International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Measuring the breath of life 97 98 EN V.J. Lund University College Hospital; Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1270 10.4193/RhinRhin.52E2 The inability to breathe freely and clearly is a major source of concern to patients and a common symptom in many sinonasal conditions. There are of course some semantic differences between terms such as 'obstruction', congestion' and 'blockage', which have to be clarified when taking a clinical history as the presence of inflammation may produce the sensation of congestion without actually being associated with mechanical obstruction to airflow. Notwthstanding this, nasal obstruc- tion is the commonest complaint in chronic rhinosinusitis with and without nasal polyps (3) and is a major feature of conditions from the common cold and acute bacterial rhinosinusitis to allergic and non-allergic rhinitis, septal deformity or a tumour. Paradoxically, many people, myself included, go through life largely oblivious to a significant septal deflection. It therefore begs the question as to why an individual with a long-standing anatomical variant such as this, suddenly presents with the symptom of nasal blockage and it is important that we do not simply focus on the septum (or turbinate) but rather ask ourselves 'Why now?' instead of simply listing the patient for septal surgery.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Objective measures for functional diagnostic of the upper airways: practical aspects 99 103 EN C Chaves Departament of Paediatrics, Faculty of Medicin, Federal University of Minas Gerais, Belo Horizonte - Minas Gerais, Brazil C.R. de Andrade C. Ibiapina 1196 10.4193/Rhin OBJECTIVE: To review the main papers published on the main available tests to obtain objective values of nasal patency and to demonstrate aspects of their use in medical practice. METHODOLOGY: We performed a non-systematic review of the MEDLINE and LILACS databases, and the most relevant articles were selected. RESULTS: Objective evaluations are important in epidemiological studies and in monitoring of patients with nasal obstruction. There is a wide variety of objective tests of nasal function; among them acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow (PNIF) are currently the most used tests. CONCLUSION: The choice of the method to evaluate nasal function depends on the conditions of each health service. PNIF has been highlighted as a simple and reliable alternative that provides easy-to-interpret results, and is thus an attractive method for clinical practice.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Cocaine induced midline destructive lesions 104 111 EN M. Trimarchi Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy G. Bertazzoni M. Bussi 1190 10.4193/Rhin PURPOSE: Review of the literature concerning cocaine induced midline destructive lesions (CIMDL). METHODS: We reviewed the English literature regarding CIMDL involving the nose and its surrounding structures. The review is based on a search of the US National Library of Medicine (PubMed) online database from January 1st, 1982 to March 31st, 2013. RESULTS: CIMDL is a pathology that mimics systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA). The prevalence of CIMDL is considered to be about 4.8% among cocaine users. Clinical manifestations include hyposmia, facial pain, crusting, ulcers, nasal septal perforation, palatal perforation, sinus wall destruction, orbital erosion and damage of the anterior skull base. The presence of ANCA directed against human neutrophil elastase (HNE) is the most distinguishing feature of CIMDL. Toxicological tests, indirect immunofluorescence microscopy, antigen specific solid assay testing, histopathological analysis, apoptosis assay and MRI imaging concur in the clinical identification of CIMDL. The pathogenesis of CIMDL is poorly understood and implicates inflammatory, infective, proapoptotic and autoimmune mechanisms. CONCLUSION: CIMDL must be readily recognized by clinicians to provide appropriate treatment. Immunosuppressive therapy has no role in the treatment of CIMDL. Only abstinence can interrupt the progression of the disease.