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Surgery Increases Quality of Life for Child
Suffering From Chronic Sinusitis

A child is diagnosed with chronic rhinosinusitis, or sinusitis, when symptoms including nasal obstruction, nasal discharge, facial pain, halitosis, and headaches last longer than three months. If rhinosinusitis goes untreated in children it can lead to more severe complications such as loss of the sense of smell, sepsis, cavernous sinus thrombosis, abscess of the eye or brain, and meningitis. Chronic rhinosinusitis can also have adverse effects on a child’s emotional and behavioral well-being by leading to loss of school days, reduced participation in activities, and poor socialization.

When children with rhinosinusitis do not respond to maximal medical therapy (typically including antibiotics, antihistamines, and nasal steroids) surgery is recommended. The first-line of surgical therapy for chornic rhinosinusitis in children is the removal of adenoids, but functional endoscopic sinus surgery (FESS) is also being performed with increased frequency to treat children with chronic rhinosinusitis.

Research on Quality of Life After Surgery for Children with Sinusitis
A team of researchers have prepared the first study to examine changes in quality of life following surgery for sinonasal disease in children using a validated instrument. The authors of “Improvements in Quality of Life Following Surgical Therapy for Sinonasal Disease in Children,” are Emily F. Rudnick MD, and Ron B. Mitchell MD, both with the Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA. Their findings were presented at the 109th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, held September 25-28, 2005, at the Los Angeles Convention Center, Los Angeles, CA.

Methodology: Children that were included in this study were those who were referred to the Pediatric Otolaryngology Service at Virginia Commonwealth University for evaluation of sinonasal symptoms between age one and 18 who underwent surgical therapy. Severity of rhinosinusitis and effectiveness of surgery for the relief of rhinosinusitis were evaluated using the SN-5 quality of life survey. The survey included the five domains of sinus infection, allergy symptoms, nasal obstruction, emotional distress, and activity limitations. Each domain consists of a number of symptom clusters. Researchers used a point scale, ranging from one (symptoms experienced none of the time) to seven (symptoms experienced all of the time) to grade the relative severity of each symptom cluster to give a mean domain score.

Results: The study population was made up of 22 children. Fourteen children (64 percent) were male. The mean age at the time of inclusion in the study was 6.5 years (range, 1.4-15.9), and thirteen children (59 percent) were younger than six years. Fourteen children (63.6 percent) were African-American, seven (32 percent) were Caucasian, and one (4.4 percent) was Native American. In all cases, the caregiver who completed the survey was the child’s mother.

The parents reported that children had been given nasal steroids (64 percent), asthma inhalers (64 percent), antibiotics (55 percent), montelukast [Singulair (50 percent)], and anti-reflux medications (23 percent) prior to presentation in the Otolaryngology clinic. Thirteen children (59 percent) had a diagnosis of asthma, 12 (55 percent) had allergic disease, and five (23 percent) had gastroesophageal reflux disease. Ten children (45 percent) had two or more medical disorders. Thirteen children (59 percent) underwent adenoidectomy, and nine underwent FESS.

The domain scores as well as the total scores for all children improved significantly after surgery. Also, scores for overall quality of life also improved for the children after surgery. When preoperative, postoperative, and change scores for all domains and overall quality of life scores were compared, there was no difference between children undergoing adenoidectomy and those children undergoing FESS. A repeated measure ANOVA was done to evaluate the effect of covariates including gender, age, ethnicity, parental education and income, on changes in SN-5 total scores after surgery. None of these covariates contributed significantly to the observed changes.

This report confirms that caregivers report an improvement in quality of life in their children following surgery for rhinosinusitis. The total survey score, the overall quality of life score, and the scores for all domains showed a significant change after surgical therapy. The greatest improvement in quality of life was found in the domains of nasal obstruction and emotional distress; the least improvement was seen in allergy symptoms.

Conclusions: To the author’s knowledge, this study is the first to prospectively evaluate changes in quality of life after treatment for chronic rhinosinusitis using a validated quality of life instrument. This study systematically evaluates caregiver (i.e. parent) perceptions of severity of disease based on symptoms and overall quality of life before and after surgical intervention. The improvement in SN-5 scores for all domains as well as the improvement in overall quality of life scores after surgery were dramatic. This finding suggests that chronic rhinosinusitis severely impacts the quality of life in children as documented by caregivers using the SN-5 questionnaire, and that caregivers observe a clearly identifiable improvement after children undergo surgery.

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