This prospective study was carried out at the Department of Otorhinolaryngology, Tbilisi Medical Academy, New Vision University, Tbilisi, Georgia. The study was approved by the Tbilisi Regional Biomedical Research Ethics Committee (N 07-15-2020/B). Prior to their enrollment in the trial, all patients provided written informed consent. The study only included CRS patients who met the EPOS criteria. Age under 18, pregnancy, and refusal to participate in the study were exclusion factors.

The pilot study included 34 participants, 11 of whom were female (32.4%) and 23 of whom were male (67.6%). Everyone was diagnosed with CRS, with or without nasal polyps. The average age was 48.79 15.20 years old (range 17-80 years). Due to the fact that five patients were unable to locate the area containing the five most significant symptoms, we decided to bold this section of the table and add an arrow to indicate its location.

Test-retest reliability was determined in a random sample of 55 CRS patients with or without nasal polyps. The exclusion criteria for the test-retest were a change in treatment and an abrupt change in symptoms related to a common cold or influenza during the interval between the two tests (10 persons). Fifteen participants were removed from the study because they were unavailable for a second review of the questionnaire or because more than fifty percent of the questionnaire slots were unfilled. Thirty individuals were approved for test-retest.

The average age of patients was 50,5 years (range 26-70 years). The subjects consisted of 33.3% females and 66.6% males. The initial mean SNOT-22 score was 56.52 ± 12.24 and the retest score was 58.44 ± 14.40. Cronbach's alpha was 0.88 at the initial assessment and 0.93 at the retest; both numbers indicated that the SNOT-22 had a high degree of internal consistency. Each item's Pearson's correlation analysis resulted in a mean value of 0.72 (p<0.001), indicating a significant correlation. Correspondingly, a high association was found between the initial test scores and the retest scores.

Control group included 71 volunteers — 26 female (36.6%) and 45 males (63.4%). The mean age was 45.10 ± 11.37 years, with a range of 30 to 70 years. The control group's mean score was 10.11, with a standard deviation of 8.309. The confidence interval for the mean values was 8.14–12.07 at 95% confidence. Before surgery, we compared the control group to the patient group. The mean SNOT-22 score in the control group was significantly lower than the mean SNOT-22 score in patients with CRS before surgery, which was 61.44 ± 14.24.  The tool was able to distinguish across patient groups (p <0.0001), indicating a high level of discriminant validity.

Three months after surgical treatment, the SNOT-22 scores of 34 CRS patients were compared to their pre-operative ratings for examination of response. The surgical group comprised of 11 female (32.4%) and 23 male (67.6%), with a mean age of 48.79 ± 15.2 years (from 17 years to 80 years). The mean score at the pre-operative evaluation was significantly higher (61.44 ±14.24) than it was three months after surgery (12.32 ± 13.85) (p<0.0001, t = 9.85). (Figure 1). The statistically substantial decrease in post-operative ratings indicated the instrument's responsiveness. Examination of pre-operative scores and scores obtained three months after surgery demonstrated a mean change in scores of 49.12 ± 16.59. The magnitude of the surgery's effect after three months was 1.32, which was considered high (>0.8).

We found that the Georgian version of SNOT-22 is a viable outcome-measuring instrument for Georgian patients with sinonasal illness. It exhibits excellent internal consistency, reliability, concurrent validity, and responsiveness.

This questionnaire has already been translated and altered for use in a variety of cultural and language settings. In this work, the SNOT-22 was translated and converted into Georgian using best practises for translation and cultural adaptation 25.

The high usefulness of the SNOT-22 as an assessment tool in patients with chronic rhinosinusitis stems from its capacity to represent the symptom-specific state of the person, highlighting the factors that have the greatest impact on QOL. In addition, the SNOT22 is of utmost importance when surgical therapy is being considered, as it can aid in evaluating the effect of surgery and the likelihood of reaching a realistic outcome.

The questionnaire focuses on a patient's physical, functional, and emotional status; hence, it is essential that it be translated into the patient's native language. Since there was no other standard HRQoL questionnaire translated into Georgian, it was not able to measure the quality of life of CRS patients. We chose to translate, evaluate, and culturally adjust the questionnaire into Georgian so that it may be used in all Georgian ENT clinics. As shown in Table 2, our results were consistent with the original validation by Hopkins et al 9 and comparable to other language translations.

A Cronbach's alpha between 0.70 and 0.95 implies that health surveys have strong internal consistency. According to our data, the Georgian version has a Cronbach's alpha of 0.88, indicating good internal consistency and high reliability of the questionnaire.

Similar to earlier investigations, test-retest reliability was outstanding and indicated proper reliability (Table 2).

Except for Eisenbach et al. 12, our preoperative CRS group exhibited relatively high SNOT-22 scores compared to prior research (Table 2). This may be a result of the Georgian theory that individuals should delay doctor visits as long as possible. The fact that these patients were scheduled for FESS surgery suggests that their condition was likely relatively advanced. After FESS, patients with higher scores report a considerably greater increase in quality of life.

When comparing the mean scores of the questionnaire between the CRS and control groups, as well as between the preoperative and postoperative groups, the Georgian version demonstrated excellent clinical validity (P .0001) and responsiveness (P .0001). These findings support the application of the SNOT-22 scale as a reliable tool for assessing the quality of life (QoL) of patients affected by CRS in the Georgian-speaking population, demonstrating that it can distinguish CRS patients from healthy patients and is sensitive to changes after surgical intervention, as reported by other authors (Table 2).

According to the findings of this study, the Georgian version of the SNOT-22 questionnaire is able to assess changes in HRQoL among surgery patients. We discovered that the difference between the preoperative and postoperative mean SNOT-22 scores was 39.12 points. At three months, the amplitude of the surgical effect was 1.32 and was classed as high (> 0.8). This suggests that FESS is an effective treatment option for the population studied.