Surgical intervention for sinusitis in children

Abstract

Pediatric rhinosinusitis represents a common endpoint of many potential etiologic factors, but fixed anatomic obstruction of sinus outflow is relatively unusual in pediatric patients. Surgical therapy is considered when medical therapy for underlying mucosal inflammation fails. Adenoidectomy is usually the first surgical intervention to be considered for young children, with the goal of improving sinus drainage and eliminating a potential source of bacteria. Endoscopic sinus surgery is considered for the small percentage of patients, most commonly those with underlying pulmonary disease, who fail less aggressive treatment measures. Every decision for surgery involves a risk-benefit analysis.

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

“…There seems to be a consensus favoring surgical intervention in children with refractory CRS who fail medical management. However, there is still disagreement about which type of surgical intervention is appropriate 2,4–11 . Adenoidectomy 4–6 and ESS 7,8,11 have both been recommended as surgical options 4–6 .…”

Long-Term Follow-Up for Children Treated With Surgical Intervention for Chronic Rhinosinusitis

“…Lusk and Muntz 41 and Gross et al 79 reported favorable results in endoscopic sinus procedures in children. Others confirmed these results 31,37,39,40,46,80–91 …”

“…Core cultures of adenoid tissue show pathogens similar to rhinosinusitis and are independent of the size of the adenoid pad 59 . Adenoidectomy is now considered an appropriate first step when medical management fails 31 . In general, the efficacy of adenoidectomy in treating chronic pediatric rhinosinusitis is approximately 48% to 75% 37–39,60 .…”

Rhinosinusitis in Children

“…It removes the obstruction as well nidus of infection [118–121]. A risk-benefit analysis should be carried out before considering other surgical approaches in children.…”