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<h5 class="section-title" id="d7494481e270">Question</h5>
<p id="d7494481e272">Can we develop and validate a novel patient-reported outcome
measure (PROM) questionnaire
to evaluate both functional and cosmetic outcomes of rhinoplasty?
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<h5 class="section-title" id="d7494481e275">Findings</h5>
<p id="d7494481e277">In this survey study, the Standardized Cosmesis and Health Nasal
Outcomes Survey (SCHNOS)
was developed and validated using internationally accepted PROM development methodology.
It was also field tested, and significant differences were found between the functional
and cosmetic rhinoplasty populations, both preoperative and postoperative.
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<h5 class="section-title" id="d7494481e280">Meaning</h5>
<p id="d7494481e282">The 10-item SCHNOS provides a short, validated questionnaire
that we recommend for
use in all functional or cosmetic rhinoplasty patients.
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<h5 class="section-title" id="d7494481e286">Importance</h5>
<p id="d7494481e288">Rhinoplasty is a common operation in which shape and function
are intimately related,
whether the procedure is cosmetic, functional, or combined in nature. There is currently
no properly developed and validated patient-reported outcome measure (PROM) to evaluate
both functional and cosmetic components of rhinoplasty.
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<h5 class="section-title" id="d7494481e291">Objective</h5>
<p id="d7494481e293">To develop, validate, and field test the Standardized Cosmesis
and Health Nasal Outcomes
Survey (SCHNOS) to evaluate both functional and cosmetic outcomes of rhinoplasty.
</p>
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<h5 class="section-title" id="d7494481e296">Design, Setting, and Participants</h5>
<p id="d7494481e298">Survey development study between October 2016 and April 2017
in a tertiary referral
facial plastic and reconstructive surgery clinic. Preoperative and postoperative adult
patients undergoing rhinoplasty, whether cosmetic or reconstructive, were included.
A fifth group of adult nonrhinoplasty patients (facial cosmetic or reconstructive)
were also included for the field test.
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<h5 class="section-title" id="d7494481e301">Main Outcomes and Measures</h5>
<p id="d7494481e303">Generated and reduced items, psychometric validation measures
of the SCHNOS, and differences
on scales between groups.
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<h5 class="section-title" id="d7494481e306">Results</h5>
<p id="d7494481e308">For survey development, a total of 18 patients and 5 experts
were interviewed. Of
these patients, 5 were male, and 13 were female. Their mean (SD) age was 38 (14.8)
years (range, 20-64 years). Field testing included 191 patients (67% were women and
the mean [SD] age was 41.5 [15.8] years). A total of 10 items were included after
generation, cognitive interviews, and item reduction. The 10 items represent 2 domains:
nasal obstruction (first 4 items) and nasal cosmesis (last 6 items). For both domains,
Cronbach α was excellent: 0.94 (95% CI, 0.92-0.95) for obstruction and 0.94 (95% CI,
0.93-0.95) for cosmesis. Exploratory factor analysis using scree plots for each domain
showed that the domains are unidimensional in nature with each domain evaluating what
it is intended to assess (nasal obstruction and cosmesis). The factor loading estimates
were high for all the items, varying from 0.74 to 0.92. Kruskal-Wallis testing showed
a significance level of
<i>P</i> < .001 when evaluating the difference between groups (preoperative cosmetic,
postoperative
cosmetic, preoperative functional, postoperative functional, and nonrhinoplasty) for
all individual questions, composite scores, and Nasal Obstruction Symptom Evaluation
(NOSE) score. Correlations between the obstruction composite score and the NOSE scores
were
<i>r</i> = 0.943 (
<i>P</i> < .001), which is very strong. The obstruction and cosmesis composite
scores were
only weakly correlated (
<i>r</i> = 0.388;
<i>P</i> < .001).
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<h5 class="section-title" id="d7494481e326">Conclusions and Relevance</h5>
<p id="d7494481e328">We have developed and validated a new PROM to evaluate both functional
and cosmetic
rhinoplasty patients. The domains of obstruction and cosmesis were found to be internally
consistent and unidimensional. The SCHNOS provides a short, validated questionnaire
that we recommend for use in all functional or cosmetic rhinoplasty patients.
</p>
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<h5 class="section-title" id="d7494481e331">Level of Evidence</h5>
<p id="d7494481e333">
<a data-untrusted="" href="http://jamanetwork.com/journals/jamafacialplasticsurgery/pages/instructions-for-authors/#SecLevelofEvidence/Ethnicity"
id="d7494481e335" target="xrefwindow">N/A</a>.
</p>
</div><p class="first" id="d7494481e339">This study reports on the development and
testing of a new patient-reported outcome
measure to evaluate both functional and cosmetic rhinoplasty patients, the Standardized
Cosmesis and Health Nasal Outcomes Survey.
</p>