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Background: Differentiating the non‐sinogenic headache from chronic rhinosinusitis (CRS) remains a significant clinical challenge due to the extensive overlap in symptoms. The objective of this study was to evaluate the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score patterns in patients with confirmed non‐sinogenic headache in order to develop negative predictors of CRS. Methods: Institutional Review Board (IRB)‐approved, retrospective review of patients diagnosed with CRS or non‐sinogenic headache defined as patients with a chief complaint of headache, facial pain, and facial pressure in the absence of both endoscopic and computed tomography (CT) evidence of inflammation. The optimal cutoff points of potential predictors of non‐sinogenic headache by SNOT‐22 score were quantified by receiver operating characteristic (ROC) curve. The negative predictive values (NPVs) for CRS were calculated in a discovery population and then validated in an independent population. Results: A total of 724 (164 non‐sinogenic headache and 560 CRS) and 412 (88 non‐sinogenic headache and 324 CRS) patients were recruited in the discovery and validation populations, respectively. Domain 3 (Ear/facial) and domain 4 (Psychological dysfunction) were significantly higher in patients with non‐sinogenic headache as compared with CRS while domain 1 (Rhinologic) and domain 2 (Extranasal rhinologic) were significantly lower. The top 4 predictors of non‐sinogenic headache were the domain 3 (Ear/facial)/domain 1 (Rhinologic) ratio, item 12, domain 3 (Ear/facial), and (item 12 + item 10)/(item 4 + item 5) ratio, with areas under the ROC curve (AUCs) ranging from 0.637 to 0.720 by ROC curve. A domain 3 (Ear/facial)/domain 1 (Rhinologic) ratio over 0.66 performed as the best negative predictor of CRS with the highest NPVs of 0.880 and 0.889 in the discovery and validation populations, respectively. Conclusion: Patients with non‐sinogenic headache have distinct SNOT‐22 score patterns compared with patients with CRS. A domain 3 (Ear/facial)/domain 1 (Rhinologic) ratio greater than 0.66 is a strong negative predictor of CRS, which can be used to aid in patient counseling and potentially limit the use of unnecessary sinonasal therapeutics. [ABSTRACT FROM AUTHOR]

Background Patient-reported control of chronic rhinosinusitis (CRS) symptoms is associated with the quality of life impact of CRS. We sought to determine if 22-item Sino-Nasal Outcome Test (SNOT-22) score is predictive of patient-perceived CRS symptom control. Methods Prospective cross-sectional study of 202 patients with CRS. Participants were asked to rate their CRS symptom control as 'not at all,' 'a little,' 'somewhat,' 'very,' and 'completely.' The severity of patient CRS symptomatology was measured using the SNOT-22. The relationship between SNOT-22 score and patient-reported CRS symptom control was determined using regression, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis. Results SNOT-22 was negatively associated with patient-reported CRS symptom control (adjusted β = −0.03; 95% CI, −0.04 to −0.02; p < 0.001), after controlling for demographic and clinical characteristics. There was a significant difference in SNOT-22 scores of participants reporting each level of symptom control ( p < 0.001) with the greatest differences between participants who rated their CRS symptom control as 'not at all,' 'a little,' and 'somewhat,' which we deem poor CRS symptom control, and the group who described their level of CRS symptom control described as 'very' and 'completely,' which we deem well-controlled CRS symptoms. These results were true across all SNOT-22 subdomains scores as well. Using ROC analysis, a SNOT-22 score of 35 identified patients reporting poor vs well-controlled CRS symptom control with 71.4% sensitivity and 85.5% specificity. Conclusion SNOT-22 score is associated with how well patients feel their CRS symptomatology is controlled. Moreover, SNOT-22 score can be used to accurately distinguish patients with poor vs well-controlled CRS symptoms. [ABSTRACT FROM AUTHOR]

