European Journal of Rhinology and Allergy
Original Article

An Examination of the Internal Validity of the Sino-Nasal Outcome Test-22 in Patients with Septal Deviation


Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom


Institute of Population Health, University of Liverpool, Liverpool, United Kingdom

Eur J Rhinol Allergy 2023; 6: 49-54
DOI: 10.5152/ejra.2023.23096
Read: 666 Downloads: 332 Published: 25 August 2023

Objective: The objective of this study was to examine the construct validity of the sino-nasal outcome test-22 in the setting of patients with nasal septal deviation undergoing septoplasty.

Methods: Retrospective case note audit recording preoperative sino-nasal outcome test-22 scores in consecutive patients undergoing septoplasty. Statistical analysis considered 4 existing factor structures for the sino-nasal outcome test-22 survey, all of which emerged from its use in the context of chronic rhinosinusitis. Structural equation modeling and factor analysis were used to compare these existing models to data from this different context of septal deviation.

Results: Between January 2017 and January 2021, 115 patients completed sino-nasal outcome test-22 scores prior to undergoing septoplasty. Using confirmatory factor analysis, none of the existing conceptual frameworks could be shown to fit data from patients with septal deviation. Subsequent exploratory factor analysis showed that multiple items failed to significantly load within a 5-factor model: Nasal obstruction, Dizziness, and Frustrated/restless/irritable.

Conclusion: Results suggest that sino-nasal outcome test-22 does not demonstrate internal validity when consider- ing symptom burden in patients undergoing septoplasty and suggest caution should be exercised when considering such results as either an indication for surgery or a method of reporting postoperative outcomes. We believe that the utility of sino-nasal outcome test-22, in the setting of nasal septal deviation, would be significantly enhanced with modifications made specific to this context.

Cite this article as: Williams SP, Hughes DM, Leong SC. An examination of the internal validity of the sino-nasal outcome test-22 in patients with septal deviation. Eur J Rhinol Allergy 2023;6(2):49-54.

EISSN 2636-8072