Determinants of noticeable symptom improvement despite sub‐MCID change in SNOT‐22 score after treatment for chronic rhinosinusitis

Background

The minimal clinically important difference (MCID) of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) is specific but not sensitive for identifying patients experiencing noticeable improvement in symptoms of chronic rhinosinusitis (CRS). It is unclear why some patients with less than 1 MCID change in SNOT‐22 score nevertheless report noticeable improvement in their CRS symptoms.

Methods

This investigation was a retrospective study of 247 CRS patients undergoing medical management who completed SNOT‐22 surveys in 2 consecutive visits 2‐12 months apart. The validated nasal, sleep, ear/facial discomfort, and emotional SNOT‐22 subdomain scores were calculated. At the second visit, patients reported their global change in CRS symptoms on a 5‐item transition rating scale as: "Much worse"; "A little worse"; "About the same"; "A little better"; or "Much better." Patient‐reported improvement in symptoms (at least "A little better") was tested for association with changes in SNOT‐22 subdomain scores.

Results

In the entire cohort, patient‐reported improvement in CRS symptoms was associated with improvement in all SNOT‐22 subdomain scores (p < 0.001). In patients with less than 1 MCID (12 points) of change in the SNOT‐22, only the nasal subdomain (adjusted odds ratio, 0.89; 95% confidence interval [CI], 0.79‐0.99; p = 0.042) was associated with patient‐reported improvement in CRS symptoms. Changes in none of the other SNOT‐22 subdomain scores were associated with patient‐reported improvement in CRS symptoms.

Conclusions

Among patients with less than 1 MCID change in the SNOT‐22, improvement in only nasal symptoms—but not extranasal symptoms—of CRS is associated with those who nevertheless report improvement of their CRS symptoms.

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