Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis

Abstract

Background: A number of factors are critical when considering the expected benefit of surgical intervention in patients with chronic rhinosinusitis (CRS) who have failed medical therapy.

Objective: To evaluate the Sino-nasal Outcome Test (SNOT-22) and other patient demographic characteristics as predictors of postsurgical improvement in patients with CRS.

Methods: Consecutive adult subjects presenting to the Otolaryngology Clinics at the University of Virginia with refractory CRS that required surgery were included. Patients were excluded if they had not completed both preoperative and postoperative SNOT-22 evaluations. Demographic and baseline measures, including asthma and smoking status, total immunuglobulin E (IgE), absolute eosinophil counts, and Lund-Mackay computed tomography (CT) scoring were also obtained for each subject. Regression analyses were performed.

Results: One hundred four subjects met criteria and were included. These subjects showed a 51% overall improvement in postsurgical SNOT-22 evaluations (95% confidence interval [CI]: [45, 57%], P < .001). Multivariate regression analysis revealed that SNOT-22 items related to "runny nose," "cough," and "sadness" were independent predictors of postsurgical SNOT-22 improvement (P < .05, for all). Although "runny nose" had a direct correlation with improvement, more severe "sadness" and "cough" scores had a negative impact on degree of improvement. Similarly, analyses indicated that questions categorized as pertaining to nasal or ear symptoms were uniquely associated with postsurgical improvement in SNOT-22 scores (P < .001 and P = .015, respectively). Neither Lund-Mackay CT scoring, total IgE, nor absolute eosinophil counts correlated with improvement in postsurgical SNOT-22 scores.

Conclusion: Physicians can use components of the SNOT-22 to predict likelihood of symptom improvement after surgical intervention in subjects with CRS.

Figure 1. Univariate Analysis of Post-operative Improvement in SNOT-22 Scores by Question

Abbreviations: PP - pain/pressure (*),PND - post-nasal drip (#).

Figure 2. Multivariate regression analysis comparing pre- and post-surgical SNOT-22 questions

“Runny nose” directly correlated with post-operative SNOT-22 improvement (p<0.05), while “cough” and “sadness” predicted less improvement overall (p<0.05, respectively). “Ear fullness” and “nasal obstruction” trended toward significance (p=0.07 and 0.09, respectively).

Figure 3. Improvement in total SNOT-22 scores as a function of baseline measures

A, Physician-diagnosed allergy did not predict post-operative improvement in SNOT-22 scores (p=0.12). B, Physician-diagnosed asthma did not predict post-operative improvement in SNOT-22 scores (p=0.98). C, Total IgE (IU/mL) scores did not predict post-operative improvement in SNOT-22 scores ([53–282 IU/mL] vs. 53 IU/mL (p=0.78); >282 IU/mL vs. <53 IU/mL (p=0.49); >282 IU/mL vs. [53–282 IU/mL] (p=0.67)). D, Absolute Eosinophil Count (AEC) did not predict postoperative improvement in SNOT-22 scores ([250–550 × 10⁹/L] vs <250 × 10⁹ /L (p=0.28); >550 × 10⁹/L vs. <250 × 10⁹/L (p=0.39); >550 × 10⁹/L vs. [250–550 × 10⁹ /L] (p=0.07)).