SNOT-22 subdomain outcomes following treatment for sinonasal malignancy: A prospective, multicenter study

David R. Grimm, Daniel M. Beswick, Sabrina L. Maoz, Eric W. Wang, Garret W. Choby, Edward C. Kuan, Erik P. Chan, Nithin D. Adappa, Mathew Geltzeiler, Anne E. Getz, Ian M. Humphreys, Christopher H. Le, Waleed M. Abuzeid, Eugene H. Chang, Aria Jafari, Todd T. Kingdom, Michael A. Kohanski, Jivianne K. Lee, Jayakar V. Nayak, James N. PalmerZara M. Patel, Carlos D. Pinheiro-Neto, Adam C. Resnick, Myung S. Sim, Timothy L. Smith, Carl H. Snyderman, Maie A. John, Phillip Storm, Jeffrey D. Suh, Marilene B. Wang, Peter H. Hwang

Research output: Contribution to journalArticlepeer-review


Background: Patients with sinonasal malignancy (SNM) present with significant sinonasal quality of life (QOL) impairment. Global sinonasal QOL as measured by the 22-item Sinonasal Outcomes Test (SNOT-22) has been shown to improve with treatment. This study aims to characterize SNOT-22 subdomain outcomes in SNM. Methods: Patients diagnosed with SNM were prospectively enrolled in a multi-center patient registry. SNOT-22 scores were collected at the time of diagnosis and through the post-treatment period for up to 5 years. Multivariable regression analysis was used to identify drivers of variation in SNOT-22 subdomains. Results: Note that 234 patients were reviewed, with a mean follow-up of 22 months (3 months–64 months). Rhinologic, psychological, and sleep subdomains significantly improved versus baseline (all p < 0.05). Subanalysis of 40 patients with follow-up at all timepoints showed statistically significant improvement in rhinologic, extra-nasal, psychological, and sleep subdomains, with minimal clinically important difference met between 2 and 5 years in sleep and psychological subdomains. Adjuvant chemoradiation was associated with worse outcomes in rhinologic (adjusted odds ratio (5.22 [1.69–8.66])), extra-nasal (2.21 [0.22–4.17]) and ear/facial (5.53 [2.10–8.91]) subdomains. Pterygopalatine fossa involvement was associated with worse outcomes in rhinologic (3.22 [0.54–5.93]) and ear/facial (2.97 [0.32–5.65]) subdomains. Positive margins (5.74 [2.17–9.29]) and surgical approach—combined versus endoscopic (3.41 [0.78–6.05])—were associated with worse psychological outcomes. Adjuvant radiation (2.28 [0.18–4.40]) was associated with worse sleep outcomes. Conclusions: Sinonasal QOL improvements associated with treatment of SNM are driven by rhinologic, extra-nasal, psychological, and sleep subdomains.

Original languageEnglish (US)
JournalInternational Forum of Allergy and Rhinology
StateAccepted/In press - 2024


  • SNOT-22
  • endoscopic sinus surgery
  • esthesioneuroblastoma
  • quality of life

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology


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