European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 5, pp 1341–1347 | Cite as

Outcomes of endoscopic sinus surgery in adult lung transplant patients with cystic fibrosis

  • Paolo LuparelloEmail author
  • Maria S. Lazio
  • Luca Voltolini
  • Beatrice Borchi
  • Giovanni Taccetti
  • Giandomenico Maggiore



Cystic Fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of Endoscopic Sinus Surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients underwent the surgical procedure rather than in the not treated ones, particulary in lung transplant patients.


We studied 54 adult patients affected by CF. Lund–Kennedy, Lund–Mackay scores, and SNOT-22 were analysed. 14 had lung transplant and 9 had both lung tranplant and ESS procedures.


22 (40.7%) out of 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund–Kennedy and Lund–Mackay scores appeared higher in the ESS group: 10 (range of 6–12) and 15 (range of 12–20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 20 (range of 3–68) and 40 (range of 10–73), respectively.


ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy, with a stabilization of respiratory function after transplantation.


Cystic fibrosis Endoscopic sinus surgery Lung transplant SNOT-22 Quality of life 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Welsh MJ, Tsui LC, Boat TF, Beauder AL (1995) The metabolic and molecular basis of inherited diseases, vol 3, 7th edn. McGraw-Hill, New York, pp 3799–3876Google Scholar
  2. 2.
    Sakano E, Ribeiro A, Barth L, Condino Neto A, Ribeiro JD (2007) Nasal and paranasal sinus endoscopy, computed tomography and microbiology of upper airways and the correlations with genotype and severity of cystic fibrosis. Int J Pediatr Otorhinolaryngol 71:41–50CrossRefPubMedGoogle Scholar
  3. 3.
    Crosby DL, Adappa ND (2014) What is the optimal management of chronic rhinosinusitis in cystic fibrosis? Curr Opin Otolaryngol Head Neck Surg 22:42–46CrossRefPubMedGoogle Scholar
  4. 4.
    Keck T, Lindemann J (2010) Simulation and air-conditioning in the nose. Laryngo Rhino Otologie 89:S1–S14CrossRefPubMedGoogle Scholar
  5. 5.
    Berkhout MC, van Rooden CJ, Rijntjes E, Fokkens WJ, el Bouazzaoui LH, Heijerman HG (2014) Sinonasal manifestations of cystic fibrosis: a correlation between genotype and phenotype? J Cyst Fibros 13:442–448CrossRefPubMedGoogle Scholar
  6. 6.
    Bhattacharyya N (2006) Clinical outcomes after endoscopic sinus surgery. Curr Opin Allergy Clin Immunol 6(3):167–171. (PubMed: 16670508)CrossRefPubMedGoogle Scholar
  7. 7.
    Poetker DM, Smith TL (2007) Adult chronic rhinosinusitis: surgical outcomes and the role of endoscopic sinus surgery. Curr Opin Otolaryngol Head Neck Surg 15(1):6–9. (PubMed: 17211176)CrossRefPubMedGoogle Scholar
  8. 8.
    Davidson TM, Murphy C, Mitchell M et al (1995) Management of chronic sinusitis in cystic fibrosis. Laryngoscope 105(4 Pt 1):354–358CrossRefPubMedGoogle Scholar
  9. 9.
    Ikeda K, Oshima T, Furukawa M et al (1997) Restoration of the mucociliary clearance of the maxillary sinus after endoscopic sinus surgery. J Allergy Clin Immun 99:48–52PubMedGoogle Scholar
  10. 10.
    Ikeda K, Tanno N, Tamura G et al (1999) Endoscopic sinus surgery improves pulmonary function in patients with asthma associated with chronic sinusitis. Ann Otol Rhinol Laryngol 108:355–359CrossRefPubMedGoogle Scholar
  11. 11.
    Hofer M, Benden C, Inci I, Schmid C, Irani S, Speich R, Weder W, Boehler A (2009) True survival benefit of lung transplantation for cystic fibrosis patients: the Zurich experience. J Heart Lung Transpl 28:334–339CrossRefGoogle Scholar
  12. 12.
