Adenoidectomy vs endoscopic sinus surgery for the treatment of pediatric sinusitis

Objective: To compare endoscopic sinus surgery with adenoidectomy for the t reatment of refractory chronic sinusitis in children. Study Design: Prospective nonrandomized study in a pediatric otolaryngology service of a university teaching hospital. Patients and Methods: Sixty-six children consecutively referred to the pedi atric otolaryngology service between 1994 and 1997 with computed tomographi c documentation of sinusitis subsequently underwent endoscopic sinus surger y or adenoidectomy. Their ages ranged from 2 to 14 years. Sixty-one childre n received follow-up. Two main outcomes were documented: (1) symptom status at least 6 months after the intervention and (2) requirement of the altern ate procedure or a revision procedure. Results: Twenty-four (77%) of 31 children who underwent endoscopic sinus su rgery had improved symptoms, compared with 14 (47%) of 30 children who unde rwent adenoidectomy (odds ratio [OR], 3.9; P = .01). Multivariable analysis demonstrated that endoscopic sinus surgery was significantly better than a denoidectomy after age, sex, allergy, asthma, day care attendance, and comp uted tomographic stage were adjusted for (OR, 5.2; P = .03). The diagnosis of asthma also appeared to be an independent predictor of success (OR, 4.37 ; P = .03). Conclusion: Endoscopic sinus surgery is better than adenoidectomy for the t reatment of refractory chronic sinusitis in a select group of children.