International Journal of Pediatric Otorhinolaryngology 79 (2015) 1561–1565

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International Journal of Pediatric Otorhinolaryngology

journal homepage: www.elsevier.com/locate/ijporl

Macroscopic findings during endoscopic sinus surgery for chronic

rhinosinusitis in children
Lechoslaw Pawel Chmielik *, Karolina Raczkowska-Labuda, Lidia Zawadzka-Glos
Medical University of Warsaw, Department of Pediatric ENT, Poland

A R T I C L E I N F O A B S T R A C T

Article history: Aim: Endeavor to intraoperative macroscopic evaluation of changes in children with CRSs. Analysis of
Received 18 May 2015 the type and incidence of pathological changes observed macroscopically during FESS was
Received in revised form 5 July 2015 undertaken as well as an parallel attempt to correlate the level of inflammation markers with
Accepted 10 July 2015
severity of disease.
Available online 23 July 2015
Materials and methods: Retrospective analysis of case records of 153 patients of the Department of
Pediatric Otolaryngology, Medical University of Warsaw, hospitalized between 2010 and 2013. During
Keywords:
that time 106 patients with a diagnosis of chronic maxillary sinusitis required surgical intervention.
Sinusitis
Chronic rhinosinusitis
102 children (avg-aged 11.5 years) were qualified to functional endoscopic surgery. The youngest
Functional endoscopic sinus surgery patient was 3 years old and the oldest 18. 26 patients presented the polypoid lesions of sinuses or nasals.
Chronic sinusitis in children At 19 confirmed the coexistence of sinus polyps with nasal polyps.
Results: 76 patients had oedematous-inflammatory lesions and 26 polypoid. Among the group of listed
above 26 children, 19 had either sinuses or nasal polyps. 15% children with polyps were diagnosed with
cystic fibrosis and 8.0% with asthma. A common deviation in the results of morphology in children with
CRSs is higher level of monocytes. Inflammation markers within the population of FESS qualified children
were low.
Conclusions: (1) Oedematous-inflammatory lesions are frequently intraoperatively identified. (2) The
CRSs without polyps is the common type of chronic sinusitis in children. (3) Nasal polyps often coexist
with sinus polyps. (4) If nasal polyps are found in pediatric population then diagnosis of CF, allergy and
GERD should be considered. (5) Markers of inflammation in CRSs are low.
ß 2015 Elsevier Ireland Ltd. All rights reserved.

1. Introduction 2. Materials and methods

The chronic sinusitis issue within the pediatric population is Retrospective analysis of case records of 106 patients of the
quite popular in the literature. The wide variety of information on Department of Pediatric Otolaryngology, Medical University of
microbiology, diagnosis or treatment are opposite to the relatively Warsaw, hospitalized between 2010 and 2013. During that time
short experience of endoscopic surgery in pediatrics. Endeavor to 106 patients with a diagnosis of chronic maxillary sinusitis
intraoperative macroscopic evaluation of changes in children with required surgical intervention. 102 children (avg-aged
CRSs. Analysis of the type and incidence of pathological changes 10.4 years) were qualified to functional endoscopic surgery
observed macroscopically during FESS was undertaken as well as (Fig. 1). The youngest patient was 3 years old and the oldest 18.
an parallel attempt to correlate the level of inflammation markers 26 patients presented the polypoid lesions of sinuses or nasals.
with severity of disease. At 19 confirmed the coexistence of sinus with nasal polyps.
There was one choanal polyp and onefold change of maxillary
sinus. Every patient had CT diagnosis done (Figs. 2 and 3).
Furthermore the results of a patient’s blood test (morphology,
* Corresponding author at: Medical University of Warsaw, Department of
CRP and ESR) were analyzed searching for statistically signifi-
Pediatric ENT ul. Marszałkowska 24, 00-576 Warszawa, Poland.
Tel.: +48 601217979. cant deviations. Samples were taken not later than 7 days prior
E-mail address: [email protected] (L.P. Chmielik). to a surgery.

http://dx.doi.org/10.1016/j.ijporl.2015.07.015
0165-5876/ß 2015 Elsevier Ireland Ltd. All rights reserved.
1562 L.P. Chmielik et al. / International Journal of Pediatric Otorhinolaryngology 79 (2015) 1561–1565

Figure 1. Patient’s age.

