In this prospective Belgian study, the authors looked at whether the baseline Sino-Nasal Outcome Test-22 (SNOT-22) was able to predict the need for surgery and localise the pathology of rhinology patients and healthy volunteers. A total of 66 healthy volunteers and 383 rhinology patients were included. The participants were divided into four groups – controls (no nasal symptoms), no surgery required, nose surgery (functional septorhinoplasty, septoplasty, turbinoplasty) and sinus surgery. The scores were analysed using multinominal logistic regression adjusting for age, gender, asthma, tobacco, history of nose surgery and trauma. The 22 items of SNOT-22 differed significantly between the four groups, with the control group showing the lowest SNOT-22 scores for all items. Patients who needed sinus surgery were more likely to complain about their sense of smell, need to blow nose, facial pain, runny nose, cough and sneezing. Patients who needed nose surgery tended to show better scores in the thick nasal discharge and postnasal discharge items of SNOT-22 when compared to those patients requiring sinus surgery. This study suggests that baseline SNOT-22 can predict whether a patient may need surgery, and whether they may need nasal or sinus surgery. The authors suggest that this could be beneficial for primary care physicians as an easy-to-administer screening tool in determining whether patients may need referral to secondary care for nasal or sinus surgery.