September 2019 HSC Section 1 Congenital and Pediatric Problems

Am J Otolaryngol 39 (2018) 418–422

L.K. House et al.

was cost e ff ective in these patients. Obviously, many patients undergo di ff erent treatment pathways, and our study does not attempt to com- pare all possible pathways involved in the treatment of this disease. Due to the more popular use of balloon catheter dilation in initial man- agement of pediatric CRS, we chose to compare the upfront use of the balloon with adenoidectomy alone as the initial surgical treatment methods. We recognize, as stated previously, that our analysis begins after patients have been treated medically and that our decision trees start at the onset of surgical treatments. Our study did attempt use decision tree analyses to follow patients through multiple steps of treatment, however, it was not feasible and this study does not attempt to see each patient through all possible steps of treatment and failures of treatment. We did take the trees a step further, to include functional endoscopic sinus surgery as an option after failure of the previous treatments. Pediatric chronic rhinosinusitis continues to be a nebulous subject, with many treatment options. Continued advances in surgical techni- ques and technology have created several options for the treatment of pediatric CRS with safety and some measure of reliability. However, the many factors involved in the treatment of such a diverse disease process hinder the study of treatment outcomes. It is vital to consider also the costs in addition to outcomes when comparing treatment modalities in our current health care environment. This study found that adenoi- dectomy as a fi rst intervention before proceeding to more advanced techniques is nearly as e ff ective and is a much more cost-e ff ective al- gorithm for the treatment of pediatric chronic rhinosinusitis. However, the physician must advocate the best treatment for his or her own pa- tients. More studies should be done in order to further evaluate the cost e ff ectiveness of the di ff erent treatment algorithms of pediatric chronic rhinosinusitis. 5. Conclusion

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