Medium-term symptom outcomes after paranasal sinus surgery in children and young adults with cystic fibrosis

Objective. To determine the effectiveness of paranasal sinus surgery (PSS) for individual symptoms and recurrence of nasal polyposis in children and young adults with cystic fibrosis and chronic rhinosinusitis (CRS). Design: Nonrandomized, prospective, clinical trial. Intervention: Children and young adults with medically refractory CRS were examined before and after PSS. The extend of nasal polyposis was graded endoscopically and on computed tomography images. The severity of symptoms of CRS was recorded on a 6-point Likert scale by the investigator. Results: In 26 patients, a complete rhinosinusitis symptom score (RSS) before and after surgery was available. The mean follow-up time after surgery was 23 months. Postoperatively, no polyp recurrence was seen in eight patients (of 26 patients). An improved polyp score was found in 14 patients. In four patients, polyp recurrence to the same extent as before surgery was seen. The mean RSS was significantly improved after surgery. Before surgery, "nasal obstruction" was the most common complaint. "Headache" was the second most common complaint before PSS. After PSS, although improved, "headache" was the most common complaint. During further follow-up, in two patients, endocranial complications caused by recurrent frontal mucopyoceles (1 frontal abscess, 1 subacute meningitis) were observed. After transfirontal revision surgery, both patients recovered without neurologic damage. Conclusions: Even in cases of polyp recurrence, PSS provides significant symptom relief for nasal and facial symptoms associated with CRS. The symptom "headache" requires special attention because it improves least after surgery and may indicate recurrence of frontoethmoidal mucopyoceles or endocranial complication of CRS.