International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Symptoms of rhinosinusitis 129 130 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 987 10.4193/Rhin This issue of our Journal contains a very interesting review from Eccles. Eccles discusses the four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell; and the secondary symptoms, cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue. From the Byzantine time and Hippocrates to recent times definition of nasal disease has been discussed. It is interesting how little we know about the role symptoms of rhinitis and rhinosinusitis play in the diagnosis and evaluation of treatment of the disease. Although a number of guidelines and consensus documents have been developed, there are considerable differences in diagnostic criteria and a lack of an accepted gold standard diagnosis. The term rhinosinusitis is now widely acknowledged and most people accept that rhinitis can occur without sinusitis but sinusitis not or only very seldom without rhinitis.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Mechanisms of the symptoms of rhinosinusitis 131 138 EN R. Eccles Common Cold Centre and Healthcare Clinical Trials, Cardiff School of Biosciences, Cardiff University, United Kingdom 971 10.4193/Rhin The review discusses the physiological and pathophysiological mechanisms associated with the symptoms of acute and chronic rhinosinusitis. An understanding of symptom mechanisms is important for the clinical diagnosis of rhinosinusitis and is important in assessing the efficacy of surgical and medical treatments for rhinosinusitis. The review will discuss the four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell; and the secondary symptoms, cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue. The review will highlight that our understanding of a key diagnostic symptoms facial pain is limited, and that the incidence of pain with rhinosinusitis is controversial. Sneezing is a common symptom of acute rhinosinusitis with allergy but is not normally described as symptom in chronic rhinosinusitis and this anomaly is in need of more research. The mechanism of unilateral nasal obstruction with rhinosinusitis is discussed.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Osteitic bone in recalcitrant chronic rhinosinusitis 139 147 EN W.J.M. Videler Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands C. Georgalas D.J. Menger Department of Otorhinolaryngology-Head and Neck Surgery, Academic Medical Centre (AMC), Amsterdam, the Netherlands N.J.M. Freling C.M. van Drunen W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 981 10.4193/Rhin INTRODUCTION: There is increasing interest in the underlying bone of the paranasal sinuses as an important player in recalcitrant Chronic Rhinosinusitis. Close inspection of CT scans often reveals areas of increased bone density and irregular thickening of the sinus walls. This osteitic bone could at least partly explain, why inflammation of the mucosa persists. METHODS: We searched PubMed for all relevant studies, using the following text words: chronic rhinosinusitis, sinusitis, bone, osteitis, osteomyelitis, histology, and treatment. Cited references of retrieved articles were also examined. RESULTS: Background, available data, potential diagnostic options, treatment implications, and suggestions for future research are discussed. CONCLUSION: Osteitis is associated with CRS, however its role in the pathogenic process is not well defined. More research is needed.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Osteogenic potential of cells derived from nasal septum 148 154 EN E. Torreggiani Department of Biochemistry and Molecular Biology, Section of Molecular Biology, University of Ferrara, Ferrara, Italy C. Bianchini L. Penolazzi E. Lambertini R. Vecchiatini A. Canella R. Gambari E. Magri S. Pelucchi A. Pastore R. Piva 965 10.4193/Rhin BACKGROUND: The research addressed to detect new molecular targets in the development of therapeutic strategies aimed to repair bone tissues. The AIM OF THIS STUDY was to determine the potential osteogenic activity of bone cells from the nasal septum and their use to perform accurate molecular analysis from a single sample. METHODOLOGY: The cells, after nasal septum surgery, were subjected to gene silencing, Reverse Transcriptase - Polymerase Chain reactions, immunocytochemistry and chromatin immunoprecipitation. RESULTS: Cells from the nasal septum can give rise to mature osteoblasts that express osteogenic markers (ALP, Runx2, Slug) and are able to mineralize. We demonstrated that Runx2, a transcription factor critical in early osteospecific differentiation, interacts in vivo with the promoter of the SLUG gene, a marker of osteoblast maturation. CONCLUSIONS: We demonstrated that nasal septum-derived osteoblasts represent an interesting alternative source for bone forming cells, and a promising material to be utilized in bone cellular therapy.