Zusammenfassung
Subjektive Lebensqualitätsbewertungen haben als Bestandteil der Bewertung der Ergebnisqualität (Outcome-Analyse) in den letzten Jahrzehnten eine zunehmende Bedeutung erfahren und werden in diesem Zusammenhang als Zielkriterium für den Effektivitätsnachweis klinischer Interventionen eingesetzt. Zur Messung der gesundheitsbezogenen Lebensqualität werden standardisierte Fragebögen eingesetzt, die hinsichtlich Reliabilität, Validität und Sensitivität gestestet sein müssen. Chirurgische Eingriffe an der Nasenscheidewand (Septumplastik) und an der äußeren Nase (Rhinoplastik) werden sehr häufig durchgeführt. Schon seit langem wird auch der subjektiv bewertete Erfolg dieser Maßnahmen in der Literatur berichtet, allerdings erst seit gut einer Dekade mit validierten Lebensqualitäts-Messinstrumenten. Zuvor erfolgten diese Messungen in der Regel über retrospektive Zufriedenheitsbewertungen oder visuelle Analogskalen. Der prospektive Einsatz validierter krankheitsspezifischer und allgemeiner Messinstrumente in zukünftigen Studien muss gefordert werden. Sowohl von Patienten mit Septumplastik als auch von Patienten mit Rhinoplastik werden die Eingriffe in Bezug auf die gesundheitsbezogenen Lebensqualität weit überwiegend als erfolgreich bewertet. Allerdings bewertet auch eine relevante Anzahl von Patienten die Eingriffe als nicht erfolgreich. Lebensqualitäts-Messinstrumente haben in diesem Zusammenhang das Potenzial, neben den objektiv messbaren biologischen Variablen weitergehende Einflussfaktoren auf das Outcome zu identifizieren. Besondere zusätzliche Aufmerksamkeit erfordern – insbesondere bei Rhinoplastik-Patienten – die psychosozialen Effekte des Eingriffs.
Abstract
Quality of Life Before and After Septoplasty and Rhinoplasty
Subjective assessment of quality of life (QOL) as an important aspect of outcomes research has received increasing importance during the past decades. QOL is measured with standardized questionnaires which had been tested with regard to reliability, validity, and sensitivity. Surgical procedures of the nasal septum (septoplasty) and the external nose (rhinoplasty) are frequently performed. Since many years subjectively assessed results of these operations have been reported in the literature. Nevertheless, validated QOL instruments were applied only for one decade. Beforehand, measurements were performed using retrospective assessment of contentment or visual analogue scales. Prospective application of validated disease-specific and general measuring instruments has to be demanded for future studies.Most of the septoplasty patients as well as most of the rhinoplasty patients evaluate the operation being successful. Nevertheless, a relevant number of patients is not satisfied with the result of surgery. In this context, QOL instruments have the potential to identify further factors influencing the outcome. Especially in rhinoplasty patients, special attention has to be drawn on potential psychosocial effects of the operation.
Schlüsselwörter
Validierung - Lebensqualität - nasale Obstruktion - Nasenfunktion
Key words
validation - quality of life - nasal obstruction - nasal function
Literatur
-
1
Carr AJ, Gibson B, Robinson PG.
Is quality of life determined by expectations or experience?.
BMJ.
2001;
322
1240-1243
-
2
Nies C, Celik I, Lorenz W, Koller M, Plaul U, Krack W, Sitter H, Rothmund M.
Outcome nach minimal-invasiver Chirurgie – Qualitative Analyse und Bewertung der klinischen Relevanz von Studienendpunkten durch Patient und Arzt.
Chirurg.
2001;
72
19-29
-
3
Kopp I, Albert US, Lorenz W.
Gesamtergebnis diagnostischer und therapeutischer Maßnahmen in der Medizin (Outcome).
Gynäkologe.
2002;
35
1073-1077
-
4
Kopp I, Müller W, Lorenz W.
Die zentrale Rolle von Outcome in Leitlinien und Disease-Management Programmen.
HNO Informationen.
2003;
28
350-354
-
5
The WHOQOL group..
Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment.
Psychol Med.
1998;
28
551-558
-
6
Browne JP, O’Boyle CA, McGee HM, Joyce CRB, McDonald NJ, O’Malley K, Hiltbrunner B.
