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[Naso-sinusal polyposis in children. Mid-term results of sinusal surgery]
J M Triglia1, R Nicollas, S Roman
1Unité d'ORL Pédiatrique, Fédération ORL, Hôpital de la Timone, Marseille.
Insights
Pediatric nasosinusal polyposis is rare. Endoscopic sinus surgery offers symptom relief for children, but recurrence rates are higher in cystic fibrosis patients, necessitating careful surgical consideration.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Context:
- Nasosinusal polyposis is uncommon in children, with unclear causes.
- This study retrospectively analyzed 49 pediatric patients over eleven years.
- Patients were categorized into isolated polyposis, or polyposis associated with asthma or cystic fibrosis.
Purpose:
- To describe the etiologic features of pediatric nasosinusal polyposis.
- To evaluate the effectiveness of endoscopic sinus surgery (ESS) for this condition.
- To assess recurrence rates and influencing factors, particularly in cystic fibrosis.
Summary:
- Allergies were noted in 10% (isolated), 80% (asthma-associated), and 19% (cystic fibrosis-associated) of patients.
- ESS indications included disabling symptoms like chronic nasal obstruction and rhinorrhea unresponsive to medical treatment.
- No surgical complications occurred; 83% experienced reduced nasal obstruction and 61% reduced rhinorrhea.
Impact:
- Recurrence was observed in 22.7% (minor) and 13.6% (major) of cases.
- Recurrence rates were higher in cystic fibrosis patients (28.6% minor, 17.8% major).
- ESS is a viable option for pediatric nasosinusal polyposis, requiring multidisciplinary collaboration and skilled execution for favorable outcomes.
Abstract:
Nasosinusal polyposis in the pediatric population is uncommon and its etiology is unclear. In this eleven-year retrospective study, we describe the etiologic features and evaluate the effectiveness of endoscopic sinus surgery in 49 children. Patients were divided into three groups according to whether nasosinusal polyposis was either isolated (n = 14), or associated with either asthma (n = 5) or cystic fibrosis (n = 30). An allergy was present in 10% of patients with isolated polyposis, 80% of patients with polyposis associated with asthma, and 19% of patients with polyposis associated with cystic fibrosis. The indications for surgery were disabling symptoms, specially chronic nasal obstruction, rhinorrhea and mouth breathing, and failure to respond to medical treatment. No surgical complications were encountered. Most patients reported improvement in quality of life with reduction of nasal obstruction in 83% of cases and rhinorrhea in 61%. Minor asymptomatic recurrence (i.e. a few micropolyp localized on the roof of the ethmoid cavity) was observed in 22.7% of the cases in this series, and major recurrence with the same functional symptoms as before surgery in 13.6%. However, recurrences were higher in patients with cystic fibrosis, since minor recurrence with no clinical manifestation was observed in 28.6% of cases and major recurrence in 17.8%. Endoscopic sinus surgery must be decided in collaboration with the pediatric and pulmonary physicians, and must be performed skillfully. With a mean follow-up of 4 years, results in this series are encouraging.
