About

Kristine A. Smith, MD, FRCSC, is an Associate Professor of Otolaryngology – Head and Neck Surgery at the University of Utah. She is a board-certified and fellowship-trained Rhinologist with a clinical focus on sinus and nasal diseases, including management of acute and chronic sinusitis, polyps, allergy, septal deviation, growths and tumors of the sinuses and skull base, and cerebrospinal fluid (CSF) leaks. Dr. Smith works with a multidisciplinary team that includes neurosurgeons, neuroradiologists, head and neck pathologists, and specialized ENT cancer surgeons to ensure optimal treatment outcomes. She also collaborates with the Ophthalmology team to support minimally invasive orbital surgeries. In addition to her clinical practice, she is actively involved in research aimed at understanding the causes and treatments of sinus disease, with interests in personalized medicine, health economics, healthcare value, inflammatory pathophysiology, clinical outcomes, and healthcare optimization. Her educational background includes medical school at the University of Saskatchewan College of Medicine, residency at the University of Calgary, and fellowship training at the University of Utah during 2017-2018.

Research topics

• Medicine
• Pathology
• Immunology
• Surgery
• Family medicine
• Dermatology
• Law
• Biology
• Biotechnology
• Internal medicine

Selected publications

• Gender Representation on the National Otolaryngology Stage: Leadership Roles and Moderator‐Panelist Trends at Recent Conferences

  Otolaryngology · 2026-02-06

  articleOpen access

  OBJECTIVE: Academic meetings provide opportunities for collaboration and career advancement in the national spotlight. We sought to explore sponsorship opportunities by gender by investigating committee leadership, keynote speakership, and panelist-moderator ratios from prior American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and Combined Otolaryngology Sections Meeting (COSM) conferences. STUDY DESIGN: Cross-sectional review of publicly available program conferencing. SETTING: Literature review. METHODS: Gender breakdowns of committee leadership and keynote speakerships were recorded from official AAO-HNS conference programming from 2013 to 2021. Panelist-moderator gender ratios were calculated for the AAO-HNS conferences from 2023 to 2024. Society leadership representation and panelist-moderator gender ratios were also investigated from recent COSM conferences between 2018 and 2024 via official programming. RESULTS: Between 2013 and 2021, analyses of the AAO-HNS national conferences determined that women comprised on average of 29.6% of annual directorship roles (range 12.5-37.55), 35.6% of board member positions (26.3%-47.4%), and 25.2% of keynote speaker appointments (0%-40%). Between 2019 and 2023, in COSM, women held on average 23.3% of available society chair/secretary positions and 19.0% of society president roles. The ratio of female:total panelist was positively correlated with female moderators. CONCLUSION: Female representation in AAO-HNS and COSM leadership and keynote speakerships has improved over time in recent years, and appears to be on par with academic otolaryngology workforce composition. However, male moderators presenting panels at both conferences had significantly fewer female panelists versus female moderators. This difference in national panel participation opportunities may impact career advancement and national reputation for female otolaryngologists.

  PublisherOA PDFDOI

• Olfaction, Eating Preference, and Quality of Life in Cystic Fibrosis Chronic Rhinosinusitis

  The Laryngoscope · 2025-03-29 · 2 citations

  articleOpen access

  OBJECTIVES: Olfactory dysfunction (OD) is common among people with cystic fibrosis (PwCF) and chronic rhinosinusitis (CRS). OD is associated with impaired quality of life (QOL) and dietary alterations in certain non-CF populations. This study explored relationships between OD, QOL, and modulator use in PwCF. METHODS: This is a cross-sectional analysis of an ongoing multicenter, prospective study (2019-2023) investigating PwCF with comorbid CRS. Participants completed the 40-Question Smell Identification Test (SIT-40), 22-question SinoNasal Outcome Test-(SNOT-22), Questionnaire of Olfactory Disorders (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Clinical and sinus CT data were collected. After stratification by SIT-40 score, data was analyzed by chi-square, Kruskal-Wallis, Spearman correlation, and logistic regression to identify factors associated with OD. RESULTS: Of 59 participants, those with anosmia (n = 12) had worse eating-related QOL (CFQ-R eating) compared to individuals with normosmia (n = 16) and hyposmia (n = 31). Participants with anosmia had worse sinus CT scores than those with hyposmia. Although PwCF treated with highly effective modulator therapy (HEMT; n = 30) had better CT scores vs. non-HEMT individuals (n = 23), rates of OD in both groups were comparable. Higher SNOT-22 total scores were associated with increased odds of hyposmia or anosmia. In an eating-related QOD-NS subscore, those with worse CFQ-R eating had 2.38 times higher odds of having OD. Each point decrease in CFQ-R eating domain score was associated with 10% increased odds of OD. CONCLUSION: In PwCF, OD was associated with increased CRS severity, impaired olfactory QOL, and decreased CFQ-R eating. There were no differences in SIT-40 or QOD-NS scores based on HEMT status. TRIAL REGISTRATION: NCT04469439.

