Sino-Nasal Outcome Test-22 (SNOT-22) Scores as an Indicator of Quality of Life in Patients with Chronic Rhinosinusitis at Bayu Asih General Hospital, Purwakarta

Azmi Agnia; Erick  Maulana Yusup

doi:10.58344/ihj.v5i3.947

Authors

Azmi Agnia RSUD Bayu Asih Purwakarta
Erick Maulana Yusup RSUD Bayu Asih Purwakarta

DOI:

https://doi.org/10.58344/ihj.v5i3.947

Keywords:

chronic rhinosinusitis, quality of life, Sino-Nasal Outcome Test-22, SNOT-22, patient-reported outcome measure, cross-sectional study

Abstract

Chronic rhinosinusitis (CRS) can substantially impair health-related quality of life through persistent sinonasal symptoms and their effects on daily activities and functioning. However, evidence regarding patient-reported symptom burden and quality of life in regional hospitals in Indonesia remains limited. This study aimed to describe the quality of life of patients with CRS at Bayu Asih General Hospital in Purwakarta, Indonesia, using the 22-item Sino-Nasal Outcome Test (SNOT-22). A descriptive observational study with a cross-sectional design was conducted among 34 patients recruited through consecutive sampling. Data were collected using a validated Indonesian-language version of the SNOT-22 and analyzed descriptively according to participants' age and sex characteristics. Most participants were female (64.7%), and 50.0% were aged 18–39 years. The mean age was 40.79 ± 15.28 years. The mean SNOT-22 score was 48.59 ± 19.17, with a median of 47 and scores ranging from 18 to 100. Based on the study's predefined operational classification, 52.9% of participants were categorized as having moderate symptom burden, 41.2% as having severe symptom burden, and 5.9% as having mild symptom burden. These findings indicated a substantial patient-reported symptom burden and associated impairment in health-related quality of life. However, the severity categories reflected study-specific operational thresholds rather than universally established SNOT-22 cutoff values. The findings highlighted the potential value of incorporating standardized patient-reported outcome measures into routine clinical assessments to support comprehensive CRS management. Further longitudinal studies involving larger samples and incorporating clinical characteristics, comorbidities, and treatment-related outcomes are warranted to identify factors associated with symptom burden and evaluate changes in health-related quality of life following treatment.

References

Adams, D. R., Xu, L. J., Vickery, T. W., Scangas, G. A., Bleier, B. S., Gray, S. T., & Metson, R. (2023). The impact of gender on long-term quality of life after sinus surgery for chronic rhinosinusitis. The Laryngoscope, 133(12), 3319–3326. https://doi.org/10.1002/lary.30719

Albu, S., Lucaciu, R., & Procopciuc, L. M. (2022). Gender differences in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery. European Archives of Oto-Rhino-Laryngology, 279, 1–8.

Asokan, A., Mace, J. C., Rice, J. D., Smith, T. L., Soler, Z. M., & Ramakrishnan, V. R. (2023). Sex differences in presentation and surgical outcomes from a prospective multicenter chronic rhinosinusitis study. Otolaryngology–Head and Neck Surgery, 168(3), 491–500.

Choi, A., Xu, S., Luong, A. U., & Wise, S. K. (2024). Current review of comorbidities in chronic rhinosinusitis. Current Allergy and Asthma Reports, 25(1), Article 4. https://doi.org/10.1007/s11882-024-01184-4

Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., et al. (2020). European position paper on rhinosinusitis and nasal polyps 2020. Rhinology, 58(Suppl. S29), 1–464. https://doi.org/10.4193/Rhin20.600

Gupta, R. (2024). Assessment of correlation between disease specific quality of life and endoscopy score after 1 month and 6 months of endoscopic sinus surgery in patients with chronic rhinosinusitis: A prospective study. Indian Journal of Otolaryngology and Head & Neck Surgery, 76(1), 112–117. https://doi.org/10.1007/s12070-023-04095-4

Hastan, D., Fokkens, W. J., Bachert, C., Newson, R. B., Bislimovska, J., Bockelbrink, A., et al. (2011). Chronic rhinosinusitis in Europe—An underestimated disease. Allergy, 66(9), 1216–1223. https://doi.org/10.1111/j.1398-9995.2011.02646.x

Hopkins, C., Gillett, S., Slack, R., Lund, V. J., & Browne, J. P. (2009). Psychometric validity of the 22-item Sinonasal Outcome Test. Clinical Otolaryngology, 34(5), 447–454. https://doi.org/10.1111/j.1749-4486.2009.01995.x

Hopkins, C., Lee, S. E., Klimek, L., & Soler, Z. M. (2022). Clinical assessment of chronic rhinosinusitis. The Journal of Allergy and Clinical Immunology: In Practice, 10(6), 1406–1416.

Juanda, I. J., Madiadipoera, T., & Ratunanda, S. S. (2017). Cultural adaptation, Indonesian translation, and validation of the Sino-Nasal Outcome Test (SNOT)-22. Majalah Kedokteran Bandung, 49(4), 267–273.