Individual quality of life in the healthy elderly.
Qual Life Res.
1994;
3
235-244
-
7 Lawton MP. A multidimensional view of quality of life in frail elders.. Academic Press, San Diego, New York, Boston, London, Sydney, Tokyo, Toronto; 1991
-
8
Maille AR, Kaptein AA, de Haes JC, Everaerd WT.
Assessing quality of life in chronic non-specific lung disease – a review of empirical studies published between 1980 and 1994.
Qual Life Res.
1996;
5
287-301
-
9
Kaasa S, Hjermstad MJ, Jordhov MS, Wisloff F, Loge JH.
Compliance in quality of life data: a Norwegian experience.
Stat Med.
1998;
17
623-632
-
10
Bullinger M.
Erfassung der gesundheitsbezogenen Lebensqualität mit dem SF-36 Health Survey.
Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz.
2000;
43
190-197
-
11 Schipper H, Clinch J, Olweny C. Quality of life studies: definitions and conceptual issues.. In: Spilker B (ed.). Quality of life and pharmacoeconomics in clinical trials. Philadelphia:Lipincott-Raven Publishers; 1996: 11-23
-
12
Schipper H, Levitt M.
Measuring quality of life: risks and benefits.
Cancer Treat Rep.
1985;
69
1115-1125
-
13 Spilker B. Introduction to the field of quality of life trials.. In: Spilker B (ed.). Quality of life and pharmaeconomics in clinical trials. Philadelphia:Lipincott-Raven Publishers; 1996;: 1-10
-
14 Kornblith AB, Holland JC. Handbook of measures for psychological, social, and physical function in cancer.. Volume 1: Quality of life. Memorial Sloan-Kettering Cancer Center, New York; 1994
-
15
Fitzpatrick R, Davey C, Buxton MJ, Jones DR.
Evaluating patient-based outcome measures for use in clinical trials.
Health Technol Assessment.
1998;
2
((14))
-
16
Wilson IB, Cleary PD.
Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes.
JAMA.
1995;
273
59-65
-
17
Hopkins C.
Patient reported outcome measures in Rhinology.
Rhinology.
2009;
47
10-17
-
18
International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use .
ICH harmonized tripartite guidelines. General considerations for clinical trials E8, 17 July 1997.
Internet:
http://www.ich.org/LOB/media/MEDIA484.pdf
-
19
Kirkova J, Davies MP, Walsh D, Tiernan E, O’Leary N, LeGrand SB, Lagman RL, Russell KM.
Cancer symptom assessment instruments: A systematic review.
J Clin Oncol.
2006;
24
1459-1473
-
20
Gesundheitsberichterstattung des Bundes..
Internet:
http://www.gbe-bund.de
-
21
Jessen M, Malm L.
Definition, prevalence and development of nasal obstruction.
Allergy.
1997;
52
((Suppl))
3-6
-
22
Buckland JR, Thomas S, Harries PG.
Can the Sino-nasal Outcome Test (SNOT-22) be used as a reliable outcome measure for successful septal surgery?.
Clin Otolaryngol.
2003;
28
43-47
-
23
Gray LP.
Deviated nasal septum. Incidence and etiology.
Ann Otol Rhinol Laryngol.
1978;
87
((Suppl))
3-20
-
24
Baumann I, Baumann H.
A new classification of septal deviations.
Rhinology.
2007;
45
220-223
-
25
Becker SS, Dobratz EJ, Stowell N, Barker D, Park SS.
Revision septoplasty: review of sources of persistent nasal obstruction.
Am J Rhinol.
2008;
22
440-444
-
26
Singh A, Patel N, Kenyon G, Donaldson G.
Is there objective evidence that septal surgery improves nasal airflow?.
J Laryngol Otol.
2006;
120
916-920
-
27
Pirilä T, Tikanto J.
Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry, and subjective assessment.
Am J Rhinol.
2001;
15
127-133
-
28
Pinkpank A.
Beziehungen zwischen Selbsteinstufung der Nasenatmung, Rhinoskopie und Rhinomanometrie.
HNO.
1986;
34
194-197
-
29
Naito K, Cole P, Chaban R, Oprysk D.
