International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 You can never have too much of a good thing 257 258 EN V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. 1016 10.4193/Rhin This 'extraordinary' issue highlights as ever, the wide spectrum of rhinology from anatomy and physiology to basic and clinical research through a wide range of pathologies including allergy, inflammation, infection and neoplasia.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 The nose, snoring and obstructive sleep apnoea 259 263 EN B. Kotecha Royal National Throat, Nose & Ear Hospital, London, United Kingdom 969 10.4193/Rhin Snoring and obstructive sleep apnoea are both due to multilevel anatomical obstruction, and the nose and nasal pathology both contribute in many cases. This paper addresses some of the issues surrounding the problem and briefly discusses the role of medication and nasal dilators and in more detail the implication of nasal surgery in various aspects of sleep related breathing disorders (SRBD). Nasal obstruction leads to mouth breathing, which destabilises the upper airway and aggravates SRBD.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 A survey on the management of acute rhinosinusitis among Asian physicians 264 271 EN D.Y. Wang R.S. Wardani K. Singh S. Thanaviratananich G. Vicente G. Xu M.R. Zia A. Gulati S.Y. Fang L. Shi Y.H. Chan D. Price V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. J. Mullol W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 995 10.4193/Rhin BACKGROUND: Based on the 'European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)', this study aimed to investigate general practitioners (GPs) and other specialists' understanding when managing patients with acute rhinosinusitis (ARS) in Asia. METHODOLOGY: Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan. RESULTS: ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS. CONCLUSION: ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Therapeutic Index (TIX) for intranasal corticosteroids in the treatment of allergic rhinitis 272 280 EN T. Schafer Practice for Dermatology and Allergy, Immenstadt, Germany M. Schnoor M. Wagenmann L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany C. Bachert 1000 10.4193/Rhin BACKGROUND: Intranasal corticosteroids (INS) are the first line treatment for allergic rhinitis (AR). To guide clinical decision-making, we created a therapeutic index (TIX) for INS reflecting efficacy and safety. METHODS: A Medline search (1966 to June 2009) was carried out to identify all placebo-controlled randomized trials, and observational reports for safety issues, with Dexamethasone, Budesonide (BUD), Fluticasone propionate (FP), Fluticasone furoate (FF), Flunisolide, Mometasone furoate (MF), Triamcinolone (TRIAM), and Beclomethasone dipropionate (BDP) as treatment for AR. Data on three efficacy (nasal symptoms, ocular symptoms, global assessment) and three safety outcomes (epistaxis, growth, systemic ocular effects) were extracted. Meta analyses were performed for each INS and outcome and results were categorised into scores by quartiles. Scores of the three efficacy and safety outcomes were summed up to create summation scores for efficacy (ES) and side effects (AES), respectively with a maximum of 9 points. The TIX was then defined as the ratio of ES and AES. RESULTS: Data of 84 studies were extracted. Based on availability of data, a TIX was calculated for 6 substances. BUD showed the highest efficacy score followed by MF and TRIAM. The lowest scores for side effects were achieved by MF and TRIAM followed by FP. These findings resulted in TIX scores of 7 and 5 for MF and TRIAM, respectively, indicating a high efficacy and low potential of adverse events. Medium scores were reached by BUD and FP and lower scores by BDP and FF. CONCLUSION: Although safety and efficacy is proven for all available INS by multiple studies, the systematic aggregation and analysis of data allows for a differentiated summary on clinically important features.