New CT-based score helps predict need for repeat sinus surgery

A new CT-scan based risk score facilitates the identification of patients at risk of revision endoscopic sinus surgery due to chronic rhinosinusitis.

This allows for early prediction of disease progression and planning of further treatment."

Professor Sanna Toppila-Salmi, University of Eastern Finland

The results of the Finnish multi-center study were published in Clinical and Translational Allergy.

Symptoms of chronic rhinosinusitis, i.e., inflammation of the nasal and sinus cavities, include nasal congestion, mucus secretion and a feeling of pressure. In the polypoid form of the disease, mucosal protrusions, or polyps, block the nasal and sinus cavities. The severe form of the disease is often associated with asthma or NSAID-exacerbated respiratory disease, N-ERD.

The disease is treated with nasally administered corticosteroids and, in the case of the polypoid form and as the diseases progresses, also with orally administered corticosteroids. If these treatments are insufficient, endoscopic sinus surgery can be considered.

Initial surgery is routinely preceded by a computed tomography scan, a CT scan, which generates CT slice images of the head. In the present study, the researchers used a new risk score that is based on CT slice images to assess the risk of revision surgery. In the new sinonasal radiological score, or the SR score for short, indicators of a high risk of revision surgery include non-detectable anatomy of the nasal turbinates, which is often associated with polypoid mucosal swelling, as well as obstructed drainage of the frontal sinus.

The existing Lund-Mackay scoring of CT scans, or the LM score for short, is based on inflammatory findings in the sinus mucosa, and on the obstruction of the maxillary sinus draining pathway. "The present study shows that the new SR score, together with the old LM score, is increasingly accurate at predicting relapse and risk of revision surgery in patients who have undergone surgery following a CT scan, regardless of the surgical method used," Toppila-Salmi says.

In addition, conditions such as asthma and N-ERD increase the risk of revision surgery. If the disease cannot be managed with conventional medical and surgical treatments, biologics, among other drugs, may be considered as well, following a risk assessment.

The study included 483 patients with chronic rhinosinusitis, 85 of whom underwent endoscopic sinus surgery in one year's time following their CT scan. During the follow-up, 28 per cent of these patients underwent revision surgery.

The study was conducted in collaboration between the University of Eastern Finland and the University of Helsinki, and a number of hospital districts across Finland.