Functional Endoscopic Sinus Surgery (FESS) Alone vs FESS and Balloon Sinuplasty: A Comparative Outcome Analysis in a Pediatric Population with Chronic Rhinosinusitis

Abstract

Objective: Chronic rhinosinusitis (CRS) is a common disease afflicting children. For those affected, conventional FESS and balloon sinuplasty are surgical options for those refractory to medical management. Our objective was to evaluate whether the addition of balloon sinuplasty would improve the treatment outcome in children who undergo FESS for CRS. Method: A 2-group, retrospective blinded chart review comparing 11 pediatric patients who underwent balloon sinuplasty to 15 undergoing FESS from 2007 to 2010 at the Detroit Medical Center. Preoperative CT scans as well as pre- and postoperative sinus symptoms and medications were compared. All group data were compared using 1-tailed independent t tests. Results: Mean age at the time of procedure was 8.74 (SD = 4.2 years; range, 2-19 years). Both groups had similar presurgical Lund-Mackay CT CRS scores (FESS: mean = 9.33, SD = 4.7; Balloon: mean = 10.5, t = -.61, p = .55). Analyses identified posttreatment differences in symptom reduction and needed intervention between the 2 groups. Postoperatively patients who underwent balloon sinuplasty reported fewer headaches (t = 2.51, P = .01), less postnasal drip (t = 1.88, P = .04), and reduced sinus congestion (t = 2.05, P = .03). A comparison of the amount of topical steroidal/saline and antibiotic use identified a reduction in the amount of topicals used in children who received balloon treatment (t = 2.66, P = .007) and a reduction of antibiotic use (t = 1.79, P = .04). Conclusion: Balloon sinuplasty directed at the frontal and maxillary sinuses resulted in better outcomes than those with traditional FESS techniques. Balloon sinuplasty patients had less sinus symptoms, required less antibiotics, and required less topical nasal steroids postoperatively. Preservation of the native anatomy in balloon sinuplasty may play a role in these findings.