Total Lund-Mackay Scores Research Articles

Diagnostic criteria for eosinophilic chronic rhinosinusitis: Comparative analysis and novel scoring system.

Accurate identification of eosinophilic chronic rhinosinusitis is essentialg because its treatment and prognosis substantially differ from other subtypes. This retrospective observational study included 640 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis in a single tertiary center from January 2021 to December 2022. Receiver operating characteristic curves were generated to compare accuracy, sensitivity, specificity of the novel scoring system, and previous diagnostic criteria (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis, European Forum for Research and Education in Allergy and Airway Diseases, European Position Paper on Rhinosinusitis and Nasal Polyps, and Sakuma etal.) for predicting eosinophilic chronic rhinosinusitis (ECRS) by tissue eosinophil count ≥70 per high power field. Patients were randomly divided into estimation (n=430) and validation (n=210) groups. The area under the receiver operating characteristic curve for the novel score was 0.753 (95% confidence interval [CI], 0.670-0.835) in the estimation group, 0.729 (0.629-0.830) in the validation group, and 0.661 (0.584-0.738) in the 20-fold cross-validation with the entire dataset. We propose a novel scoring system that incorporates three key parameters: "novel score=blood eosinophil (%) + total Lund-Mackay score of anterior ethmoid sinuses + 2 if nasal polyp present" greater than 7 can be reliably used for diagnosing ECRS. This system can facilitate decision-making processes regarding the administration of oral steroids and biologics targeting type 2 inflammation prior to surgical intervention.

Paranasal sinuses opacification on magnetic resonance imaging in relation to brain health in sporadic small vessel disease – Systematic review and pilot analysis

BackgroundThe paranasal sinus mucosal thickening, visible in magnetic resonance imaging (MRI), maybe a source of inflammation in microvessels, but its relationship with small vessel disease (SVD) is unclear. We reviewed the literature and analysed a sample of patients with sporadic SVD to identify any association between paranasal sinus opacification severity and SVD neuroimaging markers. MethodsWe systematically reviewed MEDLINE and EMBASE databases up to April 2020 for studies on paranasal sinus mucosal changes in patients with SVD, cerebrovascular disease (CVD), and age-related neurodegenerative diseases. We analysed clinical and MRI data from 100 participants in a prospective study, the Mild Stroke Study 3 (ISRCTN 12113543) at 1–3, 6 and 12 months following a minor stroke to test key outcomes from the literature review. We used multivariate linear regression to explore associations between modified Lund-Mackay (LM) scores and brain, white matter hyperintensities (WMH), enlarged perivascular spaces (PVS) volumes at each time point, adjusted for baseline age, sex, diabetes, hypercholesterolaemia, hypertension and smoking. ResultsThe literature review, after screening 3652 publications, yielded 11 primary studies, for qualitative synthesis with contradictory results, as positive associations/higher risk from 5/7 CVD studies were contradicted by the two studies with largest samples, and data from dementia studies was equally split in their outcome. From the pilot sample of patients analysed (female N = 33, mean age 67.42 (9.70) years), total LM scores had a borderline negative association with PVS in the centrum semiovale at baseline and 6 months (B = -0.25, SE = 0.14, p = 0.06) but were not associated with average brain tissue, WMH or normal-appearing white matter volumes. ConclusionThe inconclusive results from the literature review and empirical study justify larger studies between PVS volume and paranasal sinuses opacification in patients with sporadic SVD.

Tissue eosinophilia and computed tomography features in paediatric chronic rhinosinusitis with nasal polyps requiring revision surgery.

