J Rhinol.  2019 May;26(1):32-37. 10.18787/jr.2019.26.1.32.

The Effect of Long-Term Follow up on Outcome of Pediatric Endoscopic Sinus Surgery

• Kim S
• Chung YJ
• Mo JH

• KMID: 2449026
• DOI: http://doi.org/10.18787/jr.2019.26.1.32

Abstract

BACKGROUND AND OBJECTIVES
Chronic pediatric sinusitis continues to be a challenging problem to otolaryngologists and has been reported to show worse prognosis than that of adults. However, most studies were performed with short-term follow-up. In this study, we aimed to assess the clinical outcome of pediatric endoscopic sinus surgery (ESS) with a longer follow-up and to determine the effect of age on postoperative outcome.
SUBJECTS AND METHOD
A retrospective analysis was performed on pediatric patients than 15 years with ESS younger from 2005 to 2014 in a tertiary referral hospital. All patients completed a questionnaire regarding symptoms before to from 1 to 9 years after surgery. Telephone survey was performed to evaluate symptoms including nasal obstruction, nasal discharge, PND, and headache at 1 to 9 years after surgery.
RESULTS
Seventy-one pediatric patients with bilateral chronic sinusitis were treated with ESS. They showed gradual symptom improvement from 5 year after surgery for the following: nasal obstruction (p=0.032), PND (p=0.005), and headache (p=0.048). However, there was improvement in rhinorrhea after 9 years (p=0.042). In addition, when analyzed in terms of age, the outcome was poor in children younger than 13 years (p=0.003) compared with the older age group. Multivariate analysis showed that preoperative nasal obstruction was dependent on AR, and postoperative symptoms were dependent on presence of AR and involuntary smoking. Nasal discharge was dependent on presence of AR and involuntary smoking preoperatively and postoperatively. These suggest the importance of AR and involuntary smoking as risk factors for prognosis.
CONCLUSION
Chronic pediatric sinusitis showed gradual improvement after ESS and should be more carefully monitored on a long-term basis. We should keep in mind that long-term follow-up is needed for pediatric ESS cases.

Keyword

Pediatric chronic sinusitis; Rhinosinusitis; Endoscopic sinus surgery

MeSH Terms

Adult
Child
Follow-Up Studies*
Headache
Humans
Methods
Multivariate Analysis
Nasal Obstruction
Prognosis
Retrospective Studies
Risk Factors
Sinusitis
Telephone
Tertiary Care Centers
Tobacco Smoke Pollution
Tobacco Smoke Pollution

Figure

• 

  Fig. 1 Post-ESS symptom score before and after surgery. Nasal obstruction, PND, headache were gradually improved after 5 years post-ESS (*p<0.05). A: Nasal obstruction, B: Rhinorrhea, C: PND, D: Headache.

• 

  Fig. 2 Stratification of post-ESS evaluation at the time of final observation. When analyzed in terms of age, the outcome was poor in children younger than 13 years of age when compared with older age group (*p<0.05).

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  Fig. 3 Stratification of post-ESS evaluation focusing age at the time of final observation. The proportion of moderate and marked improved cases was high in children aged 13 or more.

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