Individual SNOT-22 Items Aid in Differentiating Between Spontaneous Cerebrospinal Fluid Rhinorrhea and Chronic Rhinosinusitis Without Nasal Polyps

Matthew Y. Liu, James Reed Gardner, Bradford A. Woodworth, David W. Jang, Alissa Kanaan, Jeffrey Paul Radabaugh, William C. Yao, Martin Goros, Megana Challa, Jessica W. Grayson, Zhu Wang, Philip G. Chen

Research output: Contribution to journalArticlepeer-review


Objectives: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)−22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP). Methods: A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared. Results: One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P <.001) and was more likely to designate this symptom as most important (P <.001). The CRSsNP group scored significantly higher in nasal blockage (P <.001), thick nasal discharge (P <.001), facial pain/pressure (P <.001), and in the ear/facial (P <.001) and rhinologic (P =.003) domains. Multivariable logistic regression revealed that runny nose (P <.001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P <.001), thick nasal discharge (P <.001), and facial pain/pressure (P =.001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P =.676). Conclusions: Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.

Original languageEnglish (US)
Pages (from-to)698-704
Number of pages7
JournalAnnals of Otology, Rhinology and Laryngology
Issue number6
StatePublished - Jun 2023


  • SNOT-22
  • patient reported outcome measure
  • quality of life
  • sinusitis
  • spontaneous CSF leak

ASJC Scopus subject areas

  • Otorhinolaryngology


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