The Rhinoplasty Rosetta Stone: using Rasch analysis to create and validate crosswalks between the NOSE and SCHNOS functional subscale.

BACKGROUND: The NOSE and SCHNOS functional subscale are widely used PROMs to measure functional outcomes of rhinoplasty. However, as different instruments produce scores on different metrics, results of these instruments cannot be linked directly. This hinders comparing and aggregating rhinoplasty outcome data from practices using either instrument. The aim of this study was to develop and validate crosswalks between the NOSE and SCHNOS-O. METHODS: In a sample of 552 rhinoplasty patients who completed both instruments, the NOSE and SCHNOS-O scales were co-calibrated onto a common interval-scaled metric using Rasch analysis. Separate Rasch models were run per instrument and the latent constructs were estimated using the calibrated item parameters. By anchoring original PROM scores of both instruments to this Rasch computed measurement scale, the scores of both instruments were linked. A second independent sample was used to validate the created crosswalks. RESULTS: Total scores on the NOSE and SCHNOS-O were strongly correlated. The Rasch-based co-calibration of the NOSE and SCHNOS-O items resulted in a model that adequately fitted the data. Back-and-forth crosswalk tables were created from the NOSE to the SCHNOS-O. For patients with moderate nasal obstruction, predicted SCHNOS-O scores were slightly higher for a given level of the NOSE. Intraclass correlation coefficients between predicted and actual scores were 0.93 for both directions, indicating adequate agreement for group-level comparisons. CONCLUSION: This study developed and validated Rasch-based crosswalks from the NOSE to the SCHNOS-O and vice-versa. The provided crosswalks enhance comparison and harmonization of functional rhinoplasty outcomes.

The Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery: Are We Screening the Troublesome Patients?

This study aims to clarify the current concept of performing rhinoplasty in patients with possible body dysmorphic disorder (BDD). The primary objective was to investigate the validity and evolution over time of the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) before and after surgery. Together with the BDDQ-AS, also the Nasal Obstruction Symptom Evaluation scale, FACE-Q nose and nostrils, and Utrecht questionnaire (UQ) were used for convergent validation. In this prospective study, 187 patients completed these patient-reported outcome measures at four time points: at the preoperative consultation and postoperatively at 3, 6 and 12 months. The preoperative BDDQ-AS positivity rate was as high as 55.1%. Postoperatively, there was a highly significant decrease in the odds of scoring positive on the BDDQ-AS. At the preoperative consultation, positively screened patients were less satisfied with the esthetics of their noses with worse scores on UQ, FACE-Q nose, and visual analog scale. The preoperative differences in outcome measure ratings disappeared postoperatively, except for the FACE-Q nostrils, which surprisingly showed better values in BDDQ-AS positive patients. Younger age and absence of nasal trauma were statistically significant covariates associated with positive BDDQ-AS screening. Due to the overwhelming decrease in positive BDDQ-AS outcomes after surgery, a positive screening result on the BDDQ-AS should not be interpreted as a formal contraindication for surgery. Collaboration with psychologists or psychiatrists remains crucial to diagnose BDD conclusively.

Comparison in Patient Satisfaction Between Structural Component and Hybrid T-bar Preservation Rhinoplasty: A Retrospective Propensity Score Matched Cohort Study.

BACKGROUND: Recently, a modified dorsal split preservation technique has been described. In this method, the integrity of the elastic keystone area is preserved by separation of the upper lateral cartilages from the septal T-bar. Our study aimed to evaluate the aesthetical and functional outcome in patients treated with the dorsal T-bar preservation versus the 'gold' standard dorsal split component reduction approach. METHODS: We performed a retrospective propensity score matched analysis in 234 patients enrolled for rhinoplasty. The severity of nasal obstruction was measured with the nasal obstruction symptom evaluation questionnaire (NOSE score). Aesthetic evaluation was performed with the FACE-Q nose and nostrils and Utrecht Questionnaire (UQ). Assessments were conducted prior to surgery, at 3 and at 6 months after surgery. After propensity score matching, 172 patients in two cohorts were retained. The following covariates were taken into the statistical calculation: age, gender, ethnicity, previous nasal surgery, nasal trauma, respiratory allergy, and preoperative NOSE scores. The first cohort of 110 patients underwent rhinoplasty with T-bar preservation technique (TDP). The control cohort consisted of 62 patients who underwent dorsal split component reduction (SCR). RESULTS: The mean preoperative scores for FACE-Q nose, FACE-Q nostrils, UQ and VAS score improved significantly in all patients postoperatively. Both techniques had comparable aesthetic outcome measures that remained unchanged between 3 and 6 months postop. Functional outcome as measured by the NOSE score was in favor of SCR at 3 months postop but the difference between both techniques was not significant anymore at 6 months postop. In contrast to SCR, in TDP, only 31% of the patients needed spreader grafts or autospreader flaps at the internal valve area only for functional reasons. CONCLUSION: The data in this study suggest similar patient satisfaction with SCR and TDP techniques for aesthetics as well as nasal function after 6 months postop. TDP is a very versatile cartilage-sparing method to aesthetically adapt the middle vault without interrupting the keystone area. It combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss.

