Development and Reliability Testing of the Sinonasal Assessment of Reepithelialization, a Novel Wound Healing Scale to Assess Postoperative Healing

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Abstract
Background: Sinus and skull base surgery create areas of demucosalized bone and cartilage in the sinonasal cavity, yet no standardized system exists to describe the progressive healing of these wounds. The goal of this study was to develop the novel Sinonasal Assessment of Reepithelialization (SNARE) and perform parametric testing including inter‐rater and intra‐rater reliability analyses. Methods: Using a modified Delphi method, an 11‐member expert panel comprising 10 rhinologists and one PhD otolaryngology research scientist developed a four‐stage wound healing scale over three iterative rounds, with consensus set at 80%. Consensus scale was as follows: Stage 0: Fully remucosalized; Stage 1: Mostly remucosalized; Stage 2: Extensive healing (granulation) tissue, minimal remucosalization; Stage 3: Minimal healing (granulation) tissue. Fifty‐nine postoperative videos of nasoseptal flap (NSF) harvest sites were reviewed by 14 blinded, fellowship‐trained rhinologists to assess inter‐rater reliability—12 of whom repeated the evaluation after 1 month to assess intra‐rater reliability. Results: Inter‐rater reliability for individual raters was good (intraclass correlation coefficient (ICC)(A,1) = 0.763, Round 1; 0.761, Round 2). Intra‐rater ICC(A,1) values ranged from 0.653 to 0.938 (mean = 0.83), indicating moderate reliability for one reviewer and good‐to‐excellent repeatability for the remainder. Conclusion: The SNARE is a reliable, endoscopically based staging system with good‐to‐excellent inter‐ and intra‐rater reliability for describing remucosalization of sinonasal wounds following sinus and skull base surgery. It provides a reliability‐tested metric for future studies evaluating the effects of postoperative interventions on sinonasal wound healing.

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