Is there a role for up-to-date imaging in patients awaiting sinus surgery?

Background: Endoscopic sinus surgery (ESS) is indicated in chronic rhinosinusitis (CRS) if medical therapy fails. There is a long waiting time for patients to be seen in the outpatient clinic at Australian public hospitals. A repeat computed tomography (CT) sinus scan may be performed when the patient is seen in clinic before deciding on the extent of ESS if the previous CT scan was over a year ago. This study aims to determine if there is a difference in radiology scores between the two scans and whether the repeat CT changes the extent of the planned sinus surgery. Methods: This is a retrospective multicentre Australian study. Patients who underwent two CT scans at least 12 months apart prior to ESS were included in the study. Two rhinologists reviewed the anonymized CT scans independently using the Lund-Mackay score (LMS) and decided the likely extent of surgery based on each CT scan. Wilcoxon signed-rank test was used to determine statistical significance. Results: Fifty-six patients met the inclusion criteria. The median [interquartile range (IQR)] time difference between the two scans was 2.1 (1.5–3.7) years. There were no significant differences in LMS between the first and second CT scans (P=0.43) or the extent of planned ESS (P=0.95). Conclusions: There is no significant evidence of LMS worsening while patients are on the waiting list to be seen in the ENT outpatient clinic. Many factors play a role in the extent of ESS, however, a repeat CT scan does not significantly affect the extent of ESS.