April 2020 HSC Section 4 - Plastic and Reconstructive Problems

The Cleft Palate-Craniofacial Journal 56(2)

Figure 1. Example of NOSE questionnaire administered in cleft clinic. NOSE indicates Nasal Obstruction Symptom Evaluation.

The Nasal Obstruction Symptom Evaluation (NOSE) scale is a brief and simple instrument that has been shown to be reliable, responsive to change in clinical status, and validated for both pediatric and adult patients, by self-report or by proxy report (Stewart et al., 2004; Gandomi et al., 2010; Mondina et al., 2012; Yilmaz et al., 2014; Sobol et al., 2016). The Inter- national Consortium for Health Outcomes Measurement has chosen the NOSE survey as an objective method of document- ing the presence and severity of nasal obstruction in the CL/P population (ICHOM, 2017). A previous study administering the NOSE survey to a CL and/or palate cohort lacked surgical data to correlate with symptoms (Sobol et al., 2016). This study aims to characterize the epidemiology of nasal obstruction and evaluate the influence of patient-level characteristics and sur- gical interventions on symptoms, using the NOSE survey in a large sample size of patients with CL/P. Methods As part of standard clinical evaluation, NOSE surveys were administered annually to all patients with CL/P presenting for their annual visit at a multidisciplinary cleft clinic between January 2015 and August 2017. Figure 1 presents an example of the NOSE survey administered. The survey asks respondents to rate (0 ¼ no problem, 1 ¼ very minor problem, 2 ¼ moderate problem, 3 ¼ fairly bad problem, and 4 ¼ severe problem) the severity of five nasal obstructive symptoms: 1) Nasal congestion/stuffiness 2) Nasal blockage 3) Trouble breathing through nose 4) Trouble sleeping 5) Difficulty breathing through nose during exercise

Parents were permitted to record responses for their child. Following institutional review board approval, patient charts were retrospectively reviewed to extract data on demographics, cleft phenotype, and surgical procedures. Patients with at least 1 completed survey during the study period were included. Patients were excluded if they were found not to have a cleft deformity after initial evaluation. All NOSE surveys completed by each subject were collected. The composite NOSE score was calculated by summing the numerical ratings of the 5 symptoms. For subjects who completed multiple NOSE sur- veys during the study period, the survey with the highest com- posite NOSE score and the most recent NOSE survey were identified. Statistical Analysis Mann-Whitney U and Kruskal-Wallis tests were conducted to compare NOSE scores by categorical patient variables and operative interventions. Pearson correlation was used to assess association between NOSE scores and continuous patient variables. The values of the composite NOSE scores, as well as for each individual symptom, were analyzed. For comparison by age of subjects, all surveys collected were included and grouped based on age that the survey was admi- nistered. Additionally, for subjects with multiple NOSE sur- veys, both the survey with the highest composite NOSE score and the most recent NOSE survey were identified. When comparing subjects by cleft phenotype, analyses were con- ducted for both the most recent and most severe survey data sets. Subgroup analysis was performed to consider differences within age groups. Values of P < .050 were considered statis- tically significant.

248