Abstract
Pediatric rhinosinusitis represents a common endpoint of many potential etiologic factors, but fixed anatomic obstruction of sinus outflow is relatively unusual in pediatric patients. Surgical therapy is considered when medical therapy for underlying mucosal inflammation fails. Adenoidectomy is usually the first surgical intervention to be considered for young children, with the goal of improving sinus drainage and eliminating a potential source of bacteria. Endoscopic sinus surgery is considered for the small percentage of patients, most commonly those with underlying pulmonary disease, who fail less aggressive treatment measures. Every decision for surgery involves a risk-benefit analysis.
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Aitken M, Taylor JA: Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. Arch Pediatr Adolesc Med 1998, 152:244–248.
Cunningham MJ, Chin EJ, Landgraf JM, Gliklich RE: The health impact of chronic recurrent rhinosinusitis in children. Arch Otolaryngol Head Neck Surg 2000, 126:1363–1368. This study looks at preoperative measures of general health and sinus symptoms using validated instruments. The overall health impact of pediatric rhinosinusitis as perceived by parents is surprisingly great.
Van der Veken PJ, Clement PAR, Buissert TH, et al.: Age-related CT-scan study of the incidence of sinusitis in children. Am J Rhinol 1992, 6:45–48.
Manning SC, Biavati MJ, Phillips DL: Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients. Int J Pediatr Otorhinolaryngol 1996, 37:65–74.
Lesserson JA, Kieserman SP, Finn DA: The radiographic incidence of chronic sinus disease in the pediatric population. Laryngoscope 1994, 104:159–166.
Garcia DP, Corbett ML, Eberly SM, et al.: Radiographic imaging studies in pediatric chronic sinusitis. J Allergy Clin Immunol 1994, 94:523–530.
Cotter CS, Stringer S, Rust KR, Mancuso A: The role of computed tomography scans in evaluating sinus disease in pediatric patients. Int J Pediatr Otorhinolaryngol 1999, 50:63–68. The incidence of sinus mucosal thickening, as measured by CT, in symptomatic patients was only slightly higher than in asymptomatic patients.
Kronemar KA, McAlister WH: Sinusitis and its imaging in the pediatric population. Pediatr Radiol 1997, 27:837–846.
Gwaltney JM, Phillips CD, Miller RD, Riker DK: Computed tomographic study of the common cold. N Engl J Med 1994, 330:25–30.
Leopold DA, Stafford CT, Sod EW, et al.: Clinical course of acute maxillary sinusitis documented by sequential MRI scanning. Am J Rhinol 1994, 8:19–28.
Medina J, Tom LW, Marsh RR, Bilaniuk LT: Development of the paranasal sinuses in children with sinus disease. Am J Rhinol 1999, 13:23–26. This study demonstrated no difference in underlying sinus anatomy between inflamed and clear sinuses.
Giebink S: Childhood sinusitis: pathophysiology, diagnosis and treatment. Pediatr Infect Dis 1994, 13:555–558.
Brook I, Gooch WM III, Jenkins SG, et al.: Medical management of acute bacterial sinusitis. Ann Otol Rhinol Laryngol 2000, 109(suppl 182):2–20.
Buchman CA, Yellon RF, Bluestone CD: Alternatives to endoscopic sinus surgery in the management of pediatric chronic rhinosinusitis refractory to oral antimicrobial therapy. Otolaryngol Head Neck Surg 1999, 120:219–224. This report is from an institution where pediatric patients with refractory rhinosinusitis are treated more commonly with intravenous antibiotics than with surgery.
Cook PR, Nishioka GJ: Allergic rhinosinusitis in the pediatric population. Otolaryngol Clin North Am 1996, 29:39–56.
Nguyen KL, Corbett ML, Garcia DP, et al.: Chronic sinusitis among pediatric patients with chronic respiratory complaints. J Allergy Clin Immunol 1993, 92:824–830.
Gugor A, Corey JP: Pediatric sinusitis: a literature review with emphasis on the role of allergy. Otolaryngol Head Neck Surg 1997, 116:4–15.
Phipps CD, Wood WE, Gibson WS, Cochran WJ: Gastroesophageal reflux contributing to sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg 2000, 126:831–836. Reflux is common in young patients with sinus symptoms.
Yellon RF, Coticchia J, Dixit S: Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children. Am J Med 2000, 108:1315–1385.
Bothwell MR, Parsons DS, Talbot A, et al.: Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg 1999, 121:255–262.
Demain JG, Goetz DW: Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with nasal beclomethasone. Pediatrics 1995, 95:355–364.
Lee D, Rosenfeld RM: Adenoid bacteriology and sinonasal symptoms in children. Otolaryngol Head Neck Surg 1997, 116:301–307.
Takahashi H, Fujita A, Honjo I: Effect of adenoidectomy on otitis media with effusion, tubal function and sinusitis. Am J Otolaryngol 1989, 10:208–213.
Clement PAR, Bluestone CD, Gordts F, et al.: Management of rhinosinusitis in children: consensus meeting, Brussels Belgium, September 13, 1996. Arch Otolaryngol Head Neck Surg 1998, 124:31–34.
Maes JJ, Clement PA: The usefulness of irrigation of the maxillary sinus in children with maxillary sinusitis on the basis of water’s x-ray. Rhinology 1987, 75:259–264.
Lusk RP, Stankiewicz JA: Pediatric rhinosinusitis. Otolaryngol Head Neck Surg 1997, 117(suppl 53):553–557.
