Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis

Jose L. Mattos, Luke Rudmik, Rodney J. Schlosser, Timothy L. Smith, Jess C. Mace, Jeremiah Alt, Zachary M. Soler

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)593-600
Number of pages8
JournalInternational Forum of Allergy and Rhinology
Issue number6
StatePublished - Jun 2019


  • chronic sinusitis
  • expectations
  • patient-reported outcomes
  • satisfaction
  • sinus surgery

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology


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