Objectives: The concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient‐reported and physician‐rated CRS disease control. Study Type: Cross‐sectional. Methods: A total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as "not at all," "a little," "somewhat," "very," and "completely." All participants completed a 22‐item Sinonasal Outcome Test (SNOT‐22) and also reported the number of sinus infections, CRS‐related antibiotic courses taken, CRS‐related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund‐Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT‐22 score (as well as SNOT‐22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS‐related antibiotics, CRS‐related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as "not at all," "a little," "somewhat," "very," and "completely." Associations were sought between CRS disease characteristics (SNOT‐22 score, endoscopy score, sinus infections, CRS‐related antibiotic usage, CRS‐related oral corticosteroid usage, and lost productivity due to CRS) and patient‐reported CRS control as well as mean physician‐rated CRS control. Results: Patient‐reported global CRS control was associated only with SNOT‐22 (adjusted relative risk [RR] = 0.99, 95% CI: 0.98–0.99, P < .001) but no other CRS disease characteristic. Patient‐reported CRS control was specifically associated only with nasal symptoms and not extra‐nasal symptoms of CRS. Physician‐rated CRS control was associated with SNOT‐22 score (adjusted RR [for each 1‐unit increase of SNOT‐22] = 0.99, 95% CI: 0.98–0.99, P < .001), number of acute bacterial CRS exacerbations—reflected by number of antibiotic courses taken (or sinus infections)—in the last 3 months (adjusted RR = 0.89, 95% CI: 0.82–0.98, P = .014) and the number of CRS‐related oral corticosteroid courses taken in the last 3 months (adjusted RR = 0.87, 95% CI: 0.78–0.97, P = .012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician‐rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting poorly controlled CRS. Conclusions: Patients and physicians use different criteria to determine the level of CRS control. While both rely on the burden of CRS symptomatology, patients consider primarily nasal symptoms while physicians include nasal and extra‐nasal symptoms of CRS in determining CRS control. Physicians also independently consider CRS‐related antibiotic use, as a reflection of acute bacterial CRS exacerbations, and CRS‐related oral corticosteroid use in the determination of global CRS control. Level of Evidence: 2c. [ABSTRACT FROM AUTHOR]

Background: Pathophysiology-targeting treatments exist for aspirin-exacerbated respiratory disease (AERD) through aspirin desensitization and biologics, such as dupilumab. With increasing attention paid to these treatments, which may be associated with significant side effects and/or cost, there is little description of chronic rhinosinusitis with nasal polyps (CRSwNP) response to treatment with intranasal corticosteroids and saline irrigations in AERD. Objective: To determine the effect of intranasal budesonide irrigations for the treatment of CRSwNP in AERD. Methods: This is an observational study of 14 AERD patients presenting to a rhinology clinic for CRS who were treated with twice daily high volume, low pressure irrigations with 240 mL of saline to which a 0.5 mg/2 mL respule of budesonide was added. All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) at enrollment and at follow up 1 to 6 months later. Polyp scores were also calculated at each time point. Results: SNOT-22 scores ranged from 26 to 98 (median: 40.5) at enrollment and 3 to 85 (median: 38.5) at follow-up. Polyp scores ranged from 2 to 6 (median: 4) at enrollment at 0 to 6 (median: 2) at follow-up. Over the treatment period, change in SNOT-22 score ranged from −38 to 16 (median: −18) and change in polyp score ranged from −2 to 0 (median: −0.5). Approximately 57% of participants experienced at least 1 minimal clinically important difference in SNOT-22 score and 21% of participants had a SNOT-22 score <20 at follow-up. Conclusion: Medical management with intranasal corticosteroids and saline irrigations alone leads to significant improvement in sinonasal symptomatology in a subset of AERD. [ABSTRACT FROM AUTHOR]

