Global Osteitis Scoring Scale and chronic rhinosinusitis: a marker of revision surgery

Abstract

Clin. Otolaryngol. 2010, 35, 455–461 Objectives: Determine the incidence and severity of osteitis in patients with chronic rhinosinusitis using a new Global Osteitis Scoring Scale. Design: Validation and prospective case–control study. Setting: Academic Tertiary Otolaryngology Department (Academic Medical Centre, Amsterdam). Participants: A prospective series of 102 patients undergoing a computed tomography (CT) sinuses as part of their evaluation for chronic rhinosinusitis between January and May 2008 (study group) and an age‐ and gender‐matched control group of 68 non‐rhinosinusitis patients. Seventy‐eight of the chronic rhinosinusitis patients completed the nasal subset of the RhinoSinusitis Outcome Measure (RSOM‐31) and visual analogue scales. Their CT scans were assessed for osteitis using a newly developed Global Osteitis Scoring Scale. A subsample of 35 scans were additionally scored by a second otolaryngologist and a radiologist. Main outcome measures: Global Osteitis Scoring Scale. Results: The interrater variability of Global Osteitis Scoring Scale was low (average intraclass correlation coefficient: 0.94). Forty per cent of the chronic rhinosinusitis group and none of the control group had evidence of clinically significant osteitis. In the chronic rhinosinusitis group (102 patients), the severity of osteitis was correlated with Lund–Mackay (L–M) score (P < 0.001), duration of symptoms (P < 0.01) and previous surgery (P < 0.001), rising in incidence with increasing number of previous operations. There was no association between osteitis and age, gender, smoking, co‐existing asthma, allergy or Sumpter’s triad. Additionally, there was no correlation between osteitis and symptom burden including headache, facial pain and nasal subset score of the RhinoSinusitis Outcome Measure. Conclusion: In patients with recalcitrant chronic rhinosinusitis who have undergone multiple surgeries in the past, the incidence of osteitis can be as high as 64%. It does not seem to be associated with more troublesome symptoms; however, it is strongly associated with previous sinus surgery, which may be a manifestation of a shared endpoint (underlying recalcitrant disease).

Frontal ostium neo‐osteogenesis and patency after Draf III procedure: a computer‐assisted study

“…AERD was diagnosed via nasal/bronchial provocation with lysine aspirin. The Lund-Kennedy score (LKS) 6 was used to assess the endoscopic severity of disease, while the LundMackay score (LMS) 7 and Global Osteitis Scoring Scale (GOSS) 8 were used to assess the radiologic extent of disease. GOSS assesses bone thickness, the extent of involvement of each sinus, and the number of sinuses involved.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…401,402 A variety of grading systems using CT imaging have also been proposed, including the Kennedy Osteitis Score, Global Osteitis Scoring Scale (GOSS), scoring based upon Hounsfield units (HU), thickness of bony partitions, as well as systematic examinations of separate reference points in the sinuses. 387,389,392,403,404 As with diagnostic testing for osteitis, these grading systems have not been standardized.…”

Refractory Chronic Rhinosinusitis: Etiology & Management

“…The association between osteitis and number of previous surgery remained strong even after adjusting for the disease duration. There was no association between osteitis and age, gender, smoking, co-existing asthma, allergy or Sumter's triad (Georgalas et al 2010) Osteitis and neo-osteogenesis may also affect the success rate after sinus surgery. Kim et al studied the correlation between pre-operative bony changes detected in CT scan and postoperative endoscopic signs of healed sinus cavities in 81 patients.…”

“…Pathological changes described by human histological studies included: the presence of new bone formation, fibrosis, inflammatory cells, periosteal thickening and a varying degree of increased osteoblastic-osteoclastic activity, as shown by the disruption of organised lamellar bone and formation of immature woven bone, these are best to fit under the terms ostitis and neo-osteogesis. Localized or generalized thickened, irregular, heterogeneous lining of the sinus walls, is the radiological sign observed in CT scan, as illustrated in Figure 2 (Georgalas et al, 2010).…”