Clinical Outcomes in Patients with Cystic Fibrosis-Related Chronic Rhinosinusitis Treated with Functional Endoscopic Sinus Surgery or Triple Highly Effective Modulator Therapy: A Monocentric Retrospective Experience.

Background

Cystic Fibrosis (CF) is an autosomal recessive inherited disease caused by mutations of the CF-transmembrane conductance regulator (CFTR), leading to impaired chloride ion trafficking, thickened secretions, and chronic rhinosinusitis (CF-CRS). CF-CRS was historically managed with intranasal corticosteroids (INCS) and endoscopic sinus surgery (ESS). Nowadays, the triple highly effective modulator therapy elexacaftor-tezacaftor-ivacaftor (ETI) is showing promising results in improving CF-CRS.

Methods

This is a monocentric, retrospective study comparing Sinonasal Outcome Test-22 (SNOT-22), Nasal Polyps Score (NPS), modified Lund-Kennedy score (mLKS), sniffin' sticks identification test (SSIT), and Lund-Mackay score (LMS) in patients affected by CF-CRS and treated with ESS or ETI. ETI patients were further subdivided based on previous surgery.

Results

A total of 25 patients were surgically treated, and 54 were treated with ETI (specifically, 17 surgically naïve and 37 post-FESS patients). Patients undergoing ESS and those receiving ETI experienced statistically significant improvements in SNOT-22, SSIT, and LMS with no differences between groups and regardless of genetic or demographic characteristics. Conversely, ESS patients experienced significantly higher mean changes in NPS and mLKS.

Conclusions

ETI and FESS were safe and effective in reducing the symptomatologic burden of CF-CRS. Even in the ETI epoch, surgery may play a crucial role in managing CF-CRS, particularly in patients not eligible for ETI or experiencing severe disease not adequately controlled with medical therapy alone.