No abstract availableThe Standardized Cosmesis and Health Nasal Outcomes Survey was developed to measure both nasal obstruction and cosmesis producing two scores: the Standardized Cosmesis and Health Nasal Outcomes Survey–Obstruction and the Standardized Cosmesis and Health Nasal Outcomes Survey–Cosmesis.1 The construct validity of the Standardized Cosmesis and Health Nasal Outcomes Survey, or the degree to which a test measures what it claims to be measuring, has not yet been studied.2–4 The objective of this study was to verify a two-factor theoretical model of the survey using a confirmatory factor analysis.The 350 consecutive patients (40 percent men, aged 38.0 ± 14.1 years) completed the survey during rhinoplasty consultation between June of 2017 and February of 2018. The study was approved by the institutional review board.
The modification indices suggested by the software were used to impute covariances between factors (Fig. 1) one at a time, each time testing the root mean square error of approximation closeness to the value of less than 0.05 and the relative chi-square test closeness to less than 3.0 pointing to an acceptable fit.5 All analyses were conducted using IBM SPSS Amos, Version 25.0 (IBM Corp., Armonk, N.Y.).
The average Obstruction score was 48.3 ± 31.8, and the average Cosmesis score was 33.6 ± 30.6. After adding several covariances (Fig. 1), the root mean square error of approximation was 0.05 and the relative chi-square value was 1.84, showing an acceptable fit (Tables 1 through 3). The covariance between Obstruction and Cosmesis factors was weak (0.14).
The confirmatory factor analysis verified the proposed two-factor structure of the Standardized Cosmesis and Health Nasal Outcomes Survey. All Obstruction items were perfectly correlated with their common factor (Obstruction total score), with the first item explaining greater than 80 percent of the total variance. All Cosmesis items also demonstrated perfect or substantial correlation with their common factor (Cosmesis total score), with especially strong correlations observed for two items (8 and 9).
Confirmatory factor analysis is based on a conceptual model elaborated by the researchers, and thus it is possible that there are other models equally suitable with which to assess the sample. However, this possibility is less probable, as the Standardized Cosmesis and Health Nasal Outcomes Survey was developed with this specific two-factor model in mind. Although the sample was large, it was limited to one university clinic containing predominantly young, female patients.
The covariance between item 5 of the Standardized Cosmesis and Health Nasal Outcomes Survey–Cosmesis with both the Standardized Cosmesis and Health Nasal Outcomes Survey–Cosmesis and –Obstruction common factors had to be imputed before the model become statistically acceptable. This crossover relationship may weaken the ability of the Standardized Cosmesis and Health Nasal Outcomes Survey to assess separately the severity of problems associated “purely” with nasal obstruction or with nasal cosmesis. This phenomenon was not entirely unexpected, as nasal obstruction and cosmesis may both affect a person’s mood and self-esteem.
Very high correlations between items and common factors may imply a redundancy of items, raising a question of whether the Standardized Cosmesis and Health Nasal Outcomes Survey can be used slightly differently when there is a need for a rigorous diagnostic tool compared to the need for only a screening tool for nasal problems. Two items (“having a blocked or obstructed nose” and “how well the nose suits the face”) alone may serve as a quick screening tool to evaluate nasal obstruction or cosmesis, respectively.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Mikhail Saltychev, M.D., Ph.D.
Department of Physical and Rehabilitation Medicine
Turku University Hospital and University of Turku
Turku, Finland
Cherian K. Kandathil, M.D.
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology–Head and Neck Surgery
Stanford University School of Medicine
Stanford, Calif.
Mohamed Abdelwahab, M.D.
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology–Head and Neck Surgery
Stanford University School of Medicine
Stanford, Calif.
Department of Otorhinolaryngology
Mansoura University
Mansoura, Egypt
Emily A. Spataro, M.D.
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology–Head and Neck Surgery
Stanford University School of Medicine
Stanford, Calif.
Sami P. Moubayed, M.D.
Division of Otolaryngology–Head and Neck Surgery
Department of Surgery
Université de Montréal
Montréal, Québec, Canada
Sam P. Most, M.D.
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology–Head and Neck Surgery
Stanford University School of Medicine
Stanford, Calif.
REFERENCES
1. Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg. 2018;20:37–42.
2. Cronbach LJ, Meehl PE. Construct validity in psychological tests. Psychol Bull. 1955;52:281–302.
3. Brown JD. Testing in Language Programs. 1996.Upper Saddle River, NJ: Prentice Hall Regents.
4. Polit D, Beck C. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 2012.9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
5. Carmines EG, McIver JP. Bohrnstedt GW, Borgatta EF. Analyzing models with unobserved variables. In: Social Measurement: Current Issues. 1981:Beverly Hills, Calif: Sage; 65–115.
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