Purpose: There are many year-round modifiers of chronic rhinosinusitis (CRS). However, it is unknown whether there are seasonal variations in the sinonasal symptom burden of CRS. Methods: This was a retrospective cross-sectional study of sinonasal symptom burden measured using the 22-item Sinonasal Outcome Test (SNOT-22) and its four associated nasal, sleep, ear/facial discomfort and emotional subdomains in 1028 individuals with CRS. The season (winter, spring, summer or fall) when the SNOT-22 was completed was recorded. Regressions, controlling for clinical and demographic characteristics, were performed to seek association between season of the year and SNOT-22 total and subdomain scores. Results: The mean SNOT-22 scores were 37.4 for those individuals completing their SNOT-22 in the fall, 40.5 in the winter, 37.4 in the spring and 36.0 in the summer. There was a statistically significant association between higher SNOT-22 scores and completing the SNOT-22 in the wintertime (adjusted β = 4.08, 95% CI 0.74–7.42, p = 0.017). When seeking association between season and SNOT-22 subdomain scores, wintertime was associated only with higher emotional (adjusted β = 0.48, 95% CI 0.14–0.81, p = 0.006) and sleep (adjusted β = 2.23, 95% CI 0.54–3.91, p = 0.010) subdomain scores. Examining individual SNOT-22 items, these associations were due to more symptoms related to depressed mood ("sad") and psychomotor retardation. Conclusion: There are seasonal variations in symptom burden of CRS patients, independent of aeroallergen hypersensitivity, with the greatest increase in baseline CRS symptomatology during the winter. This finding was most strongly associated with increased emotional symptomatology and depressed mood. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS) may arise due to odontogenic etiologies. However, it is unknown whether odontogenic CRS has a differential impact on patients’ quality of life (QOL) compared to standard, inflammatory (but non-odontogenic) CRS. The objective of this study was to determine whether there is a difference in the impact of sinonasal symptomatology on general health-related QOL in odontogenic CRS compared to non-odontogenic CRS. This was a retrospective review of 21 odontogenic CRS patients who visited our tertiary care center. The severity of sinonasal symptomatology and CRS-specific QOL detriment was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) and general health-related QOL was measured using the health utility index from the 5-item EuroQol survey (EQ-5D HUV). Compared to non-odontogenic CRS, odontogenic CRS was not associated with a difference in SNOT-22 score [linear regression coefficient (β) = − 1.57, 95% CI − 12.47 to 9.32, p = 0.777] but was significantly associated with decreased EQ-5D HUV (β = − 0.10, 95% CI − 0.17 to − 0.03, p = 0.008). We also found that the magnitude of association (β) between SNOT-22 and EQ5D-HUV was greater for odontogenic CRS patients compared to non-odontogenic CRS patients (p = 0.045). Our findings suggest sinonasal symptoms may have a greater impact on general QOL in odontogenic CRS compared to non-odontogenic CRS. The reason for this remains unknown, but deserves further study. [ABSTRACT FROM AUTHOR]

Background Previous studies have identified subdomains of the 22-item Sino-Nasal Outcome Test (SNOT-22), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT-22. This study aims to validate the existence of underlying symptom subdomains of the SNOT-22 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology. Methods A total of 800 patients with CRS were included into this cross-sectional study (400 CRS patients from Boston, MA, and 400 CRS patients from Reno, NV). Their SNOT-22 responses were analyzed using exploratory factor analysis (EFA) to determine the number of symptom subdomains. A CFA was performed to develop a validated measurement model for the underlying SNOT-22 subdomains along with various tests of validity and goodness of fit. Results EFA demonstrated 4 distinct factors reflecting: sleep, nasal, otologic/facial pain, and emotional symptoms (Cronbach's alpha, >0.7; Bartlett's test of sphericity, p < 0.001; Kaiser-Meyer-Olkin >0.90), independent of geographic locale. The corresponding CFA measurement model demonstrated excellent measures of fit (root mean square error of approximation, <0.06; standardized root mean square residual, <0.08; comparative fit index, >0.95; Tucker-Lewis index, >0.95) and measures of construct validity (heterotrait-monotrait [HTMT] ratio, <0.85; composite reliability, >0.7), again independent of geographic locale. Conclusion 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. [ABSTRACT FROM AUTHOR]