Abstract

Background: Chronic rhinosinusitis (CRS) significantly impacts the quality of life in pediatric patients, particularly when symptoms persist despite adenoidectomy and optimal medical therapy. Balloon catheter dilation (BCD) has emerged as a minimally invasive alternative to functional endoscopic sinus surgery (FESS), offering potential benefits in symptom resolution and safety. This study evaluates the efficacy and safety of BCD in children with refractory CRS. Methods: A total of 50 pediatric patients (ages 4–12) with persistent CRS following adenoidectomy were included. Patients underwent BCD, and symptom improvement was assessed using the Sinonasal 5 (SN-5) questionnaire at 3, 12, 24, and 52 weeks post-operatively. Success was defined as a ≥0.5-point reduction in SN-5 scores. Complications were monitored, and statistical significance was determined (p < 0.05).  Results: A significant improvement in SN-5 scores was observed, with a mean reduction of 1.8 points (p < 0.001). The success rate was 85%, with 45% experiencing significant improvement (>1.5-point reduction), 25% moderate improvement (1.0– 1.4), and 15% mild improvement (0.5–0.9). Only 15% were classified as surgical failures. The overall complication rate was 12%, with minor intraoperative events, including mucosal trauma (2%) and self-limiting bleeding (2%). Postoperative complications included nasal congestion (4%), mild epistaxis (2%), and sinus infection (4%). No major adverse events were reported, and only 4% required additional surgical intervention. Conclusion: BCD is a safe and effective intervention for pediatric CRS patients unresponsive to adenoidectomy, offering substantial symptom relief with minimal complications. It presents a promising alternative to more invasive surgical options.

• 1.   Kay DJ, Rosenfeld RM. Quality of life for children with persistent sinonasal symptoms. Otolaryngol Head Neck Surg. 2003;128(1):17– 26. doi: 10.1067/mhn.2003.41.
• 2.   Cunningham MJ, Chiu EJ, Landgraf JM, Gliklich RE. The health impact of chronic recurrent rhinosinusitis in children. Arch Otolaryngol Head Neck Surg. 2000;126(11):1363–1368. doi: 10.1001/archotol.126.11.1363.
• 3.   Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012;23:3–298.
• 4.   Levine H, Rabago D. Balloon sinuplasty: a minimally invasive option for patients with chronic rhinosinusitis. Postgrad Med. 2011;123(2):112–118. doi: 10.3810/ pgm.2011.03.2269.
• 5.   Soler ZM, Rosenbloom JS, Skarada D, Gutman M, Hoy MJ, Nguyen SA. Prospective, multicenter evaluation of balloon sinus dilation for treatment of pediatric chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017;7(3):221–229. doi: 10.1002/alr.21889.
• 6.   Ramadan HH, Bueller H, Hester ST, Terrell AM. Sinus balloon catheter dilation after adenoidectomy failure for children with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg. 2012;138(7):635–637. doi: 10.1001/ archoto.2012.1070.
• 7.   Ramadan HH, Bueller H, Hester ST, Terrell AM. Sinus balloon catheter dilation after adenoidectomy failure for children with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg. 2012;138(7):635–637. doi: 10.1001/ archoto.2012.1070.
• 8.   Patel VA, O’Brien DC, Ramadan J, Carr MM. Balloon Catheter Dilation in Pediatric Chronic Rhinosinusitis: A Meta-analysis. American Journal of Rhinology & Allergy. 2020;34(5):694- 702. doi:10.1177/1945892420917313.
• 9.   Mirza, A.A., Shawli, H.Y., Alandejani, T.A. et al. Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review. J of Otolaryngol - Head & Neck Surg 49, 69 (2020). https://doi.org/10.1186/s40463-020-00463-0.
• 10.   Patel VA, O’Brien DC, Ramadan J, Carr MM. Balloon Catheter Dilation in Pediatric Chronic Rhinosinusitis: A Meta-analysis. Am J Rhinol Allergy. 2020 Sep;34(5):694-702. doi: 10.1177/1945892420917313. Epub 2020 Apr 7. PMID: 32264691.
• 11.   BlueCross BlueShield Association. Balloon sinus ostial dilation for treatment of chronic rhinosinusitis. Technol Eval Cent Assess Program Exec Summ. 2013 Apr;27(9):1-3.
• 12.   Ramadan HH, Terrell AM. Balloon catheter sinuplasty and adenoidectomy in children with chronic rhinosinusitis. Ann OtolRhinolLaryngol. 2010 Sep;119(9):578- 82. doi: 10.1177/000348941011900902. PMID: 21033023.

Data Sharing Statement

Funding