International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Objective measurements of nasal function: necessary before nasal surgery? 289 291 EN W.J. Fokkens Department of Otorhinolaryngology, Amsterdam Medical Centre, Amsterdam, the Netherlands P.W. Hellings Department of Otorhinolaryngology, Amsterdam Medical Centre, Amsterdam, the Netherlands 1275 10.4193/RhinRhin.52E4 When we discuss nasal dysfunction, we think primarily of nasal obstruction. However, other clinical signs like rhinorrheoa, sneezing, itching, burning and loss of smell, as well as perception of the form and aesthetics of the nose should not be neglected. During the last decades, we have significantly increased our knowledge on nasal function. We are more aware of the role of questioning the patients about their symptoms, about their most bothersome symptoms and also their quality of life, and we more often report on objective measure- ments of nasal obstruction like PNIF, acoustic rhinometry and rhinomanometry. It has clearly been shown that the correlation between symptoms of nasal obstruction and objective measu- rements is low.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Rhinomanometric reference intervals for normal total nasal airflow resistance 292 299 EN J. Merkle Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany L. Kohlhas Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany G. Zadoyan Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany R. Mosges Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany M. Hellmich Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany 1264 10.4193/Rhin13.220 BACKGROUND: Reference intervals (RIs) or mean values for normal total nasal airflow resistance are essential for the diagnosis of nasal obstruction. Data relating to nasal airflow are not standardised, and valid and reliable RIs do not exist for the time being. This meta-analysis aimed to determine such "standard" 95%-RIs. METHODOLOGY: Research of related literature listed in Medline, Embase, Cochrane, and Web of Science databases. RESULTS: Airflow resistance data were gathered from 38 studies using active anterior rhinomanometry at a differential pressure of 150Pa to examine patients under congested and decongested mucosal conditions. In the meta-analysis overall values and RIs for normal total nasal airflow resistance under congested nasal mucosal conditions were calculated for all subjects at 0.25Pa/cm3/s (95%-RI 0.10-0.40Pa/cm3/s), adults regardless of gender at 0.25Pa/cm3/s (95%-RI 0.12-0.38Pa/cm3/s), men at 0.24Pa/cm3/s (95%-RI 0.09-0.39Pa/cm3/s), and women at 0.26Pa/cm3/s (95%-RI 0.08-0.44Pa/cm3/s). Asian, African and Caucasian ethnic groups exhibited rising airflow resistance mean values: 0.23Pa/cm3/s (95%-RI 0.08-0.39Pa/cm3/s), 0.25Pa/cm3/s (95%-RI 0.11-0.38Pa/cm3/s) and 0.26Pa/cm3/s (95%-RI 0.13-0.38Pa/cm3/s), respectively. Lower overall mean values resulted under decongested nasal mucosal conditions. CONCLUSION: The reference intervals and mean values ascertained in this meta-analysis improve the diagnosis of nasal obstruction and may represent a useful supplement in existing guidelines for the standardisation of rhinomanometric measurements.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Quality of life after endoscopic sinus surgery or balloon sinuplasty: a randomized clinical study 300 305 EN A.J. Bizaki Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland R. Taulu Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland J. Numminen Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland M. Rautiainen Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland 1242 10.4193/Rhin OBJECTIVES: To conduct the first prospective randomized controlled trial that evaluates and compares the clinical outcome and impact of ballonsinuplasty and endoscopic sinus surgery (ESS) on the quality of life of patients suffering from chronic or recurrent rhinosinusitis (CRS) of the maxillary sinus. METHODS: Adult patients with symptomatic chronic or recurrent rhinosinusitis without severe findings in the sinuses, as documented in the sinus' Computer Tomography scan and clinical exam, were randomized in 2 groups: ESS and Balloon Sinuplasty. The main variable in our study is the Sinonasal Outcome Test-22 (SNOT 22) and its parameters. These parameters were analysed preoperatively and at 3 months, postoperatively. RESULTS: There was a subjective improvement in symptoms after surgery. We also noticed an objective improvement in the quality of life of our patients seen as a decrease in the total SNOT 22 score. Both balloon sinuplasty and ESS significantly improved almost all the parameters of SNOT22, with no significant difference being found between these two groups. CONCLUSION: Both balloon sinuplasty and endoscopic sinus surgery improved the quality of life of patients with mild chronic or recurrent rhinosinusitis. However, the remarkably higher material cost of balloon sinuplasty compared to ESS sets limits on its broad use. There is an obvious need for further study to find out if, as an office procedure, balloon sinuplasty could deliver cost-savings high enough to cover the higher material cost of balloon sinuplasty. Our study was, however, too small to enable firm conclusions to be drawn.