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Altered quality of life in Rendu-Osler-Weber disease related to recurrent epistaxis 155 163 EN I. Ingrand Clinical Investigation Center INSERM CIC-P 802, Centre Hospitalier Universitaire, Université de Poitiers, France P. Ingrand B. Gilbert-Dussardier G. Defossez V. Jouhet V. Migeot X. Dufour J.M. Klossek 964 10.4193/Rhin OBJECTIVES: Development and validation of an epistaxis-specific quality-of-life questionnaire (EQQoL) to evaluate the impact on quality of life of epistaxis, during hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Prospective clinical study using QoL instruments administered twice in HHT patients. PATIENTS AND METHODS: In total, 109 patients who had epistaxis and a clinical diagnosis of HHT according to Curaçao criteria were included. Invoice of the questionnaire in 2004 and 2006 included SF-36, Jenkins' sleep scale and the new epistaxis-specific13-item EQQoL. RESULTS: EQQoL uptake rate was 98%, mean score 58/100 ± 27, and Cronbach alpha 0.96. EQQoL was sensitive to change with a strong correlation with the course of epistaxis. Factorial analysis showed that EQQoL was clearly distinct from SF-36 and Jenkins sleep scales. In stepwise multivariate ordinal logistic regression, frequency and duration of epistaxis were both associated with lower EQQoL. Conversely, visceral involvement and comorbidity had independent impact on SF-36 scores, but not on EQQoL. CONCLUSIONS: This new epistaxis-specific EQQoL questionnaire provides complementary information on the impact of HHT on patients quality of life relative to the SF-36 generic questionnaire. After international validation, the EQQoL might prove a useful tool for treatment evaluation.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Psychosocial quality of life in hereditary haemorrhagic telangiectasia patients 164 167 EN M. Loaëc Department of Otolaryngology - Head and Neck Surgery, CHU - Avenue Côte de Nacre, 14033 Caen Cedex, France S. Moriniere M Hitier O. Ferrant H. Plauchu E. Babin 968 10.4193/Rhin OBJECTIVES: The aim of this study was to evaluate psychosocial quality of life (PQoL) in patients with Hereditary Haemorrhagic Telangiectasia (HHT). STUDY DESIGN AND SETTING: A retrospective study was performed on PQoL in HHT patients presenting with epistaxis. One hundred fifteen patients were interviewed using a questionnaire designed by two sociologists and a head and neck surgeon. Changes over time were assessed according to information on psychosocial well-being, social life, family support, occupation, and medical and demographic data regarding age, gender and patient appearance. RESULTS: Analysis of Psychosocial Quality of Life (PQoL) revealed no statistical difference in relation to gender, marital status, household income or place of residence (rural or urban); however, a significant difference was observed with age. Elderly patients had a poorer PQoL than younger patients. Workers had a better PQoL than unemployed patients. Epistaxis and professional duties were correlated: workers with less than one episode of epistaxis per month were more active. Frequent episodes of epistaxis and abundant bleeding decreased PQoL. These patients felt different and often experienced a desire to withdraw compared to others. CONCLUSION: Epistaxis in hereditary haemorrhagic telangiectasia patients was associated with the impairment of many PQoL criteria, together with relationship modifications.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 IKK-2 inhibitor TPCA-1 represses nasal epithelial inflammation in vitro 168 173 EN F. Sachse Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Münster, Germany K. Becker Institute of Medical Microbiology, University Hospital Münster, Germany T.J. Basel Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Münster, Germany D. Weiss Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Münster, Germany C. Rudack Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Münster, Germany 986 10.4193/Rhin BACKGROUND: Nasal polyposis (NP) is considered a subgroup within chronic rhinosinusitis. NP can be further subdivided into aspirin sensitive- and aspirin tolerant types (ASNP/ ATNP). Although the true etiology of NP has not been identified so far, it is agreed that NP represents an inflammatory disease of the nasal mucosa. Alterations of cellular kinase activities