OBJECTIVES: Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results. METHODS: Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included. RESULTS: Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26). CONCLUSIONS: The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.

Multidimensionality of Patient-Reported Outcome Measures in Rhinoplasty Satisfaction.

The FACE-Q rhinoplasty module (nose and nostrils), Utrecht questionnaire, and Nasal Obstruction Symptom Evaluation (NOSE) scale are validated Dutch patient-reported outcome measures (PROMs) to evaluate rhinoplasty satisfaction. The objective of this study was to analyze the dimensionality of the measured variables in these four existing questionnaires. Additionally, we investigated the ability of the PROMS to measure change. A prospective single-center study was performed in a consecutive cohort of 106 Dutch-speaking patients. Patients were invited to fill in four PROMs: FACE-Q rhinoplasty module (nose and nostrils), Utrecht questionnaire, and NOSE scale, preoperatively and 3 months postoperatively. Item quality was calculated in all four questionnaires. The ability of the questionnaires to differentiate between pre- and postoperative patients was determined with a binary logistic regression. Exploratory factor analysis was performed to determine the latent dimensions. Item quality was confirmed in all questionnaires. Backward binary logistic regression revealed that NOSE and FACE-Q nose module were the best discriminant factors pre- and postoperatively. Combination of these two questionnaires gave a specificity of 97.33% and a sensitivity of 94.52% to discriminate between pre- and postoperative cases. Exploratory factor analysis identified the presence of four dimensions: (1) cosmesis of the nose, (2) cosmesis of the nostrils, (3) nasal function, and (4) psychosocial well-being in rhinoplasty patients. Lack of factorial invariance in the preoperative phase, as compared with the postoperative phase, was detected, especially with the FACE-Q nose and to a lesser extent with the Utrecht questionnaire. The FACE-Q rhinoplasty modules (nose and nostrils), the Utrecht questionnaire, and NOSE scale measure different dimensions of rhinoplasty satisfaction and can be used complementary to each other to obtain a more holistic evaluation of rhinoplasty patients. However, the surgeon should keep in mind that lack of factorial invariance preoperative, as opposed to the postoperative phase, may influence the outcome of these questionnaires.

Piezo-assisted Turbinoplasty Versus Partial Turbinectomy in External Septorhinoplasty: A Prospective Comparative Study in 100 Patients.

OBJECTIVES: The purpose of this study was to compare the outcome of the piezo-assisted turbinoplasty with a partial turbinectomy technique in the treatment of chronic nasal obstruction due to inferior turbinate enlargement. STUDY DESIGN: This is a prospective randomized single-center study in a cohort of 100 consecutive patients which underwent external septorhinoplasty and concomitant hybrid type of turbinoplasty. METHODOLOGY: Patients were randomly assigned into two groups. The first group included 50 patients who underwent piezo-assisted outfracturing of the inferior turbinates in combination with bipolar coagulation. The second group included 50 patients who underwent a treatment based on turbinate bipolar coagulation and partial resection of the inferior border of the turbinate. The severity of nasal obstruction was measured in both patient groups with a patient-related outcome questionnaire (NOSE) and objective measures (anterior rhinomanometry and acoustic rhinometry). Assessments were conducted prior to surgery and 3 months after the surgery. RESULTS: There was a significant improvement in the values of the NOSE questionnaire with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry also showed no statistically significant differences between the two study groups. No differences in postoperative healing were found, and postoperative complications were comparable low in both groups. However, the piezo-assisted procedure was quicker to perform with only minimal bleeding. CONCLUSION: During septorhinoplasty, the combination of thermo-coagulation with piezo-assisted turbinoplasty was as efficient as with partial turbinectomy to establish normal nasal breathing. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cross-Cultural Evaluation of the Dutch FACE-Q Rhinoplasty Questionnaires Using Rasch Analysis.

