Nasal Obstruction as the Dominant Symptom in Rhinitis Based on SNOT Scores
Yes, nasal obstruction is the most impactful symptom of chronic rhinosinusitis according to SNOT-22 scores, as it carries the greatest weight in determining overall symptom severity.
Evidence Supporting Nasal Obstruction Dominance
The most recent and highest-quality evidence directly addressing this question comes from a 2024 multicenter study that specifically analyzed how overall symptom severity (OSS) relates to individual chronic rhinosinusitis symptoms 1. This study definitively demonstrated that among all individual CRS symptoms measured, OSS scores were most strongly associated with nasal obstruction severity, followed by nasal drainage and facial pain/pressure 1.
Key findings from this analysis include:
Nasal obstruction had the strongest correlation with overall symptom severity scores compared to all other individual symptoms (nasal drainage, decreased sense of smell, facial pain/pressure, and sleep disturbance) 1
This relationship held true regardless of whether patients had nasal polyps or not, indicating the finding is generalizable across different rhinosinusitis phenotypes 1
The OSS score was most greatly associated with the mean of all individual symptom severity scores, but nasal obstruction weighted this mean most heavily 1
Supporting Evidence from Diagnostic Studies
Additional research corroborates nasal obstruction's prominence:
Among the four cardinal symptoms of CRS, nasal congestion was one of only three symptoms (along with loss of smell and rhinorrhea) that significantly differentiated between CRS and non-CRS patients when measured on SNOT-22 2
A 2024 study found that a novel SNOT-5 questionnaire (focusing on five key rhinologic domains) showed better correlation with objective disease measures than the full SNOT-22, suggesting that core nasal symptoms including obstruction are more clinically relevant than the broader quality-of-life items 3
Clinical Implications
When assessing rhinosinusitis severity and treatment response, prioritize evaluation of nasal obstruction as it serves as the primary driver of patient-reported symptom burden 1. This finding has practical implications:
Therapies targeting nasal obstruction should be prioritized in treatment algorithms 1
Changes in nasal obstruction severity can serve as a reliable proxy for overall symptom improvement 1
Patient counseling should emphasize that addressing nasal obstruction will likely have the greatest impact on their perceived symptom severity 1