including that of IKK-2 might play a role in this inflammatory process. METHODS: Paraffin sections of ASNP, ATNP and controls were immunostained with Phospho-IkB-α antibody that detects the direct IKK-2 product (IkB-α. Intensity of epithelial staining was analysed semi-quantitatively by two independent observers. In cultured nasal polyp epithelial cells (NPECs) epithelial derived cytokines IL-8 and GRO α were induced by TNF-α or Staphylococcal supernatants and subsequently repressed by IKK-2 inhibitor TPCA-1. RESULTS: Significant Phospho-IkB-α staining was observed in the nasal epithelium of ASNP compared to ATNP and controls suggesting strong IKK-2 activation in patients with ASNP in vivo. In vitro, pro-inflammatory cytokines IL-8 and GRO-α in NPECs were significantly repressed by TPCA-1. CONCLUSION: IKK-2 activity is increased in the subgroup of ASNP. IL-8 and GRO-α responses were repressed by IKK-2 inhibitor TPCA-1 in vitro. IKK-2 inhibitors might represent a potential target for anti-inflammatory intervention in ASNP.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Nasal lavage CCL24 levels correlate with eosinophils trafficking and symptoms in chronic sino-nasal eosinophilic inflammation 174 179 EN E. de Corso Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University of Medicine and Surgery, Rome, Italy S. Baroni F. Romitelli L. Luca W. Di Nardo G.C. Passali G. Paludetti 970 10.4193/Rhin OBJECTIVES: The aim of our study was to measure CCL24 (eotaxin-2) levels in nasal lavage fluid of patients with different forms of sinonasal chronic eosinophilic inflammation to verify the relationship with nasal hypereosinophilia and symptoms. METHODS: Patients with nasal hypereosinophilia were randomly recruited and grouped in persistent allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES) and chronic rhinosinusitis with polyps. Non rhinitic volunteers were recruited as controls. CCL24 concentration was measured by 'Quantikine Human CCL24 Immunoassay'. Differential cell counts were performed by microscopic cytological examination of nasal tissue scraped by inferior turbinate. RESULTS: CCL24 levels measured in patient groups were significantly higher compared to control group with the highest levels in NARES patients. Eotaxin- 2 levels were significantly correlated to severity of symptoms and to the percentage of eosinophils in nasal tissue. CONCLUSIONS: We revealed high levels of CCL24 in all patient groups showing a significant correlation with the degree of eosinophilia and clinical symptoms. A prolonged accumulation of CCL24 inside the nasal mucosa may sustain the process of unspecific self-perpetuating eosinophil recruitment pathognomonic of these patients.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 No evidence for a correlation of Glutathione S-Tranferase polymorphisms and chronic rhinosinusitis 180 184 EN K. Fruth Department of Otolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany N. Best M. Amro K. Ingel J. Gosepath W.J. Mann J. Brieger 976 10.4193/Rhin OBJECTIVE: Cellular detoxification mechanisms are mandatory for cellular protection against oxidative stress and reactive oxygen species. One major group of antioxidative active enzymes involved in cellular detoxification are the Glutathione S-Transferases (GST). Multiple subtypes like GSTM1, GSTP1, and GSTT1 and variants of them are known, arising from allelic variations of the GST loci. Moreover, functional variants occur in high percentages and have been associated with diseases like bronchial asthma and bronchial hyperresponsiveness. The interplay of oxidative stress, detoxifying genes like GSTs and the genesis of respiratory tract illness is under contradictory debate. In this study, we analysed the potential association of GST-polymorphisms and chronic rhinosinusitis (CRS). METHODS: In total 170 nasal tissue samples, 49 tissue samples from patients with CRS without nasal polyps, 69 tissue samples from CRS with nasal polyps and 52 healthy tissue controls of the inferior turbinate were analysed for their individual GST-status. Genotypes for GSTM1 (null versus present), GSTT1 (null versus present), and GSTP1 (Ile105Val) were determined by Polymerase Chain Reaction. The respective genotypes were correlated to the incidence of CRS with and without nasal polyps in aspirin-tolerant and intolerant patients and to the individual health status concerning asthma and allergies. RESULTS: No correlation between any GST-polymorphism and CRS with and without nasal polyps or allergies or asthma or aspirin-intolerance was observed. CONCLUSION: Our results do not suggest that there is a relevant genetic predisposition considering the individual GST-status for the susceptibility of nasal respiratory epithelia leading to CRS.