Peter Catalano¹*, Michael Schlewet¹, Melih Motro², John Walker² and Ayman Fraihat³

¹Department of Otolaryngology, St. Elizabeth’s Medical Center, Brighton, MA, USA
²Department of Orthodontics, Goldman School of Dentistry, Boston University, Boston, MA, USA
³Department of Otolaryngology, Sulaiman Al Habib Medical Center, Dubai, UAE

*Corresponding Author: Peter Catalano, Chief of Otolaryngology, St. Elizabeth’s Medical Center, Professor of Otolaryngology, Tufts University School of Medicine, Brighton, MA, USA.

Received: March 11, 2022; Published: April 29, 2022

Abstract

Background: Nasal airway obstruction in children is far more common than is currently appreciated, and is often associated with sleep disordered breathing and recurrent sinusitis. Surgical attempts to reduce this obstruction have primarily focused on adenoidectomy and turbinate reduction. However, many children have nasal obstruction despite adenoidectomy, or without enlarged adenoids. In adults, nasal surgery for obstruction has been limited to septoplasty and inferior turbinoplasty. We have used a different approach to nasal obstruction in children that involves minimally invasive targeted nasal and sinus surgery together. In this study, we evaluate these airway changes in highly symptomatic children with nasal obstruction and recurrent acute sinusitis.

Method: This retrospective pilot study is designed to evaluate the change in nasal obstruction and nasal airway dimensions in children with nasal obstruction, sleep disordered breathing, and recurrent acute sinusitis following targeted minimally invasive nasal and sinus surgery. Fourteen children who demonstrated recurrent acute sinusitis, nasal obstruction, and sleep disordered breathing as determined by history, physical exam, 3D sinus CT-scan, and NOSE scores, and did not have adeno-tonsillar hypertrophy, were included. No palatal expansion had yet been performed. CT imaging used to calculate nasal airway volumes was performed at baseline and 3 months post-surgery, and NOSE scores were used to evaluate nasal obstruction pre and 3 months after surgery.

Result: 14 consecutive patients aged 5-14 years (M 57%; F 43%) were included in this study. All patients demonstrated significant increase in nasal airway volume after surgery (p < 0.0001), and NOSE scores improved from an average of 59 pre-op to 8.6 post-op. There was no surgical morbidity.

Conclusion: Targeted minimally invasive nasal and sinus surgery in children with nasal obstruction, sleep disordered breathing, and recurrent acute sinusitis can produce significant improvement in nasal airflow and safely reduce disease related symptoms.

Keywords: Minimally Invasive Nasal Airway Surgery; Nasal Airflow; Nasal Breathing In Children; Pediatric Rhinology

References

1. Huang YS and Guilleminault C. “Pediatric Obstructive Sleep Apnea: Where Do We Stand?”. Advances in Otorhinolaryngology 80 (2017): 136-144.
2. Joosten KF., et al. “How do we recognize the child with OSAS?”. Pediatric Pulmonology2 (2017): 260-271.
3. Lawrence R. “Pediatric septoplasy: A review of the literature”. International Journal of Pediatric Otorhinolaryngology8 (2012): 1078-1081
4. Senior B., et al. “Quantitative impact of pediatric sinus surgery on facial growth”. Laryngoscope 11 (2011): 1866-1870.
5. De Yun Wang., et al. “Impacts of Fluid Dynamics Simulation in Study of Nasal Airflow Physiology and Pathophysiology in Realistic Human Three-Dimensional Nose Models”. Clinical and Experimental Otorhinolaryngology4 (2012): 181-187.
6. Peter J Catalano., et al. “Middle Meatal and Nasal Surgery for Obstructive Sleep Apnea: An Effective New Paradigm for Reducing the Apnea-Hypopnea Index”. Acta Scientific Otolaryngology10 (2020): 37-43.
7. Din H., et al. “Psychometric Evaluation of the Nasal Obstruction Symptom Evaluation Scale for Pediatric Patients”. Otolaryngology–Head and Neck Surgery 2 (2020): 248-254.
8. Kawai K., et al. “Validation of NOSE Scale in Pediatric Patients”. Laryngoscope (2021).
9. P Harvold., et al. “Primate Experiments on Oral Respiration”. American Journal of Orthodontics 79 (1981): 359-372.
10. Torre C and Guilleminault C. “Establishment of nasal breathing should be the ultimate goal to secure adequate craniofacial and airway development in children”. Journal of Pediatrics (Rio J) (2017).
11. D’Ascanio Lancione C., et al. “Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study”. International Journal of Pediatric Otorhinolaryngology 74 (2010): 1180-1183.
12. Can IH., et al. “Acoustic rhinometry in the objective evaluation of childhood septoplasties”. International Journal of Pediatric Otorhinolaryngology 69 (2005): 445-448De.
13. Kai Zhao., et al. “What is normal nasal airflow? A computational study of 22 healthy adults”. International Forum of Allergy and Rhinology 6 (2014): 435-446.
14. Xiong Guanxia., et al. “Numerical flow simulation in the post-endoscopic sinus surgery nasal cavity”. Medical and Biological Engineering and Computing 46 (2008): 1161-1167.
15. Catalano Peter J. “The minimally invasive sinus technique: Concepts and controversies”. Operative Techniques in Otolaryngology-Head and Neck Surgery 3 (2006): 189-196.

Citation

Citation: Peter Catalano., et al. “Nasal Airflow Changes After Targeted Nasal and Sinus Surgery in Children". Acta Scientific Otolaryngology 4.5 (2022): 77-83.

Copyright

Copyright: © 2022 Peter Catalano., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.