  PublisherOA PDFDOI

• Evaluation of Practice Patterns for 6-Sinus Balloon Sinus Dilation

  JAMA Otolaryngology–Head & Neck Surgery · 2025-11-13 · 1 citations

  articleOpen access1st authorCorresponding

  Importance: Balloon sinus dilation (BSD) is a tool for treating patients with chronic rhinosinusitis or recurrent acute rhinosinusitis. The use of BSD has increased exponentially since its introduction, with concerns for potential misuse. Expert consensus reports that most patients who are candidates for BSD do not need to have all 6 sinuses dilated (bilateral frontal, maxillary, and sphenoid). Objective: To determine the percentage of patients who are undergoing 6-sinus BSD, evaluate factors associated with this practice, and explore outlier practice patterns when performing 6-sinus BSD. Design, Setting, and Participants: This cross-sectional, retrospective review of a Medicare claims database from January 2022 to December 2023 included otolaryngologists (US Centers for Medicare & Medicaid Services code 04) who performed at least 11 BSDs during the study period, who were defined as high-volume BSD clinicians (>10 BSDs per year). Data were analyzed in July 2024. Main Outcomes and Measures: The primary outcome defined before data collection as the percentage of patients billed for 6-sinus BSD. Physician variables were explored for potential association with 6-sinus BSD. Results: Of the 522 otolaryngologists (mean [SD] age, 52 [9.3] years), most physicians were male (489 [94%]), practiced in a group setting (428 [82%]), and were in an urban environment (474 [91%]). A total of 21 290 unique BSD procedures were performed, and 12 799 procedures (60%) involved all 6 sinuses. Of the 522 otolaryngologists, 40 (8%) performed 6-sinus BSD in 100% of their BSD procedures, while 54 (10%) performed no 6-sinus BSDs. Practice patterns varied substantially, with 8 physicians (2%) responsible for 10% of 6-sinus BSDs (n = 2152). Conclusions and Relevance: The results of this cross-sectional study suggest that the high volume of 6-sinus BSD suggests the potential for overuse of BSD. Substantial variations in care emphasize the need for clear guidelines and indications for multisinus BSD to optimize the utilization and value of BSD.

  PublisherOA PDFDOI

• Preoperative Computed Tomography Utilization in Patients Undergoing Balloon Sinus Dilation

  JAMA Otolaryngology–Head & Neck Surgery · 2025-11-13

  articleOpen access

  Importance: Timely computed tomography (CT) imaging is a requirement before performance of sinus surgery, including balloon sinus dilation (BSD). Objective: To determine adherence to practice guidelines for use of CT imaging before BSD procedures. Design, Setting, and Participants: This cross-sectional study used Medicare claims data to identify and include otolaryngologists who each performed at least 11 BSDs from January 1, 2022, to December 31, 2023. Data were analyzed from April 1 to September 9, 2025. using IBM-SPSS statistics version 29 and R 4.3.2. Main Outcome(s) and Measure(s): Percentage of physicians performing BSD without CT imaging available within 1 year of the procedure in greater than 10% of procedures (outliers). Physician variables were explored for potential association with outlier status. Results: The analysis evaluated 490 otolaryngologists (29 female [5.9%] and 460 male [94.1%] individuals) who performed at least 10 BSD procedures annually in a total of 19 692 patients. Preprocedure CT imaging was not available within 1 year prior of BSD for 2905 patients (15%). In all, 156 otolaryngologist-participants (31.8%) were identified as outliers; notably, 30 of these (6.1%) accounted for more than 50% of cases without preprocedure CT imaging, affecting 1880 patients (9.5%) undergoing BSD. Moreover, 42 participants (8.6%) accounted for 47.5% of all missed CTs. Conclusion and Relevance: This cross-sectional study found that most otolaryngologists adhered to clinical consensus by obtaining CT imaging before performing BSD. However, a substantial portion did not obtain CT imaging before BSD and therefore, did not adhere to standard practice guidelines. These findings demonstrate the need for improved monitoring of adherence to the standard of practice.