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Inferior turbinate reduction; coblation versus microdebrider - a prospective, randomised study 306 314 EN H.M. Hegazy Department of Otolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt M.R. ElBadawey Department of Otolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt A. Behery Department of Otolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt 1241 10.4193/Rhin OBJECTIVES: We prospectively evaluated and compared the safety, subjective and objective efficacy of the coblation and microde- brider for inferior turbinate reduction. METHODS: We designed a prospective randomized trial recruiting 70 patients with symptomatic enlarged inferior turbinates. Forty had coblation and 30 had microdebrider. Objectively, we scored each inferior turbinate size from 1 to 3 pre- and post-operatively. Subjectively, patients completed a visual analogue scale (VAS) evaluating their nasal symptoms, before and after surgery. RESULTS: Both techniques resulted in subjective significant improvement in the VAS for nasal obstruction, and other nasal symptoms. Comparing both groups, coblation showed significantly less pain than the microdebrider. Postoperative bleeding and mucosal tears were less frequent with coblation than with microdebrider but this was nonsignificant. Patient satisfaction signifi- cantly improved after both techniques. CONCLUSION: The submucous coblation is as effective as microdebrider for inferior turbinate reduction. It is easily performed with significantly less postoperative pain than the microdebrider. Both techniques produce significant reduction of the size of the turbinates and associated with a satisfactory improvement of the nasal obstruction, nasal secretion, crust formation, itching, snee- zing and dryness. The side effects are minimal with both procedures with significant patient satisfaction postoperatively.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Development and validation of the Functional Rhinoplasty Outcome Inventory 17 (FROI-17) 315 319 EN C. Bulut Department of Otolaryngology, University of Heidelberg, Germany F. Wallner Department of Otolaryngology, University of Heidelberg, Germany P.K. Plinkert Department of Otolaryngology, University of Heidelberg, Germany I. Baumann Department of Otolaryngology, University of Heidelberg, Germany 1223 10.4193/Rhin13.098 STATEMENT OF PROBLEM: Quality of life aspects become more and more important in all fields of medicine. There is a lack of such instruments for septorhinoplasty that cover sufficiently both functional and aesthetic aspects. METHODOLOGY: In Phase 1, a group of experts identified 22 questions that represent the symptoms of patients with nasal deformities, which undergo a functional and aesthetic nasal surgery. Forty-one patients filled out the questionnaires before septorhinoplasty. The item assessment and item reduction was performed by a sequential statistical analysis, which included a single item analysis, an assessment of internal consistency, construct validity, the divergence validity and a factor analysis. The resulting 17-item questionnaire was used in a prospective validation study (Phase 2) in which 103 patients were enrolled. Statistical analysis included testing of validity, reliability and responsiveness. RESULTS: In Phase 2 data analysis revealed a good internal consistency and significant test-retest reliability. A literature survey confirmed that the relevant items were included in the questionnaire. We found significant item-score-correlations. Furthermore, the existence of concurrent validity was confirmed. Standardized Response Mean (SRM) as a measure for sensitivity to change indicated moderate to large effects. CONCLUSION: FROI-17 is a valid quality of life instrument for use in septorhinoplasty patients. The instrument is now available for prospective data collection in future septorhinoplasty outcome studies.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Validation of the sino-nasal outcome test-23 in septorhinoplasty surgery 320 326 EN A. Takhar Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom J. Stephens Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom P.S. Randhawa Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom A.L. Poirrier Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom P. Andrews Department of Facial Plastics and Rhinology, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1249 10.4193/Rhin14.1249 BACKGROUND: There has been a great expansion in patient-based outcome measures to face the ever-increasing demand to demonstrate surgical efficacy. However, surgeons have not adopted until now any systematic outcome instrument. The 22-item Sino-Nasal Outcome Test (SNOT-22) is a validated sinonasal outcome score in sinonasal and septorhinoplasty surgery but does not measure aesthetic outcome. The aim of this paper is to validate a modification to the Sino-Nasal Outcomes Test-22 (SNOT-22) with a new question regarding the shape of the nose (SNOT-23). METHODOLOGY: We conducted a prospective cohort study on 69 consecutive patients undergoing septorhinoplasty and a control group of healthy volunteers. Reproducibility, responsiveness to treatment, known group differences and validity of the SNOT-23 were analysed. Scores were compared to visual analogue scales, nasal obstruction symptoms evaluation (NOSE) score and nasal inspiratory peak flow. RESULTS: SNOT-23 has good test-retest reliability and is a valid outcome measure for assessing response to surgery especially with regards to shape of the nose and nasal obstruction when compared to other patient reported measures. CONCLUSION: SNOT-23 is a valid and reliable tool that can be easily used in routine clinical practice to assess the functional and aesthetic outcomes from septorhinoplasty surgery. The SNOT-23 could be adopted as a universal, easy to use tool in rhinology clinics for the assessment of response to septorhinoplasty and sinus surgery.