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Practice patterns in pediatric chronic rhinosinusitis: A survey of the American Rhinologic Society
Daniel M Beswick1, Hassan Ramadan, Fuad M Baroody
1Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Insights
Pediatric chronic rhinosinusitis (PCRS) management by American Rhinologic Society (ARS) members largely aligns with guidelines. Adenoidectomy is common initial surgery, while endoscopic sinus surgery (ESS) is reserved for refractory cases, and balloon catheter dilation (BCD) is rarely used.
Area of Science:
- Otolaryngology
- Pediatric Rhinology
- Surgical Practice Patterns
Background:
- Management of pediatric chronic rhinosinusitis (PCRS) is an evolving area in otolaryngology.
- Understanding current treatment strategies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the contemporary practice patterns of American Rhinologic Society (ARS) members in the management of pediatric chronic rhinosinusitis (PCRS).
Main Methods:
- A web-based survey comprising 27 items was distributed to ARS members.
- The survey focused on the medical and surgical treatments employed for PCRS.
Main Results:
- Nasal saline irrigation (90%) and topical nasal steroids (93%) were the most common initial medical therapies.
- Adenoidectomy was the primary surgical intervention (90%), often performed before CT imaging.
- Endoscopic sinus surgery (ESS) was favored for refractory cases, while balloon catheter dilation (BCD) was infrequently utilized.
Conclusions:
- ARS members' PCRS management generally aligns with established consensus statements.
- Adenoidectomy is a frequent first-line surgical treatment, sometimes combined with other procedures.
- ESS is primarily used for persistent disease after initial treatments, and BCD is rarely employed in pediatric cases.
Background:
The management of pediatric chronic rhinosinusitis (PCRS) is evolving.
Objective:
To assess current practice patterns of members of the American Rhinologic Society (ARS) in managing PCRS.
Methods:
A 27-item Web-based survey on treatment of PCRS was electronically distributed to the ARS membership.
Results:
The survey was completed by 67 members, 40% of whom had completed a rhinology fellowship. The most frequently used medical therapies as part of initial treatment for PCRS were nasal saline solution irrigation, (90%), topical nasal steroids (93%), oral antibiotics (52%), and oral steroids (20%). For initial surgical therapy, 90% performed adenoidectomy; in addition, 31% also performed sinus lavage, 17% performed balloon catheter dilation (BCD), and 17% performed endoscopic sinus surgery (ESS). Sixty percent performed adenoidectomy before obtaining computed tomography imaging. When initial surgical treatment failed, 85% performed traditional ESS. In patients with pansinusitis, 50% of the respondents performed frontal sinusotomy and 70% performed sphenoidotomy. BCD was not frequently used; overall, 66% never or rarely used it, 20% sometimes used it, 12% usually used it, and 3% always or almost always used BCD.
Conclusions:
Most aspects of PCRS management among ARS members were aligned with published consensus statements. Adenoidectomy was almost always included as part of first-line surgical treatment but was also combined with adjunctive surgical procedures with moderate frequency. ESS was performed by a minority of rhinologists as a primary procedure for medically refractory PCRS but was favored when previous surgery failed. BCD was uncommonly used in PCRS.