Validating the 22-Item Sinonasal Outcome Test (SNOT-22) in Pediatric Populations

Introduction: The Sino-Nasal Outcome Test (SNOT-22) is a widely validated patient-reported outcome measure in adult patient populations across the world, while the Sino-Nasal 5 Questionnaire (SN-5) is the only validated quality-of-life measurement in children with chronic rhinosinusitis (CRS) despite various limitations. This study aims to assess test-retest reliability, validity, responsiveness, and clinical interpretability of the SNOT-22 in identifying pediatric patients with CRS from healthy, non-CRS patients by comparing SNOT-22 and SN-5 across multiple visits.

Methods: This prospective cohort study included pediatric patients between the ages of 6-17 who presented for care at a tertiary care center’s pediatric otolaryngology clinic between January 2022 through March 2024. Pediatric patients completed the SN-5 and SNOT-22 across multiple clinic visits in-person or over the phone with the help of a parent/guardian. Exclusion criteria included nonverbal pediatric patients under 6, over 18, presenting for postop visits, with severe learning disabilities, or with sinonasal-related conditions. Preliminary data was statistically analyzed using Excel and R to examine test-retest reliability, validity, responsiveness, and clinical interpretability.

Results: Our study includes 90 total patients, including 45 experimental and 45 controls. For test-retest reliability in the experimental cohort between visits (n = 13), the SNOT-22 Pearson correlation coefficient (PCC) is 0.7 (p < 0.05), while the SN-5 PCC is 0.5 (p < 0.005). For validity, average ± standard deviation quality-of-life scores were larger in the experimental group than in the control group with both surveys but more with the SNOT-22 (p < 0.0001). For responsiveness, SNOT-22 showed a greater change in scores than SN-5 between clinic visits in experimental versus control groups (p < 0.005).

Conclusions: Statistically significant preliminary data supports the use of SNOT-22 over the limited SN-5 current standard of care during pediatric otolaryngology clinic visits to potentially help improve early identification and treatment of CRS in children.