Published: 2019-06-27

Evaluation of pre-operative sino-nasal outcome test- 22 scores as a predictor of outcome in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

Balasubramanian Krishnaswami, Prabu Velayutham, Naveenkumar Pruthivirajan, Sathiyam Murugesan, Ramkumar Murugesan


Background: Numerous factors are to be considered when offering FESS as a treatment for patients with chronic rhinosinusitis (CRS) who have failed conservative medical treatment. The objective is 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 in a tertiary hospital, with refractory CRS that required surgery were included. Subjects were excluded if they did not complete both pre and post-operative SNOT-22 Questionnaire. Demographic and baseline measures, including allergic rhinitis, asthma and addiction status, Lund Kennedy endoscopic scores and Lund-Mackay computed tomography (CT) scoring were also obtained for each subject. Regression analyses were performed.  

Results: Fifty-one subjects met criteria and were included. These subjects showed a 55.4% overall improvement in postsurgical SNOT-22 evaluations. Multivariate regression analysis revealed that SNOT-22 items related to “runny nose,” “waking up at night”, “need to blow nose”, and “sneezing” were independent predictors of postsurgical SNOT-22 improvement (p<0.05, for all).

Conclusions: ENT surgeons can utilize the SNOT-22 tool to predict the possibility of symptom improvement post FESS in patients with CRS.


Chronic rhinosinusitis, Sino-nasal outcome test-22, Functional endoscopic sinus surgery, Predictive factors, Asthma, Allergy, Smoking, Depression

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Lehrer-Coriat E, Mariño-Sánchez F, Alobid I, Mullol J. Quality of life measures in patients on rhinosinusitis trials. Clin Investigation. 2013;3(3):251-63.

Blackwell DL, Collins JG, Coles, R. Summary health statistics for U.S. adults: National Health Interview Survey. 1997. Vital Health Stat. 2002;(205):1-109.

Settipane GA. Epidemiology of nasal polyps. Allergy Asthma Proc. 1996;17(5):231–6.

Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, et al. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg. 2004;131(6):1-62.

Kennedy JL, Hubbard MA, Huyett P, Patrie JT, Borish L, Payne SC. Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis. Ann Allergy Asthma Immunol. 2013;111(4):246-51.

Messerklinger W. Endoscopy of the Nose. Baltimore: Urban and Schwarzenberg, 1978.

Wigand D. Endoscopic S11.1gery of the Paranasal Sinuses and Anterior Skull Base. New York: Thieme; 1991.

Zinreich SJ, Kennedy DW, Rosenbaum AE, Gayler BW, Kumar AJ, Stammberger H, et al. Paranasal sinuses: CT imaging requirements for endoscopic surgery. Radiology. 1987;163:769–75.

Messerklinger W. On the drainage of the normal frontal sinus of man. Acta Otolaryngol (Stockh) 1967;63:176–81.

Mackay IS, Lund VJ. Surgical management of sinusitis. In:Scott- Brown’s Otolaryngology. Oxford: Butterworth-Heinemann;1997.

Earwaker J. Anatomic variants in sinonasal CT. Radiographics 1993;13:381–415.

Brandsted R, Sindwani R. Impact of depression on disease-specific symptoms and quality of life in patients with chronic rhinosinusitis. American J Rhinol. 2007;21:50–54.

Smith TL, Mendolia-Loffredo S, Loehrl TA, Sparapani R, Laud PW, Nattinger AB. Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2005;115:2199–205.

Anderson ER, Murphy MP, Weymuller EA Jr. Clinimetric evaluation of the Sinonasal Outcome Test-16. Student Research Award 1998. Otolaryngol Head Neck Surg. 1999;121(6):702–7.

Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009;34(5):447–54.

Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62(85):17–25.

Lü W, Qi F, Gao ZQ, Feng GD, Yuan XD, Jin XF. Quality of life survey on patients with chronic rhinosinusitis by using Chinese version of the 22-item sinonasal outcome test (SNOT-22). Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008;43(1):18–21.

Kosugi EM, Chen VG, Fonseca VM, Cursino MM, Mendes Neto JA, Gregório LC. Translation, cross-cultural adaptation and validation of SinoNasal outcome test (SNOT):22 to Brazilian Portuguese. Braz J Otorhinolaryngol. 2011;77(5):663–9.

Marambaia PP, Lima MG, Santos KP, Gomes AD, Sousa MM, Marques ME. Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire. Brazilian J Otorhinolaryngol. 2013;79(1):54-8.

Poetker DM, Smith TL. Adult chronic rhinosinusitis:surgical outcomes and the role of endoscopic sinus surgery. Current opinion in Otolaryngol Head Neck Surg. 2007;15:6–9.

Smith TL, Litvack JR, Hwang PH, Loehrl TA, Mace JC, Fong KJ, et al. Determinants of outcomes of sinus surgery:a multi-institutional prospective cohort study. J Am Acad Otolaryngol-Head Neck Surg. 2010;142:5.

Levy JM, Mace JC, Rudmik L, Soler ZM, Smith TL. Low 22‐item sinonasal outcome test scores in chronic rhinosinusitis: Why do patients seek treatment? Laryngoscope. 2017;127(1):22-8.

Erskine S, Hopkins C, Kumar N, Wilson J, Clark A, Robertson A, Kara N, Sunkaraneni V, Anari S, Philpott C. A cross sectional analysis of a case-control study about quality of life in CRS in the UK;a comparison between CRS subtypes. Rhinology. 2016;54(4):311-5.

Marambaia PP, Lima MG, Macario H, de Machado Gomes A, Gomes LM, Marambaia MP, et al. Use of the long-term quality of life assessment in the decision to indicate surgery in patients with chronic rhinosinusitis. Brazilian J Otorhinolaryngol. 2018.