This article is interesting for those of us who see children regularly in secondary care but rarely see them with chronic rhinosinusitis. The authors remind the reader of the EPOS guidelines for diagnosis of CRS in children: two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior or posterior nasal drip), along with facial pain/pressure, cough, endoscopic evidence of sinus disease, or relevant changes on CT. Generally accepted regimes of medical therapy follow that of adults. Indications for surgery include acute complications of sinusitis (eg. subperiosteal abscess, Pott’s puffy tumour, intracranial abscess), nasal polyposis, fungal sinusitis, and cystic fibrosis complications. The authors describe the approach to each of the sinuses, stating that they only address those affected on the CT. When performing a middle meatal antrostomy only, they adopt an anterior to posterior approach, reducing the risk of orbital injury and accessory osteum formation. They enter the natural osteum at the level of the inferior attachment of the uncinate and remove only a small part of the uncinate. For ethmoidectomies, the uncinate is removed completely. The authors also briefly discuss the role of sinus surgery in patients with cystic fibrosis, stating that the literature fails to support intervention to improve pulmonary function. However, when it is performed, mega-antrostomies are preferred to aid sinus irrigation. It was interesting to note that in those uncomplicated children with CRS and enlarged adenoids, adenoidectomy is often the first surgical intervention of choice if less than six years old. An improvement for this article would have been surgical differences between adults and children when performing this type of surgery.

Pediatric sinus surgery for chronic rhinosinusitis.
Makary CA, Ramadan HH.
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Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

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