Allergic fungal rhinosinusitis - a new staging system

Background: The existing Kupferberg post-operative endoscopic staging system for allergic fungal rhinosinusitis (AFRS) has 4 stages based on the 'global' appearance of one side of the nose. Patients may however show visual improvement and yet remain at the same stage due to persistence in one sinus cavity, thus making the staging system ineffective. The aim of this study was to validate a new system that allows greater sensitivity in characterising the inflammation seen endoscopically. Methodology: A series of endoscopy videos of 50 patients with AFRS were retrospectively staged using a new ten-grade system, scoring each sinus cavity (maxillary, ethmoid, frontal and sphenoid) from 0 - 9 for increasing mucosal oedema and 1 point for the presence of fungal mucin giving a maximum score of 40 for each side of the nose. To assess reliability, 4 independent rhinologists were also asked to score the videos using the new system. Results: A greater variety in the spectrum of mucosal disease was demonstrated with the new system allowing for a more descriptive analysis of its severity and its response, or lack of to treatment. The inter-class correlation between the 6 total observers was 0.86. Conclusion: Use of the new staging system provides a more sensitive tool for following patients' progress post-operatively in allergic fungal rhinosinusitis and in determining their response to treatment.