThe University of North CarolinaChapel HillNorth CarolinaUSA
- Department of Otolaryngology – Head and Neck SurgeryMedical University of South CarolinaSouth CarolinaUSA
| | | | | | - Dana Albon
- Department of Internal MedicineDivision of Pulmonary and Critical CareUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Wayne Barfield
- Pediatric and Adult CF CenterMedical University of South CarolinaSouth CarolinaUSA
| | - Margo McKenna Benoit
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Daniel M. Beswick
- Department of Head and Neck SurgeryUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Eliza Callard
- Community Advisor to the Cystic Fibrosis FoundationBethesdaMarylandUSA
| | - Shelagh Cofer
- Mayo Clinic‐Otolaryngology (ENT)/Head and Neck SurgeryRochesterMinnesotaUSA
| | | | - E. Claire Elson
- Department of PharmacyChildren's Mercy Kansas CityKansas CityMissouriUSA
| | - Angela Garinis
- Oregon Hearing Research CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Ashleigh Halderman
- Department of Otolaryngology/Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Lisa Hamburger
- Community Advisor to the Cystic Fibrosis FoundationBethesdaMarylandUSA
| | - Meagan Helmick
- Community Advisor to the Cystic Fibrosis FoundationBethesdaMarylandUSA
| | - Michael McCown
- Department of PediatricsWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Cameron J. McKinzie
- Department of PharmacyUniversity of North Carolina Medical CenterChapel HillNorth CarolinaUSA
| | - Hanna Phan
- College of Pharmacy, Department of Clinical Pharmacy, The University of MichiganC.S. Mott Children's Hospital, Michigan MedicineMichiganUSA
| | - Kenneth Rodriguez
- Department of OtolaryngologyUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - Ronald C. Rubenstein
- Allergy and Pulmonary Medicine, Department of PediatricsWashington University School of MedicineSt. LouisMissouriUSA
| | - Ashley Severin
- Department of Social WorkChildren's Mercy Kansas CityKansas CityMissouriUSA
| | - Gopi Shah
- Department of Otolaryngology/Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ambika Shenoy
- Department of Pediatrics, Division of Pediatric PulmonologyNemours Alfred I. duPont Hospital for ChildrenWilmingtonDelawareUSA
| | - Brittney Sprouse
- Department of Pediatrics, Division of Pediatric PulmonologyNemours Alfred I. duPont Hospital for ChildrenWilmingtonDelawareUSA
- University of Chicago MedicineChicagoIllinoisUSA
| | - Frank Virgin
- Department of Otolaryngology – Head and Neck SurgeryMonroe Carell Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Bradford A. Woodworth
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Stella E. Lee
- Brigham and Women's Hospital, Division of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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Spielman DB, Beswick DM, Kimple AJ, Senior BA, Aanaes K, Woodworth BA, Schlosser RJ, Lee S, Cho DY, Adappa ND, DiMango E, Gudis DA. The management of cystic fibrosis chronic rhinosinusitis: An evidenced-based review with recommendations. Int Forum Allergy Rhinol 2022; 12:1148-1183. [PMID: 34933415 PMCID: PMC10083096 DOI: 10.1002/alr.22953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) chronic rhinosinusitis (CRS) has emerged as a distinct diagnostic entity, unique from other endotypes of CRS in its presentation, pathophysiology, diagnosis, treatment, and outcomes. As the sinonasal health of this patient population may have broad effects on pulmonary health and quality of life, a comprehensive understanding of the diagnostic and therapeutic approach to CF CRS is essential. In recognizing recent scientific advances and unique treatment modalities specific to this challenging patient population, in this review we systematically evaluate the scientific literature and provide an evidenced-based review with recommendations (EBRR) for fundamental management principles of CF CRS. METHODS A systematic review of the literature was performed. Studies evaluating interventions for the management of CF CRS were included. An iterative review process was implemented in accordance with EBRR guidelines. A treatment recommendation was generated based on an assessment of the benefits, harms, and the overall grade of evidence. RESULTS We evaluated the published literature on 5 unique topics. Each of the following therapeutic categories was investigated explicitly for treatment outcomes in patients with CF CRS: (1) nasal saline; (2) intranasal corticosteroids (INCS); (3) topical antibiotics; (4) cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy; and (5) endoscopic sinus surgery (ESS). CONCLUSION Based on the currently available evidence, nasal saline, ESS, and CFTR modulators are recommended in the management of CF CRS when appropriate. INCS and topical antibiotics are options. Clinical judgment and experience are essential in caring for patients with this uniquely challenging disorder.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Daniel M Beswick
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Adam J Kimple
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Brent A Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kasper Aanaes
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, University of Copenhagen, Copenhagen, Denmark
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Stella Lee
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Emily DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
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9
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Lee AJ, Huffmyer JL, Thiele EL, Zeitlin PL, Chatterjee D. The Changing Face of Cystic Fibrosis: An Update for Anesthesiologists. Anesth Analg 2022; 134:1245-1259. [PMID: 35020677 DOI: 10.1213/ane.0000000000005856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cystic fibrosis (CF) is the most common fatal genetic disease in North America. While CF is more common among Whites, it is increasingly being recognized in other races and ethnicities. Although there is no cure, life expectancy has steadily improved, with the median survival exceeding 46 years in the United States. There are now more adults than children with CF in the United States. CF is caused by mutations in a gene that encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein, expressed in many epithelial cells. More than 2100 CFTR mutations have been linked to CF, and newer CFTR modulator drugs are being used to improve the production, intracellular processing, and function of the defective CFTR protein. CF is a multisystem disease that affects primarily the lungs, pancreas, hepatobiliary system, and reproductive organs. Anesthesiologists routinely encounter CF patients for various surgical and medical procedures, depending on the age group. This review article focuses on the changing epidemiology of CF, advances in the classification of CFTR mutations, the latest innovations in CFTR modulator therapies, the impact of the coronavirus disease pandemic, and perioperative considerations that anesthesiologists must know while caring for patients with CF.