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Comprehensive quality of life outcomes for pediatric patients undergoing endoscopic sinus surgery 327 333 EN R.J. Taylor Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA J.D. Miller Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA A.S. Rose Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA A.F. Drake Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA C.J. Zdanski Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA B.A. Senior Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA C.S. Ebert Jr Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA A.M. Zanation Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA 1263 10.4193/Rhin14.028 BACKGROUND: Limited quality of life data exist for pediatric chronic rhinosinusitis (CRS) patients undergoing endoscopic sinus surgery (ESS). Further exploration of the following areas will enhance understanding and support clinical decision-making: baseline and post-ESS general and disease-specific quality of life, parent vs. child report, and correlation of nasal endoscopy to sinus CT scores. METHODOLOGY: A prospective cohort study evaluated CRS patients age 5-18 undergoing ESS. Surveys were completed at two timepoints: (1) pre-ESS and (2) 30-90 days post-ESS, with parents completing general (PedsQLTM) and CRS-specific (SNOT-16 and SN-5) quality of life surveys and children completing PedsQLTM and SNOT-16 surveys. Preoperative Lund-Kennedy nasal endoscopy and Lund-Mackay sinus CT scores were calculated. Where appropriate, outcomes were stratified by cystic fibrosis status. RESULTS: Impaired preoperative general quality of life was evidenced by parent proxy-report of PedsQLTM scores in 10 cystic fibrosis and 11 non-CF patients. ESS was associated with decreased sinus symptoms at 1-3 months postoperatively with SN-5 change scores of -1.85 and -2.2, in CF and non-CF patients, respectively. Parents reported worse CRS symptoms via higher preoperative SNOT-16 scores than their children did. Nasal endoscopy and sinus CT scores correlated with a Spearman correlation coefficient of 0.51. Scores not reaching statistical significance included CF-related CRS SNOT-16 change scores and PedsQLTM general quality of life change scores. CONCLUSION: In pediatric patients with CRS electing ESS, general quality of life is impaired preoperatively and sinus symptoms improve significantly 1-3 months after sinus surgery. Parents report statistically worse CRS symptom scores than their children do. Nasal endoscopy scores in this cohort correlated with sinus CT scores.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Comparison between endonasal endoscopic polyp size scores and quality of life outcome after optimal medical treatment 334 340 EN S.K. Aboud Department of Otorhinolaryngology, Head and Neck Surgery, Malaysian Allied Health Sciences Academy (MAHSA) University, Jalan Elmu off Jalan Universiti, Kuala Lumpur, Malaysia S. Husain Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia B.S. Gendeh Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia 1254 10.4193/Rhin BACKGROUND: The aim of this prospective study is to evaluate whether changes in endoscopy score correlate with changes in quality of life (QOL) in nasal polyposis (NP) patients after optimal medical therapy. METHODOLOGY: An interventional clinical trial study involving fifty five patients with grade I and II NP was conducted. Patients were initially treated with a single dose oral prednisolone 25 mg for 2 weeks, Macrolide 250 mg daily for the first 3 months and long-term intranasal steroids. All patients were followed up and evaluated subjectively by Rhinosinusitis Disability Index question- naire and objectively by endonasal endoscopy between December 2011 to October 2013. RESULTS: At baseline, patients showed significantly bad QOL scores on all domains. At 3 months, a significant improvement in all impaired QOL domains and reduction of the nasal polyp size were demonstrated compared to baseline. At 6 and 12 months, no significant improvement between QOL scores and nasal polyp size was observed. CONCLUSION: Optimal medical treatments improve both the QOL and nasal polyp size in grade I and II NP patients. However, the changes in endoscopy scores explain a part of the improvement in QOL outcomes as the latter are multidimensional constructs.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis 341 347 EN M. Katotomichelakis Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece E. Simopoulos Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece G. Tripsianis Department of Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece N. Zhang Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent, University Hospital, Ghent, Belgium G. Danielides Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece P. Gouma Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece C. Bachert Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent, University Hospital, Ghent, Belgium V. Danielides Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece 1252 10.4193/Rhin BACKGROUND: The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate. OBJECTIVE: Το explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS). METHODOLOGY: Patients with CRS were prospectively asked to evaluate their QoL pre-and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short Form-36). Smoking habits were expressed in pack-years. RESULTS: No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing. CONCLUSION: Although smoking did not influence preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 The determining factors of peak nasal inspiratory flow and perception of nasal airflow in asthmatics 348 354 EN W.M. Thorstensen Dept of Otolaryngology, Head and Neck Surgery, University Hospital of Trondheim, Trondheim, Norway M. Sue-Chu Thoracic Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway V. Bugten Dept of Otolaryngology, Head and Neck Surgery, University Hospital of Trondheim, Trondheim, Norway M. Cvancarova Dept of Biostatistics, University of Oslo, Oslo, Norway S.K. Steinsvåg Dept of Otolaryngology, Head and Neck Surgery, Sorlandet Hospital, Kristiansand, Norway 1244 10.4193/Rhin14.1244 BACKGROUND: The effect of pulmonary pathology on peak nasal inspiratory flow (PNIF) remains