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January 3, 2019

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

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
  • 2Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
  • 3Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
JAMA Facial Plast Surg. Published online January 3, 2019. doi:10.1001/jamafacial.2018.1639
Key Points

Question  What are the most suitable patient-reported outcome measures to measure functional and aesthetic outcome following rhinoplasty?

Findings  Using consensus-based methodology, this systematic review of 33 articles evaluated measurement properties of 12 different measurement instruments that measure outcomes after rhinoplasty: the NOSE scale (Nasal Obstruction Symptom Evaluation) was found to be the most suitable functional outcome instrument currently available. While FACE-Q and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) aesthetic subscale are promising aesthetic outcome instruments, further study is recommended.

Meaning  These evidence-based recommendations may contribute to uniformity and standardization in rhinoplasty outcome evaluations.


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.