Use of balloon catheter dilation and bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis

Abstract

Objective:To evaluate the effect of use of balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis（PCRS）. Method:A retrospective study was performed of 49 children with failed medical therapy, who underwent surgery, and children all accepted adenoidectomy.77 sides of sinus were performed with balloon catheter dilation sinuplasty. They were divided into two groups：the balloon group and the balloon with implant group. The balloon group included 26 cases, 16 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses, and 10 cases of which accepted one side. The balloon with implant group included 23 cases,12 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses plus positioning of bioabsorbable steroid-releasing sinus implants, and 11 cases of which accepted one side. VAS and SN-5 scales were completed by children and their parents to evaluate subjective symptoms. Children all accepted CT of sinus and CT score （Lund-Mackey） was completed by a doctor. We use the SPSS 23.0 with the way of Repeated measures ANOVA to analyze the data between two groups, aiming to identify the effect of the operation manners. Result:The procedures were successful in all patients in the balloon with implant group. No complications happened. No sinus implants moving and no detachment. In the balloon with implant group, VAS score declined from 6.9 before operation to 2.0 of six months after operation and SN-5 score declined from 2.397 to 1.376 and CT score of one side of operation declined from 9.628 to 1.314. VAS score, SN-5 score and CT score of the balloon with implant group all declined significantly after operation. The remission rate of the VAS and SN-5 score in the balloon with implant group were 100% and 95% respectively. The SN-5 score data of patients in two groups with SN-5 score <2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.199）, and there was no statistical significance between the data decline of SN-5 score of two groups after operation （F=2.336，P=0.14）. The data of patients in two groups with SN-5 score ≥2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.628）, and, after operation, there was statistical significance between the data decline of SN-5 score of two groups （F=13.861，P=0.001）.It meant the balloon with implant group declined more. The CT score data of patients in two groups with CT score （3-8） before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.411）,and there was no statistical significance between the data decline of CT score of two groups after operation（F=1.108，P=0.300）.The data of patients in two groups with CT score （9-12） before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.792）, and, after operation, there was statistical significance between the data decline of CT score of two groups （F=13.059，P＝0.001）. It meant the balloon with implant group declined more. Conclusion:In our study, the use of balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants made a clinical curative effect in the treatment of PCRS with failed medical therapy, and it was safety. In severe PCRS patients, balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants was more effective than the use of balloon catheter sinuplasty （BCS） alone.