September 2019 HSC Section 1 Congenital and Pediatric Problems

Reprinted by permission of Ann Otol Rhinol Laryngol. 2017; 126(9):634-639.

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https://doi.org/10.1177/0003489417719717 sagepub.com/journalsPermissions.nav DOI 10.1177/0003489417719 7 journals.sagepub.com/home/aor Annals of Otology, Rhinology & Laryngology 2017, Vol. 126(9) 634–639 © The Author(s) 2017 Reprints and permissions:

Pediatric Chronic Rhinosinusitis Management in Rhinologists and Pediatric Otolaryngologists

Daniel M. Beswick, MD 1 , Anna H. Messner, MD 1 , and Peter H. Hwang, MD 1

Abstract Objective: To compare the management of pediatric chronic rhinosinusitis (PCRS) between members of the American Rhinologic Society (ARS) and the American Society of Pediatric Otolaryngology (ASPO). Study Design: Comparison of surveys. Methods: A web-based survey was distributed to ASPO membership twice in September-October 2016. Data were compared to previously published data from ARS membership in March-April 2016. Results: ASPO survey completion rate was 22%. ARS members were more likely to employ oral steroids in initial ( P = .025) and maximal medical management ( P = .001). ASPO members more commonly performed adenoidectomy before computed tomography (CT) ( P < .001). Both groups commonly included adenoidectomy as part of initial surgical management (90% vs 94%, P = .316), while ASPO members more frequently performed adenoidectomy alone (70% vs 43%, P = .001). If initial surgical treatment failed, both groups commonly performed endoscopic sinus surgery (ESS; 81% vs 88%, P = .56) with a similar extent including frontal ( P ≥ .207) and sphenoid ( P ≥ .304) surgery. Conclusions: Pediatric chronic rhinosinusitis management is similar between groups, yet there are differences including oral steroid use, relative order of CT versus adenoidectomy, and performing concomitant procedures with adenoidectomy. Both groups commonly perform ESS with similar surgical extent if prior surgical treatment fails. Management by both groups is largely in agreement with published consensus statements.

Keywords pediatric, chronic, rhinosinusitis, management, survey

Introduction Pediatric chronic rhinosinusitis (PCRS) is a common dis- ease that, like its adult counterpart, has been shown to sig- nificantly impact patients’ quality of life. 1,2 Despite recent consensus statements that have suggested management strategies based on published evidence as well as expert opinion, 3,4 the management of PCRS continues to be a mat- ter of considerable debate and varied clinical approaches. Pediatric chronic rhinosinusitis is managed by both pedi- atric otolaryngologists and rhinologists, who undergo dif- ferent subspecialty training and generally treat different patient populations and pathologies. These groups overlap in the management of PCRS. Little is known about how the management styles of each group compare to the other. We recently assessed the practice patterns of American Rhinologic Society (ARS) members in treating PCRS. 5 The present study sought to evaluate the practice patterns of American Society of Pediatric Otolaryngology (ASPO) members in managing PCRS via a parallel survey and com- pare these results to the previously published practice pat- terns of ARS group. This information may help identify

different treatment paradigms for PCRS across different subspecialties and identify areas for further research.

Methods An anonymous survey focusing on the diagnosis, workup, and treatment of PCRS based on a recent ARS study was designed by the authors, then approved by ASPO Research Committee. The survey was electronically distrib- uted to 521 unique email addresses of ASPO members twice in September and October 2016. Only ASPO mem- bers who had completed their medical training received the survey. Pediatric chronic rhinosinusitis was defined as 90 1 Stanford University School of Medicine, Department of Otolaryngology–Head and Neck Surgery, Stanford, California, USA Corresponding Author: Daniel M. Beswick, MD, Stanford University School of Medicine, Department of Otolaryngology–Head and Neck Surgery, 801 Welch Rd, Stanford, CA 94304, USA. Email: dbeswick@stanford.edu

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