title: Comparison of two minimally invasive techniques for treating chronic rhinosinusitis in the pediatric population.
abstract: OBJECTIVE
  To compare two minimally invasive techniques for the treatment of chronic rhinosinusitis in young children.
  
  
  BACKGROUND
  Chronic rhinosinusitis (CRS) is a common diagnosis in young children. Maxillary sinus aspiration & irrigation with adenoidectomy (MSI) followed by an extended course of oral antibiotics has been shown to be an alternative to functional endoscopic sinus surgery. However, since MSI is not performed under direct visualization, it has inherent risk. This study analyzes the techniques of MSI and endoscopically guided middle meatus cultures & antral biopsy with adenoidectomy (EGC) in the (1) diagnosis of bacterial infection by culture, (2) time to resolution using double antibiotic therapy, and (3) associated morbidity of the two procedures.
  
  
  METHODS
  The medical records at Wayne State University, Department of Otolaryngology Head & Neck Surgery were reviewed from 2004 to 2010. All children who presented with CRS who underwent MSI or EGC were included in this retrospective case series.
  
  
  RESULTS
  Patients presented with a history of cough, nasal discharge, and congestion. The mean age was 3.7 years. Symptom duration prior to treatment was 7.4 months in the 64 patients who underwent MSI and 9.1 months in the 46 patients who underwent EGC. MSI identified bacteria in 80% of patients compared to 73% in EGC patients (p=0.45). The MSI group underwent antibiotic treatment for 8.7 weeks and achieved symptom resolution in 8.7 weeks compared to 6.9 weeks and 4.9 weeks respectively in the EGC group (p=0.08 and 0.01). However, if patients presented with snoring or cough, time to resolution of symptoms was significantly lower in patients undergoing EGC versus MSI (p=0.02 and p=0.01, respectively). One patient who underwent MSI experienced epistaxis requiring nasal packing, and two patients had pseudoproptosis following irrigation that resolved spontaneously shortly thereafter. No complications were reported in the EGC group.
  
  
  CONCLUSIONS
  EGC is an effective treatment for young children with CRS. EGC and MSI are equally effective in obtaining diagnostic cultures. EGC decreases time to symptom resolution, and it lowers the risk of complication when compared to MSI.
authors.affiliation: Wayne State University, Department of Otolaryngology, Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Deckard
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kruper
authors.forename: Thi
authors.initials: T
authors.lastname: Bui
authors.forename: James
authors.initials: J
authors.lastname: Coticchia
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008443:Maxillary Sinus / Q000382:microbiology / Q000473:pathology; D009296:Nasal Cavity / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D012852:Sinusitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents