Abstract
Background: Elexacaftor/tezacaftor/ivacaftor (ETI) is a highly effective triple modulator therapy that has significantly reduced morbidity and mortality in patients with cystic fibrosis. Beyond pulmonary improvements, ETI’s impact on sinus disease, olfactory function, and the sinonasal microbiome is just beginning to be understood. We present a contemporary review of sinonasal changes in patients with cystic fibrosis after ETI initiation.
Methods: We conducted a literature review using PubMed and Google Scholar. Articles about ETI’s impact on sinonasal disease and symptoms in patients with cystic fibrosis published in English from 2019 to August 2024 were eligible for inclusion. Studies were selected based on their contribution to understanding changes in sinus disease severity, sinonasal quality of life, olfactory function, and the sinonasal microbiome in patients with cystic fibrosis after starting ETI.
Results: An initial query yielded 41 articles. After screening abstracts, 23 articles were chosen for further review. A total of 19 articles met full inclusion and exclusion criteria. Evidence suggests ETI significantly improves sinus disease in patients with cystic fibrosis, with clinical, radiographical, and quality of life improvements observed within days to months and persisting for up to two years. Studies on olfactory changes showed mixed results, with persistent dysfunction demonstrated on psychophysical tests despite subjective improvements. ETI also alters the sinonasal microbiota, by reducing pathogenic bacteria and total bacterial load, though the clinical implications remain under investigation.
Conclusions: ETI therapy markedly improves both objective evidence of sinus disease and sinonasal quality of life in patients with cystic fibrosis. Despite some improvements in olfactory dysfunction, objective tests consistently report refractory impairment post-ETI. Changes in the sinonasal microbiome are evident, but dysbiosis remains a concern. Further research is needed to clarify the long-term effects of ETI on olfactory dysfunction and the sinonasal microbiome, especially in younger populations.