International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Changes in Editorial board Rhinology, Prof. Valerie Lund demits office as Editor in Chief of Rhinology 193 193 EN W.J. Fokkens 1246 10.4193/Rhin At the Editorial Board Meeting of Rhinology Valerie Lund indicated that she has decided to emit office as Editor in Chief of Rhinology. She became a member of the editorial board in 1993, a co-editor with Prof. Bert Huizing in 1999 and Editor in Chief in 2004. She leaves with our grateful thanks for her 20 years (!) of continuous effort to make Rhinology the highly cited modern Journal it has become. The editorial board asked her to become Honorary Editor together with Bert Huizing, which she gladly accepted.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Minutes of the General Assembly in Amsterdam, Wednesday, June 25th 2014, 15.30-16.15 194 194 EN W.J. Fokkens V.J. Lund 1245 10.4193/Rhin 1) Welcome from the Congress President 2) The Minutes of the General Assembly of Toulouse, published in the Rhinology Journal of June 2013 are accepted. 3) Report of President 4) Report of General Secretary 5) Report of the Treasurer 6) Report of Editor in Chief 7) Appointments

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 ERS/ISIAN 2014, Beurs van Berlage, Amsterdam 194 194 EN W.J. Fokkens V.J. Lund 1247 10.4193/Rhin From June 22 to 26th, 2014 we celebrated the 50th anniversary of the European Rhinologic Society with the 25th Congress of the European Rhinologic Society and the 32nd International Symposium of Infection and Allergy of the Nose. The congress was held in the Beurs van Berlage, an historic building, which was the former Stock Exchange of the Netherlands. Now, the Beurs van Berlage is one of the defining monuments of the Dutch capital and is a unique and inspiring congress venue in the heart of Amsterdam. The European Rhinologic Society (ERS) commemorated 50 years of expertise and experience among specialists in rhinology, skull base surgery, allergology and facial plastic surgery. It was no accident that the 25th Congress of the European Rhinologic Society was held in Amsterdam, the beautiful and historic capital of the Netherlands. After all, the inaugural meeting of the society was organised in the Netherlands by Professor Van Dishoeck in 1963 and the 25th anniversary was celebrated in Amsterdam with Professor Bert Huizing as President. We were very fortunate that Professor Huizing was willing to give an historical overview of our Society during the opening ceremony. At the opening ceremony honorary memberships of the ERS were awarded to Prof. David Kennedy and Prof. Carel Verwoerd for their outstanding contributions to rhinology.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 The ventral route to intracranial aneurysm: from the origin towards modern transsphenoidal surgery. An historical review and current perspective 195 207 EN A. Di Somma Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy M. de Notaris Department of Neuroscience, Division of Neurosurgery, "G. Rummo" Hospital, Benevento, Italy J. Enseñat Division of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain I. Alobid Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain M. Bernal-Sprekelsen Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain L.M. Cavallo Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy A. Prats-Galino Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain P. Cappabianca Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy 1209 10.4193/Rhin13.165 OBJECTIVE: A review of the main studies that have explored the use of the ventral pathway for treatment of intracranial aneurysms, including the recent reported extended transsphenoidal approaches. METHODS: A comprehensive literature review was performed using the PudMed database. We recovered 48 cases of cerebral aneurysms, approached via the transcervical-transclival, transoral-transclival, transfacial-transclival ventral pathways and the extended transsphenoidal route. The overall rates of complications and surgical success were evaluated and compared for both traditional ventral and transsphenoidal approaches. RESULTS: For traditional routes, the overall complications and surgical success rates were 74% (26/35) and 87% (13/15), respectively. For extended transsphenoidal approaches were 44% (4/9) and 78% (7/9), respectively. CONCLUSION: Our paper is a reconnaissance of what has been done via "the anterior route" and a notification of the existence of this "surgical window". Present and future of cerebral aneurysm treatment is represented by the endovascular technique. A few selected cases in specialized centers, where transsphenoidal approaches with the aid of the endoscope are routinely performed, may be treated with such techniques alone or in combination with other different procedures. Further studies in large numbers of patients will be required to validate the full benefit of this approach.