Functional Endoscopic Sinus Surgery Improves Sinus-Related Symptoms and Quality of Life in Children With Chronic Rhinosinusitis

Abstract

The surgical management in children with chronic rhinosinusitis, despite the reservations expressed by many clinicians, is effective when optimal medical treatment proves unsuccessful (grade B strength of recommendation), and is associated with improvement in the children's QoL (grade B strength of recommendation). FESS also improves the sinusitis-associated symptoms and QoL in children with cystic fibrosis (grade C strength of recommendation. Most complications of pediatric FESS reported in the literature are minor, and associated with difficulties in the postoperative assessment and care of pediatric patients.

Endoscopic Sinus Surgery in Acute and Chronic Pediatric Rhinosinusitis

“…A recent meta-analysis reported a 0.5% rate of major complications in pediatric endoscopic sinus surgery, none of which proved fatal, or irreversible. The respective rate of minor complications had not exceeded 2% [2].…”

“…Indeed, children experience an average of six to eight colds per year, with 0.5-5% of them being complicated by acute sinusitis [1]. In addition, chronic rhinosinusitis may also cause significant morbidity to children, and affect their everyday quality of life [2].…”

“…These risks should be weighed against the fact that children with chronic rhinosinusitis warranting surgical treatment have a significant chronic illness [11]. The nasal congestion, the purulent nasal discharge, the postnasal drainage, and the recurring headache inevitably affect the children's physical and emotional well-being, and thus their quality of life [2].…”

Clinical Consensus Statement: Pediatric Chronic Rhinosinusitis

“…Strong consensus was reached regarding the effectiveness of adenoidectomy as the initial surgical therapy for patients aged up to 6 years, and measurably less consensus was obtained for patients age 6 to 12 years (statements 18,19). However, the panel could not reach consensus on whether adenoidectomy was an effective first-line procedure for patients aged 13 years and older with CRS ( Table 2, statement 22).…”

“…8,42 From a clinical outcomes standpoint, a meta-analysis of 8 studies investigating the efficacy of adenoidectomy alone in pediatric CRS patients (mean age 5.8 years; range, 4.4-6.9 years) that failed medical management demonstrated that the majority of patients significantly improved sinusitis symptoms after adenoidectomy (subjective success rate = 69.3%, 95% CI, 56.8%-81.7%, P \ .001). 43 The data from these studies helped the panel reach consensus that adenoidectomy is an effective first-line surgical procedure for younger children (statements 18,19). The panel was unable to reach consensus on the utility of adenoidectomy in patients age 13 years and older due to the absence of supporting data for adolescent patients ( Table 2, statement 23).…”