Wednesday, May 2, 2012

2 staging systems for chronic signs of sinus infection

Staging systems group different chronic rhinosinusitis phases, enabling treatment comparison.  An array of staging systems has been developed to record chronic sinusitis and outcome of medication. A standardized reporting system and staging system would enhance reliability of scientific communication. However, the standardized staging system is still a dream.
In the past, staging systems tried to measure severity of disease and took into account related conditions such as polyposis, allergy and asthma. These systems have been revised and improved. For instance, in the beginning of 1990s, Kennedy proposed an improved staging system.




Kennedy’s staging system
The system emphasizes on postoperative endoscopic follow-up to collect patient data. Since recurrent signs of sinus infection can be observed during nasal endoscopy, the recurrent disorder can be treated in the initial stage by using medication or surgical debridement. The system was rated high for its predictive and prognostic merits. With this system, the patients’ conditions can be compared without considering miscellaneous agents.
The system is mainly based on extent of the disease. Kennedy used intra-operative and radiographic data to measure the extent of the disease while defining the staging system. The system consists of four patient categories and stages based on severity of the disease. The Stage I incorporates anatomic defects, unilateral sinus disorders and bilateral disorder of the ethmoid sinuses. The Stage II focuses on bilateral ethmoid sinus disorder, in which one dependent sinus is involved. The Stage III covers bilateral ethmoid sinus problems, in which at least two dependent sinuses are involved. The Stage IV represents diffuse sinonasal polyposis.
Lund-MacKay staging system
Recently, the Rhinosinuistis Task Force approved revised version of the Lund-MacKay staging system to document research work. Initially, the Lund system used quantitative results of the computed tomography (CT) scan. However, the Task Force suggested incorporating endoscopic appearance, symptom score, surgery score, information about variation in anatomy and demographic data.  Radiological staging score of all four pairs of the sinuses and ostiomeatal complex is taken into account in the Lund system.
The endoscopic appearance measures characteristics at baseline, after 3 and 6 months, and 1 and 2 years. The characteristics evaluated include left and right polyp, edema, discharge, scarring and crusting. Anatomic variants, including agger nasi cells, Haller cells, everted uncinate process, paradoxic middle turbinate, concha bullosa and absent frontal sinus, are graded radiologically. The demographic data suggested by the Task Force includes anesthetic duration, systemic and nasal diagnosis, complications, surgery date, surgeon details, operation, and patient’ name, gender, age and date of birth.
Kennedy vs. Lund
The Kennedy System is based on the extent of disease, assessed using endoscopic surgical and CT findings.  The Lund Mackay system uses findings of the objective endoscopy and CT scans, and visual analogue scale, which is subjective.
Therapy’s compatibility with endoscopic methods, extent of operative and radiological disorder, comorbidity and several other prognostic factors have been suggested for objective assessment of chronic signs of sinus infection and selecting the best management method and therapy.

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