Correlation between symptoms and radiological findings in patients with chronic rhinosinusitis: an evaluation study using the Sinonasal Assessment Questionnaire and Lund-Mackay grading system

Abstract

Computerised tomography (CT) scans are routinely performed prior to endoscopic sinus surgery (ESS) in order to confirm the diagnosis, assess the response to medical treatment and provide important landmarks for surgery. However, the correlation between the findings of CT scans and the patient's symptoms remains ambiguous. The objective was to assess the correlation between preoperative symptom scores using the validated Sino-Nasal Assessment Questionnaire and CT scores in patients undergoing ESS. Twenty-two patients who attended otolaryngology clinics with chronic rhinosinusitis (CRS) were prospectively enrolled in the study. All of these patients completed Sinonasal Questionnaires (SNAQ) before they had ESS. Their CT scans were scored blindly by the surgeon and a radiologist following Lund-Mackay grading. Patients with high preoperative SNAQ scores had high or low CT scores. The same applied for patients with low preoperative SNAQ scores. There was no statistically significant correlation between SNAQ and Lund-Mackay scores (P = 0.5). However, there was a very strong correlation (P < 0.001) between the scoring of scans by the surgeon and the radiologist, while there was a moderate degree of discrepancy in the grading of anterior ethmoid sinuses and osteo-meatal complexes. Morbidity of patients with CRS cannot be predicted from the magnitude of changes in their CT scans. Significant inter-rater variability exists in the grading of pathological changes in anterior ethmoid sinus and osteo-meatal complex as recorded in CT scans.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Despite its central role in the diagnosis and treatment planning for CRS, sinus CT represents a Ôsnapshot in timeÕ. In CRS, the correlation between a CT scan and symptoms is low to nonexistent (215,216). The most frequently-used scoring system for CT scans in CRS is the Lund-Mackay score (217).…”

Correlations and Comparison between Repeat Computed Tomography Scores, Endoscopy Scores and Symptomatic Improvement before and after Endoscopic Sinus Surgery: A Pilot Study

“…There are conflicting reports about the correlation between symptom, endoscopy scores and CT findings. [11][12][13] It has been hypothesized that patients with worse disease based on CT scan experience greater symptomatic improvement after surgical treatment. There are also many reports from western literature about the symptomatic improvement and success of surgery based on endoscopy, CT and preoperative and postoperative symptom scores.…”

Fibroblast levels are increased in chronic rhinosinusitis with nasal polyps and are associated with worse subjective disease severity

“…Likewise, there have been numerous studies citing the lack of correlation between CT scores and symptomatology. 41,[43][44][45] Continued investigation is warranted into the clinical and investigational utility of different CT scoring measures in CRS.…”