    Vos R, Vanaudenaerde BM, Geudens N, Dupont LJ, Van Raemdonck DE, Verleden GM (2008) Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation? Eur Respir J 31:1037–1045CrossRefPubMedGoogle Scholar
  13. 13.
    Borthwick LA, Sunny SS, Oliphant V, Perry J, Brodlie M, Johnson GE, Ward C, Gould K, Corris PA, De Soyza A, Fisher AJ (2011) Pseudomonas aeruginosa accentuates epithelial-tomesenchymal transition in the airway. Eur Respir J 37:1237–1247CrossRefPubMedGoogle Scholar
  14. 14.
    Liang J, Higgins TS, Ishman SL, Boss EF, Benke JR, Lin SY (2013) Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review. Int Forum Allergy Rhinol 3(10):814–822CrossRefPubMedGoogle Scholar
  15. 15.
    Rosbe KW, Jones DT, Rahbar R, Lahiri T, Auerbach AD (2001) Endoscopic sinus surgery in cystic fibrosis: do patients benefit from surgery? Int J Pediatr Otorhinolaryngol 61(2):113–119. (PubMed: 11589977)CrossRefPubMedGoogle Scholar
  16. 16.
    Aanaes K (2013) Bacterial sinusitis can be a focus for initial lung colonisation and chronic lung infection in patients with cystic fibrosis. J Cyst Fibros 12(Suppl 2):S1–S20. (PubMed: 24064077)CrossRefPubMedGoogle Scholar
  17. 17.
    Vital D, Hofer M, Boehler A, Holzmann D (2013) Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience. Eur Arch Otorhinolaryngol 270:135–139CrossRefPubMedGoogle Scholar
  18. 18.
    Holzmann D, Speich R, Kaufmann T, Laube I, Russi EW, Simmen D, Weder W, Boehler A (2004) Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience. Transplantation 77:134–136CrossRefPubMedGoogle Scholar
  19. 19.
    Lund VJ, Kennedy DW (1995) Quantification for staging sinusitis. International conference on sinus disease: terminology, staging, therapy. Ann Otol Rhinol Laryngol 104 (Suppl):17–21CrossRefGoogle Scholar
  20. 20.
    Lund VJ, Mackay IS (1993) Staging in rhinosinusitis. Rhinology 31:183–184PubMedGoogle Scholar
  21. 21.
    Alobid I, Bernal-Sprekelsen M, Mullol J (2008) Chronic rhinosinusitis and nasal polyps: the role of generic and specific questionnaires on assessing its impact on patient’s quality of life. Allergy 63:1267–1279CrossRefPubMedGoogle Scholar
  22. 22.
    Illing EA, Woodworth BA (2014) Management of the upper airway in cystic fibrosis. Curr Opin Pulm Med 20(6):623–631. (PubMed: 25250804)CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kang SH, Meotti CD, Bombardelli K, Piltcher OB, de Dalcin PTR (2017) Sinonasal characteristics and quality of life by SNOT-22 in adult patients with cystic fibrosis. Eur Arch Otorhinolaryngol 274(4):1873–1882. (Epub 2016 Dec 18)CrossRefPubMedGoogle Scholar
  24. 24.
    Leung M, Rachakonda L, Weill D, Hwang PH (2008) Effects of sinus surgery on lung transplantation outcomes in cystic fibrosis. Am J Rhinol 22(2):192–196. CrossRefPubMedGoogle Scholar
  25. 25.
    Vital D, Hofer M, Benden C, Holzmann D, Boehler A (2013) Impact of sinus surgery on Pseudomonal airway colonization, bronchiolitis obliterans syndrome and survival in cystic fibrosis lung ttransplant recipients. Respiration 86(1):25–31. (Epub 2012 Aug 22)CrossRefPubMedGoogle Scholar
  26. 26.
    Liang J, Higgins T, Ishman SL, Boss EF, Benke JR, Lin SY (2013) Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review. Int Forum Allergy Rhinol 3:814–822CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery and Translational Medicine, Clinic of Otolaryngology, Head and Neck Surgery, Careggi University HospitalUniversity of FlorenceFlorenceItaly
  2. 2.Department of Thoracic SurgeryUniversity Hospital CareggiFlorenceItaly
  3. 3.Infectious Disease DepartmentCareggi University and HospitalFlorenceItaly
  4. 4.Anna Meyer Children’s University HospitalFlorenceItaly

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