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 The association of frontal recess anatomy and mucosal disease on the presence of chronic frontal sinusitis: a computed tomographic analysis 208 214 EN W.S. Lai Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan P.L. Yang School of Nursing, National Defense Medical Center, Taipei, Taiwan C.H. Lee Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Y.Y. Lin Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Y.H. Chu Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan C.H. Wang Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan H.W. Wang Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan C.P. Shih Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 1199 10.4193/Rhin13.110 OBJECTIVES: The frontal sinus has the most complex and variable drainage routes of all paranasal sinus regions. The goal of this study was to identify these anatomical factors and inflammation areas relating to chronic frontal sinusitis by comparing radiological presentations in patients with and without frontal sinusitis. METHODS: All adult patients with chronic rhinosinusitis who had received computed tomography (CT) scans of the nasal cavities and paranasal sinuses between October 2010 and September 2011. Logistic regression analysis was used to compare the distribution of various frontal recess cells and surrounding inflammatory conditions in patients with and without frontal sinusitis. RESULTS: Analysis of 240 sides of CT scans was performed with 66 sides excluded. The opacification of the frontal recess and sinus lateralis demonstrated a strong association with an increased presence of frontal sinusitis by multiple logistic regression models. CONCLUSION: Opacification of the frontal recess and sinus lateralis was found to be associated with a significantly increased risk of frontal sinusitis and developing severe blockage of drainage pathways. It provides evidence that mucosal inflammation disease in these two areas is a very important factor leading to chronic frontal sinusitis.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Rhinosinusitis in Secondary School Children-Part 1: Pilot study of the MSNOT-20 Young Person Questionnaire (MSYPQ) 215 224 EN A.S. Sami ENT and Allergy Department, Royal National Throat, Nose and Ear Hospital, London, United Kingdom G.K. Scadding ENT and Allergy Department, Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1214 10.4193/Rhin12.011-1 BACKGROUND: The SNOT-20 questionnaire, a valid disease related quality of life instrument for rhinosinusitis, was modified for use in secondary school children and became the Modified Sino Nasal Outcome Test -20 Young Person Questionnaire, MSYPQ. METHODODOLOGY: MSYPQ was evaluated in a pilot study of disease (rhinosinusitis) and non-disease according to criteria in the European Position Paper on Rhinosinusitis and Nasal polyposis (EPOS). RESULTS: Those children who were suffering from rhinosinusitis according to the EPOS criteria showed significantly high scores on MSYPQ, whereas those who did not have rhinosinusitis had very low to zero scores on the MSYPQ. CONCLUSION: This pilot study confirmed that the MSYPQ recognises rhinosinusitis symptoms in the 11-16 year age group with its effect on quality of life and is a suitable instrument to investigate the prevalence and impact of this problem in young people.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Rhinosinusitis in Secondary School Children-Part 2: Main project analysis of MSNOT-20 Young Persons Questionnaire (MSYPQ) 225 230 EN A.S. Sami ENT and Allergy Department, Royal National Throat, Nose and Ear Hospital, London, United Kingdom G.K. Scadding ENT and Allergy Department, Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1215 10.4193/Rhin12-011-2 BACKGROUND: There is little data on rhinosinusitis in adolescent schoolchildren. We have employed a validated, disease specific quality of life questionnaire to determine the extent of this problem and its effects on their lives. METHODODOLOGY: The MSYPQ, a disease specific quality of life questionnaire, previously evaluated in a pilot study of adolescent sino-nasal disease, was used in secondary school children in East London to identify the prevalence of rhinosinusitis plus its effects on quality of life. One group of the secondary school children completed ARIA based questions for comparison with MSYPQ rhinitis sub-scores. RESULTS: 71% scored an abnormal value on the MSYPQ for at least one symptom, 32% of those assessed suffered from symptoms compatible with rhinitis, similar to the prevalence of 30% previously found in adults. Unlike adults cough was one of the most significant symptoms. Over 21% of secondary school students had their quality of life affected and 11% took time off school due to their symptoms. The ARIA assessment group showed that symptoms were intermittent in 44% and confirmed significant impairment of sleep and daily activities. CONCLUSION: The MSYPQ demonstrates a high prevalence and impact on quality of life of rhinitis and rhinosinusitis symptoms in the 11-16 age group, with levels comparable to the results from an adult population. The MSYPQ rhinitis sub group of questions was concordant with ARIA based questions.