International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Olfaction - the Cinderella of the senses? 497 498 EN V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. 1054 10.4193/Rhin In the United Kingdom this time of year is traditionally the occasion for a very particular entertainment, the Christmas pantomime. One of the most popular subjects for this comedy pastiche of fairy tale and morality play is the story of Cinderella, that archetypal tale of 'rags to riches'. Whilst the analogy may seem a little far-fetched, olfaction is not infrequently referred to as the 'Cinderella of the senses' presumably as it is perceived as receiving less attention than the other senses so it is perhaps appropriate that this December issue should contain a number of publications on this topic. Smell influences our lives from conception to death, our very survival may depend on it and yet it is interesting to reflect that whilst Nobel prizes were given in the early 1960's for the discovery of the rod and cone mechanism in the eye and to von Bekesy for his work on hearing, it was not until 2004 that Richard Axel and Linda Buck received the Nobel Prize in Physiology or Medicine for discovering olfactory receptor proteins which make up the largest gene family thus discovered.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Rhinophototherapy: gimmick or an emerging treatment option for allergic rhinitis? 499 506 EN S.C. Leong Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Aintree, Liverpool, United Kingdom 1043 10.4193/Rhin Photodynamic therapy has been used in treating immune-mediated dermatological conditions such as psoriasis and atopic dermatitis. There are emerging reports on the efficacy of intranasal phototherapy in allergic rhinitis. The aim of this review was to assess intranasal phototherapy in the treatment of allergic rhinitis, with particular emphasis on clinical efficacy, scientific basis and safety. A structured search of the U.S. National Library of Medicine (PubMed), the Cochrane Collaboration library, Google Scholar and ISI Web of Knowledge database was undertaken using MeSH terms 'phototherapy' and 'rhinitis.' Fourteen full-text articles were available for review. Three different phototherapy medical devices were assessed: (1) Bionase™, (2) Allergy Reliever SN206 and (3) Rhinolight®. Light wavelength used in these devices ranged from red light to ultraviolet. Clinical use of intranasal phototherapy appears to be safe and well tolerated. Most studies demonstrated symptomatic improvement and quality of life scores. No improvement in objective measures of nasal airflow was demonstrated. Beneficial effects of phototherapy on inflammatory markers remain equivocal. Phototherapy treatment results in DNA damage but does not appear to predispose to carcinogenesis. However, long-term prospective studies are required to verify this. The quality of published studies was variable and thus the current strength of recommending intranasal phototherapy is currently weak.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Solitary chemosensory cells in the respiratory and vomeronasal epithelium of the human nose: a pilot study 507 512 EN T. Braun Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany B. Mack Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany M.F. Kramer Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany 1053 10.4193/Rhin BACKGROUND: Recently, solitary chemosensory cells have been described in the respiratory and vomeronasal epithelium of the rodent nose. Expressing G-protein coupled receptors for sweet, umami and bitter taste transduction, these cells are thought to mediate trigeminal reflexes upon stimulation with chemical irritants. The present study analyzes human nasal mucosa for the presence of solitary chemosensory cells. METHODOLOGY: In human tissue samples from respiratory mucosa and the vomeronasal organ, gene expression of taste receptors families was studied in five patients using the Affymetrix Human Gene 1.0 ST Array and immunohistochemistry with specific antibodies. RESULTS: Immunohistochemistry revealed that solitary chemosensory cells expressing G-protein coupled receptors for sweet, umami and bitter taste transduction are present in the human nose. cDNA microarray analysis congruently showed that cells expressing bitter taste receptors accumulate in the vomeronasal organ compared to the respiratory epithelium. CONCLUSIONS: Solitary chemosensory cells expressing taste receptors are also present in the human nose. Since they are thought to mediate trigeminal reflexes, their role in the pathogenesis of nasal hyperreagibility should be elucidated in further studies.