The Sinonasal Outcome Test (SNOT-22) Is a Poor Diagnostic Tool for Chronic Rhinosinusitis

2021 ◽  
pp. 000348942199821
Author(s):  
Michael T. Yim ◽  
Richard R. Orlandi ◽  
Gretchen M. Oakley ◽  
Jeremiah A. Alt
Keyword(s):  
Chronic Rhinosinusitis ◽  
Diagnostic Tool ◽  
Operating Characteristic ◽  
Response Pattern ◽  
Nasal Congestion ◽  
Response Patterns ◽  
Optimal Cutoff Point ◽  
Sinonasal Outcome Test ◽  
Cardinal Symptoms ◽  
Snot 22

Background: The SNOT-22 is a validated and widely used outcomes tool in chronic rhinosinusitis (CRS). We hypothesized that SNOT-22 scores and response patterns could be used as a diagnostic tool to differentiate between patients with CRS and those who present with CRS-like symptoms but prove not to have CRS. Methodology/Principal: SNOT-22 measurements were collected from 311 patients who presented with a chief complaint of sinusitis to a tertiary rhinology practice. Following a full diagnostic evaluation, patients were diagnosed with CRS or determined to have non-CRS diagnoses. A response pattern “heatmap” of the SNOT-22 scores for each group was compared. An optimal cutoff point for total SNOT-22 score in predicting CRS was sought using a receiver operating characteristic (ROC) curve. Results: A total of 109 patients were diagnosed with CRS and 202 patients were assigned to non-CRS. The non-CRS SNOT-22 total score histogram had lower overall scores compared to the CRS group, although there was substantial overlap. The CRS SNOT-22 heatmaps had a distinctive pattern compared to the non-CRS group. As individual measures, 3 of the 4 cardinal symptoms of CRS (nasal congestion, loss of smell, and rhinorrhea) were found to be significantly different between the 2 groups ( P < .002). However, the ROC analysis showed the total SNOT-22 score to be a poor instrument to differentiate CRS from non-CRS patients. Conclusions: Our results cause us to reject our hypothesis and conclude that, while an effective outcomes tool, the SNOT-22 (using total score and response pattern) is a poor differentiator between CRS and non-CRS patients.

Item Response Theory for Psychometric Properties of the SNOT-22 (22-Item Sinonasal Outcome Test)

2021 ◽  
pp. 019459982110183
Author(s):  
David T. Liu ◽  
Katie M. Philips ◽  
Marlene M. Speth ◽  
Gerold Besser ◽  
Christian A. Mueller ◽  
...  
Keyword(s):  
Item Response Theory ◽  
Psychometric Properties ◽  
Item Response ◽  
Chronic Rhinosinusitis ◽  
Facial Pain ◽  
Item Discrimination ◽  
High Quality ◽  
Graded Response ◽  
Sinonasal Outcome Test ◽  
Snot 22

Objective The SNOT-22 (22-item Sinonasal Outcome Test) is a high-quality outcome measure that assesses chronic rhinosinusitis–specific quality of life. The aim of this study was to gain greater insight into the information provided by the SNOT-22 by determining its item-based psychometric properties. Study Design Retrospective cohort study. Setting Tertiary care academic centers. Methods This study used a previously described data set of the SNOT-22 completed by 800 patients with chronic rhinosinusitis. Item response theory graded response models were used to determine parameters reflecting item discrimination, difficulty, and information provided by each item toward the SNOT-22 subdomain to which it belonged. Results The unconstrained graded response model fitted the SNOT-22 data best. Item discrimination parameters and total information provided showed the greatest variability within the nasal subdomain, and the item related to sense of smell/taste demonstrated the lowest discrimination and provided the least amount of information overall. The dizziness item provided disparately lower total information and discrimination in the otologic/facial pain subdomain. Items in the sleep and emotional subdomains generally provided high discrimination. While items in the nasal, sleep, and otologic/facial pain subdomains spanned all levels of difficulty, emotional subdomain items covered higher levels of difficulty, indicating greater information provided at higher levels of disease severity. Conclusion The item-specific psychometric properties of the SNOT-22 support it as a high-quality instrument. Our results suggest the need and possibility for revision of the smell/taste dysfunction item, for example its wording, to improve its ability to discriminate among the different levels of disease burden.