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Nasal polyps do not contain olfactory structures 185 189 EN M.F. Bhutta Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom S. Al-Shaikh M. Latif R. Lee J. Uraiby 973 10.4193/Rhin BACKGROUND: Nasal polyposis can lead to olfactory dysfunction, either due to physical obstruction of the olfactory cleft or physiological disruption of the olfactory neuroepithelium. Where medical therapy has failed to relieve symptoms of nasal polyposis, surgical excision can be considered. However, removal of polyps medial to the middle turbinate is controversial: some believe this will relieve physical obstruction to odourants, others state that removal here risks excising olfactory neuroepithelium. METHODS: We stained 25 nasal polypectomy samples from the area medial to the middle turbinate with olfactory marker protein. RESULTS: We confirmed that our staining method worked on normal olfactory tissue. However, no positive staining of nasal polyps was demonstrated. CONCLUSION: We conclude that nasal polyps medial to the middle turbinate do not contain olfactory neurons, and surgical excision is not contraindicated.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Estimating the effect of nasal steroid treatment on repeat polypectomies: survival time analysis using the General Practice Research Database 190 194 EN Y.S. Punekar Schering-Plough Ltd., Hertfordshire, United Kindom A. Ahmad H.A. Saleh 966 10.4193/Rhin BACKGROUND: Intranasal steroids are effective in preventing or delaying recurrence of nasal polyps. However, their effectiveness in delaying a need for repeat polypectomy in clinical practice is unknown. OBJECTIVES: To compare time to a repeat polypectomy between post-polypectomy intranasal steroid users and non-users. METHODOLOGY/PRINCIPLE: Our cohort consisted of patients in GPRD who had undergone at least one nasal polypectomy procedure in or after the year 2000. These patients were followed for up to 4 years and the time to next polypectomy was estimated. Cox's proportional hazards regression was used to estimate the effect of post polypectomy intranasal steroid treatment on time to the next polypectomy after controlling for other respiratory conditions and their treatment. RESULTS: The cohort consisted of 1,675 patients with a mean age of 59 years and 68% males. Of these, 576 patients were post-polypectomy steroid users and 1,099 patients were steroid non-users. The median time to repeat polypectomy was 812 days among the steroid users and 736 days among steroid non-users. Significantly less proportion of intranasal steroid users experienced a repeat polypectomy compared to steroid non-users. This difference was consistent among subgroups of females and concomitant rhinitis treatments users. Patients with post polypectomy intranasal steroid use showed lower risk for a repeat polypectomy compared to steroid non-users. Concomitant rhinitis medication users showed a higher risk whereas other confounders were not significant. CONCLUSIONS: Intranasal steroids were effective in delaying a repeat polypectomy. However, further research using a prospective design is necessary to quantify the benefit of ongoing steroid treatment.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Long terms results of Draf 3 procedure 195 201 EN C. Georgalas F. Hansen Department of Otorhinolaryngology-Head and Neck Surgery, Academic Medical Centre (AMC), Amsterdam, the Netherlands W.J.M. Videler Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 982 10.4193/Rhin OBJECTIVES: To assess the effectiveness and factors associated with restenosis after Draf type III (Endoscopic Modified Lothrop) frontal sinus drainage procedure. DESIGN: Retrospective analysis of prospectively collected data. PATIENTS: A hundred and twenty two consecutive patients undergoing Draf III procedure for recalcitrant chronic frontal rhinosinusitis (CRS) (71%), frontal sinus mucocoele (15%), benign frontal sinus tumours (9%) and cystic fibrosis with severe CRS (5%) were followed up for an average of 33 months. OUTCOME MEASURES: Symptom burden (Visual Analogue Scale and Rhinosinusitis Outcome Measure), patency of neo-ostium and revision surgery. RESULTS: At the end of follow up, ninety percent of patients had a patent neo-ostium, while 88% were either clinically better or completely asymptomatic. Thirty-nine patients required endoscopic revision surgery and 9 eventually underwent frontal sinus obliteration. Sixty percent of revision operations were performed during the first two years. RSOM showed a significant improvement in both general and nasal symptoms while on a VAS, headache improved significantly. The only factor weakly associated with re-stenosis was the presence of allergy. There were no major complications during any of the procedures. CONCLUSION: Draf III Procedure is safe and effective for patients who have failed conventional frontal sinus procedures and a valid alternative to frontal sinus obliteration. Although the revision rate may appear to be quite significant, it can often be performed as an outpatient procedure and needs to be balanced against the reduced morbidity and the ease of follow-up.