Staging System for Classifying Candidates for Endoscopic or Classic Sinus Surgery by Computed Tomographic and Physiologic Response Criteria

Abstract

At the national spring meeting of the American Rhinologic Society in Waikaloa, Hawaii, William Friedman, MD, St Louis, Mo, discussed his rationale for a computed tomographic (CT)—and physiologic-based staging system for assessing management of chronic hypertrophic rhinosinusitis, whether handled classically, endoscopically, combined, or by any surgical rationale. Based on a 2278-case experience with classic endonasal sphenoethmoidectomy since 1965, Dr Friedman developed his staging system and modified it in light of 1110 surgeries performed since 1987 with the benefit of endoscopic augmented technique. Basically, Dr Friedman argues that defining results in sinus disease management should be as objective as possible and can be reported based on radiographic and clinical response staging, rather than just subjective improvement of symptoms. Dr Friedman's staging system is clear, comprehensive, easily remembered, and simple to apply to individual cases. The system's criteria employ both the preoperative CT scan and physiologic response history to medication. Stage