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Affiliation(s)
- Amy J Lee
- From the Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - Eryn L Thiele
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - Pamela L Zeitlin
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Debnath Chatterjee
- From the Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Johnson JR, Hwang PH, Nayak JV, Patel ZM. Comparison of endoscopic sinus surgery timing in lung transplant patients with cystic fibrosis. Int Forum Allergy Rhinol 2021; 12:821-827. [PMID: 34875144 DOI: 10.1002/alr.22935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/17/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND No studies have investigated when endoscopic sinus surgery (ESS) is best performed in lung transplant patients with cystic fibrosis (CF). We sought to examine the effects of ESS timing on pulmonary health in this population. METHODS A retrospective review of all adult lung transplant patients with CF who underwent ESS at our academic medical center over a near 25-year period was performed. Patients were split into two groups based on median time from lung transplantation to ESS. Twenty-three patients were included (12 ESS early and 11 ESS delayed). Outcomes included changes in pulmonary function tests (PFTs) from baseline, pre-operative to post-operative measurements, the number and duration of hospitalizations for pulmonary exacerbations, and the number of antibiotic courses used specifically to treat pulmonary exacerbations during the 12 months before and after ESS. RESULTS Baseline demographics, operative history, and pulmonary function characteristics were similar between groups. While the ESS early group saw significant improvement from pre-operative percent predicted FEV1 (ppFEV1 ) at 12 months post-operatively (CI: 0.729 - 11.452, P = 0.030), there were no significant post-operative PFT changes for the ESS delayed group. Post-operative improvement in FEV1 and ppFEV1 at 12 months was significantly higher for the ESS early group relative to the ESS delayed group (CI: 0.010 - 0.583, P = 0.043; CI: 1.240 - 16.692, P = 0.025; respectively). The ESS early group had a significant reduction in the need for total antibiotic courses compared to the ESS delayed group (ESS early median: -1, IQR: -1.5 to -0.5 vs ESS delayed median: 0, IQR: 0 to 0; P = 0.027). CONCLUSION Earlier ESS interventions following lung transplantation may improve pulmonary function and attenuate pulmonary exacerbations in CF patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joseph R Johnson
- Stanford University School of Medicine, Stanford, California, USA
| | - Peter H Hwang
- Stanford University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Stanford, California, USA
| | - Jayakar V Nayak
- Stanford University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Stanford, California, USA
| | - Zara M Patel
- Stanford University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Stanford, California, USA
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11
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Ji KSY, Frank-Ito D, Abi Hachem R, Issa K, Johnson C, Mohamedaly O, Goldstein BJ, Jang DW. Endoscopic Sinus Surgery for Cystic Fibrosis: Variables Influencing Sinonasal and Pulmonary Outcomes. Am J Rhinol Allergy 2021; 36:307-312. [PMID: 34806427 DOI: 10.1177/19458924211059606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- Keven S Y Ji
- 12277Duke University School of Medicine, Durham, NC, USA.,6684Oregon Health & Science University Hospital, Portland, OR, USA
| | | | | | - Khalil Issa
- 22957Duke University Hospital, Durham, NC, USA
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12
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Cystic fibrosis foundation consensus statements for the care of cystic fibrosis lung transplant recipients. J Heart Lung Transplant 2021; 40:539-556. [PMID: 34103223 DOI: 10.1016/j.healun.2021.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 12/27/2022] Open
Abstract
Cystic fibrosis (CF) is the indication for transplantation in approximately 15% of recipients worldwide, and Cystic Fibrosis Lung Transplant Recipients (CFLTRs) have excellent long-term outcomes. Yet, CFLTRs have unique comorbidities that require specialized care. The objective of this document is to provide recommendations to CF and lung transplant clinicians for the management of perioperative and underlying comorbidities of CFLTRs and the impact of transplantation on these comorbidities. The Cystic Fibrosis Foundation (CFF) organized a multidisciplinary committee to develop CF Lung Transplant Clinical Care Recommendations. Three workgroups were formed to develop focused questions. Following a literature search, consensus recommendations were developed by the committee members based on literature review, committee experience and iterative revisions, and in response to public comment. The committee formulated 32 recommendation statements in the topics related to infectious disease, endocrine, gastroenterology, pharmacology, mental health and family planning. Broadly, the committee recommends close coordination of care between the lung transplant team, the cystic fibrosis care center, and specialists in other disciplines with experience in the care of CF and lung transplant recipients. These consensus statements will help lung transplant providers care for CFLTRs in order to improve post-transplant outcomes in this population.