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Isolated sphenoid inflammatory diseases associated with visual impairment: 15-year experience at a single institution 202 206 EN A. Bizzoni Department of Otorhinolaryngology, University of Brescia, Italy A. Bolzoni Villaret D. Lombardi D. Tomenzoli P. Danzi F. Semeraro D. Farina P. Nicolai 974 10.4193/Rhin We present a retrospective series of 11 patients treated for isolated sphenoid inflammatory disease (ISID) with visual impairment in the period between 1994 and 2008. The series included 7 females and 4 males. All patients, preoperatively assessed by CT or MR, underwent endoscopic sinus surgery and broad-spectrum antibiotic therapy. The procedure was always performed in an emergency setting, with an interval from the onset of visual impairment ranging between 1 and 40 days (mean 9 days). The possibility of recovery was related to both the modality of onset and severity of the deficit. All patients with reduction of the visual field reported significant improvement after surgery. Patients with decreased visual acuity obtained partial or complete resolution, while in patients with preoperative blindness no improvement was observed. Moreover, no postoperative improvement was noticed in the case of severe deficits with sudden onset, whereas the treatment of mild deficits was successful even some weeks after their occurrence. In conclusion, although some factors may predict the likelihood of recovery, any patient with ISID associated with visual impairment should receive immediate medical and surgical treatment. Endoscopic surgery should be considered the technique of choice.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification 207 213 EN A. Dragonetti Unità Operativa Complessa di Otorinolaringoiatria, Ospedale S. Giuseppe, Milano, Italy R. Gera Unità Operativa Complessa di Otorinolaringoiatria, Ospedale S. Giuseppe, Milano, Italy A. Sciuto Dipartimento Testa e Collo Azienda Policlinico Umberto I, Università di Roma 'La Sapienza', Rome, Italy A. Scotti Unità Operativa Complessa di Otorinolaringoiatria, Ospedale S. Giuseppe, Milano, Italy A. Bigoni Unità Operativa Complessa di Otorinolaringoiatria, Ospedale S. Giuseppe, Milano, Italy E. Barbaro Dipartimento Testa e Collo Azienda Policlinico Umberto I, Università di Roma 'La Sapienza', Rome, Italy A. Minni Unità Operativa Complessa di Otorinolaringoiatria, Ospedale S. Giuseppe, Milano, Italy 988 10.4193/Rhin AIM: To suggest a new classification system for sinonasal papilloma based on a critical analysis of surgical indications and results obtained. METHODS: We analysed surgical data from 84 cases of sinonasal papilloma treated endoscopically. RESULTS: In 58 males and 26 females, between 25 and 85 years, the ethmoid sinus (63 cases), the maxillary sinus (43), and the nasal fossa (22) were mostly involved. No case of endocranial extension or carcinoma was reported. Complications were reported in 15.4% of patients, as well as 5 recurrences (5.9%). Median follow up was 39,5 months. To categorise the tumour for the most appropriate surgical treatment, we propose a classification based on 6 main categories that depend on the location, origin and extension of the tumour. CONCLUSION: The classification that we propose presents advantages for prognosis and surgical indication in comparison with other classifications.