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Is There a Need for a Second Look?

Hassan H. Ramadan, MD, MSc

Arch Otolaryngol Head Neck Surg. 2001;127:188-192.

Objective  To determine whether intravenous administration of dexamethasone during endoscopic sinus surgery in children will decrease scarring and edema during a second-look procedure.

Design  Prospective, randomized, double-blind, placebo-controlled trial.

Setting  University medical center.

Patients  Forty-eight children undergoing endoscopic sinus surgery for chronic sinusitis.

Intervention  Twenty-four children received intravenous dexamethasone and 24 received placebo intraoperatively before the start of the procedure.

Main Outcome Measures  The status of the ethmoid cavity, the status of the mucosa in the maxillary sinuses, and the patency of the maxillary sinus ostium during the second-look procedure performed 2 to 3 weeks after the primary procedure.

Results  Children who received intravenous dexamethasone had significantly less maxillary sinus mucosal edema, less ethmoid scarring, and a lower incidence of closure of the maxillary ostium (P = .02). During the second-look procedure, 62% of children in the noncorticosteroid group had abnormal findings vs 29% in the corticosteroid group. Patients with asthma, lower computed tomography scores, and no exposure to smoking had a significantly lower incidence of scarring with use of corticosteroids. Children older than 6 years benefited from intravenous corticosteroid therapy vs children 6 years and younger.

Conclusions  Treatment with intravenous dexamethasone during endoscopic sinus surgery was safe and was helpful in reducing scarring and swelling noted during the second-look procedure. Use of corticosteroids was particularly helpful in children with asthma, lower computed tomography scores, and no exposure to smoking and in children older than 6 years.

From the Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown.

Corresponding author and reprints: Hassan H. Ramadan, MD, MSc, Department of Otolaryngology–Head and Neck Surgery, West Virginia University, PO Box 9200, Morgantown, WV 26506-9200 (e-mail: hramadan{at}hsc.wvu.edu).

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