The Laryngoscope Lippincott Williams & Wilkins, Inc. © 2006 The American Laryngological, Rhinological and Otological Society, Inc. Long-Term Follow-Up for Children Treated With Surgical Intervention for Chronic Rhinosinusitis Rodney P. Lusk, MD; Marcella R. Bothwell, MD; Jay Piccirillo, MD Objectives/Hypothesis: The goal of this study is to retrospectively compare the long-term, 10 year, out- comes of surgical versus medical management of young children with chronic rhinosinusitis. Study Design: This is a retrospective, age-matched, cohort outcome study performed at a tertiary-care hospital. Methods: Two groups of young children (2–5 yr old) with chronic rhinosinusitis were treated with endo- scopic sinus surgery or medically managed and eval- uated 10 years after their initial therapy. Of the 131 eligible patients, 67 could be located and consented to participate in the study. Six symptoms (day cough, night cough, irritability or crankiness, headaches, na- sal airway obstruction, and purulent rhinorrhea) were used to assess the outcome of their treatment. Results: Children undergoing endoscopic sinus sur- gery had more significant disease as noted on the computed tomography (CT) scans. Their symptom severity, however, was similar. When individual symptoms were compared, there were no statistically significant differences between the surgically and medically managed groups. When the mean was con- trolled for baseline symptom severity and CT sever- ity, there was statistical improvement in nasal airway obstruction and decreased rhinorrhea. There was a trend toward improvement in cough, but this was not statistically significant. Parenteral assessment of im- provement (change) in symptoms (P  .001) and their degree of satisfaction with treatment (P  .005) was significantly higher in the surgically managed group. Conclusions: Children who have chronic rhinosinus- itis improve in their symptoms of nasal airway ob- struction and purulent discharge if they undergo surgery. Parents of young children with chronic rhi- nosinusitis appear to be more satisfied with the outcome of surgical management than medical man- agement when assessed 10 years later. Key Words: Outcome assessment (health care), rhinosinusitis sur- gery, endoscopic, chronic, rhinosinusitis, pediatric, child. Laryngoscope, 116:2099 –2107, 2006 INTRODUCTION Pediatric rhinosinusitis is a frequent problem in chil- dren, with a prevalence of approximately 8%, which is more common than chronic diseases of the tonsils or ade- noids affecting approximately 2% of children. 1 True rhi- nosinusitis, as seen by primary care physicians, occurs more commonly in the winter months. 1 Children with rhinosinusitis are perceived by their parents to have sig- nificantly more bodily pain and are more limited in their physical activities than children with other chronic disor- ders such as asthma and juvenile rheumatoid arthritis. 2 Pediatric rhinosinusitis, therefore, is a significant health problem. Americans spend approximately $200 million on prescription drugs and over $2 billion for over-the-counter medications to treat rhinosinusitis. 3 The definition of rhinosinusitis has been controver- sial, but most agree that acute rhinosinusitis can last up to 30 days, and subacute rhinosinusitis can persist 30 to 90 days. The disease becomes chronic if there are persis- tent symptoms for greater than 90 days. 4 These defini- tions are useful but difficult to apply when recurrent viral infections and acute rhinosinusitis are superimposed on chronic rhinosinusitis. The causes of recurrent acute or chronic pediatric rhinosinusitis are multifactorial. Viral infections and al- lergies are thought to be a major cause of recurrent acute or chronic rhinosinusitis. 5 Viral rhinosinusitis is associ- ated with a diffuse mucositis that is a precursor to approx- imately 80% of bacterial sinus infections. Approximately 5% to 13% of patients with a viral infection progress to a bacterial rhinosinusitis. 1,6 Viral infections are thought to From the Departments of Pediatric Otolaryngology (R.P.L.), Boys’ Town National Research Hospital, Nebraska, U.S.A., the Department of Otolaryngology (M.R.B.), University of Missouri Health Care, Colombia, Missouri, U.S.A., and the Department of Otolaryngology (J.P.), Washington University, St. Louis, Missouri, U.S.A. Editor’s Note: This Manuscript was accepted for publication August 24, 2006. Send correspondence to Dr. Rodney P. Lusk, Boys’ Town National Research Hospital, NE. E-mail: luskr@boystown.org DOI: 10.1097/01.mlg.0000244387.11129.a0 Laryngoscope 116: December 2006 Lusk et al.: Children Treated With Surgical Intervention for CRS 2099