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Children with cystic fibrosis: who should visit the otorhinolaryngologist?
Martyn G Slieker1, Anne G M Schilder, Cuno S P M Uiterwaal
1Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
Insights
A new scoring rule can help identify children with cystic fibrosis (CF) who may have sinonasal polyposis. This rule uses sex, age, rhinorrhea, and lung function to guide referrals to an otorhinolaryngologic physician.
Area of Science:
- Pediatric Otolaryngology
- Cystic Fibrosis Research
- Respiratory Medicine
Background:
- Sinonasal complications are frequent in pediatric cystic fibrosis (CF) patients.
- Persistent sinonasal polyposis often necessitates referral to an otorhinolaryngologic (ORL) physician for surgical evaluation.
- Previous research indicates clinical distinctions between CF patients with and without sinonasal polyps.
Purpose of the Study:
- To develop a predictive model for sinonasal polyposis in children with CF.
- To identify clinical characteristics and symptoms indicative of sinonasal polyposis.
- To aid in selecting pediatric CF patients who would benefit from ORL consultation.
Main Methods:
- Analysis of data from a database of 140 children with CF undergoing annual multidisciplinary examinations.
- Evaluation of clinical characteristics and symptoms to predict the presence of sinonasal polyposis.
- Development and validation of a scoring rule based on identified independent predictors.
Main Results:
- No single combination of symptoms or characteristics accurately predicted sinonasal polyposis in the entire cohort.
- In children with a history of nasal symptoms, male sex, age ≥10 years, rhinorrhea, and forced vital capacity (FVC) ≥70% predicted were independent predictors.
- The developed scoring rule demonstrated an area under the receiver operating characteristic curve of 0.77, with positive and negative predictive values of 0.86 and 0.71, respectively.
Conclusions:
- A scoring rule incorporating sex, age, rhinorrhea, and FVC can effectively stratify risk for sinonasal polyposis in pediatric CF patients.
- This rule assists in clinical decision-making regarding the need for ORL referral.
- Improved identification of at-risk children can lead to timely specialist intervention for sinonasal issues in CF.
Background:
Sinonasal complications are common in children with cystic fibrosis (CF). Generally, those children with persistent symptoms of sinonasal polyposis are referred to an otorhinolaryngologic (ORL) physician for sinus surgery. Several studies have reported differences in clinical characteristics between CF patients with and without sinonasal polyps.
Objectives:
To predict the presence of sinonasal polyposis in children with CF on the basis of symptoms and clinical characteristics and so to select those children who might benefit from referral to an ORL physician.
Design, Setting, And Patients:
Survey of data from a database on the results of yearly multidisciplinary examinations of 140 children with CF.
Main Outcome Measure:
Presence of sinonasal polyposis.
Results:
In the total population of 140 children, no combination of ORL symptoms and clinical characteristics could accurately predict the presence of sinonasal polyposis. In a subgroup of 73 children with a history of nasal symptoms, independent predictors for the presence of sinonasal polyposis were male sex, age 10 years or older, presence of rhinorrhea, and a forced vital capacity 70% or more of the predicted value. The area under the receiver operating characteristic curve of a scoring rule including these independent predictors was 0.77. The positive and negative predictive values of this rule were 0.86 and 0.71, respectively.
Conclusion:
A scoring rule including the independent predictors sex, age, symptoms of rhinorrhea, and forced vital capacity values could reasonably classify children with CF and nasal symptoms into a category with increased risk for sinonasal polyposis, thus facilitating the decision on ORL referral.
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