International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 The 25th European Rhinologic Society Congress 2014 1 2 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1210 10.4193/Rhin14.500 In three months, June 22-26th, we will celebrate the 50th birth- day of the European Rhinologic Society and the 25th congress of the ERS. The years 1963/1964 were very important years for Rhinology in Europe. Prof. Ewout Van Dishoeck first decided to have a journal to enable to publish important congress proceedings in Rhinology in 1963 (for further details please read the society news by Prof. Huizing in the Rhinology website and on page 94 of this issue). In 1964, the 1st congress of the European Rhinologic Society at Leiden was organized and the papers presented were published in the second issue of Rhinology. After successful congresses in Geneva (2010) and Toulouse (2012), now we are looking forward to the special anniversary edition in Amsterdam. The theme of the congress is: "The nose as an interface". An interface is a point where two systems, sub- jects, organizations, etc. meet and interact. The time that rhino- logists were mainly active in rhinosurgery has long passed. The 25th European Rhinologic Society Congress 2014 will certainly contain a lot of important and new information on the typical rhinology subjects.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases 3 8 EN E.P. Prokopakis Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklio, Crete, Greece I.M. Vlastos Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklio, Crete, Greece B.J. Ferguson Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, USA G. Scadding Department of Allergy and Medical Rhinology, Royal National TNE Hospital, London WC1X8DA, United Kingdom H. Kawauchi Department of Otorhinolaryngology, Shimane University, Faculty of Medicine, Izumo, Japan C. Georgalas Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam N. Papadopoulos Department of Pedo-Allergiollogy, University of Athens, Greece P.W. Hellings Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium 1189 10.4193/Rhin BACKGROUND: Our objective is to present recent research findings on recalcitrant chronic rhinosinusitis (CRS) in relation to "Severe Chronic Upper Airway Disease" (SCUAD). METHODOLOGY: Literature review using Medline and Embase databases (search terms 'chronic rhinosinusitis", "chronic sinusitis" or "Severe Chronic Upper Airway Disease") limited to articles published in the English language. RESULTS: Complex pathophysiological mechanisms characterize various forms of chronic rhinitis and rhinosinusitis (CRS), where inflammation persists in spite of adequate medical treatment. In these cases, a multifactorial etiology often underlies the development of sino-nasal inflammation. The interaction between chronic upper and lower airway inflammation via neurogenic and systemic pathways may complicate the therapy of these patients, and lead to insufficient symptom control. CONCLUSION: The recently introduced definition of "Severe Chronic Upper Airway Disease" (SCUAD) increases awareness of those patients with persistent inflammation and symptoms despite guideline-driven pharmacologic treatment. The concept of SCUAD may prove helpful in directing research towards clarifying the definition, diagnosis and pathophysiology of rhinitis and rhinosinusitis, their limits and overlap. In this review, a hypothesis on SCUAD immunopathology is also presented.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 The value of antifungal therapy in allergic fungal rhinosinusitis 9 18 EN S.G. Mistry ENT Registrar, Yorkshire & the Humber Deanery, Bradford Royal Infirmary, Bradford, United Kingdom B.N. Kumar ENT Consultant, Royal Albert Edward Infirmary, Wigan, United Kingdom 1188 10.4193/Rhin BACKGROUND: Allergic fungal rhinosinusitis (AFS) is considered to part of the disease spectrum of chronic rhinosinusitis, which affects between five to fifteen per cent of the population. Currently, there is uncertainty relating to the pathological process and therefore optimal management of AFS. Studies assessing antifungal use have shown mixed results. The aim of this review is to assess the effect of antifungals on patients with AFS. METHODS: A systematic review of the literature to include all published trials searching Pubmed, Medline (Ovid), CINAHL (EBSCO) and the Cochrane central register of controlled trials (CENTRAL) databases. RESULTS: Sixteen studies (two systematic reviews, two meta-analysis, four randomised controlled trials, five prospective cohort studies and three retrospective studies) were included in this review. There was found to be no overall benefit of topical or oral antifungals upon endoscopic findings or patient reported outcome measures in AFS. There were no statistically significant differences in adverse effect profiles between treatment and control groups. CONCLUSION: There is limited evidence to support the use of topical or oral antifungal agents in patients with AFS. Future research recommendations include large multicentre randomised trials with better matched patient groups and appropriate dosage and timing of antifungals.