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Anti-Estrogen Therapy for Hereditary Hemorrhagic Telangiectasia − A Long-Term Clinical Trial 214 216 EN E. Yaniv Nose and Sinus Institute, Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel M. Preis Nose and Sinus Institute, Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel J. Shevro Nose and Sinus Institute, Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel B. Nageris Nose and Sinus Institute, Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel T. Hadar Nose and Sinus Institute, Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 989 10.4193/Rhin STATEMENT OF PROBLEM: Hereditary hemorrhagic telangiectasia (HHT) is associated with recurrent epistaxis in 90% of the cases. Good response to hormone treatment has been documented, although its use remains controversial. The aim of this study was to examine the efficacy of an anti-estrogenic agent, tamoxifen, in the treatment of HHT-associated epistaxis. METHOD OF STUDY: Out of 46 patients with diagnosis of epistaxis due to HHT who started treatment with tamoxifen 20 mg/d, 38 patients completed a mean of 23.4 months of treatment. All patients filled out a self-assessment questionnaire of rhinologic Quality of Life and epistaxis grading scale. MAIN RESULTS: The bleeding score and the Quality of Life score improved. Hemoglobin concentration also improved. None of the patients needed blood transfusions during the treatment period. Only one patient had minor side effects of the drug. PRINCIPAL CONCLUSIONS: Tamoxifen appears to be an effective agent for the treatment of epistaxis due to HHT.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Patient-reported olfactory function following endoscopic sinus surgery with modified endoscopic Lothrop procedure / Draf 3 217 220 EN J.M. Yip Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide and Flinders University, The Queen Elizabeth Hospital, Woodville South, South Australia 5011, Australia K.A. Seiberlin Department of Otolaryngology Head and Neck Surgery, Loma Linda University Medical Center, USA P.-J. Wormald Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide and Flinders University, The Queen Elizabeth Hospital, Woodville South, South Australia 5011, Australia 990 10.4193/Rhin OBJECTIVES/HYPOTHESIS: The Modified Endoscopic Lothrop procedure (MELP) or Draf 3 is a complex procedure, performed for chronic frontal sinusitis that is refractory to standard functional endoscopic sinus surgery. The procedure involves drilling of the frontal T (formed by the septum and middle turbinate's attachment to the skull base) onto the olfactory fossa often with exposure of the first olfactory neuron and may affect olfactory function. This study was performed to assess patients' subjective sense of smell following this procedure. STUDY DESIGN: Prospective study of retrospective data. METHODS: Sixty-eight patients, who underwent modified endoscopic Lothrop by the senior author (PJW) between 2003 and 2008, completed a post-operative questionnaire asking about their perception of olfactory function. All patients had their pre-operative subjective sense of smell documented prior to undergoing surgery. Patient records were reviewed for pertinent medical information such as the presence of asthma, aspirin sensitivity and nasal polyps. RESULTS: This study found that the majority of patients reported improvement in their sense of smell post-operatively, while only a small number reported a negative impact on their smell. Thirty-nine patients reported an improvement in their post-operative smell grade. Twenty patients reported no change in their smell grade, while the remaining 9 patients stated that their sense of smell worsened after surgery. No statistically significant correlation was found between patient outcome and the presence of asthma, nasal polyps, or Samter's triad. CONCLUSIONS: The Modified endoscopic Lothrop procedure/Draf 3 had a positive effect on subjective sense of smell post-operatively in this cohort of patients.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Olfactory bulb volume and olfactory function in patients with multiple sclerosis 221 226 EN O. Goektas Department of Otolaryngology-Head and Neck Surgery, University of Berlin, Charité Campus Mitte, Smell and Taste Consultation Service, Berlin, Germany F. Schmidt G. Bohner K. Erb L. Ludemann B. Dahlslett L. Harms F. Fleiner 972 10.4193/Rhin BACKGROUND: Some studies reported olfactory dysfunction in patients with multiple sclerosis (MS). There is no agreement about the most suitable testing method for measuring olfactory function (OF) in MS patients. Recent studies showed that olfactory bulb volume changes with the degree of olfactory dysfunction. We assessed olfactory bulb volume of MS patients with magnetic resonance imaging (MRI) and related it to the OF. MATERIAL AND METHODS: Volumetric measurements of the right and left olfactory bulb (OB) were performed by manual segmentation within 36 MS patients. Psychophysical testing of the orthonasal OF was performed using threshold-discrimination-identification (TDI) score in MS patients. RESULTS: Of all MS patients, 44.4% displayed olfactory dysfunction. The TDI score of all 36 MS patients, especially the score of the Identification subtest correlated strongly with neurological scores typical of MS. In patients with a decreased OB volume, there was a positive correlation between volumetry of the OB and OF. CONCLUSION: OB volumes may provide valuable information about MS patients with olfactory dysfunction. The TDI test and Identification subtest were very sensitive in detecting olfactory dysfunction in MS patients.