Revision Endoscopic Sinus Surgery in Cystic Fibrosis With Chronic Rhinosinusitis: Before and After Cystic Fibrosis...

BackgroundThe rate of functional endoscopic sinus surgery (FESS) in cystic fibrosis (CF) with chronic rhinosinusitis (CRS) is greater than 20%, and the rate of revision FESS is higher in CF patients compared to patients without CF. Revision FESS also occurs sooner in CF. Triple modulator therapy has made a positive impact on CRS symptoms and imaging in CF, but little is known regarding its relation to revision FESS.MethodsA retrospective review of CF patients with CRS treated at a single institution identified 53 patients who met inclusion criteria and underwent FESS between 2006 and 2022. There were 32 patients treated with triple modulator therapy, or elexacaftor/tezacaftor/ivacaftor (ETI). We hypothesized that ETI would be associated with a decreased likelihood of revision FESS. Additional cofactors included age, prior modulator treatment, and history of lung transplant.ResultsThere was a decrease in revision FESS in patients treated with ETI, with only one of the 32 patients undergoing surgery since treatment initiation (3.13%). In the years prior to ETI, 18 of these same patients (56.25%) underwent revision FESS. Patients on other modulator therapy had a hazard ratio of 0.85 for revision FESS (not significant).ConclusionThe current study shows a low rate of revision FESS in patients taking ETI, consistent with prior reports on improved quality of life and radiographic measures in these patients.