Endoscopic sinus surgery (ESS) is an effective and safe treatment modality for medically recalcitrant chronic rhinosinusitis (CRS) in the paediatric population, especially in older children or those with nasal polyposis (CRSwNP). We aimed to elucidate the inflammatory pattern and clinical characteristics of CRSwNP related to revision surgery after ESS in a paediatric population. We retrospectively enrolled 146 patients with bilateral CRSwNP. Twenty-two patients had recurrent nasal polyps that required revision surgery. The clinical characteristics, computed tomography (CT) features, tissue eosinophil count, and immunoactivity of signature cytokines in the two groups were analysed. Tissue eosinophil infiltration and immunoreactivity of eosinophilic cationic protein and IL-5 in the sinus mucosa were higher in patients that required revision surgery. The revision surgery group was significantly younger and had positive aeroallergen test results, higher total Lund-Mackay scores, and ethmoid/maxillary sinus ratio on CT images than those without revision surgery. A nomogram was developed to predict the probability of the requirement of revision surgery according to the logistic regression analysis results. We developed a nomogram model using clinical characteristics, tissue eosinophilia, and CT features for the preoperative identification of patients vulnerable to revision surgery in paediatric CRSwNP. This could help clinicians predict the probability of recurrence and perform intensive postoperative adjunct therapy and follow-up.

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital. MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system. ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020). ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.

SURGICAL TREATMENT OF PATIENTS WITH CHRONIC RHINOSINUSITIS AND NASAL POLYPS UNDER ELECTIVE DENTAL IMPLANTAT PLACEMENT WITH SINUS LIFTING SURGERY

Dental implant placement is widely used method of dentition restoration, and if necessary, is performed with subantral augmentation of bone tissue and can be associated with an increased risk of complications in cases of mucosa alterations. To the disease and patency of the ostiomeatal complex and to minimize the possible risks is the key task when preparing patients with chronic rhinosinusitis and nasal polyps for sinus lifting. The aim of the study is to investigate the effect of shaver polipectomy method in chronic rhinosinusitis and nasal polyps on the outcomes of sinus lifting and the frequency rate of complications. Materials and methods. The study was based on data obtained from 72 patients having chronic rhinosinusitis and nasal polyps, who underwent endoscopic functional sinus surgery according to the principles of sparing effect on the periosteum in the alveolar bay (periosteum-preserving technology). The patients were divided into two groups: I group included 35 patients subjected to shaver polypectomy; II group consisted of 37 individuals operated on by standard conventional method. Results. The average total Lund-Mackay (LM) score before endoscopic rhinosurgery in I group was 14.57±0.52 scores, and 13.32±0.6 scores in the II group. It went down to 4.26±0.38 in I group and to 4.61±0.39 in II group (p <0.05) 3 months after the intervention. In the 6th month of post-surgical follow up there was a significant increase in the total LM score in the patients of II group up to 6.84±0.6 that indicates a more stable result after shaver-assisted sinusotomy. The incidence of sinus lifting complications after endoscopic polypectomy was 24.32±7.05% of cases in the patients of I group compared to the individuals of II group having 2 37.14±8.17% of complicated cases (p <0.05). Sinus lifting and dental implant placement were found out to be effective in all patients of I group and in 94.29±3.92% of patients in the II group. Conclusions. Endoscopic intervention stuck to principles of preserving periosteum and providing appropriate therapeutic support to patients with chronic rhinosinusitis under control allows oral surgeons to perform safe dental implant placement with subantral bone augmentation. Applying shaver-assisted periosteum-preserving technique for surgical treatment of patients with chronic rhinosinusitis and nasal polyps provides a longer clinical effect and reduces the incidence of postoperative complications of subantral bone augmentation by 12.82%.

Is there a relationship between Lund-Mackay scale, olfactory bulb depth and width, and Keros classification in patients with nasal polyps?