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Just noticeable difference in olfaction: a discriminative tool between healthy elderly and patients with cognitive disorders associated with dementia 513 518 EN J. Hidalgo Neuroscience Lab, Université de Franche, Besançon, France G. Chopard Neuroscience Lab, Université de Franche, Besançon, France J. Galmiche Centre Mémoire de Ressources et de Recherches (CMRR), Department of Neurology, University Hospital, Besançon, France L. Jacquot Neuroscience Lab, Université de Franche, Besançon, France G. Brand Neuroscience Lab, Université de Franche, Besançon, France 1036 10.4193/Rhin Olfactory dysfunction appears to be one of the earliest signs of several age-related neurodegenerative disorders, including Alzheimer's disease (AD) or Parkinson's disease (PD). To rate performance and olfactory deficits in patients with cognitive disorders, various olfactory tasks have been used such as odor detection, discrimination, recognition memory, identification and naming but no study has been focused on just noticeable difference (JND), a sensitive tool of detection. The aim of this study was to investigate and compare variations in JNDs in healthy elderly and in patients with cognitive disorders associated with dementia. The results showed significantly higher olfactory JNDs in a population with cognitive disorders associated with dementia - i.e. a lower olfactory detection performance - compared to a control population paired in age, gender and education level. Additionally, the findings of the present study showed strong correlations between cognitive performances and JND scores in the control population contrary to the patient population. These findings are discussed in relation to the relevance of using olfactory JNDs in the diagnosis of dementias.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Persistent asthma has an accumulative impact on the loss of smell in patients with nasal polyposis 519 524 EN I. Alobid Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain S. Cardelus Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, University of Barcelona, Spain P. Benitez J.M. Guilemany Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, University of Barcelona, Spain J. Roca-Ferrer Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain C. Picado Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain M. Bernal-Sprekelsen Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain J. Mullol 1037 10.4193/Rhin BACKGROUND: Loss of sense of smell is one of the most frequent complaints in patients with nasal polyposis (NP). The aim of this study was to evaluate the impact of asthma and its severity on the sense of smell. MATERIAL AND METHODS: Patients with massive NP and healthy controls were included. More than half of patients presented with asthma. Olfactometry by Barcelona Smell Test 24, nasal symptoms score, nasal endoscopy, allergy study, and paranasal sinus CT scan were assessed. RESULTS: NP patients showed a significant impairment in smell detection, identification, and forced choice compared to the control. Asthmatics reported lower scores for detection, identification, and forced choice than non-asthmatic patients. Patients with persistent asthma had an increased impairment of sense of smell on detection, identification, and forced choice than patients with intermittent asthma. No significant differences were found between mild, moderate, and severe persistent asthmatics. Paranasal sinuses opacification was inversely correlated with smell detection, identification and forced choice. CONCLUSION: These findings suggest that patients with NP have an impaired sense of smell, that asthma -particularly persistent asthma- has a further impact on sense of smell, and that loss of smell may be used as a clinical tool to identify the severity of both NP and asthma.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Clinical efficacy of a short course of systemic steroids in nasal polyposis 525 532 EN V. Kirtsreesakul Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Thailand K. Wongsritrang Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Thailand S. Ruttanaphol Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Thailand 1044 10.4193/Rhin BACKGROUND: Although oral steroids are widely used for the treatment of nasal polyposis, a subset of patients shows an unfavorable therapeutic outcome. The aim of this study was to evaluate the efficacy of a short course of oral prednisolone in nasal polyposis and to evaluate which, if any, clinical variables can predict treatment outcome in these patients. METHODOLOGY/PRINCIPAL: Using a 3:2 randomization ratio, 63 patients with nasal polyposis received 50 mg of prednisolone and 46 patients received placebo daily for 14 days. Clinical response was evaluated by total nasal symptoms score (TNSS), peak expiratory flow index (PEFI) and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test and sinus radiography. RESULTS: The prednisolone-treated group showed significantly greater improvements in all nasal symptoms, nasal flow and polyp size than the placebo-treated group (p < 0.001, all). In the prednisolone-treated group, patients with grade 3 polyps and positive nasal endoscopy showed significantly less improvement in TNSS, PEFI and TNPS than patients with grades 1-2 size and with negative nasal endoscopy. CONCLUSIONS: A short course of oral steroids showed good clinical efficacy in the treatment of nasal polyposis, however, polyps size grade 3 and/or positive nasal endoscopy predispose to a poorer treatment outcome.