Objective Outcomes in Endoscopic Sinus Surgery

Use of endoscopes in the sinonasal cavity dates as far back as the turn of the 20th century with Hirschmann and Reichert performing the first sino-endoscopies and sinus surgeries, respectively. Widespread use was limited until H.H. Hopkins helped address illumination difficulties with the rod optic system in the 1960s and Walter Messerklinger began systematic use of the endoscope to evaluate the lateral nasal wall and mucociliary clearance in the late 1970s (Lee & Kennedy 2006). With the advent of modern endoscopic sinus surgery instruments and techniques in the 1980s, the endoscope has radically altered the surgical approach and management of inflammatory and neoplastic sinonasal disease rendering many of the open approaches nearly obsolete. Successful outcomes in endoscopic sinus surgery have often been largely based on subjective qualifiers by the patient. Significant improvements in patient perceived nasal congestion, obstruction, facial pressure, rhinorrhea, headache, postnasal drainage have been the impetus for the widespread growth of functional endoscopic sinus surgery, while modest improvements in olfaction, taste, allergic symptoms and tooth pain have also been reported. (Lee & Kennedy 2006). Some objective measures of outcomes previously proposed include acoustic rhinometry, mucociliary measures using saccharine transit times and ciliary beat clearance, and olfactory thresholds using butanol testing and the UPSIT-University of Pennsylvania Smell Identification Test (Min et al 1995; Lund & Scadding 1994). Radiologic evidence of polyp disease on CT scanning has also been studied with validated scoring systems, but with poor correlation with clinical symptoms and as such a poor indicator of outcomes (Newman et al 1994; Friedman 1990; Giklich 1994; Jorgensen 1991; Browne et al 2006; Newton & Ah-See 2008). Increasingly, the rhinologic community looks to standardized objective endoscopic measures in scientific communications to evaluate success in managing sinonasal disease. These various grading schemes have been targeted at eliciting objective reproducible measures of: (1) polyp grade, (2) sinus cavity status, and (3) surgical field visibility. We present the first complete review of all objective published endoscopic scoring schemes for sinonasal disease.