A Surgical Staging System for Chronic Sinusitis

The application of new technology over the past decade has brought a considerable increase in the volume of paranasal sinus surgery, especially for ethmoid sinus disease. Most literature reports have included patients with widely disparate clinical problems, which makes interpretation and/or prediction of clinical results less meaningful. A set of clinical criteria is proposed to provide a preoperative staging system for patients with paranasal sinus disease. This is backed by clinical results of several hundred patients who have undergone various sinus surgical procedures. Clinical factors used in staging include the anatomic extent of the sinus/nasal disease (as determined both by endoscopic examination and radiographic studies), previous sinus surgical history, presence and extent of polyps (again determined both by endoscopic examination and radiographic studies), presence and severity of immunologic disease (including allergic rhinitis), and the state of control of infection within the sinuses. This staging system can be used to guide procedure selection and in preoperative discussions of likely results. Use of such a system can also promote better scientific analysis of variations in technique.