Get access

Medical management of chronic rhinosinusitis in cystic fibrosis: A systematic review

Authors

  • Jonathan Liang MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    Search for more papers by this author
  • Thomas Higgins MD, MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    Search for more papers by this author
  • Stacey L. Ishman MD, MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    Search for more papers by this author
  • Emily F. Boss MD, MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    Search for more papers by this author
  • James R. Benke BS,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    Search for more papers by this author
  • Sandra Y. Lin MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    • Send correspondence to Sandra Y. Lin, MD, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N. Caroline St., #6245, Baltimore, MD 21287-0910. E-mail: slin30@jhmi.edu

    Search for more papers by this author

  • Presented at the Triological Society Meeting of the Combined Otolaryngological Spring Meetings, Orlando, Florida, U.S.A., April 10–14, 2013.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To systematically review existing literature on the effectiveness of medical management of chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients.

Study Design

Systematic review.

Methods

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.

Results

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).

Conclusions

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

Ancillary