Postoperative Management of Pediatric Sinusitis

Postoperative management is essential to maximizing the clinical outcomes following pediatric sinus surgery. This chapter examines the current approach to postoperative care following functional endoscopic sinus surgery in the pediatric population. Nasal saline irrigations are a mainstay for many surgeons with a high efficacy and tolerability in children. Additional therapies include saline sprays, topical antibiotics, and topical steroids. Systemic forms of steroids or antibiotics may be considered in the short-term recovery period to help with healing, particularly in moderate to severe disease. Additionally, chronic rhinosinusitis with nasal polyps showed increased response rates postoperatively to systemic steroids. Unlike in adult populations, postoperative debridement is unnecessary in most pediatric cases with no demonstrated improvement in surgical success rates in patients who do not get debridement compared to those who get a second look with debridement. Postoperative care and continuing medical management should be individualized to the patient’s comorbidities and underlying etiology of chronic sinusitis. Cystic fibrosis requires special consideration with saline irrigations, corticosteroids, and antibiotics, with consideration of dornase alfa and gene therapy. The chapter concludes that functional endoscopic sinus surgery has been an effective tool in treating pediatric sinusitis refractory to medical therapy, with postoperative care recognized as having utmost importance to bridge surgical therapy with continued medical treatment for pediatric chronic rhinosinusitis.