largely unknown. We investigated an association between a diagnosis of asthma and of lung function on PNIF when adjusted for possible confounders. Further, we investigated the perception of nasal obstruction in asthmatics compared to healthy controls when adjusted for PNIF. METHODOLOGY: Eighty-seven asthmatics and 92 non-asthmatic controls underwent PNIF (categorized into groups of high, medium and low), acoustic rhinometry (AR) and spirometry, and we assessed symptoms of nasal obstruction on visual analogue scales (VAS) in three categories. RESULTS: PNIF was significantly associated with asthma and forced expiratory volume in the first second (FEV1) (% predicted). Other factors associated with PNIF were the degree of nasal obstruction measured both subjectively on a VAS and objectively with AR, age and disease status. Asthma patients were 19 times more likely to be in a higher VAS category compared to non-asth- matic controls independent of PNIF group. CONCLUSION: Special care has to be taken when interpreting PNIF values in patients with asthma or reduced FEV1 (% predicted). The sensation of nasal obstruction in asthmatics is different from controls despite being in the same PNIF group.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Does the contraceptive pill influence peak nasal inspiratory flow values? 355 359 EN G. Ottaviano Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy E. Cosmi Department of Woman and Child Health, University of Padova, Padova, Italy V. Iacono Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy B. Scarpa Department of Statistics, University of Padova, Padova, Italy A. Staffieri Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy G.K. Scadding Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1253 10.4193/Rhin BACKGROUND: Early oral contraceptive pills (OCP) had higher estrogen levels and have been thought to cause nasal obstruction in about 40% of women users. A recent small study conducted on women taking OCP showed no significant effects on nasal patency. The aim of the present study was to analyse in a large number of volunteers if Peak Nasal Inspiratory Flow (PNIF) values could be influenced by modern OCP. METHODOLOGY: PNIF was measured in 257 women (from 14 to 51 years old), divided into two groups: the study group composed of 109 healthy women taking modern OCP; the control group composed of 148 healthy women who did not take OCP. 9 women in the study group were excluded because of allergic disease, 248 females were finally considered. Data were statistically analysed and figures/tables were produced to see the effect of OCP on PNIF. RESULTS: The present study could not show any effect of OCP on nasal function. Moreover, while height influenced PNIF in both groups, age was not statistically significant. CONCLUSION: From the present study, it seems that OCP could have no effects on nasal airflow, confirming that modern OCP with lower estrogen doses should not affect nasal mucosa or nasal patency.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Comparison of classic and 4-phase rhinomanometry methods, is there any difference? 360 365 EN E.H.C. Wong Common Cold Centre and Healthcare Clinical Trials, Cardiff School of Biosciences, Cardiff University, United Kingdom R. Eccles Common Cold Centre and Healthcare Clinical Trials, Cardiff School of Biosciences, Cardiff University, United Kingdom 1255 10.4193/Rhin BACKGROUND: There are various different parameters used to measure nasal airway resistance (NAR) in rhinomanometry, which include the classic method at fixed pressure of 150Pa or 75Pa and 4-phase rhinomanometry. This study aims to determine if there is any difference between the measurements of NAR obtained by the classic and 4-phase rhinomanometry methods. METHODOLOGY: In-vitro study with measurements of NAR using both methods when applied across four artificial nose models. RESULTS: No statistically significant differences were found between NAR values obtained from both methods. Strong, positive correlations were found between NAR measured with both methods, which were statistically significant. Bland-Altman method also showed good agreement between both methods with narrow limits of agreement. CONCLUSION: There is high level of conformity between the values of nasal airway resistance measured using both methods.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Bacteriology of inverted papilloma 366 370 EN L.Y. Kim Department of Otolaryngology, Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA N.A. Cohen Department of Otolaryngology, Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA J.N. Palmer Department of Otolaryngology, Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA D.W. Kennedy Department of Otolaryngology, Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Z. Zhang Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA N.D. Adappa Department of Otolaryngology, Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA 1260 10.4193/Rhin14.007 BACKGROUND: Inverted papilloma (IP) is a benign lesion of the nasal cavity and paranasal sinuses. The aetiology of IP remains unclear. OBJECTIVE: To assess whether the sinonasal bacteriology of patients with IP is different from the bacteriology of chronic rhinosinusitis (CRS) patients and if there are differences between primary and recurrent IP. METHODOLOGY: A retrospective review of patients with IP at a tertiary referral centre. Intraoperative microbiology results from primary and revision IP resections were compared to each other and to published microbiology data from CRS patients. RESULTS: Twenty-six cases of IP were identified with a total of 83 intraoperative cultures, of which 43 were positive. The most common isolates were coagulase negative Staphylococcus (SCN), Propionibacterium, Staphylococcus aureus, and Streptococcus. The trends in the prevalence of isolates were similar to those reported for CRS patients. Additionally, similar bacteriology was identified between primary and revision IP patients. CONCLUSION: In our series, the most common bacterial isolates found in IP are similar to those of CRS, as is the prevalence of gram-negative organisms. Additionally, we did not demonstrate a difference between primary and recurrent IP. Our findings suggest that IP does not result from specific sinonasal microbial exposure.