Snot 22 Score Calculator

The Sino-Nasal Outcome Test 22 is a patient-reported outcome measure, which means it quantifies symptom burden as the patient experiences it rather than what an endoscope or CT scan shows. That distinction matters in chronic rhinosinusitis, where radiographic Lund-Mackay scores and endoscopic Lund-Kennedy grades correlate only weakly with how unwell a patient actually feels. Each of the 22 items is rated 0 for no problem to 5 for as bad as it can be, giving a total range of 0 to 110. The items cluster into four interpretable domains: rhinologic symptoms such as nasal obstruction, discharge, and loss of smell; extra-rhinologic symptoms including ear fullness, ear pain, dizziness, and facial pressure; sleep dysfunction covering sleep onset, night waking, and waking unrefreshed; and psychological dysfunction spanning fatigue, reduced concentration and productivity, irritability, sadness, and embarrassment. Interpretive anchors are well established. Totals above about 7 exceed the range typical of people without sinonasal disease, roughly 8 to 20 is mild, 20 to 50 moderate, and above 50 severe. The minimal clinically important difference is 8.9 points, so a change smaller than that should not be called a treatment response regardless of statistical significance. Endoscopic sinus surgery in appropriately selected patients typically produces mean improvements of around 20 to 25 points, and pre-operative totals below roughly 20 predict little room for benefit, which is why the score is often used as a surgical selection filter. Limitations include overlap with allergic rhinitis, migraine, and depression, all of which inflate the sleep and psychological domains, and a recall period that is usually the past two weeks and therefore sensitive to seasonal timing.

The instrument descends from the Rhinosinusitis Outcome Measure 31, a 31-item questionnaire developed by Jay Piccirillo and colleagues at Washington University in St Louis in the mid 1990s. Finding it too long for routine clinic use, Piccirillo's group reduced it to the 20-item Sino-Nasal Outcome Test, publishing validity and reliability data in Otolaryngology Head and Neck Surgery in 2002. SNOT-20 became widely adopted but omitted two symptoms that patients consistently identified as central to their disease, nasal obstruction and loss of sense of smell or taste, largely because the parent instrument had been built around general health impact rather than cardinal sinus symptoms. The 22-item version was created in the United Kingdom by Claire Hopkins, Valerie Lund, and colleagues, who added those two items while running the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis, a prospective study of several thousand patients undergoing sinus surgery across England and Wales in the mid 2000s. Their psychometric validation was published in Clinical Otolaryngology in 2009 and established the internal consistency, test-retest reliability, and the 8.9 point minimal clinically important difference still quoted today. SNOT-22 has since been translated and validated in dozens of languages and adopted as the standard patient-reported endpoint in trials of biologic therapies for chronic rhinosinusitis with nasal polyps, including the dupilumab and mepolizumab programs, and it is referenced in the European Position Paper on Rhinosinusitis and Nasal Polyps.