Arabic Validation of the Standardized Cosmesis and Health Nasal Outcome Survey for Arabic-Speaking Rhinoplasty Patients.

Abstract

Sir: The Standardized Cosmesis and Health Nasal Outcomes Survey is a newly developed patient-reported outcome measure with high discrimination abilities evaluating nasal function, cosmesis, and social perception.1,2 The objective we report here was to provide a validated patient-reported outcome measure for assessing nasal obstruction and cosmesis for Arabic-speaking patients. After institutional review board approval in Mansoura University, Faculty of Medicine, patients presenting to the outpatient clinic for cosmetic and/or functional rhinoplasty from February to May of 2018 gave consent to participate in this prospective instrument-validation study. Exclusion criteria included patients younger than 18 years old; patients not understanding Arabic; and patients with congenital facial features, persistent adenoids, sleep apnea, inflammatory, infectious or neoplastic sinus disease, facial/nasal asymmetry, or trauma within the previous 3 months. After following international guidelines for translation and cross-cultural adaptation,3 the Standardized Cosmesis and Health Nasal Outcomes Survey was translated to Arabic and back-translated to create an Arabic version (Fig. 1). Ten patients were enrolled in an evaluation phase to help improve the scale. Then, a test/retest phase included administering the Arabic version of the Standardized Cosmesis and Health Nasal Outcomes Survey after 2 weeks. A healthy reference group was included for validity testing.Fig 1.: Arabic version of the Standardized Cosmesis and Health Nasal Outcomes Survey showing the 10-item scale after translation and cross-cultural adaptation.The Standardized Cosmesis and Health Nasal Outcomes Survey items estimates were reported as medians, ranges, and interquartile ranges. Significance of difference between groups in the Arabic version of the Standardized Cosmesis and Health Nasal Outcomes Survey items estimates was assessed using the Wilcoxon rank sum test. The correlations between the first and second measures were assessed using the Spearman correlation coefficient, estimating the significance of difference between the first and second measures using the Wilcoxon signed rank test. For internal consistency of functional and cosmetic scales, the Cronbach alpha was calculated along with a one-sided (lower) 95 percent confidence limit. All analyses were performed using Stata/IC Statistical Software, release 15 (StataCorp, College Station, Texas). Thirty-seven patients met inclusion criteria; 10 were included in the evaluation phase. Thus, 27 patients, 15 men (56 percent) and 12 women (44 percent), with an age range of 18 to 42 years (mean, 26.7 years), were enrolled in the test/retest phase. The reference group included 27 respondents, 13 men (48 percent) and 14 women (52 percent), with an age range of 23 to 45 years (mean, 30.3 years). The t test did not show a statistically significant difference between the groups’ mean ages (p = 0.054) and sexes (p = 0.30). Internal consistency was good for both scores: 0.86 (lower 95 percent confidence limit, 0.80) for Standardized Cosmesis and Health Nasal Outcomes Survey functional scale items and 0.89 (lower 95 percent confidence limit, 0.85) for Standardized Cosmesis and Health Nasal Outcomes Survey cosmetic scale items. The item scores in the two groups were mostly different. Except for two items belonging to the Standardized Cosmesis and Health Nasal Outcomes Survey functional scale, the test repeatability was also good, with values of p < 0.05, and with high correlations between the two repeated measures (Table 1).Table 1.: Significance of Difference between Groups at First Measure and between Repeated Measures along with Spearman Correlations between Items and Scores (Based on Fisher’s Transformation)As evidence-based medicine is spreading, adoption of a validated patient-reported outcome measure is becoming fundamental.4 In Arabic-speaking countries, diversity of ethnicity among the population (even in one country) undergoing rhinoplasty is extremely high. Arabic is spoken as the native language in more than 15 countries, among nearly 400 million people worldwide, and is the fourth most commonly spoken language.5 Thus, establishing an Arabic-validated patient-reported outcome measure for assessment of various aspects/outcomes of the Middle Eastern rhinoplasty in daily practice and rhinoplasty-related research is necessary. The Arabic version of the Standardized Cosmesis and Health Nasal Outcomes Survey is the first rhinoplasty patient-reported outcome measure in Arabic and is a feasible tool (mean time for completion, 4.5 minutes) for assessing both cosmesis and function, with satisfactory internal consistency, reliability, reproducibility, and validity. DISCLOSURE The authors have no financial interests to declare. Mohamed Abdelwahab, M.D.Division of Facial Plastic and Reconstructive SurgeryDepartment of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanford, Calif.Department of Otolaryngology–Head and Neck SurgeryMansoura University Faculty of MedicineMansoura, Egypt Mikhail Saltychev, M.D., Ph.D.Department of Physical and Rehabilitation MedicineTurku University Hospital and University of TurkuTurku, Finland Noha A. Elkholy, M.D.Hossam Elsisi, M.D.Department of Otolaryngology–Head and Neck SurgeryMansoura University Faculty of MedicineMansoura, Egypt Sami P. Moubayed, M.D.Division of Otolaryngology–Head and Neck SurgeryUniversité de MontréalMontreal, Quebec, Canada Sam P. Most, M.D.Division of Facial Plastic and Reconstructive SurgeryDepartment of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanford, Calif.