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Microbial biofilm formation on silicone nasal splints: optimal time for splint removal 371 375 EN M. Acar Yunus Emre State Hospital, ENT Dept, Eskisehir, Turkey T. Catli Bozyaka Teaching and Research Hospital ENT Department, Izmir, Turkey I. Dag Electron Microscope Laboratory, Eskisehir Osmangazi University, Eskisehir, Turkey T. San Istanbul Medeniyet University, ENT Department, Istanbul, Turkey C. Cingi Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey 1240 10.4193/Rhin OBJECTIVES: Biofilms are sessile communities associated with persistent infections and are resistant to conventional therapeutic strategies. They survive on the surface of various inorganic medical devices and cause serious medical problems. METHODS: We recruited 25 patients who underwent nasal surgery between January and May 2013. All patients received silicone splints at the conclusion of the procedure. Pieces of the splints were collected 48, 72 and 96 h post-surgery and prepared for scan- ning electron microscopy evaluation to assess biofilm formation. RESULTS: Biofilm was observed in 3, 14 and 25 of the 25 samples at 48, 72 and 96 h, respectively. The differences in the proportions of the samples with biofilm formation at each time point (48, 72, and 96 h) were statistically significant. CONCLUSION: Our data demonstrated that biofilm formation on silicone splints increases significantly after 48 h following place- ment. Although packing may reduce complications, surgeons must consider the potential hazards of packing materials, such as biofilm formation at 48 h post-surgery.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Endoscopic modified medial maxillectomy for odontogenic cysts and tumours 376 380 EN T. Nakayama Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan N. Otori Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan D. Asaka Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan T. Okushi Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan S. Haruna Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan 1248 10.4193/Rhin BACKGROUND: Odontogenic maxillary cysts and tumours originate from the tooth root and have traditionally been treated through an intraoral approach. Here, we report the efficacy and utility of endoscopic modified medial maxillectomy (EMMM) for the treatment of odontogenic maxillary cysts and a tumour. METHODOLOGY: We undertook EMMM under general anaesthesia in six patients: four had radicular cysts, one had a dentigerous cyst, and one had a keratocystic odontogenic tumour. RESULTS: The cysts and tumours were completely excised and the inferior turbinate and nasolacrimal duct were preserved in all patients. There were no peri- or postoperative complications, and no incidences of recurrence. CONCLUSION: Endoscopic modified medial maxillectomy appears to be an effective and safe technique for treating odontogenic cysts and tumours.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma 381 385 EN R.H. Kamel Department of Otorhinolaryngology, Cairo University, Cairo, Egypt A.F. Abdel Fattah Department of Otorhinolaryngology, Cairo University, Cairo, Egypt A.G Awad Department of Otorhinolaryngology, Cairo University, Cairo, Egypt 1277 10.4193/Rhin13.230 BACKGROUND: Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. OBJECTIVE: To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. METHODOLOGY: Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. RESULTS: Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. CONCLUSION: Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Prevalence of nasal polyps in Northern Portugal: a cadaver endoscopic study 386 389 EN R. Cerejeira Department of Otolaryngology, Tamega e Sousa Hospital Center, Portugal R. Veloso-Teles Department of Otolaryngology, Alto Ave Hospital Center, Portugal N. Lousan Department of Otolaryngology, Tamega e Sousa Hospital Center, Portugal C.P. Moura Faculty of Medicine, University of Porto, Portugal 1243 10.4193/Rhin BACKGROUND: Epidemiological studies on chronic rhinosinusitis with nasal polyps are scarce and mostly based on questionnaires. Data obtained with such approaches can be unreliable, thus endoscopy is a prerequisite for an accurate estimate of the preva- lence of nasal polyps. The objective of this study was to establish the frequency of nasal polyps in Northern Portugal, using nasal endoscopy in cadavers from a District Hospital. METHODS: The cadaver specimens deposited in the mortuary room of the hospital, every early morning on week days, from De- cember 2012 to August 2013, were submitted to a systematic endoscopic examination of both nasal cavities, using a 25o, 2.7 mm rigid endoscope from R. Wolf®. A review of the medical record of the cadavers was done, to search for cause of death, co-morbidi- ties and past ENT history. RESULTS: A group of 200 consecutive caucasian cadaver specimens were analyzed, 83 women and 117 men, with a mean age of death of 77.23 ± 12.29 years (range 34-97). The prevalence of nasal polyps was 5.5% (95% confidence interval, 2.34-8.66). No statis- tically significant association between the studied clinical variables (sex, allergic rhinitis, lower respiratory diseases and smoking) and the presence of nasal polyps was identified. CONCLUSION: This study provides the first endoscopic based epidemiological data on nasal polyps in Portugal, showing a preva- lence for old age group in accordance with previous studies in Europe.