Surgical Treatment of Paediatric Chronic Rhinosinusitis

Abstract

Rhinosinusitis (RS) is a common disease in children, significantly affecting their quality of life. Chronic rhinosinusitis (CRS) is frequently linked to other respiratory diseases, including asthma. Children affected by CRS may be candidates for surgery in the case of failure of maximal medical therapy comprising three to six weeks of broad-spectrum systemic antibiotics with adjunctive therapies. Although endoscopic sinus surgery (ESS) is the surgical treatment of choice in adult patients with CRS, different surgical procedures are scheduled for refractory paediatric CRS and include adenoidectomy, paediatric ESS (PESS), and balloon catheter sinuplasty (BCS). The present paper discusses the indications and limitations of each treatment option in children with CRS. Given the amount of current evidence, it is reasonable to suggest that, in young and otherwise healthy children with refractory CRS, an adenoidectomy (eventually combined with BCS) should be offered as the first-line surgical treatment. Nevertheless, this approach may be considered ineffective in some patients who should be candidates for traditional ESS. In older children, those with asthma, or in the case of peculiar conditions, traditional ESS should be considered as the primary treatment.

Review and Analysis of Research Trends in Surgical Treatment of Pediatric Chronic Sinusitis

“…A recent literature review of published studies reported a success rate ranging from 50% to 92% with adenoidectomy alone or in combination with other procedures, 82% to 100% for ESS, and 80% to 100% with balloon catheter sinuplasty alone or in combination with other procedures. 20 However, the dearth of higher level of evidence studies, such as randomized controlled trials and studies looking at solitary surgical intervention, makes it difficult to draw meaningful comparisons between these surgical modalities.…”

Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition

“…As a matter of fact, they are widely and effectively used in children with AR, confirming that the systemic bioavailability of second-generation compounds, such as mometasone and fluticasone, is less than 1%, making them safe for long-term use [84]. In younger children refractory to appropriate medical therapy, adenoidectomy is considered the first-line surgical intervention [1,28,85], followed by functional endoscopic sinus surgery aimed at reestablishing adequate sinus ventilation and secretion drainage [86,87].…”

“…In children, paranasal sinuses and their ostia are smaller and undergo a process of maturation and development, so the ethmoidal and maxillary sinuses are already present at birth, while the frontal and sphenoidal sinuses develop later, being radiologically demonstrated by the age of 4-6 [25,26], and could be at a higher risk of obstruction. Moreover, sinus disease is usually linked to the obstruction of the OMC, which is an area located in the middle meatus where secretions from the maxillary, the anterior ethmoid, and the frontal sinuses converge [27,28]. When the OMC is obstructed due to mucosal edema, negative pressure and hypoxia develop in the sinuses, stimulating mucus production and favoring its retention, which leads to bacterial growth and acute rhinosinusitis onset, giving rise to a vicious cycle further worsening the retention of secretions, impairing ciliary function, and favoring bacterial growth and biofilm formation with chronic OMC obstruction and CRS development [2].…”

Pediatric chronic sinusitis: diagnosis and management

“…Typically maxillary sinus irrigation is also performed concurrently. However, there is variation (47-61%) in reported success rates after adenoidectomy alone, which may be related to differences in surgical approach and outcome measures collected [53]. Due to the relative efficacy and low risks involved, the EPOS and AAO-HNS consensus statement recommend adenoidectomy for first-line surgical treatment of pediatric CRS.…”