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. 2026 Jan 14:S1569-1993(25)02553-6.
doi: 10.1016/j.jcf.2025.12.022. Online ahead of print.

Psychometric validity of the 22-item sinonasal outcome test in cystic fibrosis

Christine M Liu  1 , Jakob L Fischer  1 , Jonathan B Overdevest  2 , Anna C Zemke  3 , Matthew J Strand  4 , David A Gudis  3 , Adam J Kimple  5 , Jeremy P Tervo  2 , Emily DiMango  6 , Jennifer L Goralski  7 , Claire Keating  6 , Brent Senior  5 , Amanda L Stapleton  8 , Jennifer L Taylor-Cousar  9 , Daniel M Beswick  10
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Free article

Psychometric validity of the 22-item sinonasal outcome test in cystic fibrosis

Christine M Liu et al. J Cyst Fibros. .
Free article

Abstract

Background: The 22-item sinonasal outcome test (SNOT-22) is widely used to evaluate quality of life (QOL) in cystic fibrosis chronic rhinosinusitis (CF-CRS) but lacks formal validation in people with CF (PwCF). This study explores the psychometric properties of the SNOT-22 following elexacaftor/tezacaftor/ivacaftor (ETI) administration.

Methods: Data from three prospective observational cohort studies investigating the impact of ETI on CF-CRS were pooled across four U.S. centers and used for validity assessments. SNOT-22 scores, Lund-Mackay (LM) computed tomography (CT) sinus scores, and Cystic Fibrosis Questionnaire-Revised (CFQ-R) scores were used to assess test-retest reliability, construct validity, and responsiveness to clinical change in SNOT-22 scores.

Results: Strong test-retest reliability was observed for the SNOT-22 during the first 6 months post-ETI (N = 53, all r ≥ 0.80, p < 0.001). SNOT-22 intraclass correlation coefficients were strong (0.883) at 3 and 6 months after ETI was initiated and moderate (0.693) across all time points. Mean individual scores in 20 SNOT-22 items decreased from baseline to post-ETI (90.1%, p < 0.05). Moderate convergent validity was observed between pre-treatment SNOT-22 scores and LM scores (r = -0.42, p = 0.002) and CFQ-R respiratory domain scores (r = -0.35, p = 0.025).

Conclusions: The SNOT-22 is a valid, reliable, and responsive instrument for evaluating CRS-specific QOL in adults with CF, and functions effectively as a unidimensional construct across most of its 22 items.

Keywords: Chronic rhinosinusitis; Cystic fibrosis; Elexacaftor/tezacaftor/ivacaftor; Highly effective modulator therapy.

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Conflict of interest statement

Declaration of competing interest CML: NIDCD grant related to work. JLF: None to disclose. JBO: Grant support from NIDCD K23DC019678 for investigation not affiliated with this project. ACZ: Has received grant support from CF Foundation related to this work (ZEMKE19A0). MJS: In the last 36 months, MJS has received grants from the CF Foundation related to this work. DAG: None to disclose. AJK: Grant support from the CFF and consultant for AcclarENT not related to this work. JPT: None to disclose. ED: Grant support from the CFF and Vertex Pharmaceuticals, unrelated to this work. JLG: Grant support from the CF Foundation and NHLBI unrelated to this work. Honoraria from the CF Foundation and Vertex Pharmaceuticals unrelated to this work. CK: Grant support from the CFF not related to this work. BS: Consultant for Lyra Therapeutics, Medical Center Pharmacy, Stryker, and Neurent. ALS: None to disclose. JLTC: In the last 36 months, JLT-C has received grants from the CF Foundation related to this work as well as for work unrelated to the manuscript. Unrelated to this work, she has received grants to her institution from Vertex Pharmaceuticals Incorporated, Eloxx, and 4DMT; has received fees to her institution from Vertex Pharmaceuticals Incorporated related to consultation on clinical research design; and has served on advisory boards and/or provided clinical trial design consultation for 4DMThe served on a DMC for AbbVie. She serves as the adult patient care representative to the CFF Board of Trustees, and on the CF Foundation’s Clinical Research Executive Committee, Clinical Research Advisory Board, Racial Justice Working Group and as immediate past chair of the CF TDN’s Sexual Health, Reproduction and Gender Research Working Group, and on the scientific advisory board for Emily’s Entourage. She currently serves as the Chair-elect of the ATS International Conference Committee (and associated committees) and previously served on the ATS Scientific Grant Review, Respiratory Health Awards. and Clinical Problems Assembly Programming Committees. She is a member of the International Advisory Board for Lancet Respiratory Medicine and the Editorial Board for the Journal of Cystic Fibrosis. DMB: In the last 36 months, DMB has received grant support from the NIH/NHBLI, CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity).

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