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Cross-cultural adaptation and validation of a Quality of Life questionnaire: The Nasal Obstruction Symptom Evaluation questionnaire 227 231 EN T.F.P. Bezerra Department of Otorhinolaryngology and Ophthalmology, School of Medicine, University of São Paulo, Sao Paulo, Brazil F.G.M. Padua R.R.M. Pilan Department of Otorhinolaryngology and Ophthalmology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil M.G. Stewart R.L. Voegels Department of Otorhinolaryngology and Ophthalmology, University of São Paulo, Brazil 967 10.4193/Rhin BACKGROUND: The Nasal Obstruction Symptom Evaluation (NOSE) instrument is a disease-specific questionnaire for assessing the outcome of an intervention in nasal obstruction in trials. This instrument is only available in the English language and cross-culturally valid questionnaires are very important for all research, including nasal obstruction. The aim of the current study was to reproduce the cross-cultural adaptation process for the NOSE questionnaire in the Portuguese language (NOSE-p). METHODOLOGY/PRINCIPAL: Cross-cultural adaptation and validation of the instrument were divided into two stages. Stage 1 involved four bilingual professionals, an expert committee and the author of the original instrument. In Stage 2, the NOSE-p was tested on 33 patients undergoing septoplasty for internal consistency, test-retest reliability, construct validity, discriminant validity, criterion validity, and response sensitivity. RESULTS: The cross-cultural adaptation process was completed and the NOSE-p was demonstrated to be a valid instrument with satisfactory construct validity. It showed an adequate internal consistency reliability and adequate test-retest reliability. It could discriminate between patients with and without nasal obstruction and it has a high response sensitivity to change. CONCLUSIONS: The cross-cultural adaptation and validation process demonstrated to be valid and the NOSE-p proved to be applicable in Brazil.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Effect of CPAP-therapy on bronchial and nasal inflammation in patients affected by obstructive sleep apnea syndrome 232 237 EN D. Lacedonia Institute of Respiratory Diseases, Department of Medical and Occupational Sciences, University of Foggia, Italy F.G. Salerno G.E. Carpagnano R. Sabato A. Depalo M.P. Foschino-Barbaro 977 10.4193/Rhin Background: Obstructive sleep apnea syndrome (OSAS) has been shown to be associated to upper and lower airways inflammation. Continuous positive airway pressure (CPAP) is the elective treatment of OSAS. The aim of the present study was to assess the effect of CPAP-therapy on airway and nasal inflammation. Methods: In 13 non-smoking subjects affected by untreated OSAS and in 11 non-smoking normal volunteers, airway inflammation was detected by analyses of the induced sputum. In the OSAS group measurements were repeated after 1, 10 and 60 days of the appropriate CPAP treatment. In addition, in 12 subjects of the OSAS group, nasal inflammation was detected by the analysis of induced nasal secretions at baseline, and after 1, 10 and 60 days of CPAP treatment. Results: OSAS patients, compared to normal controls, showed at baseline a higher percentage of neutrophils and a lower percentage of macrophages in the induced sputum. One, 10 and 60 days of appropriate CPAP-therapy did not change the cellular profile of the induced sputum. In addition, in the OSAS patients, the high neutrophilic nasal inflammation present under baseline conditions was not significantly modified by CPAP-therapy. Finally, no patients developed airway hyper-responsiveness after CPAP therapy. Conclusions: In OSAS subjects, the appropriate CPAP-therapy, while correcting the oxygen desaturation, does not modify the bronchial and nasal inflammatory profile.