Functional Endoscopic Sinus Surgery In Children Research Articles

Влияние сопутствующего искривления носовой перегородки на показатели мукоцилиарного транспорта в послеоперационном периоде у детей с хроническим риносинуситом

Objective. To analyze the effect of concomitant deviated nasal septum in children with chronic rhinosinusitis (CRS) on the effectiveness of functional endoscopic sinus surgery (FESS), the state of the ciliary apparatus, and the morphology of the nasal mucosa in the postoperative period. Patients and methods. A comprehensive examination was performed in 124 patients with CRS without nasal septum deviation as well as 66 patients with CRS and concomitant nasal septum deviation who underwent FESS. Results. A statistically significant improvement in the condition of the subjects after surgery was found in both groups. At the same time, patients with CRS and nasal septum deviation had a higher number of complications and the need for revision surgery. The subjective evaluation of the results of FESS was significantly higher in the group of children with CRS without nasal septum deviation. According to the results of video cytomorphometry in children with CRS without deviated nasal septum, by 6 and 12 months of the postoperative period, there was a close to significant and significant increase in the survival of epithelial cells, the number of cells with mobile cilia, the length of cilia, and the frequency of cilia beating. A year after the operation, this group of subjects also showed a statistically significant decrease in epithelial dystrophy, the number of neutrophils and lymphocytes, and a tendency to arrange cells in layers. In contrast, in patients with CRS and nasal septum deviation, a significant increase in the length of cilia was noted only by 12 months after surgery, while other parameters only tended to normalize. Synchronicity of cilia beat increased significantly by 12 months in both groups. Thus, the obtained results indicate a delayed recovery of the ciliary apparatus and the morphology of the ciliated epithelium mucosa after FESS in children with CRS and concomitant nasal septum deviation, which may be associated with persistent inflammation, causing a less favorable course of the postoperative period.

Pediatric chronic rhinosinusitis

The timing and role of surgery in the management of pediatric chronic rhinosinusitis (pCRS) remains unclear. This review attempts to summarize the existing literature regarding this topic. pCRS is a complex clinical syndrome that results from multiple potential causes. Multimodal medical therapy is the accepted primary treatment. Adenoidectomy continues to be the appropriate first-line surgical therapy, and the addition of antral lavage or balloon dilation to this procedure may improve outcomes. Functional endoscopic sinus surgery (FESS) in children is safe and effective in relieving symptoms in the majority of patients. Failure to respond to maximal medical therapy continues to be a commonly cited, although poorly defined, requisite for proceeding to surgery. Recent literature has been focused on the outcomes after FESS rather than specifically defining when this intervention should be considered. Nevertheless, the literature seems to continue to support FESS in children with persistent symptoms despite adenoidectomy and appropriate medical treatment for pCRS. As the symptoms of chronic rhinosinusitis (CRS) may result from multiple underlying causes, clinicians must understand that the role and timing of surgery may vary with particular patients' disease. Surgical management of CRS in children continues to be a frequent topic of study in the otolaryngology literature. As recent research tends to be focused on outcomes after surgery, further prospective studies comparing surgical versus nonsurgical treatment of CRS will likely be required to better define indications for proceeding to surgery at all.

Long-term results of functional endoscopic sinus surgery in children with chronic rhinosinusitis with nasal polyps

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is rare in children and has a major impact on Quality of Life (QoL). Functional endoscopic sinus surgery (FESS) has proven to be an effective treatment, but it is still unclear what long-term outcomes are in children with CRSwNP. The objective of this study was to assess long-term results of FESS in children with CRSwNP. Methodology: We performed a combined prospective and retrospective study. A QoL questionnaire was send to all children with CRSwNP who received FESS between the year 2000-2010. Almost half of these children also filled in this questionnaire preoperatively. Results: Forty-four Children underwent FESS. From 18 patients, we also prospectively collected preoperative QoL questionnaires. The mean follow-up period was 4.0 years (+- 2.9). The mean age at surgery was 13 years (+-2.9). Of these children, 9 had CF and 10 children asthma. R-SOM scores showed a significant improvement both in general symptoms as well as several different domains when comparing pre- and postoperative questionnaires. Only 5 of 44 patients needed a subsequent intervention. In children with CF this was 3 of 9. Conclusion: This study demonstrates that long-term results of FESS in children with CRSwNP are good. QoL has improved significantly, especially in nasal symptoms, showing that FESS is a good treatment in children with CRSwNP. Furthermore, even children with CF show good results.

