Minimal clinically important difference for the 22‐item Sinonasal Outcome Test in medically managed patients with chronic rhinosinusitis

Hoehle

Caradonna

et al. 2018

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Background:The minimal clinically important difference (MCID) of the 22-item Sino-Nasal Outcome Test (SNOT-22) is specific but not sensitive for identifying patients experiencing noticeable improvement in symptoms of chronic rhinosinusitis (CRS). It is unclear why some patients with less than 1 MCID change in SNOT-22 score nevertheless report noticeable improvement in their CRS symptoms. Methods:This investigation was a retrospective study of 247 CRS patients undergoing medical management who completed SNOT-22 surveys in 2 consecutive visits 2-12 months apart. The validated nasal, sleep, ear/facial discomfort, and emotional SNOT-22 subdomain scores were calculated. At the second visit, patients reported their global change in CRS symptoms on a 5-item transition rating scale as: "Much worse"; "A li le worse"; "About the same"; "A li le be er"; or "Much be er." Patient-reported improvement in symptoms (at least "A li le be er") was tested for association with changes in SNOT-22 subdomain scores. Results:In the entire cohort, patient-reported improvement in CRS symptoms was associated with improvement in all SNOT-22 subdomain scores (p < 0.001). In patients with less than 1 MCID (12 points) of change in the SNOT-22, only the nasal subdomain (adjusted odds ratio, 0.89; 95% confidence interval [CI], 0.79-0.99; p = 0.042) was associated with patient-reported improvement in CRS symptoms. Changes in none of the other SNOT-22 subdomain scores were associated with patientreported improvement in CRS symptoms. Conclusions:Among patients with less than 1 MCID change in the SNOT-22, improvement in only nasal symptoms-but not extranasal symptoms-of CRS is associated with those who nevertheless report improvement of their CRS symptoms. C 2018 ARS-AAOA, LLC. How to Cite this Article:Phillips KM, Hoehle LP, Caradonna DS, Gray ST, Sedaghat AR. Determinants of noticeable symptom improvement despite sub-MCID change in SNOT-22 score a er treatment for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2019;9:508-513.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Determinants of noticeable symptom improvement despite sub‐MCID change in SNOT‐22 score after treatment for chronic rhinosinusitis

Hoehle

Caradonna

et al. 2018

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Differential perception and tolerance of chronic rhinosinusitis symptoms as a confounder of gender‐disparate disease burden

Bergmark

Hoehle

et al. 2019

BackgroundPrevious studies have consistently shown that females with chronic rhinosinusitis (CRS) have a greater CRS symptom burden than males with CRS. Our objective was to determine whether differential disease perception could explain this phenomenon.MethodsA total of 500 participants (239 males, 261 females) with CRS were recruited. CRS symptom burden was assessed with the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). General health‐related quality of life was assessed with the visual analog scale of the 5‐dimensional EuroQol questionnaire (EQ‐5D VAS). Participants were asked to rate their CRS symptom control as “Not at all,” “A little,” “Somewhat,” “Very,” and “Completely.” “Not at all,” “A little,” and “Somewhat” controlled symptoms were considered to reflect poorly controlled symptoms.ResultsSNOT‐22 score was significantly more severe (p < 0.001) among females (mean, 44.0; standard deviation [SD], 22.5) than males (mean, 36.3; SD, 20.2). However, there was no significant difference in male‐ vs female‐reported CRS symptom control (p = 0.154). In addition, there was no significant difference (p = 0.109) in EQ‐5D VAS score between males (mean, 70.9; SD, 19.0) and females (mean, 68.4; SD, 19.5). Although a SNOT‐22 score of ≥25 was predictive of poorly controlled symptoms in males (sensitivity, 82.6%; specificity, 62.5%), a SNOT‐22 score of ≥30 was predictive of poorly controlled symptoms in women (sensitivity, 82.4%; specificity, 64.5%).ConclusionFemales with CRS reported more severe SNOT‐22 scores, despite reporting a similar level of symptom control and general health‐related quality of life as men. Women had a higher SNOT‐22 threshold for poorly controlled symptoms. Female CRS patients may have greater perception and tolerance of CRS symptoms without a corresponding significant, disparate downstream impairment.

Predictors of efficacy for combination oral and topical corticosteroids to treat patients with chronic rhinosinusitis with nasal polyps

Epperson

Caradonna

et al. 2019

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Background:A short-course oral corticosteroid taper and topical intranasal corticosteroids may be used to maximize the success of medical management for chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, we sought to identify characteristics that would be predictive of efficacy for this combination regimen. Methods:Sixty-four patients with CRS, bilateral polyps, a polyp score of at least 3, and a 22-item Sino-Nasal Outcome Test (SNOT-22) score ࣙ20 were prospectively enrolled and uniformly treated with a 15-day prednisone taper and twice daily dilute budesonide irrigations. Participants were assessed at enrollment and at follow up, 2 to 5 months later. Clinical and demographic characteristics were assessed at enrollment. At both time points, CRS symptoms were assessed with SNOT-22, and polyp score (range, 0 to 6) was assessed endoscopically. Associations were determined with regression.Results: Pretreatment SNOT-22 score (adjusted β = −0.83; 95% CI, −1.08 to −0.58; p < 0.001) and comorbid asthma (adjusted β = 15.75; 95% CI, 4.74 to 26.75; p = 0.007) were associated with a change in SNOT-22 experienced over the study period. Achieving a greaterthan-1 minimal clinically important difference (MCID) im-provement in SNOT-22 score was also associated with pretreatment SNOT-22 score (adjusted OR = 1.09; 95% CI, 1.04 to 1.14; p < 0.001) and comorbid asthma (adjusted OR = 0.13; 95% CI, 0.03 to 0.72; p = 0.019). SNOT-22 score ࣙ47 had 81.5% sensitivity and 78.4% specificity to detect patients experiencing 1 MCID improvement. Pretreatment polyp score was not associated with any outcome metric. Conclusion:In treatment of CRSwNP with prednisone and budesonide irrigations, pretreatment endoscopy was not informative of treatment response. Pretreatment SNOT-22 and comorbid asthma may be more predictive. C 2019 ARS-AAOA, LLC.