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Use of peak nasal inspiratory flowmetry and nasal decongestant to evaluate outcome of septoplasty with radiofrequency coblation of the inferior turbinate 112 115 EN H.H. Balikci Department of ORL, Susehri State Hospital, Sivas, Turkey M.M. Gurdal Department of ORL, Uskudar State Hospital, Istanbul, Turkey 1201 10.4193/Rhin13.181 BACKGROUND: To investigate the role of peak nasal inspiratory flowmetry (PNIF) in evaluating inspiratory improvements in patients who underwent both septoplasty and inferior turbinate coblation by radiofrequency (ITC-RF). METHODS: One hundred and eight patients underwent both Cottle's septoplasty and ITC-RF. PNIF measurements were performed in all patients in the preoperative period and 6 months postoperatively. All measurements were made both before and after decongestion of the nasal cavity with oxymetazoline spray. RESULTS: Mean preoperative PNIF measurements differed significantly: 104.3 ± 33.6 L/min vs 136.1 ± 27.7 L/min before and after oxymetazoline decongestion, respectively. Mean postoperative PNIF measurements were 139.2 ± 30.8 L/min and 151.2 ± 32.3 L/min before and after decongestion, respectively. Preoperatively the mean difference between before and after decongestion was 32.1 ± 16.3 L/min. Postoperatively the mean difference was 11.8 ± 11.1 L/min. CONCLUSION: PNIF can be used in the assessment of ITC-RF outcomes with the aid of nasal decongestants, even in patients who also underwent septoplasty.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction 116 121 EN D. Chin Department of Otolaryngology Head & Neck Surgery, Changi General Hospital, Singapore G. Marcells Department of Otolaryngology, Sydney Hospital, Sydney, NSW, Australia J. Malek Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia E. Pratt Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia R. Sacks Department of Otolaryngology, Concord General Hospital, Sydney, NSW, Australia K. Snidvongs Australian School of Advanced Medicine, Macquarie University Hospital, Sydney, NSW, Australia R. Harvey Department of Otolaryngology Head Neck & Skull Base Surgery, St Vincent's Hospital, Sydney, NSW, Australia 1205 10.4193/Rhin13.164 BACKGROUND: Identifying the cause of nasal obstruction is critical before surgical intervention. Structural nasal obstruction, due to nasal valve stenosis, is unlikely to benefit from simple septoplasty and turbinate reduction. This study assesses changes in nasal peak inspiratory flow (NPIF) as a tool for discriminating decongestable versus structural obstruction. METHODOLOGY: Cross-sectional study of patients undergoing nasal airflow assessment was performed. Rhinomanometry, nasal obstruction visual analogue scores (VAS) and NPIF were performed pre- and post-decongestion. Population groups were defined with decongestable or structural obstruction by relative post-decongestion changes in airways resistance and symptoms. RESULTS: Fifty two patients were assessed, 24 with decongestable, 28 with structural obstruction. Pre- and post-decongestion NPIF were similar between groups. Absolute and percentage NPIF change were larger with decongestable versus structural obstruction. Sensitivity and specificity for predicting decongestable obstruction were 75.0% and 60.7% for NPIF increase >20 L/min; 75.0% and 64.3% for NPIF increase >20%. The respective positive predictive values were 62.1% and 64.3%. CONCLUSION: NPIF increase after decongestion is larger with decongestable than structural nasal obstruction. NPIF alone cannot discriminate the two conditions and does not replace more formal assessment.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Examination versus subjective nasal obstruction in the evaluation of the nasal septal deviation 122 126 EN M. Salihoglu Otolaryngology Department of GATA Haydarpasa Training Hospital, Istanbul, Turkey E. Cekin Otolaryngology Department of GATA Haydarpasa Training Hospital, Istanbul, Turkey A. Altundag Otolaryngology Department of Istanbul Surgery Hospital, Istanbul, Turkey E. Cesmeci Otolaryngology Department of GATA Haydarpasa Training Hospital, Istanbul, Turkey 1208 10.4193/Rhin13.057 BACKGROUND: Nasal septal deviation (NSD) is a frequent complaint among patients in an otolaryngology clinic. The prevalence of NSD varies in different populations and NSD classification schemes are complex. METHODS: We aimed to determine the prevalence of NSD in a population of Turkish young males using a new NSD classification method that we developed. We compared the results with patients' complaints. All patients underwent two nasal examinations, which were performed using a nasal speculum with and without administration of vasoconstrictor agents. Inferior Concha Hypertrophy (ICH) was evaluated in the first examination and NSDs were scored during the second examination. All findings were recorded according to our classification scheme. Severity of nasal obstruction was subjectively evaluated by using a visual analogue scale (VAS). RESULTS: We found a significant association between prevalence of NSD and nasal injuries, but there was no association between the mode of delivery and prevalence of NSD. Surprisingly, about 30 % of the participants with NSD had no complaint of nasal obstruction. Although most of the participants in the study had no severe nasal obstruction complaint, we found an association between NSD presence and patient's VAS. CONCLUSION: NSD is very frequent in the Turkish population and most often related to trauma; however, its effect on patient quality of life varies.