Study designs of evaluations included in the review
Published and unpublished series of children undergoing FESS that scored more than 50 points on defined validity criteria were included. Average length of follow-up was 3.7 years. Eight retrospective and one prospective series were included.
Specific interventions included in the review
Functional endoscopic sinus surgery (FESS) usually consisted of middle meatal antrostomy and anterior ethmoidectomy with some patients requiring complete ethmoidectomy. Other procedures included frontal recess and sphenoid sinusotomy. A second procedure was frequently done, two to three weeks after surgery for removal of splints or biological debris.
Participants included in the review
Children aged from 11 months to 18 years with continued symptoms of chronic sinusitis (nasal obstruction, nasal discharge, cough, headache) despite appropriate medical therapy, and confirmed by abnormal paranasal sinus computed tomography scans were included. Children with underlying medical problems such as cystic fibrosis, immunodeficiencies, and asthma were included in 4 out of 8 published articles.
Outcomes assessed in the review
Positive outcomes assessed included the following: 'improved' defined as met expectations, improved, satisfied, improved quality of life; 'much improved' defined as exceeded expectations, greatly improved, very satisfied, disease free, cure; and 'other' including would recommend FESS to other patients or would allow repeat surgery if needed. Ascertainment of outcome was measured by follow-up care giver questionnaire or telephone survey or chart review.
How were decisions on the relevance of primary studies made?
Listings were reviewed by two authors independently and abstracts considered relevant selected. Methods sections of 23 full-length article were blindly reviewed by one author for inclusion.
Identified studies scored on validity criteria. Only studies scoring > 50 points on validity criteria were included.