Nasal endoscopy score thresholds to trigger consideration of chronic rhinosinusitis treatment escalation and implications for disease control

February 26, 2025

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Publicated to:Rhinology. 63 (1): - 2025-01-01 63(1), DOI: 10.4193/Rhin24.291

Authors: Sedaghat, Ahmad R; Cotter, Ryan A; Alobid, Isam; Alsaleh, Saad; Anselmo-Lima, Wilma Terezinha; Bernal-Sprekelsen, Manuel; Chandra, Rakesh K; Constantinidis, Jannis; Fokkens, Wytske J; Franzese, Christine; Gray, Stacey T; Halderman, Ashleigh A; Holbrook, Eric H; Hopkins, Claire; Hwang, Peter H; Kuan, Edward C; Landis, Basile N; Lund, Valerie J; Mccoul, Edward D; Niederberger-Leppin, Verena; O'Brien, Erin K; Philpott, Carl M; Pletche, Steven D; Pynnonen, Melissa A; Rimmer, Joanne; Toppila-Salmi, Sanna; Wang, Eric W; Wang, Marilene B; Wise, Sarah K; Woodworth, Bradford A; Yao, William C; Phillips, Katie M

Affiliations

Aristotle Univ Thessaloniki, AHEPA Hosp, Dept ORL Head & Neck S 1urg, Thessaloniki, Greece - Author

Barcelona Univ, Hosp Clin, ENT Dept, CIBERES,Rhinol & Skull Base Unit,August Pi i Sunye, Barcelona, Spain - Author

Emory Univ, Dept Otolaryngol Head & Neck Surg, Atlanta, GA USA - Author

Great Yarmouth & Norfolk & Norwich Univ Hosp, James Paget Univ Hosp, Norwich, England - Author

Guys & St Thomas Hosp, Dept Otolaryngol & Head & Neck Surg, London, England - Author

Harvard Med Sch, Massachusetts Eye & Ear Infirm, Dept Otolaryngol Head & Neck Surg, Boston, MA USA - Author

Helsinki Univ Hosp, Inflammat Ctr, Dept Allergy, Helsinki, Finland - Author

King Saud Univ, Coll Med, Dept Otolaryngol Head & Neck Surg, Riyadh, Saudi Arabia - Author

Kuopio Univ Hosp, Dept Otorhinolaryngol, Kuopio, Finland - Author

Mayo Clin, Dept Otolaryngol Head & Neck Surg, Rochester, MN USA - Author

Med Univ Vienna, Dept Otorhinolaryngol, Vienna, Austria - Author

Monash Hlth, Dept Otolaryngol Head & Neck Surg, Melbourne, Australia - Author

Monash Univ, Dept Surg, Melbourne, Australia - Author

Ochsner Clin Fdn, Dept Otorhinolaryngol, New Orleans, LA USA - Author

St Vincents Hosp Melbourne, Dept Otolaryngol Head & Neck Surg, Melbourne, Australia - Author

Stanford Univ, Dept Otolaryngol Head & Neck Surg, Sch Med, Stanford, CA USA - Author

Univ Alabama Birmingham, Dept Otolaryngol, Birmingham, AL USA - Author

Univ Amsterdam, Dept Otorhinolaryngol & Head & Neck Surg, Amsterdam, Netherlands - Author

Univ Barcelona, Hosp Clin, Secc ORL, Barcelona, Spain - Author

Univ Calif Irvine, Dept Otolaryngol Head & Neck Surg, Orange, CA USA - Author

Univ Calif Los Angeles, Dept Otolaryngol Head & Neck Surg, Los Angeles, CA USA - Author

Univ Calif San Francisco, Dept Otolaryngol Head & Neck Surg, San Francisco, CA USA - Author

Univ Cincinnati, Coll Med, Dept Otolaryngol Head & Neck Surg, Med Sci Bldg Room 6410,231 Albert Sabin Way, Cincinnati, OH 45267 USA - Author

Univ Coll London Hosp NHS Fdn Trust, Royal Natl ENT Hosp, London, England - Author

Univ East Anglia, Norwich Med Sch, Genet Epidemiol, Norwich, England - Author

Univ Eastern Finland, Kuopio, Finland - Author

Univ Helsinki, Helsinki, Finland - Author

Univ Hosp Geneva, Otorhinolaryngol Dept, Rhinol Olfactol Unit, Geneva, Switzerland - Author

Univ Michigan, Dept Otolaryngol Head & Neck Surg, Ann Arbor, MI USA - Author

Univ Missouri, Dept Otolaryngol, Columbia, MO USA - Author

Univ Pittsburgh, Med Ctr, Dept Otolaryngol, Pittsburgh, PA USA - Author

Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Ophthalmol Otorhinolaryngol Head & Neck Surg, Sao Paulo, Brazil - Author

Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Dept Otorhinolaryngol Head & Neck Surg, Houston, TX USA - Author

Univ Texas Southwestern Med Ctr Dallas, Dept Otolaryngol Head & Neck Surg, Dallas, TX USA - Author

Vanderbilt Univ, Med Ctr, Dept Otolaryngol Head & Neck Surg, Nashville, TN USA - Author

Abstract

Background: In the absence of direct evidence supporting how to use nasal endoscopy findings to judge chronic rhinosinusitis (CRS) disease control, experts' practice patterns could provide guidance. Methodology: Participants consisted of a diverse group of twenty-nine rhinologists. Participants were presented with every possible combination of bilateral nasal endoscopy findings represented by the modified Lund-Kennedy (MLK; range: 0-12) endoscopic scoring system and Nasal Polyp Score (NPS; range: 0-8). Reflecting the practical consequence of CRS disease control assessment, participants were asked whether they would consider CRS treatment escalation based on each scenario in the absence of any CRS symptoms, and how strongly they considered escalating therapy. The same scenarios were then presented in the context of 1 burdensome CRS symptom and participants again were asked whether they would consider treatment escalation. Results: The median threshold total MLK score for considering treatment escalation was >= 4 and 75.9% of participants' MLK thresholds were within 1 point of 4.The median threshold total NPS for considering treatment escalation was >= 3 and 62.5% of participants' NPS thresholds were within 1 point of 3. Endoscopy score thresholds decreased in the presence of 1 burdensome symptom and generally increased when requiring stronger affirmation for considering CRS treatment escalation. Conclusion: Reflecting the practice patterns of a diverse group of rhinologists, MLK score >= 4 or NPS >= 3 may serve as thresholds for considering CRS treatment escalation. Alternatively, MLK score

Keywords

Chronic rhinosinusitisControlLifLund-kennedy scoreNasal endoscopyNasal polyp scoreOutcome measurReliability

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Rhinology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 1/67, thus managing to position itself as a Q1 (Primer Cuartil), in the category Otorhinolaryngology. Notably, the journal is positioned above the 90th percentile.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-08-06:

WoS: 2

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Australia; Austria; Brazil; Finland; Greece; Netherlands; Saudi Arabia; Switzerland; United Kingdom; United States of America.

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