Persistent rhinosinusitis in children after endoscopic sinus surgery

The efficacy of endoscopic sinus surgery (ESS) in children is insufficiently addressed in the medical literature. We report a cohort of 14 children (mean age 7.7 years, median age 5.1 years) seen at our multidisciplinary clinic for refractory rhinosinusitis during a 30-month period who continued to have rhinosinusitis despite previous ESS. Prior ESS procedures were performed by 11 surgeons in 3 states. The first ESS was performed when the children were a mean age of 4.6 years, and in 10 of 14, it was performed when they were younger than 4.8 years. This cohort required a disproportionately high rate of subsequent surgical intervention, 50%, versus a 9% surgical rate in the remaining clinic population (P = 0.0002). Osteomeatal scarring was the single most difficult surgical complication. Significant morbidity, in the form of persistent disease, is encountered after ESS in young children. Although chronic rhinosinusitis after ESS, to a certain degree, can still be managed by medical therapy, judicial use of ESS, especially in the very young, is recommended.