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Am Fam Physician. 1998;57(2):336-338

Chronic sinusitis in children is characterized by persistent nasal congestion, rhinorrhea, cough, headache and mouth breathing. These symptoms may not abate despite repeated and, often, extended courses of oral antibiotics. Moreover, the diagnosis of chronic sinusitis is often clinical, and the role of adjunctive therapies such as antihistamines and decongestants has not been firmly established. The symptom complex attributed to chronic sinusitis overlaps considerably with that of adenoidal hypertrophy. The adenoids are believed to cause mechanical obstruction and stasis of nasal secretions, and may serve as a bacterial reservoir as well. Vandenberg and Heatley evaluated the efficacy of adenoidecto-my in relieving symptoms of chronic sinusitis in children.

The authors retrospectively reviewed the medical records of 48 children who underwent adenoidectomy for symptoms of chronic sinusitis. The patients ranged in age from one to 12 years (median age: 4.4 years). All of the children received extensive antibiotic therapy before surgical referral. Children with a history of cystic fibrosis or those who underwent concurrent endoscopic sinus surgery were excluded from the study.

Preoperative clinical notes were reviewed for the presence of comorbid conditions, including asthma, allergy, otitis media and obstructive sleep apnea. Symptoms of chronic sinusitis, such as rhinorrhea, cough, nasal congestion, headache, halitosis and irritability were also recorded. A telephone interview with each child's caregiver was conducted five to 24 months after surgery to assess long-term symptom control and overall improvement. Four patients were not available for follow-up and did not complete the study.

The patients were divided into three groups: those with complete or nearly complete resolution of symptoms, those with some improvement and those with minimal or no improvement. Complete or nearly complete resolution of symptoms was reported in 25 of 43 children (58 percent). Of the remaining 18 children, some improvement was noted in nine (21 percent), and another nine had no improvement. The average number of symptoms experienced by each patient decreased from 5.3 to 2.9. Also, 29 of 39 patients (74 percent) with a history of frequent antibiotic therapy were able to reduce or completely eliminate the use of antibiotics after surgery. Only three patients subsequently required endoscopic sinus surgery.

The authors conclude that adenoidectomy is an effective treatment in the majority of children with symptoms of chronic sinusitis. A reduction in the use of antibiotics and improvement in quality of life may also be considered benefits.

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