BMI Does Not Correlate with SNOT-22 Scores in Chronic Rhinosinusitis
The evidence does not support that higher BMI correlates with more severe SNOT-22 scores or symptom severity in adult patients with chronic rhinosinusitis. 1
Key Evidence
The most relevant study directly addressing this question found no relationship between obesity and sinonasal disease severity in patients with chronic rhinosinusitis:
SNOT-22 scores showed no significant differences across BMI categories in a randomized controlled trial of 236 adults with asthma and sinonasal disease (mean scores: 35.4 ± 18.5 in lean, 40.2 ± 22.8 in overweight, and 39.1 ± 21.7 in obese participants; p = 0.43). 1
Obesity had no effect on nasal, bronchial, or systemic markers of allergic inflammation in this population. 1
Important Caveats
While BMI does not correlate with symptom severity scores, there is a notable association with disease phenotype:
Late-onset asthma patients (who had significantly higher BMI) demonstrated more severe CRS disease characteristics including increased nasal polyps, higher Lund-Mackay CT scores, more oral steroid courses, and more endoscopic surgeries, despite similar SNOT-22 scores. 2
This suggests that BMI may be associated with objective disease severity markers rather than patient-reported symptom severity. 2
Clinical Implications
Patient-reported symptom burden (SNOT-22) remains independent of body weight in CRS patients. 1
A SNOT-22 score of 35 identifies patients with poorly controlled vs well-controlled CRS symptoms (71.4% sensitivity, 85.5% specificity), regardless of BMI. 3
The minimally important clinical difference for SNOT-22 is approximately 9-12 points, which can guide treatment response assessment across all BMI categories. 4, 5