Adaptive Sino-Nasal Outcome Test May Help Differentiate Chronic Rhinosinusitis from Allergy-Related Conditions: JAMA
USA: A novel adaptive Sino-Nasal Outcome Test (SNOT) diagnostic tool showed a strong association between patient-reported symptoms and objective imaging findings, unlike traditional static tests. The adaptive method may also reduce the number of questions required while helping distinguish chronic rhinosinusitis (CRS) from allergy-related conditions.
A diagnostic study published in JAMA Otolaryngology–Head & Neck Surgery evaluated whether an adaptive version of the Sino-Nasal Outcome Test could better align subjective symptom reporting with radiological evidence of disease severity in patients with CRS. The study was led by Selena K. Zhang from Mass General Brigham in Boston and colleagues.
Chronic rhinosinusitis is a common inflammatory condition that significantly affects quality of life and is typically assessed using the standard 22-item SNOT questionnaire. However, prior evidence has shown a persistent mismatch between patient-reported symptom scores and objective imaging findings, limiting its clinical precision. To address this gap, researchers assessed a novel adaptive SNOT tool that adjusts questions based on patient responses.
The study analyzed data from patients treated at tertiary care and community centers in Massachusetts between 2020 and 2025. A total of 417 patients underwent imaging with Lund–Mackay computed tomography (LMCT) to assess disease severity. The adaptive SNOT scores were compared with both imaging and traditional static SNOT-22 results.
The study led to the following findings:
- Standard SNOT-22 and other static score versions showed no meaningful association with imaging findings.
- The adaptive SNOT instrument demonstrated significant concordance with LMCT imaging results, especially for nasal symptom domains.
- The association between adaptive SNOT scores and imaging findings was stronger when LMCT scores were above 5, indicating moderate to severe disease.
- Adaptive nasal domain scores were strongly linked with imaging severity, with an odds ratio of 3.75.
- Inclusion of additional domains such as ear, sleep, psychological, productivity, and allergy symptoms maintained a significant predictive relationship with imaging results.
- Adaptive allergy-focused responses showed an inverse association with CT findings, suggesting potential usefulness in distinguishing CRS from allergic rhinitis.
- The nasal symptom domain showed high internal consistency, supporting the reliability of the adaptive instrument.
- Overall, the adaptive SNOT approach reduced the number of questions required while improving agreement between patient-reported outcomes and imaging-based assessment.
According to the authors, this improvement in concordance may enhance both clinical decision-making and research applications by bridging the gap between patient-reported outcomes and radiographic evidence. The adaptive model also demonstrated potential in differentiating CRS from allergy-related conditions, which often present with overlapping symptoms.
"The findings suggest that adaptive symptom testing may represent a meaningful advancement over traditional static questionnaires in CRS evaluation, offering a more efficient and clinically aligned approach to assessing disease severity," the authors concluded.
Reference:
Zhang SK, Prince AA, Corrales CE, et al. Concordance Between an Adaptive Sino-Nasal Outcome Test and Imaging Results in Chronic Rhinosinusitis. JAMA Otolaryngol Head Neck Surg. Published online May 14, 2026. doi:10.1001/jamaoto.2026.0839
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