SNOT-22 Subdomain Outcomes after Endonasal Endoscopic Skull Base Surgery

Introduction: Endonasal endoscopic skull base surgery (EESBS) is increasingly utilized for benign and malignant lesions of the skull base. While the 22-Item Sinonasal Outcomes Test (SNOT-22) is a frequently utilized measure of quality of life (QOL) after skull base surgery, studies addressing subdomain-specific symptoms are limited. This study aimed to evaluate changes in SNOT-22 subdomain scores in patients undergoing EESBS.

Methods: This is a single institution retrospective study of patients undergoing EESBS from January 2014 to April 2017. Electronic medical records were reviewed to extract data regarding clinical history and operative details. Pre- and postoperative (at 3 and 6 months) SNOT-22 scores were collected. Change in total and each of the five subdomain scores (rhinologic, extra-nasal rhinologic, ear/facial, psychological, and sleep dysfunction) were compared using paired t-tests. The associations between covariates and change in subdomain scores (at 3 and 6 months) were investigated using adjusted and unadjusted linear regression models. Covariates included were age, gender, tumor size, smoking history, adjuvant radiation history, use of nasoseptal flap, and surgery beyond the sella.

Results: A total of 169 EESBS patients were queried with SNOT-22 scores available for 84 patients at 3 months, and 49 patients at 6 months postoperatively. Overall, there was no significant difference for change in total SNOT-22 scores and for change in each of the subdomain scores at 3 and 6 months postoperatively. In the adjusted analysis, older age was associated with improved extra-nasal rhinologic (p = 0.04, β = −0.04, 95% CI = −0.08, 0.00), and ear/facial (p = 0.04, β = −0.04, 95% CI = −0.08, 0.00) scores at 3 months, and improved rhinologic (p = 0.03, β = −0.13, 95% CI = −0.23, −0.092), extranasal rhinologic (p = 0.04, β = −0.06, 95% CI = −0.12, 0.00), and ear/facial (p = 0.04, β = −0.09, 95% CI = −0.18, −0.01) scores at 6 months. Additionally, radiation therapy was associated with worse ear/facial (p = 0.02, β = 3.49, 95% CI = 0.75, 6.24), and sleep dysfunction (p = 0.048, β = 5.97, 95% CI = 0.14, 11.81) scores at 3 months, and worse ear/facial (p = 0.01, β = 7.47, 95% CI = 2.15, 12.78) scores at 6 months. In the unadjusted analysis, nasoseptal flap reconstruction was associated with worse rhinologic (at 3 and 6 months), extranasal rhinologic (at 3 and 6 months), and sleep dysfunction (at 6 months) scores. Radiation therapy was associated with worse rhinologic and sleep dysfunction scores at 3 months, and worse ear/facial scores at 6 months. Lastly, extended approaches beyond the sella were associated with worse extra-nasal rhinologic scores at 6 months.

Conclusion: There is no significant change in overall SNOT-22 scores 3 and 6 months after EESBS. However, nasoseptal flap reconstruction, radiation therapy, and extended approaches beyond the sella were associated with worse subdomain-specific symptoms, while older age was associated with improved subdomain-specific symptoms.

No conflict of interest has been declared by the author(s).