Children should be evaluated for an extended period after undergoing bilateral endoscopic sinus surgery (ESS), show findings from a retrospective study.
Indeed, Shinichi Haruna (Dokkyo Medical University, Tochigi, Japan) and colleagues conclude that in cases of surgery for bilateral sinusitis with polyps (BSP), postoperative evaluation should be performed for at least 4 years and until patients are at least 12 years of age. They found that, whereas most children who underwent unilateral ESS showed at least an improvement by 1 year, those with BSP tended to take longer to show improvement or cure after the surgery.
They analyzed postoperative endoscopic findings and computed tomography (CT) images available for 88 children and 33 adults who had undergone ESS. Nasal polyps were eliminated in 91% of the patients after a mean follow-up period of 2.6 years.
Among 37 children who had undergone surgery for unilateral sinusitis with polyps (USP), postoperative CT imaging showed that 12 patients were cured, 12 had marked improvement, 12 had improvement, and one patient had no changes, by the end of follow up. Among the adults (all of whom had bilateral disease) 13 were rated cured, 13 markedly improved, and seven improved.
However, among the 51 children who had operations for BSP, although 14 children were cured, 15 markedly improved, and 14 were improved, seven were unchanged and one patient had worsening of the condition.
As reported in Auris Nasus Larynx, a good postoperative course (improvement or cure) was observed in the majority of USP patients and adults after 1 year, while this was only the case among 50% of the BSP children at this time point.
However, as the follow-up period became longer, the numbers of unchanged and worsened patients decreased in the BSP children, and by 4 years after surgery all of these patients were considered cured or better.
"Repeated infections easily occur in pediatric sinusitis, and we believe that considerable time is required to achieve stabilization of the paranasal sinus mucosa," write the researchers. "Accordingly, we surmised that a longer postoperative observation period is needed for children compared with adults."
Furthermore, comparisons of the age at final observation and the postoperative course found high percentages of worsened and unchanged cases in children aged 11 or less, while the percentages in children aged 12 or more were significantly decreased.
"Therefore it can be expected that, even when the immediate postoperative course is poor, there is a possibility of improvement after the child becomes more than 12 years of age," says the team.
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