Evaluation of Measurement Properties of Patient-Reported Outcome Measures After Rhinoplasty: A Systematic Review

van Zijl FVWJ, Mokkink LB, Haagsma JA, Datema FR.

What this paper says

Appraising 33 studies covering 12 rhinoplasty questionnaires against consensus standards, the NOSE scale was selected as the best instrument for breathing outcomes, with FACE-Q and the SCHNOS aesthetic subscale recommended for further study.

Overview

The number of rhinoplasty outcome questionnaires has grown quickly, and they vary in quality, which makes results from different studies hard to combine. This systematic review graded each instrument's measurement properties using an established international standard.

Sections of note

Systematic search of Embase, Medline and Web of Science from inception to May 18, 2018.
33 articles were included, evaluating instruments measuring nasal breathing symptoms or satisfaction with nasal appearance after septoplasty or rhinoplasty.
Measurement properties were graded using COSMIN guidelines for systematic reviews of patient-reported outcome measures.
The 33 studies used 12 different measurement instruments.
High-quality studies on measurement properties were described as scarce.
The NOSE scale showed high-quality evidence for sufficient structural validity, internal consistency, reliability, construct validity and responsiveness, plus favorable interpretability and feasibility, and was selected as most suitable for functional outcome.
Among aesthetic instruments, FACE-Q and the SCHNOS aesthetic subscale are recommended for further study; the authors state content validity studies are particularly needed.

What it means for a patient

Breathing outcome measurement has one well-validated instrument, the NOSE scale.
Appearance outcome measurement does not yet have an equivalent; two candidates need more work.
Twelve instruments in use across 33 studies is why results from different surgeons often cannot be compared.
Limits: this appraises the instruments, not the surgical outcomes they measure, and the underlying validation studies are described as scarce and of mixed quality.

Why this paper matters

Comparing rhinoplasty results across surgeons and techniques depends on everyone measuring the same way with a validated tool. This applies a rigorous international standard to identify which tools qualify. The aesthetic side of rhinoplasty still lacks a fully validated instrument.

Terms

Patient-reported outcome measure: A questionnaire a patient completes about their own condition.
COSMIN: An international standard for judging the quality of health measurement instruments.
Construct validity: Whether an instrument relates to other measures as theory predicts.
Responsiveness: Whether an instrument detects real change over time.
Content validity: Whether an instrument's questions cover what matters to patients.

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

From the abstract

“The number of available rhinoplasty outcome measurement instruments has increased rapidly over the past years. A large heterogeneity of instruments of different quality now exists, causing difficulty in pooling and comparing outcome data. Objective: To critically appraise, summarize, and compare the measurement…”

Excerpt; the full abstract is on PubMed.