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Postoperative Management of Pediatric Sinusitis

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Pediatric Rhinosinusitis

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Abstract

Postoperative management is essential to maximizing the clinical outcomes following pediatric sinus surgery. This chapter examines the current approach to postoperative care following functional endoscopic sinus surgery in the pediatric population. Nasal saline irrigations are a mainstay for many surgeons with a high efficacy and tolerability in children. Additional therapies include saline sprays, topical antibiotics, and topical steroids. Systemic forms of steroids or antibiotics may be considered in the short-term recovery period to help with healing, particularly in moderate to severe disease. Additionally, chronic rhinosinusitis with nasal polyps showed increased response rates postoperatively to systemic steroids. Unlike in adult populations, postoperative debridement is unnecessary in most pediatric cases with no demonstrated improvement in surgical success rates in patients who do not get debridement compared to those who get a second look with debridement. Postoperative care and continuing medical management should be individualized to the patient’s comorbidities and underlying etiology of chronic sinusitis. Cystic fibrosis requires special consideration with saline irrigations, corticosteroids, and antibiotics, with consideration of dornase alfa and gene therapy. The chapter concludes that functional endoscopic sinus surgery has been an effective tool in treating pediatric sinusitis refractory to medical therapy, with postoperative care recognized as having utmost importance to bridge surgical therapy with continued medical treatment for pediatric chronic rhinosinusitis.

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References

  1. Brietzke SE, Shin JJ, Choi S, Lee JT, Parikh SR, Pena M, et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014;151(4):542–53.

    Article  Google Scholar 

  2. Shahid SK. Rhinosinusitis in children. ISRN Otolaryngol. 2012;2012:851831.

    Article  Google Scholar 

  3. Aitken M, Taylor JA. Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. Arch Pediatr Adolesc Med. 1998;152(3):244–8.

    Article  CAS  Google Scholar 

  4. Kakish KS, Mahafza T, Batieha A, Ekteish F, Daoud A. Clinical sinusitis in children attending primary care centers. Pediatr Infect Dis J. 2000;19(11):1071–4.

    Article  CAS  Google Scholar 

  5. Gilani S, Shin JJ. The burden and visit prevalence of pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2017;157(6):1048–52.

    Article  Google Scholar 

  6. Rizzi MD, Kazahaya K. Pediatric chronic rhinosinusitis: when should we operate? Curr Opin Otolaryngol Head Neck Surg. 2014;22(1):27–33.

    Article  Google Scholar 

  7. Ramadan HH. Revision endoscopic sinus surgery in children: surgical causes of failure. Laryngoscope. 2009;119(6):1214–7.

    Article  Google Scholar 

  8. Lee TJ, Liang CW, Chang PH, Huang CC. Risk factors for protracted sinusitis in pediatrics after endoscopic sinus surgery. Auris Nasus Larynx. 2009;36(6):655–60.

    Article  Google Scholar 

  9. Chan KH, Winslow CP, Abzug MJ. Persistent rhinosinusitis in children after endoscopic sinus surgery. Otolaryngol Head Neck Surg. 1999;121(5):577–80.

    Article  CAS  Google Scholar 

  10. Rudmik L, Smith TL. Evidence-based practice: postoperative care in endoscopic sinus surgery. Otolaryngol Clin N Am. 2012;45(5):1019–32.

    Article  Google Scholar 

  11. Pham V, Sykes K, Wei J. Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis. Laryngoscope. 2014;124(4):1000–7.

    Article  Google Scholar 

  12. Wei JL, Sykes KJ, Johnson P, He J, Mayo MS. Safety and efficacy of once-daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis. Laryngoscope. 2011;121(9):1989–2000.

    PubMed  Google Scholar 

  13. Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc08.

    PubMed  PubMed Central  Google Scholar 

  14. Freeman SR, Sivayoham ES, Jepson K, de Carpentier J. A preliminary randomised controlled trial evaluating the efficacy of saline douching following endoscopic sinus surgery. Clin Otolaryngol. 2008;33(5):462–5.

    Article  CAS  Google Scholar 

  15. Fooanant S, Chaiyasate S, Roongrotwattanasiri K. Comparison on the efficacy of dexpanthenol in sea water and saline in postoperative endoscopic sinus surgery. J Med Assoc Thail. 2008;91(10):1558–63.

    Google Scholar 

  16. Liang KL, Su MC, Tseng HC, Jiang RS. Impact of pulsatile nasal irrigation on the prognosis of functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg. 2008;37(2):148–53.

    PubMed  Google Scholar 

  17. Pigret D, Jankowski R. Management of post-ethmoidectomy crust formation: randomized single-blind clinical trial comparing pressurized seawater versus antiseptic/mucolytic saline. Rhinology. 1996;34(1):38–40.

    CAS  PubMed  Google Scholar 

  18. Pinto JM, Elwany S, Baroody FM, Naclerio RM. Effects of saline sprays on symptoms after endoscopic sinus surgery. Am J Rhinol. 2006;20(2):191–6.