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Socioeconomic status: a disease modifier of chronic rhinosinusitis? 533 537 EN S.J. Kilty Department of Otolaryngology-Head and Neck Surgery, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada J.T. McDonald Department of Economics, University of New Brunswick, Fredericton, NB, Canada S. Johnson Department of Otolaryngology-Head and Neck Surgery, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada D. Al-Mutairi Department of Otolaryngology-Head and Neck Surgery, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada 1035 10.4193/Rhin INTRODUCTION: The Lund-MacKay score (LMS) correlates poorly with chronic rhinosinusitis (CRS) symptom severity. Patients with CRS also tend to report relatively lower levels of mental wellbeing. Our purpose was to determine if there is a correlation between socio-economic status (SES) and CRS severity as measured by the LMS, and if there is an association between depression symptoms and the severity of CRS using the LMS. METHODS: A total of 127 patients diagnosed with CRS were prospectively recruited and assessed with a sinonasal assessment questionnaire (SNAQ-11), and the Patient Health Questionnaire (PHQ-9) for depression. Each patient's education level, family income, and smoking behavior were determined. The sinus CT scan was scored using the LMS. The data were analyzed using ordinary least squares (OLS) regression techniques. RESULTS: Having a highschool education or less was associated with higher SNAQ-11 scores while being a daily smoker was associated with higher SNAQ-11 scores. There was no significant relationship between educational attainment, financial income or daily smoking and sinus CT score. Including depression scores in the SNAQ-11, regression equations indicated a significant and positive relationship between depression severity and SNAQ-11 score. CRS with polyps was negatively associated with SNAQ-11 scores but, as expected, it was positively associated with a higher LMS. CONCLUSIONS: Lower SES status is a negative modifying factor of subjective CRS severity but it has no impact on the LMS. Depression symptoms are associated with increased subjective CRS severity but they have no effect on the LMS. How SES and depression impact on a patient's self-reported disease severity requires further study.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Development and validation of a symptom questionnaire for recording outcomes in adult lacrimal surgery 538 545 EN N. Mistry Department of Otorhinolaryngology, Queen's Hospital, Burton upon Trent, Staffordshire, United Kingdom T.J. Rockley Department of Otorhinolaryngology, Queen's Hospital, Burton upon Trent, Staffordshire, United Kingdom T. Reynolds Department of Chemical Pathology, Queen's Hospital, Burton upon Trent, Staffordshire, United Kingdom C. Hopkins 1027 10.4193/Rhin BACKGROUND: A symptom-based questionnaire (the 'Lac-Q' questionnaire) for adult patients undergoing lacrimal drainage surgery was developed. The questionnaire yields a numerical score that can be used to assess severity of symptoms. METHODOLOGY In this study, the questionnaire was evaluated in 17 consecutive patients undergoing 22 dacryocystorhinostomy (DCR) procedures. The questionnaire was administered pre- and postoperatively. The pathology encountered at operation was recorded. The success of surgery was judged by patient satisfaction, endoscopic evaluation of DCR stomal patency, and objective lacrimal drainage testing using the functional endoscopic dye test (FEDT). In a further group of 12 pre-operative cases, the questionnaire was repeated after 4-6 weeks but before surgery, to assess test-retest reliability in the absence of clinical change. RESULTS: The Lac-Q questionnaire was based on two broad categories of eye-specific scores and social impact scores. A numerical score, the 'Lac-Q' score, was generated pre- and postoperatively. When compared to pre-operative scores, the reduction in Lac-Q scores postoperatively was significant. Postoperative scores also correlated well with objective lacrimal drainage testing using the FEDT. Analysis of symptom scores shows that the questionnaire was reliable with regard to content validity, internal consistency, test-retest reliability, and responsiveness to clinical change. CONCLUSIONS: We conclude that the Lac-Q questionnaire is a useful clinical tool to evaluate outcomes after adult lacrimal surgery.