Descriptions of rhinosinusitis (RS) patients and evaluation of treatment effectiveness are currently hindered by the lack of a valid measure of health status and quality of life. The RSOM contains 31 RS-specific items (e.g., runny nose, cough, facial pain/pressure), grouped into 7 domains (nasal, eye, sleep, ear, and general symptoms; practical problems, and emotional consequences), and was created from discussions with RS patients. Two categorical rating scales were selected for patients to indicate the Magnitude and Importance of each item. The RSOM score is calculated as the sum of the Magnitude X Importance scores. The goal of this project was to validate the RSOM-31. In 142 patients who completed the RSOM, the average age was 45 and there were 86 women. The average total RSOM score was 5.8 (0.8—15.1 = good—bad). The domains most affected were sleep (7.7), general problems (6.4), nasal (6.3), and emotional (6.2). The RSOM score correlated significantly with an overall global quality of life question (r = 0.36); and the Vitality (r = 0.50), General Health (r = 0.47), Social Functioning (r = 0.46), and Role-Physical (r = 0.41) sub-scales of the Medical Outcomes Study Short-Form 36. The average total RSOM score decreased over time (indicating improvement) and was correlated with the patient's assessment of their response to treatment (F Value 6.49; P < 0.0001). This study demonstrates that the 31-item RSOM is a valid measure of RS health status and quality of life.

Compared with CRSsNP, patients with CRScNP have a greater burden of symptoms, more prior surgery, higher CT scan scores, and greater use of medications.

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Seventy-one cases of adenoid cystic salivary gland carcinoma were reviewed according to treatment modality and clinical course. Thirty-six patients (51%) were treated by combined surgery and radiation therapy. The tumors were classified by their histologic patterns into tubular, cribriform, and solid forms. Distant metastases, in 52%, were the most frequent and ominous sources of failure. In 35% of cases, distant metastases developed despite local control at the primary site. In this group, the disease had a more fulminant course with shorter survival. Histopathologically, the cribriform subtype was associated with multiple local recurrences, greater local aggressiveness, and a poorer salvage rate as compared with the tubular subtype. Late onset of local recurrences and distant metastases was especially associated with the cribriform subtype. Overall prognosis in terms of distant metastases and survival was worst for the solid subtype. Control of local disease is best achieved with combined surgery and radiation therapy. The high incidence of distant metastases may not be affected by this regimen. The ultimate outcome of therapy is poorly predicted. Survival appears to be based on the pattern in which distant metastases develop. Overly aggressive and mutilating surgical approaches for these tumors are not recommended in many instances. The need for the development of new, more effective forms of therapy is emphasized.

The present study was conducted to determine the effects of body position and sleep state, as well as the effect of uvulopalatopharyngoplasty (UPPP) on the regions over which the upper airway (UA) collapses during sleep. To accomplish this goal, 18 male patients with obstructive sleep apnea (OSA) underwent overnight polysomnography with simultaneous monitoring of pressures in the posterior nasopharynx, oropharynx, hypopharynx, and esophagus. From the profile of pressures recorded in the UA and esophagus, the regions over which the UA collapses during apneas could be determined. The patients were 54 +/- 14 y of age and were grossly obese with a body mass index of 37 +/- 2 kg/m2. They had moderately severe OSA with a mean apnea plus hypopnea index of 62 +/- 8 per hour. During NREM sleep, 10 of the 18 (56%) patients had collapse confined to the velopharyngeal or retropalatal segment of the upper airway. The remaining 44% of the patients demonstrated collapse of the retroglossal segment of the oropharynx located caudal to the inferior margin of the soft palate. Upper airway collapse at the level of the hyoid bone was not observed during NREM sleep. Observations made during REM sleep in nine patients demonstrated that collapse occurred in a more caudal segment of the UA in seven patients during REM than during NREM sleep. The effect of sleep position was evaluated in 10 patients and found to have little affect on the extent over which the UA collapsed during sleep independent of sleep state. The effects of UPPP on regional UA collapse were evaluated in a small group of six patients.(ABSTRACT TRUNCATED AT 250 WORDS)