Clinical Traits Characterizing an Exacerbation-Prone Phenotype in Chronic Rhinosinusitis

2019 ◽  
Vol 161 (5) ◽  
pp. 890-896 ◽  
Author(s):  
Katie M. Phillips ◽  
Eric Barbarite ◽  
Lloyd P. Hoehle ◽  
David S. Caradonna ◽  
Stacey T. Gray ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Tertiary Care ◽  
Symptom Burden ◽  
Cross Sectional ◽  
Patient Reported ◽  
Oral Corticosteroids ◽  
Sinonasal Outcome Test ◽  
Snot 22

Objective Acute exacerbation of chronic rhinosinusitis (AECRS) is associated with significant quality-of-life decreases. We sought to determine characteristics associated with an exacerbation-prone phenotype in chronic rhinosinusitis (CRS). Study Design Cross-sectional. Setting Tertiary care rhinology clinic. Subjects Patients with CRS (N = 209). Methods Patient-reported number of sinus infections, CRS-related antibiotics, and CRS-related oral corticosteroids taken in the last 12 months were used as metrics for AECRS frequency. Sinonasal symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). Ninety patients reporting 0 for all AECRS metrics were considered to have had no AECRS in the prior 12 months. A total of 119 patients reported >3 on at least 1 AECRS metric and were considered as having an exacerbation-prone phenotype. Characteristics associated with patients with an exacerbation-prone phenotype were identified with exploratory regression analysis. Results An exacerbation-prone phenotype was positively associated with comorbid asthma (adjusted odds ratio [ORadj] = 3.68, 95% CI: 1.42-9.50, P = .007) and SNOT-22 (ORadj = 1.06, 95% CI: 1.04-1.09, P < .001). Polyps were negatively associated (ORadj = 0.27, 95% CI: 0.11-0.68, P = .005) with an exacerbation-prone phenotype. SNOT-22 score ≥24 identified patients with an exacerbation-prone phenotype with a sensitivity of 93.3% and a specificity of 57.8%. Having either a SNOT-22 score ≥24 with a nasal subdomain score ≥12 or a SNOT-22 score ≥24 with an ear/facial discomfort subdomain score ≥3 provided >80% sensitivity and specificity for detecting patients prone to exacerbation. Conclusions In total, these results point to a CRS exacerbation-prone phenotype characterized by high sinonasal disease burden with comorbid asthma but interestingly without polyps.

scholarly journals Development of Sinonasal Outcome Test ( SNOT ‐22) Domains in Chronic Rhinosinusitis With Nasal Polyps

2021 ◽  
Author(s):  
Asif H. Khan ◽  
Matthew Reaney ◽  
Isabelle Guillemin ◽  
Lauren Nelson ◽  
Shanshan Qin ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Sinonasal Outcome Test ◽  
Snot 22

PHQ-9 and SNOT-22: Elucidating the Prevalence of Depression in Chronic Rhinosinusitis

2019 ◽  
Vol 162 (1) ◽  
pp. 142-147 ◽  
Author(s):  
Laura J. Vandelaar ◽  
Zi Yang Jiang ◽  
Alok Saini ◽  
William C. Yao ◽  
Amber U. Luong ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Retrospective Chart Review ◽  
Clinical Settings ◽  
Prevalence Of Depression ◽  
Patient Health ◽  
History Of ◽  
Sinonasal Outcome Test ◽  
The Impact ◽  
History Of Depression ◽  
Snot 22