Long‐term results of functional endoscopic sinus surgery in children with chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is rare in children and has a major impact on Quality of Life (QoL). Functional endoscopic sinus surgery (FESS) has proven to be an effective treatment, but it is still unclear what long term outcomes are in children with CRSwNP. Therefore the objective of this study was to assess long term results of FESS in children with CRSwNP. In this combined prospective and retrospective study a QoL questionnaire was send to all children who received FESS because of CRSwNP between the year 2000 and 2010. Almost half of these children also filled in this questionnaire preoperatively. Primary outcome was R-SOM score. 44 Children underwent FESS. From 18 patients we also prospectively collected preoperative QoL questionnaires. The response rate was 82% (36/44) and mean follow-up period was 4.0 years (± 2.9). The mean age at surgery was 13 years (± 2.9). Of these children 9 had CF (25%) and 10 children asthma (28%). R-SOM scores showed a significant improvement both in general symptoms as well as several different domains when comparing pre- and postoperative questionnaires (p=0.04). Only 14% (5) of the patients needed a subsequent intervention. In children with CF this was 33% (3/9). This study demonstrates that long term results of FESS in children with CRSwNP are good. Overall QoL has improved significantly for the whole group, especially in nasal symptoms, showing that FESS is a good treatment in children with CRSwNP. Furthermore even children with CF show good results.

Long-term results of functional endoscopic sinus surgery in children with chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is rare in children and has a major impact on Quality of Life (QoL). Functional endoscopic sinus surgery (FESS) has proven to be an effective treatment, but it is still unclear what long-term outcomes are in children with CRSwNP. The objective of this study was to assess long-term results of FESS in children with CRSwNP. We performed a combined prospective and retrospective study. A QoL questionnaire was send to all children with CRSwNP who received FESS between the year 2000-2010. Almost half of these children also filled in this questionnaire preoperatively. Forty-four Children underwent FESS. From 18 patients, we also prospectively collected preoperative QoL questionnaires. The mean follow-up period was 4.0 years (+- 2.9). The mean age at surgery was 13 years (+-2.9). Of these children, 9 had CF and 10 children asthma. R-SOM scores showed a significant improvement both in general symptoms as well as several different domains when comparing pre- and postoperative questionnaires. Only 5 of 44 patients needed a subsequent intervention. In children with CF this was 3 of 9. This study demonstrates that long-term results of FESS in children with CRSwNP are good. QoL has improved significantly, especially in nasal symptoms, showing that FESS is a good treatment in children with CRSwNP. Furthermore, even children with CF show good results.

Optimizing the surgical field in pediatric functional endoscopic sinus surgery: A new evidence-based approach

Objectives To conduct the first prospective randomized controlled study 1) evaluating the possibility of improving the quality of the operative field and to provide a bloodless functional endoscopic sinus surgery (FESS) in children through total intravenous anesthesia (TIVA) using remifentanil combined with propofol, and 2) testing the safety and efficacy of remifentanil in propofol-TIVA in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg. Study Design Randomized controlled trial. Setting General hospital. Subjects and Methods Seventy children underwent FESS under hypotensive general anesthesia with equal randomization into two groups. Group I received TIVA with remifentanil, whereas group II had balanced anesthesia (BA) with esmolol. Heart rate, blood pressure, operative time, blood loss, and quality of the surgical conditions were recorded. Results Intraoperative blood loss in the TIVA group was less than in the BA group. The quality and dryness of the surgical field in both the visual analogue scale and the six-point scale was significantly better in the TIVA group than in the BA group. Hypotension was sustained at the target mean arterial blood pressure of 50 mm Hg in the two groups, without any significant difference. Conclusion Improving the quality of the surgical field and providing a bloodless FESS in children is attainable with TIVA. TIVA using a combination of remifentanil and propofol is superior to BA, even with the use of additional potent hypotensive agents such as esmolol. Both techniques are safe and effective in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg.

