Radiographic stage fails to predict symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis

Objective. To determine whether preoperative computed tomography (CT) stage predicts degree of symptom improvement after endoscopic sinus surgery (ESS). Methods: A series of adult patients undergoing ESS was prospectively evaluated with CT and the rhinosinusitis symptom inventory (RSI) preoperatively and at a minimum of 12 months postoperatively. Symptom domains (nasal, facial, oropharyngeal, systemic, and total) were computed and both absolute change and percentage change in symptom domain scores before and after ESS were correlated with the preoperative CT scan stage according to three staging systems: Lund-MacKay, Kennedy, and Harvard. Results: One-hundred sixty-one patients (mean age, 40.2 years) completed the study with a mean follow-up of 19.4 months. Overall, statistically significant decreases in RSI symptom domains were noted for the nasal (net change -30.1 [range -100 to +100]), facial (-26.1), oropharyngeal (-13.4), systemic (-17.0), and total (-20.8) symptom scores (all P<.001). For the absolute change in total symptom score, no statistically significant correlation with CT stage was demonstrated for any of the staging systems (Lund: Spearman rho=-0.004, P=.962; Kennedy: rho=-0.008, P=.918; Harvard: rho=-0.011, P=.891). Similarly, no significant correlation with CT stage was demonstrated with the other symptom domains. Additionally, no significant correlation was identified between preoperative CT stage and percentage change in symptom domain scores. Conclusions. Although CT scan is widely accepted as an accurate diagnostic tool for chronic rhinosinusitis, CT scan stage alone does not significantly predict symptom outcomes after chronic rhinosinusitis, regardless of staging system utilized.