Concordance Between an Adaptive Sino-Nasal Outcome Test and Imaging Results in Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a highly prevalent, multifactorial, inflammatory condition commonly assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). SNOT-22 has been characterized by observed discordance between its subjective outcomes and objective imaging results, a known potential feature of instruments validated for clinical research. Improved concordance between patient-reported outcomes and diagnostic tests may enhance synergy between research and daily clinical queries.

To determine whether the findings of a novel adaptive SNOT instrument are associated with results of Lund-Mackay computed tomography (LMCT).

This diagnostic study evaluated performance for both the standard static instrument (current standard) and a novel adaptive SNOT instrument compared with LMCT results for consecutive patients at tertiary care and community sites in Massachusetts from May 2020 to March 2025. Data were analyzed from March to July 2025.

The standard static SNOT-22 or a novel adaptive version of the SNOT instrument and sinonasal LMCT-quantified imaging results; secondarily, endoscopy scores and allergy-related diagnostics were assessed.

Associations between the static or adaptive SNOT instrument scores and LMCT results were assessed and compared via ordinal regression. Clinical probabilities were calculated.

The factor analysis included 3661 patient respondents (mean [SD] age, 50 [17] years; 2468 females [67%] and 1224 males [33%]); 417 patients had imaging performed. Internal consistency within the unidimensional SNOT nasal domain was high (Cronbach α, 0.915; 95% CI, >0.91). Standard static SNOT nasal domain and overall scores (SNOT-22, -25, -26, and -29) were not measurably associated with LMCT. Adaptive SNOT scores based on item response theory data and guideline definitions demonstrated associations with LMCT, particularly for the nasal domain (odds ratio [OR], 3.75; 95% CI, 1.90-7.40) and also when ear, sleep, psychological, productivity, and allergy domains were incorporated. Adaptive allergy-focused testing was inversely associated with LMCT (OR, 0.47; 95% CI, 0.25-0.88), suggesting adaptive testing can differentiate between CRS and allergic rhinitis. Results for endoscopy scores were similar. Adaptive nasal scores had increasing probabilities of LMCT greater than 5.

In this diagnostic study, the novel adaptive SNOT instrument established an association between subjective patient-reported symptoms and objective imaging results, a characteristic distinct from traditional static testing. An adaptive approach may reduce the questions posed and discriminate between CRS and allergy diagnoses.