Functional Endoscopic Sinus Surgery In Children

During the last decade, the usefulness of functional endoscopic sinus surgery (FESS) has been clearly demonstrated in adult patients. Several recent studies have described the use of FESS in children. Most of the patients in these earlier studies have been school age or older. This paper will examine the follow-up of 44 children treated using FESS. The children's ages ranged from 14 months to 13 years with a mean age of 54.5 months. Thirty-three of the children were less than 6 years of age with a mean age of 35.3 months. Follow-up after surgery varied from 1 to 21 months with a mean of 7.4 months. There were no major surgical or anesthetic complications noted during the initial procedure or at the follow-up debridement. Overall the children did well, with 86% showing improvement. It appears that FESS can be helpful for even young children with chronic sinusitis.

CLINICAL OUTCOME OF PEDIATRIC ENDOSCOPIC SINUS SURGERY

Walner DL, Markey R, Jain V, Myer CM. Am J Rhinol. 2002;16:151–154To assess the efficacy of functional endoscopic sinus surgery (FESS) in children based on a clinical symptom survey.Preoperative and postoperative clinical outcome surveys were completed for 23 children (11 girls and 12 boys) who underwent FESS for sinusitis refractory to medical treatment. The average age at the time of surgery was 6 years (range: 2–13 years).A clinical outcome survey based on modification of the short form (SF)-36 global health assessment was completed by parents of 27 children before FESS. Approximately 2 years after surgery (range: 22.4–33.3 months), the same survey was completed by the parents of 23 children during a telephone interview. No control groups were studied. The survey consisted of 19 questions aimed at determining functional status and quality of life, as well as obtaining information about the incidence of allergies, asthma, and immune deficiencies. These authors also collected data on the presenting symptoms of sinusitis, the presence of nasal polyps, the type of sinus surgery performed, the severity of sinusitis based on preoperative computed tomography (CT), and the need for revision surgery.The most common presenting symptoms before FESS were purulent nasal discharge and chronic nasal congestion. Allergies were present in 70%, asthma in 35%, immunodeficiency in 4%, and nasal polyps in 13%. Two children (9%) required revision FESS. The survey results showed a decrease in symptom score (clinical improvement) for each of 15 outcome categories. There were statistically significant improvements in 9 of 15 categories, including frequency of cough, nasal obstruction, visits to the doctor, problems with routine activities, problems with conduct at school or school attendance, problems with parental performance at work, and problems with parental performance at home related to the child’s condition. Children with more severe disease on CT scan demonstrated less overall improvement, while those with asthma had a larger overall improvement in postoperative survey scores.The results reveal an improvement in clinical symptoms and overall quality of life, based on parental report on a survey, for children undergoing FESS for chronic sinusitis. The study supports pediatric FESS as an effective treatment for children with sinusitis that persists after medical therapy.Chronic sinusitis in children is a multifactorial disease, sharing characteristic symptoms with other common diagnoses such as allergic rhinitis and viral upper respiratory tract infection. Although the majority of cases of bacterial sinusitis respond favorably to medical management or adenoidectomy, sinus surgery may play a role in the treatment of children with persistent disease. Although previous studies have evaluated the efficacy of pediatric FESS based on symptom scores, these authors incorporated a global health survey to further quantify the benefits of sinus surgery on daily function and quality of life of both of the child and the caregiver. The survey used was a modification of the SF-36 Health Survey, which is used in outcome studies of chronic sinusitis in adults. This study is limited by the relatively small sample size of 23 children. Although preoperative survey results are used for comparison in each child, there is no control group. Ideally, the same survey would be given to a group of children/parents with sinusitis treated without surgery, to assess the effects of natural history or nonsurgical therapy. Comparison with this control group would more fully quantify the benefits of surgery. It is not clear how these 27 children were selected for study. Were they part of a larger surgical group, with some patients excluded from study? Was this a series of consecutive patients undergoing FESS for defined surgical indications? These issues affect how we can generalize the conclusions of this report. It is unlikely that we will see a randomized, prospective trial of FESS in children. Outcome studies such as this one, measuring symptom scores and quality of life changes, give support for the use of FESS in children with refractory sinus disease.

