Staging systems for chronic sinus disease.

A four-stage system is proposed for the classification of chronic hyperplastic rhinosinusitis. The system is comprehensive, simple to use, and has demonstrated extreme clinical usefulness. There is a linear correlation between recurrence rates and stage of disease. The system has virtually mandated treatment strategies for chronic sinusitis. Stage I disease is considered primarily medical, while Stages II, III and IV are surgical. The author's long-standing study is in agreement with Kennedy, Mackey and Lund in their view that radiographic assessment of extent of disease is the major determinant for staging and prognosis. This study, which began in 1988 and has been reported progressively since that time, has proven both useful and accurate for physicians using it, and more importantly has been a boon in explaining to patients the prognosis, needed treatment strategies, and potential outcomes in the treatment of their chronic sinusitis.