Lund-Mackay score

Last revised by Henry Knipe on 22 Apr 2024

The Lund-Mackay score is a CT-based scoring system for chronic rhinosinusitis 1 and is popular due to its simplicity and high inter and intra-observer reliability 6,7.

When reading a CT scan of the paranasal sinuses and ostiomeatal complex, the reader assigns each sinus a score of:

  • no abnormality: 0 points

  • partial opacification: 1 point

  • complete opacification: 2 points

N.B. ostiomeatal complex is scored differently:

  • not obstructed: 0 points

  • obstructed: 2 points

The sinuses are grouped into:

Each side is graded separately. A combined score of up to 24 is possible. Of note, an aplastic (absent) frontal sinus receives a score of 0.

The method is intentionally simplistic, for the sake of minimizing interobserver variability and expediting its application 2.​ Thus, it lends itself to application by non-radiologists and in clinical studies 1.​ Despite its simplicity, it correlates well with disease severity (higher scoress associated with worse symptoms 7), extent of surgery, treatment response (higher pre-FESS scores have better outcomes 7), complication rates, even independent of the extent of surgery 3.​

For a more accurate representation of disease burden modifications were proposed to the original system, further subdividing the assessment categories. In the modified staging system the reader assigns a score ranging from 0 to 5 based on the percentage of sinus opacification caused by mucosal thickening: 

  • 0%:

  • <25%: 1 point

  • 26-50%: 2 points

  • 51-75%: 3 points

  • 76-99%: 4 points

  • 100%: 5 points

N.B. the ostiomeatal complex is scored differently:

  • 0 (normal)

  • 1 (partially obstructed)

  • 2 (completely obstructed)

Otherwise the assessment is the same, sides are graded separately, resulting in a maximum total score of 54. It has been shown that the modified system better represents disease burden than the original Lund-Mackay score 4,5

This scoring system is named after its developers, British rhinologists Valerie J Lund and Ian S Mackay.

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