Computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis

Abstract

In this study, the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system. Fourteen percent of the patients were classified as Stage I (single-focus disease); 36% as Stage II (multifocal disease responsive to conservative therapy); 32% as Stage III (diffuse disease partially responsive to medication); and 16% as Stage IV (diffuse disease associated with bony changes and poorly responsive to conservative treatment). The incidence of recurrent or persistent disease ranged from 13% for Stage II to 30% for Stage IV. Stage I and III patients had 13% and 18% recurrence rates, respectively. Computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process.

Inverted papilloma of paranasal sinuses

“…There is a variety of systems for staging inflammatory sinus disease (Friedman et al, 1990;Kennedy, 1992;Lund and MacKay, 1993) and also for staging of carcinoma of the paranasal sinuses (Carinci et al, 1966;Greene et al, 2002). Systems have also been developed for staging IP (Skolnik et al, 1966;Schneider, 1976).…”

Outcomes Research in Rhinology: Chronic Rhinosinusitis

“…The variety of proposed CT staging systems highlights the presumed importance of the radiographic extent of disease. After Friedman et al [23] had compared their CT 'staging' system for predicting outcome with the systems of Kennedy and Lund and Mackay, they expressed agreement with the overall view that radiographic assessment of the extent of the disease is a major determinant for staging and prognosis [23,15]. Yet the literature agrees that evaluation of sinus disease using CT scans alone lacks sensitivity [22].…”

“…To properly document such a dynamic problem, frequent, serial CT scans would be necessary but are impractical. Other problems encountered in the attempted use of CT staging systems include: (1) systems are too complex for routine use, (2) poor interor intraobserver agreement for the scoring system, (3) lack of correlation between CT severity and severity of sinonasal symptoms [24][25][26], and (4) lack of acceptance of one system [23]. In an independent evaluation of several systems tested in patients with CRS, the Lund-Mackay system facilitated the highest level of both interobserver and intraobserver agreement and has been adopted by the Rhinosinusitis Task Force for further outcome research [21].…”

The utility of radiologic studies in the diagnosis and management of rhinosinusitis

“…In an attempt to allow the collection of prospective data to compare different treatments, several authors have proposed systems for the staging of rhinosinusitis on CT scans [20][21][22][23][24]. The recommended system for use in outcome research by the task force on rhinosinusitis of the American Academy of Otolaryngologists and Head and Neck Surgeons is the Lund system [25].…”