Figure 2. CT scans of patients with chronic sinusitis.

Figure 3. Oedematous-inflammatory lesion of the maxillary sinus.

3. Results 26 children, 19 had either sinuses or nasal polyps. 15% children

with polyps were diagnosed with cystic fibrosis (Fig. 7). They were
76 patients had oedematous-inflammatory lesions (Fig. 4) and the youngest in that group of patients (4, 4, 7, 8 years). Parallel –
26 polypoid (Figs. 5 and 6). Among the group of listed above 8.0% children with polypoid changes had diagnosed asthma

Figure 4. Polypoid changes of the maxillary sinus.

 L.P. Chmielik et al. / International Journal of Pediatric Otorhinolaryngology 79 (2015) 1561–1565 1563

Figure 5. Antrochoanal polyp. CT scan and clinical view.

 nasal obstruction disorders in 92 (90.19%),

 chronic infections in 95 (93.13%),
 nasal secretions in 95 (93.13%),
 headache in 68 (66.66%).

4. Discussion

Chronic rhinosinusitis (CRS) in children is very common but

challenging to diagnose and treat because the symptoms depend
on age [1–3]. Its etiology is still a subject of much debate and
ongoing research with final conclusion that the pathogenesis is
multifactorial. According to the European Position Paper on
Rhinosinusitis and Nasal Polyps 2012 (EPOS 2012) [4], CRS is
defined by 2 or more symptoms lasting beyond 12 weeks. The
symptoms are: facial pain/pressure, nasal blockage or nasal
discharge (anterior/posterior), reduction or loss of smell. It is
Figure 6. Right nasal cavity polyps.
important to remember that in pediatric population cough is sole
presenting symptom more often raised then loss of smell. Other
(Table 1). A common deviation in the results of morphology in authors agreed that CRS in children is characterized by symptoms
children with CRSs (but statistically insignificant) is higher level of persisting beyond 8 weeks [5].
monocytes, decreased number of RBC and lower level of Hgb. Chronic illness has a negative impact on a child’s quality of life.
Inflammation markers within the population of FESS qualified It is connected with complications such as chronic antibiotic
children were low. therapy, school absences, poor sleep patterns, impaired school
In children with chronic sinusitis, we observed; performance, or irritability [6].

Figure 7. Results.
1564 L.P. Chmielik et al. / International Journal of Pediatric Otorhinolaryngology 79 (2015) 1561–1565

Table 1
Patients with nasal polyps.

Analogous to CRS the pathogenesis of nasal polyposis is chronic sinusitis after tonsil surgery, 61.2% will not require further
unknown. It has been discussed with chronic inflammation, surgery.
autonomic nervous system dysfunction, and genetic predisposi-
tion. Most theories consider polyps to be the ultimate manifesta-
5. Conclusions
tion of chronic inflammation. Polyposis in children may develop
due to chronic inflammation of the mucous membrane caused by
1. Oedematous-inflammatory lesions are frequently intraopera-
allergic rhinitis, chronic sinusitis, asthma, or aspirin allergy.
tively identified.
Polyps, if present, should prompt an evaluation for cystic fibrosis,
2. The CRSs without polyps is the most common type of chronic
an allergy or asthma, GERD and drug’s intolerance syndroms [7,8].
sinusitis in children.
Medical therapy should always be prior to surgical one and it
3. Nasal polyps often coexist with sinus polyps.
continues to be prolonged courses of antibiotics. The vast majority
4. If nasal polyps are found in pediatric population then diagnosis
of patients require longterm conservative treatment: nasal saline
of CF, allergy and GERD should be considered.
irrigations, intranasal corticosteroids, antibiotics. Staged surgical
5. Markers of inflammation in CRSs are low.
intervention with initial adenoidectomy (with or without sinus
lavage) followed by partial or anterior ethmoidectomy should be
considered only when medical therapy failed [9,10].
Functional endoscopic sinus surgery (FESS) was elaborated by References
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