A review of endoscopic sinus surgery in the management of chronic rhinosinusitis and nasal polyposis in pediatric cystic fibrosis patients

Zuzanna Gorski, *Lidia Zawadzka-Głos

Summary
Introduction. Cystic fibrosis (CF) is an autosomal recessive disease affecting the epithelial lining of the respiratory tract and exocrine glands (1-5). Many children suffering from CF are often diagnosed and treated for various co-morbidities, including chronic rhinosinusitis (CRS) and nasal polyposis (NP) (3, 4, 6, 7), which will remain the focus of this article.
Aim. The aim of this study was to examine the characteristic of patients with cystic fibrosis (CF) admitted to the Pediatric Otolaryngology Department due to coexisting chronic rhinosinusitis (CRS) or nasal polyposis (NP). The study focused on the demographics, symptoms and management of children with CF with coexisting CRS and/or NP. The data was then compared to the results that had been presented in the literature.
Material and methods. A retrospective study of 26 pediatric patients previously diagnosed with CF that were admitted to the Department of Pediatric Otolaryngology of the Medical University of Warsaw between 2010 and 2015 was conducted. Patients’ medical histories were carefully reviewed. Data on patients’ age, gender, symptoms and CF comorbidities were collected. The number and type of procedures performed on each patient were documented. Further assessment of the localization of polyps was performed in all NP-positive patients.
Results. The study included 26 patients (15 males and 11 females). Mean age was 9 years. CRS and NP was present in 100% and 88.5% of the patients, respectively. 23 children underwent a total of 35 sinus surgeries due to CRS and/or NP. 6 patients required one or more revision surgeries, with a total revision rate of 54.1%. Adenoidectomy (AT) and/or adenotonsillectomy (ATT) was performed in 10 patients. 5 children were disqualified from the surgery, due to various reasons. The most common localization of NP was maxillary sinus, followed by ethmoid sinus, sphenoid sinus, frontal sinus, and nasal cavity.
Conclusions. Due to a wide range of clinical findings in many organs and high variability of symptoms in individual cases, there is currently no standardized treatment regimen for pediatric CF patients with CRS or NP. Early intervention and a multidisciplinary approach are highly recommended, due to a positive correlation between the increase in patient’s age and the number of admissions and reoperations. Endoscopic sinus surgery should be considered in CF patients with refractory, chronic or severe acute CRS or NP.

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