Nasal resistance, sensation of obstruction and rhinoscopic findings compared.
Am J Rhinol.
1988;
2
65-69
-
30
Courtiss EH, Goldwyn RM.
The effects of nasal surgery on airflow.
Plast Reconstr Surg.
1983;
72
9-19
-
31
Sipilä J, Suonpää J.
A prospective study using rhinomanometry and patient clinical satisfaction to determine if objective measurements of nasal airway resistance can improve the quality of septoplasty.
Eur Arch Otorhinolaryngol.
1997;
254
387-390
-
32
Broms P, Jonson B, Malm L.
Rhinomanometry. IV. A pre- and postoperative evaluation in functional septoplasty.
Acta Otolaryngol.
1982;
94
523-529
-
33
Farmer SEJ, Eccles R.
Chronic inferior turbinate enlargement and the implications for surgical intervention.
Rhinology.
2006;
44
234-238
-
34
Harrill WC, Pillsbury III HC, McGuirt WF, Stewart MG.
Radiofrequency turbinate reduction: a NOSE evaluation.
Laryngoscope.
2007;
117
1912-1919
-
35
Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT.
and the NOSE study investigators. Outcomes after nasal septoplasty: Results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study.
Otolaryngol Head Neck Surg.
2004;
130
283-290
-
36
Lin HC, Lin PW, Su CY, Chang HW.
Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy.
Laryngoscope.
2003;
113
673-678
-
37
Porter MW, Hales NW, Nease CJ, Krempl GA.
Long-term results of inferior turbinate hypertrophy with radiofrequency treatment: a new standard of care?.
Laryngoscope.
2006;
116
554-557
-
38
Rhee CS, Kim DY, Won TB. et al .
Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate.
Laryngoscope.
2001;
111
153-158
-
39
Coste A, Yona L, Blumen M. et al .
Radiofrequency is a safe and effective treatment of turbinate hypertrophy.
Laryngoscope.
2001;
111
894-899
-
40
Wittkopf M, Wittkopf J, Russel Ries W.
The diagnosis and treatment of nasal valve collaps.
Curr Opin Otolaryngol Head Neck Surg.
2008;
16
10-13
-
41
Becker SS, Dobratz EJ, Stowell N, Barker D, Park SS.
Revision septoplasty: review of sources of persistent nasal obstruction.
Am J Rhinol.
2008;
22
440-444
-
42
André RF, Vuyk HD.
Nasal valve surgery: our experience with the valve suspension technique.
Rhinology.
2008;
46
66-69
-
43
Kantas I, Balatsouras DG, Vafiadis M, Apostolidou MT, Korres S, Danielidis V.
Management of inner nasal valve insufficiency.
J Otolaryngol Head Neck Surg.
2008;
37
212-218
-
44
Rhee JS, Book DT, Burzynski M, Smith TL.
Quality of life assessment in nasal airway obstruction.
Laryngoscope.
2003;
113
1118-1122
-
45
Rhee JS, Poetker DM, Smith TL, Bustillo A, Burzynski M, Davies RE.
Nasal valve surgery improves disease-specific quality of life.
Laryngoscope.
2005;
115
437-440
-
46
Charlson ME, Pompei P, Ales KL, MacKenzie CR.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
J Chronic Dis.
1987;
40
373-383
-
47
Gliklich RE, Hilinski JM.
Longitudinal sensitivity of generic and specific health measures in chronic sinusitis.
Qual Life Res.
1995;
4
27-32
-
48
Becker DG.
Sinusitis.
J Long Term Eff Med Implants.
2003;
13
175-194
-
49
Ware JE, Sherbourne CD.
The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection.
Med Care.
1992;
30
473-483
-
50
Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R.
Quality of life measurement: bibliographic study of patient assessed health outcome measures.
BMJ.
2002;
324
1417-1422
-
51
Bullinger M, Kirchberger I.
SF-36. Handanweisung zum Fragebogen.
Hogrefe, Göttingen.
1998;
-
52
Siegel NS, Gliklich RE, Taghizadeh F, Chang Y. et al .
Outcomes of septoplasty.
Otolaryngol Head Neck Surg.
2000;
112
228-232
-
53
Arunchalam PS, Kitcher E, Gray J, Wilson JA.
