What is the role of the adenoid in pediatric chronic rhinosinusitis?

BACKGROUND Pediatric chronic rhinosinusitis (CRS) is broadly defined as 90 or more uninterrupted days of respiratory symptoms with corresponding endoscopic and/or computed tomography (CT) scan findings. It is a common yet difficult problem in the pediatric population. Otolaryngologists agree on initial medical management with nasal saline irrigations, nasal steroid sprays, and an antibiotic directed at the most common sinonasal pathogens. The majority of pediatric patients do not require surgery for CRS. In children with sinus disease refractory to medical therapy, there is controversy regarding surgical management. Surgical options include adenoidectomy and endoscopic sinus surgery (ESS). The goal of surgery is to improve quality of life and prevent further disease. It is preferable to avoid the need for additional or revision surgeries. This review describes the evidence regarding the role of the adenoid in pediatric CRS. Of note, pediatric CRS associated with cystic fibrosis, immunodeficiency, nasal polyposis, allergic fungal disease, and/or ciliary dyskinesia is generally not treated with adenoidectomy alone; these patients are excluded from the discussion below.