Cystic fibrosis and endoscopic sinus surgery: Relationship between nasal polyposis and likelihood of revision endoscopic sinus surgery in patients with cystic fibrosis

Arch Otolaryngol Head Neck Surg. 2010 Oct;136(10):988-92. doi: 10.1001/archoto.2010.162.


Objectives: To observe the extent of nasal polyposis endoscopically in a cystic fibrosis population before the first surgical intervention and to grade the extent using a modified Malm scale, to observe patients prospectively and record the need for revision endoscopic sinus surgery (ESS), and to compare this among the individual polyp grading groupings.

Design: Retrospective medical record review of data collected prospectively.

Setting: Tertiary care hospital.

Patients: Forty-nine consecutive patients with a clinical preoperative diagnosis of cystic fibrosis and sinusitis.

Main outcome measures: Using a modified Malm scale, the extent of polyps was prospectively graded into 3 groups before the first surgical intervention. The number of patients needing revision ESS and the mean time to revision ESS were compared among the 3 groups.

Results: Forty-nine consecutive patients underwent ESS between 1992 and 2007. We used a 3-stage system for extent of polyposis: 16 patients were noted to have no polyps (grade A), 14 had mild polyposis (grade B), and 19 had extensive polyposis (grade C). During the study, 14 patients required revision surgery: 3 with mild polyps and 11 with extensive polyps. Mean time to revision surgery was 39.7 months for those with grade B and 23.8 months for those with grade C. In the overall statistical analysis, the rate of revision ESS was significantly different among the 3 groups (P < .001). In pairwise comparisons, there were significant differences between those with grades A and C (P < .001) and between those with grades B and C (P = .04) and a trend toward significance between those with grades A and B (P = .052). There were no complications from ESS.

Conclusion: Preoperative grading of nasal polyposis in patients with cystic fibrosis can help assess the future likelihood of revision ESS.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Chronic Disease
  • Cystic Fibrosis / complications*
  • Endoscopy*
  • Female
  • Humans
  • Male
  • Nasal Polyps / classification*
  • Nasal Polyps / complications
  • Nasal Polyps / diagnostic imaging
  • Nasal Polyps / surgery*
  • Preoperative Care
  • Prospective Studies
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Sinusitis / complications
  • Sinusitis / surgery*
  • Tomography, X-Ray Computed