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 External nasal valve collapse: validation of novel outcome measurement tool 127 132 EN A.L. Poirrier The Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA, United Kingdom S. Ahluwalia I. Kwame H. Chau M. Bentley P. Andrews 1197 10.4193/Rhin BACKGROUND: We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. METHODOLOGY: For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. RESULTS: The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. CONCLUSION: External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Application of Peak Nasal Inspiratory Flow reference values in the treatment of allergic rhinitis 133 136 EN S. de Souza Campos Fernandes Department of Pediaetrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil C. Ribeiro de Andrade Department of Pediaetrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil C. da Cunha Ibiapina Department of Pediaetrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil 1211 10.4193/Rhin13.158 OBJECTIVE: To assess the applicability of the Peak Nasal Inspiratory Flow (PNIF) curves in follow-up of children in the treatment of allergic rhinitis. METHODS: Prospective study of 40 patients with AR, grouped in corticosteroid spray versus physiological saline solution use. Follow up for 10 weeks through clinical score and PNIF percentages in relation to the reference curves, with was-out at week 8. Statistical assessment of the effect of treatment on variation of PNIF and clinical score was calculated by ANOVA model and Multiple Comparison of Means Test - Least Significant Difference. RESULTS: There was a statistically significant influence of the group, time and interaction between time and group on PNIF percentages. Throughout follow up, patients from the treatment group had mean PNIF percentages significantly higher than the placebo group. Clinical score results also demonstrated a statistically significant influence between the groups, time and interaction between time and group. CONCLUSION: Increase in PNIF percentage values observed in children treated with intranasal corticosteroids revealed the applicability of PNIF curves in their follow up.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 A critical appraisal of analyzing nasal provocation test results in allergen immunotherapy trials 137 141 EN N. Graf Center for Clinical Research, University Hospital Zurich, Zurich, Switzerland B. Dinkel Center for Clinical Research, University Hospital Zurich, Zurich, Switzerland H. Rose Rose Pharma-Consulting, Burgdorf, Germany L.A. Hothorn Institute of Biostatistics, Leibniz University of Hannover, Hannover, Germany D. Gerhard Institute of Biostatistics, Leibniz University of Hannover, Hannover, Germany P. Johansen Department of Dermatology, University Hospital Zurich, Zurich, Switzerland T.M. Kündig Department of Dermatology, University Hospital Zurich, Zurich, Switzerland L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany G. Senti Center for Clinical Research, University Hospital Zurich, Zurich, Switzerland 1202 10.4193/Rhin13.145 BACKGROUND: The statistical analysis of nasal provocation tests is very complex. We compared the conventional analysis with the maximally selected test statistics and the hierarchical ordered logistic model. METHODS: We re-analyzed data from a trial with 112 patients suffering from grass pollen allergy. The patients had been randomized to receive either intralymphatic immunotherapy (ILIT) or subcutaneous immunotherapy (SCIT). RESULTS: The conventional analysis indicated that the logarithmized ratio between the pre- and the post-treatment threshold concentration was significantly lower for ILIT than for SCIT. The maximally selected test statistics was used to test different threshold symptom scores that would imply positive clinical symptoms at the given allergen concentration. A threshold score of 3 maximised the difference in improvement between the ILIT and the SCIT groups. The hierarchical ordered logistic model does not take threshold allergen concentrations as the basis for analysis, but the single scores measured at each concentration. This approach simultaneously considers the treatment effect (ILIT versus SCIT), the time effect (pre- versus post-treatment), and the dose effect (different allergen concentrations). The hierarchical ordered logistic model revealed that the clinical improvement was greater after ILIT than after SCIT. CONCLUSION: As the choice of method can affect the outcome, guidelines for analysis are highly needed.