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Background  Sinonasal adenocarcinoma (SNAC) is a rare malignancy arising from mucus-secreting glandular tissue. Limited large-scale studies are available due to its rarity. We evaluated SNAC in the National Cancer Database (NCDB), a source that affords multi-institutional, population studies of rare cancers and their outcomes. Methods  The NCDB was queried for adenocarcinoma in the sinonasal tract. Multivariate analyses were performed to evaluate for factors contributing to overall survival (OS). Results  A total of 553 patients were identified. The cohort was composed of 59.3% males. The nasal cavity was the most common primary site, representing 44.1% of cases. About 5.7% of patients presented with nodal disease, while 3.3% had distant metastases. About 40.6% of cases presented with stage IV disease. About 73.5% of patients underwent surgery, 54.2% received radiation therapy, and 27.7% had chemotherapy. Median OS was 71.7 months, while OS at 1, 2, and 5 years was 82, 73.0, and 52%, respectively. On multivariate analysis, advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02-1.05), Charlson-Deyo score of 1 (HR: 1.99; 95% CI: 1.20-3.30), advanced tumor grade (HR: 2.73; 95% CI: 1.39-5.34), and advanced tumor stage (HR: 2.71; 95% CI: 1.33-5.50) were associated with worse OS, whereas surgery (HR: 0.34; 95% CI: 0.20-0.60) and radiation therapy (HR: 0.55; 95% CI: 0.33-0.91), but not chemotherapy (HR: 1.16; 95% CI: 0.66-2.05), predicted improved OS. Conclusions  SNAC is a rare malignancy with 5-year survival approximating 50%. Surgery and radiation therapy, but not chemotherapy, are associated with improved survival, and likely play a critical role in the interdisciplinary management of SNAC.

Objective: Acute exacerbations of chronic rhinosinusitis (AECRS) are currently defined as a transient worsening of symptoms that return to baseline. This definition is narrow and can only be made retrospectively. The literature has studied this phenomenon from the physician perspective, yet a key stakeholder's—the patient's perspective is not well elucidated in the literature. To understand AECRS from the patient's perspective, we performed this study to further clarify this phenomenon. Study Design: Basic qualitative study via patient interviews using constant comparative methodology was conducted. Setting: Tertiary care academic center. Methods: Two of the authors served as coders, and via group discussion, a common codebook was created and used to identify recurrent themes. The themes were analyzed for meaning and conclusions were summarized. Results: Ten interviews were conducted with chronic rhinosinusitis (CRS) patients. Recurring themes included the following: (1) patients identify with the term flare or sinus infection more than exacerbation; (2) consistent with the current definition, patients identify AECRS by worsening sinonasal symptoms but also relate secondary symptoms, including poor sleep, fatigue, exacerbation of lower respiratory tract symptoms, and malaise to AECRS; and (3) patients are greatly affected by AECRS via decreased quality of life (QOL), worsening of general health, and decreasing productivity. Conclusion: Beyond worsening of sinonasal symptoms, the concept of AECRS reflects a more complex construct to patients with associated extranasal symptoms and systemic manifestations. In addition, AECRS have a large impact on patients, and therefore, understanding this component of CRS is pivotal in improving disease control and QOL in this patient population. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: As a cardinal symptom of chronic rhinosinusitis (CRS), hyposmia has been recommended to be assessed as a component of CRS disease control. Herein we determine the significance of hyposmia in CRS in the context of nasal obstruction and drainage symptoms. Study Design: Prospective, cross‐sectional Methods: Cross‐sectional study of 308 CRS patients (102 CRSwNP, 206 CRSsNP) without prior endoscopic sinus surgery. The burden of nasal obstruction and hyposmia were assessed using the corresponding item scores on the 22‐item Sinonasal Outcome Test (SNOT‐22). Burden of nasal discharge was assessed using the mean of "thick nasal discharge" and "thick post‐nasal discharge" SNOT‐22 item scores. Patients were all asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," or "completely." Results: In CRSwNP, only 4.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. In CRSsNP, only 1.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. On univariate association, CRS symptom control was significantly associated with nasal obstruction, hyposmia, and drainage in both CRSwNP and CRSsNP (P <.05 in all cases). Using multivariable regression to account for all nasal symptoms, only nasal obstruction and nasal discharge scores (but not hyposmia) were significantly associated with CRS symptom control. Conclusions: Hyposmia rarely occurs without nasal obstruction or nasal drainage, and may therefore be redundant to assess for CRS disease control. Moreover, hyposmia was not associated with patient‐reported CRS symptom control when accounting for the burden of nasal obstruction and drainage. Level of Evidence: 3 Laryngoscope, 131:E2116–E2120, 2021 [ABSTRACT FROM AUTHOR]