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Rhinology/Allergy

(314) Minimal Radiographic Mucosal Thickness Criterion for Sinus-specific Endoscopic Sinus Surgery

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • ZW

    Zoe A. Walters, MD

    Resident Physician
    University of Cincinnati - Dept of Otolaryngology
    Cincinnati, Ohio, United States

    • Co-Author(s)

  • Katie M. Phillips, MD

    Assistant Professor
    University of Cincinnati - Dept of Otolaryngology
    Cincinnati, OH, United States

  • MP

    Melissa Previtera, MLIS

    University of Cincinnati Health Sciences Library, USA

  • Stacey T. Gray, MD

    Associate Professor
    Harvard Medical School/Mass Eye and Ear
    Boston, MA, United States

    • Senior Author(s)

  • Ahmad R. Sedaghat, MD, PhD

    Professor, Director of Division of Rhinology, Allergy and Anterior Skull Base Surgery
    University of Cincinnati - Dept of Otolaryngology
    Cincinnati, Ohio, United States

Disclosure(s):
Zoe A. Walters, MD: No relevant relationships to disclose.
Melissa Previtera, MLIS: No relevant relationships to disclose.


Introduction: Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. Some third-party payors have implemented policies to authorize coverage for ESS in a sinus-by-sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence.

Methods: A systematic literature search was performed of the following databases: Medline, Embase, Scopus, and Web of Science. Searches were conducted from inception through May 2022 using the following search terms: sinusitis, paranasal sinus disease, chronic rhinosinusitis, inflammation, mucosal thickening, paranasal sinus mucosa, sinus disorder, ethmoid sinus, maxillary sinus, MRI imaging, CT imaging, and CBCT. Articles identified were sought to answer two questions: whether a minimal measurement of mucosal thickness or opacification in a specific sinus was predictive of either 1) having CRS in that particular sinus or 2) predictive of better outcomes after ESS.

Results: We identified 6,070 abstracts of which 120 studies were identified for full-text evaluation. Eight articles were unable to be accessed for full-text review. Out of 112 studies that underwent full-text review, we found that no study directly investigated whether any minimal measurement of radiographic mucosal thickness or opacification in a sinus was associated with, or an accurate predictor of, CRS in that sinus.

Conclusions: In our systematic review, we found no studies to support using a minimum measurement of mucosal thickness or sinus opacification as a criterion for determining appropriateness of ESS on a sinus-by-sinus basis for patients with medically recalcitrant primary CRS. The results of our systematic review highlight that the extent of ESS should be determined in a personalized, patient-specific manner that considers all patient-specific factors.