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Role of inflammation in non-allergic rhinitis 142 149 EN E. de Corso Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University of Medicine and Surgery, Rome, Italy M. Battista M. Pandolfini L. Liberati S. Baroni M. Romanello G.C. Passali A.R. Fetoni B. Sergi W. Di Nardo G. Paludetti 1193 10.4193/Rhin OBJECTIVE: To investigate the role of inflammation in non-allergic rhinitis (NAR) patients in a large series to establish the prevalence of different NAR-subtypes, clinical features and the role of nasal cytology in the diagnostic algorithm. METHODOLOGY: Patients were selected out of 3650 individuals who spontaneously presented at our institution. We consecutively enrolled 519 NAR-patients in an analytical cross-sectional study between November 2007 and June 2013 (level of evidence: 3b). All patients underwent rhinological evaluation including symptoms questionnaire, endoscopy, CT scan, allergy tests and nasal cytology. RESULTS: The inflammatory cell infiltrate affects the severity of symptoms differently, allowing for identification of different phenotypes of NAR. We distinguished two groups: "NAR without inflammation"(NAR-) and "NAR with inflammation"(NAR+), in addition to different NAR-subtypes with inflammation. A significant difference was observed in terms of clinical symptoms and association with comorbidities (previously diagnosed asthma and aspirin intolerance) between NAR-, NAR+ and between different NAR+ subtypes. CONCLUSION: Our data suggest that NAR- and NAR with neutrophils behave similarly, showing lower symptom score values and a lower risk of association with comorbidities compared to NAR with eosinophils and mast cells (singularly or mixed). In our belief it is very important to establish the presence and type of inflammation in non-allergic rhinitis patients and nasal cytology is a very useful test in correct differential diagnosis.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Bacterial biofilms in patients with chronic rhinosinusitis: a confocal scanning laser microscopy study 150 155 EN K.A. Danielsen Department of Otorhinolaryngology, Akershus University Hospital, Norway Ø. Eskeland Department of Otorhinolaryngology, Akershus University Hospital, Norway K. Fridrich-Aas Drøbak ENT, Drøbak, Akershus, Norway V.C. Orszagh Drøbak ENT, Drøbak, Akershus, Norway G. Bachmann-Harildstad Department of Otorhinolaryngology, Akershus University Hospital, Norway E. Burum-Auensen Department of Otorhinolaryngology, Akershus University Hospital, Norway 1203 10.4193/Rhin13.053 BACKGROUND: Recent research into the pathophysiology of chronic rhinosinusitis suggests an important role for biofilms. They can be detected in both healthy and diseased nasal mucosa. Several different methods of detecting biofilms have been described. This study investigates the presence of biofilm in a larger group of patients with chronic rhinosinusitis undergoing primary functional endoscopic surgery. METHODS: Sixty-one patients with chronic rhinosinusitis and 25 controls, with septal deviation, were included from 2010 to 2012. Endonasal biopsies were harvested during surgery, snap frozen in isopentane, cooled on dry ice and stored at -80oC. The samples were prepared with Invitrogens' BacLight LiveDead kit, and investigaed with confocal scanning laser microscopy for the presence of biofilm. RESULTS: In the chronic rhinosinusitis group 55/61 were biofilm positive as opposed to 14/25 in the control group. The difference was highly significant. The odds ratio was 7.2. CONCLUSION: Patients with chronic rhinosinusitis have a highly significant increased point prevalence of biofilms compared to controls.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 An unexpected route for otolaryngology bacterial contamination with a Venturi atomizer* 156 161 EN T.M. Tseng Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan P.Y. Chen Department of Otolaryngology Head & Neck Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan H. Tseng Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan H.C. Lin Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan C.Y. Chang Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan S.H. Hung Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan 1200 10.4193/Rhin13.124 BACKGROUND: The Venturi-principle atomizer is a commonly used device in otolaryngology practices. The purpose of this study is to evaluate the possible route of bacterial contamination from the nasal vestibule to the atomizer tip through the jet airflow created during the use of the Venturi atomizer. METHODS: Thirty nostrils from 15 enrolled volunteers were tested. The aerosols generated by spraying sterilized saline into the nostrils were collected using a specially made aerosol-collecting nozzle cap. The collected samples were sent for bacterial culture, and nasal vestibular swab cultures were performed for comparison. RESULTS: In the aerosol-exposed group, 18 out of 30 samples (60%) were positive for bacterial growth, confirming the bacterial contamination from the nasal vestibule to the atomizer tip through the reverse jet airflow. The bacteria species in 8 of the 18 positive samples were identical to those from the nasal swab culture results from the same nostril. CONCLUSION: In ordinary otolaryngology practices, there are significant risks for bacterial contamination from the nasal vestibule to the tip of the Venturi atomizer even without direct contact. Clinicians must be more aware of this pattern of contamination, which has not been reported in the existing literature.