Nasal septum surgery: evaluation of symptomatic and general health outcomes.
Clin Otolaryngol.
2001;
26
367-370
-
54
Busaba NY, Hossain M.
Clinical outcome of septoplasty and inferior turbinate reduction in the geriatric veterans’ population.
Am J Rhinol.
2004;
18
343-347
-
55
Bhattacharyya N.
Symptom and disease severity differences between nasal septal deviation and chronic rhinosinusitis.
Otolaryngol Head Neck Surg.
2005;
133
173-177
-
56
Baumann I, Blumenstock G, Praetorius M, Sittel C, Piccirillo JF, Plinkert PK.
Krankheitsspezifische und allgemeine gesundheitsbezogene Lebensqualität bei Patienten mit chronischer Rhinosinusitis.
HNO.
2006;
54
544-549
-
57
Metson RB, Gliklich RE.
Clinical outcomes in patients with chronic sinusitis.
Laryngoscope.
110 Suppl
2000;
94
24-28
-
58
Konstantinidis I, Triaridis S, Triaridis A, Karagiannidis K, Kontzoglou G.
Long term results following nasal septal surgery.
Focus on patients’ satisfaction. Auris Nasus Larynx.
2005;
32
369-374
-
59
Baumann I, Blumenstock G Klingmann C, Praetorius M, Plinkert PK.
Subjektive Nutzenbewertung 1 Jahr nach funktioneller endonasaler Nasennebenhöhlenoperation bei Patienten mit chronischer Rhinosinusitis.
HNO.
2007;
55
858-861
-
60
Newton JR, Shakeel M, Ram B.
Evaluation of endoscopic sinus surgery by Glasgow benefit inventory.
J Laryngol Otol.
2008;
122
357-360
-
61
Bohlin L, Dahlqvist A.
Nasal airway resistance and complications following functional septoplasty. A ten-year follow-up study.
Rhinology.
1994;
32
195-197
-
62
Samad I, Stevens HE, Maloney A.
The efficacy of nasal septal surgery.
J Otolaryngol.
1992;
21
88-91
-
63
Denholm SW, Sim DW, Sanderson RJ, Mountain RE, Marais J, Maran AG.
Otolaryngological indicator operations: one year's experience.
J R Coll Surg Edinb.
1993;
38
1-3
-
64
Sherman AH.
A study of nasal airway function in the postoperative period of nasal surgery.
Laryngoscope.
1977;
87
299-303
-
65
Stocksted P.
Long-term results, following plastic septum surgery.
Rhinology.
1969;
7
53-61
-
66
Jessen M, Ivarsson A, Malm L.
Nasal airway resistance and symptoms after functional septoplasty: comparison of findings at 9 months and 9 years.
Clin Otolaryngol Allied Sci.
1989;
14
231-234
-
67
Dinis PB, Haider H.
Septoplasty: Long-term evaluation of results.
Am J Otolaryngol.
2002;
23
85-90
-
68
Bothra R, Mathur NN.
Comparative evaluation of conventional versus endoscopic septoplasty for limited septal deviation and spur.
J Laryngol Otol.
2008;
DOI: doi:10.1017/S0022215108004192
-
69
Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT.
Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.
Otolaryngol Head Neck Surg.
2004;
130
157-163
-
70
Most SP.
Anterior septal reconstruction. Outcomes after a modified extracorporeal septoplasty technique.
Arch Facial Plast Surg.
2006;
8
202-207
-
71
Alsarraf R, Larrabee Jr WF, Anderson S, Murakami CS, Johnson CM.
Measuring cosmetic facial plastic outcomes. A pilot study.
Arch Facial Plast Surg.
2001;
3
198-201
-
72
Hern J, Hamann J, Tostevin P, Rowe-Jones J, Hinton A.
Assessing psychological morbidity in patients with nasal deformity using the CORE questionnaire.
Clin Otolaryngol.
2002;
27
359-364
-
73
Most SP, Alsarraf R, Larrabee WF.
Outcomes of facial cosmetic procedures.
Facial Plast Surg.
2002;
18
119-124
-
74
Toriumi DM, Josen J, Weinberger M, Tardy Jr ME.
Use of alar batten grafts for correction of nasal valve collaps.
