1226 Non-invasive intervention for failed adenoidectomy for chronic rhinosinusitis CRS)

Chronic rhinosinusitis has been assessed as affecting about 30 million Americans each year. Most will respond to conventional treatment which includes varying combinations of antibiotics, saline irrigations, nasal steroids, antihistamines, specific allergy therapy and asthma control. However some have persistent symptoms despite maximum medical management and alternatives require exploration. One such alternative is FESS (functional endoscopic sinus surgery) but while successful in 75-88% of cases, can be technically difficult and may result in complications such as haemorrhage, CSF leak and orbital complications. Otorhinolaryngologists have therefore explored other options, with sinus balloon catheter dilatation emerging as candidate with acceptable success rates and fewer complications. In a prospective, non-randomised, uncontrolled study carried out in West Virginia, USA, researchers at a tertiary referral hospital enrolled 26 patients in whom adenoictemy had failed at a mean follow-up of 12 months despite continued medical treatment. Assessment included full allergy evaluation, Ig- deficiency work-up and sweat test when considered appropriate. Severity of the refractory CRS was measured objectively using the Lund-Mackay system and sinonasal 5 (SN- 5) questionnaire at the same time as the pre-intervenion CT scan. Once the guide wire position in the maxillary sinus had been confirmed by transillumination the balloon catheter was placed over the ostium and inflated. Postoperatively all children (aged between 4 and 12; mean 7.7 years) were evaluated at 3, 12, 24 and 52 weeks and SN-5 was repeated at 52 weeks and/or beyond. As previously described, a ≤0.5 change in SN-5 score was regarded as a success. Mean SN-5 scores were 4.6±0.9 before the intervention and dropped significantly to 3.0±1.2 (p<0.001) in 21 of the 26 subjects (81%). There were no surgical complications in the 33 sinuses treated in the 26 patients, although ‘hybrid’ procedures were required in a few cases (e.g. contralateral antrostomy for for hypoplastic sinus). The authors recommend a randomised trial comparing FESS to balloon catheter dilatation.

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