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Mechanical disfunction in the mucosal oedema formation of patients with nasal polyps 162 166 EN R. Pezato Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Belgium R.L. Voegels Department of Otorhinolaryngology and Ophthalmology, University of São Paulo, Brazil T.F. Pinto Bezerra Department of Otorhinolaryngology and Ophthalmology, University of São Paulo, Brazil C. Perez-Novo Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Belgium A.C. Stamm Department of Otolaryngology-Head and Neck Surgery, Federal University of São Paulo, Brazil L.C. Gregorio Department of Otolaryngology-Head and Neck Surgery, Federal University of São Paulo, Brazil 1213 10.4193/Rhin13.066 BACKGROUND: Nasal polyposis (NP) is characterized by an anomalous tissue growth with oedema and a lack of extracellular matrix. In this study, we investigated whether a mechanical disfunction of the forces that act in oedema formation is present in NP. METHODS: We compared the interstitial hydrostatic pressure behaviour during a saline solution infusion between healthy nasal mucosa (inferior and middle turbinate from 10 patients) and inflamed nasal mucosa from NP patients (inferior, middle turbinate and a nasal polyp from 6 patients). We used Controlled Disc Stimulation equipment to compare the curve Pressure/Volume created during the saline solution infusion. RESULTS: The pressure at 0.2 ml infusion was lower in the middle turbinate of NP patients than in the middle turbinate of control patients. The lowest P/V mean assessed was in the polypoid tissue. CONCLUSIONS: The interstitial hydrostatic pressure showed different behaviour during liquid infusion in nasal mucosa from NP patients when compared with healthy nasal mucosa. This study allows us to cogitate on a new pathophysiological mechanism contributing to the development of the NP.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Importance of nasal septal cartilage perichondrium for septum strength mechanics: a cadaveric study 167 171 EN N.S. Tekke Department of ORL, Kahramanmaras Necip Fazıl State Hospital, Kahramanmaras, Turkey Z. Alkan Department of ORL, Istanbul Training and Research Hospital, Istanbul, Turkey O. Yigit Department of ORL, Istanbul Training and Research Hospital, Istanbul, Turkey A. Bekem Department of Metallurgical and Materials Engineering, Faculty of Chemical Metallurgy, Yildiz Technical University, Istanbul, Turkey A. Unal Department of Metallurgical and Materials Engineering, Faculty of Chemical Metallurgy, Yildiz Technical University, Istanbul, Turkey F. Sahin Ministry of Justice National Forensic Institute, Istanbul, Turkey H.H. Balikci Department of ORL, Susehri State Hospital, Sivas, Turkey E. Acioglu Department of ORL, Istanbul Training and Research Hospital, Istanbul, Turkey Y.M. Durna Department of ORL, Istanbul Training and Research Hospital, Istanbul, Turkey 1217 10.4193/Rhin13.199 OBJECTIVE: This study aimed to investigate the biomechanical qualities of the perichondrium and cartilage, and to determine the strength of the septal cartilage against bending forces. STUDY DESIGN: This paper describes an experimental cadaver study. MATERIALS AND METHODS: The nasal septal cartilages of 14 fresh cadavers (8 hours postmortem) were excised from the cadavers and cut into two strips: one with the perichondrium (group A) and one without perichondrium (group B). A bending test was then performed on the strips. RESULTS: The deflection of group A strips was larger than the deflection of group B strips. Flexural strength was also larger in group A strips compared to group B strips. The average modulus of elasticity was 122% higher in group A compared to group B. All conducted tests revealed statistically significant differences between groups. CONCLUSION: This study objectively shows that the perichondrium provides the cartilage with a 25% bending strength.