Meta-Analysis of Outcomes of Pediatric Functional EndoscopicSinus Surgery

Hebert RL, Bent JPLaryngoscope.1081998796799Functional endoscopic sinus surgery (FESS) has been accepted as a useful treatment or children with chronic sinusitis refractory to medical therapy. The authors attempted to create a consensus of published outcomes of pediatric FESS, assessing the effectiveness and safety of this surgery in children.Eight articles on pediatric sinus surgery were analyzed, which reported on 832 children (age range, 11 months–18 years) who underwent FESS for computed tomography-proven chronic sinusitis. These articles were published between 1986 and 1996. An additional 50 children underwent FESS at the authors' institution between 1991 and 1996. Patients were followed for an average of 3.7 years. Two of the eight articles reported separately on FESS in children with underlying medical conditions such as cystic fibrosis or immunodeficiency.A retrospective review was performed to determine the outcome of pediatric FESS at the authors' institution using a telephone survey. This series was used as unpublished data in the meta-analysis to control for the tendency towards overrepresentation of positive findings in the published literature.The meta-analysis included articles retrieved from a MEDLINE search that reported new patient data on outcomes in pediatric FESS. Articles were rated by a scoring system that assessed number of patients per study, length of follow-up, prospective versus retrospective design, and exclusion or separation of patients with severe underlying systemic diseases. Eight articles, as well as the unpublished data, met the rating criteria for inclusion. Outcome was categorized simply as “positive” or “not positive” based on questionnaire responses or clinic visit documentation of overall satisfaction and degree of improvement.Positive outcomes of pediatric FESS in the eight publications chosen for the meta-analysis ranged from 77% to 100% with a “pooled” positive outcome in 88.4% of children. The positive outcome for FESS in the unpublished series of children was 92%. The two papers that separately analyzed FESS in children with immunodeficiency or cystic fibrosis reported less favorable outcomes, with 0% and 57% positive outcomes reported. These patients tended to require multiple procedures. The major complications of FESS in children in the pooled analysis were hemorrhage requiring blood transfusion (n= 2) and meningitis (n = 2), yielding a complication rate of 0.6%.Endoscopic sinus surgery is a safe and effective treatment of refractory chronic sinusitis in children, with >88% of children having a positive outcome and <1% of children experiencing a major complication. Children with sinusitis accompanied by chronic illnesses such as cystic fibrosis and immunodeficiency have poorer outcomes with FESS, and often require multiple surgical procedures.The authors used meta-analysis to assess outcomes of children with refractory chronic sinusitis treated with FESS. They report a positive outcome of 88.4% and a major complication rate of 0.6%. In the absence of a large prospective trial, this approach enables the pooling of data from multiple studies. However, one must note that 500 out of 882 patients included in this meta-analysis were derived from a single large series.As medical literature tends to be dominated by positive results, the authors have included an unpublished retrospective series of 50 patients from their own institution to control against “publication bias.” The results of FESS assessed in this unpublished series agree with those of the eight published studies that were analyzed.The meta-analysis in this article has several limitations. Eight of 9 of the patient series included in the analysis used a retrospective design. Objective, standardized measurements of surgical outcomes have not been used. The patient population being treated with FESS may be heterogeneous, as each series varies with regard to patient selection criteria, severity of sinusitis (no staging system has been uniformly used), and presence of underlying systemic disease. The type of surgery performed varies from child to child and from series to series, as most children are treated with middle meatal antrostomy and anterior ethmoidectomy, while other children may have more extensive sinus surgery. Few studies have prospectively compared FESS with prolonged medical therapy. A prospective study of long-term surgical outcomes of pediatric FESS is needed, as well as a better understanding of the natural history of chronic sinusitis in children.