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 The role of B cell Activating Factor (BAFF) expression on pathogenesis of nasal polyp in chronic rhinosinusitis with nasal polyposis 390 396 EN Y.H. Yoon Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, South Korea J. Jin Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, South Korea K.R. Kwon Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, South Korea S.H. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, South Korea K.S. Rha Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, South Korea Y.M. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, South Korea 1256 10.4193/Rhin13.154 AIM: B cells, plasma cells, and local immunoglobulins, are important as a mucosal immune barrier function, and tend to increase in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). However, their association with eosinophils' aggregation has not been fully understood. The objectives of this study was to explore whether BAFF expression in the subepithelial area in nasal polyp tissues of CRSwNP was associated with eosinophils' accumulation, and also to evaluate cells which cells produce BAFF. METHODOLOGY: Immunohistochemical and immunofluorescence staining were used to analyse expression of BAFF, CD20, immunoglobulin A (IgA) and a proliferation inducing ligand (APRIL) on nasal tissues from CRSwNP patients and control subjects. To identify the relationship between BAFF and tissue eosinophilia, CRSwNP subjects were divided into eosinophilic polyp and non-eosinophilic groups. Double immunofluorescence analysis for BAFF and CD11c or CD11b was performed to identify cells producing BAFF. RESULTS: The numbers of BAFF, CD20, and IgA-positive cells in the subepithelial area were significantly higher in the CRSwNP group (both eosinophilic polyps and non-eosinophilic polyps) compared to the control group, and also significantly higher in eosinophilic polyps compared to non-eosinophilic polyps. There were statistically significant correlations between the number of BAFF and CD20-positive cells, CD20 and IgA-positive cells, and BAFF and IgA-positive cells. CD11b-positive cells were co-localized with BAFF positive cells. CONCLUSION: The subepithelial expression of BAFF was associated with increased number of B cells and plasma cells, and increased production of IgA in the patients with CRSwNP, especially eosinophilic nasal polyps. Therefore, BAFF-induced IgA production may be associated with eosinophils' aggregation and degranulation, which cause aggravation of tissue inflammation and finally polyp formation. The expression of BAFF in the subepithelial area may be associated with innate inflammatory cells (CD11b+ cells), such as monocytes, granulocytes, macrophages, and natural killer cells.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 25479222 Evaluation of the nasal contractility capacity in postmenopausal women 397 402 EN Y.S. Yildirim Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey E. Senturk Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey S. Tugrul Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey O. Ozturan Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey 1239 10.4193/Rhin13.107 OBJECTIVE: The aim of this study was to objectively compare nasal contractility in premenopausal and postmenopausal patients by means of rhinomanometry, acoustic rhinometry, and peak inspiratory nasal flow. METHODS: Design: prospective, clinical case - controlled study. Setting: university tertiary-care hospital, referral center. Participants: the study included 97 participants divided into two groups: 49 postmenopausal (the study group) and 48 preme- nopausal (control) females. Nasal evaluations were made utilizing anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, and anterior rhinomanometry. RESULTS: The differences between before and after decongestant application of Minimal Cross-sectional Area (MCA) 1, Minimal Cross-sectional Area (MCA) 2, Peak inspiratory nasal flow (PNIF), Rhinomanometry (RMM), Flow, and Volume values were been statistically significant in both postmenopausal and premenopausal group (control). CONCLUSION: Before and after all the subjects were administered nasal decongestant, nasal contractility was evaluated using objective nasal tests (acoustic rhinometry, rhinomamometry, and peak inspiratory nasal flow. Results showed that erectile tis- sues were not affected after menopause: postmenopausal women have the same nasal contractility capacity as premenopausal women.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 The prevalence of Epstein-Barr Virus-positive lymphoid cells in nasal mucosa: an extremely rare event 403 405 EN S.Y. Ha Department of Pathology, Gachon University School of Medicine, Incheon, Korea S.H. Park Department of Pathology, and Global Top 5 Program, Ewha Womans University School of Medicine, Seoul, Korea 1257 10.4193/Rhin13.178 BACKGROUND: The prevalence of EBV (Epstein-Barr virus)-positive lymphoid cells is unknown. Because EBV is implicated in the etiology of extranodal NK/T-cell lymphoma, nasal type (nasal ENKL), the presence of EBV-positive lymphoid cells (EPLs) in nasal mucosa specimens is expected. This study evaluated the presence of EBV-positive lymphoid cells in the nasal mucosa of 420 patients who had undergone surgical resection of lesions of the nasal cavity due to nasal septal deviation, chronic paranasal rhinosinusitis, chronic hypertrophic rhinosinusitis, nasal polyps, allergic rhinitis, papillomas, and cysts. METHODOLOGY: Three representative 1.0-mm-diameter core biopsies were taken from one paraffin-embedded donor tissue block per case and subsequently arranged in new recipient paraffin blocks with a trephine. EBV in situ hybridization study was performed to detect EPLs. RESULTS: None of the cases demonstrated EPLs. CONCLUSION: The presence of EPLs in the nasal mucosa is an extremely rare event in immunocompetent individuals. Therefore, the detection of EPLs in nasal biopsy specimens should prompt the pathologist to perform further testing to exclude the possibility of nasal ENKL.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 The effect of Epigallocatechin-3-Gallate in allergic airway inflammation 406 412 EN Y.S. Choi Department of Otorhinolaryngology - Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea C.H. Bae Department of Otorhinolaryngology - Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea S.Y. Song Department of Otorhinolaryngology - Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea Y.D. Kim Department of Otorhinolaryngology - Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea 1259 10.4193/Rhin13.189 BACKGROUND: The variety of beneficial effects of green tea has been reported. Epigallocatechin-3-gallate (EGCG) is a major component of green tea extract. The biological activity of EGCG includes anti-allergic and anti-inflammatory activities. However, the precise effect of EGCG on the allergic airway inflammation has not been fully defined. METHODOLOGY: In lung tissues of an asthma model-mouse, and nasal epithelial cells of patients with allergic rhinitis, the effect and brief signaling pathway of EGCG on MUC5B expression were investigated using real-time polymerase chain reaction, immunohistochemical, and immunoblot analysis. RESULTS: In the asthma model-mouse, mucus production, MUC5B expression, p38 mitogen-activated protein kinase (MAPK) and matrix metalloprotease (MMP)-9 expression of the asthma group were significantly higher than in the control group. Extracellular signal related kinase (ERK)1/2 MAPK expression did not change. Mucus production, MUC5B expression, p38 MAPK expression, and MMP-9 expression of the asthma + EGCG group were significantly lower than in the asthma group. In the nasal epithelial cells of patients with allergic rhinitis, EGCG significantly decreased phorbol 12-myristate 13-acetate (PMA)-induced MUC5B and MMP-9 expression. CONCLUSION: These results suggest that EGCG reduces mucin expression in the asthma model-mouse and nasal epithelial cells of patients with allergic inflammation.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: long-term results in 91 procedures 413 418 EN A. Saratziotis Department of Otolaryngology, Head and Neck Surgery, University Hospital of Larissa, Greece E. Emanuelli Department of Otolaryngology and Otologic Surgery, University Hospital of Padova, Italy H. Gouveris Department of Otolaryngology, Head and Neck Surgery, University of Mainz Medical Center, Mainz, Germany E. Tsironi Department of Ophthalmology, University Hospital of Larissa, Greece K. Fountas Department of Neurosurgery, University Hospital of Larissa, Greece 1261 10.4193/Rhin13.218 BACKGROUND: The purpose of the present study was to evaluate long-term outcomes of endoscopic dacryocystorhinostomy (DCR) using a drill without the use of mucosal flaps. Ninety one procedures in eighty seven patients were reviewed. All patients showed epiphora, caused by primary or secondary nasolacrimal obstruction. METHODOLOGY: All patients underwent preoperative evaluation (irrigation and probing of the lacrimal drainage system, fluorescein tests, computerized tomography scan of the paranasal sinuses, dacryocystography and endoscopic examination of the nasal cavity). In 19 patients further intranasal procedures were conducted simultaneously with DCR (10 FESS, 2 septoplasties, 5 functional endoscopic sinus surgery (FESS) and septoplasties, 2 septoplasties and turbinoplasties). Stents were placed intraoperatively and removed 4 to 12 weeks, postoperatively. Postoperative follow-up ranged between 12 and 24 months. RESULTS: Long-term success was achieved in 87/91 procedures. No major complications were observed. Failure was caused by granulation tissue formation in three patients and inappropriate stent removal in one patient. CONCLUSION: The success rate achieved is comparable to success rates of external DCR.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Asymmetry of the anterior skull base at the level of frontal ostium, a radioanatomical study 419 423 EN T. Gotlib Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland M. Kuzminska Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland M. Held-Ziolkowska Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland K. Niemczyk Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland 1268 10.4193/Rhin14.071 BACKGROUND: Radioanatomical studies have shown that the ethmoid roof is asymmetric in 10 to 40% of individuals. The right ethmoid roof has been found on average to be lower compared to the left. The aim of this study was to extend existing results by assessing asymmetry between the right and left anterior skull base at the level of the frontal ostium. METHODOLOGY: Curved multiplanar reconstruction was used to analyse 247 consecutive paranasal sinus CT scans. The corresponding left and right parasagittal profiles of the skull base marked from the anterior ethmoidal artery to the level of the orbital roof were superimposed and compared. RESULTS: Asymmetry greater than 1 mm was found in 87% of patients, greater than 2 mm in 40.5% of patients, and greater than 3 mm in 8% of patients. The prevalence of the patients with lower skull base on the right side was greater than those with lower skull base on the left side at a ratio of more than 2:1. CONCLUSION: Skull base asymmetry in the region of the frontal ostium is observed in a large percentage of the population and may be a potential source of complications during endoscopic sinus surgery.