MANAGEMENT OF SINUSITIS IN ADULT CYSTIC-FIBROSIS

Until recently, cystic fibrosis was frequently fatal during childhood. However, with current medical management, many patients are living in to adulthood. This has created a new population of patients with chron ic sinusitis and severe medical problems. In this report, experience w ith 22 patients, eight of whom have undergone sinus surgery, is presen ted, and recommendations for management are proposed. Presenting sympt oms are typical of sinusitis, but in a few patients, severe debilitati ng headaches predominate. Oral antibiotics are often of little use due to the numerous courses of high dose intravenous antibiotics used for resistant pulmonary infections. Topical nasal steroids and mucolytics have been of some benefit Fourteen operative procedures were performe d on eight patients. These procedures included 12 endoscopic sphenoeth moidectomies, four Caldwell-Luc procedures, two frontal sinus oblitera tions, and one transseptal sphenoidotomy (many of these were in combin ation.) Results from this experience indicate 1) Failure of endoscopic surgery to control frontal and maxillary sinus disease; 2) Delayed he aling of the ethmoid cavity with persistent crusting; and 3) Significa nt, albeit short term, symptomatic relief following surgical intervent ion. Based on this limited series, we conclude that surgery should be delayed until absolutely necessary and that an aggressive approach sho uld be adopted when surgery is performed. In our hands this included i nitial endoscopic sphenoethmoidectomy with open surgical techniques us ed for removal of trapped inspissated secretions. We recommend long te rm intravenous antibiotics postoperatively and frequent cleaning of th e ethmoid cavity after surgery, continuing indefinitely, to optimize t he benefit of surgery.