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Study of microbial spread when using multiple-use nasal anaesthetic spray 281 285 EN M. Rashid Department of Otolaryngology, Tameside Hospital, Ashton-under-Lyne, United Kingdom Y.G. Karagama Department of Otolaryngology, Tameside Hospital, Ashton-under-Lyne, United Kingdom 1008 10.4193/Rhin BACKGROUND: Current economic constraints have led to the emergence of reusable anaesthetic sprays with replacement nozzles (Xylocaine) as an alternative to disposable anaesthetic solutions (Co-phenylcaine) for rhinological procedures. The former costs 213.84€ per year vers12,047.69€ for the latter, at equivocal doses. However, research regarding the sterility of such instruments is limited. The aim of this in vitro study was to determine whether bottles of Xylocaine could pose a risk of cross-infection to patients. METHODS: Two techniques were used. The first was to introduce nozzles into methylene blue and fluorescein dyes, and then analysing the anaesthetic solutions using spectrophotometry for assessment of colour change indicating retrograde contamination. The second method involved spraying Xylocaine into cultures of Staphylococcus aureus with concurrent nozzle changes. This was repeated over a 36-day-period. Sterility checks were performed on the Xylocaine before and after inoculation into the culture. RESULTS: None of the anaesthetic solutions showed the presence of dyed saline following spectrophotometric analysis. No S. aureus was isolated from any of the 30 spray bottles cultures over the 36-day trial period. CONCLUSION: It was demonstrated that using the Xylocaine spray with disposable nozzles for each patient should not pose a cross infection risk to patients.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Nasally inhaled pulsating aerosols: lung, sinus and nose deposition 286 291 EN W. Möller Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany G.K. Saba Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany K. Häussinger Department of Pulmonary Medicine, Asklepios Fachkliniken München-Gauting, Gauting, Germany S. Becker Department of Otolaryngology, Head and Neck Surgery, Großhadern Medical Centre, Ludwigs Maximilians University München, München, Germany M. Keller Pari Pharma GmbH, Gräfelfing, Germany U. Schuschnig Pari Pharma GmbH, Gräfelfing, Germany 1009 10.4193/Rhin OBJECTIVES: Topical delivery of drugs to the sinuses is challenging and requires also particular administration manoeuvres from the patient. This study was conducted to investigate 1) the delivery efficiency of a pulsating aerosol (Vibrent prototype device) to the sinuses and the nose, 2) the aerosol fraction that will deposit in the lungs and 3) potential differences regarding sinus and nasal deposition ratio when comparing aerosol administration during two different administration routes. METHODS: An open label deposition study in healthy volunteers was conducted using 99mTc-DTPA radiolabeled pulsating aerosols in comparison to nasal pump sprays. Deposition and retention of pulsating aerosols was assessed by gamma camera imaging during spontaneous nasal breathing and during closed soft palate administration. RESULTS: Aerosol administration during nasal breathing vs. application with closed soft plate results in significant lung, nasal and sinus deposition. No significant differences were observed for nasal clearance. In comparison, drug delivery using nasal pump sprays resulted in non-significant sinus, 100 % nasal and non-significant lung deposition. The clearance kinetics after nasal pump spray delivery was significantly accelerated. DISCUSSION: The standard application mode of pulsation aerosols with closed soft palate results in negligible lung deposition and therefore limits drug delivery to the nasal cavity only, minimizing unwanted side effects. Administration during spontaneous nasal breathing shows only 10% lung deposition, which is tolerable during drug administration. Relevant paranasal sinus deposition is noted during both application modes and clearance kinetics remains essentially unchanged. In contrast, nasal pump sprays do not show sinus drug delivery and nasal drug residence time is shortened. CONCLUSION: Pulsating aerosols offer advantageous topical nasal and sinus drug delivery options.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Visual analogue scale assessment of nasal obstruction might define patients candidates to spirometry 292 296 EN G. Ciprandi Department of Internal Medicine, San Martino Hospital, Genoa, Italy M.A. Tosca A. Signori I. Cirillo 996 10.4193/Rhin BACKGROUND: Asthma may be frequently associated with allergic rhinitis. Bronchial obstruction is a characteristic of asthma and spirometry is a cardinal step in asthma diagnosis. However, spirometry is rarely suitable in medical office. Visual Analogue Scales (VAS) is frequently used in common practice. OBJECTIVE: This study aimed at evaluating the suitability of the use of VAS assessment of nasal obstruction to define patients with allergic rhinitis