September 2019 HSC Section 1 Congenital and Pediatric Problems

Beswick et al

Medical Management.  For initial medical management, nasal steroid sprays (90%, 104/115) and nasal saline irriga- tions (87%, 101/115) are frequently used. Oral antibiotics (57%, 66/115) and oral antihistamines (24%, 28/115) are sometimes used. Oral steroids (8%, 9/115), nasal antihista- mines (7%, 8/115), anti-leukotrienes (6%, 7/115), and anti- reflux medications (4%, 4/115) are rarely used. For maximal medical therapy, nasal steroid sprays (96%, 111/115), nasal saline irrigations (93%, 107/115), and oral antibiotics (91%, 105/115) are commonly used. Oral ste- roids (43%, 49/115), oral antihistamines (38%, 44/115), anti-leukotrienes (36%, 42/115), anti-reflux medications (26%, 30/115), nasal antihistamine sprays (20%, 23/115), and nasal steroid irrigations (19%, 22/115) are sometimes used. Nebulized antibiotics (7%, 8/115), nebulized steroids (7%, 8/115), and intravenous antibiotics (3%, 3/115) are rarely used. When utilizing antibiotics, 65% (73/113) treat for 15 to 21 days, 24% (27/113) for >21 days, and 11% (13/113) for <14 days. ComputedTomography Imaging.  Overall, computed tomogra- phy (CT) use has declined among ASPO members over the past decade: 43% (49/113) have decreased usage over this period, 51% (58/113) have not changed their CT usage, and 5% (6/113) have increased. The majority of respondents, 82% (93/114), typically perform adenoidectomy prior to obtaining sinus CT imag- ing, whereas only 6% (7/114) obtain CT imaging prior to adenoidectomy. For 12% (14/114), the decision to perform imaging or adenoidectomy first varies according to the clinical situation. Most respondents, 83% (95/115), obtain CT imaging prior to any surgical treatment other than adenoidectomy. Surgical Management.  Adenoidectomy is commonly per- formed for PCRS, with 63% (71/113) of respondents per- forming 3 or more monthly on average for PCRS. Endoscopic sinus surgery (ESS) is much less commonly performed; 42% (48/115) perform none per month, 41% Table 1.  Geographic Distribution of Survey Respondents. a Region No. (%) North Central 23 (20) Mid-Atlantic 20 (18) South Central 19 (17) Southeast 18 (16) West 15 (13) Northeast 5 (4) Mountain West 5 (4) International 8 (7) a International respondents were from Canada (4), Saudi Arabia (2), and Taiwan (1).

continuous days of symptoms with objective evidence of sinus inflammation in patients aged 6 months to 12 years of age. The target group was ASPO members who manage patients with PCRS. Specific areas investigated included clinical practice type and makeup, the frequency of treating pediatric patients with rhinologic issues, and details on diagnosis, workup, and management of PCRS. Results were collated via SurveyMonkey’s software (Palo Alto, California, USA) and analyzed via SAS 9.4 (SAS Institute, Cary, North Carolina, USA). The Pearson chi-square test was used to compare nonordinal responses between groups. The Cochran- Mantel-Haenszel chi-square test was used to compare ordi- nal responses between groups. Fisher’s exact test was used if the frequency of any value was less than 5. Analysis was performed by a professional biostatistician. Geographic areas for the United States were defined as follows: West (Washington, Oregon, California, Alaska, Hawaii), Mountain West (Wyoming, Idaho, Montana, Nevada, Utah, Colorado, New Mexico, Arizona), North Central (North Dakota, South Dakota, Nebraska, Kansas, Missouri, Iowa, Minnesota, Wisconsin, Illinois, Michigan, Indiana, Ohio), South Central (Tennessee, Texas, Oklahoma, Arkansas, Kentucky, Alabama, Louisiana, Mississippi), Southeast (Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida), New England (Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island), and Mid-Atlantic (New York, New Jersey, Pennsylvania, Maryland, Delaware, Washington, DC). This study was issued an exemption by the Stanford University Institutional Review Board. Demographics.  One hundred and fifteen respondents com- pleted the survey for a response rate of 22% (115/521). Clinical practice types were divided among academic (63%, 72/115), private (19%, 22/115), combined academic and private (15%, 17/115), and other (3%, 4/115). Geographi- cally, respondents were distributed across the United States and internationally (Table 1). Almost all respondents had completed a pediatric otolar- yngology fellowship (96%, 109/114). Mean years spent in clinical practice was 15.5 (range, 0-44, SD = 10.2). The mean percentage of respondents’ practices comprised of pediatric patients was 98% (range, 70%-100%, SD = 6.0) and of pediatric rhinologic patients was 30% (range, 5%-90%, SD = 22.1). Diagnosis.  Nasal endoscopy is variably used to establish a diagnosis of PCRS, with 37% (41/112) sometimes, 27% (30/112) usually, 25% (28/112) always/almost always, and 12% (13/112) rarely/never employing endoscopy. Results ASPO Survey Data

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