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 3D stereophotogrammetric analysis of lip and nasal symmetry after primary cheiloseptoplasty in complete unilateral cleft lip repair 546 553 EN B. van Loon Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands S.G. Reddy N. van Heerbeek K.J.A.O. Ingels T.J.J. Maal W.A. Borstlap R.R. Reddy A. Kuijpers-Jagtman S.J. Berge 1051 10.4193/Rhin BACKGROUND: The aim of this study was to evaluate symmetry of the lip and nose in patients with CUCLP after primary cheiloseptoplasty (Afroze technique), in comparison to non-cleft controls. METHODOLOGY: In this prospective study, forty-four patients with operated non-syndromic CUCLP were included. The control group consisted of 44 volunteers without cleft defects of approximately the same age and sex. Primary septoplasty was performed in conjunction with the cleft lip (CL) repair using the Afroze incision. 3D facial images were acquired using 3D stereophotogrammetry. After a 3D cephalometric analysis of the lip and nose was performed in both groups, linear and volumetric data were acquired. Lip and nose symmetry were calculated and compared using Student's t-tests as well as the Chi square test. RESULTS: For all measurements, the control group was up to 36% closer to perfect symmetry compared to the CUCLP group after primary surgery. This difference was statistically significant. CONCLUSIONS: After primary cheiloseptoplasty according to the Afroze technique in patients with CUCLP, asymmetry in the nose and lip area still exists as compared to non-cleft controls. Although non-cleft individuals also show some degree of asymmetry, the results of this study stress the difficulty in obtaining near normal symmetrical relations.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Antimicrobial peptides in nasal secretion and mucosa with respect to Staphylococcus aureus colonization in chronic rhinosinusitis with nasal polyps 554 561 EN M.L. Thienhaus Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Kiel, Germany J. Wohlers R. Podschun J. Hedderich P. Ambrosch M. Laudien 1042 10.4193/Rhin Objective: Nasal carriage of Staphylococcus aureus in patients with chronic rhinosinusitis with nasal polyps (NP) is hypothesized to have pathophysiological impact on the disease. Antimicrobial peptides (AMP), especially human beta-defensin-3 (hBD-3) and LL-37, are an important part of the multifactorial defence against microorganisms in barrier organs like the nasal mucosa. The interaction of S. aureus colonization and AMP in nasal secretions and mucosa of NP were investigated in this study. Patients and Methods: AMP were quantified in nasal secretions of 13 normal controls (NC) and 12 NP patients, each with and without S. aureus colonization, by ELISA. Immunohistochemistry was used to investigate the cellular sources of AMP in the nasal mucosa. To explore the AMP response of primary nasal epithelial cell cultures (NEC) towards S. aureus stimulation, a functional assay was established. Results: AMP could be demonstrated in nasal secretions of all groups without differences in hBD-3 concentrations comparing S. aureus carriers vs. non-carriers. In NC, higher LL-37 concentrations were observed in S. aureus colonized as compared to non-colonized patients. This effect was not detectable in NP patients. Epithelial cells, submucosal glands and cells of the connective tissue could be identified as sources of AMP by immunohistochemistry. An AMP response of NEC towards S. aureus stimulation was detected in all groups. Conclusion: In NP patients, LL-37 response towards S. aureus colonization is disturbed while the ability of NEC to respond on S. aureus challenge is preserved. This deregulation of the nasal barrier could be involved in the multifactorial pathophysiology of NP.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Impact of cell culture methods on the outcomes of the in vitro inflammatory response in nasal polyps 562 569 EN L. FernÔndez-Bertolín Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain J. Mullol I. Alobid Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain J. Roca-Ferrer Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain C. Picado Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain L. Pujols Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain 1039 10.4193/Rhin BACKGROUND: In vitro culture of nasal polyp cells is frequently used in the investigation of inflammatory mechanisms and effect of treatments in nasal polyposis. Research outcomes may, however, be influenced by the culture methodology used. METHODS: Nasal polyp and nasal mucosa in vitro fibroblast cultures were pre-treated with foetal bovine serum (FBS)-free culture medium or medium supplemented with either FBS or charcoal-stripped (cs) FBS. Cells were then stimulated with FBS or csFBS, with or without different doses of dexamethasone for 4 and 24h. IL-6, IL-8, GM-CSF and VEGF release and cell viability were measured. RESULTS: The highest cytokine levels were found in growth-arrested cells stimulated with 10% FBS. csFBS poorly stimulated cytokine release. Nasal polyp released larger IL-8 amounts than nasal mucosa fibroblasts. Dexamethasone decreased cytokine production dose- and time-dependently in both nasal mucosa and nasal polyp fibroblasts. The IC25 of IL-8 inhibition by dexamethasone was higher in nasal polyp than in nasal mucosa fibroblasts. Cell viability did not differ among treatments. CONCLUSIONS: Cytokine production by in vitro cultured nasal fibroblasts is affected by the culture conditions used and is inhibited by dexamethasone in both fibroblast types. Our results highlight the importance of culture methodology on nasal polyp research outcomes.