candidates for spirometry. METHODS: 1728 patients with allergic rhinitis were consecutively evaluated. Clinical examination, skin prick test, VAS assessment, and spirometry were performed in all patients. RESULTS: 7.9% of patients had impaired FEV1 values and 24.5% had impaired FEF25-75 values. A VAS value < 3.3 might identify with good reliability patients with impaired FEF25-75 values, such as having initial bronchial airflow limitation. CONCLUSIONS: This study, performed in a large cohort of subjects, highlights the close link between upper and lower airways and shows the possible suitability of the use of nasal obstruction VAS assessment to define patients with allergic rhinitis candidates for spirometry.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 The value of bilateral simultaneous nasal spirometry in the assessment of patients undergoing septoplasty 297 303 EN G. Fyrmpas 1st Academic Department of Otolaryngology Head & Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece D. Kyrmizakis Department of Otolaryngology, District General Hospital of Veria, Asomaton, 59100 Veria, Greece V. Vital 1st Academic Department of Otolaryngology Head & Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece J. Constantinidis 2nd Academic ORL Dept, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece 993 10.4193/Rhin PROBLEM: There is no consensus regarding the best approach to select patients for septoplasty. Patient dissatisfaction after septoplasty implies that clinical examination alone is inadequate to detect a clinically relevant nasal septal deviation (NSD). Objective testing provides an in-depth analysis of nasal obstruction and its underlying anatomic causes but it is effort consuming, requires training and it is not widely available. AIM: We studied the role of bilateral simultaneous nasal spirometry (BSNS) in the preoperative selection of patients for septoplasty. PATIENTS, SUBJECTS AND METHODS: Thirty patients with nasal obstruction and NSD were assessed by subjective measures and BSNS before and after septoplasty. The decongested nasal partitioning ratio (NPR) was used as a measure of the degree of NSD. Thirty healthy controls were recruited for providing a normal range of NPR values. RESULTS: All patients were subjectively improved after septoplasty but only those with NPR out of the normal limits had a significant reduction of NPR. Patients with unilateral symptoms and NPR beyond normal limits were also able to identify the more obstructed side preoperatively. For this group of patients, physicians were able to identify the convex side of NSD preoperatively. No correlation between subjective measures of nasal obstruction or airflow asymmetry and NPR was observed. CONCLUSION: BSNS is a rapid, easily interpretable, noninvasive technique, which identifies patients with large NSDs who, irrespective of concomitant mucosal factors of nasal obstruction, warrant septoplasty. BSNS is not applicable in cases with a septal perforation or an S type septal deviation, it cannot detect an insufficient nasal valve and it does not substitute rhinomanometry or acoustic rhinometry.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Reference values for peak nasal inspiratory flow in children and adolescents in Brazil 304 308 EN C. da Cunha Ibiapina Department of Pediaetrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil C. Ribeiro de Andrade Department of Pediaetrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil P.A. Moreira Camargos Department of Pediatrics, Pediatric Pulmonology Unit, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil C. Gonçalves Alvim Department of Pediatrics, Pediatric Pulmonology Unit, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil A. Augusto Cruz ProAR, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil 999 10.4193/Rhin STATEMENT OF THE PROBLEM: Allergic rhinitis is a global public health issue. Peak nasal inspiratory flow (PNIF) can help in the assessment of patients with allergic rhinitis. However, reference values in the literature for PNIF in school children and adolescents are limited. THE AIM OF THIS STUDY was to identify reference values of PNIF among children and adolescents. METHODS: We conducted a cross-sectional study to identify reference values of PNIF among healthy school children and adolescents aged from eight to fifteen years old, selected from 14 randomly selected public schools. Participants performed measurements of PNIF using the In-check-inspiratory flow meter (Clement Clarke, Harlow, England). PNIF values were correlated to gender, age, height, weight and body mass index. RESULTS: A total of 526 subjects participated in the study. The final linear regression model for PNIF allowed obtaining the following equation for subjects aged from eight to 15 years old: PNIF (l/m) = height (centimeters) x 0.7 + 11.2, for boys and PNIF (l/m) = height (centimeters) x 0.7, for girls. CONCLUSION: the equations of the final regression model resulted in a simple formula to obtain reference values of PNIF for subjects aged from 8 to 15 years old.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Characteristics and Risk Factors of Mucosal Cysts in the Paranasal Sinuses 309 314 EN I.J. Moon Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea J.E. Lee Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea S.T. Kim Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea D.H. Han Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea C.S. Rhee Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea C.H. Lee Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Y.G. Min Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea 994 10.4193/Rhin BACKGROUND: Though mucosal cysts in the paranasal sinuses (PSMCs) are common findings on radiographic images, the nature of PSMCs and risk factors for the development of PSMCs have not yet been determined. The aim of this study was to evaluate the characteristics of PSMCs using brain magnetic resonance (MR) imaging. METHODOLOGY/PRINCIPAL: A total of 6831 subjects who underwent health checkup including brain MR imaging were included in this study. The characteristics of PSMCs, including their location, number and size, as well as the presence of obstruction of the sinus ostium and sinusitis, were analysed using brain MR images. Structured questionnaires and medical records were reviewed to evaluate the smoking status and comorbid medical conditions. RESULTS: The overall prevalence of PSMCs was 7.4% and was significantly higher in females than in males. PSMCs were most commonly found in the maxillary sinus, most of which were located unilaterally as a solitary cyst. Large cysts were associated with obstruction of the sinus ostium and subsequent sinusitis. Smoking was a single important risk factor for developing PSMCs. No significant associations were found between symptoms (nasal/respiratory) and the presence of PSMCs. CONCLUSIONS: The prevalence of PSMCs was 7.4% and decreased with age. Large cysts may lead to obstruction of the sinus and subsequent sinusitis. Smoking was an important risk factor for PSMCs, and the total amount of smoking correlated with cyst size. Most subjects were asymptomatic, and specific treatment was not performed.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Spontaneous silent sinus syndrome (Imploding antrum syndrome): case series of 16 patients 315 317 EN H. Babar-Craig Royal National Throat Nose and Ear Hospital, London, United Kingdom. H. Kayhanian Royal National Throat Nose and Ear Hospital, London, United Kingdom. D.J. De Silva Orbital Unit, Moorfields Eye Hospital, London EC1V 2PD, United Kingdom G.E. Rose Orbital Unit, Moorfields Eye Hospital, London EC1V 2PD, United Kingdom V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. 1004 10.4193/Rhin INTRODUCTION: Silent sinus syndrome (SSS) is a rare idiopathic collapse of the maxillary sinus and orbital floor. We present the second largest series of sixteen patients with SSS and describe their management. METHODS: A cohort of 16 patients with spontaneous SSS between 1999 and 2009 were reviewed at the Royal National Throat Nose and Ear Hospital. All patients were initially referred from a postgraduate ophthalmic hospital, Moorfields Hospital. RESULTS: Fourteen patients required endoscopic sinus surgery to re-establish maxillary sinus drainage and the remaining two settled with intranasal medical therapy consisting of steroids and decongestions. Follow- up ranged from 6 months to 4 years with a mean of 2.6 years. An improvement in enophthalmos and was seen in all surgically treated patients with a mean improvement of 2.2mm and range 0.5-4mm. DISCUSSION: SSS arises from congestion of the ostiomeatal complex resulting in negative pressure within the maxillary sinus and a gradual implosion of the antral cavity. Endoscopic sinus surgery successfully re-establishes maxillary aeration in our series and leads to clinical and aesthetic improvement in the degree of enophthalmos and has avoided the need for orbital floor repair in all but two cases.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Allergic fungal rhinosinusitis - a new staging system 318 323 EN C.M. Philpott A.R. Javer A. Clark 992 10.4193/Rhin BACKGROUND: The existing Kupferberg post-operative endoscopic staging system for allergic fungal rhinosinusitis (AFRS) has 4 stages (0-3) based on the 'global' appearance of one side of the nose. Patients may however show visual improvement and yet remain at the same stage due to persistence in one sinus cavity, thus making the staging system ineffective. The aim of this study was to validate a new system that allows greater sensitivity in characterising the inflammation seen endoscopically. METHODOLOGY: A series of endoscopy videos of 50 patients with AFRS were retrospectively staged using a new ten-grade system, scoring each sinus cavity (maxillary, ethmoid, frontal and sphenoid) from 0-9 for increasing mucosal oedema and 1 point for the presence of fungal mucin giving a maximum score of 40 for each side of the nose. To assess reliability, 4 independent rhinologists were also asked to score the videos using the new system. RESULTS: A greater variety in the spectrum of mucosal disease was demonstrated with the new system allowing for a more descriptive analysis of its severity and its response, or lack of, to treatment. The inter-class correlation between the 6 total observers was 0.86 (95% CI: 0.83, 0.92). CONCLUSION: Use of the new staging system provides a more sensitive tool for following patients' progress post-operatively in allergic fungal rhinosinusitis and in determining their response to treatment.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Gustatory and olfactory dysfunction in older adults: a national probability study 324 330 EN S. Boesveldt Monell Chemical Senses Center, Philadelphia, PA, USA and Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands S.T. Lindau M.K. McClintock T. Hummel J.N. Lundstrom 991 10.4193/Rhin BACKGROUND: Olfactory and gustatory functions have not been well characterized in older adults in the US. Consequently, their relationships to sociodemographic characteristics, as well as physical and mental health, were studied in a large national probability sample using brief validated tests of chemosensory function. METHODS: A five-odour identification test and taste-impregnated strips of filter paper (sweet, sour, bitter, and salty) assessed the ability to identify chemosensory stimuli. RESULTS: Severe gustatory dysfunction was more prevalent than severe olfactory dysfunction. Age, education and sex were independently associated with performance on both the olfactory and gustatory identification tasks. Higher scores were associated with female sex, higher level of education, and lower age. Odour identification scores exhibited a positive, albeit weak, correlation with BMI, and food-related odours were better identified than non-food odours. In addition, odour identification performance was also negatively associated with depressive symptoms. CONCLUSIONS: These data demonstrate a high prevalence of severe gustatory and, to a somewhat lesser extent, olfactory dysfunction in a population-based sample and demonstrate that even brief tests are capable of detecting correlations between both chemical senses and relevant health measures outside a clinical setting.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Correlation analyses of detection thresholds of four different odorants 331 336 EN R. Zernecke Department of Neuroradiology, Ludwig-Maximilians-University of Munich, Germany T. Frank Department of Neuroradiology, Ludwig-Maximilians-University of Munich, Germany K. Haegler Department of Neuroradiology, Ludwig-Maximilians-University of Munich, Germany J. Albrecht Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany H. Bruckmann Department of Neuroradiology, Ludwig-Maximilians-University of Munich, Germany M. Wiesmann Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany 1002 10.4193/Rhin The detection threshold task of the Sniffin' Sticks can be conducted using two different odorants - n-butanol or phenylethyl alcohol (PEA). Previous studies show contradictory results regarding the correlation analysis of the two odorants. The current study investigated the relationship between PEA and n-butanol with respect to previous findings and subject population. We compared four different odorants (PEA, n-butanol, isoamyl butyrate, isobutanol) in an olfactory detection threshold task depending on subject population. Test odorants were applied to 73 healthy subjects. The experiment