MANAGEMENT OF CHRONIC SINUSITIS IN CYSTIC-FIBROSIS

Chronic rhinosinusitis is extremely common in patients with cystic fib rosis. It causes numerous problems in these patients and can put them at risk for life-threatening illness. Potential problems include nasal obstruction, congestion, sinus pain and pressure, infection (usually with Pseudomonas organisms), hyposmia or anosmia, and the seeding of b acteria into the lower respiratory tract. Cystic fibrosis patients wit h chronically infected sinuses are at increased risk for pneumonia fol lowing lung transplantation. A prophylactic protocol has been develope d for the management of chronic sinusitis in patients with cystic fibr osis. These patients are fully evaluated at the Nasal Dysfunction Clin ic of the University of California, San Diego (UCSD), Medical Center. Based on the results of the evaluation, they are treated with endoscop ic sinus surgery, partial middle turbinectomy, septoplasty, and a larg e middle meatal maxillary antrostomy. Surgery is followed by a rigorou s regimen of pulsatile hypotonic saline nasal irrigation to wash away tenacious cystic secretions. Tobramycin (Nebcin(R)) is given once dail y in the nasal irrigant to inhibit the growth of Pseudomonas organisms . At the USCD Nasal Dysfunction Clinic, this prepulmonary transplantat ion protocol is now used in all cystic fibrosis patients with chronic sinusitis.