BACKGROUND: The English version of the FACE-Q rhinoplasty module, developed according to Rasch measurement theory, has recently been translated into Dutch. Before conclusions can be drawn from the Dutch version, this translation must also fit the item analysis by the Rasch model. OBJECTIVES: The primary aim of this study was to evaluate cross-cultural equivalence between the Dutch and English versions of the FACE-Q rhinoplasty module by applying Rasch methodology. METHODS: Rasch analysis performed with Winsteps (Beaverton, OR) was used to evaluate the Dutch version of the FACE-Q nose and nostrils scales with data from a prospective consecutive cohort of 100 Dutch-speaking septorhinoplasty patients. New Dutch-related conversion tables were constructed for the FACE-Q nose and nostrils scales and compared to the original ones. Psychometric cross-validation was performed by receiver operating characteristics (ROC) analysis. RESULTS: Both questionnaires adequately met the requirement of invariance. Within an acceptable range, some issues with item and person fit were found, as well as some local item dependency and differential item functioning. However, comparison of the Dutch- and English-related conversion tables by ROC analysis demonstrated identical results for the FACE-Q nose and nostrils scales. CONCLUSIONS: Item analysis by the Rasch model on the data of a Dutch-speaking population proved the conceptual correspondence with the original English version.

Dutch Translation and Validation of the FACE-Q Rhinoplasty Module.

FACE-Q was developed by Klassen et al in 2010 as a validated psychometric evaluation instrument for patients undergoing aesthetic surgery. The aim of this study was to translate, adapt, and validate the FACE-Q rhinoplasty module into a Dutch version of the FACE-Q questionnaire conceptually equivalent to the original English version. "Satisfaction with nose" and "satisfaction with nostrils" questionnaires were used and translated from English into Dutch. The translation process and cross-cultural adaptation were conducted in accordance to the International Society for Pharmacoeconomics and Outcomes Research and World Health Organization guidelines. Psychometric validation was performed prospectively on a patient cohort of 30 patients. Each step in the translation process allowed us to make changes to achieve a conceptual translation equivalent to the original version. Psychometric validation revealed highly significant values for internal consistency, test-retest reliability, and responsiveness. The use of international translation guidelines, with a strict translation-back-translation process, led to a Dutch version of the FACE-Q rhinoplasty module. Statistical validation proved the conceptual correspondence with the original English version. The FACE-Q rhinoplasty module is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction. This tool measures twofold: the degree of success with respect to the patient as well as being an assessment tool for the surgeon. We hope this will provide an additional tool to the clinician evaluating the Dutch-speaking rhinoplasty patient.

Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children.

Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening-Flanders (VIS-Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS-Flanders project aims to set an example for other regions worldwide.

Bimodal Therapy for Chronic Subjective Tinnitus: A Randomized Controlled Trial of EMDR and TRT Versus CBT and TRT.

INTRODUCTION: To date, guidelines recommend the use of a stepped care approach to treat tinnitus. The current clinical management of tinnitus frequently consists of audiologic interventions and tinnitus retraining therapy (TRT) or cognitive behavioral therapy (CBT). Due to the high heterogeneity of the tinnitus population and comorbidity of tinnitus with insomnia, anxiety, and depression, these interventions may not be sufficient for every patient. The current study aims to determine whether a bimodal therapy for chronic, subjective tinnitus consisting of the combination of TRT and eye movement desensitization reprocessing (EMDR) results in a clinically significant different efficacy in comparison with the prevailing bimodal TRT and CBT therapy. METHODS: Patients were randomized in two treatment groups. The experimental group received the bimodal therapy TRT/EMDR and the active control group received the bimodal therapy TRT/CBT. Evaluations took place at baseline (T0), at the end of the treatment (T1), and 3 months after therapy (T2). The tinnitus functional index (TFI) was used as primary outcome measurement. Secondary outcome measurements were the visual analog scale of tinnitus loudness (VASLoudness), tinnitus questionnaire (TQ), hospital anxiety and depression scale (HADS), hyperacusis questionnaire (HQ), global perceived effect (GPE), and psychoacoustic measurements. FINDINGS: The TFI showed clinically significant improvement in both bimodal therapies (mean decrease 15.1 in TRT/CBT; p < 0.001 vs. 16.2 in TRT/EMDR; p < 0.001). The total score on the TQ, HADS, HQ, and VASLoudness all demonstrated significant decrease after treatment and follow-up (p < 0.001) in the experimental and the active control group. GPE-measurements revealed that more than 80% (i.e., 84% in TRT/CBT vs. 80% in TRT/EMDR) of the patients experienced substantial improvement of tinnitus at follow up. Treatment outcome remained stable after 3 month follow-up and no adverse events were observed. CONCLUSION: Both psychotherapeutic protocols result in a clinically significant improvement for patients with chronic subjective tinnitus. No significant different efficacy was found for the TRT/EMDR treatment compared to the combination of TRT and CBT. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03114878. April 14, 2017.