Validation and cross-cultural adaptation of the arabic version of the nasal obstruction symptom evaluation scale

Perception of Rhinoplasty Outcome Utilizing Patients' Photography

BACKGROUND

Patient satisfaction with rhinoplasty results is evaluated in a manner of subjective and qualitative values, and to a certain degree, it can indicate successful outcomes in rhinoplasty.

METHODS

The present study was a descriptive study that assessed the rhinoplasty outcome of adult patients who underwent septorhinoplasty between January 2015 and August 2023 at a single center in Saudi Arabia utilizing Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores pre-operatively, postoperatively, and postoperatively with showing the patients their photo before surgery.

RESULTS

The comparison of Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores showed statistically significant with P value of 0.000 when comparing these scores pre-operatively, postoperatively, and postoperatively with showing the patient their photos before surgery.

CONCLUSION

Presenting patients with pre-operative images may help them recognize changes in their clinical appearance and, consequently, score higher on the postoperative satisfaction scale. It can help the surgeon to increase patient satisfaction postoperatively.

Assessment of Nasal Obstruction Symptoms and Pulmonary Function Following Functional Endoscopic Sinus Surgery (FESS) in Chronic Rhinosinusitis with Nasal Polyps

The upper and lower airways are typically subjected to identical inflammatory stimuli and comprise a single organ that is functionally connected. 40 patients with chronic rhinosinusitis with nasal polyps who had failed medical treatment and undergone FESS participated in our study. Prior to surgery and three months after surgery, nasal obstruction symptoms were measured using the NOSE score system and pulmonary function tests were evaluated using spirometry. The mean Nose Score was 70 before surgery but dropped to 4 afterward, with a p value < 0.001 showing a statistically significant improvement in the nasal symptoms following FESS. The mean pre-operative FVC, FEV1, and FEV1/FVC% values were 3.19, 2.53, and 78.81%, respectively, while the mean post-operative values were 3.14, 2.5, and 79.01%. Following FESS, there wasn't a statistically significant change in lung function tests. Our study showed that percentage of change of total NOSE score has a statistically significant Negative correlation with percentage of change of pulmonary function tests parameters. This study demonstrates the positive effects of FESS on nasal polyposis patients' quality of life and nasal obstruction symptoms without having any negative impacts on the lower airways.

Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta-analysis

OBJECTIVE

Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient-reported nasal obstructive symptoms in the post-operative follow-up.

METHODS

An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results.

RESULTS

A total of 2577 patients (males: 65.1%, 95% CI: 59.9-70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4-36.2) were included in this meta-analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3-71.9). The pooled MD in NOSE score at 6-months follow-up compared to baseline was -48.8 (n = 1730, 95% CI: -54.6 to -42.9).

CONCLUSIONS

Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:3237-3246, 2023.

Validation and psychometric evaluation of the Swedish version of the Nasal Obstruction Symptom Evaluation scale

Objectives

The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific quality-of-life questionnaire for patients suffering from nasal obstruction. The instrument is designed specifically for patients with septal deviation and for the evaluation of the outcome of septoplasty. The aim of this study was to validate a Swedish version of the NOSE instrument for use in clinical practice and research.

Methods

A Swedish version of the NOSE was tested in a case group consisting of 125 subjects with nasal obstruction (of which 31 underwent septoplasty) and a control group consisting of 65 healthy subjects. Base line data for the case and control groups were used to evaluate face validity, known groups validity, construct validity, internal consistency and factor structure analysis. Fifty participants in both the case groups and control groups were assessed both at baseline and after 2 weeks to evaluate test-retest reliability. The participants who underwent septoplasty were assessed at baseline and after 3-6 months to evaluate responsiveness.

Results

The S-NOSE was found to be reliable, valid, and responsive. Both Cronbach's α and McDonald Omega coefficients were >0.7, and the intra class coefficient was 0.942. The S-NOSE scores were significantly correlated with nasal patency VAS in both the case group and the control group (p < .001 and p = .018, respectively). After septoplasty, the mean S-NOSE score were significantly improved (p < .001). Furthermore, the S-NOSE was shown to have excellent and robust psychometric properties.

Conclusion

The S-NOSE can be recommended in both clinical practice and research to evaluate the outcome of septoplasty in Swedish-speaking populations.

Level of Evidence

NA.

