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Comparison of two minimally invasive techniques for treating chronic rhinosinusitis in the pediatric population
Nathan A Deckard1, Gregory J Kruper, Thi Bui
1Wayne State University, Department of Otolaryngology, Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Insights
Endoscopically guided middle meatus cultures and antral biopsy with adenoidectomy (EGC) offers faster symptom resolution and fewer complications for young children with chronic rhinosinusitis (CRS) compared to maxillary sinus aspiration and irrigation with adenoidectomy (MSI). Both techniques effectively diagnose bacterial infections in pediatric CRS patients.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Infectious Diseases
Background:
- Chronic rhinosinusitis (CRS) is prevalent in young children.
- Maxillary sinus aspiration & irrigation with adenoidectomy (MSI) is an alternative to functional endoscopic sinus surgery but carries risks due to lack of direct visualization.
- This study compares MSI with endoscopically guided middle meatus cultures & antral biopsy with adenoidectomy (EGC).
Purpose of the Study:
- To compare the diagnostic accuracy of bacterial infection by culture between MSI and EGC.
- To evaluate the time to symptom resolution using double antibiotic therapy for both procedures.
- To assess the associated morbidity of MSI versus EGC in pediatric CRS patients.
Main Methods:
- Retrospective case series of children with CRS treated with MSI or EGC between 2004 and 2010.
- Data collected from medical records at Wayne State University, Department of Otolaryngology Head & Neck Surgery.
- Comparison of bacterial culture results, time to symptom resolution, and complication rates.
Main Results:
- Both MSI and EGC demonstrated high bacterial identification rates (80% vs. 73%, p=0.45).
- EGC showed a trend towards faster symptom resolution (4.9 weeks) compared to MSI (8.7 weeks), particularly for snoring and cough (p<0.05).
- MSI had associated morbidities including epistaxis and transient pseudoproptosis; EGC reported no complications.
Conclusions:
- Endoscopically guided middle meatus cultures and antral biopsy with adenoidectomy (EGC) is an effective treatment for pediatric CRS.
- EGC and MSI are comparable in obtaining diagnostic cultures.
- EGC offers reduced time to symptom resolution and a lower risk of complications compared to MSI.
Objective:
To compare two minimally invasive techniques for the treatment of chronic rhinosinusitis in young children.
Background:
Chronic rhinosinusitis (CRS) is a common diagnosis in young children. Maxillary sinus aspiration & irrigation with adenoidectomy (MSI) followed by an extended course of oral antibiotics has been shown to be an alternative to functional endoscopic sinus surgery. However, since MSI is not performed under direct visualization, it has inherent risk. This study analyzes the techniques of MSI and endoscopically guided middle meatus cultures & antral biopsy with adenoidectomy (EGC) in the (1) diagnosis of bacterial infection by culture, (2) time to resolution using double antibiotic therapy, and (3) associated morbidity of the two procedures.
Methods:
The medical records at Wayne State University, Department of Otolaryngology Head & Neck Surgery were reviewed from 2004 to 2010. All children who presented with CRS who underwent MSI or EGC were included in this retrospective case series.
Results:
Patients presented with a history of cough, nasal discharge, and congestion. The mean age was 3.7 years. Symptom duration prior to treatment was 7.4 months in the 64 patients who underwent MSI and 9.1 months in the 46 patients who underwent EGC. MSI identified bacteria in 80% of patients compared to 73% in EGC patients (p=0.45). The MSI group underwent antibiotic treatment for 8.7 weeks and achieved symptom resolution in 8.7 weeks compared to 6.9 weeks and 4.9 weeks respectively in the EGC group (p=0.08 and 0.01). However, if patients presented with snoring or cough, time to resolution of symptoms was significantly lower in patients undergoing EGC versus MSI (p=0.02 and p=0.01, respectively). One patient who underwent MSI experienced epistaxis requiring nasal packing, and two patients had pseudoproptosis following irrigation that resolved spontaneously shortly thereafter. No complications were reported in the EGC group.
Conclusion:
EGC is an effective treatment for young children with CRS. EGC and MSI are equally effective in obtaining diagnostic cultures. EGC decreases time to symptom resolution, and it lowers the risk of complication when compared to MSI.