Abstract OBJECTIVE. We investigated the relationship between Lund-Mackay scale, olfactory bulb depth and width, and Keros classification in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). MATERIAL AND METHODS. In this retrospective study, paranasal sinus computed tomography (PNSCT) images of 47 patients with CRSwNP and 47 healthy subjects (control) were evaluated. In the CRSwNP group, PNSCT scans were assessed based on Lund-Mackay scale. In both groups, olfactory fossae (OF) depth and width, and Keros classification were evaluated. RESULTS. The total Lund-Mackay score was 17.1±5.9. There were no significant differences between OF depth and width values of the nasal polyps group and control group. For both groups, Type II Keros was the most detected type; secondly, Keros type I and rarely Keros type III were detected. There was no significant correlation between Lund-Mackay score (All items and total score) and OF depth and width, and Keros type. There were negative correlations between ipsilateral OF depth and width (p<0.05), whereas there were positive correlations between contralateral OF depth and width (p>0.05). Keros type was positively correlated between ipsilateral and contralateral OF depth and Keros type (p<0.05). In older patients, left OF depth and Keros type decreased (p<0.05). CONCLUSION. As a conclusion, there was no correlation between Lund-Mackay score and olfactory fossa dimensions (depth and width). When considering age, one could notice that Keros type decreased in older patients.

Analysis of the clinical features of Japanese patients with primary ciliary dyskinesia

ObjectivePrimary ciliary dyskinesia (PCD) is a rare hereditary disease. Most reports of PCD in Japan are case reports, and clinical analysis has not been performed. Differences in the causative genes might affect the clinical features in different ethnic groups. The purpose of this study was to clarify the clinical features of Japanese patients with PCD. MethodsWe performed a retrospective chart review of PCD patients seen at Mie University Hospital and patients whose blood samples were sent to us for genetic analysis from 2011 to 2020. Data on the following items were collected and analyzed: age at first visit to the hospital, age at diagnosis of PCD, process of referral to our facility, chief complaint, situs status, PrImary CiliARy DyskinesiA Rule (PICADAR) score, nasal nitric oxide concentration, otoscopic findings, rhinoscopic findings, and paranasal computed tomography scan findings. ResultsSixty-seven patients (24 male, 43 female) were diagnosed with PCD during the study period. Age at diagnosis ranged from 2 months to 69 years (median, 17 years). Respiratory symptoms (77%) were the most common complaint, followed by nasal (15%) and aural (8%) symptoms. Situs inversus was present in 17 (25%) cases. Only 2 cases had congenital cardiac anomalies. The mean PICADAR score was 7.3 (range, 3–14) points. Approximately 50% of tympanic membranes showed retraction, suggesting otitis media with effusion. The mean Lund-Mackay score was 12.8 (range, 7–17) points, suggesting that the radiographic findings were not always severe. There was no significant difference in the total Lund-Mackay score between patients with and without situs inversus (12.7 vs. 12.6, respectively). ConclusionSitus inversus was present in 25% of Japanese PCD patients, which is much lower than observed in other countries. This is a result of differences in the major disease-causing genes. The general rule that “situs inversus is observed in approximately 50% of PCD patients” cannot be applied, at least, in Japanese PCD patients.

Peripheral blood eosinophil levels in chronic rhinosinusitis and its predictive value in eosinophilic chronic rhinosinusitis

Background The prevalence of eosinophilic CRSwNP in China has increased significantly over the last 20 years, noninvasive methods that could assist in diagnosis are urgently needed. Aims The aim of this study is to explore the clinical significance of peripheral blood eosinophil in diagnosing ECRS. Materials and methods We conducted a prospective study of 221 patients diagnosed with CRS. Lund–Mackay score, peripheral blood eosinophil absolute count, peripheral blood eosinophil percentage were detection to compare the clinical features with ECRS and non-ECRS. ROC curve was performed to assess the efficiency of clinical index to predict ECRS. Results The ECRS group of patients had significantly higher scores compared with those of the non-ECRS group. Different extent and severity of mucosal thickening on total Lund–Mackay scores, anterior ethmoidal, posterior ethmoidal and ostiomeatal complex have confirmed different blood eosinophil levels in CRS patients. The combination of peripheral blood eosinophil percentage and posterior ethmoidal score to predict ECRS was 0.807. Conclusions and significance The increase in peripheral blood eosinophil percent indicates the deterioration the inflammation of chronic rhinosinusitis and the level of posterior ethmoidal score and peripheral blood eosinophil percentage have a positive predictive value regarding ECRS identification.

