In patients with allergic rhinitis, is nasal obstruction the most severe symptom according to the Sinonasal Outcome Test‑22 (SNOT‑22) scores?

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No, Nasal Obstruction Is NOT the Most Severe Symptom in Allergic Rhinitis Based on SNOT-22 Scores

Sleep-related and otologic symptoms, not nasal obstruction, are associated with the greatest severity and negative impact on quality of life in patients with allergic rhinitis according to SNOT-22 assessment. 1

Key Findings from SNOT-22 Analysis

The most comprehensive study directly addressing this question in allergic rhinitis patients found a clear hierarchy of symptom severity:

  • Sleep-related symptoms and otologic symptoms were associated with the greatest decrease in general health-related quality of life in adults with persistent allergic rhinitis 1

  • Nasal symptoms were least associated with general health-related quality of life, contrary to what clinicians might expect 1

  • Nasal obstruction specifically showed no significant association with general health-related quality of life (p = 0.267), which was confirmed by the lack of correlation between the Nasal Obstruction Severity Evaluation (NOSE) score and quality of life measures (r = -0.05, p = 0.582) 1

Clinical Implications

This finding has important practical consequences for patient assessment:

  • Routine assessment should prioritize sleep disturbances and ear-related symptoms rather than focusing predominantly on nasal obstruction when evaluating disease severity and treatment response in allergic rhinitis patients 1

  • While nasal obstruction is a dominant presenting symptom and may be what patients initially complain about, it does not correlate with the actual impact on their overall health and quality of life 1, 2

Symptom Pattern in Allergic Rhinitis

The symptom profile varies by allergen type:

  • Patients with seasonal pollen allergies typically complain more of sneezing and rhinorrhea 2

  • Patients with perennial allergen sensitivity (dust mite, molds, animal dander) more often report obstruction as their primary complaint, with episodic sneezing and rhinorrhea only during high allergen exposure 2

However, regardless of which nasal symptom predominates clinically, the SNOT-22 data clearly demonstrates that sleep and otologic symptoms drive the severity assessment and quality of life impact, not nasal obstruction. 1

References

2
Research

[Rhinitis in adults].

Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti, 2011

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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