(575) Chronic rhinosinusitis in cystic fibrosis: a review of surgical management and our surgical experience.

Background: Clinical and basic scientific research, focusing on therapeutic strategies for Cystic Fibrosis (CF)-associated chronic rhinosinusitis (CRS), is limited; endoscopic sinus surgery (ESS) it can help in management of infection, improve quality of life and stabilize lung function decline.

Methods: Studies published between January 2015 and January 2021 were selected by a Medline search; “endoscopic sinus surgery AND rhinosinusitis AND cystic fibrosis” were used as search string.

Results: 20-60% of CF patients are going to require ESS; it is generally reserved for those who have failed more conservative medical therapy; to reduce pulmonary pathogen colonization, especially in transplant CF patients, is mandatory. Proposed predictive criteria for ESS are: massive polyposis, prior history of ESS, high Lund-Mackay score, high SNOT-22 score and severe CFTR mutations; delay in surgery did not affect post-operative improvement. A pre-operative evaluation of CT findings is essential to avoid complications; an intra-operative image guidance can be useful, especially in revision cases. ESS procedure in pediatric patients is totally safe. ESS also plays a critical role in reducing or eradicating pulmonary colonization of pathogens in CF patients. Surgery leads to relieve nasal obstruction, decrease purulent nasal discharge, increase activity level and improve olfaction. At our ENT-CF clinic CF patients are evaluated with CT and cone-beam CT (CBCT) for pediatric patients; radiological results are qualitatively and quantitatively evaluated using Lund-Mackay score and together with endoscopic Meltzer's Score and SNAQ-11 questionnaire are used for the assessment of a CF sinus score (CFSS). In the last 5 years, 98 patients (53.2% under 18 years old) underwent ESS with clinical and symptomatic improvement. Our experience is consistent with the results in the literature regarding similar strategies.

Conclusions: The treatment of CRS in CF is complex and challenging; ESS has been shown to improve sinus and pulmonary bacterial colonization, as well as reducing patient symptoms. Increasing research suggested that a multi-disciplinary approach offers the most optimal treatment for CF patients.

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