Revision Endoscopic Sinus Surgery in Cystic Fibrosis With Chronic Rhinosinusitis: Before and After Cystic Fibrosis Transmembrane Conductance Regulator Triple Modulator Therapy

BackgroundThe rate of functional endoscopic sinus surgery (FESS) in cystic fibrosis (CF) with chronic rhinosinusitis (CRS) is greater than 20%, and the rate of revision FESS is higher in CF patients compared to patients without CF. Revision FESS also occurs sooner in CF. Triple modulator therapy has made a positive impact on CRS symptoms and imaging in CF, but little is known regarding its relation to revision FESS.MethodsA retrospective review of CF patients with CRS treated at a single institution identified 53 patients who met inclusion criteria and underwent FESS between 2006 and 2022. There were 32 patients treated with triple modulator therapy, or elexacaftor/tezacaftor/ivacaftor (ETI). We hypothesized that ETI would be associated with a decreased likelihood of revision FESS. Additional cofactors included age, prior modulator treatment, and history of lung transplant.ResultsThere was a decrease in revision FESS in patients treated with ETI, with only one of the 32 patients undergoing surgery since treatment initiation (3.13%). In the years prior to ETI, 18 of these same patients (56.25%) underwent revision FESS. Patients on other modulator therapy had a hazard ratio of 0.85 for revision FESS (not significant).ConclusionThe current study shows a low rate of revision FESS in patients taking ETI, consistent with prior reports on improved quality of life and radiographic measures in these patients.