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13
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Shah P, Lowery E, Chaparro C, Visner G, Hempstead SE, Abraham J, Bhakta Z, Carroll M, Christon L, Danziger-Isakov L, Diamond JM, Lease E, Leonard J, Litvin M, Poole R, Vlahos F, Werchan C, Murray MA, Tallarico E, Faro A, Pilewski JM, Hachem RR. DUPLICATE: Cystic Fibrosis Foundation Consensus Statements for the Care of Cystic Fibrosis Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Dadgostar A, Nassiri S, Quon BS, Manji J, Alsalihi S, Javer A. Effect of endoscopic sinus surgery on clinical outcomes in DeltaF508 cystic fibrosis patients. Clin Otolaryngol 2021; 46:941-947. [PMID: 33686728 DOI: 10.1111/coa.13751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
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 (% predicted Forced Expiratory Volume in 1 second [ppFEV1 ]), number of pulmonary exacerbations (IV/oral antibiotic therapy ± hospital admission) and total number days hospitalised 2-year postoperatively 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 ppFEV1 (72.5% vs. 72.7%, P = .98), 2-year preoperative number of pulmonary exacerbations (3.05 vs. 1.65, P = .10), or Lund-Mackay scores (12.25 vs. 11.55, P = .71). No significant difference was found in 1-year (70.5% vs. 72.8%, P = .84) or 2-year (70.4% vs. 72.6% P = .80) postoperative ppFEV1 and 2-year postoperative pulmonary exacerbations (1.7 vs. 1.45, P = .87). A significant increase was identified in total number days hospitalised postoperatively (4.85, P = .02). In the surgical group, no significant difference was identified between preoperative and postoperative ppFEV1 , 1 year (-2.51%, P = .32) and 2 years after ESS (-3.10%, P = .51), postoperative rate of pulmonary exacerbations (-1.28, P = .11), or in total number days hospitalised (3.74, P = .14). CONCLUSIONS In this study, ESS does not appear to significantly improve ppFEV1 or decrease the number of pulmonary exacerbations postoperatively.
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Affiliation(s)
- Anali Dadgostar
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Sepehr Nassiri
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Bradley S Quon
- Adult Cystic Fibrosis Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Jamil Manji
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Salahuddin Alsalihi
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Amin Javer
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
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Wang C, Johnson R, Horani S, Brown C, Mitchell R, Shah G. Chronic rhinosinusitis and endoscopic sinus surgery in children admitted for pulmonary exacerbations of cystic fibrosis. Int J Pediatr Otorhinolaryngol 2021; 140:110548. [PMID: 33302019 DOI: 10.1016/j.ijporl.2020.110548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Non-surgical management of chronic rhinosinusitis (CRS) in children with cystic fibrosis (CF) has been increasing over the last decade. This study examines inpatient children with pulmonary exacerbation of CF who were also diagnosed with CRS and underwent endoscopic sinus surgery (ESS). STUDY DESIGN We used the 2003 to 2016 Kids Inpatient Database to perform a cross-sectional analysis of inpatients (ages 0-21 years) diagnosed with CF and CRS in the United States from 2003 to 2016. Demographics and CF-associated comorbidities were recorded and rates of CRS and ESS in children with CF were examined. RESULTS 49,110 children were included in the study. A total of 9334 (19%) were diagnosed with CRS. The average age was 13 (SD 5.9) years; the majority were female (56%), and White (67%). The prevalence of CRS increased from 2003 to 2016 (14%-23%, p < 0.001) while the rate of ESS decreased (20%-11%, p < .001). Patients with CRS that underwent ESS more commonly had CF-associated comorbidities including GI manifestations (15%-25%, p < .001) and liver disease (15%-30%, p < .001). CONCLUSION The diagnosis of CRS in children with CF hospitalized for pulmonary exacerbation has increased while ESS has decreased in the last decade. Patients with CRS that underwent ESS more commonly had CF-associated comorbidities. Studies to determine whether children with CF-associated comorbidities are more likely to benefit from ESS are needed.
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Affiliation(s)
- Cynthia Wang
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Romaine Johnson
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sami Horani
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Clarice Brown
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ron Mitchell
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gopi Shah
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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16
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Senior BA. Cystic fibrosis: On the cusp of cure? Int Forum Allergy Rhinol 2020; 11:745-746. [PMID: 33070464 DOI: 10.1002/alr.22714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Brent A Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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17
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Beswick DM, Saavedra MT. Stakeholder feedback informs investigations for chronic rhinosinusitis in cystic fibrosis. Int Forum Allergy Rhinol 2020; 11:79-80. [PMID: 32996261 DOI: 10.1002/alr.22705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, University of Colorado, Aurora, CO.,Division of Specialty Services, National Jewish Health, Denver, CO
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18
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Johnson BJ, Choby GW, O'Brien EK. Chronic rhinosinusitis in patients with cystic fibrosis-Current management and new treatments. Laryngoscope Investig Otolaryngol 2020; 5:368-374. [PMID: 32596478 PMCID: PMC7314487 DOI: 10.1002/lio2.401] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this article is to provide a state-of-the-art review of the literature and summarize the latest publications on medical and surgical treatment of cystic fibrosis (CF) chronic rhinosinusitis (CRS), with an emphasis on describing recent advancements in cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies. METHODS A comprehensive literature review was conducted utilizing the PubMed database with search phrases detailed within the body of the article. Abstracts were reviewed to include publications detailing medical, surgical, and CFTR modulating therapies for CF CRS. Findings from studies not previously reviewed and publications regarding CFTR modulators