Decrease in Antibiotic Use and Radiographic Sinus Severity after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis and Antibody Immunodeficiencies

Abstract

Antibody immunodeficiencies are common in patients with chronic rhinosinusitis (CRS) and are associated with recurrent sino-pulmonary infections. The role of functional endoscopic sinus surgery (FESS) has not been established in the management of these infections and clinical guidelines suggest caution with surgery. This study evaluates number of antibiotic courses for sino-pulmonary infections and radiographic sinus disease severity after FESS in patients with CRS and antibody immunodeficiencies. Patients with CRS and antibody immunodeficiencies undergoing FESS at Northwestern Medicine between 2007-2017 were identified using an automated review of electronic medical records. A manual chart review of 35 randomly selected patients was performed. The number of antibiotic courses prescribed annually for sino-pulmonary infections was determined, 1 year before and up to 5 years after FESS. Lund-Mackay scores were calculated in patients who had sinus CT scans available before and after FESS. The 35 patients identified were 51.4% male, 82.9% white, and had an average age of 52.9±8 years. There was a reduction in the mean±SD number of antibiotics prescribed per year for sino-pulmonary infections after FESS (2.8±2.2 pre vs. 1.5±1.2 post, P=0.001) in patients with CRS and antibody immunodeficiencies. There was a reduction in Lund-Mackay scores with FESS (N=21, 10.2±5.3 pre vs. 7.5±3.2, P=0.009). FESS is associated with a reduction in antibiotic prescriptions for sino-pulmonary infections and improvement in radiographic sinus disease severity in patients with CRS and antibody immunodeficiencies. This suggests that FESS can be an effective strategy for reducing sino-pulmonary infections and disease burden in these patients.