  PublisherOA PDFDOI

• EPS6.04Abridging the 22-item Sino-Nasal Outcome Test (SNOT-22) in people with cystic fibrosis to limit survey burden

  Journal of Cystic Fibrosis · 2025-06-01

  article
  PublisherDOI

• Gravimetric compounding workflow technology insights for pharmacists and pharmacy technicians

  American Journal of Health-System Pharmacy · 2025-04-23 · 2 citations

  articleOpen access
  PublisherDOI

• Balloon Sinus Dilation Use

  JAMA Otolaryngology–Head & Neck Surgery · 2025-11-13

  articleOpen access

  This cross-sectional study analyzes use of balloon sinuplasty after the 2018 publication of the American Academy of Otolaryngology–Head and Neck Surgery’s clinical consensus statement defining its appropriate indications and use.

  PublisherOA PDFDOI

• Abridging the 22‐Item Sino‐Nasal Outcome Test (SNOT‐22) in People With Cystic Fibrosis: Limiting Survey Burden

  International Forum of Allergy & Rhinology · 2025-05-15

  articleOpen access

  Chronic rhinosinusitis (CRS) affects quality-of-life (QoL) in people with cystic fibrosis (PwCF), despite the reduction in symptoms and symptom severity associated with cystic fibrosis transmembrane conductance regulator (CFTR) modulators [1]. To precisely assess sinus symptoms and treatment needs in the post-modulator period, patient-related QOL instruments should be revisited. The 22-item SinoNasal Outcome Test (SNOT-22) measures CRS burden and QoL. Abbreviated surveys can lessen respondent fatigue. Item response theory (IRT) can help refine surveys by identifying the most informative survey items while maintaining reliability [2-4]. IRT assesses item discrimination (ɑ), the ability to differentiate trait levels, and difficulty (β), which defines thresholds for response categories [2-4]. Liu et al. refined the SNOT-22 using IRT with strong reliability and validity [5]. Given PwCF's unique CRS burden, this study used IRT to create abbreviated SNOT-22 versions by selecting the most informative items. A secondary aim explored SNOT-22 differences by modulator therapy history. This cross-sectional study, approved by local Institutional Review Boards, analyzed 185 adults (age 18 and over) with cystic fibrosis (CF) and CRS from 12 academic centers between 2018 and 2023, primarily from an ongoing trial (NCT04469439). Baseline SNOT-22 scores were analyzed, with full information maximum likelihood used to handle missingness in the graded response IRT models assessing item discrimination and difficulty. Demographic and clinical data were collected. Shortened surveys were developed by first retaining items contributing above-average information within subdomains (nasal, otologic/facial pain, sleep, emotional), whereupon we applied a stricter rule ensuring at least 30% of the test information was retained from each subdomain to produce a further shortened survey, as implemented by Feng et al. [6]. Internal consistency (Cronbach's α > 0.7) and convergent validity (Pearson's r >0.8) confirmed reliability and efficacy of shortened surveys. Statistical analyses were conducted using R with the “mirt” and “psych” packages [7, 8]. The study included 185 PwCF with CRS, predominantly male (60%), with history of modulator therapy use (77%), and with F508del variants (59%) (Table 1). The mean total SNOT-22 score was 39.3 [±19.8]. Subdomain mean scores were 13.0 [±8.3] for nasal, 4.8 [±3.8] for otologic/facial pain, 13.0 [±9.7] for sleep, and 1.5 [±2.0] for emotional. Responses ranged from 0 (“No problem”) to 5 (“Severe problem”) across most subdomains, except for the emotional subdomain, which lacked the most extreme responses. Initial IRT analysis for all PwCF retained above-average information items across subdomains, preserving 55%–63% of subdomain information and yielding an 11-item survey. A stricter 30% threshold retained six items, covering 34%–54% of information in each subdomain (Figure 1). Despite shortening, difficulty thresholds remained consistent, capturing the full range of symptom severity. Of 142 PwCF with history of modulator therapy, IRT analysis produced nine-item and seven-item surveys. Compared to the total PwCF cohort, the nine-item survey excluded “reduced concentration” and “reduced productivity,” while the seven-item survey retained “dizziness.” All other items were consistent between groups (Figure 1). Notably, PwCF with history of modulator therapy had lower average scores for “thick nasal discharge” (2.0) and “post nasal discharge” (1.7) than those not on therapy (2.4 and 2.2, respectively). Item contributions are detailed in Table S1. Correlation analysis showed strong agreement between shortened and original SNOT-22 scales, with Pearson's coefficients of r = 0.97 (11-item) and r = 0.94 (6-item) for the total PwCF cohort, and r = 0.96 (9-item) and r = 0.95 (7-item) for the