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Is there a future for pediatric sinus surgery? An American perspective
1Division of Pediatric Otolaryngology, St. Louis Children's Hospital, St. Louis, MO 63110, USA. claryr@msnotes.wustl.edu
Insights
Pediatric sinus surgery for chronic sinusitis has evolved, with endoscopic techniques now widely used. This review examines factors influencing its use, including antibiotic resistance and surgical outcomes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Rhinology
Background:
- Endoscopic sinus surgery (ESS) emerged as a primary treatment for pediatric chronic sinusitis in the early 1990s.
- Initial applications of ESS included congenital nasosinus malformations and acute orbital complications.
- The 1996 Brussels consensus classified chronic sinusitis as a 'possible indication' for ESS, contrasting with 'absolute indications' for other conditions.
Purpose of the Study:
- To review the evolution of pediatric sinus surgery over the past decade.
- To analyze factors influencing the changing role of sinus surgery in pediatric chronic sinusitis.
- To incorporate recent research on surgical outcomes and related factors.
Main Methods:
- Literature review of studies published within the last decade.
- Analysis of trends in the perception and management of pediatric sinusitis.
- Examination of research on instrumentation, adenoidectomy, and facial growth effects.
Main Results:
- The perception of nasal symptoms has shifted, influenced by antibiotic resistance.
- Advancements in surgical instrumentation have improved ESS techniques.
- Research has investigated the impact of ESS on facial growth and overall surgical outcomes.
Conclusions:
- The indications and application of pediatric sinus surgery have significantly evolved.
- Factors such as antibiotic resistance, improved technology, and adenoidectomy play crucial roles.
- Ongoing research continues to refine the understanding and practice of ESS in children.
Abstract:
The role of pediatric sinus surgery in chronic sinusitis continues to evolve. By the early 1990s, endoscopic sinus surgery was being touted as a primary intervention of chronic pediatric sinusitis. Around this same time these endoscopic techniques were being attempted in congenital nasosinus malformations, acute orbital complications of sinusitis and other areas. In 1996 the Brussels consensus paper on pediatric sinusitis recommended that the latter set of nasal disorders were "absolute" indications, and ironically, chronic sinusitis was a "possible indication". This report reviews some of the changes which have impacted the use of sinus surgery during the last decade including the perception of nasal symptoms during the era of antibiotic resistance in bacteria, improved instrumentation, the role of adenoidectomy, research on the effects of sinus surgery on facial growth, and the research on surgical outcomes.
