Otolaryngology (ENT)

Sinonasal Outcome Test-22 (SNOT-22): A Full Guide for Researchers and Clinicians

Name: Sinonasal Outcome Test-22 (SNOT-22): A Full Guide for Researchers and Clinicians
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Introduction

Chronic sinonasal conditions, such as rhinosinusitis, significantly affect patient’s quality of life, necessitating precise assessment tools. Consequently, the Sinonasal Outcome Test-22 (SNOT-22) emerges as a critical instrument for evaluating these impacts. Developed by Jay F. Piccirillo in 2006 and later refined by Claire Hopkins and colleagues in 2009, this 22-item questionnaire targets sinonasal symptoms, including nasal obstruction, facial pain, and psychological effects. With over 1,700 citations on Google Scholar, its robust psychometric properties and concise format make it indispensable for otolaryngologists, allergists, and researchers.

Therefore, this article provides a comprehensive guide to the SNOT-22, detailing its structure, applications, and clinical value for improving patient outcomes in sinonasal health.

Key Features of the Sinonasal Outcome Test-22 (SNOT-22)

Purpose and Use

The SNOT-22 specifically measures the severity of sinonasal symptoms and their impact on quality of life. It covers 22 items across five domains:

Rhinologic symptoms
Extra-nasal rhinologic symptoms
Ear/facial symptoms
Psychological dysfunction
Sleep dysfunction

Unlike generic quality of life tools, its targeted design ensures relevance for patients with chronic rhinosinusitis (CRS) or other sinonasal disorders.

Target Population

The SNOT-22 is designed for adults with sinonasal conditions, including:

Young Adults (18-24 years)
Middle-Aged Adults (25-44 years)
Older Adults (45-64 years)
Seniors (+65 years)
Patients with chronic rhinosinusitis (CRS)

Thus, it is highly adaptable for ENT clinics and allergy practices. However, it lacks validation for pediatric or non-sinonasal populations.

Structure

The SNOT-22 comprises 22 items divided into five subscales:

Rhinologic Symptoms (8 items): Assesses nasal obstruction, loss of smell, and post-nasal drip.
Extra-Nasal Rhinologic Symptoms (3 items): Evaluates sneezing, runny nose, and cough.
Ear/Facial Symptoms (4 items): Measures ear pain, facial pressure, and dizziness.
Sleep Dysfunction (5 items): Addresses fatigue, poor sleep, and reduced productivity.
Psychological Dysfunction (5 items): Captures emotional impacts like frustration and embarrassment.

Each item uses a 6-point Likert scale (0 = No problem, 5 = Problem as bad as it can be), ensuring clear and consistent responses.

Scoring Method

The SNOT-22 employs a 0-5 Likert scale, producing a total score ranging from 0 to 110, with higher scores indicating greater sinonasal impact on quality of life. Subscales are scored by summing their respective items, allowing clinicians to identify specific issues, such as rhinologic or sleep-related concerns. For example, a high score in the psychological dysfunction subscale might prompt mental health support. While no universal cut-off exists, a minimal clinically important difference (MCID) of 9 points helps detect meaningful changes.

Administration Format

The SNOT-22 takes from 3 to 5 minutes to complete, making it suitable for busy clinical settings. It can be administered via:

Paper-based forms
Digital (online) platforms
In-person interviews
Mobile apps
Phone or video calls

Notably, the questionnaire is self-administered, requiring no specialized training for administration or interpretation.

Applications of Sinonasal Outcome Test-22 (SNOT-22)

The SNOT-22 offers versatile applications:

Monitoring: Tracks symptom changes before and after interventions, such as sinus surgery.
Treatment Planning: Guides personalized treatment based on subscale scores.
Research: Supports studies on sinonasal disease impacts and treatment efficacy.

For instance, clinicians might use elevated rhinologic scores to prioritize nasal therapies, while researchers analyze trends to inform CRS management protocols.

Language and availability

To enhance global accessibility, the SNOT-22 is available in multiple languages, including:

Arabic
English
French
German
Italian
Polish
Spanish
Turkish

This multilingual support broadens its use in diverse research and clinical contexts. Notably, permission from Washington University in St. Louis is required, with potential licensing fees for commercial use.

Reliability and Validity

The SNOT-22 boasts strong psychometric properties. Validation studies confirm its reliability and responsiveness. With a Cronbach’s alpha above 0.90, it demonstrates excellent internal consistency. Additionally, its sensitivity to changes in sinonasal health makes it a reliable tool for monitoring outcomes in research and clinical practice.

Original validation study: link
Spanish validation study: link
Arabic validation study: link
Turkish validation study: link
German validation study: link

Limitations and Considerations

Despite its strengths, the SNOT-22 has a few limitations:

Self-report: Responses may be influenced by social desirability bias or personal interpretation.
Age Restrictions: Not suitable for all age groups, as it lacks validation for pediatric populations.
Limited Correlation with Objective Clinical Findings: Scores may not align with CT or endoscopy results, limiting its diagnostic utility.

Additional Resources

For more information on the SNOT-22 and to access the full questionnaire, explore these resources:

Original Validation Study: Link
SNOT-22 PDF
For inquiries, contact Dr. Timothy L. Smith (MD, MPH) the developer of the SNOT instruments at smith@wustl.edu
For Licensing and Permissions consult Washington University in St. Louis.

Frequently Asked Questions (FAQ)

Who can use the SNOT-22?
Clinicians, researchers, and healthcare providers use the SNOT-22 for patients aged 18 and older with sinonasal conditions.
How long does it take to complete the SNOT-22?
Patients typically complete it in about 3-5 minutes, making it suitable for busy clinical settings.
How is the SNOT-22 administered?
Healthcare teams can administer it via paper, digital, mobile app, or interview formats, offering flexibility.
Is there any cost to using the SNOT-22?
The SNOT-22 is free for non-commercial use. For commercial or funded academic projects, permission from the publisher may be necessary.

A word from ResRef about Sinonasal Outcome Test-22 (SNOT-22)

The Sinonasal Outcome Test-22 (SNOT-22) is a validated instrument designed to assess symptoms and quality of life in sinonasal disorders. Its concise format and strong psychometric properties make it suitable for both clinical and research settings. By addressing key areas of concern for patients, the SNOT-22 aids in the early detection and management of sinonasal issues, contributing to better patient outcomes.

References

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. link
de los Santos, G., Reyes, P., del Castillo, R. et al. Cross-cultural adaptation and validation of the sino-nasal outcome test (SNOT-22) for Spanish-speaking patients. Eur Arch Otorhinolaryngol 272, 3335–3340 (2015). link
Psychometric Arabic Sino-Nasal Outcome Test-22: validation and translation in chronic rhinosinusitis patients Fatma Alanazy, Surayie Al Dousary, Ahmed Albosaily, Turki Aldriweesh, Saad Alsalyh, and Turki Aldrees link
Cakir Cetin A, Kumus O, Keskinoglu P, Sutay S, Ecevit MC. Turkish validation of the Sino-Nasal Outcome Test-22. Clin Otolaryngol. 2019 Jul;44(4):557-564. doi: 10.1111/coa.13332. Epub 2019 Apr 14. PMID: 30891883. link
Albrecht, T., Beule, A.G., Hildenbrand, T. et al. Cross-cultural adaptation and validation of the 22-item sinonasal outcome test (SNOT-22) in German-speaking patients: a prospective, multicenter cohort study . Eur Arch Otorhinolaryngol 279, 2433–2439 (2022). link