Hh. Ramadan, Corticosteroid therapy during endoscopic sinus surgery in children - Is there a need for a second look?, ARCH OTOLAR, 127(2), 2001, pp. 188-192
Objective: To determine whether intravenous administration of dexamethasone
during endoscopic sinus surgery in children will decrease scarring and ede
ma during a second-look procedure.
Design: Prospective, randomized, double-blind, placebo-controlled trial.
Setting: University medical center.
Patients: Forty-eight children undergoing endoscopic sinus surgery for chro
nic sinusitis.
Intervention: Twenty-four children received intravenous dexamethasone and 2
4 received placebo intraoperatively before the start of the procedure.
Main Outcome Measures: The status of the ethmoid cavity, the status of the
mucosa in the maxillary sinuses, and the patency of the maxillary sinus ost
ium during the second-look procedure performed 2 to 3 weeks after the prima
ry procedure.
Results: Children who received intravenous dexamethasone had significantly
less maxillary sinus mucosal edema, less ethmoid scarring, and a lower inci
dence of closure of the maxillary ostium (P=.02). During the second-look pr
ocedure, 62% of children in the noncortico-steroid group had abnormal findi
ngs vs 29% in the corticosteroid group. Patients with asthma, lower compute
d tomography scores, and no exposure to smoking had a significantly lower i
ncidence of scarring with use of corticosteroids. Children older than 6 yea
rs benefited from intravenous corticosteroid therapy vs children 6 years an
d younger.
Conclusions: Treatment with intravenous dexamethasone during endoscopic sin
us surgery was safe and was helpful in reducing scarring and swelling noted
during the second-look procedure. Use of corticosteroids was particularly
helpful in children with asthma, lower computed tomography scores, and no e
xposure to smoking and in children older than 6 years.