    Article  Google Scholar 

  19. Staffieri A, Marino F, Staffieri C, Giacomelli L, D'Alessandro E, Maria Ferraro S, et al. The effects of sulfurous-arsenical-ferruginous thermal water nasal irrigation in wound healing after functional endoscopic sinus surgery for chronic rhinosinusitis: a prospective randomized study. Am J Otolaryngol. 2008;29(4):223–9.

    Article  CAS  Google Scholar 

  20. Shoseyov D, Bibi H, Shai P, Shoseyov N, Shazberg G, Hurvitz H. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol. 1998;101(5):602–5.

    Article  CAS  Google Scholar 

  21. Harvey RJ, Goddard JC, Wise SK, Schlosser RJ. Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg. 2008;139(1):137–42.

    Article  Google Scholar 

  22. Grobler A, Weitzel EK, Buele A, Jardeleza C, Cheong YC, Field J, et al. Pre- and postoperative sinus penetration of nasal irrigation. Laryngoscope. 2008;118(11):2078–81.

    Article  Google Scholar 

  23. Pundir V, Pundir J, Lancaster G, Baer S, Kirkland P, Cornet M, et al. Role of corticosteroids in functional endoscopic sinus surgery--a systematic review and meta-analysis. Rhinology. 2016;54(1):3–19.

    Article  Google Scholar 

  24. Jorissen M, Bachert C. Effect of corticosteroids on wound healing after endoscopic sinus surgery. Rhinology. 2009;47(3):280–6.

    Article  CAS  Google Scholar 

  25. Yoon HY, Lee HS, Kim IH, Hwang SH. Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis. Clin Otolaryngol. 2018;43(2):525–32.

    Article  CAS  Google Scholar 

  26. Sastre J, Mosges R. Local and systemic safety of intranasal corticosteroids. J Investig Allergol Clin Immunol. 2012;22(1):1–12.

    CAS  PubMed  Google Scholar 

  27. Arianpour K, Svider PF, Guys N, Shenouda K, Folbe E, Hsueh WD, et al. Incorporation of antibiotics and systemic steroids by sinus surgeons: is there widespread consensus? Int Forum Allergy Rhinol. 2018;8(9):1034–40.

    Article  Google Scholar 

  28. Wright ED, Agrawal S. Impact of perioperative systemic steroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis: evaluation with the novel Perioperative Sinus Endoscopy (POSE) scoring system. Laryngoscope. 2007;117(11 Pt 2 Suppl 115):1–28.

    Article  CAS  Google Scholar 

  29. Makary CA, Ramadan HH. The role of sinus surgery in children. Laryngoscope. 2013;123(6):1348–52.

    Article  Google Scholar 

  30. Younis RT, Gross CW, Lazar RH. Toxic shock syndrome following functional endonasal sinus surgery: a case report. Head Neck. 1991;13(3):247–8.

    Article  CAS  Google Scholar 

  31. Barbour SD, Shlaes DM, Guertin SR. Toxic-shock syndrome associated with nasal packing: analogy to tampon-associated illness. Pediatrics. 1984;73(2):163–5.

    CAS  PubMed  Google Scholar 

  32. Ramadan HH, Hinerman RA. Outcome of endoscopic sinus surgery in children with allergic rhinitis. Am J Rhinol. 2006;20(4):438–40.

    Article  Google Scholar 

  33. Yelverton JC, Holmes TW, Johnson CM, Gelves CR, Kountakis SE. Effectiveness of leukotriene receptor antagonism in the postoperative management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(3):243–7.

    Article  Google Scholar 

  34. Korkmaz H, Yao WC, Korkmaz M, Bleier BS. Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery. Int Forum Allergy Rhinol. 2015;5(12):1118–23.

    Article  Google Scholar 

  35. Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ, et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology. 2018;129(1):89–105.

    Article  Google Scholar 

  36. Mitchell RB, Pereira KD, Younis RT, Lazar RH. Pediatric functional endoscopic sinus surgery: is a second look necessary? Laryngoscope. 1997;107(9):1267–9.

    Article  CAS  Google Scholar 

  37. Bugten V, Nordgard S, Steinsvag S. Long-term effects of postoperative measures after sinus surgery. Eur Arch Otorhinolaryngol. 2008;265(5):531–7.

    Article  Google Scholar 

  38. Bugten V, Nordgard S, Steinsvag S. The effects of debridement after endoscopic sinus surgery. Laryngoscope. 2006;116(11):2037–43.

    Article  Google Scholar 

  39. Rudmik L, Soler ZM, Orlandi RR, Stewart MG, Bhattacharyya N, Kennedy DW, et al. Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2011;1(6):417–30.

    Article  Google Scholar 

  40. Ramadan HH. Corticosteroid therapy during endoscopic sinus surgery in children: is there a need for a second look? Arch Otolaryngol Head Neck Surg. 2001;127(2):188–92.

    Article  CAS  Google Scholar 

  41. Virgin FW, Rowe SM, Wade MB, Gaggar A, Leon KJ, Young KR, et al. Extensive surgical and comprehensive postoperative medical management for cystic fibrosis chronic rhinosinusitis. Am J Rhinol Allergy. 2012;26(1):70–5.