Lund VJ: Inferior meatal antrostomy: fundamental considerations of design and function. J Laryngol Otol Suppl 1988, 15:1–18.
Manning SC: A 3-year old child with a severely deviated septum and airway obstruction. Arch Otolaryngol Head Neck Surg 1999, 125:699–700.
Lazar R, Younis R, Gross C: Pediatric functional endonasal sinus surgery: review of 210 cases. Head Neck 1992, 14:92–98.
Parsons D, Phillips SD: Functional endoscopic surgery in children: a retrospective analysis of results. Laryngoscope 1993, 103:899–903.
Herbert RL, Bent JP III: Meta-analysis of pediatric functional endoscopic sinus surgery. Laryngoscope 1998, 108:796–799.
Stankiewicz JA: Pediatric endoscopic nasal and sinus surgery. Otolaryngol Head Neck Surg 1995, 113:204–210.
Chan KH, Winslow CP, Abzng MJ: Persistent rhinosinusitis in children after endoscopic sinus surgery. Otolaryngol Head Neck Surg 1999, 121:577–580.
Duplechain JK, White JA, Miller R: Pediatric sinusitis: the role of endoscopic sinus surgery in cystic fibrosis and other forms of sinus disease. Arch Otolaryngol Head Neck Surg 1991, 117:422–426.
Ramadan HH: Adenoidectomy vs endoscopic sinus surgery for the treatment of pediatric sinusitis. Arch Otolaryngol Head Neck Surg 1999, 125:1208–1211.
Rosenfeld RM: Pilot study of outcomes in pediatric rhinosinusitis. Arch Otolaryngol Head Neck Surg 1995, 121:729–736.
Jones ML, Piccirillo JF, Haidak A, Thawley SE: Functional endoscopic sinus surgery: do ratings of appropriateness predict patient outcomes? Am J Rhinol 1998, 12:249–255.
Gliklich RE, Metson R: Effect of sinus surgery on quality of life. Otolaryngol Head Neck Surg 1997, 117:12–17.
Osguthorpe JD: Surgical outcomes in rhinosinusitis: what we know. Otolaryngol Head Neck Surg 1999, 120:451–453. This study, although not exclusively pediatric, provides a good overview of surgical outcome studies.
Manning SC, Wasserman R, Silver R, Phillips D: Results of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. Arch Otolaryngol Head Neck Surg 1994, 120:1142–1145.
Jones JW, Parsons DS, Cuyler JP: The results of functional endoscopic sinus (FES) surgery on the symptoms of patients with cystic fibrosis. Int J Pediatr Otorhinolaryngol 1993, 28:25–32.
Nishioka GJ, Barbero F, Konig P, et al.: Symptom outcome after functional endoscopic sinus surgery in patients with cystic fibrosis: a prospective study. Otolaryngol Head Neck Surg 1995, 113:440–445.
Cuyler JP: Follow-up of endoscopic sinus surgery on children with cystic fibrosis. Arch Otolaryngol Head Neck Surg 1992, 118:505–506.
Bush A, Cole P, Harir M, et al.: Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J 1998, 12:982–989.
Kennedy CA, Adams GL, Neglia JP, Giebink GS: Impact of surgical treatment on paranasal fungal infections in bone marrow transplant patients. Otolaryngol Head Neck Surg 1997, 116:610–616.
Choi SS, Milmoe GJ, Dinndorf PA, Quinones RR: Invasive aspergillus sinusitis in pediatric bone marrow transplant patients: evaluation and management. Arch Otolaryngol Head Neck Surg 1995, 121:1188–1192.
Friedman M, Landsberg R, Tanyeri H, et al.: Endoscopic sinus surgery in patients infected with HIV. Laryngoscope 2000, 110:1613–1616.
Murphy C, Davidson TM, Jellison W, et al.: Sinonasal disease and olfactory impairment in HIV disease: endoscopic sinus surgery and outcome measures. Laryngoscope 2000, 110:1707–1710.
Mair EA, Bolger WE, Breisch EA: Sinus and facial growth after pediatric endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 1995, 121:547–552.
Zweig JL, Carran RL, Celin SE, et al.: Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: predictors of success. Otolaryngol Head Neck Surg 2000, 123:195–201.
Talbot AR: Frontal sinus surgery in children. Otolaryngol Clin North Am 1996, 29:143–158.
Weber R, Hochapfel F, Draf W: Packing and stents in endonasal surgery. Rhinology 2000, 38:49–62.
Tom LW, Palasti S, Potsic WP, et al.: The effects of gelatin film stents in the middle meatus. Am J Rhinol 1997, 11:229–232.
Garcia GH, Harris GJ: Criteria for non-surgical management of subperiosteal abscess of the orbit: analysis of outcome 1988–1998. Ophthalmology 2000, 107:1454–1456.
Manning SC: Endoscopic management of medial subperiosteal orbital abscess. Arch Otolaryngol Head Neck Surg 1993, 119:789–791.
Otten FW, Van Arem A, Grote JJ: Long-term follow-up of chronic therapy resistant purulent rhinitis in children. Clin Otolaryngol 1992, 17:32–33.
Giannoni C, Salek M, Friedman EM: Intracranial complications of sinusitis: a pediatric series. Am J Rhinol 1998, 12:173–178.
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Manning, S. Surgical intervention for sinusitis in children. Curr Allergy Asthma Rep 1, 289–296 (2001). https://doi.org/10.1007/s11882-001-0021-7
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DOI: https://doi.org/10.1007/s11882-001-0021-7