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Anti-IL-5 immunomodulates the effect of Staphylococcus aureus enterotoxin on T cell response in nasal polyps 570 576 EN S. Langier Allergy and Clinical Immunology Unit, Tel Aviv University, Tel Aviv, Israel R. Landsberg K. Sade S. Kivity 1047 10.4193/Rhin BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a T helper-2 (Th2) inflammatory disease with considerable impact on the quality of life. Staphylococcus aureus enterotoxins (SAEs) can induce and/or amplify inflammation. In this study, we investigated the immunomodulatory effect of SAEs on cytokine production by T cell obtained from nasal polyps (NPs) and examined whether neutralizing interleukin 5 (IL-5) can reverse the immunological effect mediated by those toxins. METHODS: NP tissues were obtained from all patients who underwent endoscopic sinus surgery for CRSwNP. NP cells were isolated and stimulated in vitro with SAEs in the presence or absence of anti-IL-5. Flow cytometry (FACS) analyses were performed to measure specific T lymphocyte cytokine production. RESULTS: Seventeen patients (mean age 48 years) were enrolled. SAEs significantly increased the IL-4, IL-5 (Th2) and interferon (INF)-γ (Th1) cytokines released from T lymphocytes of NPs. The addition of anti-IL-5 suppressed IL-4 and INF-γ release, which was most evident on NP tissue with high basal levels of IL-5. CONCLUSIONS: Neutralizing IL-5 is a potential therapeutic modality in patients with NPs, the effect of which is dependent on IL-5 levels.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Influence of cigarette smoking on endoscopic sinus surgery long-term outcomes 577 582 EN A. Krzeski Department of Otolaryngology, Warsaw Medical University, Warsaw, Poland A. Galewicz R. Chmielewski M. Kisiel 1045 10.4193/Rhin OBJECTIVE: The purpose of this study was to explore the influence of smoking on long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis. METHODS: The study prospectively enrolled 274 patients at the Department of Otolaryngology of the Warsaw Medical University from 1993 to 2000. All patients were diagnosed with chronic rhinosinusitis and scheduled for the endoscopic sinus surgery. We evaluated subgroups of patients with respect to bronchial asthma, allergy, aspirin triad, gastro-esophageal reflux disease and nasal septal deviation. Patients were divided into smokers and non-smokers. Patient CT scan results were recorded according to the four-grade classification system by Kennedy. Patients were observed over a period between 2 to 9 years following the surgical intervention and had their surgery revised if the severity of symptoms were at the same level or worsened. RESULTS: Prior to endoscopic sinus surgery, 23% of smokers and 20% of non-smokers scored III or IV on the Kennedy Scale. The revision ESS was carried out in 27 patients. In this group there were 20% smokers and 7% non-smokers, with the difference being significant. There was no significant difference in the postoperative quality of life scale scores. CONCLUSIONS: The study shows that while smoking did not influence preoperative symptoms, smokers had worse postoperative outcomes.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 The relationship between nasal index and nasal airway resistance, and response to a topical decongestant 583 586 EN N.M. Doddi Common Cold Centre and Healthcare Clinical Trials, Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom R. Eccles Common Cold Centre and Healthcare Clinical Trials, Cardiff School of Biosciences, Cardiff University, United Kingdom 1038 10.4193/Rhin The differences in the shape and size of the nose have been proposed to be an adaptation to climate with broad noses (platyrrhine) evolving in a warm humid environment where there was little need for air conditioning and narrow noses (leptorrhine) evolving in colder climates where the air needed more warming. The main aim of this research was to determine if there was any relationship between the shape of the nose as expressed in terms of nasal height and width (nasal index) and total nasal airway resistance (NAR), as one would predict that the narrower leptorrhine noses would have a greater resistance to air flow than the broader platyrrhine noses. It was also proposed that the narrow leptorrhine nose would have better developed vascular tissue than the broad platyrrhine nose in order to condition cold air, and would exhibit a greater response to nasal decongestion. No correlation was found between nasal index and NAR (r = -0.09) and similarly no correlation was found between nasal index and response to a topical nasal decongestant (r = 0.02). The absence of any physiological differences between the different nose types may be due to acclimatisation of participants to the area of recruitment.