The Lund‐Mackay staging system for chronic rhinosinusitis: How is it used and what does it predict?

TLDR

The Lund‑Mackay score is widely used in assessment of chronic rhinosinusitis. We aimed to describe its relationship to other measures of pre‑ and post‑treatment health status. Multicenter prospective study of 1840 patients undergoing surgery for chronic rhinosinusitis in the UK. The study found that higher Lund‑Mackay scores predict more extensive surgery, correlate with disease severity markers and symptom improvement, but not with SNOT‑22 scores, and are linked to higher complication and revision rates, highlighting both its predictive value and limitations.

Abstract

Objectives The Lund‐Mackay score is widely used in assessment of chronic rhinosinusitis. We aimed to describe its relationship to other measures of pre‐ and post‐treatment health status. Study Design Multicenter prospective study of 1840 patients undergoing surgery for chronic rhinosinusitis in the UK. Results There was no absolute threshold for surgery, but patients with higher Lund‐Mackay scores underwent more extensive surgery. There was no correlation between Lund‐Mackay and SNOT‐22 scores. The Lund‐Mackay increased with increasing grade of polyposis. The Lund‐Mackay score was associated with symptom reduction (coefficient = 0.24, P = 0.02) complication rates (odds ratio, 1.08, 95%CI 1.06 to 1.1), and revision rates (odds ratio, 1.03, 95% CI 1.001 to 1.06). Conclusions The Lund‐Mackay score measures a different aspect of disease to “subjective” symptom scores. However, it correlates well with other markers of disease severity, the nature of surgery offered, and its outcome. Significance This demonstrates the strengths and limitations of a commonly used staging system.