A validated model for the 22‐item Sino‐Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Feng, Allen L.; Wesely, Nicholas C.; Hoehle, Lloyd P.; Phillips, Katie; Yamasaki, Alisa; Campbell, Adam P.; Gregório, Luciano Lobato; Killeen, Thomas E.; Caradonna, David S.; Meier, Josh; Gray, Stacey T.; Sedaghat, Ahmad R.

doi:10.1002/alr.22025

Cited by 102 publications

(156 citation statements)

References 33 publications

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“…There are a variety of ways to classify phenotypes of CRS patients. Patients can be classified based on the severity of their symptoms (mild, moderate, severe) or the preponderance of nasal and extra‐nasal symptoms . Patients may also be classified by the frequency with which they experience acute exacerbations of CRS or acute super‐infections .…”

Section: Discussionmentioning

confidence: 99%

“…Patients can be classified based on the severity of their symptoms (mild, moderate, severe) 11 or the preponderance of nasal and extra-nasal symptoms. [11][12][13][14] Patients may also be classified by the frequency with which they experience acute exacerbations of CRS or acute super-infections. 15 Most commonly, CRS patients have been catalogued based on the presence of comorbid signs or conditions such as nasal polyps, asthma or atopy.…”

Section: Crs Phenotypesmentioning

confidence: 99%

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Understanding and clinical relevance of chronic rhinosinusitis endotypes

Husain

Sedaghat

2019

Clinical Otolaryngology

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Background Chronic rhinosinusitis (CRS) is the downstream manifestation of heterogeneous pathophysiologic mechanisms leading to chronic sinonasal inflammation. Traditional grouping of patients by symptoms or clinical findings/phenotypes is being replaced by classification of CRS patients based on the underlying pathophysiologic mechanisms: endotypes. Objective of Review To provide an up‐to‐date review on the current knowledge of CRS endotypes with a focus on how the pathophysiologic mechanisms defined by each endotype may be targeted therapeutically. Special emphasis is placed on the clinical relevance of the material and how it may inform the current practice of otolaryngologists. Type of Review A systematic review of contemporary literature review focusing on the latest studies examining the role of endotypes in the management and treatment of CRS. Search Strategy A MEDLINE and PubMed Central search were undertaken to perform this review using the keywords “Endotype” and “Sinusitis.” Evaluation Method Articles containing the keywords, as well as the references of those articles, were then examined for relevance. Results The endotypes for CRS are often defined based on the balance of T‐helper cell patterns of inflammation and can be grouped into Th2 and non‐Th2 inflammation. These groups have shown a variable response to medical and surgical therapy, demonstrating that existing mainstream treatments can be tailored to patients with specific endotypes. The inflammatory mediators of Th2 inflammation, IL‐4, IL‐5 and IL‐13 as well as IgE, are targeted by available biologic drugs that can be used for treatment of refractory disease. Conclusions Increased understanding of CRS endotypes has led to the identification of biomarkers that define these endotypes and act as targets for potential therapeutics. Increasing knowledge about characteristics associated with these endotypes and their responses to treatments, including both established mainstream CRS treatments and novel biologic medications, has allowed incorporation of CRS endotypes into the current clinical decision‐making. Treatment of CRS patients based on consideration of their endotypes is therefore not only presently possible but may improve clinical outcomes of those patients as well.

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Section: Discussionmentioning

confidence: 99%

Section: Crs Phenotypesmentioning

confidence: 99%

Understanding and clinical relevance of chronic rhinosinusitis endotypes

Husain

Sedaghat

2019

Clinical Otolaryngology

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“…Paired t test was used to compare pre‐ and postoperative overall and subcategorical scores for the SNOT‐22 and LMS. The following subdomain categories from the SNOT‐22 were analyzed: sleep symptoms, nasal symptoms, otologic/facial pain symptoms, and emotional function . Univariate analysis based on gender, median age, and median tumor size was performed.…”

Section: Methodsmentioning

confidence: 99%

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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Objectives The utilization of the nasoseptal flap (NSF) in endoscopic anterior skull base surgery (EASB) has resulted in reduced rates of postoperative cerebrospinal fluid leak (CSF). The long‐term impact on sinonasal function after surgery remains incompletely defined. Methods A consecutive series of patients undergoing EASB with NSF and with at least 3 years follow‐up was prospectively evaluated. Patient demographics, pre‐ and postoperative Sino‐nasal Outcome Test‐22 (SNOT‐22) scores, Lund‐Mackay scores (LMS), CSF leak, and sinonasal complications were analyzed. Results A total of 46 patients undergoing EASB with NSF met inclusion criteria. The mean follow‐up was 67.4 months (range 39–90, standard deviation [SD] 14.2 months). No statistically significant differences were noted between the mean overall pre‐ (16) and postoperative SNOT‐22 scores (18). SNOT‐22 scores improved in 27 patients (58.7%), deteriorated in 17 patients (37.0%) and stayed the same in two patients (4.3%). Deterioration in SNOT‐22 scores was greater in younger (mean change + 7.2 [SD17.4] vs. older patients −3.4 [SD 7.5], P = 0.010). A statistically significant increase in LMS was noted (mean preoperative LMS0.9 vs. mean postoperative LMS 2.2, P = 0.001). The LMS decreased in nine patients (19.6%), increased in 22 patients (47.8%), and remained the same in 15 patients (32.6%). One patient (2.2%) developed a postoperative CSF leak following resection of metastatic skull base lesion and was successfully treated with placement of a lumbar drain, Foley catheter balloon, and strict bed rest. One patient (2.2%) developed a postoperative mucocele requiring decompression 3 years after initial surgery. Conclusion Whereas long‐term sinonasal quality of life is overall improved in the majority of patients following NSF use for EASB, younger patients show higher incidence of deterioration. Increased sinus opacification on imaging is generally noted and may require continued follow‐up and management. The incidence of reoperation for symptomatic mucocele formation is low. Level of Evidence 4 Laryngoscope, 129:1035–1040, 2019

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“…The burden of CRS symptomatology and CRS‐specific quality of life may be quantified through numerous validated tools and questionnaires . The 22‐item Sinonasal Outcome Test (SNOT‐22), which reflects nasal, sleep, ear/facial discomfort and emotional symptoms, is one such questionnaire and is widely utilised in both the clinical and research settings . An important concept regarding the use of patient‐reported outcome measures, such as the SNOT‐22, is the minimal clinically important difference (MCID) .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The 22-item Sinonasal Outcome Test , which reflects nasal, sleep, ear/facial discomfort and emotional symptoms, is one such questionnaire and is widely utilised in both the clinical and research settings. 10,11 An important concept regarding the use of patient-reported outcome measures, such as the SNOT-22, is the minimal clinically important difference (MCID). 12,13 The MCID reflects the minimum change in a patient-reported outcome measure that translates to a noticeable, and therefore clinically meaningful, change for the patient.…”

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confidence: 99%

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

Phillips

Hoehle

Caradonna

et al. 2018

Clinical Otolaryngology

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102

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A validated model for the 22‐item Sino‐Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Abstract: The use of the 4-subdomain structure for SNOT-22 (reflecting sleep, nasal, otologic/facial pain, and emotional symptoms of CRS) was validated as the most appropriate to calculate SNOT-22 subdomain scores for patients from different geographic regions using CFA.

Cited by 102 publications

References 33 publications

Understanding and clinical relevance of chronic rhinosinusitis endotypes

Understanding and clinical relevance of chronic rhinosinusitis endotypes

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

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

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