الفهرس 
Chapter 1: Medical treatmentOnly 14 pages are availabe for public view
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Abstract
Chronic Rhinosinusitis (CRS) in children is defined as chronic inflammation of the nose and the paranasal sinuses more than three months characterized by two or more symptoms one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip) ± facial pain/pressure ± cough and either endoscopic signs of mucosal edema, purulent drainage or nasal polyposis and/or CT scan changes showing mucosal changes within the ostiomeatal complex and/or sinuses in a pediatric patient aged 18 years or younger.
The most common clinical symptoms and signs are rhinorrhea, cough, nasal congestion and post nasal drip. And either endoscopic signs of nasal polyps, and/or mucopurulent discharge primarily from middle meatus and/or oedema/mucosal obstruction primarily in middle meatus and/or CT changes as mucosal changes within the ostiomeatal complex and/or sinuses. Questions on allergic symptoms (i.e. sneezing, watery rhinorrhea, nasal itching, and itchy watery eyes) should be included and if positive allergy testing should be performed.
Different modalities of treatment can be employed in treatment of children with CRS. Medical treatments in the form of antibiotics, topical nasal corticosteroids and nasal lavage with saline solutions are always the first station in the management. When it failed the disease can be considered as refractory form of the disease. Many options are available for treatment but without known of which modality can act better than the other. Adenoidectomy is among the most frequent surgical procedures performed on children with PCRS. Other studies identified that
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children with more severe sinus diseases as evidenced by CT had a higher success rate if a maxillary sinus wash was performed with adenoidectomy.
After failure of medical treatment and adenoidectomy endoscopic sinus surgery (ESS) is another option for such patient. As there is no evidence which modality can entail more benefit to the patient the following prospective controlled randomized clinical trial was conducted. The aim of the present study is to compare randomly the efficacy (short term 6 m) of adenoidectomy alone, adenoidectomy with maxillary sinus wash and adenoidectomy with FESS in clinical improvement (Visual Analog Scale for sinonasal symptoms and CT Lund Mackay score) of CRS that associated with adenoid hypertrophy in children.
Fifty-five patients were enrolled randomly in three treatment groups: Group I: control group (adenoidectomy), group II: (adenoidectomy with maxillary sinus wash) and group III: (endoscopic sinus surgery (ESS) and adenoidectomy). Patients were enrolled for the present study at the Department of Otolaryngology–Head and Neck Surgery, Menoufia University Hospital. Patients were assessed preoperatively and 6 months postoperatively regarding Visual Analog Scale (VAS) for sinonasal symptoms and CT Lund Mackay score (CT LMS).
In the present study patients were randomly enrolled in-to three treatment groups. Their mean age was 10.35 with SD ± 4.29 years in-group I, 11.55 with SD ± 3.35 in-group II and 9.33 with SD ±4.40 in-group III. No significant differences between the groups regarding age, sex, total Visual Analog nasal symptoms Scale and CT Lund Mackay Score preoperatively (P >0.05). All the groups had
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postoperative improvement regarding VAS and CT LMS (P <0.001). Regarding the postoperatively mean total symptoms of VAS and CT LMS the results in group III was better than group II (P=0.09),(P<0.001) and group I (P< 0.001) ,(P< 0.001).Also group II better than group I (P 0.05),(P 0.03) respectively. Regarding the postoperative mean differences of total symptoms of VAS and CT Lund Mackay score: The results in group III were better than group II (P= 0.04),(P= 0.05) and group I (P< 0.001). Also group II better than group I (P= 0.03),(P= 0.01) respectively.
With 6 months of follow up endoscopic sinus surgery (ESS) and adenoidectomy had better results than adenoidectomy with or without maxillary sinus wash. Adenoidectomy with maxillary sinus wash had better results than adenoidectomy alone in children with CRS who failed medical treatment and met the inclusion criteria.