Does Medical Therapy Improve SinoNasal Outcomes Test-22 Domain Scores? An Analysis of Clinically Important Differences

• Type of Material: Article
• Authors: Naweed I. Chowdhury, Vanderbilt University; Jess C. Mace, Oregon Health and Science University; Todd E. Bodner, Portland State University; Jeremiah A. Alt, University of Utah; Adam S. Deconde, University of California San Diego; Joshua Levy, Emory University; Timothy L. Smith, Oregon Health and Science University
• Language: English
• Date: 2019-01-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 The American Laryngological, Rhinological and Otological Society, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/lary.27470
• Title of Journal or Parent Work: LARYNGOSCOPE
• Volume: 129
• Issue: 1
• Start Page: 31
• End Page: 36
• Grant/Funding Information: There are no relevant financial disclosures for either Adam S. DeConde or Joshua M. Levy.; Public clinical trial registration (www.clinicaltrials.gov) ID# NCT01332136.; Naweed Chowdhury is a consultant for OptiNose, Inc.; Timothy L. Smith, Todd E. Bodner, Jeremiah A. Alt, and Jess C. Mace are supported by a grant for this investigation from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD., USA (R01 DC005805; PI/PD: TL Smith).
• Keywords: CHRONIC RHINOSINUSITIS; Research & Experimental Medicine; Medicine, Research & Experimental; paranasal sinuses; quality of life; Otorhinolaryngology; Science & Technology; QUALITY-OF-LIFE; chronic disease; INTRAINDIVIDUAL CHANGES; VALIDITY; RELEVANCE; Life Sciences & Biomedicine; ENDOSCOPIC SINUS SURGERY; Sinusitis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objectives/Hypothesis: Minimum clinically important differences (MCIDs) for the 22-item SinoNasal Outcomes Test (SNOT-22) in patients with chronic rhinosinusitis (CRS) electing endoscopic sinus surgery (ESS) are well described. However, similar estimations for the MCID have not been investigated for patients electing continued appropriate medical therapy (CAMT). We sought to determine MCID values for a medically treated CRS cohort and compare them to historical MCIDs associated with ESS. Study Design: Prospective observational cohort study. Methods: One hundred twenty patients with refractory CRS electing CAMT were prospectively enrolled from academic referral clinics into an observational cohort study. Baseline and posttreatment SNOT-22 survey responses were collected. Four distribution-based methods for calculating MCIDs (e.g., half-standard deviation, Cohen's d, standard error of measurement, and minimum detectable change) were used to identify a range of MCID values for SNOT-22 total and domain scores. Results: The average MCID value for SNOT-22 total scores was 8.0, whereas mean MCID values for rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom domain scores were 3.9, 2.5, 3.3, 3.4, and 2.9, respectively, comparable to previously reported values for patients electing ESS. Although change in SNOT-22 total scores following CAMT exceeded the MCID, none of the average SNOT-22 domain score improvements surpassed their respective MCID thresholds. Conclusions: MCID values for SNOT-22 total and domain scores in patients electing CAMT are similar to previously published MCID values associated with ESS, indicating that MCID values are independent of treatment modality selection. Therefore, despite evidence of statistical significance, CAMT for CRS may not be associated with clinically discernable improvements in average SNOT-22 domain scores. Level of Evidence: 2c Laryngoscope, 129:31–36, 2019.