title: Extensive surgical and comprehensive postoperative medical management for cystic fibrosis chronic rhinosinusitis.
abstract: BACKGROUND
  Chronic rhinosinusitis has a major impact on the quality of life of patients with cystic fibrosis (CF) and may contribute to progression of chronic lung disease. Despite multiple sinus surgeries, maxillary sinus involvement is a recurrent problem. The modified  endoscopic medial maxillectomy (MEMM) permits debridement in the clinic, improves mucus clearance with nasal irrigations, and increases access for topical delivery of therapeutics. However, clinical outcomes of aggressive sinus surgery with regimented postoperative medical treatment have not  been systematically evaluated.
  
  
  METHODS
  CF patients completed the 22-Item Sinonasal Outcome Test questionnaires before sinus surgery (and bilateral MEMM) and at sequential postoperative visits. Objective measures included Lund-Kennedy endoscopic score and pulmonary function  tests (forced expiratory volume at 1 second percent [FEV(1)%] predicted). Culture-directed antibiotic therapy, prednisone, and topical irrigations were initiated postoperatively.
  
  
  RESULTS
  Twenty-two patients (mean age, 26.5 years; 4.9 prior sinus operations) underwent  MEMM and sinus surgery. Symptom scores were significantly reduced at 60 days (primary outcome, 64.7 ± 18.4 presurgery versus 27.5 ± 15.3 postsurgery; p < 0.0001) and up to a year postoperatively (27.6 ± 12.6; p < 0.0001). Endoscopic scores were also reduced after  surgery (10.4 ± 1.1 presurgery versus 5.7 ± 2.4 [30 days], 5.7 ± 1.4 [60 days], 5.8 ± 1.3 [120 days], and 6.0 ± 1.1 [1 year]; p < 0.0001)]. There were no differences in FEV(1)% predicted up to 1 year postoperatively, but hospital admissions secondary  to pulmonary exacerbations significantly decreased (2.0 ± 1.4 versus 3.2 ± 2.4, respectively; p < 0.05).
  
  
  CONCLUSIONS
  Prospective evaluation indicates sinus surgery with MEMM is associated with marked improvement in sinus disease outcomes. Additional studies  are necessary to confirm whether this treatment paradigm is associated with improved CF pulmonary disease.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, 1530 3rd Avenue S., Birmingham, AL 35294, USA.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Virgin
authors.forename: Steven M
authors.initials: SM
authors.lastname: Rowe
authors.forename: Mary B
authors.initials: MB
authors.lastname: Wade
authors.forename: Amit
authors.initials: A
authors.lastname: Gaggar
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Leon
authors.forename: K Randall
authors.initials: KR
authors.lastname: Young
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000601:surgery / Q000628:therapy*; D003646:Debridement; D018450:Disease Progression; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery*; D011182:Postoperative Care; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012220:Rhinitis / Q000601:surgery / Q000628:therapy*; D012852:Sinusitis / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011241:Prednisone