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 Palmer; Zara M Patel; Carlos D Pinheiro-Neto; Adam C Resnick; Myung S Sim; Timothy L Smith; Carl H Snyderman; Maie A John St; Phillip Storm; Jeffrey D Suh; Marilene B Wang; Peter H Hwang

doi:10.1002/alr.23338

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

Int Forum Allergy Rhinol. 2024 Feb 19. doi: 10.1002/alr.23338. Online ahead of print.

Authors

David R Grimm¹, Daniel M Beswick², Sabrina L Maoz², Eric W Wang³, Garret W Choby³, Edward C Kuan⁴, Erik P Chan¹, Nithin D Adappa⁵, Mathew Geltzeiler⁶, Anne E Getz⁷, Ian M Humphreys⁸, Christopher H Le⁹, Waleed M Abuzeid⁸, Eugene H Chang⁹, Aria Jafari⁸, Todd T Kingdom⁷, Michael A Kohanski⁵, Jivianne K Lee², Jayakar V Nayak¹, James N Palmer⁵, Zara M Patel¹, Carlos D Pinheiro-Neto¹⁰, Adam C Resnick¹¹, Myung S Sim¹², Timothy L Smith⁶, Carl H Snyderman³, Maie A John St², Phillip Storm¹¹, Jeffrey D Suh², Marilene B Wang², Peter H Hwang¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.
² Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA.
³ Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Oregon, Portland, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
⁹ Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA.
¹⁰ Department of Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹² Department of Medicine-Statistics Core, University of California Los Angeles, Los Angeles, California, USA.

PMID: 38372441
DOI: 10.1002/alr.23338

Abstract

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.

Keywords: SNOT-22; endoscopic sinus surgery; esthesioneuroblastoma; quality of life.