Sinonasal Outcomes Test‐22 as a Tool to Identify Chronic Rhinosinusitis among Adults with Cystic Fibrosis

Abstract

Objectives: (1) Investigate the ability of a sinus-specific health-related quality of life questionnaire (HRQoL) to distinguish clinically significant chronic rhinosinusitis (CRS) among adults with cystic fibrosis (CF). (2) Determine an appropriate cutoff score on the Sinonasal Outcomes Test-22 (SNOT-22) with sufficient test sensitivity and specificity, to assist caregivers in identifying adults with CF who may warrant specialist referral and treatment. Methods: Participants were enrolled at an adult-specific CF clinic in a tertiary academic hospital in Vancouver, Canada. Subjects completed the SNOT-22 followed by endoscopic assessment by otolaryngologists. The Canadian Clinical Practice Guidelines for Chronic Rhinosinusitis were used to confirm diagnosis of CRS. Results: To date, 52 of 80 individuals with a confirmed diagnosis of CF have participated in this study. Thirty-nine (75.0%) individuals were identified with CRS, 12 (30.8%) of whom presented with nasal polyposis. Aggregate SNOT-22 scores were significantly higher among individuals with CRS compared to non-CRS counterparts (39.4 ± 20.0 vs 22.7 ± 8.7, P = .007, 95% confidence interval [CI] for mean difference: 4.7, 28.7). A SNOT-22 score >26 was found to have a test sensitivity of 74.4% and specificity of 66.7% for diagnosis of CRS (AUC = 0.77, P < .01). Using SNOT-22 scores related to rhinological symptoms increased the likelihood ratio of a positive test when compared to aggregate scores (8.3 vs 2.2, respectively). Conclusions: The SNOT-22 significantly discriminates between CF adults with and CF adults without CRS. Using rhinological symptom scores increases the likelihood of detecting true CRS cases. The use of this questionnaire may assist specialists in identifying individuals who have clinically significant CRS, warranting specialist referral and treatment.