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The SCHNOS Questionnaire: Development, Use, and Recommendations in the Literature
The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a 10-item questionnaire, also termed patient-reported outcome measure (PROM), that is used to assess both functional and cosmetic outcomes after rhinoplasty surgery. It was developed in 2017 by Dr. Sami Moubayed and a team of researchers at Stanford University, and has since become the most widely used PROM for rhinoplasty outcomes. At the time, Dr. Moubayed was pursuing his fellowship in Advanced Facial Plastic and Reconstructive Surgery under the tutelage of Sam Most. For the development of the SCHNOS, Dr. Moubayed won the Sir Harold Delf Gillies Award at the American Academy of Facial Plastic Surgery meeting for one of the best research paper of the year by a fellow.
The SCHNOS questionnaire was developed using a rigorous process that involved patient interviews, cognitive testing, and item reduction. The final 10 items are divided into two domains: nasal obstruction (4 items) and nasal cosmesis (6 items). Each item is rated on a 5-point Likert scale, with higher scores indicating better outcomes.
The SCHNOS questionnaire has been validated in several studies, and has been shown to be reliable, valid, and responsive to change. It is also short and easy to administer, making it a practical tool for use in clinical practice. A 2022 study by Zhu et al. showed that the SCHNOS is the 8th most cited rhinoplasty paper of the past 10 years.https://pubmed.ncbi.nlm.nih.gov/36684203/)
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Use of the SCHNOS questionnaire
The SCHNOS questionnaire can be used in a variety of ways, including:
- To assess patient outcomes before and after rhinoplasty surgery
- To track patient progress over time
- To compare outcomes between different surgical techniques
- To identify patients who may be at risk for complications
- To conduct clinical research
The SCHNOS questionnaire can be administered to patients in person, by phone, or online. It is typically administered preoperatively, 2-3 weeks postoperatively, and 6-12 months postoperatively.
Recommendations for the use of the SCHNOS questionnaire
The SCHNOS questionnaire is a valuable tool for assessing both functional and cosmetic outcomes after rhinoplasty surgery. It is recommended for use in all rhinoplasty patients, regardless of the type of surgery performed.
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Here are some specific recommendations for the use of the SCHNOS questionnaire:
- Administer the SCHNOS questionnaire to all rhinoplasty patients preoperatively, 2-3 weeks postoperatively, and 6-12 months postoperatively.
- Use the SCHNOS questionnaire to track patient progress over time and to identify patients who may be at risk for complications.
- Use the SCHNOS questionnaire to compare outcomes between different surgical techniques and to conduct clinical research.
The American Society of head and neck surgeon practicing in facial plastic surgerys, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned the multidisciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty and the SCHNOS is one of the recommended tools for assessment of rhinoplasty patients.
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The SCHNOS questionnaire has been published in multiple languages
Conclusion
The SCHNOS questionnaire is a well-validated and reliable questionnaire PROM that can be used to assess both functional and cosmetic outcomes after rhinoplasty surgery. It is recommended for use in all rhinoplasty patients.
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