Psychometric Validation of the Youth Quality of Life-Facial Differences Questionnaire in Patients following Ear Reconstruction with Rib Cartilage in Microtia

Sir:FigureMicrotia repair with rib cartilage leads to superior aesthetic results.1 Several surgeons have reported increased quality of life using polyethylene implants.2 More attention has been paid to the psychosocial situations of patients with microtia using validated psychometric instruments.2,3 In particular, disease-related quality-of-life tools offer the opportunity to recognize specific everyday problems of patients with facial deformities in a standardized manner. Because adolescents represent the most relevant age group and because age dependency is well known in the psychosocial context,4 the age aspect requires consideration. The Youth Quality of Life-Facial Differences questionnaire is a validated instrument that focuses on head and neck deformities and concentrates on adolescents,5 and is available in English and Spanish. Our study aimed to establish a linguistic German translation according to the Youth Quality of Life-Facial Differences questionnaire guidelines and to assess psychometric test criteria. A forward translation was established by two German native speakers. After clarifying different interpretations, a backward translation was performed by a bilingual English native speaker who had not read the original version. In a third step, six German adolescents with different congenital conditions in the head and neck area filled out the questionnaire and responded regarding misleading wordings. Suggestions were approved by the Youth Quality of Life-Facial Differences questionnaire test authors for the final version. Next, 50 patients with congenital ear deformities who had undergone ear reconstruction with rib cartilage within the past 3 years were included (median age, 16.0 years; range, 10 to 20 years; balanced sex ratio). To minimize surgical bias and exclude minor results of the primary learning curve, all patients underwent reconstruction performed by the same experienced surgeon (R.M.) (Fig. 1). The Munich Quality of Life Questionnaire for Children to evaluate convergent validity and the Depression Inventory for Children and Adolescents to evaluate the discriminant validity were sent out to these patients.Fig. 1: (Above) Preoperative views of an 11-year-old boy with lobule-type microtia. (Below) Views of postoperative result after two surgical stages.Among the evaluated patients, 82 percent replied that the new auricles belong to their bodies. The thoracic scar was judged as absolutely acceptable by 79 percent of the patients in relation to the new auricle. The analysis of the five subdomains of the Youth Quality of Life-Facial Differences questionnaire showed no sex dependency and no correlation with age. Three subdomains of the Youth Quality of Life-Facial Differences questionnaire correlated highly with the Munich Quality of Life Questionnaire for Children (Table 1), indicating good convergent validity between the two instruments for measuring health-related quality of life in adolescents. In the German version of the Children's Depression Inventory, the Depression Inventory for Children and Adolescents, test values above 18 points implicate clinically relevant depressive symptoms. There were significant differences regarding the evaluation of patients with scores above 18 points in three subdomains of the Youth Quality of Life-Facial Differences questionnaire (Table 1), which shows discriminant validity.Table 1: Evaluation for Convergent Validity between the Youth Quality of Life-Facial Differences Questionnaire and the Munich Quality of Life Questionnaire for Children Quality-of-Life Tests and for Discriminative Validity in the Depression Inventory for Children and AdolescentsBecause of its practicability, considering age-specific aspects and the everyday relevance of its items for microtia patients in comparison with other quality-of-life tools,2–4 the Youth Quality of Life-Facial Differences questionnaire can be regarded as suitable for everyday work with patients with microtia. Because of the rarity of and the need for international outcome studies, research on different surgical reconstruction techniques requires common instruments such as the Youth Quality of Life-Facial Differences questionnaire that are adapted to specific cultural contexts. Armin Steffen, M.D. Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany Ralph Magritz, M.D. Department of Otolaryngorhinolaryngology, Prosper-Hospital, Recklinghausen, Germany Henning Frenzel, M.D. Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany Todd Edwards, Ph.D. Seattle Quality of Life Group, University of Washington, Seattle, Wash. Ralf Siegert, M.D., M.D.D. Department of Otolaryngorhinolaryngology, Prosper-Hospital, Recklinghausen, Germany ACKNOWLEDGMENTS The authors thank Drs. Kathrin Steffen, Anne Brüggemann, and Tim Lu for their excellent work in the translation process of the Youth Quality of Life-Facial Differences questionnaire. They thank Mrs. Peters for her help in collecting the questionnaires. They especially express their gratitude to Prof. Dr. Inke König for statistical advice and for helping to bring out new aspects by rethinking their report. DISCLOSURE The authors declare that they have no financial interests associated with this work. There was no external funding. PATIENT CONSENT Parents or guardians provided written consent for use of the patient's images.