Hybrid Balloon-Assisted Endoscopic Sinus Surgery for Refractory Chronic Rhinosinusitis in a Pediatric Patient with Cystic Fibrosis: A Case Report

The management of refractory chronic rhinosinusitis (CRS) in children with cystic fibrosis (CF) remains a challenge, especially in those who are not candidates for highly effective modulator therapy. These patients often have severe sinus disease that does not improve with medical treatment, requiring surgery as the definitive treatment. We report a case of a 9-year-old female patient with CF and refractory CRS presenting with significant nasal obstruction, postnasal drainage, and frontal headaches that severely impacted her quality of life. A hybrid technique that involved balloon catheter dilation (BCD) along with endoscopic sinus surgery (ESS) allowed the management of complex anatomical problems associated with the severe polyposis, copious purulence, and narrow frontal recesses during the surgery. This improved our ability to visualize the surgical field, minimize blood loss, and better preserve the mucosa, which ultimately led to better surgical and clinical outcomes. Our findings suggest that hybrid BCD-assisted ESS may offer an effective solution to manage severe CRS in pediatric CF patients, particularly for those who have limited therapeutic options.