Friday, July 1, 2011

Sinus Surgery Won't Aid Lung Function in CF

NEW YORK (Reuters Health) Jun 28 - Endoscopic sinus surgery doesn't improve microbial pathogen load or pulmonary function in young cystic fibrosis (CF) patients, according to a retrospective medical record review.

"Prospective studies are needed to evaluate potentially short-lived effects of surgery on these variables, as well as to assess subjective or symptomatic improvements from a quality-of-life standpoint," Dr. Alexander J. Osborn of the University of Toronto and the Hospital for Sick Children and his colleagues conclude.

Treating inflammation of the upper airways can improve pulmonary function in asthma patients, Dr. Osborn and his colleagues note in the June Archives of Otolaryngology-Head and Neck Surgery. Nearly all CF patients suffer from rhinosinusitus, they add, and the severity of these symptoms has been tied to worse pulmonary function.

To investigate whether the unified airway model might hold true in CF as well asthma, and determine if treating sinusitis might improve pulmonary function, Dr. Osborn and his team reviewed medical records for pediatric CF patients who had undergone endoscopic sinus surgery in their practice.

The 41 patients in the study, whose average age was about 11, underwent 91 procedures in all, with a median of 2 per patient. The researchers excluded procedures performed within 2 years before or after another surgery, to ensure that preoperative values represented a patients' real baseline state. This left 56 procedures for analysis.

Using several different measures of pulmonary function, the researchers found no differences before and after surgery. And their analysis of the 62 procedures for which pre- and post-operative cultures were available showed no effect of sinus surgery on microbial pathogens.

Sinus surgery likely helps asthma patients' pulmonary function because the sinonasal area may be the sole source of inflammation in these patients' airways, Dr. Osborn and his team suggest. "In contrast, CF leads to chronic infection of both the sinuses and the lungs," they add. "Eliminating the inflammation or bacterial load in the sinuses still leaves a significant inflammatory source in the lungs."

The lack of improvement in pulmonary function and microbial colonization seen in the current study "does not obviate the need for surgery in these patients," the researchers add, pointing out that patients do see symptomatic improvement after the surgery.

"The lack of effect of endoscopic sinus surgery on pulmonary function test results and respiratory tract microbial pathogens in our study highlights the need for prospective assessments of postoperative quality-of-life improvement and of adjunct medical therapy efficacy," they conclude.

Original Post: Medscape Today