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Diode laser versus radiofrequency treatment of the inferior turbinate - a randomized clinical trial 424 430 EN U. Kisser Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany K. Stelter Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany R. Gürkov Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany M. Patscheider Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany F. Schrőtzlmair Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany R. Bytyci Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany C. Adderson-Kisser Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany A. Berghaus Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Germany B. Olzowy Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Germany 1266 10.4193/Rhin14.001 BACKGROUND: Laser and radiofrequency induced volume reduction of the inferior turbinates are frequently used treatment modalities. Which of both is superior, however, is not clear to date due to a lack of controlled prospective studies. Here, we compare both methods regarding improvement of nasal breathing, complications, patient comfort and wound healing. METHODOLOGY: Prospective, randomized, single-blinded clinical trial with intra-individual design. After randomization, one side of the nose was treated with a 940nm diode laser and the other side with bipolar radiofrequency therapy. Pre- and postoperative evaluation was performed using visual analogue scales, nasal endoscopy and objective measurements of nasal patency. RESULTS: Of 27 enrolled patients, 26 completed the protocol. No severe complications were observed. Intraoperative discomfort was significantly more severe on the radiofrequency side. After three months, a significant reduction of nasal obstruction was observed for laser treatment and radiofrequency therapy with no significant difference between them. Objective parameters did not improve significantly. When asked which treatment modality they would chose again 50 % of the patients decided for radiofrequency treatment, 23 % for laser treatment, and 19 % for both. CONCLUSION: DLVR and RFVR are well-tolerated treatment modalities and both significantly reduce the degree of nasal obstruction in patients with hypertrophic inferior turbinates. There was no significant difference between both treatment modalities regarding efficiency.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Nasal response in patients with diisocyanate asthma 431 436 EN J. Sastre Allergy Dept., Fundacion Jimenez Diaz and CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain (Institute Carlos III, Ministry of Economy and Competitiveness) A. Poltronieri Allergy Dept., Fundacion Jimenez Diaz and CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain (Institute Carlos III, Ministry of Economy and Competitiveness) I. Mahillo-Fernandez Epidemiology Dept., Fundacion Jimenez Diaz, Madrid, Spain E. Aguado Allergy Dept., Fundacion Jimenez Diaz and CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain (Institute Carlos III, Ministry of Economy and Competitiveness) M. Garcia del Potro Allergy Dept., Fundacion Jimenez Diaz and CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain (Institute Carlos III, Ministry of Economy and Competitiveness) M. Fernandez-Nieto Allergy Dept., Fundacion Jimenez Diaz and CIBER de Enfermedades Respiratorias (CIBERES) Madrid, Spain (Institute Carlos III, Ministry of Economy and Competitiveness) 1267 10.4193/Rhin14.005 BACKGROUND: To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC). OBJECTIVES: This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents. METHODS: Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses. RESULTS: Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response. CONCLUSION: SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.

International Rhinologic Society Rhinology 0300-0729 52 4 2014 12 1 Predictive value of disease severity on self-reported rating and quantitative measures of olfactory function outcomes after primary endoscopic sinus surgery. A prospective study 437 443 EN F. Minwegen Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany J.P. Thomas Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany M. Bernal-Sprekelsen Department of Otorhinolaryngology, Rhinology Unit and Smell Clinic, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain S. Dazert Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany A. Minovi Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany 1274 10.4193/Rhin14.043 BACKGROUND: This prospective study investigates the influence of primary Endoscopic Sinus Surgery (ESS) in patients with chronic rhinosinusitis (CRS) on olfactory function and on the patient's quality of life. We assess the role of preoperative disease severity measured by computed tomography (CT) scan in predicting outcome. METHODOLOGY: Adults undergoing ESS were examined preoperatively (n = 92) and five months postoperatively. Coronal CT scans were evaluated referencing the Lund Mackay (LM) system. On the basis of the LM score, the collective was divided into two groups. We performed the olfactory test "Sniffin' Sticks" and handed out the specific health-related quality of life questionnaire SNOT-20. RESULTS: We could demonstrate that olfactory function of patients with strong opacification on CT scans improved by an average by 2.49 points more than olfactory function of patients with less severe disease. In terms of the self-reported rating of smell, the degree of amelioration differed significantly. Both groups showed an improvement in quality of life irrespective of severity of disease. CONCLUSION: Mean olfactory function of patients with a high degree of disease in CT scan improved more than that of patients with less opacification on CT scan. Patient's subjective perception of smell impairment was in line with these findings.