Surgical Management

As our knowledge of the natural history of chronic rhinosinusitis in children is limited, it is often challenging to identify those patients who will experience spontaneous regression of their disease with time, and those who will require more aggressive interventions. A

study of 40 children with chronic rhinosinusitis and no history of allergy showed spontaneous resolution of symptoms in 95% by the age of 7 years,24,73,74 which is presumed to be reflective of the immature immune system in the younger child. These findings thus support that uncomplicated rhinosinusitis in children is usually self-limiting. The potential for self-resolution of disease with maturation must always be kept in mind when considering more invasive therapies or surgical management in chronic pediatric rhinosinusitis. Unfortunately, the existing literature evaluating surgical management in this disease is confusing and lacks studies that would provide a clear decision-making guide.

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