International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. 1 12 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. J. Mullol C. Bachert I. Alobid Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain F. Baroody N. Cohen A. Cervin R. Douglas P. Gevaert C. Georgalas H. Goossens R. Harvey Department of Otolaryngology Head Neck & Skull Base Surgery, St Vincent's Hospital, Sydney, NSW, Australia P. Hellings C. Hopkins N. Jones G. Joos L. Kalogjera B. Kern M. Kowalski D. Price H. Riechelmann R. Schlosser B. Senior M. Thomas E. Toskala R. Voegels D.Y. Wang P.J. Wormald 1078 10.4193/Rhin The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also propose definitions for 'difficult to treat' rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between the upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com To cite this article: Wytske J. Fokkens, Valerie J. Lund, Joachim Mullol, Claus Bachert, Isam Alobid, Fuad Baroody, Noam Cohen, Anders Cervin, Richard Douglas, Philippe Gevaert, Christos Georgalas, Herman Goossens, Richard Harvey, Peter Hellings, Claire Hopkins, Nick Jones, Guy Joos, Livije Kalogjera, Bob Kern, Marek Kowalski, David Price, Herbert Riechelmann, Rodney Schlosser, Brent Senior, Mike Thomas, Elina Toskala, Richard Voegels, Wang Deyun, Peter John Wormald The European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology. 2012 Suppl. 23: 1-299.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Assessment of chemosensory function using electroencephalographic techniques 13 21 EN Ph. Rombaux C. Huart Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium A. Mouraux 1064 10.4193/Rhin Electroencephalographic techniques are widely used to provide an objective evaluation of the chemosensory function and to explore neural mechanisms related to the processing of chemosensory events. The most popular technique to evaluate brain responses to chemosensory stimuli is across trial time-domain averaging to reveal chemosensory event-related potentials (CSERP) embedded within the ongoing EEG. Nevertheless, this technique has a poor signal-to-noise ratio and cancels out stimulus-induced changes in the EEG signal that are not strictly phased-locked to stimulus onset. The fact that consistent CSERP are not systematically identifiable in healthy subjects currently constitutes a major limitation to the use of this technique for the diagnosis of chemosensory dysfunction. In this review, we will review the different techniques related to the recording and identification of CSERP, discuss some of their limitations, and propose some novel signal processing methods which could be used to enhance the signal-to-noise ratio of chemosensory event-related brain responses.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Normal peak nasal inspiratory flow rate values in healthy children aged 6 to 11 years in the Netherlands 22 25 EN E. van Spronsen Department of Otorhinolaryngology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands F.A. Ebbens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1067 10.4193/Rhin BACKGROUND: The measurement of peak nasal inspiratory flow (PNIF) is a simple, quick, easy to perform and cheap tool for determining the extent of nasal airway patency. However, normative data are rare and not available for Dutch children aged 6 to 11 years. METHODS: Repeated PNIF measurements were obtained from 212 Dutch children of primary school age. Of these 212 children, 166 fulfilled the inclusion criteria of our study. The influence of age, gender, ethnicity, weight and height on PNIF was studied. RESULTS: Age is the only parameter of influence on PNIF. All other parameters do not influence PNIF. Normative data are presented. CONCLUSION: PNIF measurements are possible in children aged six years and older. Age does influence PNIF, but gender, weight, height and ethnicity do not.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Non-invasive diagnostics of the maxillary and frontal sinuses based on diode laser gas spectroscopy 26 32 EN M. Lewander Division of Atomic Physics, Department of Physics, Lund University, Lund, Sweden S. Lindberg T. Svensson R. Siemund K. Svanberg S. Svanberg 1061 10.4193/Rhin PROBLEM: Suspected, but objectively absent, rhinosinusitis constitutes a major cause of visits to the doctor, high health care costs, and the over-prescription of antibiotics, contributing to the serious problem of resistant bacteria. This situation is largely due to a lack of reliable and widely applicable diagnostic methods. METHOD: A novel method for the diagnosis of rhinosinusitis based on non-intrusive diode laser gas spectroscopy is presented. The technique is based on light absorption by free gas (oxygen and water vapour) inside the sinuses, and has the potential to be a complementary diagnostic tool in primary health care. The method was evaluated on 40 patients with suspected sinus problems, referred to the diagnostic radiology clinic for low-dose computed tomography (CT), which was used as the reference technique. MAIN RESULTS: The data obtained with the new laser-based method correlated well with the grading of opacification and ventilation using CT. The sensitivity and specificity were estimated to be 93% and 61%, respectively, for the maxillary sinuses, and 94% and 86%, respectively, for the frontal sinuses. Good reproducibility was shown. PRINCIPAL CONCLUSION: The laser-based technique presents real-time clinical data that correlate well to CT findings, while being non-intrusive and avoiding the use of ionizing radiation.