Functional endoscopic sinus surgery (FESS) alone versus balloon catheter sinuplasty (BCS) and ethmoidectomy: a comparative outcome analysis in pediatric chronic rhinosinusitis.
Thottam PJ, Haupert M, Saraiya S, Dworkin J, Sirigiri R, Belenky WM.
Take Home Points:
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- This is the first study comparing BCS and FESS in children.
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- BCS with ethmoidectomy and FESS are both safe and effective treatment options for otherwise healthy children suffering from uncomplicated CRS who do not respond to medical therapy
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- There is a significant overall decrease in sinus symptoms for both traditional FESS and BCS with ethmoidectomy.
- More patients who had BCS reported no further antibiotic use post-operatively than patients who had FESS.
The Details:
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- Retrospective cohort blinded chart review of patients between the ages 3-17 with CRS who underwent sinus surgery (Functional endoscopic sinus surgery or Balloon catheter sinuplasty) at Children’s Hospital of Michigan from 2008-2011. These patients failed medical therapy and experienced intractable symptoms for at least 90 days.
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- Exclusion Criteria: children diagnosed with craniofacial abnormalities, immunodeficiency, disorders, mucociliary disease, child with complicated rhinosinusitis described by 2007 sinusitis guidelines with sinonasal polyps or unilateral sinus disease.
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- Measures: cough, headache, rhinorrhea, facial pain, PND and/or congestion refractory to medical therapy and affecting daily life. Assessed pre-surgical intervention, 2-4 weeks post-surgical intervention, and final post surgical exam (>4 months). All subjects had CT evidence of disease and Lund-Mackay score completed pre-operatively.
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- Outcomes: Created a symptomatic score. Each symptom received 1 point if they had symptoms for more than 6 h a day and affecting daily life. Success and improvement was defined as decrease in total complaint score by 1 or more points
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- Refer to Table 1 for symptom statistics
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- Refer to Fig 1 for breakdown of which patients underwent which surgery
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- 31 patients met inclusion and exclusion criteria and were included in this study
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- Pre-operatively, no differences were seen in symptoms or Lund-Mackay scores between groups.
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- In the 2-4 week post-operative period, there was a significant improvement of sinus congestion in the BCS group compared to FESS group.
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- 80% of patients who had BCS with ethmoidectomy and 62.5% of patients who had FESS with ethmoidectomy had significant improvement of sinus complaints at final postoperative assessment (average follow up of 37 weeks)
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- 73.3% of BCS patients reported no further use of antibiotics while only 37.5% of FESS patient reported no further use of antibiotics.
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- BCS significantly improved congestion in patients at their final post surgical visit when compared to FESS (p =.05). Patients with headaches demonstrated a significant improvement after undergoing FESS (p =.05)
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- Refer Table 2 for individual symptom report pre-surgery and final post surgical visit
- Refer Table 3 for number and percentages of patients in their respective groups reporting improvement of sinus symptoms.
Limitations:
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- Low statistical power (31 patients)
- Subjective measures of symptoms
Summary contributed by Sahil Patel