The anterior skull base nasal inventory (ASK nasal inventory): a clinical tool for evaluating rhinological outcomes after endonasal surgery for pituitary and cranial base lesions

Abstract

The goal of this project was to develop a prospectively-validated, site-specific patient quality of life survey for assessing nasal outcomes following endonasal pituitary and skull base surgery. (ClinicalTrials.gov #NCT01322945) An 9-item patient survey (the ASK Nasal Inventory) focusing on the most common postoperative complaints, such as crusting, sinusitis, pain, and ease of breathing, was developed by the anterior skull base team at the Barrow Neurological Institute. Content was validated in structured patient interviews and by four subject matter experts. This survey was self-administered before and 3 months after surgery to 94 patients (52 endonasal surgery and 42 controls) between October 2010 and June 2011. Standard methods for psychometric evaluation were applied. Cronbach's alpha was 0.83 indicating good internal consistency. Test-retest reliability was excellent in both groups (r = 0.87 and 0.95; P < 0.001). Discriminant validity was determined by comparing mean scores at 3 months in the endonasal and control groups and the difference was significant (13.5 vs. 17.2, P = 0.001). Standardized response mean was 0.17 suggesting that the scale was sensitive to clinical change. Concurrent validity was determined by mean ASK Nasal score for each level of self-reported overall functioning at 3 months (P = 0.001). Preliminary psychometric evaluation of the performance of the ASK Nasal Inventory suggests that it meets criteria as a clinical and research instrument in endonasal surgery. This study also suggests modifications to the instrument, which will serve as key quality of life endpoint in an ongoing multicenter nasal outcomes study.

Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12

“…Based on our initial experience with the ASK Nasal-9 18 and by incorporating patient and expert feedback, we went back to the drawing board and rebuilt the tool by expanding the question pool, engaging additional subject matter experts, and modifying its symptom assessment to incorporate severity rather than just frequency. We believe that the iterative process we used to validate the tool adds to its validity as the process allowed for enhancements to be made along the way.…”

“…17,18 There was a strong correlation between mean ASK Nasal-12 score and overall functioning (r = 0.64, 95% CI 0.51-0.74; p < 0.001).…”

“…As the first step, a preliminary 9-item tool was developed. 18 During the validation process of this instrument, we discovered opportunities for enhancements, and therefore initiated the study reported herein to improve the scale. As part of this process, we engaged 4 additional subject matter experts in otolaryngology and neurosurgery, learned from the critiques of reviewers during the formal manuscript review process, conducted patient exit interviews for feedback, and reexamined current literature that had been published since the beginning of this project.…”

“…In this study, we describe the development of the first approach-specific rhinological morbidity instrument for endonasal skull base surgery, the ASK Nasal-12, to complement other multidimensional QOL scales. This research effort used a multistep validation process that included creating a preliminary scale, 18 refining and expanding the instrument based on patient and expert feedback, and completing final validation in a multicenter prospective study.…”

Postoperative Findings in Endoscopic Endonasal Surgery of The Skull Base

“…Until now, the following tests have been applied in English literature; Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QOL-AGHDA) [7], Hypopituitarism Quality of Life Satisfaction (QLS-H) [ [14], or ASK nasal inventory [15]. The handicaps of these tests are that they do not include specific areas about quality of life and cancer, visual defects, hormonal deficiency and sinonasal symptoms.…”