International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 This and that ! 113 114 EN V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. 1092 10.4193/Rhin We have deliberately printed the June issue early so that it would be readily available for our European Rhinologic Society biennial meeting in Toulouse, which I very much hope you will be attending (www.ers-isian2012.com). Toulouse is a wonderful city (la Ville Rose) especially in July and is a cultural and gastronomic epicentre, which will provide us with a wonderful backdrop to what I know will be an excellent scientific meeting. Some of the topics covered in this issue will undoubtedly be the subject of discussion in the many plenary sessions, symposia, free papers and posters during the meeting.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Gene therapy and nasopharyngeal carcinoma 115 121 EN J. Hughes entre for Molecular Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom G. Alusi Y. Wang 1075 10.4193/Rhin In 2003, a non-replicating adenoviral gene therapy product received the world's first government licence for the treatment of head and neck cancer. Two years later approval was granted to a replication-selective adenovirus for the treatment of nasopharyngeal carcinoma in combination with chemotherapy. This review introduces the reader to gene therapy as an emerging treatment modality, and outlines its application to the management of nasopharyngeal carcinoma by examining recent pre-clinical and clinical research.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Allergic rhinitis and associated factors in schoolchildren from Bogotá, Colombia 122 128 EN A. Peñaranda Department of Otorrinolaringology, Fundación Santa Fe de Bogotá. Bogotá, Colombia G. Aristizabal E. Garcia C. Vasquez C.E. Rodriguez-Martinez C.L. Satizábal 1076 10.4193/Rhin BACKGROUND: Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of and the factors associated with self-reported allergic rhinitis symptoms in schoolchildren from Bogotá, Colombia. METHODOLOGY/PRINCIPAL: We followed the International Study of Asthma and Allergies in Childhood (ISAAC) methodology. Our sample included 3,256 children aged 6 - 7 and 3,830 adolescents aged 13 - 14 years. RESULTS: The prevalence of self-reported allergic rhinitis symptoms was 30.8% among children and 36.6% among adoles- cents. Factors associated with self-reported allergic rhinitis among children included current asthma and atopic dermatitis symptoms; use of acetaminophen in the first year of life and in the last 12 months; antibiotic use in the first year of life; high- school and university maternal education; smokers at home; and caesarean delivery. Among adolescents, associated factors included current asthma and atopic dermatitis symptoms; current acetaminophen use once per month; frequent fast-food consumption; cat exposure at home; and smoking. CONCLUSION: Further exploration of factors associated with allergic rhinitis symptoms is needed.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Prevalence of chronic rhinosinusitis in São Paulo 129 138 EN R.R. Pilan Department of Otorhinolaryngology and Ophthalmology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil F.R. Pinna T.F. Bezerra Department of Otorhinolaryngology and Ophthalmology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil R.L. Mori Department of Otorhinolaryngology and Ophthalmology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil F.G. Padua R.F. Bento Department of Otorhinolaryngology and Ophthalmology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil C. Perez-Novo Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Belgium C. Bachert R.L. Voegels Department of Otorhinolaryngology and Ophthalmology, University of São Paulo, Brazil 1085 10.4193/Rhin INTRODUCTION: Studies designed to investigate chronic rhinosinusitis (CRS) epidemiology play an important role to assess population's distribution and risk factors to result in the development and promotion of public health policies. METHOD: This study design is a survey carried out with a complex two-stage cluster sampling plan. Personal interviews were carried out with 2,003 individuals. The questionnaire included the epidemiological criteria for CRS. Demographic data, history of physician-diagnosed respiratory diseases (asthma, sinusitis, rhinitis), smoking, family income, educational attainment, and household characteristics were also evaluated. RESULTS: The overall response rate was 93.9% of the households. Mean age was 39.8 ± 21 years; 45.33% were male. The overall prevalence of CRS in the city of São Paulo was 5.51%. We found a significant association between diagnosis of CRS and diagnosis of asthma and CRS and diagnosis of rhinitis and a significant association between presence of CRS and belonging to the low-income subgroup. CONCLUSION: The municipality of São Paulo has an urban population of 11 million. According to the present study, the prevalence of CRS is 5.51%, which represents more than 500,000 individuals affected by this condition in the city.