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ICAR SINONASAL TUMORS

A Skull base QOL instruments The first QOL instrument to be developed specifically for skull base pathologies was the Anterior Skull Base Surgery QOL questionnaire (ASBS-Q). It is a 35-item question instrument for patients undergoing open skull base approaches. Several sinonasal tumors including IP, SCC, ONB, ACC, adenocarcinoma, and melanoma were included in its initial development and analysis. It is com posed of six domains (performance, physical function, vitality, pain, influence on emotions, and specific symp toms) and demonstrated sufficient reliability and validity. The instrument was validated by testing its agreement with the hypothesized effect of certain clinical variables (e.g., malignancy, adjuvant radiation) on domain scores. The instrument was also able to differentiate between patient groups with different health statuses (e.g., older patients achieved lower scores in the performance and physical function domains than younger patients), further demonstrating its validity. High internal consistency was demonstrated by Cronbach’s alpha > 0.8 in all domains. 2068 The minimal clinically important difference (MCID) has been determined as 0.4 (8%, score range 1–5). 2069 The Skull Base Inventory (SBI) is a comprehensive instrument of 41 items designed for patients with anterior or central skull base pathologies undergoing endoscopic or open surgical approaches. It was developed using a population of 138 patients with several sinonasal tumors such as ONB, ACC, and adenocarcinoma, in addition to intracranial skull base pathologies such as pituitary ade noma, craniopharyngioma, or meningioma. There are 11 domains including cognitive, emotional, family, financial, social, spiritual, endocrine, nasal, neurologic, visual, and other. 2070 The endocrine domain may be less relevant to patients with sinonasal tumors, especially for those who do not undergo adjuvant therapy. Psychometric properties were tested in a multi-institutional study of 180 patients. Concurrent validity was assessed by comparing the SBI to the ASBS-Q and the nasal domain of the SBI to the Sino-Nasal Outcomes Test-22 (SNOT-22). There was very strong correlation with the SBI and moderate correlation of the nasal domain with SNOT-22. In assessing construct validity, three out of six hypotheses were satisfied and one displayed a trend toward satisfaction. While it was hypoth esized that QOL would be worse in patients receiving adjuvant therapy or in those with malignant disease, these hypotheses were not satisfied by the SBI. Cross-cultural and convergent validity were also found to be acceptable. Responsiveness was demonstrated by significant mean dif ferences between preoperative and 2-week postoperative total scores and among seven of the domains. 2065,2070 The Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q) is a multidimensional

instrument to assess general health-related QOL as well as sinonasal morbidity following endoscopic endonasal surgery. The EES-Q consists of 30 questions across three domains (physical, psychological, social). It was validated in a total sample of 300 patients undergoing endoscopic skull base surgery predominantly for pituitary adenoma, as well as patients undergoing endoscopic sinus surgery. Of note, 15 patients with IP were included and seven medial maxillectomies were performed. 2071 A subsequent study validated the instrument by demonstrating significant pos itive and negative correlations between the EES-Q and the SNOT-22 and postoperative health status. The SNOT-22 is a 22-item disease-specific QOL instrument that has been val idated in patients with CRS. It is widely used to assess nasal morbidity across all pathology, despite not being validated in patients with sinonasal or skull base tumors. The EES-Q has also demonstrated excellent test–retest reliability with intraclass correlation coefficients (ICCs) of 0.9 or greater across the three domains. The instrument also demon strated responsiveness to clinical change when measured preoperatively and 3 months postoperatively. 2072 Sinonasal QOL is of particular importance for patients undergoing EEA. The Sino-Nasal Outcome Test for Neu rosurgery (SNOT-NC) and Anterior Skull Base Nasal Inventory (ASK Nasal-12) were developed specifically to assess sinonasal symptom-specific outcomes and do not assess general health-related QOL. The SNOT-NC was modeled after the SNOT-22 and consists of 23 items across five domains (nasal discomfort, sleep problems/reduced productivity, ear and head discomfort, visual impairment, and olfactory disturbance). It was validated in a sam ple of 102 patients with sellar pathology and found to have good reliability, although retest reliability has not been performed. 2073 Similarly, the ASK Nasal-12 was also validated in a sample of 104 patients with pituitary adeno mas undergoing endoscopic transsphenoidal approaches. It consists of 12 items in one domain reported as a single score. 2074 De Almeida reviewed the nine QOL instruments spe cific to anterior and central skull base pathology includ ing Acromegaly QOL (AcroQOL), ASBS-Q, Quality of Life Satisfaction Hypopituitarism (QLS-H), Pituitary ade noma QOL, Addison’s disease QOL (AddiQOL), QOL for Growth Hormone Deficiency (QOL-AGHDA), Hormone Deficiency-Dependent Quality of Life (HDQOL), Princess Margaret Hospital Midface Dysfunction Scale (MDS), and Cushing QOL. Seven of these instruments examined pitu itary pathology QOL, one measures midface dysfunction, and another measures general skull base pathology. Three instruments (ASBQ, QLS-H, and QOL-AGHDA) demon strated reliability as assessed by both internal consistency and reproducibility. Three instruments (Pituitary QOL, AddiQOL, and MDS) failed to demonstrate some form of