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 The impact of allergic rhinitis on symptoms, and quality of life using the new criterion of ARIA severity classification 33 36 EN A. Valero R. Munoz-Cano J. Sastre A.M. Navarro E. Marti-Guadano I. Davila A. del Cuvillo C. Colas I. Antepara I. Izquierdo J. Mullol 1058 10.4193/Rhin INTRODUCTION: Allergic rhinitis (AR) is a common disease with major socieconomic burden and a significant impact on quality of life. OBJECTIVE: The objective of the study was to assess the impact of AR severity, using the modified ARIA (m-ARIA) severity criterion in order to discriminate among moderate and severe AR, in symptoms and quality of life assessed with the questionnaire ESPRINT-15. METHODS: The specific quality of life questionnaire (ESPRINT-15) was applied in over thousand untreated RA patients. Severity was evaluated by the m-ARIA classification, which categorizes AR as mild, moderate, and severe. Nasal symptoms were evaluated by using categorized (none, low, middle, and high) Total Four Symptom Score (T4SS). RESULTS: Using the m-ARIA severity classification, significant differences in quality of life, both global score and specific domains, and categorized T4SS were found among the AR severity groups. CONCLUSION: Modified ARIA severity classification in mild, moderate, and severe allergic rhinitis clearly discriminates the impact of AR in all domains of quality of life and categorized symptom's score.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Cyclamen europaeum nasal spray, a novel phytotherapeutic product for the management of acute rhinosinusitis: a randomized double-blind, placebo-controlled trial 37 44 EN O. Pfaar Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany J. Mullol C. Anders K. Hörmann L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany 1072 10.4193/Rhin AIM: To evaluate the efficacy and safety of a phytotherapeutic nasal spray containing Cyclamen europaeum (CE) in the treatment of acute rhinosinusitis (ARS). MATERIAL/METHODS: We performed a randomized, double-blind, placebo-controlled trial of CE nasal spray once daily for 15 days in 99 adult patients with moderate-to-severe ARS who also received amoxicillin 500 mg three times daily for the first 8 days. The primary endpoint was the change in mean total symptom scores (TSS) on day 7. Secondary endpoints included individual symptom scores (nasal congestion, mucus secretion, facial pain, impairment of smell) and endoscopic findings on days 7 and 15 and others. RESULTS: No statistically significant difference in TSS was noted for CE versus placebo on day 7. Moreover, the individual scores were not statistically different between the groups for the ITT-population on day 7. However, both a reduction in facial pain (PP) and an improvement in endoscopically-assessed mucosal obstruction (ITT) significantly favoured CE on day 7. The most common adverse events were nasal burning and mild epistaxis, but no severe adverse events were documented. CONCLUSION: In summary, this is the first randomized controlled trial on phytotherapy in patients with moderate-to-severe ARS demonstrating clinical safety and some encouraging effects of CE which merit to investigate phytotherapeutic products in further large-scale clinical trials.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Long-term low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis 45 55 EN W.J.M. Videler Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands K. van Hee Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands S.M. Reinartz C. Georgalas F.W. van der Meulen Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1066 10.4193/Rhin INTRODUCTION: In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam. PATIENTS AND METHODS: Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term. RESULTS: Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group. DISCUSSION: Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Long-term effects of cutting versus non-cutting instruments in FESS 56 66 EN L. Mus Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium R. Hermans Department of Radiology, University Hospitals Leuven, Leuven, Belgium M. Jorissen 1056 10.4193/Rhin BACKGROUND: Currently most ENT surgeons advocate using cutting instruments in Functional Endoscopic Sinus Surgery (FESS), based on the assumption of superior wound healing due to mucosal preservation. However, there is no scientific evidence of superiority of the cutting instruments. METHODS: A prospective, randomized double blinded study was performed in 100 patients undergoing FESS, operated one side with non-cutting and the contra lateral side with cutting instruments. After a mean follow-up of 12 years after FESS, unilateral and global sino-nasal symptoms were scored by the patients using VAS, endoscopic abnormalities scored at both sides at the Outpatient clinic and radiologic abnormalities were described. RESULTS: No significant differences between the sides operated by cutting and non-cutting instruments were found for sino-nasal symptomatic or for radiologic abnormalities between both sides. For the endoscopic parameters there was no difference for secretion or mucosa. Only for the presence of endoscopic synechiae there was a statistically significant difference between both groups. At the non-cutting side more synechiae were noticed, but no interference with sinus access, neither ventilation nor drainage was observed. CONCLUSION: FESS performed with cutting instruments results in less synechiae formation compared to non-cutting instruments. However, the presence of synechiae is not associated with more symptoms or CT scan abnormalities.