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Medical and surgical treatment outcomes in patients with chronic rhinosinusitis and immunodeficiency: a systematic review
Author(s) -
Samargandy Shireen,
Grose Elysia,
Chan Yvonne,
Monteiro Eric,
Lee John M.,
Yip Jonathan
Publication year - 2021
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22647
Subject(s) - medicine , primary immunodeficiency , sinusitis , population , prospective cohort study , medline , immunodeficiency , randomized controlled trial , intensive care medicine , disease , surgery , immunology , environmental health , immune system , political science , law
Background Immunodeficiency is a risk factor for recalcitrant chronic rhinosinusitis (CRS). Currently, there is no consensus on effective treatment modalities for immunodeficient CRS patients. This review aims to evaluate the existing evidence on the treatment outcomes and its limitations in patients with CRS and immunodeficiency. Methods MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to April 2019 for studies reporting measurable medical or surgical treatment outcomes for adult patients with CRS and underlying primary or secondary immunodeficiency. Results Of the 2459 articles screened, 13 studies met the inclusion criteria: 2 prospective double‐blind placebo‐controlled trials, 2 prospective case‐control studies, 2 prospective cohort studies, and 7 case series. The high degree of study heterogeneity precluded a meta‐analysis. Antibiotic monotherapy was not linked with significant improvement in clinical, radiographic, or endoscopic outcomes. Immunoglobulin replacement therapy may potentially reduce the frequency of acute or chronic sinusitis in patients with primary immunodeficiency (PID) but may not improve their sinonasal symptoms. Outcomes from endoscopic sinus surgery (ESS) were reported in 8 studies, which found that surgery was linked with improvement in symptoms, disease‐specific quality of life, endoscopy scores, and radiographic scores. The average reported ESS revision rate was 14%. Conclusion Patients with CRS and immunodeficiency likely benefit from ESS based on the available evidence. Data supporting medical therapy in this targeted population is limited overall, but there may be a potential role for immunoglobulin therapy in patients with PID and CRS.