My son is four years old and has suffered with sinus problems and vomiting since he was an infant. The ENT now wants to remove his tonsils and adenoids and perform an endoscopic antrostomy. The tonsil and adenoid procedures are scary enough, but I can understand them. The antrostomy is what I don't understand, and I can't seem to find any information on it. Even the doctor's office did not have any material on it because they said they don't do the procedure enough. What is it exactly?

C.O.

The upper jaw bone is called the "maxilla." The maxilla includes the tooth sockets for all of the upper teeth, much of what we call the cheekbones, and the lower rim of the orbit (the orbit is the bony chamber that houses the eye, eye muscles, tear glands, etc.). The maxilla is a hollow bone. The central hollowed-out area is the "maxillary sinus," but it is also called the "antrum."
Any surgically created opening is called a stoma, from the Latin word for mouth. For example, a tracheostomy is a hole in the neck that opens into the trachea, and a gastrostomy is a hole in the abdominal wall that opens into the stomach (gaster is the Latin word for stomach). Thus, an antrostomy is a surgically created opening into the maxillary sinus (antrum).

I do not know if your son's ENT explained "endoscopic" to you. This word refers to the fact that slender telescopes known as endoscopes are used to perform this surgery. After your son is thoroughly anesthetized, the ENT surgeon will insert the endoscope into his nostril to see a magnified view of the side nasal wall (the wall between the nasal cavity and the maxillary sinus). Using surgical instruments that are designed specifically for this operation, the ENT will enlarge the natural opening into the maxillary sinus. This operation is an "endoscopic maxillary sinus antrostomy," and it is done to improve the sinus's ability to drain.

Whenever I encounter a child who has had persistent sinus disease since infancy, I wonder about the diagnosis of cystic fibrosis. The fact that your son also has gastrointestinal problems makes me even more suspicious of this diagnosis. If your son has not been tested for cystic fibrosis, he should be.

Cystic fibrosis (CF) is a hereditary disease, but it can certainly arise in families with no history of the problem. The spectrum of disease ranges from the child whose health appears normal (perhaps having only an occasional bout of diarrhea or sinusitis) to the infant who dies of the disease in the first year of life. Thus, the diagnosis of CF is often missed if the child has few problems. Children with CF have a variety of problems involving the respiratory and gastrointestinal systems. Chronic and recurrent sinusitis, lung infections, fatty diarrhea and intestinal blockage are not uncommon.

CF is typically diagnosed with a sweat chloride test. (CF patients have saltier sweat than healthy individuals.) If your son has been seen by a pediatric gastroenterologist, I strongly suspect that he has had this test, as such a specialist would be very sensitive to the possibility of CF and would order this test if it had not already been performed. Nevertheless, if you are not sure whether the possibility of this disease has been eliminated, I would recommend that you ask your son's pediatrician or gastroenterologist about CF.