The impact of nasal airflow on sinus mucosa: A radiographic review

BackgroundChronic rhinosinusitis (CRS) is a disease of widespread prevalence and high morbidity. Many suggest that the introduction of toxins and allergens via nasal airflow plays a significant role in the development of CRS. In patients who have undergone total laryngectomy, nasal airflow is disrupted, providing an opportunity to examine the role of nasal airflow in sinonasal pathology. MethodsAll patients who received a total laryngectomy between 2002 and 2012 with preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. The Lund-Mackay (LM) score for each sinus was recorded for both scans. The assessment of differences in pre-operative and post-operative LM scores was analyzed utilizing paired t-tests. Results56 patients underwent total laryngectomy and had both preoperative and postoperative CT scans. There were no significant differences in the LM scores between pre-operative and post-operative scans within each sinus (frontal sinus, p = 1.0; anterior ethmoid sinus, p = 0.77; posterior ethmoid sinus, p = 0.45; maxillary sinus, p = 0.90; sphenoid sinus, p = 0.63; ostiomeatal complex, p = 0.78) or in the total LM scores (p = 0.97). Furthermore, patients with pre-operative sinonasal mucosal thickening (total LM score > 0) showed no significant change in their total LM score post-operatively (p = 0.13). ConclusionIn total laryngectomy patients, studies demonstrate that a disruption in nasal airflow is correlated to altered sinonasal physiology and decreased subjective symptoms. However, our study shows that the disruption of nasal airflow results in no significant change in radiographic evidence of sinonasal mucosal thickening.

The value of sinonasal CT scan in diagnosing of eosinophilic chronic rhinosinusitis with nasal polyps

Objective: To compare the value of sinonasal CT scan with other clinical parameters in the pre-diagnosis of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP). Methods: From January to May of 2016, One hundred and fifty consecutive CRSwNP patients (90 eCRSwNP and 60 non-eosinophilic CRSwNP) undergoing endoscopic functional sinus surgery in Beijing Tongren Hospital were recruited in this study. Preoperative CT scan, skin prick test (SPT) and oral fractional exhaled nitric oxide (FeNO) measurements were performed in each patient and full blood count with differential analysis was performed within 1 week before surgery. t test and X2 test were used to compare the age, gender, history of surgery, onset of asthma, history of allergy, CT scores' ratio for the ethmoid sinus and maxillary sinus (E/M ratio) and presence of osteoneogenesis of two groups. Mann-Whitney analysis was used to compare the total Lund-Mackay scores, FeNO and blood eosinophil counts of two groups. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to assess the predictive value of clinical parameters. Results: E/M ratio, FeNO, blood eosinophil percentage of eCRSwNP group was significantly higher than those of non-eosinophilic CRSwNP group [3.56±0.37 vs 1.80±0.10, (34.4±18.1) μg/L vs (22.1±11.7) μg/L, 8.19%±1.50% vs 4.55%±5.60%; χ(2) value was 0.900; t value was 0.994 and 0.900, respectively; all P<0.05]. E/M ratio had the highest predictive value, with area under curve (AUC) value of 0.938. The cut-off point of 2.59 for E/M ratio demonstrated a sensitivity of 94.3% and a specificity of 89.6% for eCRSwNP. Conclusion: The E/M ratio is a more useful predictor in the diagnosis of eCRSwNP compared to other clinical parameters.

Predictive significance of computed tomography in eosinophilic chronic rhinosinusitis with nasal polyps.

Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP), characterized by eosinophil-predominant inflammation in mucosa, is a subject of much investigation. However, no satisfactory atraumatic clinical parameter has been established to date for prediagnosis of this condition. The aim of this study was therefore to compare the use of computed tomography (CT) scans with other clinical parameters in prediagnosis of eCRSwNP. This was a prospective cohort, single-institution study. Two hundred consecutive CRSwNP patients (123 eCRSwNP and 77 non-eosinophilic CRSwNP [neCRSwNP]) undergoing functional endoscopic sinus surgery in Beijing TongRen Hospital were recruited. Preoperative CT scan, skin-prick test (SPT), and oral fractional exhaled nitric oxide (FENO) measurements were performed in each patient and full blood count with differential analysis under the patients' regular condition was performed within 1 week before surgery. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to assess the predictive value of clinical parameters. History of surgery, onset of asthma, history of allergy, total Lund-Mackay scores, presence of osteoneogenesis, FENO, and blood eosinophil counts were all significantly higher in the eCRSwNP group, compared to the neCRSwNP group. The ratio of the CT scores for the ethmoid sinus and maxillary sinus (E/M ratio) had the highest predictive value, with an area under the ROC curve (AUC) of 0.938. The cutoff point of >2.59 for E/M ratio demonstrated a sensitivity of 94.2% and a specificity of 89.6% for eCRSwNP. The E/M ratio is a more useful predictor in diagnosis of eCRSwNP compared to the other clinical parameters.

Predictive factors in patients undergoing endoscopic sinus surgery for odontogenic sinusitis.

Odontogenic sinusitis (OS) presents a therapeutic dilemma. Evidence is lacking whether dental treatment alone is sufficient or whether patients will eventually require endoscopic sinus surgery (ESS). Our aim was to identify predictors of OS patients undergoing ESS. Retrospective review performed of OS patients (n = 43) analyzing multiple factors including age, sex, symptoms, prior dental procedures, treatment, diabetes, immunosuppression, smoking history, retained dental hardware, oral-antral fistula (OAF), and Lund-Mackay scores (LMSs). Descriptive statistics, Wilcoxon rank sum, and logistic regression analyses were performed. Common presenting symptoms included facial pressure, discolored nasal drainage, and foul smell/taste. Half of patients presented either after a recent dental procedure or with dental complaints. Forty-eight percent required ESS after failing medical and dental therapy alone. Total LMS was significantly higher in the group undergoing ESS (8.3 vs 3.7; p = 0.0003). Multivariate analysis showed 2 significant predictors of undergoing ESS: (1) OMC involvement (OR 37.3, p = 0.003) and prior dental procedure (OR 7.4, p = 0.03). All patients with OAF or retained dental hardware required ESS. Forty-eight percent of patients who presented with OS underwent ESS for symptom control and prevention of complications. Patients who underwent ESS had significantly higher total LMS than those who did not. In multivariate analysis, prior dental procedures and OMC involvement significantly increased the likelihood of requiring ESS.

Long-term radiological findings after endonasal endoscopic approach to the skull base

ObjectiveTo study the long-term radiological findings after endonasal endoscopic approach to the skull base. Material and methodsProspective study that included 55 patients who underwent advance endoscopic skull base surgery. All patients were evaluated with MRI before, 3months and 12months after surgery. We used the Lund–Mackay staging system for chronic rhinosinusitis to evaluate the paranasal cavities and the sinonasal scoring system to assess sinonasal symptoms. ResultsSeventeen patients (30.9%) underwent extended endonasal approach that required a nasoseptal flap (NSF) for reconstruction of skull base. At baseline the mean total Lund–Mackay score was 0.63±1.2 (range 0–4), and at 3 and 12months postoperatively the mean scores were 3.5±3.8 (range 0–14) and 2.0±2.5 (range 0-8) respectively. Patients who needed an NSF for reconstruction had a greater Lund–Mackay score (p<0.05). Moreover, NSF is correlated with sinonasal mucosal thickening and fluid retention at 3months (r=0.45, p<0.01) and 12months (r=0.4, p<0.01). Total 5-symptom score (T5SS) was similar between both groups at baseline. Patients with extended endoscopic approach reported more smell loss (40.1±26.2; p<0.05) and posterior nasal discharge (49.3±30.1; p<0.05) than TTEA patients (21.6±30.9 and 22.5±27.5 respectively). ConclusionsWe observed that sinus opacity is still present after one year of advance endoscopic skull base surgery but symptoms seems to return to basal after 12months of follow-up.