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Treatment with a topical glucocorticoid, budesonide, reduced the variability of rhinomanometric nasal airway resistance 19 24 EN H.L. Thulesius Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Växjő Central Hospital, Sweden A. Cervin Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Lund University, Sweden M. Jessen Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Växjő Central Hospital, Sweden 1186 10.4193/Rhin14.1186 BACKGROUND: Previous rhinomanometry studies have shown significant long-term variability of the nasal airway resistance and questioned the clinical validity of rhinomanometry. Research question: Could treatment with a topical glucocorticoid, budesonide, influence the long-term variability of active anterior rhinomanometry? METHODS: Eight healthy volunteers participated in an unblinded controlled trial without, and later with, nasal budesonide once a day for 5 months. Their nasal airway resistance was measured every two weeks with active anterior rhinomanometry before and after decongestion with xylometazoline hydrochloride. In addition, subjective nasal obstruction was evaluated on a Visual Analogue Scale before each measurement. The participants had a year earlier been investigated with rhinomanometry every two weeks during 5 months but without budesonide treatment. We compared the variability of nasal airway resistance during the two periods with and without treatment with topical budesonide. RESULTS: Budesonide significantly reduced mean nasal airway resistance and the standard deviation of the mean after decongestion for 6 of 8 participants. The mean reduction of the nasal airway resistance was 40% for the decongested nasal cavity compared to the period without treatment with nasal budesonide. Subjective nasal obstruction assessed by Visual Analogue Scale was reduced in 3 of the 8 participants. CONCLUSION: The variability of nasal airway resistance was significantly reduced by treatment with topical budesonide for 6 out of 8 healthy volunteers participating in an unblinded repeated 5 month trial where the participants served as their own controls.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses 25 30 EN G. Ottaviano Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom. E. Nardello Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences, University of Padova, Padova, Italy G. Frasson Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy A. Staffieri Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy G.K. Scadding Ear Institute, University College London, London, United Kingdom 1176 10.4193/Rhin AIMS: Peak Nasal Inspiratory Flow (PNIF) is an easy method to assess nasal patency. Normative unilateral PNIF data in adults have been proposed. The study purpose was to compare PNIF and unilateral PNIF values to total and unilateral nasal resistances measured by anterior active rhinomanometry (AAR) in subjects with and without nasal obstruction to see whether unilateral PNIF is sensitive to detect nasal obstruction. METHODS AND RESULTS: Measurements of PNIF, unilateral PNIF and AAR were performed in 125 volunteers. Seventy of them were healthy subjects not complaining of nasal symptoms and entered into the study as the 'normal' group. The other group consisted of fifty-five symptomatic subjects. Data were analysed to show the correlation between PNIF, unilateral PNIF and nasal resistances. The ability of PNIF and AAR in predicting pathologies were compared by receiver operating characteristic (ROC) analysis indicating that PNIF and AAR have a similar and significant power to discriminate pathologic from healthy subjects. CONCLUSION: The measurement of unilateral PNIF could be a helpful method to support the diagnosis of nasal blockage also in those cases with single nostril obstruction, but, in cases of doubt, AAR should also be performed to improve diagnostic accuracy.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Improvement of nasal breathing and patient satisfaction by the endonasal dilator Airmax® 31 34 EN P.W. Hellings Department of Otorhinolaryngology, Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium, Department of Otorhinolaryngology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands G.J. Nolst Trenité Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Ghent, Belgium 1178 10.4193/Rhin BACKGROUND: Patients suffering from nasal obstruction due to external nasal valve dysfunction may benefit from either corrective surgery or a conservative approach with a nasal dilator. At present, devices for widening the external nasal valve region can be applied externally or endonasally. It remains unknown to what extent the endonasal dilator Airmax® objectively improves the nasal flow and can be offered as an alternative for surgery. METHODOLOGY: Thirty patients suffering from nasal obstruction due to external nasal valve problems were proposed to use the nasal dilator for 4 weeks as an alternative for corrective surgery. The improvement of nasal flow by the dilator was evaluated by measuring the peak nasal inspiratory flow (PNIF). Then, patients were asked for their willingness to continue to use the nasal dilator or to undergo nasal valve surgery. RESULTS: The endonasal dilator improved the mean PNIF from baseline values with a mean increase of 176.1 %. After a 4 week trial period, 19 of 30 patients expressed the intention to continue the use of the nasal dilator. Inappropriate size, local irritation and/or aesthetic nasal complaints were mentioned by the other patients as reasons for discontinuation of using the nasal dilator. CONCLUSION: The endonasal dilator Airmax® represents a powerful device to improve nasal breathing in the target patients and therefore represents a good alternative for corrective surgery.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Clinical analysis of submucosal Medpor implantation for empty nose syndrome 35 40 EN Y.Y. Tam Department of Otolaryngology, Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Kwei-Shan, Tao-Yuan, Taiwan T.J. Lee Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan C.C. Wu Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan P.H. Chang Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan Y.W. Chen Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan C.H. Fu Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan C.C. Huang Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan 1184 10.4193/Rhin BACKGROUND: Empty nose syndrome (ENS) describes symptomatology and radiographic findings after surgeries on turbinates. The treatment of ENS is still debatable. PURPOSE: To analyse clinical outcomes of submucosal Medpor® implantation for ENS. METHODS: A total of 18 patients underwent submucosal Medpor® implantation from 2006 to 2011. We applied SNOT-22 (Sino-Nasal Outcome Test) for statistical survey of the patients' symptoms before and after surgery. RESULTS: Two patients were lost to follow up after the surgery. Most of the patients developed ENS-related symptoms gradually within 2 years to 16 years after the previous nasal surgery or treatment. The sites of submucosal implantation are mainly septum and nasal floor, unilaterally or bilaterally. There is a significant improvement of SNOT-22 pre-operatively to one year post-operatively. CONCLUSIONS: The symptomatolgy remains the most important point when dealing with patients with ENS. Submucosal implantation of Medpor® is a feasible surgical treatment to ENS. A positive cotton test is suggested for the surgical indication and planning.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Olfactory source localization in the open field using one or both nostrils 41 47 EN A. Welge-Lüssen Department of Otorhinolaryngology, University Hospital Basel, Switzerland G.L. Looser Department of Otorhinolaryngology, University Hospital Basel, Switzerland B. Westermann Department of Neurosurgery, University Hospital Basel, Switzerland T. Hummel Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School, Dresden, Germany 1192 10.4193/Rhin OBJECTIVE: This study aims to examine humans ́ abilities to localize odorants within the open field. METHODOLOGY: Young participants were tested on a localization task using a relatively selective olfactory stimulus (2-phenylethyl-alcohol, PEA) and cineol, an odorant with a strong trigeminal component. Participants were blindfolded and had to localize an odorant source at 2 m distance (far-field condition) and a 0.4 m distance (near-field condition) with either two nostrils open or only one open nostril. RESULTS: For the odorant with trigeminal properties, the number of correct trials did not differ when one or both nostrils were used, while more PEA localization trials were correctly completed with both rather than one nostril. In the near-field condition, correct localization was possible in 72-80% of the trials, irrespective of the odorant and the number of nostrils used. Localization accuracy, measured as spatial deviation from the olfactory source, was significantly higher in the near-field compared to the far-field condition, but independent of the odorant being localized. CONCLUSION: Odorant localization within the open field is difficult, but possible. In contrast to the general view, humans seem to be able to exploit the two-nostril advantage with increasing task difficulty.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Staphylococcus aureus is a major pathogen in severe acute bacterial rhinosinusitis 48 52 EN A. Byrjalsen Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospitals, Aarhus, Denmark T. Ovesen Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospitals, Aarhus, Denmark T. Kjaergaard Department of Otorhinolaryngology, Head & Neck Surgery, Aarhus University Hospitals, Aarhus, Denmark 1183 10.4193/Rhin PURPOSE: The purpose of this study was to investigate the epidemiology and microbiology of severe acute bacterial rhinosinusitis in patients admitted to a Danish tertiary hospital. METHODS: A retrospective study was performed including all cases of acute rhinosinusitis admitted to the ENT-department of Aarhus University Hospital, in the period 2001 to 2011. RESULTS: In total, 143 cases of acute rhinosinusitis were identified of which 51% were children. The most prevalent bacterial strains were Staphylococcus aureus followed by group A streptococcus, Haemophilus influenzae and Streptococcus pneumonia. Morexella catarrhalis was