were emphasized. RESULTS No clear guidelines for treatment of CF CRS are available. Nasal saline rinses, topical steroids, topical antibiotics, and topical dornase alfa are reported medical therapies. Ivacaftor has some sinonasal symptomatic benefit. A new triple therapy CFTR modulator, elexacaftor/tezacaftor/ivacaftor, is capable of treating 90% of patients with CF and has shown the greatest FEV1 improvement of any CFTR modulator yet. There is no clear consensus on surgical indications or technique, though aggressive surgery in recalcitrant disease has shown some symptomatic benefit. Endoscopic sinus surgery after lung transplantation may benefit some patients in whom the sinuses serve as a reservoir for recurrent pulmonary infections by decreasing rates of bronchiolitis obliterans syndrome and improving 5 year survival. CONCLUSION As lifespan increases for patients with CF, further investigation into medical therapy, CFTR modulator sinonasal outcomes, and surgical technique and outcomes for CF CRS is needed. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Garret W. Choby
- Department of OtorhinolaryngologyMayo ClinicRochesterMinnesotaUSA
| | - Erin K. O'Brien
- Department of OtorhinolaryngologyMayo ClinicRochesterMinnesotaUSA
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19
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Okafor S, Kelly KM, Halderman AA. Management of Sinusitis in the Cystic Fibrosis Patient. Immunol Allergy Clin North Am 2020; 40:371-383. [DOI: 10.1016/j.iac.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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20
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Lee DJ, Yao CMKL, Sykes J, Rizvi L, Tullis E, Lee JM. Complete versus Limited Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Cystic Fibrosis. Otolaryngol Head Neck Surg 2020; 162:572-580. [PMID: 32093566 DOI: 10.1177/0194599820904956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
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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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Sykes
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Leena Rizvi
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Elizabeth Tullis
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John M Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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21
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Update on long-term outcomes for chronic rhinosinusitis in cystic fibrosis. Curr Opin Otolaryngol Head Neck Surg 2020; 28:46-51. [DOI: 10.1097/moo.0000000000000596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Surgical Management of Chronic Rhinosinusitis in Cystic Fibrosis. Med Sci (Basel) 2019; 7:medsci7040057. [PMID: 30959944 PMCID: PMC6524042 DOI: 10.3390/medsci7040057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
Cystic fibrosis patients frequently develop chronic rhinosinusitis as a result of their propensity to form inspissated mucus and impairment of mucociliary clearance. They exhibit variable symptom burden even in the setting of positive radiographic and endoscopic findings. Current evidence suggests a positive effect of managing sinonasal disease on pulmonary health. Topical antimicrobial and mucolytic therapies are frequently required to manage the disease with surgery reserved for refractory cases. Endoscopic sinus surgery has been demonstrated to be safe and efficacious in controlling symptoms of chronic rhinosinusitis in patients with comorbid cystic fibrosis. However, the impact of surgery on pulmonary health remains an active area of investigation. In addition, a growing body of research has suggested a more extended surgical approach creating large sinonasal cavities with gravity-dependent drainage pathways, followed by adjuvant medical therapies, as an ideal strategy to optimally control disease and prevent pulmonary exacerbations. In this manuscript, we provide an up-to-date review of current evidence in the surgical management of chronic rhinosinusitis in cystic fibrosis patients.
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23
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Cheng TZ, Choi KJ, Honeybrook AL, Zakare-Fagbamila RT, Gray AL, Snyder LD, Palmer SM, Abi-Hachem R, Jang DW. Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation. Am J Rhinol Allergy 2019; 33:354-358. [PMID: 30781973 DOI: 10.1177/1945892419830624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Tracy Z Cheng
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina.,2 School of Medicine, Duke University, Durham, North Carolina
| | - Kevin J Choi
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Adam L Honeybrook
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | | | - Alice L Gray
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Laurie D Snyder
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - Scott M Palmer
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - Ralph Abi-Hachem
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - David W Jang
- 1 Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
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24
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Luparello P, Lazio MS, Voltolini L, Borchi B, Taccetti G, Maggiore G. Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis. Eur Arch Otorhinolaryngol 2019; 276:1341-1347. [PMID: 30689038 DOI: 10.1007/s00405-019-05308-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Cystic Fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of Endoscopic Sinus Surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients underwent the surgical procedure rather than in the not treated ones, particulary in lung transplant patients. METHODS We studied 54 adult patients affected by CF. Lund-Kennedy, Lund-Mackay scores, and SNOT-22 were analysed. 14 had lung transplant and 9 had both lung tranplant and ESS procedures. RESULTS 22 (40.7%) out of 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund-Kennedy and Lund-Mackay scores appeared higher in the ESS group: 10 (range of 6-12) and 15 (range of 12-20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 20 (range of 3-68) and 40 (range of 10-73), respectively. CONCLUSIONS ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy, with a stabilization of respiratory function after transplantation.
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Affiliation(s)
- Paolo Luparello
- Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University Hospital, University of Florence, Largo Brambilla, 3-50134, Florence, Italy.
