title: Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis.
abstract: OBJECTIVE
  Chronic rhinosinusitis(CRS) results in significant morbidity and health care expenditure. Safety and efficacy of nasal irrigation use in the treatment of pediatric CRS have been demonstrated, but long-term outcomes are unknown. We reviewed characteristics and treatment outcomes after 6 weeks of once daily nasal irrigation in pediatric CRS based on computed tomography (CT) scans, and summarized parental reports of subsequent use of nasal irrigation for recurring symptoms
  
  
  METHODS
  Retrospective cohort study and cross-sectional survey.
  
  
  METHODS
  Review and survey of 144 pediatric CRS patients diagnosed between July 2003 and January 2012.
  
  
  RESULTS
  One hundred four patients were reviewed. Mean age was 8.0 years, and 65.4% were male. Presenting symptoms included congestion (95.2%), cough (79.8%), rhinorrhea (60.6%), headache (48.1%), and fatigue (40.4%). Comorbidities included positive allergy test (50%), asthma (57.3%), and gastroesophageal reflux disease (28.2%). After 6 weeks, 57.7% of patients reported complete resolution of symptoms. Reductions in Lund-Mackay CT scores were 4.14 and 4.38 on the left and right sides, respectively (P < .001). Of the 54 parents who completed the prospective surveys, 53.7% reported using irrigation again in the past 12 months (median = 1, interquartile range = 3). Only nine patients underwent functional endoscopic sinus surgery (FESS) after the initial 6 weeks. Patients requiring FESS were, on average, 3.6 years older than those who did not receive FESS (P = 0.0005). Median length of follow-up was 48 months (range = 20-113). There were no significant differences in age, Lund-MacKay score changes, and symptom resolution proportions between those who completed the survey and those who did not.
  
  
  CONCLUSIONS
  Nasal irrigation is effective as a first-line treatment for pediatric CRS and subsequent nasal symptoms, and reduces the need for FESS and CT imaging.
  
  
  METHODS
  2b.
authors.affiliation: University of Kansas School of Medicine, Kansas City, Kansas, USA.
authors.forename: Vinh
authors.initials: V
authors.lastname: Pham
authors.forename: Kevin
authors.initials: K
authors.lastname: Sykes
authors.forename: Julie
authors.initials: J
authors.lastname: Wei
mesh_terms: D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055556:Nasal Lavage / Q000379:methods*; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Nasal irrigation; chronic rhinosinusitis; outcome studies; saline irrigation