title: Use of the SNOT-22 and UPSIT to appropriately select pediatric patients with cystic fibrosis who should be referred to an otolaryngologist: cross-sectional study.
abstract: OBJECTIVE
  Sinonasal disease and, specifically, nasal polyps, occur frequently in children with cystic fibrosis (CF). As survival rates have improved, it has become imperative that otolaryngologists become involved in the care of patients with CF to provide appropriate medical and surgical interventions for sinonasal disease. Despite significant variability in the subjective reporting of clinical symptoms, previous work has suggested there may be a relationship between clinical indicators and sinonasal disease in this population.
  
  
  OBJECTIVE
  To determine whether the 22-item Sino-Nasal Outcome Test (SNOT-22), the University of Pennsylvania Smell Identification Test (UPSIT), and other measures of sinonasal disease could be used to predict the presence of subclinical nasal polyps in children with CF.
  
  
  METHODS
  This was a cross-sectional study performed from May 2012 through April 2013 at a cystic fibrosis clinic at BC Children's Hospital in Vancouver, British Columbia, Canada. There were 72 eligible children with CF for this study (with a confirmed diagnosis of CF based on genetic testing; their ages ranged from 6 to 18 years, and they were not actively being treated by an otolaryngologist). Thirty-seven of these patients (23 males, 14 females) consented to participate in this study. Twenty-three declined participation, and 12 could not be contacted.
  
  
  METHODS
  Potential clinical predictors for the presence of subclinical nasal polyps were determined a priori. All 37 recruited participants completed a full study assessment. Nasal endoscopy (the gold standard) was performed to determine the presence of nasal polyps. Potential predictors that were assessed included age, sex, genotype, pancreatic function, SNOT-22 and UPSIT scores, oral culture swab result, and severity of forced expiratory volume in 1 second (FEV(1)).
  
  
  RESULTS
  A SNOT-22 score of greater than 11 was the only statistically significant predictor of nasal polyps (P = .04). The positive predictive value was 68.1%, the negative predictive value was 66.7%, and the positive likelihood ratio was 1.82.
  
  
  CONCLUSIONS
  Given that the SNOT-22 is easy to administer and inexpensive, this sinus disease-specific questionnaire seems to be an appropriate tool for routine use by respirologists when assessing patients with CF to help predict subclinical nasal polyps.
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thamboo
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Rachelle C Dar
authors.initials: RC
authors.lastname: Santos
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Lalenthra
authors.initials: L
authors.lastname: Naidoo
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rahmanian
authors.affiliation: Division of Respirology, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Chilvers
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Chadha
mesh_terms: D000293:Adolescent; D001955:British Columbia; D002648:Child; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D009298:Nasal Polyps / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D000857:Olfaction Disorders / Q000175:diagnosis*; D013517:Otorhinolaryngologic Surgical Procedures; D012017:Referral and Consultation; D016896:Treatment Outcome