A Comparison of Symptom Improvement and Outcomes After Septoplasty Alone Versus Septoplasty With Turbinoplasty

Background Various causes can lead to nasal obstruction, with the most frequent anatomical cause being deviated nasal septum. It seriously affects patients' quality of life. As a result, septoplasty is performed to enhance the nasal airways. This study aimed to compare the improvement of nasal symptoms following septoplasty with or without turbinoplasty and evaluate the surgical outcomes in both different groups. Methodology A retrospective study was conducted at a tertiary hospital among patients who had undergone septoplasty with or without turbinoplasty between 2020 and 2022. Data regarding demographics, clinical features, surgical data, and complications were collected from patient files. The Nasal Obstruction Symptom Evaluation (NOSE) scale score was assessed through structured interviews. Results In our analysis of 209 patients who underwent surgery for deviated nasal septum, septoplasty was done in 110 (52.6%) patients, whereas the remaining 99 (47.4%) underwent septoplasty with turbinoplasty. The mean NOSE score was found to be 32.94 ± 35.67%. Patients who underwent septoplasty alone significantly showed higher mean scores (56.36 ± 34.62%) compared to those who underwent septoplasty with turbinoplasty (11.14 ± 18.93%) (p < 0.001). The long-term complications showed revision surgery was done in 13 patients, which was comparatively more often done in patients who underwent a septoplasty. Other long-term complications were found to be significantly higher in patients who underwent septoplasty (76.9%) compared to those who underwent septoplasty with turbinoplasty (23.1%). Conclusions Patients who underwent additional turbinoplasty experienced an improvement in nasal symptoms than those who underwent septoplasty alone. In addition, more long-term complications were noted in patients who underwent septoplasty alone.

Arabic translation, cultural adaptation, and validation of the BDDQ-AS for rhinoplasty patients

BACKGROUND

Body Dysmorphic Disorder (BDD) is a significant aspect that compromises patient satisfaction after rhinoplasty. BDDQ-AS (Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery) is a validated, simple, reliable patient-reported outcome measure. It is a screening tool to detect body dysmorphic disorder in rhinoplasty patients. This study aimed to translate, culturally adapt, and validate BDDQ-AS to Arabic as a novel tool for screening and detecting BDD in Arabic rhinoplasty individuals.

METHODS

BDDQ-AS was translated from English to Arabic following the international consensus guidelines. We tested the translation on ten Arabic-speaking rhinoplasty patients to ensure that the final version was understandable and acceptable. The proposed Arabic version was then completed by 112 patients whose average age was 28.79 ± 9.32 years. The screening is assumed positive if the patients expressed bother and preoccupation about their appearance (questions 1 and 2 "yes"), as well as a moderately disrupted everyday life (question 7 "yes" or questions 3, 4, 5, or 6 are equal to or greater than "3''). The internal consistency, test-retest reliability, and item-response theory (IRT) were used to evaluate psychometric validations.

RESULTS

The Arabic BDDQ had a high level of internal consistency, as measured by Cronbach's alpha 0.995. The A-BDDQ-AS was deemed reliable with an Intraclass Correlation Coefficient (ICC) of 0.989. A-BDDQ had good discrimination scores (above 2.0) with adequate difficulty parameters. The overall scale content validity average was 0.83, affirming that all items were relevant, clear, and straightforward.

CONCLUSION

The Arabic version of the BDDQ-AS is reliable, culturally adapted, and psychometrically validated to be readily used and incorporated into clinical practice. It is a beneficial tool that can guide the screening of Arabic rhinoplasty patients suffering from body dysmorphic disorder and be utilized in further studies to optimize patient outcomes.

Cross-cultural adaptation of the Hebrew Nasal Obstruction Symptom Evaluation (NOSE) scale

Objective

Nasal obstruction is a common complaint. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable validated tool used to assess the quality of life of patients with nasal obstruction. The purpose of this study is to validate the Hebrew version of the NOSE scale (He-NOSE).

Methods

A prospective instrument validation was conducted. The NOSE scale was translated primarily from English to Hebrew and then back from Hebrew to English according to the accepted guidelines of the cross-cultural adaptation process. The study group included surgery candidates suffering from nasal obstruction due to a deviated nasal septum and/or inferior turbinate hypertrophy. The study group completed the validated He-NOSE questionnaire twice prior to the surgery and once again, a month post-surgery. A control group of individuals with no history of nasal complaints or surgeries was asked to complete the questionnaire once. Reliability, internal consistency, validity, and responsiveness to change of the He-NOSE were evaluated.