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Long-term follow-up of posttraumatic olfactory disorders 67 72 EN A. Welge-Lussen Department of Otorhinolaryngology, University Hospital Basel, Basel, Switzerland A. Hilgenfeld Department of Otorhinolaryngology, University Hospital Basel, Basel, Switzerland Th. Meusel Department of Otorhinolaryngology, University Hospital Erlangen, Erlangen, Germany Th. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University of Dresden Medical School, Dresden, Germany 1069 10.4193/Rhin OBJECTIVE: This study aims to determine the long-term recovery rate of posttraumatic olfactory disorders and to evaluate whether a lateralized disorder influences recovery. METHOD: Olfactory function of 67 patients with posttraumatic olfactory disorders were examined twice using the 'Sniffin´ Sticks' test battery. Olfactory function was classified based on composite TDI (Threshold, Discrimination and Identification) score. Subjective impairment was rated by visual analogue scale ranging from 0 to 10. RESULTS: First and second examinations were conducted an average of 16.7 months and 74 months after trauma, respectively. From first to second examination, mean TDI score of the better nostril increased significantly, the number of patients with anosmia of the better nostril decreased, and number of hyposmic and normosmic patients increased. Subjective impairment decreased. Neither age, sex, nor side differences between nostrils affected improvement. CONCLUSION: After the follow-up period, in 27% of the patients the TDI score improved ≥ 6 points score and subjective impairment decreased. A follow-up period of more than 2 years is recommended.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Low meningitis-incidence in primary spontaneous compared to secondary cerebrospinal fluid rhinorrhoea 73 79 EN S.C. Poletti-Muringaseril Department of Otolaryngology Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland K. Rufibach C. Ruef D. Holzmann M.B. Soyka 1065 10.4193/Rhin OBJECTIVE: Spontaneous cerebrospinal fluid (CSF) rhinorrhoea is a separate clinical entity with elevated intracranial pressure as its most probable pathophysiological mechanism. Having the clinical impression of distinct courses of diseases in primary spontaneous (PS) compared to secondary CSF rhinorrhoea, our objective was to identify whether the two forms differ in the duration of CSF rhinorrhoea and the incidence of meningitis. METHODS: Chart review performed on all patients referred with a CSF leak to our tertiary-care medical center over a 20-year period from 1990 to 2010. RESULTS: In total, 58 cases suffering from CSF rhinorrhoea could be included. The aetiology was primary spontaneous in 23 (40%) and secondary in 35 (60%) patients. The duration of CSF rhinorrhoea was notably longer in patients with PS CSF rhinorrhoea. Moreover, we could show a significantly lower incidence of meningitis with PS CSF rhinorrhoea compared to the secondary group (annual incidence of 0.12 vs. 1.22 episodes). CONCLUSION: A significantly lower incidence and delayed onset of meningitis in patients suffering from PS CSF rhinorrhoea could be explained by an elevated intracranial pressure that hinders the ascension of bacteria. The closure of a leak in secondary CSF fistula seems more urgent than in PS CSF fistulas.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Local sclerotherapy with Polydocanol (Aethoxysklerol®) for the treatment of Epistaxis in Rendu-Osler-Weber or Hereditary Hemorrhagic Telangiectasia (HHT): 15 years of experience 80 86 EN D. Morais Service of Otorhinolaryngology, Valladolid University Hospital, Vallodolid, Spain T. Millas Service of Otorhinolaryngology, Valladolid University Hospital, Vallodolid, Spain R. Zarrabeitia HHT Unit, Sierrallana Hospital, Cantabria, Spain L.M. Botella Centro de Investigaciones Biológicas, CSIC, Madrid, Spain A. Almaraz Department of Preventive Medicine, Faculty of Medicine, Valladolid, Spain 1070 10.4193/Rhin Hereditary Haemorrhagic Telangiectasia or Rendu-Osler-Weber syndrome is a rare autosomal dominant vascular disease characterized by mucocutaneous and gastrointestinal telangiectases and localized arteriovenous malformations in lung, brain and liver. Epistaxis, due to rupture of telangiectases of the nasal mucosa, is the most frequent clinical manifestation, leading in many cases to severe impairment of the quality of life in the patients. Though several treatments have been used to reduce epistaxis, none have been completely effective, with the exception of polydocanol (Aethoxysklerol®) in submucosal or subpericondrial injections, which was first presented in 2000 with very good results. After fifteen years using polydocanol in submucosal injections on 45 patients and with nearly 300 injections, we have observed that in 95% of all cases, their nose bleeds improved with respect to frequency and quantity without any important side effects. There was just one case of septal perforation, another with increased septal perforation, and one patient who suffered from dizziness and blurred vision for a few minutes. In this paper the results obtained using this technique over a fifteen-year period will be presented and evaluated.