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 A prospective study of bacterial flora in nasal cavity of patients with persistent allergic rhinitis 139 146 EN M.B. Taylor Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore I.T. Tan Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore K.T. Chan L. Shen L. Shi D.Y. Wang 1074 10.4193/Rhin It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts. A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed. PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens. In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Lysozyme expression is increased in the sinus mucosa of patients with chronic rhinosinusitis 147 156 EN C.M. Woods Flinders ENT, Department of Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia V.S. Lee D.J. Hussey S. Irandoust E.H. Ooi L.W. Tan A.S. Carney 1079 10.4193/Rhin BACKGROUND: The presence of fungi and bacteria in the paranasal sinuses may contribute to ongoing inflammation. Lyso- zyme is an innate immune peptide with bactericidal and fungicidal activity. The expression of lysozyme in chronic rhinosinu- sitis (CRS) is poorly understood and deficiencies in lysozyme expression may contribute to the ongoing inflammation in CRS patients. OBJECTIVE: Determine lysozyme expression in sinus mucosa of normal and CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. METHODOLOGY: Sinus mucosa specimens (n = 82) were processed for standard histology, immunohistochemical localisation of lysozyme, immunofluorescent localisation of fungi, and qPCR analysis of lysozyme expression. RESULTS: CRS specimens displayed high-levels of lysozyme immunoreactivity in many of the abundant serous cells. Moderate levels were detected in some epithelial cells and inflammatory cells. Low levels were detected in some subepithelial glands of control specimens. No difference in immunoreactivity was detected between CRSwNP and CRSsNP specimens. Fungal elements were not visualised in any sinus specimen. qPCR analysis demonstrated variable lysozyme expression between individuals. CONCLUSIONS: Lysozyme protein expression is increased in patients with CRS, suggesting a defect in lysozyme expression is not responsible for the microbial colonisation often associated with CRS. The functional activity of lysozyme in CRS patients needs to be further investigated.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 22616076 Numerical simulation of humidification and heating during inspiration within an adult nose 157 164 EN F. Sommer Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Ulm, Germany R. Kröger ANSYS Germany GmbH, Darmstadt, Germany J. Lindemann Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Ulm, Germany 1077 10.4193/Rhin11.231 BACKGROUND: The temperature of inhaled air is highly relevant for the humidification process. Narrow anatomical conditions limit possibilities for in vivo measurements. Numerical simulations offer a great potential to examine the function of the human nose. OBJECTIVE: In the present study, the nasal humidification of inhaled air was simulated simultaneously with temperature distribution during a respiratory cycle. METHODS: A realistic nose model based on a multislice CT scan was created. The simulation was performed by the Software Fluent�. Boundary conditions were based on previous in vivo measurements. Inhaled air had a temperature of 20�C and relative humidity of 30%. The wall temperature was assumed to be variable from 34�C to 30�C with constant humidity saturation of 100% during the respiratory cycle. RESULTS: A substantial increase in temperature and humidity can be observed after passing the nasal valve area. Areas with high speed air flow, e.g. the space around the turbinates, show an intensive humidification and heating potential. Inspired air reaches 95% humidity and 28�C within the nasopharynx. CONCLUSION: The human nose features an enormous humidification and heating capability. Warming and humidification are dependent on each other and show a similar spacial pattern. Concerning the climatisation function, the middle turbinate is of high importance. In contrast to in vivo measurements, numerical simulations can explore the impact of airflow distribution on nasal air conditioning. They are an effective method to investigate nasal pathologies and impacts of surgical procedures.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Combined transnasal transcervical robotic dissection of posterior skull base: feasibility in a cadaveric model 165 170 EN I. Dallan Otorhinolaryngologic Unit, University of Insubria, Italy P. Castelnuovo V. Seccia P. Battaglia F. Montevecchi M. Tschabitscher C. Vicini 1062 10.4193/Rhin The current surgical trend is to expand the variety of minimally invasive approaches and, in particular, the possible application of robotic surgery in head and neck surgery. For this purpose, we explored the feasibility of a combined transcervical-transnasal approach to the posterior skull base, using the da Vinci Surgical System in 3 cadaver heads. Superb visualization of the sellar, suprasellar and clival regions was possible in all three specimens. The trocars' placement through a transcervical port made a more cephalad visualization possible, eliminating the need to split the palate. The advantages of robotic surgery applied to the posterior cranial fossa are similar to the ones already clinically experienced in other districts (oropharynx, tongue base), in terms of tremor-free, bimanual, precise dissection. The implementation of instruments for bony work will definitely increase the applicability of such a system in the forthcoming years.