Functional endoscopic sinus surgery in children using a limited approach

Objectives: To evaluate the efficacy of the limited approach of functional endoscopic sinus surgery (FESS) in pediatric patients with chronic rhinosinusitis (CRS) and to interpret the indications for second-look endoscopy. Designs A retrospective review of medical records of patients who received pediatric FESS between January 1995 and September 2002 and a comprehensive parental questionnaire were used to assess postoperative symptom improvement at a mean postoperative follow-up of 27.2 months after surgery. Setting: A university-affiliated medical center. Patients: We studied 101 patients who received treatment of pediatric CRS refractory to optimal medical treatment Main Outcome Measures: We analyzed preoperative and postoperative nasal obstruction, purulent rhinorrhea, postnasal drip, headache, hyposmia, and chronic cough. Interventions: Patients underwent a limited surgical approach of FESS, basically a drainage rather than an extirpation procedure, for the treatment of pediatric CRS refractory to optimal medical treatment. Additionally, 29 patients (28%) underwent second-look endoscopy. Results: The proportions of patients whose symptoms improved were as follows: nasal obstruction, 91%; purulent rhinorrhea, 90%; postnasal drip, 90%; headache, 97%; hyposmia, 89%; and chronic cough, 96%. Of the 101 patients, parents of 87 (86%) were satisfied with the surgery. Conclusions: Our literature review did not reveal any other large series in the Asian population. The limited approach to FESS was effective in treating medically recalcitrant CRS in the children we studied. Second-look endoscopy was indicated for selected cases to ensure the extirpation of residual disease and the patency of ostiomeatal complex and sinus ostia.