was divided into two sessions performed on two different days. The correlation coefficient between individual thresholds of PEA and n-butanol was not significant when exclusively normosmic subjects were included, but significant when additionally hyposmic, older subjects were studied. Comparable results were found for the analysis of the odorants n-butanol and isoamyl butyrate. Correlation between n-butanol and isobutanol was significant, both for exclusively normosmic, and additionally older, hyposmic subjects. The analyses of all other odorants revealed no significant correlations. Results give explanations for previous contradictory findings regarding investigations of PEA and n-butanol in a detection threshold task, and indicate that a formal validation of the Sniffin' Sticks with PEA as odorant is required.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Factors affecting the impact of olfactory loss on the quality of life and emotional coping ability 337 341 EN C.H. Shu Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan P.O. Lee Department of Electrical Engineering, National Central University, Jhongli, Taiwan M.Y. Lan Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan Y.L. Lee Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan 1013 10.4193/Rhin BACKGROUND: Olfactory impaired patients have decreased quality of life and may need to develop a coping ability for the olfactory loss. This study investigated how factors like olfactory function, disease duration, etiology, age, and gender affect patients' quality of life and emotional ability to cope. METHODS: Four hundred and thirteen consecutive patients with the chief complaint of olfactory dysfunction were evaluated. The Questionnaire of Olfactory Disorders (QOD) included negative statements (QOD-NS) that indicated the impact on the quality of life, and positive statements (QOD-PS) reflecting the emotional coping ability. Relations between studied factors and QOD-NS or QOD-PS were analyzed. RESULTS: Poorer olfaction and younger age correlated with increased QOD-NS scores, whereas longer disease duration and older age correlated with increased QOD-PS scores. Females had poorer coping than males. QOD-PS scores were inversely related to QOD-NS scores. CONCLUSIONS: The impact of olfactory loss is more significantly felt by younger patients with poorer olfaction. Older patients or those with longer disease duration develop better emotional coping abilities so as to reduce the impact on quality of life. It may be helpful for the patients with olfactory loss to develop emotional coping as early as possible to decrease the olfactory impact.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 The effect of a herbal combination of primrose, gentian root, vervain, elder flowers, and sorrel on olfactory function in patients with a sinonasal olfactory dysfunction 342 346 EN J. Reden Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School, Dresden, Germany D.J. El-Hifnawi Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School, Dresden, Germany T. Zahnert Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School, Dresden, Germany T. Hummel 1005 10.4193/Rhin Olfactory dysfunction is a common symptom in patients with inflammation of the nasal mucosa. Among numerous drugs, so far only the use of steroids has been shown to have a positive effect on olfactory function. Therefore the aim of the present study was to investigate whether patients with sinonasal disease would benefit in terms of olfactory function from oral treatment with a herbal drug (combination of primrose, gentian root, vervain, elder flowers, and sorrel: Sinupret®) which is commonly used in sinusitis. Olfactory function was tested using a standardised olfactory test kit ('sniffin' sticks'). The drug was applied in a double-blind fashion: after an initial therapy of 7 days of oral prednisolone for all participants with a sinonasal olfactory disease, participants were divided into a placebo- and a verum-group; tests were performed before and after treatment over a 2 months period. Statistical analysis did not reveal any major differences in olfactory function in relation to treatment. Considering that its benefit for the inflammatory component of sinusitis has been shown, the herbal drug may exhibit positive effects on olfactory function in a different setting, e.g., when applied without preceding administration of prednisolone, or when used in patients with certain degrees of rhinosinusitis.