Children with cystic fibrosis: who should visit the otorhinolaryngologist?

BACKGROUND: Sinonasal complications are common in children with cystic fibrosis (CF). Generally, those children with persistent symptoms of sinonasal polyposis are referred to an otorhinolaryngologic (ORL) physician for sinus surgery. Several studies have reported differences in clinical characteristics between CF patients with and without sinonasal polyps.

OBJECTIVES: To predict the presence of sinonasal polyposis in children with CF on the basis of symptoms and clinical characteristics and so to select those children who might benefit from referral to an ORL physician.

DESIGN, SETTING, AND PATIENTS: Survey of data from a database on the results of yearly multidisciplinary examinations of 140 children with CF.

MAIN OUTCOME MEASURE: Presence of sinonasal polyposis.

RESULTS: In the total population of 140 children, no combination of ORL symptoms and clinical characteristics could accurately predict the presence of sinonasal polyposis. In a subgroup of 73 children with a history of nasal symptoms, independent predictors for the presence of sinonasal polyposis were male sex, age 10 years or older, presence of rhinorrhea, and a forced vital capacity 70% or more of the predicted value. The area under the receiver operating characteristic curve of a scoring rule including these independent predictors was 0.77. The positive and negative predictive values of this rule were 0.86 and 0.71, respectively.

CONCLUSION: A scoring rule including the independent predictors sex, age, symptoms of rhinorrhea, and forced vital capacity values could reasonably classify children with CF and nasal symptoms into a category with increased risk for sinonasal polyposis, thus facilitating the decision on ORL referral.