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Clinical Challenges
July 2011

Endoscopic Sinus Surgery in Children: Con

Author Affiliations

Author Affiliation: Department of Otolaryngology, Walter Reed Army Medical Center, Washington, DC

Arch Otolaryngol Head Neck Surg. 2011;137(7):699-701. doi:10.1001/archoto.2011.111

Hypothesis: Endoscopic sinus surgery is indicated and effective in children.

Endoscopic sinus surgery in trained hands clearly has a role to play in the management of pediatric sinusitis. However, careful review of the evidence reveals many important factors that should be considered thoroughly before its use should become widespread. First, stepwise medical therapy is very effective in the great majority of patients. Beyond that, adenoidectomy is a safe and simple procedure that has been shown to be very effective in improving symptoms in most patients for whom medical therapy fails. In addition, growing bacteriologic and molecular evidence suggests that the adenoid may be the key reservoir of virulent bacteria in the nose and paranasal sinuses, and it therefore may be the best target for invasive therapy. Finally, compared with adenoidectomy, pediatric ESS is clearly a more complex procedure. It also has a significantly greater risk profile, scant long-term outcome data, and virtually no placebo-controlled data.

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