Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis
Jose L. Mattos MD, MPH  Luke Rudmik MD, MSc  Rodney J. Schlosser MD  Timothy L. Smith MD, MPH Jess C. Mace MPH  Jeremiah Alt MD, PhD  Zachary M. Soler MD, MSc
First published: 12 February 2019 https://doi.org/10.1002/alr.22309
Funding sources for the study: National Institute on Deafness and Other Communication Disorders, National Institutes of Health (R01 DC005805 [PI: T.L.S./Z.M.S.] to J.A.A., R.J.S., J.C.M., T.L.S., and Z.M.S.). This funding organization did not contribute to the design or conduct of this study, preparation, review, approval, or decision to submit this manuscript for publication.
Potential conflict of interest: Z.M.S.: Olympus, OptiNose, Regeneron, and Novartis, consultant (not affiliated with this study); J.A.A.: Medtronic, OptiNose, Spirox, and GlycoMira Therapeutics, consultant (not affiliated with this study); R.J.S.: OptiNose, Entellus, and IntersectENT, grant support (not associated with this study), and Olympus, Meda, and Arrinex, consultant (not affiliated with this study). The remaining authors have no disclosures.
Presented orally at the American Rhinologic Society at the American Academy of Otolaryngology‒Head and Neck Surgery Annual Meeting and OTO Experience, in Atlanta, GA, on October 5‐6, 2018.
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Abstract
Background
Sinonasal symptoms and poor quality of life (QOL) prompt chronic rhinosinusitis (CRS) patients to undergo sinus surgery (ESS). However, little is known regarding the symptoms most important to patients and how these impact expectations and postoperative satisfaction.

Methods
A prospective, multi‐institutional cohort study of 100 CRS patients undergoing ESS completed a novel adaptation of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) wherein they rated how important it was for specific symptoms to improve after surgery, along with preoperative expectations and postoperative satisfaction. The primary satisfaction measure was whether a patient would choose to undergo endoscopic sinus surgery (ESS) again. A multivariate, logistic regression model was built using demographics, objective measures, and the adapted SNOT‐22 data. Spearman correlation analysis was also performed.

Results
Nasal obstruction was rated as “extremely” or “very” important by 93% of patients, followed by smell/taste, thick nasal discharge, need to blow nose, postnasal discharge, and sleep symptoms (range, 61‐72%). Symptoms like sadness and embarrassment were not considered important by preoperative patients (≤28%). In multivariate logistic regression, postoperative satisfaction depended on preoperative expectations being met and ESS improving their most important symptoms (odds rato, 19.6‐27.5; p < 0.005). Postoperative satisfaction was not correlated with achieving a minimal clinically important difference, but it was correlated with magnitude of change in SNOT‐22 (r = 0.35; p < 0.05).

Conclusions
Nasal, smell, and sleep‐related symptoms were consdidered most important by this cohort. Meeting of preoperative expectations, improvement of the most important symptoms, and the magnitude of change in the SNOT‐22 may drive postoperative satisfaction.