{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:19:13Z","timestamp":1791346753713,"version":"4.3.1"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T00:00:00Z","timestamp":1507852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have identified subdomains of the 22\u2010item Sino\u2010Nasal Outcome Test (SNOT\u201022), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT\u201022. This study aims to validate the existence of underlying symptom subdomains of the SNOT\u201022 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 800 patients with CRS were included into this cross\u2010sectional study (400 CRS patients from Boston, MA, and 400 CRS patients from Reno, NV). Their SNOT\u201022 responses were analyzed using exploratory factor analysis (EFA) to determine the number of symptom subdomains. A CFA was performed to develop a validated measurement model for the underlying SNOT\u201022 subdomains along with various tests of validity and goodness of fit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>EFA demonstrated 4 distinct factors reflecting: sleep, nasal, otologic\/facial pain, and emotional symptoms (Cronbach's alpha, &gt;0.7; Bartlett's test of sphericity, <jats:italic>p<\/jats:italic> &lt; 0.001; Kaiser\u2010Meyer\u2010Olkin &gt;0.90), independent of geographic locale. The corresponding CFA measurement model demonstrated excellent measures of fit (root mean square error of approximation, &lt;0.06; standardized root mean square residual, &lt;0.08; comparative fit index, &gt;0.95; Tucker\u2010Lewis index, &gt;0.95) and measures of construct validity (heterotrait\u2010monotrait [HTMT] ratio, &lt;0.85; composite reliability, &gt;0.7), again independent of geographic locale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The use of the 4\u2010subdomain structure for SNOT\u201022 (reflecting sleep, nasal, otologic\/facial pain, and emotional symptoms of CRS) was validated as the most appropriate to calculate SNOT\u201022 subdomain scores for patients from different geographic regions using 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