Department of Head and Neck Surgery, University of California, Los Angeles, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
Int Forum Allergy Rhinol. 2024 Apr;14(4):807-818. doi: 10.1002/alr.23270. Epub 2023 Sep 19.
Comorbid chronic rhinosinusitis (CRS) remains unresolved for many people with cystic fibrosis (PwCF). While highly effective modulator therapy improves quality-of-life and symptom severity, the impact of this intervention and other factors associated with pursuing endoscopic sinus surgery (ESS) remains understudied.
Adult PwCF + CRS were enrolled into a prospective, observational, multi-institutional study. Participants completed validated outcome measures to evaluate respiratory symptom severity, depression, headache, and sleep quality, as well as nasal endoscopy, sinus computed tomography (CT), and olfactory testing. Bivariate comparisons and regression modeling evaluated treatment cofactors, disease characteristics, and outcome measures associated with pursuing ESS.
Sixty PwCF were analyzed, including 24 (40%) who elected ESS. Pursuing ESS was associated with worse SinoNasal Outcome Test (SNOT-22) total, rhinologic, psychological, and sleep dysfunction domain scores; worse Patient Health Questionnaire-9-Revised depression scores; worse Pittsburgh Sleep Quality Index total scores; worse weight, role, emotion, and eating domain scores on the Cystic Fibrosis Questionnaire-Revised; more severe disease on nasal endoscopy; and lack of modulator therapy (all p < 0.050). Multivariable regression identified that worse SNOT-22 total score was associated with electing ESS (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02-1.16, p = 0.015) and elexacaftor/tezacaftor/ivacaftor (ETI) treatment (OR 0.04, 95% CI 0.004-0.34, p = 0.004) was associated with pursing medical therapy.
Worse sinonasal symptom burden, lack of ETI treatment, sleep quality, depression, and nasal endoscopy scores were associated with electing ESS, while lung disease severity and sinus CT scores were not. ETI use was associated with lower odds of pursuing ESS independent of sinonasal symptom burden.
许多囊性纤维化（CF）患者（PwCF）仍存在合并的慢性鼻-鼻窦炎（CRS）未得到解决。虽然高效调节剂治疗可改善生活质量和症状严重程度，但这种干预措施的影响以及与进行内镜鼻窦手术（ESS）相关的其他因素仍研究不足。
纳入了一项前瞻性、观察性、多机构研究的成年 PwCF + CRS 患者。参与者完成了有效的评估呼吸症状严重程度、抑郁、头痛和睡眠质量的结果测量，以及鼻内镜、鼻窦计算机断层扫描（CT）和嗅觉测试。进行了双变量比较和回归模型分析，以评估与 ESS 相关的治疗因素、疾病特征和结果测量。
分析了 60 名 PwCF，其中 24 名（40%）选择了 ESS。选择 ESS 与更差的鼻-鼻窦结局测试（SNOT-22）总分、鼻科学、心理和睡眠功能障碍域评分、更差的修订版患者健康问卷-9 修订版抑郁评分、更差的匹兹堡睡眠质量指数总分、更差的体重、角色、情绪和饮食领域的囊性纤维化问卷修订版评分；鼻内镜检查显示更严重的疾病；以及缺乏调节剂治疗（所有 p<0.050）相关。多变量回归确定，SNOT-22 总分越差与选择 ESS 相关（比值比[OR]1.09，95%置信区间[CI]1.02-1.16，p=0.015），并且埃利卡法特/特扎卡法特/伊伐卡法特（ETI）治疗（OR 0.04，95%CI 0.004-0.34，p=0.004）与选择药物治疗相关。
更严重的鼻-鼻窦症状负担、缺乏 ETI 治疗、睡眠质量、抑郁和鼻内镜评分与选择 ESS 相关，而肺部疾病严重程度和鼻窦 CT 评分则无关。无论鼻-鼻窦症状负担如何，ETI 的使用与选择 ESS 的可能性降低相关。
