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Background: Despite treatment advances, comorbid chronic rhinosinusitis (CRS) remains unresolved for many people with CF (PwCF). CRS limits quality of life and harbors pathogenic bacteria that may descend into the lower airway [1, 2]. Although endoscopic sinus surgery (ESS) remains an established treatment for CRS that is refractory to medical management, expansion of disease-altering therapies has dramatically shifted the landscape of CF treatment. The highly effective modulator therapy elexacaftor-tezacaftor-ivacaftor (ETI) improves CRS-specific quality of life and symptom severity, but the impact of this intervention and other factors associated with pursuing ESS remains understudied. Methods: Adults with CF and CRS were enrolled in a prospective, observational, multi-institutional study from five US CF centers from 2018 to 2022. Participants completed validated outcome measures to evaluate …