[Application of the discharge, inflammation, polyps/edema (DIP) endoscopic scoring system in patients with chronic rhinosinusitis].
OBJECTIVE
To validate the discharge, inflammation, polyps/edema (DIP) scoring system for the assessment of endoscopic sinus surgery (ESS) outcomes in patients with chronic rhinosinusitis (CRS).


METHODS
Thirty patients with CRS were included in this prospective study. All patients were evaluated before and 2 months after surgery. Baseline measures and postoperative outcomes were evaluated using sino-nasal outcome test-20 (SNOT-20), visual analogue scale (VAS) symptom score and Lund-Mackay CT score (in baseline only). All endoscopic videos were recorded before surgery and in the end of follow-up. All videos were scored blindly by two rhinologistis using the DIP and Lund-Kennedy system for investigating the inter-rater and test-retest reliability, as well as the correlations with the existing subjective and objective scoring systems.SPSS17.0 software was used to analyze the data.


RESULTS
The average scores of VAS, SNOT-20, Lund-Kennedy, and DIP before and after surgery were listed below. Baseline, 29.73 ± 13.05, 24.43 ± 13.76, 7.70 ± 3.25 and 32.67 ± 13.48. Post-surgical, 13.60 ± 8.67, 10.40 ± 7.45, 5.03 ± 2.04 and 16.97 ± 8.37. All scores were declined significantly from baseline (t value were 7.43, 6.49, 6.88 and 10.93, all P < 0.001). The DIP system showed a higher inter-rater and rest-rest reliability than Lund-Kennedy system (interclass coefficient,ICC > 0.75). The Pearson analysis revealed that VAS scores were significantly correlated with SNOT-20 scores both in baseline and post-surgical assessments (r = 0.518 6, P = 0.003, and r = 0.546 7, P = 0.000). Before surgery, Lund-Kennedy scores were significantly correlated with DIP and Lund-Mackay CT scores (r = 0.937 5, P = 0.000 and r = 0.748 0, P = 0.000). DIP scores were significantly correlated with Lund-Mackay CT scores (r = 0.712 2, P = 0.000). After surgery,DIP scores were significantly correlated with Lund-Kennedy scores (r = 0.869 6, P = 0.000). But there were no significant correlations between subjective scores (VAS and SNOT-20) and objective scores (Lund-Kennedy, DIP and Lund-Mackay CT), (all P > 0.05).


CONCLUSIONS
The DIP scoring system shows substantial inter-rater and test-retest reliability.It is also significantly correlated with existing objective scoring parameters. It is suitable and reliable to use.
Department of Otorhinolaryngology of First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
Peng
P
Wu
Zhenzhen
Z
Wang
Lu
L
Zhang
Zhenxiao
Z
Huang
Yamei
Y
Luo
Huijuan
H
Li
Linghao
L
Zhang
Email: liaozhisu111@163.com.
Zhisu
Z
Liao
D002908:Chronic Disease; D004487:Edema; D004724:Endoscopy; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D009298:Nasal Polyps / Q000175:diagnosis*; D010256:Paranasal Sinuses; D011127:Polyps; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D012220:Rhinitis / Q000175:diagnosis; D012852:Sinusitis / Q000175:diagnosis*