| | - Maria S Lazio
- Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University Hospital, University of Florence, Largo Brambilla, 3-50134, Florence, Italy
| | - Luca Voltolini
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy
| | - Beatrice Borchi
- Infectious Disease Department, Careggi University and Hospital, Florence, Italy
| | - Giovanni Taccetti
- Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy
| | - Giandomenico Maggiore
- Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University Hospital, University of Florence, Largo Brambilla, 3-50134, Florence, Italy
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Pletcher SD, Goldberg AN, Cope EK. Loss of Microbial Niche Specificity Between the Upper and Lower Airways in Patients With Cystic Fibrosis. Laryngoscope 2018; 129:544-550. [PMID: 30284279 DOI: 10.1002/lary.27454] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the relationship between mucosal-associated sinus and bronchial microbiota in cystic fibrosis (CF) patients compared to non-CF patients with chronic rhinosinusitis (CRS). STUDY DESIGN Case series. METHODS We examined the microbial composition of 52 paired sinus and bronchial brushings from 26 patients with CRS. Paired airway samples from nine subjects with CF were compared with samples from 17 non-CF-CRS disease control patients. The Illumina MiSeq platform was used to sequence the V4 region of the 16S rRNA gene. Sequences were analyzed using QIIME 1.9.0. RESULTS CF patients demonstrate increased severity of sinus inflammation (Lund-Mackay score 16.3 vs. 12.4, P = .023) and diminished diversity of microbial communities in both the sinuses (Shannon diversity 0.98 vs. 3.3, P = .009) and lungs (Shannon diversity 2.2 vs. 4.0, P = .042) relative to non-CF-CRS. Non-CF-CRS sinus and lung microbiota were distinct and clustered by niche (sinus vs. lung, P = .004). However, CF airway microbiota demonstrated a loss of niche specificity (sinus vs. lung, P = .492). Two CF patients underwent lung transplantation at 4.5 and 9 months prior to sampling. Sinus and lung samples from these two patients demonstrated distinct microbial communities. CONCLUSIONS Patients with CF undergoing surgery for CRS exhibit substantial bacterial community collapse in the sinuses and a loss of niche specificity between the upper and lower airways compared to non-CF patients with CRS. These results extend previous studies elucidating the lower airway microbiome in cystic fibrosis and provide support for the concept of microbial translocation in the cystic fibrosis airways. LEVEL OF EVIDENCE 4 Laryngoscope, 129:544-550, 2019.
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Affiliation(s)
- Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Andrew N Goldberg
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Emily K Cope
- Pathogen and Microbiome Institute, Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, U.S.A
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Shah GB, De Keyzer L, Russell JA, Halderman A. Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review. Int Forum Allergy Rhinol 2018; 8:729-736. [DOI: 10.1002/alr.22082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Gopi B. Shah
- Department of Otolaryngology-Head and Neck Surgery; University of Texas-Southwestern Medical Center and Children's Health Dallas; Dallas TX
| | - Linde De Keyzer
- Department of Pulmonology; University of Texas-Southwestern Medical Center and Children's Health; Dallas TX
| | - Joy A. Russell
- Health Sciences Digital Library and Learning Center; University of Texas-Southwestern Medical Center; Dallas TX
| | - Ashleigh Halderman
- Department of Otolaryngology-Head and Neck Surgery; University of Texas-Southwestern Medical Center and Children's Health Dallas; Dallas TX
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Khalfoun S, Tumin D, Ghossein M, Lind M, Hayes D, Kirkby S. Improved Lung Function after Sinus Surgery in Cystic Fibrosis Patients with Moderate Obstruction. Otolaryngol Head Neck Surg 2017; 158:381-385. [PMID: 29182491 DOI: 10.1177/0194599817739284] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives Cystic fibrosis (CF) is characterized by infection and inflammation of the sinorespiratory tract. Functional endoscopic sinus surgery (FESS) is an option for patients with severe sinusitis. We sought to evaluate pulmonary function testing after FESS in pediatric and adult patients with CF. Study Design Retrospective chart review using data from all patients with CF who underwent FESS from January 2009 to July 2014. Setting Patients were from a single institution. Subjects and Methods Data were extracted for 181 patients and 320 surgeries. Lung function data, including the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, were retrieved within 1 year before and after surgery. Mixed-effects regression was used to compare FEV1 trajectories before and after surgery. The effect of surgery was stratified by presurgery FEV1 to compare patients with mild/no lung disease (FEV1 >80%) and moderate/severe lung disease (FEV1 <80%). Results Of the 181 patients reviewed, 131 with primary FESS had FEV1 data. Presurgery average age was 16 years (95% confidence interval [CI], 14.27-17.73), and FEV1 mean was 85% (95% CI, 81.02-88.98). There were 88 patients with FEV1 >80% and 43 patients with FEV1 <80%. For the entire cohort, lung function did not change related to FESS. Among patients with FEV1 <80%, FEV1 declined presurgery by 3.5% per year (95% CI, -6.1% to -0.8%; P = .010), which halted after surgery with these patients, then showing no subsequent change in FEV1 (95% CI, 0.9%-3.7%; P = .240). No benefit was identified for patients with FEV1 >80%. Conclusion Pulmonary function testing improved in patients with moderate/severe lung disease 1 year following FESS. This suggests FESS may benefit pulmonary outcomes.