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Oral and intranasal steroid treatments improve nasal patency and paradoxically increase nasal nitric oxide in patients with severe nasal polyposis 171 177 EN I. Alobid Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain P. Benitez A. Valero R. Muñoz C. Langdon J. Mullol 1073 10.4193/Rhin INTRODUCTION: Recently, we demonstrated that acoustic rhinometry (AR) measurements correlated with nasal cavity volumes in patients with nasal polyposis (NP). The aim of the present study was to evaluate whether AR and nasal nitric oxide (nNO) are useful methods in monitoring and follow-up of medical treatment of NP. MATERIAL AND METHODS: Patients with severe nasal polyps were randomized into two groups after a 4-week steroid washout period (w0): a treatment group received oral prednisone for 2 weeks (w2) and intranasal budesonide for 12 weeks (w12) while the control group received no steroid treatment. Nasal volume (Vol 0-6), minimum cross-sectional area (mCSA), nNO, peak nasal inspiratory flow (PNIF), nasal obstruction, and smell loss were evaluated. RESULTS: At w2, the treatment group showed a significant increase of vol 0-6 compared to w0 and the control group. The mCSA area also increased compared to w0 and the control group. At w12, the improvement in vol 0-6 and mCSA was maintained after intranasal steroids compared to w0. At w2, the treatment group showed a paradoxical increase of nNO compared to w0 and the control group. At w12, this increase was maintained by intranasal steroids. CONCLUSION: Both oral and intranasal steroid treatments improve nasal patency and paradoxically increase nNO, by opening the ostiomeatal complex. This suggests that AR and nNO are useful methods in the monitoring and follow-up of patients with NP.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Olfaction after endoscopic sinus surgery: long-term results 178 184 EN H.R. Briner N. Jones D. Simmen 1090 10.4193/Rhin Loss of olfactory function is one of the main symptoms in patients with chronic rhinosinusitis. This prospective, non-ran- domized interventional study reports five years results of olfaction of patients with chronic rhinosinusitis who underwent endoscopic sinus surgery in conjunction with topical medical treatment. Forty-five patients with chronic rhinosinusitis who underwent endoscopic sinus surgery were evaluated preoperatively, after three months and 34 (76%) of them after five years. Olfactory function was assessed by a subjective visual analogue scale, by a screening test of olfaction with Smell Diskettes and by measuring the N-Butanol threshold. Patient's subjective sense of olfaction using a visual analogue scale was improved in 79% at 5 years. Objective measurements by Smell Diskettes improved in 53% at 5 years whilst the quantitative measure- ment by the N-Butanol threshold improved in 85% at 5 years. The high percentage of patients with improvement of olfaction five years after surgery indicates that endoscopic sinus surgery in conjunction with continued topical treatment leads to a long term improvement of the sense of smell. However, it was found that - measured by the sensitive N-Butanol threshold - up to 9% had no improvement and 6% had deterioration in their olfaction at 5 years after endoscopic sinus surgery. This fact has to be considered in the preoperative counselling of patients.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Are too many septal deviations operated on? A retrospective patient's satisfaction questionnaire with 11 years follow-up 185 190 EN N.M. Toyserkani Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Denmark T. Frisch 1055 10.4193/Rhin BACKGROUND: Not much is known about long-term satisfaction of septoplasty. The goalof this study was to assess disease specific quality of life outcomes as well as satisfaction at more than 10 years follow-up after septoplasty. METHODOLOGY/PRINCIPAL: The study was conducted as a retrospective questionnaire study (based on the NOSE scale) in which a questionnaire was sent to every patient and followed up by a telephone interview conducted in a tertiary otorhinolaryngologic clinic. RESULTS: 238 out of 369 patients who underwent septoplasty accepted to participate of which 222 were eligible. We found a significant reduction in NOSE score from 56.9 before surgery to 31.9 at follow-up. 68.0% experienced improved nasal breathing and 55.9% were satisfied with the overall outcome. Predictive analysis showed that only severity of symptoms before surgery was predictive of all final outcome parameters. CONCLUSIONS: Long-term outcome of septoplasty appears to be in line with shorter follow-up. Surprisingly a sizable difference was noted between rate of satisfaction and improvement in nasal breathing. It is important that the surgeon and patient have the same expectations to septoplasty as to avoid any inappropriate disappointment, which is more likely to occur if symptoms are not severe.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 The microdebrider, a step forward or an expensive gadget? 191 198 EN M.E. Cornet Department of Otorhinolaryngology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands S.M. Reinartz C. Georgalas E. van Spronsen Department of Otorhinolaryngology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1086 10.4193/Rhin BACKGROUND: Although the use of the microdebrider (shaver) is well known in endoscopic sinus surgery (FESS), there is lack of evidence from comparative studies focussing on the difference in operating time, intra-operative blood loss and user- friendliness between the microdebrider and traditional operating techniques. In this study we compared the use of the microdebrider to conventional instruments in FESS in these areas. METHODS: A prospective randomised double blind controlled trial in 60 patients with chronic rhinosinusitis with nasal poly- posis (CRSwNP) undergoing bilateral FESS. Each subject received FESS using only traditional instruments (Blakseley forceps) on one side and the other side with the additional use of the microdebrider, this way serving as their own control. The primary outcome was operation time, intra-operative blood loss and user friendliness and secondly safety and postoperative healing with a follow-up period at different time points up to three months postoperative. RESULTS: We found a 37% longer operating time when operating without a microdebrider. This difference was highly signifi- cant. The microdebrider scored significantly higher on every different parameter of user friendliness, except on the prepara- tion of the instrument needed before surgery. For estimated blood loss during surgery we found no differences. Also there was no significant difference in postoperative healing at any point of time. CONCLUSIONS: This study demonstrates that operating patient with CRSwNP with the microdebrider is efficient and that the microdebrider at the same time is safe and easy to use.