Pediatric ESS Effective, Safe to Treat Chronic Sinusitis With Nasal Polyps

Reduced disease recurrence and postoperative pain were likely outcomes following a review and meta-analysis of 9 studies on the therapeutic effectiveness of endoscopic sinus surgery (ESS) among pediatric patients who had chronic sinusitis with nasal polyps. High cure rates and safety levels were also seen following ESS.

Findings from this investigation appeared in a recent issue of Translational Pediatrics, with the 9 studies all deemed to have a low risk of bias and to be of medium or high quality. Terms used for the search were endoscopicsinus surgery, antrochoanal polyps, chronic sinusitis with nasal polyps, and nasal polyps, and the studies were found after a search of PubMed, Medline, Embase, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Wanfang, VIP, and Google Scholar from inception to December 30, 2021. Each of the 9 studies compared outcomes between traditional surgical treatment (the control group) and ESS (the experimental group), matching each patient in a study cohort with a counterpart in the control group.

“Childhood rhinosinusitis is an infectious respiratory tract disease and is correlated with multiple factors, including nasal stenosis, nasal trauma, and poor resistance,” the study investigators wrote. “ESS for sinusitis with nasal polyps has been found to effectively promote the cure time and treatment effect. However, it is not widely used because its safety is not clear.”

Statistical differences were not seen between the control and experimental groups (χ² = 0.03; I² = 0%; P = .98) overall, although following a fixed-effect analysis, far fewer patients in the experimental group developed polyps than the control group after ESS (Z = 2.65; P = .008).

There was also no statistical heterogeneity found in postop disease recurrence between the study cohorts (χ² = 1.59; I² = 0%; P = .45), and postop recurrence occurred significantly less in the experimental vs control group (Z = 2.92; odds ratio, 2.78; 95% CI, 1.40-5.52; P = .004). Follow-up visits were used to evaluate recurrence. In addition, patients in the control group had more frequent postop intervention compared with the experimental group (Z = 4.56; P < .00001).

Just 4 of the 9 studies investigated postoperative visual analogue (VAS) pain scores, and among these, statistical heterogeneity was found (χ² = 1.59; I² = 84%; P = .002). Random-effects modelling showed VAS scores were markedly lower in the experimental vs control groups (Z = 16.29; P < .00001), by 4.51 (95% CI, 3.96-5.05) points.

“Our results revealed that ESS treatment could reduce postoperative recurrence and pain among patients and showed high efficacy and safety in the treatment of children with chronic sinusitis with nasal polyps,” the investigators concluded. “However, the meta-analysis in this study is limited due to various confounding factors. In addition, many risk factors and indicators may not be included in the study, which greatly reduces the combined effect.”

To continue making progress in this space, they suggest larger sample sizes and follow-up analysis of patients with sinusitis and nasal polyps that explore ESS plus systemic corticosteroid treatment, “so as to improve the results of the meta-analysis.”

Reference

Sheng J, Yu L, Hu W, Yu Y. Systematic review and meta-analysis of the curative effects and safety of endoscopic sinus surgery in children with chronic sinusitis with nasal polyps. Transl Pediatr. 2022;11(7):1171-1181. doi:10.21037/tp-22-189