2018 CSO General Scientific Program
“Management of chronic rhinosinusitis in cystic fibrosis with immediate or deferred surgery”
Noel Ayoub, Andrew Thamboo, Al-Rahim Habib, Peter Hwang
Objectives: To compare outcomes of medical versus surgical management of recalcitrant chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients and the transition between them.
Methods: 136 patients were divided into: medical management (A), upfront surgery(B), or crossover(C). Sino-nasal outcomes (SNOT-22), pulmonary function tests (PFTs), and rates of additional surgeries were assessed up to 48 months.
Results: Greater incidence of nasal polyposis (p=0.0011), prior sinus surgery (p=0.0025), lower %FEV1 (p=0.0063), higher Lund-Mackay (p=0.0025) and SNOT-22 scores (p=0.0229) observed in B (n=46) versus A (N=90). Crossover (n=32) was associated with a 6.1-point increase in SNOT-22 and 6.6% deterioration in %FEV1. Group-C ultimately achieved similar postoperative SNOT-22 (p=0.831) and %FEV1 (p=0.114) as group A. None improved the PFT.
Conclusions: Surgery effectively reduces CRS-related symptoms. A worsening of symptoms may prompt conversion to surgery in group-A. Patients who delay surgery may achieve similar outcomes as those who pursue surgery upfront.
- To determine whether patients who choose to delay surgery to first receive medical treatment achieve similar outcomes as those who pursue surgery upfront
- To discover the patient characteristics associated with the decision to convert from medical to surgical therapy
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Corresponding Author: Dr. Andrew Thamboo
Senior Author: Dr. Andrew Thamboo
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