Efficacy of endoscopic sinus surgery in patients under six years old

Objectives: To examine safety and efficacy of very young patients under the age of six who underwent endoscopic sinus surgery (ESS) at our institution for the indications of either complicated acute rhinosinusitis (ARS) or chronic rhinosinusitis (CRS).

Methods: Retrospective cohort review of patients under six years old who underwent ESS for sinonasal pathology between 2016 and 2023 at a freestanding pediatric hospital. Age, sex, weight, diagnosis, laterality of disease, medications, types and number of surgical interventions, usage of image guidance, and outcomes were obtained from the medical record.

Results: A total of 25 patients met inclusion criteria (range 1 month-5 years). Eighteen of the patients underwent surgery for an indication of complicated ARS and 7 patients underwent surgery for CRS. Ages were separated into three categories, <1 year (n = 1), 1-3 year (n = 3), 3-6 year (n = 21). Chi squared testing between these three age groups revealed no significant differences in revision rates. There were 5 children who required revision surgery, 3 of which had CRS. Ages of the children who required revision ranged from 2 to 4 years old. There was only one surgical complication observed.

Conclusions: Endoscopic sinus surgery has been increasingly considered safe in pediatric otolaryngology, however, our database in particular focuses on a very young subset of these patients in which there were very few (one) morbidities and no mortalities. Further study of this population should be continued to determine long term outcomes; however, it should be considered safe in acute situations.

Level of evidence: Level 4.