SNOT‐22 quality of life domains differentially predict treatment modality selection in chronic rhinosinusitis

Abstract

Background Prior study demonstrated that baseline Sinonasal Outcomes Test-22 (SNOT-22) aggregate scores accurately predict selection of surgical intervention in patients with chronic rhinosinusitis (CRS). Factor analysis of the SNOT-22 survey has identified 5 distinct domains that are differentially impacted by endoscopic sinus surgery (ESS). This study sought to quantify SNOT-22 domains in patient cohorts electing both surgical or medical management and post-interventional change in these domains. Methods Patients CRS were prospectively enrolled into a multi-institutional, observational cohort study. Subjects elected continued medical management or ESS. SNOT-22 domain scores at baseline were compared between treatment cohorts. Post-intervention domain score changes were evaluated in subjects with at least 6-month follow-up. Results 363 subjects were enrolled with 72(19.8%) electing continued medical management while 291(80.2%) elected ESS. Baseline SNOT-22 domain scores were comparable between treatment cohorts in sinus-specific domains (Rhinologic, Extra-nasal rhinologic, and Ear/facial symptoms, p>0.050); however, the surgical cohort reported significantly higher psychological (16.0(8.4)vs.12.0(7.1); p<0.001) and sleep dysfunction (13.7(6.8)vs.10.5(6.2); p<0.001) than the medical cohort. Effect sizes for ESS varied across domains with Rhinologic and Extra-nasal rhinologic symptoms experiencing the greatest gains (1.067 and 0.997, respectively) while Psychological and Sleep dysfunction experiencing the smallest improvements (0.805 and 0.818, respectively). Patients experienced greater mean improvements after ESS in all domains compared to the medical management (p<0.001). Conclusions Subjects electing ESS report higher sleep and psychological dysfunction compared to medical management but have comparable sinus-specific symptoms. Subjects undergoing ESS experience greater gains than medical management across all domains; however these gains are smallest in the psychological and sleep domains.

Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

“…Such studies likely include subjects with higher burden or wide-ranging impact of disease compared to subjects that elect continued medical management as has been demonstrated in another North American cohort. 10,11 Regardless, literature reporting pain in surgical cohorts tend to report pain 8,9 or headache 8,9,20 in the majority of subjects at baseline with significant improvements postoperatively. In contrast, cross-sectional studies evaluating subjects with CRS upon presentation report pain in only a minority of patients with CRS.…”

“…32 Characterizing the differential cytokine profiles of CRS subtypes and identifying associated symptom profiles may be an important step in understanding why some subjects experience greater health-related burden of disease, 27 which is an important predictor of electing surgical intervention over continued medical therapy. 10 …”

“…7,9 Furthermore, this data is often reported in subjects that have elected surgical treatment, 8,9 which may be a biased interpretation as prior study has shown that differential symptom burden is associated with therapeutic decisions. 10,11 …”

Chronic Rhinosinusitis: Epidemiology and Burden of Disease

“…Specifically, examination of the Sinonasal Outcomes Test 22 16 revealed that patients who elect surgical intervention over medical therapy are more likely to experience sleep and psychologic dysfunction. 17 No difference was found in the rhinologic-specific domains between the patients who elected surgery and those who continued with medical therapy. These findings indicate that patients are more likely to take the riskier intervention when the disease process impacts sleep and psychologic function.…”

Multimodal Frequency Treatment for Facial Pain Caused by Chronic Rhinosinusitis: A Pilot Study

“…The secondary endpoints included facial pain as measured by the BPI-SF (pain severity and pain interference scores) and the Sino-Nasal Outcome Test-22 (SNOT-22) [16,49]. We used SNOT-22 scores to investigate changes in disease-related quality of life, because mechanical vibrations may improve CRS symptoms, as well as pain [43,50].…”