{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T10:18:31Z","timestamp":1769163511414,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,2,20]],"date-time":"2017-02-20T00:00:00Z","timestamp":1487548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The indications for surgical management of chronic rhinosinusitis (CRS) in patients with cystic fibrosis (CF) are poorly defined. In this study we compare outcomes of medical versus surgical treatment and examine trends associated with the transition from medical to surgical therapy in CF patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred thirty\u2010six patients with CF referred to a tertiary rhinology practice were retrospectively divided into 3 cohorts: Medical, Upfront Surgery, or Crossover, if they converted from medical to surgical management. The 22\u2010item Sino\u2010Nasal Outcome Test (SNOT\u201022) and pulmonary function test (PFT) data were assessed up to 48 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to patients initially managed medically (n = 90), those who pursued upfront surgery (n = 46) had a greater incidence of nasal polyposis (<jats:italic>p<\/jats:italic> = 0.0011), prior sinus surgery (<jats:italic>p<\/jats:italic> = 0.0025), lower percent\u2010predicted forced expiratory volume in 1 second (%FEV<jats:sub>1<\/jats:sub>) (<jats:italic>p<\/jats:italic> = 0.0063), and higher Lund\u2010Mackay (<jats:italic>p<\/jats:italic> = 0.0025) and SNOT\u201022 (<jats:italic>p<\/jats:italic> = 0.0229) scores. Within the medical group, 35.5% converted to surgery after a mean of 14.3 months. Crossover (n = 32) was associated with a 6.1\u2010point increase in SNOT\u201022 and a 4.5% deterioration in %FEV<jats:sub>1<\/jats:sub>. Despite worsened symptom severity, the Crossover cohort ultimately achieved similar postoperative SNOT\u201022 scores (<jats:italic>p<\/jats:italic> = 0.831) and %FEV<jats:sub>1<\/jats:sub> (<jats:italic>p<\/jats:italic> = 0.114) as those who underwent upfront surgery. Although the Medical cohort had the lowest baseline SNOT\u201022 scores (<jats:italic>p<\/jats:italic> &lt; 0.001), surgery at any time normalized scores to the same baseline level (<jats:italic>p<\/jats:italic> = 0.652). Neither medical therapy nor surgery improved PFTs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgery effectively reduces CRS\u2010related symptoms in CF patients but may not improve pulmonary function. In patients who first pursue medical therapy, symptomatic decline may prompt eventual conversion to surgery. Patients who delay surgery may achieve similar outcomes as those who pursue surgery upfront.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.21912","type":"journal-article","created":{"date-parts":[[2017,2,20]],"date-time":"2017-02-20T12:56:52Z","timestamp":1487595412000},"page":"450-458","source":"Crossref","is-referenced-by-count":24,"title":["Determinants and outcomes of upfront surgery versus medical therapy for chronic rhinosinusitis in cystic fibrosis"],"prefix":"10.1002","volume":"7","author":[{"given":"Noel","family":"Ayoub","sequence":"first","affiliation":[{"name":"Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Thamboo","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Al\u2010Rahim","family":"Habib","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter H.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine  Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,2,20]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Annual Data Report to the Center Directors","author":"Cystic Fibrosis Foundation Patient Registry","year":"2014"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348941112000701"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199608000-00018"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21695_c"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2006.08.015"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940211101204"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2010.162"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21252"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21190"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24503"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24027"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25108"},{"key":"e_1_2_6_14_1","first-page":"391","article-title":"STRIDE\u2014an integrated standards\u2010based translational research informatics platform","author":"Lowe HJ","year":"2009","journal-title":"AMIA Ann Symp Proc"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2007.07.021"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59989770005-6"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(97)70129-3"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2009.01995.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21607"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin11.271"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.5.9712056"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2013.10.011"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.04.030"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000107"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2008.22.3146"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1995.01890050058011"}],"container-title":["International Forum of Allergy &amp; 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