Clinical course of Chronic Intractable Sinusitis in Children

Lee, Soo Jin; Ahn, Young Min; Hur, Jung A

Abstract

PURPOSE
Chronic intractable sinusitis is a sinus infection persisting for more than 3 months and characterized by refractoriness to conventional treatment. Despite much research on pathogenesis and treatment, its prevalence is reported to be on the increase and the management of chronic sinusitis has also become increasingly problematic for pediatricians. So we evaluated the effectiveness of treatments targetted the causes and followed the course of childhood chronic sinusitis persisting for more than 3 months despite maximal medical therapy.
METHODS
We followed up 41 patients diagnosed as chronic intractable sinusitis between January 1998 and December 2002 at the Department of Pediatrics, Kangnam General Hospital (Seoul Medical Center). The mean age was 4 years and the female to male ratio was 1.2:1. The duration of follow-up was 4.2 years. From medical records and questionnaires, a composite symptom score and medication use outcome (good/bad result) was created by assigning points to each category of symptom score and use of medication. Nasal endoscopy, allergy skin prick test, and serum immunoglobulin level checks were performed in all patients. CT scans were done in 3 patients and saccharin tests for diagnosis of ciliary dysfunction in 6 patients. A 24 hour pH mornitoring, esophagography, and upper GI endoscopy were done in 1 patient, respectively.
RESULTS
Adenoidectomy was done in 17 patients. Fifteen patients with adenoidectomies were assessed to have good results. Among them, 4 patients had concommitant alleric rhinitis treatments, 1 patient a GERD treatment. Two patients with adenoidectomies were assessed to have bad results. Twenty-four patients without adenoidectomies were assessed to have good results. Among the 7 patients with underlying allergic rhinitis, 4 patients improved after immunotherapy. Two patients had polypectomies and 15 patients improved with medical management of sinusitis. One patients had functional endoscopic sinus surgery.
CONCLUSION
If medical treatments with management of underlying diseases including immunotherapy, GERD management, and adenoidectomy are done, functional endoscopic sinus surgery is rarely necessary for treatment of chronic sinusitis in children.