Nasal Obstruction and SNOT-22 Scores in Allergic Rhinitis
Nasal obstruction is NOT associated with higher SNOT-22 scores in allergic rhinitis patients; in fact, it shows no significant correlation with general health-related quality of life measures.
Key Evidence
The most definitive study directly addressing this question found that nasal obstruction was not at all associated with general health-related quality of life (p = 0.267) in adults with persistent allergic rhinitis 1. This was further confirmed by demonstrating no significant correlation between the Nasal Obstruction Severity Evaluation (NOSE) score and quality of life measures (r = -0.05; p = 0.582) 1.
What Actually Drives High SNOT-22 Scores
Instead of nasal symptoms, the following factors are most strongly associated with elevated SNOT-22 scores in allergic rhinitis patients:
- Sleep-related symptoms were associated with the greatest decrease in general health-related quality of life and higher SNOT-22 scores 1
- Otologic symptoms (ear-related complaints) showed the second strongest association with decreased quality of life 1
- Nasal symptoms were least associated with general health-related quality of life among all symptom categories assessed 1
Clinical Context and Symptom Patterns
While nasal obstruction is indeed a common symptom in allergic rhinitis:
- Nasal congestion occurs in approximately 94% of allergic rhinitis patients 2
- Nasal blockage is more characteristic of perennial rhinitis compared to seasonal rhinitis 3
- Obstruction tends to be more predominant in perennial allergic rhinitis (PAR) compared to seasonal allergic rhinitis (SAR) 4
However, the presence or severity of nasal obstruction does not translate into higher SNOT-22 scores or worse quality of life outcomes 1.
Clinical Implications
When evaluating allergic rhinitis patients with elevated SNOT-22 scores, prioritize assessment of:
- Sleep disturbances (difficulty falling asleep, waking at night, lack of restful sleep) as these drive quality of life impairment 1
- Ear symptoms (fullness, pressure, pain, eustachian tube dysfunction) which significantly impact patient-reported outcomes 1
- Recognize that patients complaining primarily of nasal obstruction may have relatively preserved quality of life despite bothersome symptoms 1
Important Caveat
The SNOT-22, while a validated outcomes tool, is a poor diagnostic instrument for differentiating between patients with and without chronic rhinosinusitis, despite its utility in tracking symptom burden 5. Therefore, use SNOT-22 scores for monitoring treatment response rather than diagnosis 5.