Incidence of neoplasia in patients with clinically suspicious nasal lesions and the value of computed tomography imaging in diagnosis.

There is no consensus as to whether all routine bilateral polypectomy specimens should be sent for formal histopathological diagnosis to exclude underlying neoplastic pathology. This study assessed the necessity for histopathological investigation as routine practice in cases of bilateral and unilateral nasal lesions by estimating the incidence of unexpected pathologies. It also evaluated the ability of computed tomography to predict histopathological diagnosis in patients with unilateral nasal lesions. A retrospective analysis was conducted of 98 patients undergoing nasal polypectomy over a 12-month period. Five of 23 patients with a unilateral lesion on nasendoscopy had inverted papillomas on histopathological examination. None of the 75 patients with clinically bilateral lesions on nasendoscopy showed evidence of neoplasia on histopathological examination. Patients with inverted papillomas had significantly lower total Lund-Mackay scores than those with bilateral polyps. Asymmetry scores of inverted papilloma patients were significantly higher compared to both bilateral and unilateral polyps patients. The results suggest that histopathological diagnosis is only necessary in unilateral lesion patients as no unexpected histopathological diagnoses were made in bilateral lesion patients. Computed tomography imaging may have a role in predicting histopathological diagnosis by demonstrating asymmetry and less overall sinus opacification in patients with neoplastic lesions.

Sinus Disease following Total Laryngectomy: A Radiographic Review

Objectives: (1) Compare the incidence of radiographic sinus disease before and after laryngectomy by retrospective analysis of preoperative and postoperative computed tomography (CT) scans. (2) Analyze the change in pre-existing radiographic sinus disease via a subset analysis. Methods: A single-institution retrospective chart review was conducted. Patients who received a total laryngectomy or total laryngopharyngectomy between 2002 and 2012 with preoperative and postoperative CT scans were included. The Lund-Mackay (LM) Scores for each sinus as well as the total LM score were recorded for both scans. The assessment of differences in these scores is based on McNemar’s statistic for each sinus and on a paired t-test for the total LM score. Results: Surgical removal of the larynx creates an anatomical disconnect between the sinonasal cavity and distal respiratory tract. Normal nasal airflow is disrupted, resulting in alterations to the nasal mucosa, mucociliary clearance, and nasal flora. While the incidence of sinonasal disease in patients undergoing total laryngectomy has been studied via subjective scoring methods, this study is the first to evaluate radiographic sinusitis via an objective measure by comparing Lund-Mackay scores before and after total laryngectomy. There were no significant differences in the LM scores between preoperative and postoperative scans within each sinus ( P value &gt;.05) or in the total LM score ( t statistic &gt;0.56). Conclusions: In patients undergoing total laryngectomy, disruption in nasal airflow has been correlated with altered sino-nasal physiology and decreased subjective symptoms. However, our study shows no significant change in radiographic evidence of sinonasal disease after laryngectomy.

Is there any relationship between the clinical, radiological and histopathologic findings in sinonasal polyposis?