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Nasal polyposis and cystic fibrosis (CF): review of the literature 347 355 EN M.N. Feuillet-Fieux Biochemistry A Laboratory, Necker-Enfants Malades Hospital, 149 rue de Sèvres 75015 Paris, France G. Lenoir I. Sermet C. Elie J. Djadi-Prat M. Ferrec M. Magen V. Couloigner Y. Manach B. Lacour J.P. Bonnefont 1010 10.4193/Rhin The aim of this study was to address whether NP might be a predictive factor for severity of CF. The authors collected data from the literature on NP as a unique or associated sign in CF and reviewed the clinical and molecular aspects of CF associated with NP. CF genotypes and clinical severity in NP(+) vs. NP(-) patients were reviewed, taking into account pulmonary function, frequency of P. aeruginosa lung infection, frequency of allergy, nutritional status, and exocrine pancreatic function. The CFTR gene was also analyzed in a patient with isolated severe NP as the unique feature of CF. This review of the literature showed a 'milder' phenotype in 'NP+' vs. 'NP-' CF patients, contrasting with a marked association between NP and 'severe' CF mutations. In addition, a complex genotype was identified, associating four heterozygous variants, namely p.Q493X (a severe mutation) on the paternal allele, and p.V562I, p.A1006E, and (TG)11(T)5 (IVS8-5T) on the maternal allele, in a case of CF presenting as isolated NP. The authors speculate that genetic/environmental factors associated with NP might attenuate the functional impact of 'severe' CF mutations. The overrepresentation of CF carriers among patients with isolated NP also advocates the need for CFTR molecular screening in such populations for genetic counselling purposes.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Indoleamine 2,3-dioxygenase expression is associated with chronic rhinosinusitis with nasal polyps and antrochoanal polyps 356 363 EN T. Honkanen Department of Pathology, University of Tampere, Tampere, Finland A. Luukkainen M. Lehtonen T. Paavonen J. Karjalainen M. Hurme J. Myller Department of Otorhinolaryngology, University of Tampere, Tampere, Finland H. Huhtala M. Rautiainen Department of Otorhinolaryngology, University of Tampere, Tampere, Finland S. Toppila-Salmi Department of Eye, Ear and Oral Diseases, Tampere University Hospital and University of Tampere, Tampere, Finland 1015 10.4193/Rhin Chronic rhinosinusitis without and with nasal polyps (CRSwNP and CRSsNP), and antrochoanal polyps are different phenotypes with different pathomechanisms. Indoleamine 2,3-dioxygenase (IDO) is an enzyme expressed in many cells involved in the catabolism of the essential amino acid tryptophan to kynurenine. IDO might have a role in allergic airway inflammation. The aim was to evaluate if IDO expression is associated with CRSsNP, CRSwNP, or ACP. One hundred fifty specimens from the nasal cavity and sinus mucosa were immunohistochemically stained with mAb anti-IDO. The expression of epithelial and leukocyte IDO was associated with CRSwNP and ACP. The presence of ASA intolerance, asthma, atopy, smoking and use of medication did not significantly change the results. The different expression of IDO could putatively indicate the differences in the pathomechanisms of CRSsNP, CRSwNP and ACP. Further studies on the role of IDO in upper airways pathologies are required.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Optical and electromagnetic tracking for navigated surgery of the sinuses and frontal skull base 364 368 EN F. Kral Department of Otorhinolaryngology, Medical University Innsbruck, Austria E.J. Puschban Department of Otorhinolaryngology, Medical University Innsbruck, Austria H. Riechelmann F. Pedross Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Austria W. Freysinger Department of Otorhinolaryngology, Medical University Innsbruck, Austria 1011 10.4193/Rhin BACKGROUND: New hardware and software algorithms in electromagnetic tracking for computer assisted surgery (CAS) have been developed. We aimed to compare electromagnetic tracking for navigated procedures in frontal skull base surgery to optical tracking. METHODS: Target registration error (TRE) was determined in 6 anatomic specimens in an experimental wet-lab. As targets, 6 titanium screws were evenly distributed over the surgical areas of interest from the frontal sinus to the clivus. Optical tracking and electromagnetic tracking was evaluated in identical software environment using a last generation commercially available navigation system. RESULTS: Submillimetric application accuracy could be achieved with both tracking modalities. Optical was more accurate than electromagnetic tracking and its reliability was better. Target position did not influence TRE, however TRE varied significantly from skull to skull. CONCLUSIONS: Although less accurate than optical tracking, electromagnetic tracking still offers excellent accuracy and reliability for anterior skull base surgery. Electromagnetic tracking is not dependent on direct line of sight between its hardware components and therefore easily integrated even in cluttered operating theatres.