Modified Lund Mackay Postoperative Endoscopy Score for defining inflammatory burden in chronic rhinosinusitis
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Published on: June 20, 2018
Objective:
The Lund Mackay Postoperative Endoscopy Score (LMES) for chronic rhinosinusitis (CRS) is a poor measure of the patient experience. A proposed Modified Lund Mackay Postoperative Endoscopy Score (MLMES) aims to better describe the inflammatory burden in CRS.
Methods:
A prospective study on CRS patients having endoscopic sinus surgery (ESS) was conducted. Endoscopy was recorded at the 6th and the 12th week post-op. The MLMES recorded changes in mucosa, mucus and purulence for each of the maxillary, ethmoid, sphenoid, frontal sinuses and olfactory fossa in post-ESS cavities. The correlation between MLMES and visual analogue scale of total rhinosinusitis symptoms, global anchor score of nasal function, Sino-Nasal Outcome Test 22 (SNOT-22) and nasal symptom score was analyzed. The inter-observer reliability, intra-observer reliability and correlation between the change in MLMES and in subjective measures were also investigated.
Results:
Thirty patients were assessed. The MLMES significantly correlated with visual analogue scale, SNOT-22, global anchor and nasal symptom score. The change in MLMES correlated with the change in SNOT-22 and nasal symptom score. The inter-observer and intra-observer reliability were excellent.
Conclusion:
Objectives measurements for post-ESS patients can be reconsidered to represent the cumulative inflammatory burden of all sinuses. The proposed MLMES represents total sinus inflammatory burden and correlates well with patient reported outcome measures.
Insights
The Modified Lund Mackay Postoperative Endoscopy Score (MLMES) effectively measures chronic rhinosinusitis (CRS) inflammatory burden after surgery. This new score correlates well with patient-reported outcomes, offering a better assessment than the original LMES.
Area of Science:
- Otolaryngology
- Rhinology
- Surgical Outcomes
Background:
- The Lund Mackay Postoperative Endoscopy Score (LMES) has limitations in assessing patient experience in chronic rhinosinusitis (CRS).
- A need exists for objective measures that better reflect the inflammatory burden post-endoscopic sinus surgery (ESS).
Purpose of the Study:
- To introduce and validate a Modified Lund Mackay Postoperative Endoscopy Score (MLMES) for CRS.
- To evaluate the correlation between the MLMES and patient-reported outcome measures (PROMs).
- To assess the reliability of the MLMES in a postoperative setting.
Main Methods:
- A prospective study involving 30 CRS patients undergoing ESS.
- Endoscopic evaluation at 6 and 12 weeks post-surgery using the MLMES, recording mucosal changes, mucus, and purulence.
- Correlation analysis with visual analogue scale, global anchor score, Sino-Nasal Outcome Test 22 (SNOT-22), and nasal symptom score.
- Assessment of inter-observer and intra-observer reliability.
Main Results:
- The MLMES demonstrated significant correlations with visual analogue scale, SNOT-22, global anchor score, and nasal symptom score.
- Changes in MLMES correlated well with changes in SNOT-22 and nasal symptom score.
- Excellent inter-observer and intra-observer reliability were achieved for the MLMES.
Conclusions:
- The MLMES provides an objective measurement of total sinus inflammatory burden in post-ESS patients.
- The MLMES shows strong correlation with PROMs, suggesting it is a valuable tool for assessing CRS outcomes.
- The MLMES is a reliable and improved objective measure for evaluating postoperative CRS management.