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Cultural adaptation of an olfactory test: the odour in a bottle test 172 177 EN A. Gül Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey M. Akdağ Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey F.E. Ã-zkurt Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey B. Yılmaz Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey E. Şengül Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey S. Bakır Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey I. Topcu Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakir 21280, Turkey 1212 10.4193/Rhin13.055 AIM: Our objective was to create a culturally appropriate test of olfactory perception based on the Sniffin' Sticks test to determine the effects of age, gender, education level, and smoking on patients' sense of smell in Diyarbakır, Turkey. MATERIAL AND METHODS: A total of 180 subjects participated in the study including 111 males. These were patients at the Dicle University Otolaryngology Polyclinic and voluntarily participated in the study between June and December 2012. They were subdivided according to age: Group 1 included 100 patients between 18-35 years of age, Group 2 contained 50 patients between 36-55 years of age, and Group 3 was comprised of 30 patients over 55 years old. All subjects received olfactory testing with our modified Sniffin' Sticks test. RESULTS: There was a significant negative correlation between olfactory perception scores and increasing age. No significant relationship was found between olfactory perception and gender. When olfaction scores were evaluated according to education level, it was found that subjects with lower education had significantly decreased olfaction scores. Smokers also had significantly lower olfactory perception scores when compared to nonsmokers. In terms of odorant identification, sesame and cumin were the least likely to be correctly identified, as they were recognized only 21% and 40% of the time, respectively. CONCLUSION: We created a culturally appropriate test of olfactory perception based on the Sniffin' Sticks test to determine the effects of age, gender, education level, and smoking on our local patients' sense of smell. Our results suggest that age and smoking status negatively affect olfaction, and cumin and sesame should be replaced by more culturally familiar odorants.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Resonator properties of paranasal sinuses: preliminary results of an anatomical study 178 182 EN M. Havel Department of ORLHNS, Munich University Hospital, Munich, Germany L. Ertl Department of ORLHNS, Munich University Hospital, Munich, Germany D. Bauer Chair of Medical Education, Munich University Hospital, Munich, Germany M. Schuster Department of ORLHNS, Munich University Hospital, Munich, Germany K. Stelter Department of ORLHNS, Munich University Hospital, Munich, Germany J. Sundberg Department of Speech, Music and Hearing, School of Computer Science and Communication, KTH (Royal Institute of Technology), Stockholm, Sweden 1219 10.4193/Rhin13.097 BACKGROUND: The contribution of the nasal and paranasal cavities to vocal tract resonator properties is unclear as are voice effects of sinus surgery. Here we investigate resonance phenomena of paranasal sinuses with and without selective occlusion of the middle meatus and maxillary ostium in a cadaver. METHODOLOGY: Nasal and paranasal cavities of a Thiel-embalmed cadaver were excited by sine-tone sweeps from an earphone in the epipharynx. The response was picked up by a microphone at the nostrils. Different conditions with blocked and unblocked middle meatus were tested. Additionally, infundibulotomy was performed allowing direct access to and selective occlusion of the maxillary ostium. RESULTS: Responses showed high reproducibility. Minor effects appeared after removal of meatal occlusion. A marked low frequency dip was detected after removal of occlusion of maxillary ostium following infundibulotomy. CONCLUSION: Reproducible frequency responses of nasal tract can be derived from cadaver measurements. Marked acoustic effects of the maxillary sinus appeared only after direct exposure of the maxillary ostium following infundibulotomy.

International Rhinologic Society Rhinology 0300-0729 52 2 2014 6 1 Multiple causes for rhinolithiasis 183 186 EN T. Send Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany M. Jakob Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany K.W.G. Eichhorn Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Germany 1207 10.4193/Rhin13.153 BACKGROUND: Rhinoliths are rare affections of the main nasal cavity and the paranasal sinuses. Initially, as a result of their low incidence, they are often incorrectly classified as calcified tumors in clinical examination. METHODOLOGY: We have identified three cases in our patient population and evaluated the clinical symptoms as well as the pathological findings and the causes of the disease. RESULTS: Due to their extension and the respective clinical pattern, all masses were surgically removed under endotracheal anesthesia. The histopathological findings comprised an ectopic tooth, a vegetable (most likely a leaf from the garden) as well as a textile foreign body (probably of iatrogenic origin). CONCLUSION: Undiscovered foreign bodies of the main nasal cavity are a common cause for the formation of rhinoliths. We have also displayed the respective incidence and the therapeutic options.