Presented at the Triological Society Meeting of the Combined Otolaryngological Spring Meetings, Orlando, Florida, U.S.A., April 10–14, 2013.
Medical management of chronic rhinosinusitis in cystic fibrosis: A systematic review
Article first published online: 11 DEC 2013
© 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 124, Issue 6, pages 1308–1313, June 2014
How to Cite
Liang, J., Higgins, T., Ishman, S. L., Boss, E. F., Benke, J. R. and Lin, S. Y. (2014), Medical management of chronic rhinosinusitis in cystic fibrosis: A systematic review. The Laryngoscope, 124: 1308–1313. doi: 10.1002/lary.24503
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 27 MAY 2014
- Article first published online: 11 DEC 2013
- Accepted manuscript online: 7 NOV 2013 02:11AM EST
- Manuscript Accepted: 30 OCT 2013
- Manuscript Revised: 23 OCT 2013
- Manuscript Received: 9 JUL 2013
- Chronic rhinosinusitis;
- cystic fibrosis;
- topical steroid;
- dornase alfa;
To systematically review existing literature on the effectiveness of medical management of chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients.
We performed a literature search of PubMed, Embase, and Cochrane CENTRAL from 1987 to 2012. Inclusion criteria included English language as containing original data, with five or more subjects, measurable clinical outcomes, and readily available interventions. Data were systematically collected on study design, patient demographics, clinical characteristics and outcomes, and level of evidence. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment.
Of 415 abstracts identified, 12 articles were included. These 12 studies reported on 701 adult and pediatric CF patients who underwent medical therapy. Medical treatment included antibiotics (4/12), topical steroids (4/12), dornase alfa (3/12), and ibuprofen (1/12). Outcome measures included symptom scores (7/12), endoscopic findings (7/12), radiographic findings (4/12), pulmonary function testing (4/12), and rhinomanometry (2/12). Most studies found improvement in at least one of the outcome measures. There was statistical significance in clinical outcomes with dornase alfa, beclomethasone, and betamethasone. Most studies were level 3 or 4 evidence (9/12), but three studies were level 1 or 2 evidence (two dornase alfa studies, one betamethasone study).
Dornase alfa and, to a lesser extent, topical steroids demonstrated significant benefits in the medical treatment CRS in CF. There was a lack of evidence to support antibiotic therapy in the outcomes assessed. Further high-quality studies should be carried out to determine the efficacy of various medical therapies for CRS in CF.
Level of Evidence
NA Laryngoscope, 124:1308–1313, 2014