Psychometric validity of the 22-item sinonasal outcome test in cystic fibrosis

Christine M Liu; Jakob L Fischer; Jonathan B Overdevest; Anna C Zemke; Matthew J Strand; David A Gudis; Adam J Kimple; Jeremy P Tervo; Emily DiMango; Jennifer L Goralski; Claire Keating; Brent Senior; Amanda L Stapleton; Jennifer L Taylor-Cousar; Daniel M Beswick

doi:10.1016/j.jcf.2025.12.022

Psychometric validity of the 22-item sinonasal outcome test in cystic fibrosis

J Cyst Fibros. 2026 Mar;25(2):353-358. doi: 10.1016/j.jcf.2025.12.022. Epub 2026 Jan 14.

Authors

Affiliations

¹ University of California, Los Angeles, Department of Otolaryngology-Head and Neck Surgery, USA.
² Columbia University, Department of Otolaryngology-Head and Neck Surgery, USA.
³ University of Pittsburgh, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, USA.
⁴ National Jewish Health, Division of Biostatistics, USA.
⁵ University of North Carolina, Department of Otolaryngology-Head and Neck Surgery, USA.
⁶ Columbia University, Division of Pulmonary, Allergy and Critical Care Medicine, USA.
⁷ University of North Carolina, Department of Medicine, Division of Pulmonary/Critical Care Medicine, USA.
⁸ University of Pittsburgh, Department of Otolaryngology-Head and Neck Surgery, USA.
⁹ National Jewish Health, Departments of Medicine, USA; National Jewish Health, Department of Pediatrics, USA.
¹⁰ University of California, Los Angeles, Department of Otolaryngology-Head and Neck Surgery, USA. Electronic address: dbeswick@mednet.ucla.edu.

PMID: 41535163
DOI: 10.1016/j.jcf.2025.12.022

Abstract

Background: The 22-item sinonasal outcome test (SNOT-22) is widely used to evaluate quality of life (QOL) in cystic fibrosis chronic rhinosinusitis (CF-CRS) but lacks formal validation in people with CF (PwCF). This study explores the psychometric properties of the SNOT-22 following elexacaftor/tezacaftor/ivacaftor (ETI) administration.

Methods: Data from three prospective observational cohort studies investigating the impact of ETI on CF-CRS were pooled across four U.S. centers and used for validity assessments. SNOT-22 scores, Lund-Mackay (LM) computed tomography (CT) sinus scores, and Cystic Fibrosis Questionnaire-Revised (CFQ-R) scores were used to assess test-retest reliability, construct validity, and responsiveness to clinical change in SNOT-22 scores.

Results: Strong test-retest reliability was observed for the SNOT-22 during the first 6 months post-ETI (N = 53, all r ≥ 0.80, p < 0.001). SNOT-22 intraclass correlation coefficients were strong (0.883) at 3 and 6 months after ETI was initiated and moderate (0.693) across all time points. Mean individual scores in 20 SNOT-22 items decreased from baseline to post-ETI (90.1%, p < 0.05). Moderate convergent validity was observed between pre-treatment SNOT-22 scores and LM scores (r = -0.42, p = 0.002) and CFQ-R respiratory domain scores (r = -0.35, p = 0.025).

Conclusions: The SNOT-22 is a valid, reliable, and responsive instrument for evaluating CRS-specific QOL in adults with CF, and functions effectively as a unidimensional construct across most of its 22 items.

Keywords: Chronic rhinosinusitis; Cystic fibrosis; Elexacaftor/tezacaftor/ivacaftor; Highly effective modulator therapy.

Publication types

Observational Study

MeSH terms

Adult
Aminophenols / administration & dosage
Aminophenols / therapeutic use
Benzodioxoles / administration & dosage
Benzodioxoles / therapeutic use
Chronic Disease
Cystic Fibrosis* / complications
Cystic Fibrosis* / drug therapy
Cystic Fibrosis* / psychology
Drug Combinations
Female
Humans
Indoles / administration & dosage
Indoles / therapeutic use
Male
Prospective Studies
Psychometrics* / methods
Pyrazoles / therapeutic use
Quality of Life*
Quinolones / administration & dosage
Quinolones / therapeutic use
Reproducibility of Results
Rhinitis* / diagnosis
Rhinitis* / drug therapy
Rhinitis* / etiology
Rhinitis* / psychology
Sino-Nasal Outcome Test*
Sinusitis* / diagnosis
Sinusitis* / drug therapy
Sinusitis* / etiology
Sinusitis* / psychology

Substances

Aminophenols
Benzodioxoles
Quinolones
Drug Combinations
Indoles
Pyrazoles