The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for Functional and Cosmetic Rhinoplasty

Moubayed SP, Ioannidis JPA, Saltychev M, Most SP.

PubMed 28880988 Publisher (DOI)Free full text (PMC)

What this paper says

The authors developed and validated SCHNOS, a 10-question survey covering both breathing and appearance after rhinoplasty, field tested in 191 patients with excellent internal consistency in both domains.

Overview

Rhinoplasty changes both how the nose works and how it looks, but existing questionnaires measured only one or the other. This study built a single short instrument covering both, through patient and expert interviews, item reduction, and statistical validation, then tested it across five patient groups.

Sections of note

Survey development between October 2016 and April 2017 in a tertiary referral facial plastic surgery clinic.
Development involved 18 patients, 5 male and 13 female, mean age 38 years SD 14.8, plus 5 experts.
Field testing included 191 patients, 67 percent women, mean age 41.5 years SD 15.8.
The final instrument has 10 items in 2 domains: nasal obstruction, the first 4 items, and nasal cosmesis, the last 6.
Cronbach alpha was 0.94 for both domains; factor loadings ranged from 0.74 to 0.92, and each domain was unidimensional.
Scores differed significantly between the five groups, preoperative and postoperative cosmetic, preoperative and postoperative functional, and nonrhinoplasty, P below .001.
The obstruction score correlated very strongly with the NOSE score, r 0.943, while obstruction and cosmesis scores correlated only weakly with each other, r 0.388.

What it means for a patient

Breathing and appearance are largely independent: a nose can work well and still not look how a patient wants, and the reverse.
Ten questions cover both, so results can be compared between surgeons who use the instrument.
Limits: developed and tested at one tertiary center, and the abstract reports no data on whether scores change meaningfully with treatment over time.

Why this paper matters

Comparing rhinoplasty results across surgeons has been hindered by inconsistent measurement. A short validated instrument spanning both domains addresses that directly. Whether SCHNOS detects change reliably in routine practice outside this center is the open question.

Terms

Patient-reported outcome measure: A questionnaire a patient completes about their own symptoms or satisfaction.
Cronbach alpha: A statistic showing how consistently a questionnaire's items measure one thing.
Unidimensional: Measuring a single underlying concept rather than several mixed together.
Factor loading: How strongly an individual question relates to the concept being measured.
NOSE score: The Nasal Obstruction Symptom Evaluation, an established blockage questionnaire.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Rhinoplasty is a common operation in which shape and function are intimately related, whether the procedure is cosmetic, functional, or combined in nature. There is currently no properly developed and validated patient-reported outcome measure (PROM) to evaluate both functional and cosmetic components of rhinoplasty.

Objective: To develop, validate, and field test the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) to evaluate both functional and cosmetic outcomes of rhinoplasty.

Design, Setting, And Participants: Survey development study between October 2016 and April 2017 in a tertiary referral facial plastic and reconstructive surgery clinic. Preoperative and postoperative adult patients undergoing rhinoplasty, whether cosmetic or reconstructive, were included. A fifth group of adult nonrhinoplasty patients (facial cosmetic or reconstructive) were also included for the field test.

Main Outcomes And Measures: Generated and reduced items, psychometric validation measures of the SCHNOS, and differences on scales between groups.

Results: For survey development, a total of 18 patients and 5 experts were interviewed. Of these patients, 5 were male, and 13 were female. Their mean (SD) age was 38 (14.8) years (range, 20-64 years). Field testing included 191 patients (67% were women and the mean [SD] age was 41.5 [15.8] years). A total of 10 items were included after generation, cognitive interviews, and item reduction. The 10 items represent 2 domains: nasal obstruction (first 4 items) and nasal cosmesis (last 6 items). For both domains, Cronbach α was excellent: 0.94 (95% CI, 0.92-0.95) for obstruction and 0.94 (95% CI, 0.93-0.95) for cosmesis. Exploratory factor analysis using scree plots for each domain showed that the domains are unidimensional in nature with each domain evaluating what it is intended to assess (nasal obstruction and cosmesis). The factor loading estimates were high for all the items, varying from 0.74 to 0.92. Kruskal-Wallis testing showed a significance level of P < .001 when evaluating the difference between groups (preoperative cosmetic, postoperative cosmetic, preoperative functional, postoperative functional, and nonrhinoplasty) for all individual questions, composite scores, and Nasal Obstruction Symptom Evaluation (NOSE) score. Correlations between the obstruction composite score and the NOSE scores were r = 0.943 (P < .001), which is very strong. The obstruction and cosmesis composite scores were only weakly correlated (r = 0.388; P < .001).

Conclusions And Relevance: We have developed and validated a new PROM to evaluate both functional and cosmetic rhinoplasty patients. The domains of obstruction and cosmesis were found to be internally consistent and unidimensional. The SCHNOS provides a short, validated questionnaire that we recommend for use in all functional or cosmetic rhinoplasty patients.

Level Of Evidence: N/A.

Abstract as indexed by PubMed; the article is open access (PubMed Central).