Objective
An effective treatment program for refractory chronic sinusitis in patients with cystic fibrosis has not been achieved. We developed a long-term management approach by combining endoscopic surgery with serial antimicrobial lavage (ESSAL).
Design
In a before and after trial, results of ESSAL in 32 patients were compared with those of conventional sinus surgery without serial antimicrobial lavage in 19 patients. At least 1 year follow-up was available in all but one patient.
Setting and Patients
Patients attending the Stanford (Calif) Cystic Fibrosis Center were consecutively referred for otolaryngologic evaluation for symptoms and signs of refractory sinusitis. Those subjects who were evaluated before 1990 were treated conventionally and afterward by ESSAL.
Intervention
Conventionally treated patients underwent one or more of the following procedures: polypectomy, ethmoidectomy, antrostomy, or Caldwell-Luc operation. The ESSAL approach incorporated preoperative rhinosinuscopy and computed tomography, endoscopic surgery, a postoperative course of antral antimicrobial lavage, and monthly maintenance antimicrobial lavage via brief antral catheterization.
Main Outcome Measure
Intensity and frequency of sinus surgery after initial presentation.
Results
The two groups were similar demographically and in clinical presentation, including the presence of nasal polyposis in 34% and 42%, respectively. The ESSAL group had fewer operations per patient, Caldwell-Luc procedures, and a decrease in repeated surgery at 1-year (10% vs 47%) and 2-year (22% vs 72%) follow-ups.
Conclusion
The ESSAL is a successful approach to treatment of sinusitis in cystic fibrosis that reduces recurrence requiring further surgery for at least 2 years.
(Arch Otolaryngol Head Neck Surg. 1995;121:566-572)