Arch Otolaryngol Head Neck Surg.
1997;
123
802-808
-
75
Guyuron B, Bokhari F.
Patient satisfaction following rhinoplasty.
Aest Plast Surg.
1996;
20
153-157
-
76
Constantinides MS, Adamson PA, Cole P.
The long-term effects of open cosmetic septorhinoplasty on nasal air flow.
Arch Otolaryngol Head Neck Surg.
1996;
122
41-45
-
77
McKee GJ, O’Neill G, Roberts C, Lesser TH.
Nasal airflow after septorhinoplasty.
Clin Otolaryngol Allied Sci.
1994;
19
254-257
-
78
Dziewulski P, Dujon D, Spyriounis P. et al .
A retrospective analysis of the results of 218 consecutive rhinoplasties.
Br J Plast Surg.
1995;
48
451-454
-
79
Alsarraf R.
Outcomes instruments in facial plastic surgery.
Facial Plast Surg.
2002;
18
77-86
-
80
Klassen A, Jenkinson C, Fitzpatrick R, Goddacre T.
Patients’ health related quality of life before and after aesthetic surgery.
Br J Plast Surg.
1996;
49
433-438
-
81
Cole RP, Shakespeare V, Shakespeare P, Hobby JAE.
Measuring outcome in low-priority plastic surgery patients using quality of life indices.
Br J Plast Surg.
1994;
47
117-121
-
82
Robinson K, Gatehouse S, Browning GG.
Measuring patient benefit from otorhinolaryngological surgery and therapy.
Ann Otol Rhinol Laryngol.
1996;
105
415-422
-
83
Stewart EJ, Robinson K, Wilson JA.
Assessing of patient's benefit from rhinoplasty.
Rhinology.
1996;
34
57-59
-
84
Slator R.
Rhinoplasty patients revisited.
Br J Plast Surg.
1993;
46
327-331
-
85
Most SP.
Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument.
Arch Facial Plast Surg.
2006;
8
306-309
-
86
Hellings PW, Nolst Trenite GJ.
Long-term patient satisfaction after revision rhinoplasty.
Laryngoscope.
2007;
117
985-989
-
87
Timmerman AA, Anteunis LJ, Meesters CM.
Response-shift bias and parent-reported quality of life in children with otitis media.
Arch Otolaryngol Head Neck Surg.
2003;
129
987-991
-
88
Meningaud JP, Lantieri L, Bertrand JC.
Rhinoplasty: An outcome research.
Plast Reconstr Surg.
2008;
121
251-257
-
89
Jerome L.
Body dysmorphic disorder: a controlled study of patients requesting cosmetic rhinoplasty.
Am J Psychiatry.
1992;
149
577-578
-
90
Thomas CS, Goldberg DP.
Appearance, body image and distress in facial dysmorphophobia.
Acta Psychiatr Scand.
1995;
92
231-236
-
91
Castle DJ, Honigman RJ, Phillips KA.
Does cosmetic surgery improve psychosocial wellbeing?.
Med J Aust.
2002;
176
601-604
-
92
Ercolani M, Baldoro B, Rossi N, Trombini E, Trombini G.
Short-term outcome of rhinoplasty for medical or cosmetic indication.
J Psychosom Res.
1999;
47
277-281
-
93
Ercolani M, Baldoro B, Rossi N, Trombini G.
Five-year follow-up of cosmetic rhinoplasty.
J Psychosom Res.
1999;
47
283-286
-
94
Dinis PB, Dinis M, Gomes A.
Psychosocial consequences of nasal aesthetic and functional surgery: a controlled prospective study in an ENT setting.
Rhinology.
1998;
36
32-36
-
95
Phillips KA, Dufresne RG.
Body Dismorphic Disorder. A guide for dermatologists and cosmetic surgeons.
Am J Clin Dermatol.
2000;
1
235-243
-
96
Veale D, De Haro L, Lambrou C.
Cosmetic rhinoplasty in body dysmorphic disorder.
Br J Plast Surg.
2003;
56
546-551
Korrespondenzadresse
Prof. Dr. med. Ingo Baumann
Universitäts-HNO-Klinik
Im Neuenheimer Feld 400
69120 Heidelberg
eMail: ingo.baumann@med.uni-heidelberg.de
