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Objectives/Hypothesis: Research surrounding outcome differences for patients with recurrent acute rhinosinusitis (RARS) is scarce. This investigation explored quality of life (QOL) and sinonasal attributes in patients during acute episodes (AEs) and in‐between AEs of RARS. Study Design: Retrospective outcomes research. Methods: Data from patients with RARS were collected from two academic institutions between 2009 and 2017 using prospective and retrospective methodology. During clinical presentation, subjects were classified as with or without an AEs using guideline definitions of acute bacterial rhinosinusitis (ABRS). Between‐group differences in 22‐item Sino‐Nasal Outcome Test (SNOT‐22) survey and Lund‐Kennedy (LK) endoscopy scores were assessed. Results: Four hundred twenty‐three clinical visits from 202 patients were included. Visits during an AE (168/423, 40%) were associated with significantly worse SNOT‐22 total scores compared to between AEs (255/423, 60%; median = 53.0 [interquartile range (IQR) = 24.0] vs. 34.0 [IQR = 29.5]) and all SNOT‐22 subdomain scores (all P <.001). LK scores were available for 167 visits, with 56 (34%) completed during an AE. Compared to visits without an AE, endoscopy findings associated with an AE were less frequently normal (LK score = 0, 45% vs. 62%, P =.031) with worse median LK scores (2.0 [IQR = 4.0] vs. 0.0 [IQR = 2.0], P =.005). Conclusions: AEs are associated with significantly worse QOL and mildly worse endoscopic findings. Almost half of visits during AEs had negative endoscopy, identifying a disparity between patient symptoms and objective findings and calling into question alternative or concomitant diagnoses. Diagnostic criteria for ABRS or AEs in RARS do not require objective confirmation of inflammation, presenting a conundrum for clinicians. The potential for overdiagnosis of ABRS and AEs should be considered when determining the risk/benefit ratio of treatments for RARS. Level of Evidence: 2c Laryngoscope, 2019 [ABSTRACT FROM AUTHOR]

Background: Frontal sinus trephination is traditionally performed through a small cutaneous incision and osteotomy, allowing irrigation of the frontal sinus. Utilizing the trephination osteotomy for endoscopic visualization and surgical manipulation requires a larger opening. This "mega‐trephination" is thought to carry an increased risk of cosmetic deformity given the increased bony removal at the anterior table. The purpose of our study was to clarify the risks of frontal sinus mega‐trephination and examine how this technique is incorporated into a modern, tertiary care rhinology practice. Methods: Patients were identified through billing records and confirmed by retrospective chart review. All patients underwent frontal sinus mega‐trephination, which is defined as an osteotomy large enough for insertion of a 4‐mm endoscope and an operative instrument simultaneously. All patients had at least 2 years of follow‐up. The primary outcome was complication rate, including cosmetic deformity. Results: Sixty‐four patients underwent frontal sinus mega‐trephination from 2006 to 2016. The most common surgical indications were chronic sinusitis (34%), mucocele (19%), osteoma (17%), acute sinusitis (11%), and inverting papilloma (9%). Ten patients (16%) underwent mega‐trephination alone, whereas the others had mega‐trephination with endoscopic sinus surgery. Twenty‐one patients (33%) had minor complications. The most common complications were self‐limited paresthesia (11%), infection (8%), and epistaxis (3%). No patient complained of permanent cosmetic deformity or required revision surgery for cosmesis. Conclusion: Frontal sinus mega‐trephination is a useful tool to augment the rhinologist's armamentarium in complex frontal sinus anatomy and pathology. This procedure is well tolerated, safe, and not associated with long‐term cosmetic deformity. [ABSTRACT FROM AUTHOR]