Cystic Fibrosis and Sinusitis in Children: Outcomes and Socioeconomic Status

Objectives. Although chronic sinusitis is prevalent in children with cystic fibrosis (CF), little is known regarding pulmonary outcomes following endoscopic sinus surgery (ESS). Furthermore, lower socioeconomic status (SES) is associated with increased morbidity in children with CF. The investigators evaluated the impact of surgery and SES on pulmonary function tests (PFTs) in children with CF and rhinosinusitis. Study Design. Longitudinal, retrospective cohort study. Setting. Urban tertiary CF center. Subjects and Methods. Children with CF ages 0 to 21 evaluated for sinusitis between 1998 and 2008 were analyzed. Children were grouped according to surgery status (ESS or no ESS). Medicaid (MA) insurance was used as a proxy for lower SES. PFTs (percent predicted forced vital capacity [FVC% predicted] and percent predicted forced expiratory volume in 1 second [FEV1% predicted]) were recorded over 2 years. Multivariate linear regression models and interaction terms (ESS and MA) were used to analyze PFTs. Results. Of 62 patients evaluated, 21 (34%) underwent ESS, and 16 (26%) had MA. Polyps were more common in the ESS group (86% vs 32%, P < .001). FEV1% predicted and FVC% predicted were lower at all times for children with MA (P < .001). After adjustment for MA, mean FEV1% predicted was higher for the ESS group at all time points (P < . 02), and mean FVC% predicted was higher at 1 and 2 years (P = .02, P = .01). Compared with the nonsurgical group, children without MA undergoing ESS had higher mean FEV1% predicted at all 3 follow-up visits (P < .05). Children with MA who underwent ESS had higher mean FVC% predicted at 1 year (P = .04) and higher mean FEV1% predicted preoperatively and at 1 year (P <=.01). Conclusions. Children with CF and sinusitis who undergo ESS experience some increase in PFTs over time, although this change is not uniform. Children with CF and sinusitis who are from lower socioeconomic backgrounds have lower PFTs over time regardless of surgical intervention.