April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Original Investigation Research

Standardized Cosmesis and Health Nasal Outcomes Survey

Currently, the PROM with the most robust methodology to assess nasal cosmesis is the FACE-Q, developed by Klassen et al. 15 The nasal module of the FACE-Q involves 3 different questionnaires (satisfaction with nose [10 questions], ad- verse effects [4 questions], and satisfaction with nostrils [5 questions]), and the total of 19 questions can be a burden on a single patient. Based on our interviews, patients did not iden- tify current adverse effects or nostrils as a priority during their cosmeticor functional rhinoplastyexperience. TheFACE-Qwas developed using input from only 9 rhinoplasty patients com- pared with 18 in our study. Other disadvantages are that the rhinoplastypopulationwas poorlydefined as towhether itwas functional or cosmetic, and the recall period for the FACE-Q is the past week. We believe that a recall period of a month is more appropriate toassess nasal functionandcosmesis,mainly to avoid tainting the questionnaire by a recent upper respira- tory tract infection. For these reasons, we believe that the SCHNOS cosmetic domain is comprehensive enough yet can avoid excessive patient burden. Evaluation of functional and aesthetic changes in all types of rhinoplasty is paramount. The SCHNOS provides a short, validated questionnaire that we recommend for use in all functional or cosmetic rhinoplasty patients. There are no specific instructions other than handing the question- naire to the patient and asking him or her to complete it. By tracking the individual patient’s progress, the clinician can identify problems that may not be evident during routine clinical interaction. Limitations The generalization of our results should be made with cau- tion before the results are confirmed in bigger samples and in different settings. The Likert-type ordinal data used for the fac- tor analysis were considered interval data. While common, such an approach is always an approximation, and this should be taken into account. The ordinal data obtained from the SCHNOSmay further be analyzed using a Rasch analysis or an item response theory (both methods require big samples). However, the SCHNOS was created based on a sound concep- tual framework, and it was tested using the commonly rec- ommended psychometric methods for the initial evaluation of a new test. Conclusions We have developed and validated a new PROM to evaluate both functional and cosmetic rhinoplasty patients. The SCHNOS contains 2 independent domains describing nasal obstruction and nasal cosmesis. The domains were found to be internally consistent and unidimensional. The use of the SCHNOS was tested on practice in 191 patients presenting to a facial plastic surgery clinic. Future directions include establishing levels of meaningful change and minimal clini- cally important difference, evaluating the ability to detect change in a single patient, and establishing whether the questionnaire can be administered electronically rather than in paper format. Overall symmetry of the nose 0.36 0.39 0.34 0.43 0.66 0.60 0.65 0.71 0.60 Abbreviations: NA, not applicable; SCHNOS, Standardized Cosmesis and Health Nasal Outcomes Survey. How well nose suits the face 0.33 0.34 0.33 0.32 0.70 0.85 0.78 0.74 NA

Table 2. Correlation Matrix of the 10-Item SCHNOS Domains and Items Nasal Obstruction Domain Score Nasal Cosmesis Domain Scores Blocked or Obstructed Nose Getting Air Through the Nose During Exercise Congested Nose Breathing Through the Nose During Sleep Decreased Mood and Self-esteem Nasal obstruction domain Getting air through the nose during exercise 0.84 NA NA NA NA NA NA NA NA Congested nose 0.80 0.73 NA NA NA NA NA NA NA Breathing through the nose during sleep 0.80 0.83 0.73 NA NA NA NA NA NA Nasal cosmesis domain Decreased mood and self-esteem 0.20 0.23 0.27 0.21 NA NA NA NA NA Shape of the Nasal Tip Straightness of Nose Shape of Nose From the Side How Well Nose Suits the Face

Shape of the nasal tip 0.38 0.40 0.39 0.41 0.66 NA NA NA NA Straightness of nose 0.27 0.29 0.32 0.29 0.79 0.77 NA NA NA The shape of nose from the side 0.13 0.18 0.21 0.20 0.84 0.67 0.83 NA NA

(Reprinted) JAMA Facial Plastic Surgery January/February 2018 Volume 20, Number 1

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