    Article  Google Scholar 

  42. Cho DY, Hwang PH. Results of endoscopic maxillary mega-antrostomy in recalcitrant maxillary sinusitis. Am J Rhinol. 2008;22(6):658–62.

    Article  Google Scholar 

  43. Crockett DJ, Wilson KF, Meier JD. Perioperative strategies to improve sinus surgery outcomes in patients with cystic fibrosis: a systematic review. Otolaryngol Head Neck Surg. 2013;149(1):30–9.

    Article  Google Scholar 

  44. Holzmann D, Speich R, Kaufmann T, Laube I, Russi EW, Simmen D, et al. Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience. Transplantation. 2004;77(1):134–6.

    Article  Google Scholar 

  45. Halvorson DJ, Dupree JR, Porubsky ES. Management of chronic sinusitis in the adult cystic fibrosis patient. Ann Otol Rhinol Laryngol. 1998;107(11 Pt 1):946–52.

    Article  CAS  Google Scholar 

  46. Moss RB, King VV. Management of sinusitis in cystic fibrosis by endoscopic surgery and serial antimicrobial lavage. Reduction in recurrence requiring surgery. Arch Otolaryngol Head Neck Surg. 1995;121(5):566–72.

    Article  CAS  Google Scholar 

  47. Suri R, Metcalfe C, Lees B, Grieve R, Flather M, Normand C, et al. Comparison of hypertonic saline and alternate-day or daily recombinant human deoxyribonuclease in children with cystic fibrosis: a randomised trial. Lancet. 2001;358(9290):1316–21.

    Article  CAS  Google Scholar 

  48. Raynor EM, Butler A, Guill M, Bent JP 3rd. Nasally inhaled dornase alfa in the postoperative management of chronic sinusitis due to cystic fibrosis. Arch Otolaryngol Head Neck Surg. 2000;126(5):581–3.

    Article  CAS  Google Scholar 

  49. Cimmino M, Nardone M, Cavaliere M, Plantulli A, Sepe A, Esposito V, et al. Dornase alfa as postoperative therapy in cystic fibrosis sinonasal disease. Arch Otolaryngol Head Neck Surg. 2005;131(12):1097–101.

    Article  Google Scholar 

  50. Wagner JA, Nepomuceno IB, Messner AH, Moran ML, Batson EP, Dimiceli S, et al. A phase II, double-blind, randomized, placebo-controlled clinical trial of tgAAVCF using maxillary sinus delivery in patients with cystic fibrosis with antrostomies. Hum Gene Ther. 2002;13(11):1349–59.

    Article  CAS  Google Scholar 

  51. Becker SS, de Alarcon A, Bomeli SR, Han JK, Gross CW. Risk factors for recurrent sinus surgery in cystic fibrosis: review of a decade of experience. Am J Rhinol. 2007;21(4):478–82.

    Article  Google Scholar 

  52. Marks SC, Kissner DG. Management of sinusitis in adult cystic fibrosis. Am J Rhinol. 1997;11(1):11–4.

    Article  CAS  Google Scholar 

  53. Aanaes K, Johansen HK, Skov M, Buchvald FF, Hjuler T, Pressler T, et al. Clinical effects of sinus surgery and adjuvant therapy in cystic fibrosis patients - can chronic lung infections be postponed? Rhinology. 2013;51(3):222–30.

    Article  CAS  Google Scholar 

  54. Goldsmith AJ, Rosenfeld RM. Treatment of pediatric sinusitis. Pediatr Clin N Am. 2003;50(2):413–26.

    Article  Google Scholar 

  55. Bothwell MR, Parsons DS, Talbot A, Barbero GJ, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg. 1999;121(3):255–62.

    Article  CAS  Google Scholar 

  56. El-Serag HB, Gilger M, Kuebeler M, Rabeneck L. Extraesophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterology. 2001;121(6):1294–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Jason R. Rudman, Mikhaylo Szczupak & Ramzi T. Younis

  2. Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA

    Douglas M. Nguyen

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  1. Jason R. Rudman
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  2. Douglas M. Nguyen
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  3. Mikhaylo Szczupak
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  4. Ramzi T. Younis
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Corresponding author

Correspondence to Ramzi T. Younis .

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Editors and Affiliations

  1. Department of Otolaryngology, West Virginia University, School of Medicine, Morgantown, WV, USA

    Hassan H. Ramadan

  2. Section of Otolaryngology–Head and Neck Surgery, The University of Chicago Medicine and The Comer Children’s Hospital, Chicago, IL, USA

    Fuad M. Baroody

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Rudman, J.R., Nguyen, D.M., Szczupak, M., Younis, R.T. (2020). Postoperative Management of Pediatric Sinusitis. In: Ramadan, H., Baroody, F. (eds) Pediatric Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-030-22891-0_20

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  • DOI: https://doi.org/10.1007/978-3-030-22891-0_20

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