Discrepancies Between SNOT-22 Questionnaire, Objective Assessments, and Histopathologic Findings in Chronic Rhinosinusitis With Nasal Polyps

Abstract

Background The Sinonasal Outcome Test-22 (SNOT-22) is widely used to evaluate symptom burden in chronic rhinosinusitis with nasal polyps (CRSwNP), yet its relationship with objective disease measures, pathological features, and specific endotypes remains unclear. Objective To assess correlations between SNOT-22 scores, including subdomains, and clinical, radiologic, and histopathologic features in patients undergoing endoscopic sinus surgery (ESS) for CRSwNP. Methods We retrospectively reviewed records of 83 adult patients with CRSwNP treated with ESS at a single tertiary medical center between 2018 and 2024. All patients completed the SNOT-22 questionnaire and underwent preoperative computed tomography imaging. Nasal polyp scores (NPS), Lund-Mackay staging, and histopathologic characteristics were documented. Correlations between SNOT-22 domains and demographic, clinical, objective parameters, and histopathological findings were analyzed using appropriate statistical tests. Results The mean preoperative SNOT-22 total score was 55.9 ± 23.5. No significant associations were observed between total SNOT-22 scores and Lund-Mackay staging, NPS, or clinical endotypes. Female sex correlated with higher rhinologic subdomain scores ( P = .037). Higher NPS demonstrated an association with greater emotional burden (Pearson correlation coefficient = 0.249, P = .038). Among histopathologic features, tissue eosinophil count showed a nonsignificant trend toward higher emotional subdomain scores ( P = .081). No other significant correlations were identified. Conclusions In this cohort, SNOT-22 scores and their subdomains showed limited correlation with objective measures of disease severity, radiologic burden, endotype classification, and histopathologic findings. These findings underscore the complex interplay between subjective symptom perception and objective disease markers in CRSwNP.