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Affiliation(s)
- Sabrina Khalfoun
- 1 Division of Pediatrics, Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dmitry Tumin
- 2 Division of Pediatrics, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Maroun Ghossein
- 3 Division of Pulmonary and Critical Care, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Meredith Lind
- 4 Division of Pediatrics, Section of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- 1 Division of Pediatrics, Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stephen Kirkby
- 1 Division of Pediatrics, Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Ayoub N, Walgama E, Thamboo A, Nayak JV, Hwang PH. Efficacy of endoscopic sinus surgery for chronic rhinosinusitis following primary radiotherapy and concurrent chemotherapy for nasopharyngeal carcinoma. Int Forum Allergy Rhinol 2017; 7:1045-1051. [DOI: 10.1002/alr.22002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/22/2017] [Accepted: 07/26/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Noel Ayoub
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Evan Walgama
- Division of Otolaryngology, Department of General Surgery; Cedars Sinai Medical Center; Los Angeles CA
| | - Andrew Thamboo
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Jayakar V. Nayak
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Peter H. Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
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Tumin D, Hayes D, Kirkby SE, Tobias JD, McKee C. Safety of endoscopic sinus surgery in children with cystic fibrosis. Int J Pediatr Otorhinolaryngol 2017; 98:25-28. [PMID: 28583497 DOI: 10.1016/j.ijporl.2017.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Data on the safety of endoscopic sinus surgery (ESS) are limited in children with cystic fibrosis (CF). We used a multi-institutional surgical registry to examine ESS outcomes in children with CF. METHODS The 2014-2015 American College of Surgeons' National Surgical Quality Improvement Program-Pediatric database was queried for patients age <18 years undergoing elective ESS. Prolonged hospital stay (>1 day), 30-day readmission, and 30-day unplanned reoperation were compared according to presence of CF diagnosis. RESULTS The data included 213 children with CF (age 10 ± 5 years, 105/108 male/female) and 821 children without CF (age 10 ± 5 years, 504/317 male/female). CF patients were more likely than non-CF patients to require prolonged hospital stay (30% vs. 9%, p < 0.001), yet had similar rates of readmission (6% vs. 4%; p = 0.189) and reoperation (0 vs. 1%; p = 0.133). All readmissions but one among CF patients were unrelated to ESS. In the non-CF cohort, reasons for ESS-related readmissions included recurrence of sinusitis, postoperative pain, and bleeding. CONCLUSIONS We demonstrate the safety of ESS in the largest cohort of children with CF reviewed to date. Multi-institutional review of ESS safety may contribute to monitoring expansion of this intervention in children with CF.
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Affiliation(s)
- Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, United States.
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Stephen E Kirkby
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, United States; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, United States; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH 43210, United States
| | - Christopher McKee
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, United States; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH 43210, United States
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Brook CD, Maxfield AZ, Ahmed H, Sedaghat AR, Holbrook EH, Gray ST. Factors influencing the need for endoscopic sinus surgery in adult patients with cystic fibrosis. Am J Rhinol Allergy 2017; 31:44-47. [PMID: 28234153 DOI: 10.2500/ajra.2017.31.4385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risk factors in adult patients with cystic fibrosis (CF) associated with surgical intervention have not been delineated. OBJECTIVE To identify characteristics of adult patients with CF and with chronic rhinosinusitis that predict surgical intervention with endoscopic sinus surgery (ESS). METHODS Patients were identified in a tertiary sinus center by the International Classification of Diseases, Ninth Revision codes 277.00-277.03, which represent CF. Charts were reviewed for the CF transmembrane conductance regulator (CFTR) gene mutation, Lund-Mackay score (LMS), the 22-item Sino-Nasal Outcome Test (SNOT-22) score, previous ESS, and occurrence of ESS after presentation. The Fisher exact test was used to test frequency of events between the groups, and the Mann Whitney U test and the t-test were used to compare means among LMS, SNOT-22, and age. The Cox proportional hazard analysis was used to calculate hazard ratios (HR) for the impact of LMS, SNOT-22 score, previous ESS, and CFTR gene mutation status on the occurrence of ESS after presentation. RESULTS One hundred and fifteen patients met the inclusion criteria for the study. Patients with a history of surgery more often underwent ESS after presentation (p ≤ 0.01). The LMS and the SNOT-22 score were not significantly different between the groups of previous ESS and no previous ESS (p = 0.23 and p = 0.28, respectively). A severe mutation genotype was predictive of ESS after presentation (p = 0.03). SNOT-22 scores did not differ between the severe and mild groups (36.0 and 32.4, respectively; p = 0.57), but the mean LMS was significantly higher in the severe mutation group (12.5 and 9.7; p ≤ 0.01). Univariate Cox proportional hazard analysis revealed an increased occurrence of ESS for patients with severe mutations (HR, 3.6; p ≤ 0.01) or a history of ESS (HR, 2.3; p ≤ 0.01). CONCLUSION The occurrence of ESS in adult patients with CF was predicted by previous ESS intervention as well as the severity of CFTR mutation.
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Abstract
Systemic and odontogenic etiologies of chronic rhinosinusitis, although rare, are an integral consideration in the comprehensive management of patients with sinonasal disease. Proper knowledge and timely recognition of each disease process, with referrals to appropriate consultants, will facilitate treatment, because many of these conditions require both local and systemic therapy. In some instances, medical therapy plays a pivotal role, with surgery being a supplemental treatment technique. We review the most commonly encountered systemic etiologies of chronic rhinosinusitis and odontogenic sinusitis, including clinical presentation, diagnosis, management, and treatment outcomes.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA) Medical Center, 10833 Le Conte Avenue, 62-132 CHS, Los Angeles, CA 90095, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA) Medical Center, 10833 Le Conte Avenue, 62-132 CHS, Los Angeles, CA 90095, USA.
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32
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Hull BP, Chandra RK. Refractory Chronic Rhinosinusitis with Nasal Polyposis. Otolaryngol Clin North Am 2017; 50:61-81. [PMID: 27888916 DOI: 10.1016/j.otc.2016.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents a subset of chronic sinusitis with various causes. Some forms of the disease are driven by allergy, often in association with asthma. Refractory CRSwNP can be associated with cystic fibrosis and other clinical syndromes. More recent literature is presented regarding roles of innate immunity and superantigens. Effective treatment of CRSwNP requires careful endoscopic sinus surgery followed by an individualized treatment plan that often includes oral and topical steroids. Recidivism of polyps is common, and patients require long-term follow-up.
