Pediatric endoscopic sinus surgery: postoperative management

Chronic rhinosinusitis in pediatric patients is commonly managed with medical therapy; however, there are a significant number of patients who will require endoscopic sinus surgery for refractory disease. In this review, we aim to elucidate the best practices for postoperative care in this patient population.

Overall, there is limited data in the pediatric patient population to direct all aspects of postoperative care and many recommendations have been developed from older literature or extrapolated from adult studies. Nasal saline rinses and topical nasal steroid sprays are cornerstones of management following surgery. The use of steroid impregnated saline is gaining more traction in the adult world but it has not been adequately studied among pediatric patients and should be carefully considered. Routine postsurgical antibiotics and second look endoscopy are not widely recommended but can be implemented on a case by case basis.

The use of saline irrigation and topical steroids sprays are safe and effective measures to maximize healing after sinus surgery and to help prevent recurrence of symptoms. More research is needed to understand the implications and indications for systemic steroids, antibiotics, and debridement after sinus surgery.