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

被引:8
作者
Beswick, Daniel M. [1 ,14 ]
Han, Ethan J. [1 ]
Mace, Jess C. [2 ]
Markarian, Karolin [3 ]
Alt, Jeremiah A. [4 ]
Bodner, Todd E. [5 ]
Chowdhury, Naweed I. [6 ]
Eshaghian, Patricia H. [7 ]
Getz, Anne E. [8 ]
Hwang, Peter H. [9 ]
Khanwalkar, Ashoke [8 ]
Kimple, Adam J.
Lee, Jivianne T. [1 ]
Li, Douglas A. [7 ]
Norris, Meghan [10 ]
Nayak, Jayakar V. [9 ]
Owens, Cameran [8 ]
Patel, Zara [9 ]
Poch, Katie [11 ]
Schlosser, Rodney J.
Smith, Kristine A. [4 ]
Smith, Timothy L. [2 ]
Soler, Zachary M. [12 ]
Suh, Jeffrey D. [1 ]
Turner, Grant [7 ]
Wang, Marilene B. [1 ]
Taylor-Cousar, Jennifer L. [11 ,13 ]
Saavedra, Milene [11 ]
机构
[1] Univ Calif Los Angeles, Dept Head & Neck Surg, Los Angeles, CA USA
[2] Oregon Hlth & Sci Univ, Dept Otolaryngol Head & Neck Surg, Portland, OR USA
[3] Univ Calif Los Angeles, David Geffen Sch Med, CTSI, Los Angeles, CA USA
[4] Univ Utah, Dept Otolaryngol Head & Neck Surg, Salt Lake City, UT USA
[5] Portland State Univ, Dept Psychol, Portland, OR USA
[6] Vanderbilt Univ, Dept Otolaryngol Head & Neck Surg, Nashville, TN USA
[7] Univ Calif Los Angeles, Dept Pulm Med, Los Angeles, CA USA
[8] Univ Colorado, Dept Otolaryngol & Head & Neck Surg, Aurora, CO USA
[9] Stanford Sch Med, Dept Otolaryngol Head & Neck Surg, Stanford, CA USA
[10] Univ N Carolina, Dept Otolaryngol Head & Neck Surg, Chapel Hill, NC USA
[11] Natl Jewish Hlth, Dept Med, Denver, CO USA
[12] Med Univ South Carolina, Dept Otolaryngol Head & Neck Surg, Charleston, SC USA
[13] Natl Jewish Hlth, Dept Pediat, Denver, CO USA
[14] Univ Calif Los Angeles, Dept Head & Neck Surg, 10833 Conte Ave,CHS 62-235, Los Angeles, CA 90095 USA
关键词
chronic rhinosinusitis; cystic fibrosis; endoscopic sinus surgery; highly effective modulator therapy; patient symptoms; QUALITY-OF-LIFE; CYSTIC-FIBROSIS; SLEEP QUALITY; CHRONIC RHINOSINUSITIS; DEPRESSION;
D O I
10.1002/alr.23270
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
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.
引用
收藏
页码:807 / 818
页数:12
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