Lund and Mackay developed a staging system for patients with rhinosinusitis based on clinical and radiological findings. This can be used to monitor the patient prior to and after surgery. The authors are from University College and Charing Cross Hospital in London.
Parameters:
(1) radiological findings
(2) anatomic variants
(3) surgical score
(4) endoscopic appearance
(5) symptom score
|
Radiologic Findings on CT |
Finding |
Points |
|---|---|---|
|
maxillary sinus |
no abnormality |
0 |
|
|
partial opacification |
1 |
|
|
total opacification |
2 |
|
anterior ethmoids |
no abnormality |
0 |
|
|
partial opacification |
1 |
|
|
total opacification |
2 |
|
posterior ethmoids |
no abnormality |
0 |
|
|
partial opacification |
1 |
|
|
total opacification |
2 |
|
sphenoids |
no abnormality |
0 |
|
|
partial opacification |
1 |
|
|
total opacification |
2 |
|
frontal sinus |
no abnormality |
0 |
|
|
partial opacification |
1 |
|
|
total opacification |
2 |
|
ostiomeatal complex |
not obstructed |
0 |
|
|
obstructed |
2 |
radiologic findings score for left side =
= SUM(points for findings on left side)
radiologic findings score for right side =
= SUM(points for findings on right side)
|
Anatomic Changes |
Findings |
Points |
|---|---|---|
|
frontal sinus |
present |
0 |
|
|
absent |
1 |
|
concha bullosa |
absent |
0 |
|
|
present |
1 |
|
paradoxical middle turbinate |
absent |
0 |
|
|
present |
1 |
|
everted uncinate process |
absent |
0 |
|
|
present |
1 |
|
Haller cells |
absent |
0 |
|
|
present |
1 |
|
Agger nasi cells |
absent |
0 |
|
|
present |
1 |
where:
• Haller cells are ethmoid air cells that can project into the medial roof of the maxillary sinus.
anatomic score for left side =
= SUM(points for findings on left side)
anatomic score for right side =
= SUM(points for findings on right side)
|
Surgical |
Findings |
Points |
|---|---|---|
|
uncinectomy |
no |
0 |
|
|
yes |
1 |
|
middle meatal antrostomy |
no |
0 |
|
|
yes |
1 |
|
anterior ethmoidectomy |
no |
0 |
|
|
yes |
1 |
|
posterior ethmoidectomy |
no |
0 |
|
|
yes |
1 |
|
sphenoidectomy |
no |
0 |
|
|
yes |
1 |
|
frontal recess surgery |
no |
0 |
|
|
yes |
1 |
|
reduction of middle turbinate |
no |
0 |
|
|
yes |
1 |
surgical score for left side =
= SUM(points for findings on left side)
surgical score for right side =
= SUM(points for findings on right side)
|
Endoscopic Appearance |
Finding |
Points |
|---|---|---|
|
polyp |
none |
0 |
|
|
confined to middle meatus |
1 |
|
|
beyond middle meatus |
2 |
|
discharge |
none |
0 |
|
|
clear and thin |
1 |
|
|
thick and purulent |
2 |
|
edema |
none |
0 |
|
|
mild to moderate |
1 |
|
|
marked |
2 |
|
scars or adhesions |
none |
0 |
|
|
mild to moderate |
1 |
|
|
extensive |
2 |
|
crusting |
none |
0 |
|
|
mild to moderate |
1 |
|
|
extensive |
2 |
endoscopic score for left side =
= SUM(points for findings on left side)
endoscopic score for right side =
= SUM(points for findings on right side)
Symptom score based on 10 cm VAS (0 absent, 10 extreme):
(1) nasal blockage, congestion and/or pressure
(2) headache
(3) facial pain
(4) problems with smell
(5) nasal discharge
overall symptom score =
= SUM(points for all 5 VAS)
Interpretation:
• minimum radiologic findings score: 0
• maximum radiological findings score: 12 for each side, 24 for both sides
• minimum anatomic findings score: 0
• maximum anatomic findings score: 6 for each side, 12 for both sides
• minimum surgical findings score: 0
• maximum surgical findings score: 7 for each side, 14 for both sides
• minimum endoscopic score: 0
• maximum endoscopic score: 10 for each side, 20 for both sides
• minimum symptom score: 0
• maximum symptom score: 50
Specialty: Otolaryngology, Infectious Diseases, Immunology/Rheumatology
ICD-10: ,