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 The significance of rhinomanometry in evaluation of postlaryngectomy olfactory rehabilitation by polite yawning technique 238 242 EN D. Manestar Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre Rijeka, Rijeka, Croatia R. Ticac M. Velepic T. Braut I. Manestar-Donadic K. Manestar G. Malvic R. Starcevic 975 10.4193/Rhin OBJECTIVE: To corroborate the result of postlaryngectomy olfactory rehabilitation evaluating the efficacy of the Polite Yawning Technique (PYT) with rhinomanometry and odours with the Smell diskettes Olfaction test (SDOT). MATERIALS AND METHODS: Thirty-two laryngectomised patients were subjected to olfactory rehabilitation consisting of 15-minute training and independent exercising for two weeks. The sense of smell and nasal airflow in laryngectomised patients were examined before and after implementation of PYT. RESULTS: The differences in SDOT results prior to and after introduction of PYT were statistically significant, most patients achieving better results after rehabilitation. A significant positive correlation was obtained in results of SDOT and rhinomanometry prior to and after introduction of PYT. The results of measurements after rehabilitation showed that 75% of patients had improved nasal breathing, 78% of patients had a better sense of smell and 40% of patients became normosmic. CONCLUSIONS: PYT has proved to be an effective method in olfaction rehabilitation following total laryngectomy. Using rhinomanometry, evaluation of the rehabilitation success is substantiated while the technique is simplified.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Reference values for acoustic rhinometry in children at baseline and after decongestion 243 247 EN L.E. Haavisto Department of Otorhinolaryngology, Turku University Hospital, Turku, Finland T.J. Vahlberg Department of Biostatistics, University of Turku, Turku, Finland J.I. Sipilä Department of Otorhinolaryngology, Turku University Hospital, Turku, Finland 983 10.4193/Rhin BACKGROUND: Acoustic rhinometry is widely used for objective evaluation of nasal dimensions. However, there is a lack of agreement on the normative values in children at baseline, and especially after decongestion. The purpose of this study was to determine the reference values for Finnish school children for acoustic rhinometry in non-decongested and decongested noses, and to find out which of the potential predictors (age, sex, body surface area (BSA) and height) would be the most useful one(s). METHODOLOGY: The study included 124 children aged between 6.90 and 13.84 years with no permanent nasal symptoms. RESULTS: At baseline, the mean total minimal cross-sectional area (MCA) was 0.752 cm2, and the mean total volume between 0 - 3 cm (VOL) was 4.00 cm3. After decongestion, the total MCA was 0.794 cm2, and the VOL was 4.38 cm3. There was a significant correlation between MCA and age, between VOL and height, and between VOL and BSA at baseline and after decongestion. We found no difference in the values between boys and girls. CONCLUSIONS: We conclude that acoustic rhinometry is a suitable objective method to monitor the changes in mucosal swelling and nasal obstruction in children. Age and height or BSA of a child can be suggested as predictive factors.

International Rhinologic Society Rhinology 0300-0729 49 2 2011 6 1 Radiological examinations of the anatomy of the inferior turbinate using Digital Volume Tomography (DVT) 248 252 EN L. Balbach Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg, Germany V. Trinkel Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg, Germany C. Guldner Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg, Germany S. Bien Department of Neuroradiology, UKGM, Marburg, Germany A. Teymoortash Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg, Germany J.A. Werner Department of Otorhinolaryngology, Head and Neck Surgery, UKGM, Marburg, Germany M. Bremke Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Cologne, Germany 985 10.4193/Rhin BACKGROUND: Since the last 120 years there were only few descriptions of the anatomical sizes of the inferior turbinate in the literature. On this background the current study should evaluate the radiological dimensions of the inferior turbinate and the septum using DVT. METHODS: The latest generation of the Accu-I-tomo was used. The data of 100 adult patients have been evaluated. RESULTS: The bony length was found to be 38.9 mm, the mucosal length 51.0 mm. The findings of the total mucosal thickness at different measuring points were between 8.1 mm and 10.9 mm, those of the bony thickness were between 0.9 mm and 2.3 mm and those of the bony height were between 3.9 mm and 20.8 mm. CONCLUSION: The results of this radiological study are able to point out the importance of preoperative anatomical evaluation of radiological images. The preoperative focus on the individual anatomy is very important because of the choice of an adequate surgical treatment. Today new radiological techniques can help to find out whether the reason for hypertrophied turbinates is caused by bone, mucosa or both. This knowledge enables a concerted treatment concept.