Assessment of the Validity of the Sinonasal Outcomes Test‐22 in Pituitary Surgery: A Multicenter Prospective Trial

Abstract

Objectives/Hypothesis: Sinonasal Outcomes Test-22 (SNOT-22) is used widely as a patient-reported sinonasal qualityof-life (QOL) instrument for endoscopic endonasal pituitary surgery. However, it has never been validated in this population. This study explores the psychometric validity of SNOT-22 to determine if it is a valid scale in patients undergoing endoscopic pituitary surgery.Study Design: Multicenter prospective trial. Methods: Adult patients (n = 113) with pituitary tumors undergoing endoscopic surgery were enrolled in a multicenter study. Patient-reported QOL was assessed using SNOT-22 and the Anterior Skull Base Nasal Inventory-12. Face validity, internal consistency, responsiveness to clinical change, test-retest reliability, and concurrent validity were determined using standard statistical methods.Results: Internal consistency using Cronbach's alpha at baseline and 2 weeks postoperatively were 0.911 and 0.922, indicating SNOT-22 performed well as a single construct. Mean QOL scores were significantly worse at 2 weeks than baseline (16.4 AE 15.1 vs. 23.1 AE 16.4, P < .001), indicating the scale is responsive to clinical change. However, only 11/22 items demonstrated significant changes in mean scores at 2 weeks. Correlation between scores at 2 and 3 weeks was high, suggesting good test-retest reliability, r(107) = 0.75, P < .001. Factor analysis suggests the five-factor solution proposed for the SNOT-22 in rhinosinusitis patients is not valid in pituitary surgery patients.Conclusions: The SNOT-22 is a valid QOL instrument in patients undergoing endoscopic pituitary surgery. However, because it includes 22 items, can be applied only as a single construct, 50% of the items do not demonstrate changes after surgery, and is not as sensitive to change as other scales, shorter instruments developed specifically for this patient population may be preferable.

Skull Base Registries: A Roadmap

“…At the dawn of the microsurgical era, skull base surgeons focused on building the fundamentals: anatomy, approaches and techniques. As experience accumulated over the ensuing decades, attention was directed to the indications and goals of surgery -in particular, balancing aggressive treatment with functional preservation, with an increased emphasis on patient-centered quality of life including vision, olfaction, hearing and cranial nerve function [1][2][3][4] . While this has often led to better outcomes, hospitals, payors and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs.…”

“…As experience accumulated over the ensuing decades, attention was directed to the indications and goals of surgery, particularly balancing aggressive treatment with functional preservation, with an increased emphasis on patient-centered quality of life including vision, olfaction, hearing, and cranial nerve function. [1][2][3][4] While this has often led to better outcomes, hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed, as they have the most intimate knowledge of clinical behavior.…”

Prospective evaluation of multidimensional health‐related quality of life after endoscopic endonasal surgery for pituitary adenomas using the endoscopic endonasal sinus and skull base surgery questionnaire

“…4,7 Other frequently used disease-specific instruments to evaluate the effect of EES on HRQoL do not capture all relevant HRQoL domains, do not assess nasal morbidity, or are not validated for EES or pituitary adenomas. 8,9 Our research group developed and validated the endoscopic endonasal sinus and skull base surgery questionnaire (EES-Q) to assess HRQoL after EES. 8,10 It is a reliable and comprehensive instrument including physical, social and psychological domains.…”

“…HRQoL should be evaluated in physical, psychological and social domains 4,7 . Other frequently used disease‐specific instruments to evaluate the effect of EES on HRQoL do not capture all relevant HRQoL domains, do not assess nasal morbidity, or are not validated for EES or pituitary adenomas 8,9 …”

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

“…As experience of EEA with these benign tumors has increased and surgeons have advanced on the learning curve, some groups have begun to advocate for an increased focus on minimizing sinonasal morbidity and improving long-term patient QOL. [11][12][13][14][15] In this very recent and rapidly evolving area of EEA investigation, a variety of initiatives have been described including preservation of turbinates, minimizing the morbidity of reconstructive techniques, development of alternative minimally invasive EEA corridors, and more accurately measuring QOL following EEA. Thus, the purpose of this contemporary review is to highlight recent efforts focused on minimizing sinonasal morbidity following EEA and to describe a variety of techniques that can be considered in this effort.…”