Prognostic staging system and therapeutic effectiveness for recurrent or chronic sinusitis in children

OBJECTIVE: We sought to assess the clinical status of pediatric sinusitis patients after a minimum of 2 years follow-up and to evaluate relative treatment effectiveness. STUDY DESIGN: We conducted a medical record review of 308 patients, with a 2-year follow-up questionnaire. RESULTS: Overall, 55% of children were "much improved." A 4-stage prognostic system was developed and used to compare results in 133 patients who had not responded to medical treatment and who had positive sinus computed tomography scans. Endoscopic sinus surgery (ESS) had no apparent advantages in stages I and IV, but in stages II and III, rates of "much improved" for ESS versus medical therapy were 79% versus 54% and 68% versus 42%, respectively. CONCLUSION: These results suggest that ESS may be particularly effective for patients from intermediate prognostic stages. SIGNIFICANCE: This type of prognostic staging and evaluation of treatment effectiveness is necessary and important in chronic sinusitis, where randomized trials are unlikely to be performed.