only rarely cultured. Anerobes were not assessed routinely. Of all patients, 47.8% presented with orbital complications and 2.1% developed intracranial complications. Patients infected with group A streptococcus had significantly higher leukocyte and neutrophil counts than other patients. All cultured S. aureus were resistant to penicillin, but sensitive to methicillin. CONCLUSION: Our results imply that S. aureus and group A streptococcus are important pathogens in severe and complex cases of ABRS, in addition to the accepted pathogens S. pneumoniae and H. influenzae. On the contrary M. catarrhalis appears less significant. These findings have important implications regarding the selection of relevant treatment strategy in secondary care, which may currently be underestimating the role of S. aureus.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Modified Lund Mackay Postoperative Endoscopy Score for defining inflammatory burden in chronic rhinosinusitis 53 59 EN K. Snidvongs Australian School of Advanced Medicine, Macquarie University Hospital, Sydney, NSW, Australia D. Dalgorf 3 Department of Otolaryngology-Head and Neck, Skull Base Surgery, St Vincent's Hospital, Australia L. Kalish Department of Otolaryngology, Concord General Hospital, Australia, Sydney Medical School, University of Sydney, Australia R. Sacks Australian School of Advanced Medicine, Macquarie University, Australia, Department of Otolaryngology, Concord General Hospital, Australia, Sydney Medical School, University of Sydney, Australia E. Pratt Sydney School of Public Health, University of Sydney, Australia R.J. Harvey Australian School of Advanced Medicine, Macquarie University, Australia , Department of Otolaryngology-Head and Neck, Skull Base Surgery, St Vincent's Hospital, Australia, St Vincent's Centre for Applied Medical Research, University of New South Wal 1182 10.4193/Rhin OBJECTIVE: The Lund Mackay Postoperative Endoscopy Score (LMES) for chronic rhinosinusitis (CRS) is a poor measure of the patient experience. A proposed Modified Lund Mackay Postoperative Endoscopy Score (MLMES) aims to better describe the inflammatory burden in CRS. METHODS: A prospective study on CRS patients having endoscopic sinus surgery (ESS) was conducted. Endoscopy was recorded at the 6th and the 12th week post-op. The MLMES recorded changes in mucosa, mucus and purulence for each of the maxillary, ethmoid, sphenoid, frontal sinuses and olfactory fossa in post-ESS cavities. The correlation between MLMES and visual analogue scale of total rhinosinusitis symptoms, global anchor score of nasal function, Sino-Nasal Outcome Test 22 (SNOT-22) and nasal symptom score was analyzed. The inter-observer reliability, intra-observer reliability and correlation between the change in MLMES and in subjective measures were also investigated. RESULTS: Thirty patients were assessed. The MLMES significantly correlated with visual analogue scale, SNOT-22, global anchor and nasal symptom score. The change in MLMES correlated with the change in SNOT-22 and nasal symptom score. The inter-observer and intra-observer reliability were excellent. CONCLUSION: Objectives measurements for post-ESS patients can be reconsidered to represent the cumulative inflammatory burden of all sinuses. The proposed MLMES represents total sinus inflammatory burden and correlates well with patient reported outcome measures.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Patient comfort following FESS and Nasopore® packing, a double blind, prospective, randomized trial 60 65 EN K.G. Kastl HNO-Praxis 5 Seen Land, Gilching, Germany M. Reichert Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, University of Ulm, Ulm Germany M.O. Scheithauer Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, University of Ulm, Ulm Germany F. Sommer Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, University of Ulm, Ulm Germany U. Kisser Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany T. Braun Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany M. Havel Department of ORLHNS, Munich University Hospital, Munich, Germany A. Leunig Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany 1198 10.4193/Rhin13.020 BACKGROUND: The use of nasal packing after functional endoscopic sinus surgery (FESS) is often associated with pain and a feeling of pressure for patients. The aim of the present work was to investigate a modern wound dressing made of polyurethane (Nasopore®) that makes removal of the nasal packing unnecessary and is focussed on patient comfort. METHODOLOGY: Following bilateral FESS, after randomisation, one side was packed with Nasopore® while the other side was without packing as a control. The following parameters from 47 patients were determined daily in two centres from post-operative day 1 for the duration of the inpatient stay in a double-blinded setting: side-specific post-operative bleeding, nasal breathing and feeling of pressure as well as the general parameters sleep disturbance, headaches and general well-being. Which side patients considered subjectively the better was also recorded. RESULTS: No significant differences were determined between the two sides in terms of the rates of post-operative bleeding and nasal breathing. The feeling of pressure was slightly less on the side packed with Nasopore® on post-operative days 2 and 3. No trend could be observed regarding which side patients described as being subjectively better. CONCLUSION: There were only slight differences in patient comfort between the Nasopore® side and the control. Because the feeling of pressure in the midface was significantly less and there were no complications, this suggests there is greater patient comfort when using Nasopore® compared to using no nasal packing.