Management of sinusitis in cystic fibrosis by endoscopic surgery and serial antimicrobial lavage. Reduction in recurrence requiring surgery.
OBJECTIVE
An effective treatment program for refractory chronic sinusitis in patients with cystic fibrosis has not been achieved. We developed a long-term management approach by combining endoscopic surgery with serial antimicrobial lavage (ESSAL).


METHODS
In a before and after trial, results of ESSAL in 32 patients were compared with those of conventional sinus surgery without serial antimicrobial lavage in 19 patients. At least 1 year follow-up was available in all but one patient.


METHODS
Patients attending the Stanford (Calif) Cystic Fibrosis Center were consecutively referred for otolaryngologic evaluation for symptoms and signs of refractory sinusitis. Those subjects who were evaluated before 1990 were treated conventionally and afterward by ESSAL.


METHODS
Conventionally treated patients underwent one or more of the following procedures: polypectomy, ethmoidectomy, antrostomy, or Caldwell-Luc operation. The ESSAL approach incorporated preoperative rhinosinuscopy and computed tomography, endoscopic surgery, a postoperative course of antral antimicrobial lavage, and monthly maintenance antimicrobial lavage via brief antral catheterization.


METHODS
Intensity and frequency of sinus surgery after initial presentation.


RESULTS
The two groups were similar demographically and in clinical presentation, including the presence of nasal polyposis in 34% and 42%, respectively. The ESSAL group had fewer operations per patient, Caldwell-Luc procedures, and a decrease in repeated surgery at 1-year (10% vs 47%) and 2-year (22% vs 72%) follow-ups.


CONCLUSIONS
The ESSAL is a successful approach to treatment of sinusitis in cystic fibrosis that reduces recurrence requiring further surgery for at least 2 years.
Moss
R B
RB
Department of Pediatrics, Stanford University Medical Center, Calif, USA.
King
V V
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D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D003131:Combined Modality Therapy; D003550:Cystic Fibrosis / Q000150:complications*; D004724:Endoscopy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011552:Pseudomonas Infections / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000601:surgery*; D018709:Statistics, Nonparametric; D007507:Therapeutic Irrigation / Q000379:methods / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed