Pediatric Chronic Rhinosinusitis Research Articles

Arabic translation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) in pediatric patients with chronic rhinosinusitis

BackgroundThis study aimed to validate the translation of the Sinus and Nasal Quality of Life Survey (SN-5) into Arabic (SN-5a) in pediatric chronic rhinosinusitis (CRS) patients. A prospective cohort randomized controlled study was conducted on 129 children with CRS and 100 age- and sex-matched healthy children. The questionnaire was translated into the Arabic language with cross-cultural adaptation. Caregivers answered the questionnaire during their first visits and after 1 week; to assess test–retest reliability and after 2 weeks of medical treatment to test the questionnaire’s ability to detect changes in patients’ symptoms. The responses of the patients and control groups were compared to assess the external validity.ResultsThe SN-5a showed internal consistency and reliability, with Cronbach’s alpha value being 0.69. Item–item and item–total correlation analysis showed adequate construct validity with a highly significant negative correlation between the SN-5 questionnaire items and visual analog scale (VAS) (p < 0.001). There were highly significant positive correlations between items of the questionnaire in the 1st and 2nd visits at 1 week (p < 0.001). A highly significant difference between the case and control groups had been shown for all SN-5a items (p < 0.001). Two weeks after treatment, there were large changes in all the questionnaire items between the first and last visits (effect size > 0.8 for all).ConclusionThe translated SN-5a exhibited adequate construct validity, internal consistency, test–retest reliability, and external validity with quite enough ability to assess the longitudinal changes of the disease.

Current issues in the diagnostics of paediatric chronic rhinosinusitis

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Predictive Value of Radiologic Central Compartment Atopic Disease for Identifying Allergy and Asthma in Pediatric Patients.

Central compartment atopic disease (CCAD) has recently been suggested as a phenotype of chronic rhinosinusitis (CRS). This study aims to investigate the prevalence of the radiologic CCAD phenotype in CRS within a pediatric population and identify its ability to predict comorbid allergy and asthma. Computed tomography and endoscopic examination were conducted on pediatric patients with CRS either with or without nasal polyps. Allergen sensitization was determined with the multiple-allergen simultaneous test and skin prick test. Serum total immunoglobulin E (IgE), peripheral blood eosinophil percentage, and presence of asthma were also evaluated. A total of 82 pediatric patients were enrolled. Overall, 55 (67.1%) of the participants demonstrated aeroallergen sensitization, and 31 (18.9%) of the 164 sides of sinuses were radiologically defined to fit the CCAD phenotype. Patients having CRS with the CCAD phenotype had a higher prevalence of aeroallergen sensitization (87.1% vs 62.4%, P = .008), particularly house dust mite (74.2% vs 53.4%, P = .035), and a higher incidence of asthma (16.1% vs 3.8%, P = .010). Additionally, patients having CRS with the CCAD phenotype demonstrated a high serum total IgE levels (51.6% vs 30.1%, P = .023) in comparison to patients having CRS without CCAD. In pediatric CRS, the radiological CCAD phenotype was associated with allergen sensitization and asthma. Furthermore, the CCAD phenotype was associated with high serum total IgE levels, suggesting allergy etiology should be considered with this type of pediatric patients with CRS.

A Survey on the Management of Chronic Rhinosinusitis in the Korean Rhinologic Society

Background and Objectives: There are several diagnostic and therapeutic modalities for chronic rhinosinusitis (CRS), but specific guidelines have not been developed for Koreans. This study sought to evaluate and report CRS practice patterns of members of the Korean Rhinologic Society.Materials and Method: An anonymous survey including 32 items was conducted from August to September 2015. The survey items were categorized into three parts: general information, diagnosis and treatment of CRS, and endoscopic sinus surgery.Results: A total of 267 members participated in this survey. Almost half of the respondents (41.9%) were in their 40s and 42.7% had 10-20 years of experience. A total of 61.8% were private practitioners, while the rest worked in hospitals (38.2%). The prevalence rate of acute rhinosinusitis was higher in private clinics compared to hospitals (p&lt;0.001). Intranasal steroids and saline irrigation were more commonly prescribed among hospital doctors compared to private practitioners (p&lt;0.001). Amoxicillin/clavulanic acid was the drug of choice for adult and pediatric CRS patients among private practitioners. However, hospital doctors preferred macrolides for adult CRS patients and third-generation cephalosporins for pediatric CRS patients. Most private clinics performed surgery under local anesthesia (90.8%), while those in a hospital setting preferred general anesthesia (78.4%). Revision surgery rates were higher in hospitals compared to private clinics (p&lt;0.001).Conclusion: There were significant variations in CRS practice patterns between private clinics and hospitals. For effective and standardized diagnosis and management of CRS, appropriate local guidelines are needed.

Management of Pediatric Chronic Rhinosinusitis

Chronic pediatric rhinosinusitis is a common entity, with an annual incidence of 4% in the US schoolchildren’s population. The predominant contributing factor in younger children is adenoid pathology and in older children, allergic rhinitis. Recent research on sinus microbiome, biofilm, inflammatory response, and therapeutic alternatives is providing new insights in this prevalent disease. Adenoid size does not correlate with the severity of the disease suggesting that it is due to the biofilms observed in both adenoiditis and hypertrophic adenoids. There is new consensus among the experts on the definition and clinical diagnosis of pediatric chronic rhinosinusitis (PCRS). In PCRS, inflammation is mediated by helper T lymphocyte type 2 with limited glandular hyperplasia or fibrosis observed histologically. Both innate and adaptive immunity contribute to the heterogeneous inflammatory pathogenesis of PCRS that is driven by genetic, environmental, and microbiome factors. Medical treatment includes nasal hygiene, anti-inflammatory, and antibiotic therapy. When medical treatment fails, adenoidectomy is the surgical treatment of choice in children less than 6 years old, adenoidectomy plus possible endoscopic endonasal surgery (EES) between ages 6 and 12, and EES for children 12 and older. Balloon sinuplasty has been reported to be effective between 70 and 80% in older children. This review focuses on the most recent PCRS consensus statements, novel research in histopathology and microbiome, and the evolving medical and surgical therapeutic options for this challenging disease.

Pediatric Chronic Rhinosinusitis: Unmet Needs

Pediatric chronic rhinosinusitis (CRS) remains an elusive diagnostic medical condition, largely based on imperfect diagnostic criteria, lack of controlled studies of therapy, lack of measure for resolution, and lack of information of pediatric sinus microbiome dysbiosis. The true prevalence of pediatric CRS is unknown, and symptoms often over-lap with other diagnoses. We review the unmet needs in pediatric CRS, to highlight potential research opportunities to improve understanding and therapy of the disease process.

Pediatric Versus Adult Chronic Rhinosinusitis.

Pediatric and adult chronic rhinosinusitis (CRS) have some similarities but a number of differences. This article reviews the similarities and differences between pediatric and adult CRS. Rhinosinusitis is an inflammatory disease of the nose and the paranasal sinuses. In adults, inflammation in CRS without polyps (CRSsNP) mainly manifests with T-helper 1 lymphocytes while in CRS with polyps (CRSwNP) manifests with T-helper 2 lymphocytes and eosinophilic inflammation. In children, CRS inflammation manifests with neutrophils, macrophages, and lymphocytes. The associations between the ostiomeatal complex occlusion and CRS are revealed in adults but are not so evident in children. Although the relationship between the CRS and allergic rhinitis is still controversial, recent findings have shown an association between allergen sensitization and a specific group of adults with rhinosinusitis. Intranasal corticosteroids and saline constitute the first-line of medical treatment for both pediatric and adult rhinosinusitis. Low-dose macrolides are used for immunomodulatory activities and beneficial effects to adult patients with CRSsNP were demonstrated by recent meta-analyses. For surgical treatment, adenoidectomy is a key strategy to eradicate mature biofilms in pediatric CRS and effective in treating children with CRS regardless of the adenoid size. Although endoscopic sinus surgery has been proven to improve quality of life outcomes in adult CRS, it should be only considered in the pediatric CRS after failure of adenoidectomy. Pediatric and adult CRS are different in many aspects, including immunopathogenesis and management. Investigations should be considered in specific cases. After failure of medical treatments, endoscopic sinus surgery is recommended for adults, while adenoidectomy is primarily considered for children.

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

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.

The Pediatric Sinus Staging System: A Computed Tomography-Based Approach to Grading Pediatric Sinus Disease.

Pediatric chronic rhinosinusitis (CRS) is a prevalent disease with few objective measurements available to predict which patients will require surgical intervention. The Lund-Mackay (LM) score for computed tomography (CT) scans is one objective data point available for the adult population; however, a dedicated scoring system in the pediatric population has not been popularized. We present a Pediatric Sinus Staging System (PSSS) that considers both opacification and the varying developmental stages of each sinus. Retrospective chart review. We analyzed CT scans of pediatric patients with a diagnosis of CRS. Both LM and PSSS scores were calculated for each scan. Groups were formed based on treatment outcomes and included patients who were treated successfully with medical therapy and/or adenoidectomy (med/adenoid), patients who required functional endoscopic sinus surgery (FESS), and patients who required revision FESS. Overall, 76 patient scans were reviewed. PSSS values were significantly less than LM for the control group (P = .001) and significantly higher for patients with cystic fibrosis (P = .027) and with CRS with polyps (P = .001). The ideal cutoff for PSSS to distinguish between med/adenoid and single FESS treatment with a sensitivity 90.6% and specificity of 50.0% was ≥2. The PSSS gives a more descriptive score by accounting for the opacification and pneumatization of each sinus. Our current results show similar values between PSSS and LM scores, which suggests internal validity. In addition, a PSSS score of ≥2 may help physicians better counsel families on the likelihood of requiring FESS. Further investigation is needed to fully validate the PSSS. 3b Laryngoscope, 131:E642-E648, 2021.

Working towards consensus in the management of pediatric chronic rhinosinusitis in cystic fibrosis

ObjectiveThe prevalence of chronic rhinosinusitis (CRS), defined by mucosal thickening on imaging, approaches 100% in the cystic fibrosis (CF) population. CRS is associated with significant morbidity in CF, including its ability to trigger pulmonary exacerbations. CRS in CF is typically managed by pediatricians, otolaryngologists and pulmonologists. This survey evaluates the variance in practice patterns of CRS in CF amongst specialists. MethodsThis is a cross-sectional, electronic survey in which maximum variation purposive sampling was used by a multi-disciplinary group of pediatric, otolaryngology and pulmonology providers in order to select a survey population with expertise in CRS in CF patients. The survey was distributed to 381 practitioners from September to October 2019. Results175 participants responded (45% response rate). Ten (of 54) statements achieved 75% consensus agreement. Consensus statements included: The decision to pursue surgical intervention for CRS in CF is a multi-disciplinary approach (94%; n = 146); maximal medical management should include nasal saline irrigation (93%; n = 142), topical steroids (75%; n = 117), maximal medical management should not include intravenous steroids (79%; n = 122); image guidance in surgery is necessary for all surgery involving the frontal sinuses (77%; n = 43), and all revision surgery(80%, n = 45); the appropriate setting for sinus surgery in a CF patient varies depending on patient presentation (89%; n = 133); post-operative regimen should include nasal saline (93%; n = 137); but does depend on the severity of disease discovered intra-operatively (84%; n = 124); post-operative antibiotics should be guided by intra-operative culture data (82%; n = 121). ConclusionsThere is a great deal of variation amongst specialists in the treatment of CRS in CF, however 10 statements met consensus criteria and should be considered when forming clinical care guidelines in this population.

Phenotypes of Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a complex heterogeneous disease with different phenotypes and endotypes. Recent advances in our understanding of the pathogenetic mechanisms of CRS endotypes have led to the introduction of effective biologic agents for CRS management. Traditionally, CRS phenotypes have been divided into with or without nasal polyps depending on the presence of polyps. Although this classification does not reflect the various endotypes that are recently emerging, it is simple and easily recognized by clinicians. Other phenotypes of CRS are fungal rhinosinusitis (including invasive and noninvasive subtypes), infectious rhinosinusitis, aspirin-exacerbated respiratory disease, cystic fibrosis, pediatric CRS, and CRS associated with systemic diseases. This article reviews the diagnostic approaches and up-to-date treatment strategies for each CRS phenotype with the hope that a better understanding of endotypes will result in a more scientific understanding of phenotypes and precise, personalized treatments.

Balloon Catheter Dilation in Pediatric Chronic Rhinosinusitis: A Meta-analysis.

Paranasal sinus balloon catheter dilation (BCD) represents a tool that has been shown to be safe in the management of pediatric chronic rhinosinusitis (pCRS); however, its efficacy compared to standard treatment regimens has not been well established. The purpose of this meta-analysis was to evaluate the clinical utility of BCD in pCRS. Articles reporting BCD for pCRS in patients under 18 years of age were identified via the following search terms: sinusitis OR rhinosinusitis AND balloon dilatation OR balloon dilation OR balloon sinuplasty OR sinuplasty AND adolescent OR children OR infant OR pediatric OR toddler. The primary outcome analyzed includes quality of life improvement as measured via Sinus and Nasal Quality of Life Survey (SN-5) or Sino-nasal Outcome Test (SNOT-22) scores. Eighty studies were abstracted; 10 studies were included for final qualitative analysis after dual investigator screening. Three studies described BCD with surgical controls, including adenoidectomy, saline irrigation, or maxillary antrostomy. Noninferiority was not demonstrated (ie, BCD is inferior) in 2 of 3 studies. Pooled analysis utilizing a random effects model revealed a decreased effect size yet no statistically significant difference between BCD and standard operative techniques as measured by quality of life measures (g = -0.04, I2 = 41%). This work highlights a lack of published evidence regarding the role of BCD in pCRS. Two of the 3 included studies demonstrated the inferiority of BCD when compared to other standard surgical interventions, whereas meta-analysis was unable to detect any statistically significant difference between standard treatment regimens. Future scientific investigations are necessary to assess the comparative effectiveness of BCD in pCRS.

Chronic Rhinosinusitis in Pediatric Immunodeficiency

Chronic rhinosinusitis and other sinopulmonary infections can be a hallmark of impaired immunity in children. Rhinosinusitis in the setting of immunodeficiency can often be chronic and refractory, and involve opportunistic pathogens. We review the evaluation and management of pediatric chronic rhinosinusitis in the context of primary immunodeficiency diseases. Immunodeficiencies found to be associated with chronic rhinosinusitis include common variable immune deficiency, X-linked agammaglobulinemia, antibody deficiencies, hyper-IgM syndrome, hyper-IgE syndrome, Wiskott–Aldrich syndrome, activated PI3K disease, DiGeorge syndrome, and chronic granulomatous disease. Chronic rhinosinusitis in children may be a clinical manifestation of immunodeficiency. The evaluation and diagnosis of immunodeficiencies are essential for initiating appropriate therapeutic strategies, including antibiotics, prophylaxis, topical therapy, surgery, and immunoglobulin replacement.

Low-dose macrolides for treating pediatric rhinosinusitis: A retrospective study and literature review.

The effects of low-dose macrolide (LDM) therapy on pediatric chronic rhinosinusitis (CRS) patients are unknown. This study aimed to assess the effectiveness of LDM for treating pediatric refractory CRS. A retrospective study was conducted by a medical chart review. Pediatric CRS patients (age <15 years) who received LDM after standard medical treatments failure between 2013 and 2019 were identified. The LDM treatments with any macrolide agents, doses, and regimens were included. Any co-interventions were allowed. Duration of the LDM therapy was ≥6 weeks. Outcomes were the total nasal symptoms by the visual analogue scale (TNS), presence of individual symptoms, physician-assessment nasal discharge and adverse events. Six patients (67% male, mean age 7±3.4 years) were assessed. All patients had failed to intranasal steroids and nasal saline irrigation but continued. The addition of LDM significantly improved TNS (mean difference ± standard deviation 5.83 ± 1.33; 95% confidence interval 4.44–7.23, p< 0.001). At the end of treatment, the numbers of patients with individual symptoms were decreased: nasal obstruction (100%–67%), rhinorrhea (83%–50%), hyposmia (50%–0%), cough (100%–33%), and physician-assessment thick mucoid discharge (33%–0%). No patients had facial pain. One patient reported mild tolerable nausea. Preliminary findings of this study showed some beneficial effects of LDM added to intranasal steroids and nasal saline irrigation in pediatric CRS after standard treatments failure. The beneficial effects included the improvements of the TNS and individual nasal symptoms and decrease in thick mucoid discharge.

Nitric Oxide and Biological Mediators in Pediatric Chronic Rhinosinusitis and Asthma.

Background: In the context of the so-called unified airway theory, chronic rhinosinusitis (CRS) and asthma may coexist. The inflammation underlying these conditions can be studied through the aid of biomarkers. Main body: We described the main biological mediators that have been studied in pediatric CRS and asthma, and, according to the available literature, we reported their potential role in the diagnosis and management of these conditions. As for CRS, we discussed the studies that investigated nasal nitric oxide (nNO), pendrin, and periostin. As for asthma, we discussed the role of fractional exhaled nitric oxide (feNO), the role of periostin, and that of biological mediators measured in exhaled breath condensate (EBC) and exhaled air (volatile organic compounds, VOCs). Conclusion: Among non-invasive biomarkers, nNO seems the most informative in CRS and feNO in asthma. Other biological mediators seem promising, but further studies are needed before they can be applied in clinical practice.

Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link?

Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for “(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)”. At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score.

Immunologic Evaluation of Pediatric Chronic and Recurrent Acute Rhinosinusitis.

Background Although pediatric rhinosinusitis is a commonly encountered clinical entity, the diagnostic approach and treatment algorithm are constantly evolving. In addition to anatomic and allergic etiologies, immunologic deficiencies have been implicated in the pathogenesis of rhinosinusitis; however, the prevalence of immunologic disease in pediatric rhinosinusitis is poorly defined. Objective To inform the approach to the evaluation of pediatric patients with rhinosinusitis, this retrospective pilot study examined the prevalence of abnormal results detected on immunologic testing in pediatric patients with chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS). Methods Patients between 2008 and 2018 were identified using International Classification of Diseases 9/10 codes. Imaging, endoscopy findings, and clinical criteria were used to diagnose CRS and RARS (n = 27). We reviewed available results, including quantitative immunoglobulins (Igs), thyroid evaluation, complete blood count, and titers to Streptococcus, Haemophilus influenzae type B (HiB), Diphtheria, and Tetanus. Statistical analyses were performed with the Mann–Whitney U test and Fisher’s exact test. Results Our initial search yielded 140 patients, of which 27 met diagnostic criteria for CRS (17) or RARS (10). Eight patients (29.6%) underwent adenoidectomy and 5 (18.5%) underwent endoscopic sinus surgery. The most common Ig deficiencies were IgM, 13.0%, and IgA, 11.1%. Four (23.5%) of the 17 patients had significantly elevated IgE levels, indicating a possible allergic etiology. Within this cohort, there was an increased incidence of insufficient protective titers to polysaccharide vaccines. HiB titers were not protective in 35% of our cohort. Insufficient pneumococcal protection was more common in patients &gt;10 years, while deficient IgM was more common in those &lt;10 years. Conclusion High-yield testing in pediatric rhinosinusitis should include titers to polysaccharide antigens, specifically Streptococcus pneumoniae and H. influenzae. Low-yield tests that may be deferred during initial testing include thyroid studies and Tetanus and Diphtheria antibodies. Prospective, high-volume studies are required to further elucidate the role of immunologic testing in this population.

Balloon Sinuplasty in Pediatric Rhinosinusitis

Balloon catheter dilation (BCD) is increasingly utilized as an adjunct to adenoidectomy or functional endoscopic sinus surgery in the surgical management of pediatric chronic rhinosinusitis (CRS). The goal of this review is to analyze existing evidence for the efficacy of BCD in treating pediatric CRS. We also assess expanded indications of BCD such as acute complications of sinusitis or surgery for critically ill patients. Pearls and pitfalls of the technique are discussed. BCD shows potential as an effective adjuvant procedure in addition to adenoidectomy and as a stand-alone procedure. Multiple studies have shown its safety; however, studies on efficacy have been limited by lack of randomized control. BCD is safe and an important addition to the surgical treatment of selected pediatric CRS. Further randomized controlled studies are necessary to clearly define the efficacy of BCD as an adjuvant or stand-alone procedure in the management of pediatric CRS and to investigate expanded indications.

Role of Endoscopic Sinus Surgery in Pediatric Chronic Rhinosinusitis

In children with chronic rhinosinusitis (CRS) refractory to medical therapy, both adenoidectomy and endoscopic sinus surgery (ESS) are considered to be surgical options. This review presents the current literature regarding the role of ESS in management of CRS in the pediatric population. Adenoidectomy has a success rate of 40–69% with a complication rate of 3.2%. Similarly, ESS has a reported success rate of 71–100% with a complication rate of 0.6–3%. ESS does not appear to have long-term adverse effects on facial growth based on recent longitudinal human studies. Age appears to be a factor in the efficacy of endoscopic sinus surgery. Patients older than 6 years have been shown to have better success rates for both ESS and adenoidectomy than those under six. In addition, ESS may be more effective than adenoidectomy in children older than 6 years. However, in children younger than 6 years, the difference in success rates has not been found to be statistically significant between the two procedures. ESS is an effective surgical treatment for pediatric patients with CRS and is best performed when medical therapy, adenoidectomy, or both have failed.

Balloon Sinuplasty Utilization in the Pediatric Population: A National Database Perspective.

Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. Retrospective review. National pediatric database. All cases of children aged ≤18 years who underwent BS or traditional endoscopic sinus surgery (ESS) 5 years before and after the introduction of BS billing codes were studied with the Pediatric Health Information System database. We evaluated overall trends, demographics, performing physicians, readmissions, and cost data. A total of 14,079 patients met inclusion criteria: 13,555 underwent traditional ESS and 524 had a BS procedure. There was no significant increase in BS rates between 2011 and 2016. BS was more commonly performed among younger children than ESS (median age [interquartile range], 6 years [4-10] vs 9 years [6-13]; P < .001). There were 23 (4.4%) readmissions within 30 days in the balloon cohort versus 474 (3.5%) in the ESS cohort. The median cost of balloon maxillary antrostomy (US $6560 [$5420-$8250]) was higher than that of traditional maxillary antrostomy (US $5630 [$4130-$7700], P < .001). Physicians who performed BS had a larger volume of ESS procedures when compared with those who did not perform BS. Rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.