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. 2017 Dec;7(12):1140-1148.
doi: 10.1002/alr.22025. Epub 2017 Oct 13.

A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Allen L Feng  1   2 , Nicholas C Wesely  3 , Lloyd P Hoehle  1   2 , Katie M Phillips  1   2 , Alisa Yamasaki  1   2 , Adam P Campbell  1   2 , Luciano L Gregorio  4 , Thomas E Killeen  3   5 , David S Caradonna  1   6 , Josh C Meier  3   5 , Stacey T Gray  1   2 , Ahmad R Sedaghat  1   2   6   7
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A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Allen L Feng et al. Int Forum Allergy Rhinol. 2017 Dec.

Abstract

Background: Previous studies have identified subdomains of the 22-item Sino-Nasal Outcome Test (SNOT-22), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT-22. This study aims to validate the existence of underlying symptom subdomains of the SNOT-22 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology.

Methods: A total of 800 patients with CRS were included into this cross-sectional study (400 CRS patients from Boston, MA, and 400 CRS patients from Reno, NV). Their SNOT-22 responses were analyzed using exploratory factor analysis (EFA) to determine the number of symptom subdomains. A CFA was performed to develop a validated measurement model for the underlying SNOT-22 subdomains along with various tests of validity and goodness of fit.

Results: EFA demonstrated 4 distinct factors reflecting: sleep, nasal, otologic/facial pain, and emotional symptoms (Cronbach's alpha, >0.7; Bartlett's test of sphericity, p < 0.001; Kaiser-Meyer-Olkin >0.90), independent of geographic locale. The corresponding CFA measurement model demonstrated excellent measures of fit (root mean square error of approximation, <0.06; standardized root mean square residual, <0.08; comparative fit index, >0.95; Tucker-Lewis index, >0.95) and measures of construct validity (heterotrait-monotrait [HTMT] ratio, <0.85; composite reliability, >0.7), again independent of geographic locale.

Conclusion: The use of the 4-subdomain structure for SNOT-22 (reflecting sleep, nasal, otologic/facial pain, and emotional symptoms of CRS) was validated as the most appropriate to calculate SNOT-22 subdomain scores for patients from different geographic regions using CFA.

Keywords: SNOT-22; chronic rhinosinusitis; disease severity; rhinosinusitis; sinusitis; statistics.

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