Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis.
BACKGROUND
A number of factors are critical when considering the expected benefit of surgical intervention in patients with chronic rhinosinusitis (CRS) who have failed medical therapy.


OBJECTIVE
To evaluate the Sino-nasal Outcome Test (SNOT-22) and other patient demographic characteristics as predictors of postsurgical improvement in patients with CRS.


METHODS
Consecutive adult subjects presenting to the Otolaryngology Clinics at the University of Virginia with refractory CRS that required surgery were included. Patients were excluded if they had not completed both preoperative and postoperative SNOT-22 evaluations. Demographic and baseline measures, including asthma and smoking status, total immunuglobulin E (IgE), absolute eosinophil counts, and Lund-Mackay computed tomography (CT) scoring were also obtained for each subject. Regression analyses were performed.


RESULTS
One hundred four subjects met criteria and were included. These subjects showed a 51% overall improvement in postsurgical SNOT-22 evaluations (95% confidence interval [CI]: [45, 57%], P < .001). Multivariate regression analysis revealed that SNOT-22 items related to "runny nose," "cough," and "sadness" were independent predictors of postsurgical SNOT-22 improvement (P < .05, for all). Although "runny nose" had a direct correlation with improvement, more severe "sadness" and "cough" scores had a negative impact on degree of improvement. Similarly, analyses indicated that questions categorized as pertaining to nasal or ear symptoms were uniquely associated with postsurgical improvement in SNOT-22 scores (P < .001 and P = .015, respectively). Neither Lund-Mackay CT scoring, total IgE, nor absolute eosinophil counts correlated with improvement in postsurgical SNOT-22 scores.


CONCLUSIONS
Physicians can use components of the SNOT-22 to predict likelihood of symptom improvement after surgical intervention in subjects with CRS.
Asthma and Allergic Disease Center, Carter Immunology Center, University of Virginia Health System, Charlottesville, Virginia. Electronic address: jk2gb@virginia.edu.
Joshua L
JL
Kennedy
Matthew A
MA
Hubbard
Phillip
P
Huyett
James T
JT
Patrie
Larry
L
Borish
Spencer C
SC
Payne
D000328:Adult; D000339:Affect; D002908:Chronic Disease; D003371:Cough / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires