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Objective: We recently described the development of the Neck Fibrosis Scale (NFS). In this submission, we confirm domain structure and validate a scoring system for the NFS. Study Design: Prospective cross‐sectional study. Methods: Between January 2020 and December 2021, 127 head and neck cancer patients with varying degrees of cutaneous neck fibrosis completed the original 15 item NFS. Exploratory factor analysis was used to identify optimal groupings with similar underlying factors. The association between the domains of the NFS and various measures of neck morbidity (i.e., construct validity) were assessed using gamma regression. Results: Exploratory factor analysis confirmed 13 of the 15 items from the NFS mapped onto two factors, which were labelled 'physical' and 'emotional' domains. Of the remaining two items, 'energy' did not load uniquely onto one factor and was removed. 'Neck‐swelling' did not load on either factor (loadings <0.3) but was retained within the physical domain based on clinical importance. This resulted in a revised 14‐item questionnaire. Internal consistency for these two domains was high (>0.8, p < 0.01). Both the physical and emotional domains of the revised NFS show strong correlation with the neck dissection impairment index and neck range of motion. The physical domain strongly correlated with neck elasticity (0.902 [95%CI 0.839–0.972], p < 0.01). Patients receiving multimodal therapy had physical domain scores that were 31.6% [95% 13.9–51.8] higher (worse) than unimodal therapy patients. Conclusions: A domain structure and scoring strategy have been developed for the NFS. Future efforts should be directed toward an evaluation of responsiveness. Level of Evidence: NA Laryngoscope, 133:2198–2202, 2023 [ABSTRACT FROM AUTHOR]

BACKGROUND: The objective of this study was to evaluate the utility of a caprine model in endoscopic ear surgical education using the index procedures of tympanoplasty and ossiculoplasty. Specifically, this study assessed the face and content validity of the caprine model, and the potential impact of anatomical differences on trainee understanding of human middle ear anatomy. METHODS: Twelve otolaryngology trainees attended a 3-hour endoscopic ear surgery course utilizing the caprine model in which they completed canalplasty, tympanoplasty, and ossiculoplasty. Prior to the course, the trainees completed a self-reported needs assessment and knowledge assessment of human middle ear anatomy. Following the course, the trainees repeated the knowledge assessment and completed evaluation and validation questionnaires. Five-point Likert scores were used for the needs assessment and validation questionnaire. RESULTS: Of the 12 trainees, 9 participated in the study. All domains of the learner needs assessment showed an average improvement of 1 point on the post-course evaluation with 6 of 9 domains being significantly improved using the Wilcoxon signed-rank test (P< .05). The model achieved validation in the domains of face, content, and global content validity with an average Likert score > 4. Knowledge assessment scores increased by 7% (P=.23) after the course compared to before. CONCLUSION: The caprine model offers an effective surgical simulation model for endoscopic ear surgery training with good face and content validity. We find it to be readily available and affordable. We currently use it routinely to give otolaryngology residents the experience of endoscopic ear surgery before operating on patients. [ABSTRACT FROM AUTHOR]

Objective: Despite increasing recognition of the importance of functional outcomes for patients with head and neck cancer, post‐treatment neck fibrosis remains poorly understood. We sought to develop and validate a patient reported outcome measure for head and neck cancer patients with neck fibrosis. Study Design: Prospective multiphase cross‐sectional study. Methods: To guide instrument development, we employed the World Health Organization International Classification of Functioning, Disability and Health as our conceptual framework. Items were generated using a composite strategy consisting of patient focus groups, literature review, and expert opinion from a multidisciplinary group. Candidate items were reduced through the item impact method. Preliminary psychometric properties of the finalized instrument were evaluated through measures of internal consistency, test–retest reliability, and construct validity. Results: Four in person focus groups were held with 13 head and neck cancer patients. The process of item generation led to 221 relevant citations and 68 unique items. An additional 17 items were identified from review of existing neck disability questionnaires and expert opinion. A draft instrument with 25 candidate items was generated and reduced to its final 15‐item scale using item impact method. Early psychometric testing revealed excellent internal consistency (Cronbach's alpha = 0.95) and test–retest reliability [ICC = 0.95]. Internal consistency at the item level was good (>0.7) for 11/15 individual items. Four separate constructs were evaluated. Three of the four constructs matched our a priori hypotheses. Conclusion: The Neck Fibrosis Scale demonstrates preliminary reliability and validity for discriminate use. Further research is needed to confirm dimensionality and assess responsiveness. Level of Evidence: NA Laryngoscope, 132:1015–1021, 2022 [ABSTRACT FROM AUTHOR]