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

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.

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

Otolaryngology ◽

10.1177/01945998211018383 ◽

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.

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Clinical Traits Characterizing an Exacerbation-Prone Phenotype in Chronic Rhinosinusitis

Otolaryngology ◽

10.1177/0194599819865474 ◽

2019 ◽

Vol 161 (5) ◽

pp. 890-896 ◽

Cited By ~ 3

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.

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

The Laryngoscope ◽

10.1002/lary.29766 ◽

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

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

Otolaryngology ◽

10.1177/0194599819886852 ◽

2019 ◽

Vol 162 (1) ◽

pp. 142-147 ◽

Cited By ~ 1

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.

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

Acta Otorhinolaryngologica Italica ◽

10.14639/0392-100x-n0364 ◽

2020 ◽

Vol 40 (2) ◽

pp. 113-121 ◽

Cited By ~ 1

Author(s):

Stefania Gallo ◽

Federico Russo ◽

Francesco Mozzanica ◽

Andrea Preti ◽

Francesco Bandi ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Prognostic Value ◽

Sinonasal Outcome Test ◽

Snot 22

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

Rhinology Journal ◽

10.4193/rhin21.253 ◽

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.

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Correlation Between the Severity of Chronic Rhinosinusitis and Sleep Quality in Adult Patients

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v3i2.22024 ◽

2020 ◽

Vol 3 (2) ◽

pp. 62

Author(s):

Clarisa Christina Gabriella ◽

Kristanti Wanito Wigati ◽

Budi Sutikno

Keyword(s):

Sleep Quality ◽

Chronic Rhinosinusitis ◽

Nasal Obstruction ◽

Facial Pain ◽

Sampling Technique ◽

Adult Patients ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Chi Square ◽

Cross Sectional

Introduction: Chronic rhinosinusitis (CRS) usually accompanied by one of the symptoms (nasal obstruction, rhinorrhea) and one of associated symptoms (facial pain and/or hyposmia/anosmia). In addition, most of CRS sufferers have poor sleep quality. Thus, we aim to determine the relationship between the severity of CRS and sleep quality in adult patients.Methods: This study was cross-sectional method study. Consecutive sampling technique with estimate a proportion in finite population formula was used. The variables studied were the CRS severity based on visual analogue scale (VAS), and subjects’ sleep quality based on the Pittsburgh sleep quality index (PSQI). The data collection was carried out using a questionnaire and analyzed using chi-square test and continued with fisher’s exact test.Results: Of the 24 study subjects, 45.8% were male and 54.2% female. 83.3% had a nasal obstruction, 66.7% had rhinorrhea, 54.2% had hyposmia/anosmia, and 66.7% had facial pain. The severity of subject was mild, moderate and severe by 41,67%, 29,17%, and 41,67% respectively. 87.5% had poor sleep quality. There was no significant correlation between the severity of CRS and sleep quality (p=1,00).Conclusion: Although there was no correlation between CRS severity and sleep quality in adult patients, but CRS patients in general had poor sleep.Further study using more subjects, apply objective assessments, and include other more specific will help describe the correlation in population.

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

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v50i1.350 ◽

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.

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Patient-reported chronic rhinosinusitis disease control is a valid measure of disease burden

Rhinology Journal ◽

10.4193/rhin21.282 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

K.M. Phillips ◽

F.A. Houssein ◽

K. Singerman ◽

L.M. Boeckermann ◽

A.R. Sedaghat

Keyword(s):

Disease Control ◽

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Disease Burden ◽

Valid Measure ◽

Patient Reported ◽

Vas Scores ◽

Prospective Longitudinal ◽

Snot 22

Background: Disease control is an important treatment goal for chronic uncurable conditions such as chronic rhinosinusitis (CRS). The objective of this study was to determine whether patient-reported CRS disease control is a valid reflection of disease burden. Methods: Prospective longitudinal study of 300 CRS patients (35% CRS with nasal polyps, 65% CRS without nasal polyps). At enrollment and at a subsequent follow-up timepoint, all participants were asked to rate their CRS disease control as “not at all,” “a little,” “somewhat,” “very,” or “completely”, as well as to complete a 22-item Sinonasal Outcome Test (SNOT-22) and the 5-dimension EuroQol general health questionnaire from which the visual analogue scale (EQ-5D VAS) was used. Results: At enrollment and follow-up timepoints, patient-reported CRS disease control was significantly correlated with SNOT-22 and EQ-5D VAS scores. The change in patient-reported CRS disease control was significantly correlated with change in SNOT-22 and change in EQ-5D VAS scores. There was significant cross-sectional and longitudinal correlation between patient-reported control and all SNOT-22 subdomain scores. A SNOT-22 score of ≤ 25 points or lower, or an EQ-5D VAS score of ≥77 was predictive of having well - (i.e. “very” or “completely”) controlled CRS. Conclusions: Patient-reported CRS disease control is a valid measure of CRS disease burden and general QOL. A patient-reported assessment of CRS disease control could be considered as a component of a more comprehensive measure of CRS disease control.

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