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. 2025 Aug 2.
doi: 10.1002/lary.70002. Online ahead of print.

Epidemiologic Assessment and Quality of Life Impact of Sinonasal Disease in Cleft Lip and Palate

Grace Anne Longfellow  1 , Elena Quinonez Del Cid  1 , Lauren Cook  1 , Aurelia S Monk  1 , Amelia F Drake  2
Affiliations

Epidemiologic Assessment and Quality of Life Impact of Sinonasal Disease in Cleft Lip and Palate

Grace Anne Longfellow et al. Laryngoscope. .

Abstract

Objective: To characterize the prevalence, clinical manifestations, and risk factors of sinonasal pathology in patients with cleft lip and/or palate (CL/P).

Methods: This prospective cohort study included patients aged ≥ 12 years with a history of CL/P, seen at a tertiary craniofacial center from May 2024 to February 2025. Participants completed the Sino-Nasal Outcome Test-22 (SNOT-22) and the Nasal Obstruction Symptom Evaluation (NOSE), assessing sinonasal symptoms. Clinical and demographic data were collected via chart review. Primary outcomes were normalized SNOT-22 and NOSE scores. Statistical analyses included paired and independent t-tests, Pearson correlation, and linear regression to evaluate associations with scores, Veau classification, and age.

Results: Ninety patients were included. Most (83.3%) had non-syndromic CL/P. Chronic rhinosinusitis and allergic rhinitis were reported by 12.2% and 21.1% of participants, respectively. Despite these rates, current sinonasal medication use was high (36.7%). Otolaryngology referrals for sinonasal symptoms were documented in only 21.1% of cases. NOSE scores were significantly higher than SNOT-22 scores (t = -3.65, p < 0.001). After excluding nasal obstruction items in SNOT-22, and quality of life items from both surveys, NOSE scores remained significantly higher (t = -4.65, p < 0.001). No significant differences in total SNOT-22 scores were found across Veau classifications (p = 0.406) or with age (Pearson's r = 0.123, p = 0.250).

Conclusions: Patients with CL/P experience clinically meaningful sinonasal symptoms, predominantly nasal obstruction. Medication use exceeded sinonasal diagnoses, suggesting a higher prevalence of subclinical disease. Incorporating patient-reported outcome measures is essential to uncover the burden of sinonasal pathology and guide multidisciplinary management.

Level of evidence: II.

Keywords: NOSE scale; SNOT‐22; cleft lip and palate (CL/P); sinonasal disease; sinusitis.

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