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Juvenile angiofibroma: major and minor complications of preoperative embolization 199 202 EN A.I. Ogawa Division of Otorhinolaryngology, University of São Paulo, Brazil M.A. Fornazieri L.V. da Silva F.R. Pinna R.L. Voegels Department of Otorhinolaryngology and Ophthalmology, University of São Paulo, Brazil L.U. Sennes P.P. Júnior J.G. Caldas 1087 10.4193/Rhin INTRODUCTION: Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. AIM: To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. METHODS: Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. RESULTS: All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. CONCLUSION: In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Sinonasal malignant melanoma: an analysis of 115 cases assessing outcomes of surgery, postoperative radiotherapy and endoscopic resection 203 210 EN V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. E.J. Chisholm D.J. Howard University College London, Ear Institute, London, United Kingdom W.I. Wei 1091 10.4193/Rhin BACKGROUND: Melanomas account for 4% of sinonasal malignancies. We present the largest single institution series reported thus far and analyze the outcome with reference to lymph node involvement, radiotherapy and endoscopic resection. METHODOLOGY: Survival and recurrence data were analyzed on sinonasal melanoma cases collected from 1963-2010 to com- pare treatment strategies and to ascertain factors predicting outcome. RESULTS: 115 cases (mean age 65.9) were treated at our institution during this period. All underwent surgical resection of the tumour, 31 (27%) endoscopically, and 51 (44%) also received radiotherapy. Five year overall survival was 28% and disease-free survival was 23.7%. Local control was achieved for a median of 21 months, 5-year disease control rate of 27.7%. Endoscopi- cally resected cases showed a significant overall survival advantage up to 5 years. Radiotherapy did not improve local control or survival. Cervical metastases conferred a dramatically worse outcome. CONCLUSIONS: Endoscopic resection of sinonasal melanoma does not prejudice outcome. The role of radiotherapy is unproven.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Endonasal endoscopic approach for removal of intranasal nasal glial heterotopias 211 217 EN N.-X. Bonne Department of Pediatric Otolaryngology, Jeanne de Flandre Children Hospital, University Hospital of Lille, Lille, France S. Zago G. Hosana M. Vinchon T. Van den Abbeele P. Fayoux 1083 10.4193/Rhin BACKGROUND: Nasal Glial Heterotopias also called Nasal Gliomas (NG) are rare congenital tumours of the midline frontonasal space arising from a normal neurectodermal tissue entrapped during the closure of the anterior neuropore. Historically, such tumours were approached using a frontal craniotomy. The study aims to evaluate a fully endonasal endoscopic approach for intranasal NG removal. METHODS: We report a retrospective study of intranasal and mixed NG treated using endonasal endoscopic techniques and computer assisted navigation system from 1997 to 2010 in two tertiary referral centres of Paediatric Otolaryngology. All tumours were investigated using two imaging modalities: craniofacial MRI and CT-scan. RESULTS: Fifteen patients were included (0 to 14 years of age). All tumours were totally removed and no recurrence was observed after a mean follow-up of 32 months. A skull base plasty was done in 13 cases to cover a bony defect or to treat a cerebrospinal leak. Nasal packing was usually removed 24 hours after surgery and all children were discharged home after 2 to 4 days. CONCLUSION: Removal of intranasal NGs using an endonasal endoscopic approach and a dedicated computer assisted navigation system is a safe and efficient procedure. Early management is recommended to treat neonatal airway obstruction.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 How we do it: Mini Posterior Septal Artery Flap for coverage after transphenoidal approaches 218 220 EN J.D. Khetani McMaster University, Hamilton, Ontario, Canada D.C. Micomonaco University of Alberta, Edmonton, Alberta, Canada E.D. Wright University of Alberta, Edmonton, Alberta, Canada 1068 10.4193/Rhin We propose a novel posterior nasal flap for use in endoscopic approaches to the sella and parasellar region that involve resection of the sphenoid face and a posterior nasal septectomy. It involves elevation of the mucosa of the posterior septum and sphenoid face with preservation of the angiosome based on the posterior septal artery. This flap has the advantages of maximal mucosal preservation in order to optimize postoperative healing and has been demonstrated to permit future elevation of a complete naso-septal flap for reconstruction of anterior skull base defects. An illustration of the technique is provided.

International Rhinologic Society Rhinology 0300-0729 50 2 2012 6 1 Society News 221 223 EN 1089 10.4193/Rhin OBITUARY - Jacques Valère Joseph Corneille Willemot (October 19,1928 - September 3, 2011) The view from the Netherlands - a short summary of the national rhinologic activities in the Netherlands Agenda of the General Assembly in Toulouse Meeting Calender