Outcome of Adenoidectomy Versus Adenoidectomy With Maxillary Sinus Wash for Chronic Rhinosinusitis in Children

Abstract

Objectives: To compare postoperative outcomes of adenoidectomy versus adenoidectomy with maxillary sinus wash as surgical treatment of chronic rhinosinusitis (CRS) in children. Study Design: A retrospective review of prospectively collected data. Methods: Children who failed to respond to medical therapy for CRS and had an adenoidectomy alone (A) or an adenoidectomy with a maxillary sinus wash (wash/A) were reviewed. Outcome was assessed at least 12 months postoperatively. Results: Sixty children who satisfied the inclusion criteria were reviewed. Thirty‐two of the children had a sinus wash at the time of adenoidectomy. The age range was 3 to 13 years (mean, 6.3 years) and the mean computed tomography (CT) score was 6.1. The two surgical groups were comparable with regard to age, sex, presence of allergies, asthma, and smoking in the household. Twenty‐eight (87.5%) of the 32 patients who underwent wash/A showed improvement of their symptoms after 12 months follow‐up compared with 17 (60.7%) of 28 patients who underwent A (P = .017). Multivariable analysis using logistic regression analysis with age, sex, asthma, allergy, and CT score as covariables showed that the success of wash/A compared with adenoidectomy was higher (93% to 60%) for children with a high CT score compared to those with a lower CT score (P = .011). None of the other variables showed statistical significance. Conclusions: Children with more severe sinus disease as evidenced by a high CT score had a higher success rate if a maxillary sinus wash was performed at the time of adenoidectomy. Children with a low CT score did not have that benefit.

Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis

“…Moderate to significant improvement was seen in 80% of the balloon group versus only 52% in those treated only with adenoidectomy. Of note, Ramadan [20] had also previously reported an increased success rate (88%) when a maxillary sinus saline wash was performed in conjunction with adenoidectomy compared with adenoidectomy alone (∼50%). The maxillary sinus is relatively simple to access for irrigation via the inferior meatus with an inexpensive needle and syringe compared with all the other paranasal sinuses.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…1431 For pediatric patients with LM scores greater than 6, the addition of maxillary sinus irrigation at the time of adenoidectomy was found to improve clinical symptoms 1 year after the procedure. 1432 There are several potential roles of ESS in PCRS. One use for pediatric ESS in CRS is opening anatomic corridors for irrigation and topical therapy delivery.…”

Antral lavage using the luma transilluminaton wire and vortex irrigator—A safe and effective advance in treating pediatric sinusitis

“…Recently, maxillary sinus lavage in conjunction with adenoidectomy has been shown to be more effective than adenoidectomy alone in treating chronic rhinosinusitis [2]. Typically performing this procedure involves a puncture into the maxillary sinus via the inferior meatus; however, it has also been performed through the natural ostium using a 45 degree needle [2].…”

“…When first line medical management fails, the treatment options include IV antibiotic therapy, adenoidectomy, sinus lavage, and functional endoscopic sinus surgery (FESS). Many authors recommend adenoidectomy prior to considering FESS, and recent evidence points to the possible advantage of combining adenoidectomy with antral lavage over adenoidectomy alone [2,3].…”