What is the role of balloon catheter sinuplasty (BCS) in the surgical management of pediatric sinus disease?
Background: Adenoidectomy and functional endoscopic sinus surgery have traditionally comprised the surgical management of chronic recurrent sinusitis (CRS) recalcitrant to medical therapy in the pediatric population. First introduced in 2006, BCS does not involve tissue removal and is, theoretically, mucosal sparing.
Explore this issue:October 2011
Study design: The Triological Society Best Practice Literature Review.
Setting: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston; Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston; Department of Otology and Laryngology, Harvard Medical School, Boston.
Synopsis: The authors noted that several studies have evaluated the safety, feasibility and efficacy of BCS in children with computed tomography-confirmed CRS who did not have cystic fibrosis, ciliary dysfunction or obvious anatomic derangements. Clinical outcomes were measured using a previously validated sinonasal (SN)-5 questionnaire evaluating five symptom categories: sinus infection, nasal obstruction, allergy symptoms, emotional distress and activity limitations.
In one study with 30 children, over 90 percent of sinuses were successfully cannulated and dilated. Failures consisted of four hypoplastic maxillary sinuses and one frontal sinus. In a second study with 32 children, successful reduction of SN-5 scores by at least 0.5 was achieved in 87 percent of patients. However, 15 of the children also underwent adenoidectomy, and six had a partial ethmoidectomy. A subsequent nonrandomized assessment compared children who underwent both BCS and adenoidectomy to a group of pediatric CRS patients who underwent adenoidectomy alone. A 0.5 reduction in SN-5 scores was successfully achieved in 80 percent of the BCS-with-adenoidectomy cohort in contrast to only 52.6 percent who underwent adenoidectomy alone. A bias may have been that the adenoidectomy-alone group was less symptomatic preoperatively.
Bottom line: The clinical benefit afforded by BCS is equivalent to traditional CRS management techniques and is safe for use in the pediatric CRS population.
References: Sedaghat AR, Cunningham MJ. Does balloon catheter sinuplasty have a role in the surgical management of pediatric sinus disease? Laryngoscope. 2011;121(10):2053-2054.
—Reviewed by Sue Pondrom