Factors that predict pursuing sinus surgery in the era of highly effective modulator therapy

Daniel M Beswick; Ethan J Han; Jess C Mace; Karolin Markarian; Jeremiah A Alt; Todd E Bodner; Naweed I Chowdhury; Patricia H Eshaghian; Anne E Getz; Peter H Hwang; Ashoke Khanwalkar; Adam J Kimple; Jivianne T Lee; Douglas A Li; Meghan Norris; Jayakar V Nayak; Cameran Owens; Zara Patel; Katie Poch; Rodney J Schlosser; Kristine A Smith; Timothy L Smith; Zachary M Soler; Jeffrey D Suh; Grant Turner; Marilene B Wang; Jennifer L Taylor-Cousar; Milene Saavedra

doi:10.1002/alr.23270

Factors that predict pursuing sinus surgery in the era of highly effective modulator therapy

Int Forum Allergy Rhinol. 2024 Apr;14(4):807-818. doi: 10.1002/alr.23270. Epub 2023 Sep 19.

Authors

Daniel M Beswick¹, Ethan J Han¹, Jess C Mace², Karolin Markarian³, Jeremiah A Alt⁴, Todd E Bodner⁵, Naweed I Chowdhury⁶, Patricia H Eshaghian⁷, Anne E Getz⁸, Peter H Hwang⁹, Ashoke Khanwalkar⁸, Adam J Kimple¹⁰, Jivianne T Lee¹, Douglas A Li⁷, Meghan Norris¹⁰, Jayakar V Nayak⁹, Cameran Owens⁸, Zara Patel⁹, Katie Poch¹¹, Rodney J Schlosser¹², Kristine A Smith⁴, Timothy L Smith², Zachary M Soler¹², Jeffrey D Suh¹, Grant Turner⁷, Marilene B Wang¹, Jennifer L Taylor-Cousar^{11

13}, Milene Saavedra¹¹

Affiliations

¹ Department of Head and Neck Surgery, University of California, Los Angeles, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
³ CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
⁵ Department of Psychology, Portland State University, Portland, Oregon, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA.
⁷ Department of Pulmonary Medicine, University of California, Los Angeles, California, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA.
⁹ Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
¹¹ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹³ Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.

PMID: 37725072
DOI: 10.1002/alr.23270

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: chronic rhinosinusitis; cystic fibrosis; endoscopic sinus surgery; highly effective modulator therapy; patient symptoms.

MeSH terms

Adult
Chronic Disease
Cystic Fibrosis* / drug therapy
Cystic Fibrosis* / surgery
Endoscopy / methods
Humans
Paranasal Sinuses* / diagnostic imaging
Paranasal Sinuses* / surgery
Prospective Studies
Quality of Life
Rhinitis* / drug therapy
Rhinitis* / surgery
Sinusitis* / drug therapy
Sinusitis* / surgery

Grants and funding

BESWIC20A0/Cystic Fibrosis Foundation