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Rhinology/Allergy

Validation of a Novel Allergy-Specific Domain for the SNOT-22

Tuesday, October 3, 2023
8:12 AM - 8:18 AM East Coast USA Time
Location: 103BC

    Presenting Author(s)

  • Anne Y. Feng, MD

    Resident Physician
    Rutgers-New Jersey Medical School
    Jersey City, NJ, United States

    • Co-Author(s)

  • Anne Li, MS, MPH

    Research Assistant II
    Brigham and Women's Hospital
    Malden, MA, United States

  • EW

    Elizabeth G. Willard, MPH

    Research Assistant II
    Brigham and Women's Hospital
    Boston , MA, United States

  • AP

    Anthony A. Prince, MD

    Associate Surgeon
    Brigham and Women’s Hospital
    Dedham, MA, United States

  • Carleton E. Corrales, MD

    Assistant Professor
    Brigham & Women's Hospital/Harvard Medical School
    Newton, MA, United States

  • Jay F. Piccirillo, MD

    Professor, Vice Chair for Research
    Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine
    St. Louis, MO, United States

    • Senior Author(s)

  • Jennifer J. Shin, MD, SM

    Vice Chair for Academic Affairs, Vice Chair for Faculty Development
    Harvard Medical School
    Boston, MA, United States

Disclosure(s):
Jay F. Piccirillo, MD: No relevant relationships to disclose.
Introduction: The purpose of this study was to validate a novel 4-item allergy-specific domain for the 22-item Sino-Nasal Outcomes Test (SNOT-22) to efficiently quantify the impact of allergy concurrent with chronic rhinosinusitis.

Methods: The proposed 4-item domain was evaluated for face validity, internal consistency, intra-rater reliability, convergent validity, discriminant validity, and responsiveness to change. Participants with nasal symptoms were recruited October 2020–2022 from outpatient clinics to complete: 1) allergy domain items; 2) disease-specific instruments: SNOT-22, Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE), and Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire (MiniRQLQ); and 3) global health assessments: Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) and EQ-5D-5L. The novel domain and additional alternative item groupings were assessed via factor analysis.

Results: Among 663 participants, allergy domain scores ranged from 0 to 5 (mean 1.4). Internal consistency was high (Cronbach alpha 0.81 within domain, 0.91 within all SNOT items). There was strong convergent validity with other nasal surveys: NOSE (Spearman 0.52, 95% CI 0.45–0.57), MiniRQLQ (0.69, 0.59–0.76), and SNOT-22 nasal domain (0.70, 0.65–0.73) and overall scores (0.64, 0.56–0.69). PROMIS physical health scores (¯0.25, ¯0.35–¯0.14) and EQ-5D-5L (¯0.23, ¯0.34–¯0.12) were also strongly correlated. Intra-rater reliability was substantial within patients with unchanged symptoms on an independent disease-specific query (kappa 0.7). Discriminant validity was established as scores indicated present or absent allergic states (¯0.75, 95% CI ¯0.95–¯0.55). Responsiveness to change was assessed among patients who improved after management; scores significantly improved (¯0.35, 95% CI ¯0.49–¯0.21). Alternative domain groupings based on factor analysis with extant SNOT-22 items also had strong properties.

Conclusions: This novel domain for SNOT-22 is a valid and efficient concurrent measure of allergic rhinitis concurrent with chronic rhinosinusitis.