Our Summary

This research paper provides a current overview of how to diagnose and treat long-term sinus infections (called pediatric chronic rhinosinusitis, or PCRS) in children. The paper explains that doctors are now better at diagnosing PCRS using nose examinations and CT scans. It also discusses that chronic inflammation of the adenoids (a mass of tissue at the back of the throat) can be a separate cause of symptoms similar to a sinus infection. Allergies and weak immune systems can impact how PCRS is managed. Surgical treatments for PCRS have changed a lot in the last 15-20 years, and now frequently include removing the adenoids or doing surgery on the sinuses. PCRS is very common in children and can negatively impact their quality of life. The paper emphasizes that the main treatment is still medical management and dealing with any other health conditions that may make the PCRS worse. If medical treatment doesn’t work, knowing the correct diagnosis can help doctors decide on the best surgical option.

FAQs

  1. What is the current method of diagnosing pediatric chronic rhinosinusitis (PCRS)?
  2. What role does chronic adenoiditis play in symptoms of chronic sinusitis?
  3. What are the current surgical interventions for PCRS when medical management fails?

Doctor’s Tip

A helpful tip a doctor might tell a patient about adenoidectomy is to follow post-operative care instructions carefully, including keeping the nasal passages clean and avoiding strenuous activity that may increase bleeding. It is also important to attend follow-up appointments to monitor healing and ensure proper recovery. Additionally, maintaining good nasal hygiene and managing any underlying allergies or immune deficiencies can help prevent recurrence of symptoms.

Suitable For

Patients who are typically recommended adenoidectomy include those with chronic rhinosinusitis, chronic adenoiditis, and symptoms of chronic sinusitis. Adenoidectomy may also be recommended for children with allergic rhinitis and immune deficiency who are not responding well to medical management. Surgery for pediatric chronic rhinosinusitis has evolved in recent years to include adenoidectomy as well as endoscopic sinus surgery, and making the correct diagnosis is crucial for determining the appropriate surgical intervention.

Timeline

  • Before adenoidectomy:
  1. Patient experiences symptoms of chronic rhinosinusitis, such as nasal congestion, facial pain or pressure, postnasal drip, and cough.
  2. Diagnosis may involve nasal endoscopy and computed tomography scanning to confirm chronic adenoiditis as a possible cause of symptoms.
  3. Co-morbidities such as allergic rhinitis and immune deficiency are evaluated and managed.
  4. Medical management, including antibiotics, nasal steroids, and saline irrigation, is the first line of treatment.
  5. If medical management fails, surgery, such as adenoidectomy and endoscopic sinus surgery, may be considered.
  • After adenoidectomy:
  1. Patient undergoes adenoidectomy surgery to remove the adenoids, which are a common cause of chronic rhinosinusitis in children.
  2. Recovery typically involves a few days of rest and limited activity to allow for healing.
  3. Symptoms of chronic rhinosinusitis may improve or resolve after surgery.
  4. Follow-up appointments with the healthcare provider are scheduled to monitor the patient’s progress and ensure the success of the procedure.
  5. Patient may experience improved quality of life due to relief from chronic rhinosinusitis symptoms.

What to Ask Your Doctor

  1. What are the symptoms of chronic adenoiditis and how is it diagnosed?
  2. How does chronic adenoiditis differ from chronic sinusitis in children?
  3. What role do allergies and immune deficiencies play in pediatric chronic rhinosinusitis?
  4. When is surgery, such as adenoidectomy, considered as a treatment option for pediatric chronic rhinosinusitis?
  5. What are the risks and potential complications associated with adenoidectomy in children?
  6. How long is the recovery process typically after adenoidectomy?
  7. Are there any alternative treatments or therapies that can be considered before opting for surgery?
  8. How often will follow-up appointments be needed after adenoidectomy?
  9. Are there any specific medications or post-operative care instructions that should be followed after adenoidectomy?
  10. What is the long-term outlook for a child who undergoes adenoidectomy for chronic rhinosinusitis?

Reference

Authors: Ramadan HH. Journal: Eur Arch Otorhinolaryngol. 2024 Mar;281(3):1131-1137. doi: 10.1007/s00405-023-08307-z. Epub 2023 Oct 30. PMID: 37899371