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Affiliation(s)
- Benjamin P Hull
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University, 1215 21st Ave S, 7209 MCE-S, Nashville, TN 37232-8605, USA.
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Tipirneni KE, Woodworth BA. Medical and Surgical Advancements in the Management of Cystic Fibrosis Chronic Rhinosinusitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:24-34. [PMID: 28989817 PMCID: PMC5626435 DOI: 10.1007/s40136-017-0139-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide otolaryngologists with the most up-to-date advancements in both the medical and surgical management of CF-related sinus disease. RECENT FINDINGS Recent studies have supported more aggressive CRS management, often with a combination of both medical and surgical therapies. Comprehensive treatment strategies have been shown to reduce hospital admissions secondary to pulmonary exacerbations in addition to improving CRS symptoms. Still, current management strategies are lacking in both high-level evidence and standardized guidelines. SUMMARY The unified airway model describes the bi-directional relationship between the upper and lower airways as a single functional unit and suggests that CRS may play a pivotal role in both the development and progression of lower airway disease. Current strategies for CF CRS focus primarily on amelioration of symptoms with antibiotics, nasal saline and/or topical medicated irrigations, and surgery. However, there are no definitive management guidelines and there remains a persistent need for additional studies. Nevertheless, otolaryngologists have a significant role in the overall management of CF, which requires a multi-disciplinary approach and a combination of both surgical and medical interventions for optimal outcomes of airway disease. Here we present a review of currently available literature and summarize medical and surgical therapies best suited for the management of CF-related sinus disease.
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Ayoub N, Thamboo A, Habib AR, Nayak JV, Hwang PH. Determinants and outcomes of upfront surgery versus medical therapy for chronic rhinosinusitis in cystic fibrosis. Int Forum Allergy Rhinol 2017; 7:450-458. [DOI: 10.1002/alr.21912] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Noel Ayoub
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Andrew Thamboo
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Al-Rahim Habib
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Jayakar V. Nayak
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Peter H. Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
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35
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Halderman AA, West N, Benke J, Roxbury CR, Lin SY. F508del genotype in endoscopic sinus surgery: do differences in outcomes exist between genotypic subgroups? Int Forum Allergy Rhinol 2017; 7:459-466. [PMID: 28182336 DOI: 10.1002/alr.21913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/25/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The impact of endoscopic sinus surgery (ESS) on pulmonary function in cystic fibrosis (CF) patients with chronic rhinosinusitis remains unclear, as studies have demonstrated conflicting results. To date, no study has looked specifically at the impact of CF genotype on lung function after ESS. In this study, we reviewed changes in pulmonary function test (PFT) results after ESS in F508del homozygotes and heterozygotes. METHODS The charts of 25 patients with CF without prior lung transplant, who underwent ESS performed by the same surgeon between the period of July 2005 to July 2015, were retrospectively reviewed. Data including genotype and PFT results were collected. Patients were grouped based on genotype. Pre- and postoperative PFTs were compared. RESULTS Some differences in PFT outcomes after ESS could be seen on subgroup analyses. For example, when considered as a whole group, the overall cohort showed a significant improvement from preoperative FEV1 levels at 6 months after surgery (p = 0.0127). Interestingly, on subgroup analysis, the heterozygous group saw significant improvements from preoperative FEV1 levels at 6 and 12 months (p = 0.0155 and p = 0.0333, respectively). No significant improvements were seen from "baseline" FEV1 in either group at any timepoint. CONCLUSION Prior studies investigating the impact of ESS on pulmonary function in CF patients have shown conflicting results. To our knowledge, those earlier udies did not separate and compare different genotypes, which may have introduced heterogeneity in their patient populations. Our study suggests that grouping CF patients more strictly according to genotype or disease severity when investigating outcomes may reveal differences among various subgroups.
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Affiliation(s)
- Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Natalie West
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - James Benke
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher R Roxbury
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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McCoul ED, Tabaee A. A Practical Approach to Refractory Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:183-198. [DOI: 10.1016/j.otc.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamilos DL. Chronic Rhinosinusitis in Patients with Cystic Fibrosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:605-12. [DOI: 10.1016/j.jaip.2016.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 12/01/2022]
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Mohd Slim MA, Dick D, Trimble K, McKee G. Paediatric nasal polyps in cystic fibrosis. BMJ Case Rep 2016; 2016:bcr-2016-214467. [PMID: 27329094 DOI: 10.1136/bcr-2016-214467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with cystic fibrosis (CF) are at increased risk of nasal polyps. We present the case of a 17-month-old Caucasian patient with CF who presented with hypertelorism causing cycloplegic astigmatism, right-sided mucoid discharge, snoring and noisy breathing. Imaging suggested bilateral mucoceles in the ethmoid sinuses. Intraoperatively, bilateral soft tissue masses were noted, and both posterior choanae were patent. Polypectomy and bilateral mega-antrostomies were performed. Histological examination revealed inflammatory nasal polyposis typical of CF. The role of early functional endoscopic sinus surgery (FESS) in children with CF nasal polyposis remains questionable as the recurrence rate is higher, and no improvement in pulmonary function has been shown. Our case, however, clearly demonstrates the beneficial upper airway symptom relief and normalisation of facial appearance following FESS in a child with this condition.