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Endoscopic treatment of maxillary inverted papilloma 369 374 EN F. Pagella Department of Otorhinolaryngology, University of Pavia and Foundation IRCCS Policlinico S. Matteo, Pavia, Italy G. Giourgos Department of Otorhinolaryngology, University of Pavia and Foundation IRCCS Policlinico S. Matteo, Pavia, Italy E. Matti Department of Otorhinolaryngology, University of Pavia and Foundation IRCCS Policlinico S. Matteo, Pavia, Italy F.R. Canevari Department of Otorhinolaryngology, University of Pavia and Foundation IRCCS Policlinico S. Matteo, Pavia, Italy P. Carena Department of Otorhinolaryngology, University of Pavia and Foundation IRCCS Policlinico S. Matteo, Pavia, Italy 1012 10.4193/Rhin OBJECTIVES: Evaluate the efficacy of endoscopic treatment in maxillary inverted papilloma (IP). METHODOLOGY: Between July 2002 - April 2008, 20 patients affected by maxillary localization of IP were treated in our Clinic. All patients underwent endoscopic treatment consisting of an endoscopic medial maxillectomy (simple or extended), or attachment-site endoscopic tumour surgery. RESULTS: The cohort was composed of 20 patients (♂: 15, ♀: 5), mean age 58 years, and included 21 endoscopic resections of maxillary IP. Minimum follow-up: 24 months, mean follow-up: 50 months. We registered only 1 case of tumour persistence/recurrence after 15 months, which underwent a second endoscopic treatment. No association with malignant lesions was noted. The efficacy of the endoscopic treatment was 95% (19/20 cases) after primary surgery, and 100% after endoscopic revision. CONCLUSIONS: Our experience demonstrates the efficacy of endoscopic treatment in maxillary IP. Based On its reduced morbidity in comparison to external approaches and its good control of the disease, we consider it our standard treatment for maxillary-originated inverted papilloma.

International Rhinologic Society Rhinology 0300-0729 49 3 2011 8 1 Revison endonasal dacryocystorhinostomies: analysis of 44 procedures 375 380 EN P. Komínek Department of Otorhinolaryngology, University Hospital Ostrava, Czech Republic S. Červenka Department of Otorhinolaryngology, University Hospital Ostrava, Czech Republic T. Pniak Department of Otorhinolaryngology, University Hospital Ostrava, Czech Republic K. Zeleník Department of Otorhinolaryngology, University Hospital Ostrava, Czech Republic H. Tomášková Department of Epidemiology and Public Health, Faculty of Health Studies, University of Ostrava, Czech Republic P. MatouÅ¡ek Department of Otorhinolaryngology, University Hospital Ostrava, Czech Republic 1014 10.4193/Rhin PURPOSE: To determine the success rate of revision endoscopic dacryocystorhinostomies (DCR) and to analyse 44 revision DCRs. METHODS: The operative and postoperative data were collected in 44 revision DCRs. The corrections of associated structural anatomic alterations were performed during the surgery (resection of the scarr, the bone window creating, resection of the head of the middle turbinate, septoplasty, ethmoidectomy etc.) and the intubation was performed in all cases. RESULTS: The follow-up interval ranged from 12 to 36 months. The 44 ReEDCRs were performed in adults and there were only 5 children under the age of 15. The surgery was performed under local or general anaesthesia. The most frequent secondary procedures were scar resections, creating a wider bone window, and partial middle turbinate resection. Four patients were excluded for their follow-up periods had not been completed. An average time of the tubes removal was 5.6 months. The total success rate was 84.0%; the success rate was 85.7% in the group with closed rhinostomy and 1/2 in the group of canalicular and rhinostomy obstructions. CONCLUSIONS: The endonasal revision DCR is a safe and very effective surgical procedure following the failed DCRs. The correction of associated structural anatomic alterations that may be involved in the failure of previous surgeries can be easily performed.