STAGING OF CHRONIC HYPERPLASTIC RHINOSINUSITIS - TREATMENT STRATEGIES

In 1990 we reported an initial prospective study of 100 patients using a four-stage system for classification of chronic rhinosinusitis. Bet ween January 1988 and July 1992, we used this system in staging an add itional 1814 patients, on whom 2980 intranasal sphenoethmoidectomies w ere performed. In this staging system a protocol trial of medication w as given for 2 weeks, followed by axial and coronal computed tomograph y, Medication consisted of a second-generation cephalosporin antibioti c, usually cefuroxime; a 4-day burst of intraoral steroids, usuary pre dnisone; and an antihistamine decongestant if not contraindicated. The stages of chronic hyperplastic rhinosinusitis included the stages des cribed in the 1990 report (i,e., stage I, single-focus disease; stage II, discontiguous disease throughout the ethmoid labyrinth; stage II, diffuse disease responsive to medication; and stage TV, diffuse diseas e unresponsive to or poorly responsive to medication), The results of this study have shown that the computed tomography staging system base d on computed tomography extent of disease after medical therapy is a simple, easily remembered, and very effective modality for the classif ication of chronic sinusitis. This system provides a rationale for dis cussing and planning surgery with patients and physicians and is a con venient reference for the reporting of end results. More importantly a lineal relationship between disease stage and outcomes is demonstrate d. This statistically highly significant feature of the staging system provides a firm basis for the production of outcomes after various tr eatment strategies, particularly ethmoidectomy and the treatment of si nusitis.