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Affiliation(s)
| | - David Dick
- Department of Ear, Nose and Throat, Royal Victoria Hospital, Belfast, UK
| | - Keith Trimble
- Department of Ear, Nose and Throat, Royal Victoria Hospital, Belfast, UK
| | - Gary McKee
- Department of Ear, Nose and Throat, Royal Victoria Hospital, Belfast, UK
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40
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152:S1-S39. [PMID: 25832968 DOI: 10.1177/0194599815572097] [Citation(s) in RCA: 495] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This update of a 2007 guideline from the American Academy of Otolaryngology--Head and Neck Surgery Foundation provides evidence-based recommendations to manage adult rhinosinusitis, defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. Changes from the prior guideline include a consumer added to the update group, evidence from 42 new systematic reviews, enhanced information on patient education and counseling, a new algorithm to clarify action statement relationships, expanded opportunities for watchful waiting (without antibiotic therapy) as initial therapy of acute bacterial rhinosinusitis (ABRS), and 3 new recommendations for managing chronic rhinosinusitis (CRS). PURPOSE The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult rhinosinusitis and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy for adult rhinosinusitis, promote appropriate use of ancillary tests to confirm diagnosis and guide management, and promote judicious use of systemic and topical therapy, which includes radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. ACTION STATEMENTS The update group made strong recommendations that clinicians (1) should distinguish presumed ABRS from acute rhinosinusitis (ARS) caused by viral upper respiratory infections and noninfectious conditions and (2) should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography. The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (if a decision is made to treat ABRS with an antibiotic); (3) should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; (4) should distinguish CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms; (5) should assess the patient with CRS or recurrent ARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia; (6) should confirm the presence or absence of nasal polyps in a patient with CRS; and (7) should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS. The update group stated as options that clinicians may (1) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis; (2) recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation) for symptomatic relief of ABRS; and (3) obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent ARS. The update group made recommendations that clinicians (1) should not obtain radiographic imaging for patients who meet diagnostic criteria for ARS, unless a complication or alternative diagnosis is suspected, and (2) should not prescribe topical or systemic antifungal therapy for patients with CRS.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, School of Medicine, St Louis, Missouri, USA
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Kaparaboyna Ashok Kumar
- Department of Family Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Maggie Kramper
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard R Orlandi
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James N Palmer
- Department Otolaryngology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Anju Peters
- Department of Internal Medicine, Northwestern University Allergy Division, Chicago, Illinois, USA
| | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
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Kariya S, Okano M, Nishizaki K. Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review. World J Otorhinolaryngol 2015; 5:44-52. [DOI: 10.5319/wjo.v5.i2.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/04/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.
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43
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Hughes A, Adil EA. What is the role of endoscopic sinus surgery in adult patients with cystic fibrosis? Laryngoscope 2015; 125:2018-20. [PMID: 25682930 DOI: 10.1002/lary.25210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/23/2014] [Accepted: 01/09/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Amy Hughes
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eelam A Adil
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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44
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What is the optimal management of chronic rhinosinusitis in cystic fibrosis? Curr Opin Otolaryngol Head Neck Surg 2014; 22:42-6. [DOI: 10.1097/moo.0000000000000014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soudry E, Mohabir PK, Miglani A, Chen J, Nayak JV, Hwang PH. Outpatient endoscopic sinus surgery in cystic fibrosis patients: predictive factors for admission. Int Forum Allergy Rhinol 2014; 4:416-21. [PMID: 24431198 DOI: 10.1002/alr.21285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/16/2013] [Accepted: 12/03/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND An increasing number of adult patients with cystic fibrosis (CF) are becoming candidates for elective endoscopic sinus surgery (ESS). We sought to identify perioperative factors in this patient population that were predictive of postoperative admission. METHODS Retrospective chart review of CF patients who underwent ESS during the years 2005 through 2012. Multiple preoperative, intraoperative, and immediate postoperative variables were analyzed. RESULTS Thirty-three patients who underwent 37 outpatient ESSs were identified. Successful same-day discharge was observed in 54%. In 46% of cases, postoperative admission was necessary, with a mean postoperative stay of 1.4 days. Pulmonary function, CF-related comorbidities, and history of lung transplant were not predictors of postoperative admission. Univariate analysis demonstrated that patients were more likely to be admitted if they had 1 of the following conditions: history of ≥4 prior ESS; procedure duration >2.5 hours; intraoperative blood loss greater than 150 mL; increased immediate postoperative pain scores; or larger narcotic requirements for pain control. On logistic regression analysis, a maximum pain score ≥ 7 out of 10 in the postanesthesia recovery unit was the only significant predisposing factor for postoperative admission. CONCLUSION Although over 50% of adult CF patients can successfully undergo ESS on a same-day discharge basis, it is prudent to have contingent plans for potential inpatient observation postoperatively. Multivariate analysis suggests that preoperative demographics and pulmonary status cannot predict the need for postoperative admission, whereas higher pain scores in the postanesthesia care unit are predictive of the necessity for inpatient observation.
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Affiliation(s)
- Ethan Soudry
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
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47
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Liang J, Higgins T, Ishman SL, Boss EF, Benke JR, Lin SY. Medical management of chronic rhinosinusitis in cystic fibrosis: A systematic review. Laryngoscope 2013; 124:1308-13. [DOI: 10.1002/lary.24503] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Thomas Higgins
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Emily F. Boss
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - James R. Benke
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Sandra Y. Lin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
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