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Surgical Treatment of Paediatric Chronic Rhinosinusitis
Sara Torretta1,2, Claudio Guastella3, Tullio Ibba4
1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy. sara.torretta@unimi.it.
Insights
For children with chronic rhinosinusitis (CRS) unresponsive to medical treatment, adenoidectomy, possibly with balloon catheter sinuplasty (BCS), is the initial surgical option. Traditional endoscopic sinus surgery (ESS) is recommended for older children or those with asthma.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Chronic rhinosinusitis (CRS) significantly impacts children's quality of life.
- CRS in children often co-exists with other respiratory conditions like asthma.
- Surgical intervention for pediatric CRS is considered after maximal medical therapy failure.
Purpose of the Study:
- To discuss surgical treatment options for refractory pediatric CRS.
- To outline indications and limitations for each surgical approach.
- To provide evidence-based recommendations for surgical management.
Main Methods:
- Review of current evidence on surgical treatments for pediatric CRS.
- Comparison of adenoidectomy, pediatric endoscopic sinus surgery (PESS), and balloon catheter sinuplasty (BCS).
- Analysis of treatment outcomes based on patient age and comorbidities.
Main Results:
- Adenoidectomy, potentially combined with BCS, is suggested as first-line surgery for young, healthy children with refractory CRS.
- Traditional PESS may be necessary for patients unresponsive to adenoidectomy/BCS.
- ESS is indicated as primary treatment for older children, those with asthma, or specific conditions.
Conclusions:
- Surgical management of pediatric CRS requires tailored approaches based on individual patient factors.
- Adenoidectomy with BCS offers a less invasive initial surgical option for select pediatric CRS cases.
- Endoscopic sinus surgery remains a crucial option for complex or persistent pediatric CRS.
Abstract:
Rhinosinusitis (RS) is a common disease in children, significantly affecting their quality of life. Chronic rhinosinusitis (CRS) is frequently linked to other respiratory diseases, including asthma. Children affected by CRS may be candidates for surgery in the case of failure of maximal medical therapy comprising three to six weeks of broad-spectrum systemic antibiotics with adjunctive therapies. Although endoscopic sinus surgery (ESS) is the surgical treatment of choice in adult patients with CRS, different surgical procedures are scheduled for refractory paediatric CRS and include adenoidectomy, paediatric ESS (PESS), and balloon catheter sinuplasty (BCS). The present paper discusses the indications and limitations of each treatment option in children with CRS. Given the amount of current evidence, it is reasonable to suggest that, in young and otherwise healthy children with refractory CRS, an adenoidectomy (eventually combined with BCS) should be offered as the first-line surgical treatment. Nevertheless, this approach may be considered ineffective in some patients who should be candidates for traditional ESS. In older children, those with asthma, or in the case of peculiar conditions, traditional ESS should be considered as the primary treatment.
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