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David L. Walner, MD; Mercedes Falciglia, MD; J. Paul Willging, MD; Charles M. Myer III, MD

Arch Otolaryngol Head Neck Surg. 1998;124:425-428.

Objective  To determine if second-look nasal endoscopy (SLE) improves clinical outcome after pediatric functional endoscopic sinus surgery (FESS).

Design  A retrospective review was performed for all patients who had undergone FESS between January 1993 and December 1994. The patients were divided into 2 groups: those who underwent SLE 2 to 3 weeks after FESS (n=94) and those who did not undergo SLE after FESS (n=53). Patients with a history of cystic fibrosis, bone marrow transplantation, or isolated sphenoidal sinus disease were excluded from the study.

Setting  Pediatric tertiary care hospital.

Patients  All patients had a diagnosis of chronic rhinosinusitis, had failed medical therapy, and had subsequently undergone FESS.

Main Outcome Measures  The need for revision sinus surgery was used as the definition for poor clinical outcome, indicating that sinus disease recurred or was persistent. The number of patients requiring revision sinus surgery in each group was compared.

Results  Revision surgery was performed in 20 of the 94 patients who underwent SLE after FESS. Revision surgery was performed in 10 of the 53 patients who did not undergo SLE after FESS. Six patients in the "no-second-look group" underwent follow-up nasal endoscopy at some time after the initial FESS. There was no significant difference in terms of clinical outcome between the 2 groups.

Conclusions  The rate of revision sinus surgery was comparable in those patients who underwent SLE after FESS and those who did not. The usefulness and application of SLE need to be considered carefully.

From the Department of Pediatric Otolaryngology and Maxillofacial Surgery, Children's Hospital Medical Center, Cincinnati, Ohio. Dr Walner is now with the Department of Otolaryngology– Bronchoesophagology, Rush-Presbyterian-St Lukes Medical Center, Chicago, Ill.

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