Keshari, S., Kumar, N., Varghese, A., Singh, S. P., Yadav, R., & Niranjan, A. S. (2024). Treatment outcome post endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). Indian Journal of Otolaryngology and Head & Neck Surgery, 76(5), 4126–4132. https://doi.org/10.1007/s12070-024-04799-1

Khan, A. H., Reaney, M., Guillemin, I., Wright, E. D., Hopkins, C., Vautrin, A., et al. (2022). Development of Sinonasal Outcome Test (SNOT-22) domains in chronic rhinosinusitis with nasal polyps. The Laryngoscope, 132(5), 933–941.

Klingler, A. I., Stevens, W. W., Tan, B. K., Peters, A. T., Poposki, J. A., Grammer, L. C., et al. (2021). Mechanisms and biomarkers of inflammatory endotypes in chronic rhinosinusitis without nasal polyps. Journal of Allergy and Clinical Immunology, 147(4), 1306–1317. https://doi.org/10.1016/j.jaci.2020.11.037

Macchi, A., Giorli, A., Cantone, E., et al. (2023). Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients. Frontiers in Allergy, 4, Article 1083964. https://doi.org/10.3389/falgy.2023.1083964

Nappi, E., Marzio, V., Giombi, F., Costanzo, G., Merli, S., Nicolosi, S., Cavaglià, E., Rizzini, F. L., Traversi, S., & Vrenna, A. (2025). Chronic rhinosinusitis with and without nasal polyps: the state-of-the-art of current treatment strategies and future developments. Frontiers in Allergy, 6, 1714577.

Orlandi, R. R., Kingdom, T. T., Smith, T. L., Bleier, B. S., DeConde, A. S., Luong, A. U., et al. (2021). International consensus statement on allergy and rhinology: Rhinosinusitis 2021. International Forum of Allergy & Rhinology, 11(3), 213–739. https://doi.org/10.1002/alr.22741

Phillips, K. M., Houssein, F. A., Boeckermann, L. M., Singerman, K. W., Liu, D. T., & Sedaghat, A. R. (2021). Multi-institutional minimal clinically important difference of the 22-item Sinonasal Outcome Test in medically managed chronic rhinosinusitis. Rhinology, 59(6), 552–559.

Plath, M., Sand, M., Cavaliere, C., Plinkert, P. K., Baumann, I., & Zaoui, K. (2023). Normative data for interpreting the SNOT-22. Acta Otorhinolaryngologica Italica, 43(6), 390–399.

Ramos, L., Massey, C. J., Asokan, A., Rice, J. D., Kroehl, M., & Ramakrishnan, V. R. (2022). Examination of sex differences in a chronic rhinosinusitis surgical cohort. Otolaryngology–Head and Neck Surgery, 167(3), 583–589.

Riedl, D., Dejaco, D., Steinbichler, T. B., Innerhofer, V., Gottfried, T., Bektic-Tadic, L., et al. (2021). Assessment of health-related quality-of-life in patients with chronic rhinosinusitis—Validation of the German Sino-Nasal Outcome Test-22 (German-SNOT-22). Journal of Psychosomatic Research, 140, Article 110316. https://doi.org/10.1016/j.jpsychores.2020.110316

Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Ashok Kumar, K., Kramper, M., et al. (2015). Clinical practice guideline (update): Adult sinusitis. Otolaryngology–Head and Neck Surgery, 152(2 Suppl.), S1–S39. https://doi.org/10.1177/0194599815572097

Rudmik, L., & Smith, T. L. (2011). Quality of life in patients with chronic rhinosinusitis. Current Allergy and Asthma Reports, 11(3), 247–252.

Sedaghat, A. R., Kuan, E. C., & Scadding, G. K. (2022). Epidemiology of chronic rhinosinusitis: prevalence and risk factors. The Journal of Allergy and Clinical Immunology: In Practice, 10(6), 1395–1403.

Sharma, A., Raghuwanshi, N., Gupta, Y., Upadhyay, A., & Mundra, R. (2023). SNOT-22 a predictive and assessment tool for subjective improvement after FESS in patients of chronic rhinosinusitis. Indian Journal of Otolaryngology and Head & Neck Surgery, 75(Suppl. 1), 1062–1068. https://doi.org/10.1007/s12070-023-03582-y

Singerman, K. W., Phillips, K. M., & Sedaghat, A. R. (2022). Minimal clinically important difference for subdomains of the 22-item Sino-Nasal Outcome Test in medically managed chronic rhinosinusitis patients. International Forum of Allergy & Rhinology, 12(9), 1196–1199. https://doi.org/10.1002/alr.22967

Verma, P., Rawat, D. S., Aseri, Y., Verma, P. C., & Singh, B. K. (2022). A prospective longitudinal study of clinical outcome and quality of life assessment in patients with chronic rhinosinusitis after functional endoscopic sinus surgery using Sino-Nasal Outcome Test-22. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl. 2), 2458–2463.

Wu, C., & Zhan, X. (2024). Sleep and psychological disorders seriously affect the quality of life of chronic rhinosinusitis patients. European Archives of Oto-Rhino-Laryngology, 281(7), 3615–3623.

Yim, M. T., Orlandi, R. R., Oakley, G. M., & Alt, J. A. (2021). The Sinonasal Outcome Test (SNOT-22) is a poor diagnostic tool for chronic rhinosinusitis. Annals of Otology, Rhinology & Laryngology, 130(11), 1220–1227.