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Nasal septal body and inferior turbinate sizes differ in subjects grouped by sex and age 231 237 EN T. San ENT Department, Gőztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey N.B. Muluk ENT Department , Medical Faculty, Kırıkkale University, Kırıkkale, Turkey S. Saylisoy Department of Radiology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey M. Acar ENT Department, Yunus Emre State Hospital, Eskisehir, Turkey C. Cingi ENT Department, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey 1216 10.4193/Rhin13.138 OBJECTIVES: To compare the size of the nasal septal body (SB) and inferior turbinate (IT) of subjects grouped by sex and age. METHOD: We measured SB and IT areas (in cm2) bilaterally in computed tomography (CT) sections of 150 paranasal sinuses from 72 males and 78 females. RESULTS: The right and left SB areas were smaller in females than in males. In the ≤25-year-old group, the right IT (RIT) was significantly smaller in females than in males. In the 26-35 and 46-45 age groups, the right SB (RSB) was significantly smaller in females than in males. CONCLUSION: The nasal SB may play a role in nasal physiology similar to a turbinate and help support optimal airflow. The vascular and glandular structures of the SB should be investigated in detail, and minimal invasive procedures should be performed in nasal surgery to avoid damaging essential structures.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Extraocular muscle injury during endoscopic sinus surgery: A series of 10 cases at a single center 238 245 EN J.H. Sohn Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S.D. Hong Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea J.H. Kim Hana ENT Hospital, Seoul, Korea H.-J. Dhong Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S.-K. Chung Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea H.Y. Kim Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S.Y. Oh Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 1220 10.4193/Rhin13.131 BACKGROUND: Extraocular muscle (EOM) injury is a rare but serious complication of endoscopic sinus surgery (ESS). The aim of this study is to describe the clinical characteristics and course of EOM injury occurring during ESS. DESIGN: Retrospective case series. METHODS: Medical records and CT images of patients who suffered from EOM injury after ESS between 2006 and 2012 were retrospectively reviewed. Patient demographics, endoscopic anatomy, type of surgery (primary or revision), predisposing risk factors, site and extent of injury on CT imaging, and associated complications were evaluated. In addition, data regarding ophthalmologic management and clinical outcomes were collected. RESULTS: Ten patients with EOM injuries after ESS were included in this study. One patient was undergoing revision ESS. All patients sustained medial rectus muscle injury and one patient suffered concurrent ipsilateral inferior rectus muscle injury. A microdebrider was used in nine cases. Right-sided injury (90% of patients) was more prevalent than left-sided injury, and 70% of injured medial rectus muscles were completely transected. After subsequent strabismus surgery, 8/9 patients regained binocular single vision in primary gaze despite residual diplopia in some gaze positions. CONCLUSION: Although proper ophthalmologic surgery after EOM injury may improve deviation in the primary gaze position, none of the patients regained normal EOM movement. Therefore, prevention of this complication through adequate surgical technique and precautions is important.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Tumour necrosis factor inhibitor-associated sinusitis 246 251 EN S. Yoshihara Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan K. Kondo Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan K. Kanaya Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan K. Suzukawa Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan S. Baba Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan M. Toma-Hirano Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan S. Kikuta Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Y. Iwasaki Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan K. Fujio Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan T. Yamasoba Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan 1224 10.4193/Rhin13.074 AIM: To describe the features of chronic sinusitis associated with the use of tumour necrosis factor (TNF) inhibitors. METHODOLOGY: A retrospective review of the medical records between 2003 and 2011 revealed that five patients had developed chronic sinusitis after the start of TNF inhibitor administration and required rhinological evaluation and treatment. RESULTS: The incidence of refractory sinusitis associated with TNF inhibitors was approximately 2%. Of the five patients identified, four patients were medicated with etanercept and one with infliximab. The maxillary sinus was most commonly involved and cultures of the sinus discharge revealed Pseudomonas aeruginosa in three cases. Two patients showed improvement of sinusitis with antibiotic medication, despite the continuous use of TNF inhibitor, while in two other patients, sinusitis was resistant to antibiotic medication. Another patient who had developed recurrence of sinusitis after complete remission of previous chronic sinusitis by endoscopic sinus surgery showed remission only after cessation of TNF inhibitor. CONCLUSION: Chronic sinusitis associated with TNF inhibitors is considered to be a new disease entity, and it will become more common due to the increasing use of TNF inhibitors.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Japanese traditional medicine, Senn-kinn-naidaku-sann up-regulates Toll-like receptor 4 and reduces murine allergic rhinitis 252 259 EN I. Morikura Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Izumo, Japan A. Murata Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Izumo, Japan N. Aoi Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Izumo, Japan Y. Shimizu Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Izumo, Japan T. Fuchiwaki Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Izumo, Japan E. Prokopakis Department of Otorhinolaryngology, University of Crete, Crete, Greece H. Kawauchi Department of Otorhinolaryngology, Shimane University Faculty of Medicine, Izumo, Japan 1218 10.4193/Rhin11.269 OBJECTIVE: To determine the mechanisms by which a traditional herbal medicine, Senkinnaidakusan (SKNS), controls Th2 responses, we examined the production of IL-12 by murine macrophages treated with SKNS. RESULTS: Treatment with SKNS significantly increased TLR4 mRNA in macrophages. Furthermore, pre-treatment with SKNS enhanced the production of IL-12 by macrophages stimulated with LPS. When SKNS was orally administered to C3H/HeN mice at the induction phase after OVA sensitization, the serum levels of OVA-specific immunoglobulin (Ig)E and IgG1 decreased, Interleukin (IL)-4 production by spleen T cells in response to OVA was significantly suppressed, while interferon (IFN)-gamma production was increased. After nasal challenge of OVA, eosinophilic infiltration in the nasal mucosa and the number of sneezes were significantly inhibited in SKNS-treated mice compared with control mice. Besides, expression of IL-5 in the nasal mucosa was also inhibited. Using another strain of mice, C3H/HeJ (TLR4 negative), there was no difference in OVA-specific Igs or splenic cytokine production between the SKNS treatment and non-treatment groups. The eosinophilic infiltration in the nasal mucosa, the number of sneezes and IL-5 expression in the nasal mucosa were also not effected even after SKNS treatment. CONCLUSION: These results suggest that oral administration of SKNS inhibits Th2 responses by enhancement of IL-12 release from macrophages via up-regulation of TLR4 expression

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Mono-allergic and poly-allergic rhinitis patients have comparable numbers of mucosal Foxp3+CD4+ T lymphocytes 260 266 EN B. Muller Department of Otorhinolaryngology, AMC, Amsterdam, The Netherlands S.M. Reinartz Department of Otorhinolaryngology, AMC, Amsterdam, The Netherlands D. van Egmond Department of Otorhinolaryngology, AMC, Amsterdam, The Netherlands E.J.J. de Groot Department of Otorhinolaryngology, AMC, Amsterdam, The Netherlands W.J. Fokkens Department of Otorhinolaryngology, AMC, Amsterdam, The Netherlands C.M. van Drunen Department of Otorhinolaryngology, AMC, Amsterdam, The Netherlands 1231 10.4193/Rhin13.223 BACKGROUND: We previously found that allergic rhinitis patients with an isolated pollen sensitization responded more strongly to a nasal provocation with grass pollen (GP) than patients who had an additional house dust mite (HDM) sensitization. To elucidate this phenomenon, we investigated the dynamics of Foxp3+CD4+ T lymphocytes in allergic rhinitis patients with distinct allergen sensitizations. METHODS: Three groups of allergic rhinitis patients with skin prick test confirmed allergic sensitizations were investigated and compared to 14 healthy controls: 14 subjects with an isolated grass pollen sensitization (Mono-GP); 9 subjects with isolated house dust mite sensitization (Mono-HDM); 29 subjects with grass pollen ánd house dust mite sensitization (poly-sensitized). Subjects in the Mono-GP group were challenged with grass pollen extract, subjects in the Mono-HDM group were challenged with house dust mite extract, subjects in the poly-sensitized group and the healthy controls were randomly challenged with either grass pollen or house dust mite. Nasal biopsies were taken before and after nasal provocation. We compared the distribution of FoxP3+CD4+ cells in nasal biopsies before and after nasal provocation using immunohistochemistry. RESULTS: There was no difference in the number of FoxP3+CD4+ cells between healthy and the three allergic groups at baseline. Nasal provocation did result in an increase in eosinophils in the three allergic groups, but did not result in a change in the number of FoxP3+CD4+ cells in any of the groups or induced differences between any of the groups. CONCLUSION: Clinical differences in the response between mono-GP and multiple-sensitized allergic individuals are not related to differences in the number of regulatory T cells in the nasal mucosa.