Epidemiologic Assessment and Quality of Life Impact of Sinonasal Disease in Cleft Lip and Palate.

Abstract

To characterize the prevalence, clinical manifestations, and risk factors of sinonasal pathology in patients with cleft lip and/or palate (CL/P). This prospective cohort study included patients aged ≥ 12 years with a history of CL/P, seen at a tertiary craniofacial center from May 2024 to February 2025. Participants completed the Sino-Nasal Outcome Test-22 (SNOT-22) and the Nasal Obstruction Symptom Evaluation (NOSE), assessing sinonasal symptoms. Clinical and demographic data were collected via chart review. Primary outcomes were normalized SNOT-22 and NOSE scores. Statistical analyses included paired and independent t-tests, Pearson correlation, and linear regression to evaluate associations with scores, Veau classification, and age. Ninety patients were included. Most (83.3%) had non-syndromic CL/P. Chronic rhinosinusitis and allergic rhinitis were reported by 12.2% and 21.1% of participants, respectively. Despite these rates, current sinonasal medication use was high (36.7%). Otolaryngology referrals for sinonasal symptoms were documented in only 21.1% of cases. NOSE scores were significantly higher than SNOT-22 scores (t = -3.65, p < 0.001). After excluding nasal obstruction items in SNOT-22, and quality of life items from both surveys, NOSE scores remained significantly higher (t = -4.65, p < 0.001). No significant differences in total SNOT-22 scores were found across Veau classifications (p = 0.406) or with age (Pearson's r = 0.123, p = 0.250). Patients with CL/P experience clinically meaningful sinonasal symptoms, predominantly nasal obstruction. Medication use exceeded sinonasal diagnoses, suggesting a higher prevalence of subclinical disease. Incorporating patient-reported outcome measures is essential to uncover the burden of sinonasal pathology and guide multidisciplinary management. II.