.When Surgery to Treat Sinusitis is Needed.
When considering surgery for a child with chronic sinusitis …
Before even considering sinus surgery for a child, I insist that a strong, integrative holistic medical approach has been tried, and failed. All other options must have been exhausted. This includes doing daily sinus rinses. Really doing them. Really. Check this link for my 5-Step Program to Eliminate Biofilm and Chronic Rhino-Sinusitis.
It also means a thorough evaluation for why this child is having chronic sinusitis. After all, chronic infection is not normal, and it may reflect underlying pathology such as immune deficiency, or other severe disease. Only after we rule out ALL other, correct-able issues, so we move on to consider surgery.
A computed tomographic (CT) scan can reveal the condition of the sinuses, and whether there is obstructing adenoid growth in the nasopharynx or obstruction of the sinus openings. Check this link for How To Read Your Child’s Sinus CT Scan.
In my practice, even if the child’s adenoid tissue appears small on the CT scan, I will still consider an adenoidectomy to be the first surgery step for my patients with chronic sinusitis. Why? Removing the adenoid tissue can eliminate a potential reservoir of bacteria near the nose and sinuses. Check this link for more on the Anatomy of the Nose and Sinuses.
Also, if the child has been on multiple courses of antibiotics, there is increased risk of resistant bacteria being present in the sinuses. That is, the bacteria that are present are often resistant to most of our antibiotics. In order to treat those resistant bacterial infections, it can be very helpful to determine what bacteria are causing your child’s sinusitis.
How can we find out which bacteria are present?
If my patients go to surgery for an adenoidectomy, that is a good time to irrigate their maxillary (cheek) sinuses and send this for culture to identify the bacteria that are present (Faust, Rimell, 1996); the term for this procedure is “sinus centesis”. Knowing the types of bacteria that are present, and which antibiotics that are effective against them, can be useful for fighting chronic sinusitis.
Unfortunately, culture of sinus infections may not always reveal all of the bacteria that are present. The latest technique is to clone the DNA of bacteria that are present, and compare them to a database of known bacterial species. This method reveals that culture methods can miss a large number of bacteria. Check this link for the very latest methods for identifying bacteria in the aero-digestive tract (Griffen & colleagues, 2011).
The time of an adenoidectomy is also the time to perform a “wash,” or irrigation, of the maxillary sinuses. Rinsing out the sinuses while under general anesthetic greatly increases the success over just doing adenoidectomy alone to treat chronic sinusitis (Ramdan & Cost, 2008).
Finally, there is never a downside to performing daily nasal saline rinses. I use the Nasopure nasal rinse system for myself and my family, and this is the system that I recommend to my patients.
Transparency: I have no financial or other arrangements with Nasopure.com, and by-the-way, they have THE best videos of how to do nasal rinses on their site! Check it out. Those videos were the only way that I could get my 5-year-old to try it.
Next Time: I will review my preferred method of minimally-invasive sinus surgery.
Faust RA and Rimell FL: Chronic rhinosinusitis in children. Current Opinion in Otolaryngology, Head and Neck Surgery, vol. 4: 373-377, 1996.
Ramadan HH, Cost JL: Outcome of adenoidectomy versus adenoidectomy with maxillary sinus wash for chronic rhinosinusitis in children. Laryngoscope Vol. 118: 871-873; 2008.
Ramadan HH: Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children. Annals of Otology, Rhinology & Laryngology. Vol. 118(3): 161-165; 2009
Ann L. Griffen, Clifford J. Beall, Noah D. Firestone, Erin L. Gross, James M. DiFranco, Jori H. Hardman,Bastienne Vriesendorp, Russell A. Faust, Daniel A. Janies, Eugene J. Leys.CORE: A Phylogenetically-Curated 16S rDNA Database of the Core Oral Microbiome; PLoS ONE, 2011: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0019051
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