In chronic rhinosinusitis (CRS), surgical intervention is indicated when symptom improvement cannot be achieved with conservative measures.
In severe cases of disease, puncture of the maxillary sinus followed by irrigation may be required.
Children who have chronic rhinosinusitis (CRS) but no longer respond to pharmacotherapy benefit from sinus balloon catheter dilation (SBCD) in the same way as adults. The effectiveness of sinus balloon dilation was significantly greater than pharmacotherapy alone, regardless of whether adenotomy (removal of so-called adenoid growths; these are hyperplastic adenoids) was performed at the same time.
Functional endoscopic sinus surgery (FESS) has also been established in children. It is suitable for CRScNP (chronic rhinosinusitis with (cum) nasal polyps), nasal polyps in the context of cystic fibrosis or allergic fungal sinusitis. In the case of foreign bodies in the maxillary sinus (root debris, root filling material) or in the case of a mouth-antrum connection (connection between the maxillary sinus and the oral cavity), surgical intervention must also be performed.
Minimum criteria for adults with recurrent acute rhinosinusitis for sinus surgery:
- At least one episode of sinusitis must be objectively proven (by computed tomography or endoscopically)
- Expected benefits and potential risks of intervention must be discussed with the patient.Note: e.g., 0.25 percent serious complications to the brain or eyes.The patient’s preference is decisive (participatory decision making; shared decision making)
- One of two other criteria must be met on the part of the patient:
- Unsuccessful treatment attempt with a topical steroid (corticosteroids in topical application) or.
- Sinusitis episodes significantly limit their productivity.