modulator therapy subgroup. The original SNOT-22 had a Cronbach's α of 0.93, while shortened versions maintained strong internal consistency (0.90–0.84), ensuring reliable CRS-specific QoL assessment in PwCF. The SNOT-22 is a validated CRS assessment tool for PwCF [5]. Using IRT in a multi-institutional cohort, we retained high-information items and created reliable abbreviated versions of the questionnaire specifically relevant for PwCF. PwCF retained different SNOT-22 items using IRT than other populations [5], indicating distinct symptom distributions and QoL impacts. The 11-item version kept “dizziness,” “facial pain/pressure,” and “embarrassed,” while omitting “ear pain/pressure,” “nasal blockage,” and “sad.” The six-item version showed greater divergence, retaining “waking up tired” and “fatigue.” These differences underscore the need for further study on CRS symptom distribution across populations. When IRT analysis was applied only to PwCF on modulator therapy, it generated largely similar abbreviated surveys to across the entire sample. PwCF on modulators, however, omitted “reduced concentration” and “reduced productivity” from the 11-item SNOT-22 creating a nine-item version. Using the 30% threshold, they retained the six-item SNOT-22 with the addition of “dizziness.” These variations may reflect differences in symptom perception post-therapy and warrant further study. Respondent fatigue, a decline in data quality due to survey length and complexity, may be mitigated by abbreviated surveys [9]. PwCF experience significant fatigue, with severe cases affecting up to 26% [10]. While respondent fatigue in PwCF remains unstudied, abbreviated surveys could enhance participation and data quality. Our findings support shortening the SNOT-22 to reduce fatigue while retaining key information, emphasizing the need for tailored CRS patient reported outcome measures and validation for PwCF. Limitations of this study include modest sample size, limited sociodemographic data, skewed beta parameters, and SNOT-22 midpoint clustering, which may underrepresent CRS severity. Key symptoms such as nasal blockage and dysosmia were excluded in IRT-based shortening, raising concerns about capturing CRS impact. Additional psychometric validation of the shortened scales is required. Despite this, the study supports IRT-based SNOT-22 shortening for PwCF while preserving key information. This work was supported by the Cystic Fibrosis Foundation (BESWIC20A0 and BESWIC22Y5). This foundation provided support for the planning and execution of this work but did not have specific involvement in the study design, data collection, analysis, or interpretation, or decision to submit the article for publication. Research reported in this publication was supported by the National Center for Advancing Translational Science (NCATS) of the National Institutes of Health under the UCLA Clinical and Translational Science Institute grant number UL1TR001881. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE-2034835. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation. Daniel M. Beswick: In the last 36 months. Daniel M. Beswick has received grant support from NIH/NHLBI, CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity). Jeremiah A. Alt: Consultant for OptiNose and Medtronic. Speaker panel GSK. GlycoMira board and equity holder. Kristine A. Smith: In the last 24 months, served as consultant for SanofiGenzyme. Zachary M. Soler: Consultant for OptiNose, Regeneron, and Lyra; Medical Directory for Healthy Humming. Rodney J. Schlosser: Consultant for OptiNose, Medtronic, Stryker, Cyrano; Medical Directory for Healthy Humming. Jennifer L. Taylor-Cousar: In the last 36 months, JLT-C has received grants from the CF Foundation related to this work as well as for work unrelated to the manuscript. Unrelated to this work, she has received grants for her institution from Vertex Pharmaceuticals Incorporated, Eloxx, and 4DMT; received fees from Vertex Pharmaceuticals Incorporated related to consultation on clinical research design, participation on advisory boards, and speaking engagements; and served on advisory boards and/or provided clinical trial design consultation for Insmed, 4DMT, and AbbVie. She serves on a DMC for AbbVie. She serves as the adult patient care representative to the CFF Board of Trustees, and on the CF Foundation's Clinical Research Executive Committee, Clinical Research Advisory Board, Racial Justice Working Group and as immediate past chair of the CF TDN's Sexual Health, Reproduction and Gender Research Working Group, on the scientific advisory board for Emily's Entourage, and on the ATS Respiratory Health Awards, Scientific Grant Review and Clinical Problems Assembly Programming Committees. All other authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