Objective Chronic rhinosinusitis (CRS) has been associated with comorbid depression, yet the prevalence of depression among all patients with CRS is not well described. The Patient Health Questionnaire–9 (PHQ-9), a validated instrument for diagnosing depression, has been used to assess depression in a variety of clinical settings. PHQ-9 scores ≥10 are the threshold for a depression diagnosis. The purpose of this study was to assess the prevalence of depression in a rhinology practice and compare the PHQ-9 with the 22-item Sinonasal Outcome Test (SNOT-22). Study Design Retrospective chart review. Setting Tertiary rhinology practice. Subjects and Methods During the 2-month period ending April 30, 2018, all rhinology patients were asked to complete the PHQ-9 and SNOT-22. Results Among 216 patients, 46 (21.3%) had a self-reported history of depression, and 39 (18.1%) had a PHQ-9 score ≥10. Of the 39 patients screening positive for depression, 18 (41.9%) had no history of depression. Comparison of PHQ-9 with overall SNOT-22 score had a Pearson’s coefficient of 0.632 ( P < .005). Logistic regression showed that the highest 2 quintiles of SNOT-22 scores had an odds ratio of 60.6 (95% CI, 9.7-378.3) for a positive depression screen (PHQ-9 score ≥10). Conclusion Depression rates (estimated by PHQ-9 responses) among rhinology patients are similar to chronic disease populations; depression may be underdiagnosed in rhinology patients. Higher SNOT-22 scores were associated with higher PHQ-9 scores. Further studies are warranted to understand the impact of comorbid conditions of depression and CRS in patient quality of life.

scholarly journals Prognostic value of the Sinonasal Outcome Test 22 (SNOT-22) in chronic rhinosinusitis

2020 ◽  
Vol 40 (2) ◽  
pp. 113-121 ◽  
Author(s):  
Stefania Gallo ◽  
Federico Russo ◽  
Francesco Mozzanica ◽  
Andrea Preti ◽  
Francesco Bandi ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Prognostic Value ◽  
Sinonasal Outcome Test ◽  
Snot 22

Multi-institutional minimal clinically important difference of the 22-item Sinonasal Outcome Test in medically managed chronic rhinosinusitis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
K.M. Phillips ◽  
F.A. Houssein ◽  
L.M. Boeckermann ◽  
K.W. Singerman ◽  
D.T. Liu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Chronic Rhinosinusitis ◽  
General Health ◽  
Nasal Polyps ◽  
Minimal Clinically Important Difference ◽  
Medical Treatments ◽  
Clinically Important Difference ◽  
Sinonasal Outcome Test ◽  
Snot 22

Background: With a rapid proliferation of clinical trials to study novel medical treatments for CRS, the objective of this study was to study the minimal clinically important difference (MCID) of the 22-item Sinonasal Outcome Test (SNOT-22) in medically-managed CRS patients. Methods: A total of 183 medically-treated CRS patients were recruited. All patients completed a SNOT-22 at enrollment and subsequent follow up visit. Distribution and anchor-based methods were used for MCID calculation. These data were combined with data from a previously published study on SNOT-22 MCID in 247 medically managed CRS patients to determine a final recommended MCID value using the combined cohort of 430 patients. Results: In our cohort, distribution- and anchor-based methods—using both sinus-specific and general health anchors—provided greatest support for a 12-point SNOT-22 MCID, which had approximately 55% sensitivity but 81% specificity for detecting patients explicitly reporting improvement in their sinus symptoms and general health. In the combined cohort of 430 patients, we also found greatest support for a 12-point SNOT-22 MCID, which had approximately 57% sensitivity and 81% specificity for detecting patients explicitly reporting improvement in their sinus symptoms and general health. We also find evidence that the MCID value may be higher in CRS patients without nasal polyps compared to those with nasal polyps. Conclusions: Our results - which include data from patients from two different institutions and regions - confirm a SNOT-22 MCID of 12 in medically managed CRS patients. The SNOT-22 MCID was specific but not sensitive for identifying CRS patients experiencing improvement in symptoms or general health.

scholarly journals Impact of Pharmacotherapy to decrease Interleukin-6 in patients with chronic rhinosinusitis without nasal polyp

2020 ◽  
Vol 50 (1) ◽  
pp. 30
Author(s):  
Lina Marlina ◽  
Sinta Sari Ratunanda ◽  
Teti Madiadipoera
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Visual Analog Scale ◽  
Interleukin 6 ◽  
Analog Scale ◽  
Prick Test ◽  
Significant Difference ◽  
Sinonasal Outcome Test ◽  
Snot 22

