Surgical management of chronic rhinosinusitis in cystic fibrosis: A systematic review

Background: The objective of this work was to systematically review literature on the effectiveness of surgical management for chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients. Methods: We performed a literature search encompassing the last 25 years in PubMed, Embase, and Cochrane CENTRAL. Inclusion criteria included English language papers containing original data, more than 6 subjects, and measurable clinical outcomes. Data was systematically collected on study design, patient demographics, clinical characteristics and outcomes, and level-of-evidence. Two investigators independently reviewed all manuscripts. A quality assessment of the included studies was performed. Results: The initial search yielded 416 abstracts, of which 24 articles met inclusion criteria, detailing 680 adult and pediatric CF patients who underwent surgical therapy. Surgical treatment included primarily endoscopic sinus surgery (ESS) (22/24). Outcome measures included sinonasal symptoms (14/24), endoscopic findings (8/24), pulmonary function testing (8/24), recurrence or revision surgery (5/24), hospitalization (4/24), need for antibiotic therapy (2/24), radiographic findings (2/24), and pulmonary exacerbations (1/24). The level-of-evidence was predominantly Level 4 (21/24); there were no Level 1 evidence studies. Most studies found improvement in symptom measures and endoscopic findings but no improvement in lower airway function after surgical therapy. Postoperative measures of the other outcomes were inconclusive or inconsistent. Conclusion: For adult and pediatric CF sinusitis, ESS yielded clinical improvement as measured primarily by sinonasal symptoms and endoscopic findings. It is unclear if surgical intervention modifies lower airway disease. Future prospective studies with predetermined, objective, and validated outcome measures are needed to determine the effectiveness of surgical intervention for CF-related CRS. Overall evidence Grade B/C.