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Illness perception, mood and coping strategies in allergic rhinitis: are there differences among ARIA classes of severity? 66 71 EN F. Braido Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genova, Italy I. Baiardini Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genova, Italy N. Scichilone Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 'Villa Sofia-Cervello' Hospital, Palermo, Italy A. Musarra Allergy Unit, National Healthcare System, Reggio Calabria, Italy S. Menoni University of Genoa, Biostatistic Unit, Department of Health Science, Genoa, Italy E. Ridolo Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy F. Gani Allergy Unit, Respiratory Diseases Division, A.O.U. San Luigi , Orbassano, Torino, Italy V. Pravettoni Clinical Allergy and Immunology Unit, Foundation Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy G. Colombo Allergy and Immunology Department, IRCCS Fondazione San Raffaele del Monte Tabor, Milan, Italy M. Crivellaro Servizio di Allergologia Dipartimento di Medicina Ambientale e Salute Pubblica, Università di Padova, Padova, Italy G.E. Senna Allergy Service, Verona Major Hospital, Verona, Italy F. Fumagalli ASL 2 Savonese, Savona, Italy O. Rossi Department of Biomedicine, AOUC, University of Florence, Florence, Italy G.W. Canonica Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genova, Italy 1187 10.4193/Rhin BACKGROUND: This study was designed to assess if illness perception, mood state and coping strategies differ according to allergic rhinitis (AR) persistence and severity. METHODS: Illness perception, mood profiles, coping behaviors and rhinitis symptoms were assessed by means of validated tools in patients classified according to ARIA guidelines. RESULTS: Two hundred and thirty-one patients underwent data analysis. No difference in age, sex, socio-economic status, smoking habits was detected comparing patients according to AR severity, duration or 4 ARIA classes. Patients with intermittent AR reported higher scores than those with persistent AR in confusion-bewilderment of POMS; patients with moderate/severe rhinitis had significantly higher scores than those with mild rhinitis in T5SS, Identity and Consequences. No differences were detected in all assessed outcomes in the 4 ARIA classes. CONCLUSIONS: The patient's perspective about AR is independent of persistence and severity of symptoms. This may explain why AR remains under-diagnosed and under-treated, even in its most severe forms. Self-management plans should consider the patient's perspective.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Nationwide survey on immunotherapy practice by ENT specialists 72 77 EN M. Cornelis Department of Otorhinolaryngology, Head and Neck surgery, University hospitals Leuven, Leuven, Belgium Ph. Rombaux Department of Otorhinolaryngology, Head and Neck surgery, University hospitals St-Luc, Brussels, Belgium M. Jorissen Department of Otorhinolaryngology, Head and Neck surgery, University hospitals Leuven, Leuven, Belgium P.W. Hellings Department of Otorhinolaryngology, Head and Neck surgery, University hospitals Leuven, Leuven, Belgium 1185 10.4193/Rhin BACKGROUND: According to the Federal Institution of Health Insurance, ENT doctors perform more skin prick tests for the diagnosis of allergic rhinitis (AR) than other medical specialties in Belgium. However, immunotherapy (IT) is not practiced by all. This study aims to obtain insight into IT practice by ENT doctors, the type of IT performed and the reasons not to perform IT. METHODOLOGY: A questionnaire was sent to all registered ENT doctors of Belgium (n=648), involving questions on type and duration of ENT practice, geography and gender. In addition, the questionnaire informed about diagnosis of AR, indication for IT, type of IT performed, and reasons not to perform IT and referral pattern. RESULTS: The response rate among ENT doctors was 54%, with 7% of responders being excluded as they do not diagnose AR. 81% of Belgian ENT doctors make the indication for IT in AR patients, with 19% neglecting the indication for IT in AR patients. The two main reasons for not indicating IT are lack of expertise and the perception of high costs associated with IT. 70% of ENT specialists are practicing IT themselves, with sublingual IT being mostly performed. Interestingly, IT is mostly frequently performed by those ENT doctors with long-standing ENT practice, in private practice and in Wallonia. CONCLUSION: Despite the high prevalence of AR in ENT practice, IT is most frequently performed by ENT doctors with longstanding practice, working in private practice and/or in the French speaking part of Belgium. Among the different types of IT, sublingual IT is the most frequently performed means of IT by ENT doctors.