The Pediatric Sinus Staging System: A Computed Tomography– Based Approach to Grading Pediatric Sinus Disease

Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12504 Kathmandu Univ Med J 2013; 43(3):201-205

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Correlation of Clinical Examination with Computer Tomography in Paranasal Sinus Disease

American Journal of Rhinology ◽

10.2500/105065897781751848 ◽

1997 ◽

Vol 11 (3) ◽

pp. 193-196 ◽

Cited By ~ 34

Author(s):

Roy R. Casiano

Keyword(s):

Computed Tomography ◽

Paranasal Sinus ◽

Clinical Examination ◽

Middle Turbinate ◽

Staging System ◽

Sinus Surgery ◽

Clinical Staging ◽

Sinus Disease ◽

Ostiomeatal Complex ◽

Paranasal Sinus Disease

The accuracy of clinical examination in predicting radiologic paranasal sinus disease was investigated. Two hundred forty-seven patients who underwent endoscopic sinus surgery over a 4-year period were clinically and radiologically staged prior to surgery. A clinical staging system was developed utilizing fiberoptic intranasal examination to adequately visualize the anterior and posterior ostiomeatal complex structures with special attention to the mucosal status. The degree to which the clinical staging was able to predict and correlate with radiologic staging and predict the degree of sinus opacification was determined. Clinical and radiological presence of middle turbinate anomalies, septal deviation, and other structural anomalies were also evaluated. Clinical examination correlated well with radiologic examination: 74% sensitivity and 84% specificity). More than 94% of the patients with frank polyp disease had pansinus opacification involving the sphenoid. In the presence of normal mucous membranes, the absence of middle turbinate anomalies correlated with a normal computed tomography. However, with the exception of middle turbinate hypertrophy, the ability to clinically predict concha bullosa or paradoxical curvature was low and did not influence the overall computed tomography result.

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Quantification for Staging Sinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949510410s02 ◽

1995 ◽

Vol 104 (10_suppl) ◽

pp. 17-21 ◽

Cited By ~ 342

Author(s):

Valerie J. Lund ◽

David W. Kennedy

Keyword(s):

Computed Tomography ◽

Chronic Sinusitis ◽

Staging System ◽

Acute Sinusitis ◽

Endoscopic Appearance ◽

Sinus Disease ◽

Endoscopic Findings ◽

Severity Of Disease ◽

Surgical History

A method of quantifying the symptoms, radiologic data, and endoscopic findings in extensive sinus disease is proposed. It is intended to enable clinicians to classify patients with extensive sinus disease according to severity of disease and prognostic category. The rubric of extensive sinus disease, for scoring and staging, comprises recurrent acute sinusitis and chronic sinusitis, but not an isolated episode of acute sinusitis. The method assigns simple numeric scores to specific computed tomography findings, elements of surgical history, presence of defining symptoms of sinusitis, and endoscopic appearance. This quantitative system may be rationalized into a staging system.

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A Comparison of Sinus Computed Tomography (CT) Staging Systems for Outcomes Research

American Journal of Rhinology ◽

10.2500/105065894781874197 ◽

1994 ◽

Vol 8 (6) ◽

pp. 291-298 ◽

Cited By ~ 50

Author(s):

Richard E. Gliklich ◽

Ralph Metson

Keyword(s):

Computed Tomography ◽

Outcomes Research ◽

Staging System ◽

Classification Systems ◽

Rater Agreement ◽

Sinus Disease ◽

Staging Systems ◽

Preoperative Ct ◽

Definition Of ◽

Ct Classification

The success of outcomes research for sinus disease will depend in part on the utilization of a computed tomography (CT) staging system that meets rigorous statistical criteria. Such a staging system must demonstrate an even distribution of population by scale, a high inter-rater and intra-rater agreement, and a low percentage of unclassifiable scans. Four proposed sinus CT classification systems were evaluated for these parameters. Each system was used by four masked raters to rate 42 consecutive preoperative CT scans on two separate occasions. One of these systems is based on the site of disease rather than the degree of sinus opacification and gives a clear definition of sinus disease (2 mm or greater of mucosal thickening). This system had the highest inter-rater agreement (κ = 0.61, range = 0.38 to 0.61) and the lowest percentage of unclassifiable scans (0.6%, range = 0.6 to 14.2%). The statistical attributes of this particular sinus CT staging system support its use for outcomes research in sinus disease.

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