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Impaired nasal breathing may prevent the beneficial effect of weight loss in the treatment of OSA 587 592 EN H. Blomster Departments of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland T. Kemppainen J. Numminen P. Ruoppi J. Sahlman M. Peltonen J. Seppä H. Tuomilehto 1052 10.4193/Rhin BACKGROUND: Weight loss is considered an effective treatment for obstructive sleep apnoea (OSA) in overweight patients. Some patients, however, do not benefit from weight loss. It has been postulated that nasal obstruction may act as an independent risk factor for OSA. OBJECTIVE: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands The aim of our study was to evaluate whether impaired nasal airflow might explain the missing effect of weight reduction on OSA. METHODOLOGY: Fifty-two overweight adult patients with mild OSA were recruited. After the 12-month lifestyle intervention, all patients who achieved ≥ 5% weight loss were divided into two groups based on whether they still had OSA or not. Change in nasal resistance measured by rhinomanometer and AHI were the main outcome variables. RESULTS: A total of 26/52 patients achieved 5% weight reduction. Of those 26 patients, 16 were objectively cured from OSA and 10 patients did not benefit from weight loss. Nasal resistance reduced significantly more in patients who had been cured from OSA. Smoking had a negative impact on both nasal resistance and improvement of AHI. CONCLUSIONS: Impaired nasal breathing and smoking may prevent the beneficial effects of weight reduction in the treatment of OSA.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Wnt-pathway activation in intestinal-type sinonasal adenocarcinoma 593 599 EN J.P. Diaz-Molina Dept. of Otolaryngology, IUOPA, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain J.L. Llorente Department of Otorhinolaryngology, Instituto Universitario de Oncología del Principado de Asturias. Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain B. Vivanco P. Martínez-Camblor M. Florentino-Fresno J. Pérez-Escuredo C. Álvarez-Marcos M.A. Hermsen 1048 10.4193/Rhin BACKGROUND: Intestinal-type sinonasal adenocarcinoma (ITAC) is an epithelial cancer of the sinonasal sinuses that shows histological similarity to colorectal cancer (CRC) and share chronic inflammation as a possible etiological factor. The Wnt-pathway is one of the most important tumourigenic pathways in CRC. The aim of this study was to investigate if the Wnt-pathway is activated in ITAC. METHODOLOGY: Protein expression profiles of E-cadherin, β-catenin, c-myc and cyclin D1 were analysed by immunohistochemistry in 83 samples of ITAC, organized into tissue microarray blocks. RESULTS: Nuclear β-catenin expression was observed in 31% of the cases and was twice as frequent in papillary/colonic ITAC compared to solid/mucinous subtypes. Loss of membranous β-catenin staining occurred in 24% and loss of membranous E-cadherin in 6% of the cases and this was more prominent in mucinous types. Strong c-myc and cyclin D1 expression was observed in 30% and 4% of the cases, respectively. Nuclear β-catenin expression was significantly related to poor clinical outcome, independent from established factors as tumour stage and histological type. CONCLUSION: The presence of nuclear β-catenin in 31% of patients with ITACs indicated that in a subset of patients, the Wnt-pathway is active and conveys a worse prognosis.

International Rhinologic Society Rhinology 0300-0729 49 5 2011 12 1 Treatment of epistaxis without the use of nasal packing, a patient study 600 604 EN E. Vis ENT Department, Medisch Centrum Leeuwarden, the Netherlands H. van den Berge ENT Department, Medisch Centrum Leeuwarden, the Netherlands 1046 10.4193/Rhin We questioned how many patients with epistaxis can be treated by cautery without the use of nasal packing, as cautery is more effective and efficient. To investigate this, we performed a retrospective study of a cohort of 418 patients with epistaxis who presented to one ENT consultant at the ENT department of Medisch Centrum Leeuwarden (the Netherlands) between 1997 and 2007. Main outcomes were the treatment modality (cautery and/or nasal packing), recurrence of epistaxis and need for hospitalization. In 98% of all patients the bleeding site could be found and treated by cautery. The incidence of recurrent bleeding was 6%. Two percent of all patients had to be admitted to the hospital. This is considerably lower compared with recurrence rates and hospitalization after treatment by nasal packing known from the literature. Therefore we concluded that nearly all patients can be effectively treated by cautery with a low recurrence rate. In addition, this method of treatment is very cost effective. Because cautery requires skill and appropriate facilities, we recommend special attention for this in ENT training programs.