Results

Fifty-three patients and 100 controls were included in this study. The scale showed excellent ability to discriminate between the study and the control group, exhibiting significantly lower scores in the control group (73.8 and 7 average scores respectively, p < .001). Good internal consistency (Cronbach's alpha .71 and .76) and test-retest reliability (Spearman rank correlation r = .752, p < .0001) were measured. Moreover, the scale revealed remarkable responsiveness to change (p < .00001).

Conclusion

The translated and adapted He-NOSE scale can be a useful tool to be applied in both clinical and research fields when assessing nasal obstruction.

Level of evidence

N/A.

Outcome comparison of submucous resection versus combined submucous diathermy and outfracture for treatment of inferior turbinate hypertrophy

OBJECTIVES

The aim of this study was to compare the outcome of submucous resection and combined submucous diathermy with outfracture technique in treatment of nasal obstruction caused by inferior turbinate hypertrophy.

METHODS

This study is a prospective randomized clinical trial involving 90 patients with hypertrophied inferior turbinate not responding to medical treatment. All patients were selected with equal or near equal mucosal and bony turbinate components using computed tomography (CT) and then randomly allocated into two groups; group A (n = 45): underwent submucous resection in both sides and group B (n = 45): underwent combined submucous diathermy and outfracture in both sides. Subjective (NOSE score) and objective (4-grades endoscopic classification system and PNIF evaluation) measures of nasal airflow were done preoperatively and postoperatively.

RESULTS

Subjective assessment using NOSE scale proved that both techniques were effective in relieving nasal obstruction as it improved in both groups postoperatively compared to the preoperative data. However, resection technique was better than diathermy technique with a statistically significant difference (p < 0.05), while objective assessment of nasal obstruction showed better results in resection group than diathermy group, but with no statistically significant difference.

CONCLUSION

Both techniques are effective in relief of nasal obstruction due to inferior turbinate hypertrophy. However, submucous resection showed marked improvement compared to diathermy technique especially at long-term follow-up.

Evaluation of Measurement Properties of Patient-Reported Outcome Measures After Rhinoplasty: A Systematic Review

Importance

The number of available rhinoplasty outcome measurement instruments has increased rapidly over the past years. A large heterogeneity of instruments of different quality now exists, causing difficulty in pooling and comparing outcome data.

Objective

To critically appraise, summarize, and compare the measurement properties of all patient-reported outcome measures (PROMs) that measure functional or aesthetic symptoms of patients undergoing rhinoplasty, using consensus-based methodology and guidelines. This facilitates an evidence-based recommendation on the most suitable instrument to measure rhinoplasty outcomes and identifies promising instruments worthy of further research.

Evidence Review

A systematic literature search of Embase, Medline, and Web of Science was conducted from the databases' respective inception dates to May 18, 2018. Thirty-three articles evaluating 1 or more measurement properties of instruments measuring symptoms related to nasal breathing or satisfaction with nasal appearance in patients who had undergone septoplasty and/or rhinoplasty were included. Measurement properties were graded according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for systematic reviews of PROMs.

Findings

The search strategy identified 33 studies that used 12 different measurement instruments. In general, high-quality studies on measurement properties of instruments measuring aesthetic and/or functional symptom-specific outcome of rhinoplasty are scarce. The Nasal Obstruction Symptom Evaluation (NOSE) scale demonstrated high-quality evidence for sufficient structural validity, internal consistency, reliability, construct validity, and responsiveness, along with favorable interpretability and feasibility aspects, and was therefore selected as the most suitable instrument to measure functional outcome. Among instruments measuring aesthetic outcome, the FACE-Q and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) aesthetic subscale are recommended for further study. Future studies on the measurement properties of the identified PROMs, in particular content validity studies, are necessary.

Conclusions and Relevance

Three instruments with high potential for further use were identified in a systematic review of rhinoplasty outcome instruments using a standardized, consensus-based methodology: the NOSE, FACE-Q, and SCHNOS. These findings may contribute to standardized collection of outcome data in rhinoplasty.

Prevalence of considering revision rhinoplasty in Saudi patients and its associated factors

Background

Primary rhinoplasty outcomes may not meet individual expectations. Consequently, reoperation may be advocated to improve results. This study examines the prevalence of individuals considering revision rhinoplasty, while identifying the main cosmetic and functional complaints and factors associated.

Methodology

This is a cross-sectional study conducted in Saudi Arabia using a self-reported online questionnaire distributed through social media channels. The sample included 1370 participants who were all Saudi nationals over the age of 16 who had undergone primary rhinoplasty at least 1 year prior.