  PublisherOA PDFDOI

• Characterizing air pollution exposure methodologies in rhinology: a scoping review

  International Journal of Environmental Health Research · 2025-03-13 · 1 citations

  reviewOpen accessSenior author

  ABST RACTCharacterization of air pollution assessment methodologies in rhinologic disease research is lacking. A scoping review was thus conducted to survey exposure methods in studies examining common rhinologic conditions: allergic rhinitis (AR) and chronic rhinosinusitis (CRS). Several medical databases were queried for variables relating to (1) adults with a diagnosis of CRS or AR and (2) air pollution exposure. Data was extracted for pollutants assessed, method of quantifying exposure, assessment of residential stability, inclusion of authors with expertise in environmental exposure assessment, and disease-related outcomes. Thirty-four articles were included for analysis - 16 for AR and 18 for CRS. Fifteen studies originated from East Asia, 10 from North America, and 6 from Europe. The most common pollutant studied was PM2.5 (28 studies), with most studies investigating multiple pollutants. Twenty-one studies used a nearby air monitor to quantify exposure, 9 studies reported whether subjects had residential stability for the period assessed, and 17 studies included authors with climate science background. Timeframes included both acute and chronic exposure. Current methods to quantify air pollution exposure in rhinology vary considerably and inconsistently employ expertise from environmental scientists. Future investigations may benefit from multidisciplinary collaboration, reporting of residential stability, and standardized reporting metrics.

  PublisherOA PDFDOI

• Patient perspectives on chronic rhinosinusitis in cystic fibrosis: Symptom prioritization in the era of highly effective modulator therapy

  International Forum of Allergy & Rhinology · 2024-02-11 · 4 citations

  articleOpen access

  BACKGROUND: Chronic rhinosinusitis (CRS) is common in people with cystic fibrosis (PwCF). Rhinologic symptom prioritization and areas that influence CRS treatment choices, including pursuing endoscopic sinus surgery (ESS), remain understudied. METHODS: Adult PwCF + CRS were enrolled at eight centers into a prospective, observational study (2019-2023). Participants were administered the 22-SinoNasal Outcome Test (SNOT-22) survey and a modified SNOT-22 instrument examining symptom importance. We determined importance rankings for individual symptoms and SNOT-22 symptom importance subdomains in two sets of subgroups-those pursuing ESS versus continuing medical management (CMT), and those on elexacaftor/tezacaftor/ivacaftor (ETI) versus not on ETI. RESULTS: Among 69 participants, the highest priorities were nasal congestion (n = 48, 69.6% important), post-nasal discharge (32, 46.4%), facial pain (29, 43.3%), waking up tired (27, 39.1%), and fatigue (26, 37.7%). Those electing surgery (n = 23) prioritized sleep and psychological dysfunction symptoms compared to those pursuing CMT (n = 49) (sleep median score = 19.0 [interquartile range: 12.0, 25.0] vs. 4.5 [0.0, 12.8]; p < 0.0001; psychological = 17.0 [7.0, 26.0] vs. 7.0 [0.0, 15.8]; p = 0.002). ETI users had comparable SNOT-22 total symptom importance scores to non-ETI users (p = 0.14). Non-ETI users (n = 34) showed a trend toward prioritizing sleep symptoms compared to ETI users (n = 35) (13.0 [2.8, 22.3] vs. 6.0 [2.0, 17.0]; p = 0.055). CONCLUSIONS: Nasal congestion and post-nasal discharge were top priorities reported by PwCF + CRS. Those electing surgery prioritized sleep and psychological symptoms, highlighting their importance in pre-operative discussions. Non-ETI users' prioritization of sleep improvement may highlight their unique disease impact and therapeutic needs; however, additional investigation is required.

  PublisherOA PDFDOI

Frequent coauthors

• Jeremiah A. Alt

  University of Utah

  35 shared

• Richard R. Orlandi

  University of Utah

  23 shared

• Luke Rudmik

  University of Calgary

  20 shared

• Gretchen M. Oakley

  17 shared

• Amber Williams

  Wichita State University

  16 shared

• Katie Sellers

  16 shared

• Susan Goekler

  Brewer Science (United States)

  16 shared

• Timothy L. Smith

  Oregon Health & Science University

  12 shared

Education

• M.D.

  University of Saskatchewan College of Medicine

• Other

  University of Calgary

• Other

  University of Utah