title: Functional endoscopic sinus surgery improves sinus-related symptoms and quality of life in children with chronic rhinosinusitis: a systematic analysis and meta-analysis of published interventional studies.
abstract: OBJECTIVE
  To assess the current knowledge and evaluate the quality of evidence in the use of FESS for the treatment of chronic rhinosinusitis in children, regarding the respective changes in the quality-of-their-life (QoL) and the outcome that follows the operation.
  
  
  METHODS
  Systematic literature review in Medline and other database sources and meta-analysis of pooled data.
  
  
  RESULTS
  15 studies were systematically analyzed. Four represented Level II, five Level III, and six Level IV evidence. The total number of treated patients was 1301. Thirteen research groups reported that pediatric FESS is an effective treatment for chronic rhinosinusitis; the respective positive outcome ranged between 71 and 100% of operated children. Five studies concluded that this treatment modality is associated with significant improvement in the children's postoperative QoL. Systemic diseases and environmental factors may have unfavourable prognostic effects; cystic fibrosis is associated with at least 50% recurrence rate. The rate of major complications following pediatric FESS is 0.6%, and the respective rate of minor complications 2%.
  
  
  CONCLUSIONS
  The surgical management in children with chronic rhinosinusitis, despite the reservations expressed by many clinicians, is effective when optimal medical treatment proves unsuccessful (grade B strength of recommendation), and is associated with improvement in the children's QoL (grade B strength of recommendation). FESS also improves the sinusitis-associated symptoms and QoL in children with cystic fibrosis (grade C strength of recommendation. Most complications of pediatric FESS reported in the literature are minor, and associated with difficulties in the postoperative assessment and care of pediatric patients.
authors.affiliation: 1MITERA Paediatric Infirmary, Athens, Greece.
authors.forename: Petros V
authors.initials: PV
authors.lastname: Vlastarakos
authors.forename: Melpomeni
authors.initials: M
authors.lastname: Fetta
authors.forename: John V
authors.initials: JV
authors.lastname: Segas
authors.forename: Pavlos
authors.initials: P
authors.lastname: Maragoudakis
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Nikolopoulos
mesh_terms: D002648:Child; D002908:Chronic Disease; D004724:Endoscopy; D006801:Humans; D011788:Quality of Life; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D016896:Treatment Outcome
keywords: FESS; children; chronic rhinosinusitis; cystic fibrosis; nasal polyposis; quality of life; rhinitis