|
Category | References | Description | Level of evidence | Evidence grade | Conclusion |
|
Sinonasal manifestations in CF | [3, 4] [5] | Expert opinion Individual cohort studies | 5 2b | D B | Sinonasal manifestations are prevalent in almost all CF patients |
|
Presence of nasal polyps in CF | [10–14, 16] [15] | Expert opinion Lower quality cohort study | 5 3b | D C | Nasal polyps may occur in up to 86% of CF patients |
|
Radiological evidence of sinus disease in CF | [17] [59] | Nonconsecutive cohort study Expert opinion | 3b 5 | C D | Virtually all CF patients demonstrate radiological evidence of sinus disease |
|
Radiological abnormalities | [17, 18] | Retrospective chart review | 4 | C | The most prevalent radiological abnormalities in CF are bilateral uncinate process demineralization and medial displacement of the lateral nasal wall |
|
Failing of medical therapy | [33] | Retrospective cohort study | 2b | B | Many CF patients will ultimately fail medical therapy and undergo sinus surgery |
|
ESS as a treatment for sinus disease in CF | [11, 37–43] | Retrospective cohort studies, individual case control studies and retrospective chart reviews | 2b, 3, 4 | B-C | ESS is a safe and effective treatment of sinus disease in CF |
|
Revision sinus surgery | [51] | Retrospective cohort study | 2b | B | A high proportion of CF patients will eventually require revision sinus surgery |
|
Risk factors for revision surgery | [51] | Retrospective cohort study | 2b | B | The identification of factors associated with an increased likelihood of need for revision sinus surgery has resulted in equivocal outcomes |
[52, 53] | Lower quality cohort study | 4 | C | |
|
Effects of surgery on pulmonary outcomes | [55–58] | Lower quality cohort studies | 4 | C | There is an improvement of pulmonary symptoms and a reduced need for hospitalizations after sinus surgery in CF, but no differences in pulmonary function test outcomes |
|
Postoperative complications | [38, 39] | Lower quality cohort studies | 4 | C | There is no association between sinus surgery in CF and increased rates of postoperative complications |
|
Surgical revision rates | [53] | Lower quality cohort study | 4 | C | Surgical revision rates CF patients with polyps are much higher than in those without polyps |
|