Background: Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal sinuses mucosa, ongoing for more than 12 weeks. Even now it still creates socioeconomic problem in both developed and developing countries. Pharmacotherapy administration is essential for decreasing the severity of symptom, improving quality of life, and decreasing interleukin (IL)-6 level. Objective: To find out the effect of pharmacotherapy on severity of the symptom, quality of life, and IL-6 level. Method: Randomized clinical trial with pre and posttest design, on 20 CRS without polyp patients, divided into two groups based on skin prick test results. Both groups were equally treated with nasal irrigation, nasal corticosteroid, and antibiotic amoxicillin clavulanate for 14 days. All subjects were assessed for Visual Analog Scale (VAS) score, nasoendoscopy (NE) score, Sinonasal Outcome test (SNOT)-22, and IL-6 level. Statistical analysis was performed with Mann Whitney and Wilcoxon methods. Result: There were significant differences in total analysis results on VAS scores, NE scores, SNOT-22, and IL-6 levels in both groups, with values p<0.05. There was improvement in all variables after pharmacotherapy, but there was no significant difference between the case and control groups, with values p>0.05. Conclusion: Pharmacotherapy in both groups resulte’ in reduced severity of symptoms, improved quality of lives, and decreased IL-6 levels.Keywords: Interleukin-6, pharmacotherapy, chronic rhinosinusitis without polyp, quality of life ABSTRAK Latar belakang: Rinosinusitis kronik (RSK) merupakan inflamasi pada mukosa hidung dan sinus paranasal, yang berlangsung selama lebih dari 12 minggu. Hingga saat ini masih memengaruhi sosioekonomi di negara maju maupun negara berkembang. Pemberian farmakoterapi sangat penting untuk memperbaiki derajat gejala, meningkatkan kualitas hidup, dan menurunkan kadar interleukin (IL)-6. Tujuan: Mengetahui pengaruh pemberian farmakoterapi terhadap perbaikan derajat gejala, peningkatan kualitas hidup, dan penurunan kadar IL-6. Metode: Penelitian kuasi eksperimental, label terbuka pra dan pascaterapi, pada 20 penderita RSK tanpa polip, dibagi dua kelompok berdasarkan hasil uji tusuk kulit. Perlakuan pada kedua kelompok sama, diberikan irigasi hidung, kortikosteroid intranasal, dan antibiotik amoksisilin klavulanat selama 14 hari. Penelitian dilakukan dengan menilai skor Visual Analog Scale (VAS) gejala hidung, skor nasoendoskopi (NE), Sinonasal Outcome test (SNOT)-22, dan kadar IL-6. Analisis statistik menggunakan metode Mann Whitney dan Wilcoxon. Hasil: Didapati perbedaan bermakna pada hasil analisis total pada skor VAS gejala hidung, skor NE, SNOT-22, dan kadar IL-6 pada kedua kelompok dengan nilai p<0,05. Didapati perbaikan pada semua variabel setelah 14 hari pemberian medikamentosa maksimal, namun tidak terdapat perbedaan bermakna antara kedua kelompok dengan nilai p>0,05. Kesimpulan: Pemberian farmakoterapi pada kedua kelompok memberikan hasil berupa perbaikan derajat gejala, peningkatan kualitas hidup, dan penurunan kadar IL-6.