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 Frontal sinus mucocoeles: new algorithm for surgical management 267 275 EN A. Sama Department of Otolaryngology, Queen's Medical Centre, Nottingham, Nottinghamshire, NG7 2UH, United Kingdom L. McClelland Department of Otolaryngology, Queen's Medical Centre, Nottingham, Nottinghamshire, NG7 2UH, United Kingdom J. Constable, Department of Otolaryngology, Queen's Medical Centre, Nottingham, Nottinghamshire, NG7 2UH, United Kingdom 1237 10.4193/Rhin13.103 Abstract Background: Frontal sinus mucocoeles require a structured approach to their surgical management. We share our experience of a novel method of positional classification for frontal mucocoele and corresponding surgical algorithm. Methods: A retrospective case-note review examined all frontal sinus surgery for mucocoele, spanning three years (2008-2010). Patients had pre-operative nasendoscopy, multi-planar CT and MRI when indicated. Several important variables (position, drainage dimensions, fronto-ethmoidal cells and degree of neo-osteogenesis) were noted. A systematic algorithm was used for surgical drainage based on these characteristics. The three year outcomes using this approach are presented. Results: Thirty-six patients were identified with a total of 43 frontal mucocoeles. Using our classification, 30 mucocoeles were medial; seven were intermediate; six were lateral. Thirty-four patients underwent a primary endoscopic procedure; six required a combined primary osteoplastic-flap (OPF) and endoscopic approach. Six patients required revision surgery for polypoidal change or neo-ostium stenosis. All patients were eventually rendered asymptomatic. Conclusion: Implementation of our positional classification and surgical algorithm was successful with a revision rate of 19%. Presence of frontal sinus wall dehiscence and extra-sinus mucocoele extension are invalid indicators for external approach. We feel our classification and treatment algorithm, with its associated indicators for surgical escalation (i.e. limited dimensions of frontal ostium, presence of Type III / IV front-ethmoidal cells etc), are applicable for future management of frontal mucocoeles.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 A novel technique for mitomycin-c application in frontal sinus surgery 276 280 EN I. Konstantinidis 2nd Academic ORL Dept, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece A. Chatziavramidis 2nd Academic ORL Dept, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece J. Constantinidis 2nd Academic ORL Dept, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece 1221 10.4193/Rhin13.060 OBJECTIVE: Local application of mitomycin-c (MMC) seems to be effective in reducing adhesions and stenosis after FESS. However this is not clearly seen in frontal sinusotomy. This study assesses the effectiveness of local MMC in the frontal ostium using a foamy material (otowick) and compared with cottonoids. METHODS: Forty-seven patients with chronic rhinosinusitis without polyps enrolled in this study. Two subgroups were studied: one with MMC application in one nostril using cottonoids and a second with MMC injected in an otowick. In all patients MMC was applied twice, intraoperatively and 4 weeks later. In both groups normal saline was applied to the other nostril on the same material with the MMC side. Six months postoperatively all patients were assessed endoscopically by a clinician blinded to the MMC side. RESULTS: Overall, MMC application was more effective than normal saline in both groups. Otowick use presented favorable initial results especially in primary cases regarding ostium patency, and need for revision surgery. The use of MMC cottonoids did not show any benefit in primary cases. CONCLUSION: The described technique seems to be effective in maintening frontal ostium patency as it provides a more precise and deeper drug delivery to this area.

International Rhinologic Society Rhinology 0300-0729 52 3 2014 9 1 The effect of two sphenoidotomy approaches on the sense of smell: trans-ethmoidal versus trans-sphenoethmoidal 281 287 EN A. Thamboo Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada B.A. Chang Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada A.R. Habib Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada J. Manji Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada I. Hathorn Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada V. Sunkaraneni Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada A. Javer Division of Otolaryngology, University of British Columbia, St. Paul's Sinus Centre, Vancouver, British Columbia, Canada 1222 10.4193/Rhin13.106 BACKGROUND: There are generally two methods to access the sphenoid sinus: either through the natural ostium (trans-spheno-ethmoidal or via sphenoethmoidal recess), or by creating a second opening through the posterior ethmoids (trans-ethmoidal). This study psychophysically and subjectively evaluates the effect of the trans-sphenoethmoidal technique to the trans-ethmoidal technique for sphenoid sinusotomy on olfactory function. METHODS: Prospective cohort analysis of 48 patients with comparable sinus disease underwent primary sphenoidotomy via trans-sphenoethmoidal (n = 24) versus trans-ethmiodal (n = 24) technique between September 2011 and February 2012. The patients had their olfaction measured psychophysically with "Sniffin' Sticks" and subjectively with a visual analogue scale (VAS) pre-operatively and at 5 weeks post-operatively. RESULTS: Psychophysical scores from the Sniffin' sticks provide a Threshold, Discrimination and Identification (TDI) score out of 48. The TDI change (post-operative TDI score minus pre-operative score) as well as VAS change (post-operative VAS minus pre-operative VAS) were analyzed using t-test analysis, which showed no significant difference between the two measurements. CONCLUSION: If the trans-sphenoethmoidal technique is done meticulously, patients have the same olfactory relief, psychophysically and subjectively, as those undergoing the trans-ethmoidal technique.