eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pediatric Otolaryngology

Pediatric Sinusitis, Surgical Treatment: Follow-up

Author: John E McClay, MD, Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School
Contributor Information and Disclosures

Updated: Oct 29, 2008

Outcome and Prognosis

Pediatric functional endoscopic sinus surgery (FESS) has been shown to provide effective treatment for children with chronic sinus disease refractory to maximum medical therapy with success rates from 80-93%.

In patients with polyposis, especially associated with CF, recurrence instead of cure is the norm. In patients with CF and polyposis, resolution of preoperative symptoms occurs in 40-70% of cases. Recurrence rates are over 50%.

For patients with allergic fungal sinusitis (AFS), decreased recurrence rates, which are quoted to be 10-100%, have been observed with immunotherapy.

Future and Controversies

The main controversy is over whether or not any child should have sinus surgery because most rhinologists believe that the problem is basically a medical condition. Children have maturation of their immune system from birth to age 6-8 years. Over this time, if they are exposed to pathogens repeatedly, they are likely to have recurrent or chronic infections of the upper respiratory tract. Certainly, avoidance of social situations where multiple young children reside in the same physical space (eg, day care, preschool, nurseries) may decrease the likelihood of infections. Drastic measures of avoidance must be weighed against financial needs of the family and social needs of the child in this situation, and staunch proponents of both sides of the debate are easily found. New medical breakthroughs, including new antimicrobials, vaccines, and anti-inflammatory drugs rooted in basic science, may eliminate the need for surgery altogether.

If surgery is indicated for chronic sinusitis refractory to medical therapy in the absence of polyposis or an underlying medical condition, some controversy exists as to how aggressive the approach should be. Several authors advocate minimal surgery to open the outflow tracts to the sinuses, occasionally improving the status of adjacent sinuses without specifically manipulating them (see Minimally invasive technique in the Treatment section). In pediatric sinus surgery, sometimes less is more.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jennifer Jordan, MD, to the development and writing of this article.



More on Pediatric Sinusitis, Surgical Treatment

Overview: Pediatric Sinusitis, Surgical Treatment
Workup: Pediatric Sinusitis, Surgical Treatment
Treatment: Pediatric Sinusitis, Surgical Treatment
Follow-up: Pediatric Sinusitis, Surgical Treatment
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Further Reading

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Keywords

sinusitis, pediatric sinusitis, sinuses, sinus, paranasal sinuses, functional endoscopic sinus surgery, FESS, endoscopic sinus surgery, ESS, maxillary sinuses, ethmoid sinuses, frontal sinuses, sphenoid sinuses, chronic sinusitis, recurrent sinusitis

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Contributor Information and Disclosures

Author

John E McClay, MD, Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School
John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ted L Tewfik, MD, FRCS(C), Professor, Department of Otolaryngology, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director, Director of Professional Affairs of Otolaryngology, Department of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital
Ted L Tewfik, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society of Pediatric Otolaryngology, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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