Longitudinal improvement and stability of the SNOT‐22 survey in the evaluation of surgical management for chronic rhinosinusitis

Abstract

Background Patients with chronic rhinosinustis (CRS) have significant quality-of-life (QOL) improvements following endoscopic sinus surgery (ESS). These improvements remain stable and persist between 6-months and 20-months as measured by the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey. There has yet to be an evaluation of the longitudinal stability of the Sinonasal Outcome Test-22 (SNOT-22) after ESS in patients with CRS. Methods Adults with medically recalcitrant CRS who were considered surgical candidates were enrolled in a prospective, multi-center, observational cohort study from February 2011 to February 2013. Baseline evaluation of subjects included assessment of clinical characteristics, measures of CRS-specific disease severity, and QOL evaluation using the SNOT-22. Subjects were then re-evaluated at approximately 6-month, 12-month, and 18-month intervals postoperatively. Data was analyzed using repeated measures ANOVA with Bonferroni corrections for matched pairwise comparisons. Results 110 patients completed baseline evaluations and follow-up for all three postoperative time points. Significant improvement in SNOT-22 scores was seen between baseline and 6-months across both SNOT-22 total and subdomain scores (p<0.001). There was no statistically significant difference between the 6-month, 12-month, and 18-month time points in the total SNOT-22 score or its domains (p≥0.125) for both the entire cohort or subgroups (p≥0.077). Conclusions Postoperative improvement in CRS-specific QOL and symptom severity, as measured by the SNOT-22, suggest stability and durability between 6-months and 18-months. Further study on the longitudinal stability of the SNOT-22 past the 18-month timeframe will help further refine clinical study of CRS and provide further understanding of temporal improvements following ESS.

Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis

“…Study data was manually entered into a HIPAA compliant relational database (Access, Microsoft Corp., Redmond, WA) and statistical analyses were conducted using commercial software (SPSS v.23, IBM Corp., Armonk, NY). Last available SNOT-22, BSIT, and endoscopy scores were used to operationalize postoperative evaluations due to previously reported similarity of mean postoperative scores between 6, 12, and 18 month follow-up in this cohort 21,22 Postoperative improvement was determined by subtracting preoperative scores from postoperative scores and averaged. Descriptive analytics are reported while comparisons in preoperative measures while between-group differences were evaluated using either two-sided independent sample t-tests, Mann-Whitney U tests, or Pearson’s chi-square testing, based on scale distribution or count frequency.…”

Outcomes of complete vs targeted approaches to endoscopic sinus surgery

“…The last available follow-up of at least six months was used for determining interval change in SNOT-22 scores. 17 Patients were lost to follow-up if they did not complete any survey evaluations within 18 months after enrollment. Physicians at each site were blinded to all patient-based survey responses for the study duration.…”

Outcomes of Surgical Treatment of Chronic Rhinosinusitis

“…Although, short-term followup remains a valuable means to establishing the efficacy of surgical intervention, it is unclear which subjects will go on to have recurrent disease. Examination of 6-, 12-and 18-month outcomes data as captured by the RSDI, CSS, and SNOT-22 are stable between 6-and 18-month time points [38,39]. When these interval outcomes are stratified by polyp status on the SNOT-22, there is a trend (p = 0.077) of increasing burden of disease in subjects with polyps [39].…”

“…Examination of 6-, 12-and 18-month outcomes data as captured by the RSDI, CSS, and SNOT-22 are stable between 6-and 18-month time points [38,39]. When these interval outcomes are stratified by polyp status on the SNOT-22, there is a trend (p = 0.077) of increasing burden of disease in subjects with polyps [39]. These trends may represent the earliest symptoms of recurrent disease at 18 months in this subgroup of patients.…”

“…Although QOL instruments have been shown to be stable between the 6-and 18-month time points across a variety of measures [38,39], CRS is a long-term disease that may have late recurrences. In subjects with CRSwNP, time to revision surgery averaged approximately 5 years [40].…”