A Comparison of Symptom Scores and Radiographic Staging Systems in Chronic Rhinosinusitis

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Abstract
Background: The aim of this study was to determine if one of the popular computed tomography (CT) scan staging systems exhibits better correlation with sinonasal symptom severity in chronic rhinosinusitis (CRS). Methods: Adult patients meeting diagnostic criteria for CRS were prospectively studied with the Rhinosinusitis Symptom Inventory and their paranasal sinus CT scan was staged according to the Kennedy, Harvard, and Lund staging systems. From the Rhinosinusitis Symptom Inventory, Likert symptom severity scores were obtained and the nasal, facial, oropharyngeal, systemic, and total symptom scores were computed. Correlation analysis was conducted between symptom scores and CT scan stage for each of the three staging systems. Results: Two hundred patients met inclusion criteria (mean age, 41.1 years; 42% men). The mean Lund score for the entire cohort was 10.0 (SD, 5.3). The Kennedy stage distributions were 40, 42, 84, and 34 patients for stages 1–4, respectively. The Harvard stage distributions were 17, 53, 85, and 45 patients for stages 1–4, respectively. All three staging systems exhibited statistically significant Pearson correlation (all p < 0.001) for the nasal symptom domain (nasal obstruction, rhinorrhea, and hyposmia), although the magnitude of the correlation coefficient generally was small (range of Pearson's r, 0.242–0.345). The Kennedy and Harvard systems exhibited significant but negative correlation with the oropharyngeal symptom domain. All three staging systems failed to significantly correlate CT stage with facial symptoms, systemic symptoms, and total symptom scores. Conclusion: The Lund staging system exhibited the best correlation between nasal symptom scores and CT stage in CRS, but the degree of correlation remained small. All three systems were lacking in staging value for nonnasal sinonasal symptoms.