Our Summary

This research paper focused on a surgery called endoscopic sinus surgery (ESS), which is often used to treat children with stubborn chronic sinusitis - an ongoing condition causing inflammation in the sinuses. The researchers wanted to understand why the success rate of this surgery varies with the age of the patient and to identify the factors that can predict if a child might need a second surgery. They also wanted to figure out the best age for a child to undergo this surgery.

To do so, they looked back at medical records of children who had this surgery between 2004 and 2017. They studied their age, medical history, lab data, other health conditions, and the results of their CT scans.

They found that about 13% of the 188 children in the study needed a second surgery. Children with allergies and those with more severe sinus inflammation (as shown by a higher score on a specific rating scale used in CT scans) were more likely to need a repeat surgery. They also found that older children had a better outcome from the surgery. They concluded that 15.68 years was the best age for this surgery and a score of 10.5 on the CT scan scale was the best predictor of needing a second surgery.

This study is important because it helps doctors predict which children might need a second surgery and determine the best time to perform the surgery to maximize success rates.

FAQs

  1. What is endoscopic sinus surgery (ESS) and why is it performed on children?
  2. What factors were found to increase the likelihood of a child needing a second ESS?
  3. What was concluded to be the best age for a child to undergo ESS according to the research?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sinus surgery is to follow all pre-operative instructions carefully, such as avoiding certain medications, fasting before surgery, and informing the surgical team about any allergies or medical conditions. It is also important to follow all post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and avoiding activities that could increase the risk of complications. Additionally, maintaining good sinus hygiene, such as using a saline nasal spray or rinse as directed by your doctor, can help promote healing and prevent infection after surgery.

Suitable For

Therefore, children with chronic sinusitis, especially those with allergies and severe sinus inflammation, are typically recommended for endoscopic sinus surgery. The study also suggests that older children may have better outcomes from the surgery, and a specific score on a CT scan can help predict the need for a second surgery. Ultimately, the decision to recommend sinus surgery will be made on a case-by-case basis by the child’s healthcare provider based on their individual medical history and symptoms.

Timeline

Before sinus surgery:

  1. Patients experience ongoing symptoms of chronic sinusitis, such as nasal congestion, facial pain or pressure, headache, and reduced sense of smell.
  2. Patients may undergo various treatments, such as medications, nasal sprays, and allergy testing, to manage their symptoms.
  3. Patients may undergo imaging tests, such as CT scans, to assess the severity of their sinusitis and determine if surgery is necessary.

After sinus surgery:

  1. Patients undergo endoscopic sinus surgery, which involves inserting a thin, flexible tube with a camera into the sinuses to remove blockages and improve drainage.
  2. Patients may experience some discomfort, swelling, and congestion in the days following surgery.
  3. Patients typically experience gradual improvement in their symptoms over the following weeks and months.
  4. Patients may need to follow up with their surgeon for post-operative care and monitoring to ensure proper healing and optimal outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sinus surgery include:

  1. What are the potential risks and complications associated with endoscopic sinus surgery?
  2. How long is the recovery process and what can I expect in terms of pain and discomfort?
  3. Will I need to take time off work or school after the surgery?
  4. What are the expected outcomes of the surgery and how will it improve my symptoms?
  5. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  6. How experienced are you in performing endoscopic sinus surgery and what is your success rate?
  7. Will I need any follow-up appointments or additional treatments after the surgery?
  8. How will my age and medical history impact the success of the surgery?
  9. What specific factors will you be looking for in my CT scans to determine the need for a second surgery?
  10. Is there a specific age range that is considered ideal for undergoing endoscopic sinus surgery?

Reference

Authors: Wu PW, Huang CC, Yang SW, Huang Y, Huang CC, Chang PH, Lee YS, Lee TJ. Journal: Laryngoscope. 2020 Apr;130(4):1051-1055. doi: 10.1002/lary.28106. Epub 2019 Jun 6. PMID: 31169921