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Characterisation of patients with endoscopy-negative, computer tomography-negative midfacial segment pain using the sino-nasal outcome test 78 83 EN S.C. Leong Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Aintree, Liverpool, United Kingdom H.K. Tsang Department of Anaesthesiology and Pain Management, Royal Liverpool University Hospital, Liverpool, United Kingdom M.D. Wilkie Department of Otorhinolaryngology - Head and Neck Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom G. Banhegyi Department of Otorhinolaryngology - Head and Neck Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom 1204 10.4193/Rhin13.123 BACKGROUND: The purpose of this study was to qualitatively characterise patients with midfacial segment pain (MSP) using the Sino-Nasal Outcome Test (SNOT). The data will provide a detailed overview of the physical and psychological impact on patients' well-being, and how it compares with the normal, healthy population. METHODS: Suitable patients were prospectively identified from the Multi-disciplinary Facial Pain Clinic at the Royal Liverpool University Hospital, based on the diagnostic criteria for MSP. The pre-treatment SNOT-22 of these patients were also compared to patients with chronic rhinosinusitis and normal healthy volunteers. RESULTS: Twenty-nine consecutive patients with a diagnosis of MSP were identified, and compared with 30 CRS patients and 34 healthy volunteers. The average SNOT-22 scores of MSP and CRS patients were higher than normal healthy volunteers. Patients with CRS had the highest rhinological subscale SNOT scores compared to normal healthy volunteers and MSP. Conversely, the reported ear and facial symptoms of MSP patients were most unfavourable. A similar trend was observed in reported sleep function where MSP patients recorded higher subscale scores than the other two cohorts. The subscale mean score for psychological function of MSP patients was not significant when compared to the mean score of patients diagnosed with CRS. CONCLUSION: MSP has an adverse impact on both physical and psychological well-being. The subtle differences in the SNOT sub-scores between MSP and CRS have provided greater insight into the character and disease impact of MSP. We propose that the SNOT may be suitably utilised in MSP to document disease severity and measure response to treatment.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Validation of a symptom-score questionnaire and long- term results of endoscopic dacryocystorhinostomy 84 89 EN E. Penttilä Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Finland G. Smirnov Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Finland, Oivauni Sleep Clinic, Kuopio, Finland J. Seppä Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Finland H. Tuomilehto Department of Otorhinolaryngology, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Finland, Oivauni Sleep Clinic, Kuopio, Finland H. Kokki Department of Anesthesia and Operative Services, Kuopio University Hospital, and Institute of Clinical Medicine, University of Eastern Finland, Finland 1191 10.4193/Rhin BACKGROUND: Endoscopic dacryocystorhinostomy (EN-DCR) is a commonly used procedure in the treatment of nasolacrimal duct obstruction (NLDO). However, there is no generally accepted disease-specific questionnaire for assessing outcomes. METHODOLOGY: We conducted a prospective study to initially validate a Nasolacrimal Duct Obstruction Symptom Score question- naire (NLDO-SS) and to evaluate the long-term success of EN-DCR procedures. Seventy-six patients (86 eyes) were evaluated in follow-up visits at 1-8 years after EN-DCR. The patients completed the NLDO-SS questionnaire twice, first, at home and, second, after receiving information from the otorhinolaryngologist, during the visit. The surgical outcome was considered successful if the irrigation succeeded and if the patient symptoms were relieved as assessed with the NLDO-SS. RESULTS: The diagnostic accuracy of the NLDO-SS was 84%, sensitivity 82%, specificity 85%, positive predictive value 58%, ne- gative predictive value 95%, odds ratio 26, risk ratio 11 and usefulness index 0.55. Cronbach's alpha was 0.85, and the test-retest reliability coefficient was 0.87. The long-term success rate after EN-DCR was 79%. CONCLUSION: The NLDO-SS iss a feasible clinical tool in assessing the success of EN-DCR. The success rate was found to decrease EN-DCR at long-term follow-up.

International Rhinologic Society Rhinology 0300-0729 52 1 2014 3 1 Comments on: The feasibility of balloon sinuplasty in patients with chronic rhinosinusitis: the Graz experience 90 91 EN J. de Carpentier 1206 10.4193/Rhin13.LTE We regret that we find ourselves commenting on this paper from such an eminent centre for endoscopic sinus surgery. John de Carpentier and David Lowe We share the authors ́ concern over the poor results of the Graz ́ balloon sinuplasty feasibility study - albeit for reasons different from theirs. H. Stammberger, H. Braun, P.V. Tomazic