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Human papillomavirus load and physical status in sinonasal inverted papilloma and squamous cell carcinoma 87 94 EN M. Hasegawa Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan Z. Deng Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan H. Maeda Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan Y. Yamashita Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan S. Matayoshi Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan A. Kiyuna Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan S. Agena Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan T. Uehara Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan M. Suzuki Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan 1063 10.4193/Rhin BACKGROUND: This study investigated prospectively the role of human papillomavirus (HPV) in paranasal inverted papilloma (IP). METHODS: HPV presence and viral load and physical status of HPV-16 were examined by polymerase chain reaction-based methods using fresh frozen samples obtained from 13 patients with IP (IP group), 11 with squamous cell carcinoma in the maxillary sinus (SCC group) and 39 with chronic inflammatory lesions (inflammatory group). RESULTS: The presence of the HPV genome was detected in 46.1%, 27.3% and 7.6% of patients in the IP, SCC and inflammatory groups, respectively. The IP group showed significantly higher HPV-positive rates than the inflammatory group. All types of HPV detected were high-risk HPV, especially HPV-16. The relative HPV-16 copy numbers varied from 2.5 to 1524.1 per 50 ng genomic DNA. The viral load was higher in the IP and SCC groups than in the inflammatory group. In the IP group, no significant relationship was found between HPV-16 viral load and clinical characteristics, or between physical status and clinical characteristics. One patient with IP and concomitant squamous cell carcinoma, however, showed high viral load and integration. CONCLUSIONS: HPV infection is involved in the pathogenesis of IP, and high viral load and integration of HPV have an important role in malignant lesion in association with IP.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Treatment of juvenile angiofibromas: 18-year experience of a single tertiary centre in Spain 95 103 EN F. Lopez Department of Otorhinolaryngology, Instituto Universitario de Oncología del Principado de Asturias. Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain V. Suarez Department of Otorhinolaryngology, Instituto Universitario de Oncología del Principado de Asturias. Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain M. Costales Department of Otorhinolaryngology, Instituto Universitario de Oncología del Principado de Asturias. Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain C. Suarez Department of Otorhinolaryngology, Instituto Universitario de Oncología del Principado de Asturias. 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 1059 10.4193/Rhin BACKGROUND: The management of juvenile angiofibroma (JA) has changed during the last decades but it still continues to be a challenge. The objective of this study was to review the used treatment and our outcomes. METHODS: From 1992 to 2010, 48 cases of JA were treated at our department. Charts were reviewed for standard demographic, tumour size and location, vascular supply and results of embolization, surgical approach, operative results, adjuvant therapies, recurrence and postoperative follow-up. RESULTS: Most tumours were Andrews-Fisch stages III and IV and surgery was used as the main treatment in all cases. We used an open surgical approach in 37 (77%) patients and 11 (23%) were treated endoscopically. The most common open approach used in this series was the subtemporal-preauricular approach. Until 1995, all tumours were operated on by a conventional open approach. Afterwards, early-stage tumours were operated on through an endoscopic approach. Ten patients were treated through surgery followed by radiosurgery. Two (4%) patients had recurrent disease. CONCLUSIONS: These tumours should be treated at centres with expertise in skull base surgery to achieve complete surgical resections with low morbidity. Radiosurgery after surgery seems to be a valuable option in the long-term control of some extended JAs.

International Rhinologic Society Rhinology 0300-0729 50 1 2012 3 1 Canine fossa trephine is a beneficial procedure in patients with Samter's triad 104 108 EN K.A. Seiberling Department of Otolaryngology, Loma Linda University Medical Center, Loma Linda, CA, USA C.A. Church M. Tewfik A. Foreman D. Chang M. Ghostine P.J. Wormald 1050 10.4193/Rhin BACKGROUND: Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcitrant maxillary sinusitis. CFT allows for disease clearance in areas of the maxillary sinus that are hard to reach with standard endoscopic techniques. The objective of this study was to compare the surgical outcome of CFT to standard middle meatal antrostomy (MMA) in matched patients with the severely diseased maxillary sinus. STUDY DESIGN: Prospective clinical study METHODS: Patients undergoing sinus surgery were enrolled in either the CFT or MMA group. All patients had nasal polyps, Lund Mackay score of 2 in the maxillary sinus, and nasal endoscopy showing the maxillary sinus full of polyps. The patients were followed and the maxillary sinus was graded endoscopically at 3, 6 and 12 months after the surgery. Length of surgery, disease recurrence and need for revision surgery was documented. RESULTS: Forty-two CFTs and MMA were performed in each group. At 6 and 12 months the CFT group demonstrated statistically significant improvement in nasal endoscopy scores. Six patients recurred by the one year mark in the MMA group, 4 of which underwent revision surgery. In the CFT group 2 patients recurred, one who underwent a unilateral revision CFT. Furthermore the CFT did not prolong the surgical time and was often faster than performing a MMA. CONCLUSION: CFT allows for clearance of all gross disease in the maxillary sinus and appears to improve postoperative outcome at 6 and 12 months and decrease the need for revision surgery.