The aim of this study was to assess the relationship between clinical, radiological and histopathological findings in nasal polyposis. This was a retrospective study of 85 patients with nasal polyposis who were treated by endoscopic sinus surgery between the years of 2005 and 2010. All patients underwent preoperative paranasal sinus Computerized Tomography scan in the coronal plane and these images was evaluated with Lund-Mackay scores. The biopsy materials diagnosed as nasal polyp were identified by archive scanning at the pathology department. The Haematoxylin-Eosin stained preparations of the biopsy materials were re-evaluated. All of the results were analyzed by using the SPSS 13.0 soft ware program. Statistical significance was determined as p-value < 0.05. When the patients with (16.4%) and without (83.6%) bronchial asthma were compared regarding the eosinophil, lymphocyte, neutrophil, macrophage, mast cells and goblet cells/ epithelial cell rate, no statistical significance was found (p > 0.05). There was a positive relationship between the preoperative complaint durations and the total Lund-Mackay scores (r=0.270, p=0.012). The neutrophil amount (16.53 ± 19.87) on the preparations of the patients with metaplasia was higher than the neutrophil amount (8.71 ± 23.98) on the preparations of the patients without metaplasia (p=0.001). Radiologically, there was a positive correlation between the infiltration of anterior-posterior sinuses by the polyp tissues and the Lund-Mackay score of the nasal cavity. There was a positive correlation between preoperative complaint duration and squamous metaplasia; and there was also a positive correlation between the preoperative complaint duration and the total Lund-Mackay score. There was no histopathological difference between the polypoid infiltration of the front and rear group sinuses.

Validating the Use of Report-Derived Lund-MacKay Scores

The Lund-MacKay score (LMS) is the standard for communicating radiological extent of chronic rhinosinusitis in research. However, retrospective analyses are often hindered by a substantial lack of radiological data. Calculating LMS from radiologists' reports may overcome this but has not been formally validated. Twenty South Australian and 20 Texan patients with varying degrees of sinus disease were randomly chosen to undergo analysis. CT-derived LMSs were calculated directly by two expert rhinologists at each institution and compared with scores derived solely from accompanying radiology reports by two blinded reviewers. The total LMS obtained via the expert rhinologists correlated very highly with that obtained from radiology reports (Spearman rank correlation, 0.75-0.88; p < 0.001). However, when individual sinuses were specifically analyzed, the correlation was highly variable. The results show that in both South Australian and Texan tertiary rhinology centers, radiologists' reports can be reliably used to calculate the total LMS.

Are maxillary mucosal cysts a manifestation of inflammatory sinus disease?

The aetiology of maxillary mucosal cysts is uncertain. Chronic rhinosinusitis has been proposed as a probable aetiological explanation for their formation. We recruited 500 consecutive patients who had undergone computed tomography scanning of the paranasal sinuses for possible chronic sinus disease. We identified 110 (22 per cent) cases of maxillary mucosal cysts. Patients' mean age was 42.65 years, with a female to male ratio of 0.69:1 (45:65). The mean cyst size was 14.27 mm, and most were located on the inferior surface of the antrum. Only in two cases did the cyst obstruct the sinus ostium. Of patients with antral cysts, 52.7 per cent had computed tomography evidence of sinus disease, whereas only 41.3 per cent of noncyst (control) patients had sinus pathology. The total Lund-Mackay score was significantly greater in the cyst group (n=390) compared with the noncyst group (Mann-Whitney; p<0.05). Chronic rhinosinusitis plays an important role in the aetiology of maxillary mucosal cysts.

Lack of Significant Correlation between Rhinosinusitis Symptoms and Specific Regions of Sinus Computer Tomography Scans

The sinonasal computer tomography (CT) scan is frequently used to help confirm the diagnosis of rhinosinusitis. However, little data exist correlating patient symptoms with CT findings. Immediately preceding CT of the sinuses, 94 subjects without evidence of trauma, nasal tumors, or previous sinus surgery completed the Rhinosinusitis Outcome Measure 31 symptom questionnaire and were asked to locate areas of facial pain or pressure. CT scans were graded according to the Lund-MacKay system, and agger nasi and ethmoid bulla cells were measured. Data from CT scans and symptom/pain questionnaire responses were analyzed for significant correlations. No correlation was identified when comparing total Lund-MacKay scores, opacification of individual sinuses, and size of the agger nasi and ethmoid bulla cells with the Rhinosinusitis Outcome Measure 31 subset scores and areas of facial pain or pressure. The sinus CT scan is a necessary tool for preoperative planning; however, it should not be used to predict symptoms or to localize areas responsible for facial pain or pressure.