Results

The prevalence of individuals considering revision rhinoplasty was 44.7%. The primary reason for considering it was the desire for further esthetic improvement in an already acceptable result (50.16%). The most common cosmetic complaints subjectively reported were poorly defined nasal tip (32.35%). The most prevalent nasal function symptom was nasal obstruction (56.9%). Significant factors associated with considering revision rhinoplasty included the physician not understanding the patient’s complaints, short consultation time, low monthly income, inadequate information about the expected results, not using computer imaging to predict outcomes, lack of rapport with the surgeon, and inadequate information about the risks and complications.

Conclusions

A thorough understanding of patient concerns and expectations, as well as thoughtful consideration of risk factors, may help surgeons achieve more successful outcomes and potentially reduce the incidence of revision rhinoplasties.

Level of evidence

III

Validation of Patient-Reported Outcomes for Clinical Trials in Allergic Rhinitis: A Systematic Review

Although regulatory authorities have recently recommended the use of a combined symptom-medication score as a primary efficacy end point, none has been psychometrically validated. Here, we sought to determine to what extent allergic rhinitis (AR)-related patient-reported outcomes (symptom scores, medication scores, disease control scores, and satisfaction or quality-of-life scales) have been assessed for construct, content, and/or criterion validity, reliability, responsiveness, and the minimal clinically important difference. We searched the PubMed database from January 1997 to June 2018 with logical combinations of key words related to validation, AR, and patient-rated outcomes and scales. From a total of 1705 potentially relevant publications, 55 were reviewed. Despite the current emphasis on a combined symptom-medication score for evaluating the efficacy of allergen immunotherapy in AR, symptom scores have not been extensively validated, and we did not find any publications describing the validation of a medication score. Disease control scales (mainly the Rhinitis Control Assessment Test, the Control of Allergic Rhinitis and Asthma Test, and the Allergic Rhinitis Control Test) and health-related quality-of-life scales (mainly the Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and the mini-RQLQ) have been extensively validated in AR but have some practical disadvantages as primary efficacy criteria in clinical trials.

Adaption and validation of the nasal obstruction symptom evaluation scale in German language (D-NOSE)

Background

Questionnaires have proven their worth in detecting changes in quality of life after medical interventions. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable and valid tool to identify restrictions of quality of life in patients with nasal problems. The aim of this prospective study was the validation of the German version of the NOSE scale (D-NOSE).

Methods

Adaption of the NOSE in German language was performed by forward and backward translation process. Patients undergoing functional septorhinoplasty were asked to complete the D-NOSE preoperatively, one, three or twelve months after surgery. Healthy volunteers served as controls. Reliability, validity and responsiveness of the D-NOSE were determined.

Results

The D-NOSE showed a good internal consistency as well as good inter-item, item-total correlation and a satisfactory test-retest reliability. The convincing validity of the adapted NOSE scale was approved by good construct validity and an excellent discriminant validity. Furthermore, a high sensitivity to identify clinical changes due to an intervention indicates a good responsiveness of the D-NOSE.

Conclusions

The adapted German version of the NOSE questionnaire (D-NOSE) is an appropriate and validated tool to assess the influence of nasal obstruction in quality of life in German speaking patients.

Adaption and validation of the nasal obstruction symptom evaluation scale in German language (D-NOSE)

BACKGROUND

Questionnaires have proven their worth in detecting changes in quality of life after medical interventions. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable and valid tool to identify restrictions of quality of life in patients with nasal problems. The aim of this prospective study was the validation of the German version of the NOSE scale (D-NOSE).

METHODS

Adaption of the NOSE in German language was performed by forward and backward translation process. Patients undergoing functional septorhinoplasty were asked to complete the D-NOSE preoperatively, one, three or twelve months after surgery. Healthy volunteers served as controls. Reliability, validity and responsiveness of the D-NOSE were determined.

RESULTS

The D-NOSE showed a good internal consistency as well as good inter-item, item-total correlation and a satisfactory test-retest reliability. The convincing validity of the adapted NOSE scale was approved by good construct validity and an excellent discriminant validity. Furthermore, a high sensitivity to identify clinical changes due to an intervention indicates a good responsiveness of the D-NOSE.

CONCLUSIONS

The adapted German version of the NOSE questionnaire (D-NOSE) is an appropriate and validated tool to assess the influence of nasal obstruction in quality of life in German speaking patients.