Utility of Visual Analog Scale of Subdomain Scores of the 22-Item Sinonasal Outcome Test in Chronic Rhinosinusitis

2022 ◽  
pp. 019459982110687
Author(s):  
Katie M. Phillips ◽  
Firas A. Houssein ◽  
Marlene M. Speth ◽  
Ahmad R. Sedaghat
Keyword(s):  
Chronic Rhinosinusitis ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Visual Analog Scales ◽  
Vas Scores ◽  
Sinonasal Outcome Test ◽  
Preliminary Study ◽  
Highly Correlated ◽  
Frequent Sampling ◽  
Snot 22

The burden of chronic rhinosinusitis (CRS) symptomatology is frequently measured with the 22-item Sinonasal Outcome Test (SNOT-22). In some situations, such as when there is need for frequent sampling, a full SNOT-22 may be impractical, and an abbreviated measure may be useful. Herein, we study 4 questions reflecting the 4 SNOT-22 subdomains as accurate reflections of SNOT-22 content. In total, 250 patients with CRS completed a SNOT-22 and answered 4 questions about their total nasal symptoms, poor sleep quality, ear/facial pain, and mood (reflecting SNOT-22 subdomains) using visual analog scales (VASs). The 4 SNOT-22 subdomain VAS scores each correlated strongly with the corresponding SNOT-22 subdomain scores. The sum of the 4 subdomain question VAS scores was highly correlated with the total SNOT-22 score ( r = 0.77, P < .001). This preliminary study suggests information from the SNOT-22 may be ascertained through 4 questions reflecting the 4 SNOT-22 subdomains, although further validation is needed.

scholarly journals NAVIGATE I: Randomized, Placebo-Controlled, Double-Blind Trial of the Exhalation Delivery System With Fluticasone for Chronic Rhinosinusitis With Nasal Polyps

2018 ◽  
Vol 33 (1) ◽  
pp. 69-82 ◽  
Author(s):  
Raj Sindwani ◽  
Joseph K. Han ◽  
Daniel F. Soteres ◽  
John C. Messina ◽  
Jennifer L. Carothers ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Delivery System ◽  
Nasal Polyps ◽  
Short Form ◽  
High Morbidity ◽  
Double Blind ◽  
End Points ◽  
Sf 36 ◽  
Cardinal Symptoms ◽  
Snot 22

Background Chronic rhinosinusitis is a common, high-morbidity chronic inflammatory disease, and patients often experience suboptimal outcomes with current medical treatment. The exhalation delivery system with fluticasone (EDS-FLU) may improve care by increasing superior/posterior intranasal corticosteroid deposition. Objective To evaluate the efficacy and safety of EDS-FLU versus EDS-placebo in patients with nasal polyps (NP). Coprimary end points were change in nasal congestion and polyp grade. Key secondary end points were Sino-Nasal Outcome Test-22 (SNOT-22) and Medical Outcomes Study Sleep Scale-Revised (MOS Sleep-R). Other prespecified end points included all 4 cardinal symptoms of NP, 36-Item Short Form Health Survey (SF-36), Patient Global Impression of Change (PGIC), Rhinosinusitis Disability Index (RSDI), and key indicators for surgical intervention. Design Randomized, double-blind, EDS-placebo-controlled, multicenter study. Methods Three hundred twenty-three subjects with NP and moderate-severe congestion/obstruction, most with history of corticosteroid use (94.4%) and/or prior surgery (60.4%), were randomized to EDS-FLU 93 µg, 186 µg, or 372 µg or EDS-placebo twice daily (BID) for 24 weeks (16 double-blind + 8 single-arm extension with EDS-FLU 372 µg BID). Results All EDS-FLU doses produced significant improvement in both coprimary end points ( P < .05) and in SNOT-22 total score ( P ≤ .005). EDS-FLU significantly improved all 4 cardinal symptoms of NP ( P < .05), including congestion/obstruction, facial pain/pressure, rhinorrhea/post-nasal drip, and hyposmia/anosmia. Approximately 80% of subjects reported improvement with EDS-FLU, with 65% reporting “much” or “very much” improvement by week 16. Adverse events were generally local in nature and similar to other intranasal steroids studied for similar durations in similar populations, with the most common being epistaxis. Conclusions In patients with chronic rhinosinusitis with NP (CRSwNP) who were symptomatic despite high rates of prior intranasal steroid use and/or surgery, EDS-FLU produced statistically significant and clinically meaningful improvements compared to EDS-placebo in multiple subjective and objective outcomes (symptoms, SNOT-22, RSDI, SF-36, PGIC, and NP grade), including all 4 cardinal symptoms of CRSwNP.

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