2015 HSC Section 1 Book of Articles

Reprinted by permission of Otolaryngol Head Neck Surg. 2014; 151(4):542-553.

Invited Article

Otolaryngology– Head and Neck Surgery 2014, Vol. 151(4) 542–553 American Academy of Otolaryngology—Head and Neck

Clinical Consensus Statement: Pediatric Chronic Rhinosinusitis

Surgery Foundation 2014 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814549302 http://otojournal.org

Scott E. Brietzke, MD, MPH 1 , Jennifer J. Shin, MD 2 , Sukgi Choi, MD 3 , Jivianne T. Lee, MD 4 , Sanjay R. Parikh, MD 5 , Maria Pena, MD 6 , Jeremy D. Prager, MD 7 , Hassan Ramadan, MD 8 , Maria Veling, MD 9 , Maureen Corrigan 10 , and Richard M. Rosenfeld, MD, MPH 11

percent to 13% of childhood viral upper respiratory tract infections may progress to acute rhinosinusitis, 1-4 with a proportion of these progressing to a chronic condition. PCRS may also coexist and/or be exacerbated by other widespread conditions such as allergic rhinitis and adenoid disease, 5-9 and some suggest the incidence of PCRS may be rising. 10 In addition, PCRS has a meaningful impact on quality of life, 11 with its related adverse effects potentially exceeding that of chronic respiratory and arthritic disease. 12 PRCS also has the potential to exacerbate asthma, 13,14 a condition that negatively affects 2% to 20% of children. 15-17 In spite of its prevalence and impact on affected families, many aspects of PCRS remain ill-defined. At the most basic level, even the diagnostic definition of PCRS has not been concretely elucidated among our specialty societies, creating challenges in discussing clinical presentations or establish- ing human study protocols. Similarly, while performing nasal endoscopy and obtaining site-specific cultures may be routine in the cooperative adult population, their role in the evaluation of children has not been clearly established. Likewise, the concept of maximal medical therapy has yet to be specifically delineated, although there is a broad spectrum 1 Walter Reed National Military Medical Center, Bethesda, Maryland, USA 2 Harvard Medical School, Boston, Massachusetts, USA 3 University of Pittsburgh/Children’s Hospital of Pittsburgh of UMPC, Pittsburgh, Pennsylvania, USA 4 David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA 5 University of Washington/Seattle Children’s Hospital, Seattle, Washington, USA 6 Children’s National Medical Center, Washington, DC, USA 7 University of Colorado/Children’s Hospital Colorado, Aurora, Colorado, USA 8 West Virginia University, Morgantown, West Virginia, USA 9 University of Texas–Southwestern Medical Center/Children’s Medical Center-Dallas, Dallas, Texas, USA 10 American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA 11 SUNY Downstate Medical Center, Brooklyn, New York, USA Corresponding Author: Scott E. Brietzke, MD, MPH, Walter Reed Department of Otolaryngology, 8901 Wisconsin Ave., Bethesda, MD 20889. Email: SEBrietzke@msn.com

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Abstract Objective. To develop a clinical consensus statement on the optimal diagnosis and management of pediatric chronic rhi- nosinusitis (PCRS). Methods. A representative 9-member panel of otolaryngolo- gists with no relevant conflicts of interest was assembled to consider opportunities to optimize the diagnosis and man- agement of PCRS. A working definition of PCRS and the scope of pertinent otolaryngologic practice were first established. Patients of ages 6 months to 18 years without craniofacial syndromes or immunodeficiency were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results. After 2 iterative Delphi method surveys, 22 state- ments met the standardized definition of consensus while 12 statements did not. Four statements were omitted due to redundancy. The clinical statements were grouped into 4 categories for presentation and discussion: (1) definition and diagnosis of PCRS, (2) medical treatment of PCRS, (3) ade- noiditis/adenoidectomy, and (4) endoscopic sinus surgery (ESS)/turbinoplasty. Conclusion. Expert panel consensus may provide helpful infor- mation for the otolaryngologist in the diagnosis and manage- ment of PCRS in uncomplicated pediatric patients. Keywords pediatric otolaryngology, rhinosinusitis, chronic rhinosinusi- tis, evidence-based medicine, review, Delphi method

Received May 7, 2014; revised July 30, 2014; accepted August 8, 2014.

Introduction Pediatric chronic rhinosinusitis (PCRS) is a commonly encountered condition in otolaryngological practice. Five

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