BACKGROUND: Prior study demonstrated that baseline 22-item Sino-Nasal Outcome 
Test (SNOT-22) aggregate scores accurately predict selection of surgical 
intervention in patients with chronic rhinosinusitis (CRS). Factor analysis of 
the SNOT-22 survey has identified five distinct domains that are differentially 
impacted by endoscopic sinus surgery (ESS). This study sought to quantify 
SNOT-22 domains in patient cohorts electing both surgical or medical management 
and postinterventional change in these domains.
METHODS: CRS patients were prospectively enrolled into a multi-institutional, 
observational cohort study. Subjects elected continued medical management or 
ESS. SNOT-22 domain scores at baseline were compared between treatment cohorts. 
Postintervention domain score changes were evaluated in subjects with at least 
six-month follow-up.
RESULTS: A total of 363 subjects were enrolled with 72 (19.8%) electing 
continued medical management, whereas 291 (80.2%) elected ESS. Baseline SNOT-22 
domain scores were comparable between treatment cohorts in sinus-specific 
domains (rhinologic, extranasal rhinologic, and ear/facial symptoms; p > 0.050); 
however, the surgical cohort reported significantly higher psychological (mean ± 
standard deviation [SD]: 16.0 ± 8.4 vs 12.0 ± 7.1; p < 0.001) and sleep 
dysfunction (13.7 ± 6.8 vs 10.5 ± 6.2; p < 0.001) than the medical cohort. 
Effect sizes for ESS varied across domains with rhinologic and extranasal 
rhinologic symptoms experiencing the greatest gains (1.067 and 0.997, 
respectively), whereas psychological and sleep dysfunction experiencing the 
smallest improvements (0.805 and 0.818, respectively). Patients experienced 
greater mean improvements after ESS in all domains compared to medical 
management (p < 0.001).
CONCLUSION: Subjects electing ESS report higher sleep and psychological 
dysfunction compared to medical management but have comparable sinus-specific 
symptoms. Subjects undergoing ESS experience greater gains compared to medical 
management across all domains; however, these gains are smallest in the 
psychological and sleep domains.