Walner DL, Markey R, Jain V, Myer CM. Am J Rhinol. 2002;16:151–154
Purpose of the Study.
To assess the efficacy of functional endoscopic sinus surgery (FESS) in children based on a clinical symptom survey.
Preoperative and postoperative clinical outcome surveys were completed for 23 children (11 girls and 12 boys) who underwent FESS for sinusitis refractory to medical treatment. The average age at the time of surgery was 6 years (range: 2–13 years).
A clinical outcome survey based on modification of the short form (SF)-36 global health assessment was completed by parents of 27 children before FESS. Approximately 2 years after surgery (range: 22.4–33.3 months), the same survey was completed by the parents of 23 children during a telephone interview. No control groups were studied. The survey consisted of 19 questions aimed at determining functional status and quality of life, as well as obtaining information about the incidence of allergies, asthma, and immune deficiencies. These authors also collected data on the presenting symptoms of sinusitis, the presence of nasal polyps, the type of sinus surgery performed, the severity of sinusitis based on preoperative computed tomography (CT), and the need for revision surgery.
The most common presenting symptoms before FESS were purulent nasal discharge and chronic nasal congestion. Allergies were present in 70%, asthma in 35%, immunodeficiency in 4%, and nasal polyps in 13%. Two children (9%) required revision FESS. The survey results showed a decrease in symptom score (clinical improvement) for each of 15 outcome categories. There were statistically significant improvements in 9 of 15 categories, including frequency of cough, nasal obstruction, visits to the doctor, problems with routine activities, problems with conduct at school or school attendance, problems with parental performance at work, and problems with parental performance at home related to the child’s condition. Children with more severe disease on CT scan demonstrated less overall improvement, while those with asthma had a larger overall improvement in postoperative survey scores.
The results reveal an improvement in clinical symptoms and overall quality of life, based on parental report on a survey, for children undergoing FESS for chronic sinusitis. The study supports pediatric FESS as an effective treatment for children with sinusitis that persists after medical therapy.
Chronic sinusitis in children is a multifactorial disease, sharing characteristic symptoms with other common diagnoses such as allergic rhinitis and viral upper respiratory tract infection. Although the majority of cases of bacterial sinusitis respond favorably to medical management or adenoidectomy, sinus surgery may play a role in the treatment of children with persistent disease. Although previous studies have evaluated the efficacy of pediatric FESS based on symptom scores, these authors incorporated a global health survey to further quantify the benefits of sinus surgery on daily function and quality of life of both of the child and the caregiver. The survey used was a modification of the SF-36 Health Survey, which is used in outcome studies of chronic sinusitis in adults. This study is limited by the relatively small sample size of 23 children. Although preoperative survey results are used for comparison in each child, there is no control group. Ideally, the same survey would be given to a group of children/parents with sinusitis treated without surgery, to assess the effects of natural history or nonsurgical therapy. Comparison with this control group would more fully quantify the benefits of surgery. It is not clear how these 27 children were selected for study. Were they part of a larger surgical group, with some patients excluded from study? Was this a series of consecutive patients undergoing FESS for defined surgical indications? These issues affect how we can generalize the conclusions of this report. It is unlikely that we will see a randomized, prospective trial of FESS in children. Outcome studies such as this one, measuring symptom scores and quality of life changes, give support for the use of FESS in children with refractory sinus disease.