International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 How I changed my practice in the last five years and what is likely to change in the next five years 1 2 EN W.J. Fokkens Department of Otolaryngology, Academic Medical Center, Amsterdam, The Netherlands 1306 10.4193/Rhin53E1 The fast development of our field in the last decades has had significant impact on the way we practice our profession. This year my editorials will focus on the impact of these develop- ments on my own daily practice. When I started in otorhinolaryngology functional endoscopic sinus surgery was the new kid on the Block. We learned to operate as functional as possible. The primary goal of FESS was to restore normal ventilation and remove irreversibly changed mucosa. The concept was that by restoring proper ventilation the sinus would heal itself. In the past decades, we have more and more discovered that CRS and especially CRS with nasal polyps is a mucosal disease that needs intensive medical treat- ment if necessary combined with ESS. The concept of FESS has moved from improving ventilation to opening up sinus for local medical treatment. Local medical treatment has been shown to be more effective when it is able to enter the sinus. Although we do not have all data available yet, rinsing with saline in which local corticosteroids have been dissolved seems to be more effective than using nasal drops and certainly more effective than nasal spray.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Efficacy and side effects of antibiotics in the treatment of acute rhinosinusitis: a systematic review 3 9 EN WJ Sng House Officer, Yong Loo Lin School of Medicine, National University of Singapore, Singapore DY Wang Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 1281 10.4193/Rhin13.225 BACKGROUND: Acute rhinosinusitis (ARS) is one of the most common diagnoses for which an antibiotic is prescribed. Although the usage of antibiotics in the treatment of mild, moderate or uncomplicated ARS is not recommended by most international guideli- nes, overuse of antibiotics is still an alarming problem among patients and healthcare practitioners. We thus sought to review the evidence available through a systematic review of the existing literature on antibiotic usage in ARS. METHODOLOGY: A search of the PubMed database was conducted for studies on antibiotic and placebo usage in the treatment of ARS. RESULTS: A total of 31 random control trials (RCT) reporting the clinical efficacy of treating ARS and side effects of using cefuroxime axetil, telithromycin, amoxicillin/potassium clavulanate, levofloxacin, moxifloxacin and clarithromycin were included in the review. Among them, 9 studies were performed double-blinded with placebo controls. The results showed that while antibiotics are more efficacious than placebos in the treatment of ARS, the risks of potential side effects need to be weighed against the potential be- nefit that antibiotics give to the patient. This is especially pertinent as usage of the placebo has shown to be almost as efficacious as using the antibiotic therapy, and also much safer. CONCLUSION: The usage of antibiotics in ARS is widespread and there seems to be only slight added benefit in the usage of antibi- otics over placebo in the treatment of ARS. Hence, larger scale studies should be done in the future to confirm the results of these studies.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Does time to endoscopic sinus surgery impact outcomes in Chronic Rhinosinusitis? Prospective findings from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis 10 17 EN C. Hopkins ENT Dept , Guy's and St Thomas' Hospitals, London, United Kingdom J. Rimmer Royal National Throat, Nose and Ear Hospital, London, United Kingdom V.J. Lund Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1251 10.4193/Rhin13-217 OBJECTIVES: Patients with chronic rhinosinusitis refractory to medical management undergo elective surgery. The time from initial diagnosis to surgery varies considerably. The impact of this delay on surgical success has never previously been evaluated. DESIGN: First-time patients within the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis were grouped based on time to surgery: 1) Early cohort: < 12 months; 2) Mid cohort: 12-60 months; and 3) Late cohort: > 60 months. Co-morbidities and preoperative CT scores were analysed for all patients. MAIN OUTCOME MEASURES: The 22-item Sino-Nasal Outcome Test scores (SNOT-22) were collected at 0, 3, 12 and 60-months. Absolute and relative SNOT-22 changes from baseline were evaluated. RESULTS: Asthma and allergies were significantly more prevalent in the Late versus the Early and Mid-cohorts. In addition, patients in the Late cohort had greater symptom burden on the SNOT-22 and more extensive preoperative radiographic disease as determined by Lund-Mackay (LM) scores. SNOT-22 scores demonstrated greater percentage improvements in the Early versus the Mid- and Late cohorts, at all time points after surgery. At 12 and 60 months after surgery, significantly more patients in the Early group achieved a clinically important change in SNOT-22 scores compared with the other groups. These differences were maintained when cohorts were matched for preoperative co-morbidities. CONCLUSION: Patients with asthma and/or allergies are more likely to experience delayed surgical intervention versus other patients. Overall, patients with delayed surgery reported less improvement in SNOT-22 scores than patients treated at earlier time points, regardless of co-morbid status. Delaying surgical intervention may worsen long term clinical outcomes.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Does time to endoscopic sinus surgery impact outcomes in chronic rhinosinusitis? Retrospective analysis using the UK clinical practice research data 18 24 EN C. Hopkins Guy s Hospital, ENT Department, London, UK P. Andrews Royal National Throat, Nose and Ear Hospital, London, UK C.E. Holy Acclarent Inc, Menlo Park, CA, USA 1278 10.4193/Rhin14.077 BACKGROUND: Patients with chronic rhinosinusitis (CRS) refractory to medical management may elect endoscopic sinus surgery (ESS). Recent data showed that clinical outcomes of patients treated earlier outperformed those of patients treated later in the disease continuum. In this study, CRS-related healthcare utilisation of patients treated early versus late was analysed using the UK-based Clinical Practice Research Database. METHODS: Two cohorts ("Early Cohort": ESS within 12 months of first CRS diagnosis, versus "Late Cohort": ≥ 5 years from diagnosis to ESS) were matched for age, gender, asthma, polyposis. Healthcare needs related to CRS were analysed post-operatively for 5 years. RESULTS: Patients in the Late cohort used significantly more CRS-related care than patients in the Early cohort visits and 0.54 prescriptions per patient per year. A sub-analysis of patients with and without asthma indicated that patients in the Late cohort without asthma had healthcare needs equivalent to patients in the Early cohort with asthma. CONCLUSION: Delayed surgical intervention for CRS is associated with greater post-operative healthcare needs than ESS within 12 months of first CRS diagnosis.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Heredity of nasal polyps 25 28 EN A. Bohman Department of Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden M. Oscarsson Department of Otorhinolaryngology, Hospital of Skaraborg, Skovde, Sweden K. Holmberg Department of Otorhinolaryngology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden L. Johansson Department of Otorhinolaryngology, Hospital of Skaraborg, Skovde, Sweden E. Millqvist Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden S. Nasic Research and Development Centre, Hospital of Skaraborg, Skovde, Sweden A. Torinsson-Naluai Department of Clinical Genetics, Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden M. Bende Department of Otorhinolaryngology, Hospital of Skaraborg, Skovde, Sweden 1279 10.4193/Rhin14.032 BACKGROUND: Nasal polyps is a common disease but little is known about its' pathogenesis. Our hypothesis was that there are genetic factors involved in the development of this disease. The aim of this study was to examine close relatives of patients with nasal polyps and comparing them with a general population with regard to prevalence of polyps. METHODOLOGY: Patients with nasal polyps who attended the clinic were recruited to the study and were asked whether they had any close adult relatives (siblings, parents or children). We intended to recruit two relatives per patient, one of each gender, for nasal endoscopy. The prevalence of nasal polyps in these relatives was compared with the prevalence of nasal polyps in a general population. RESULTS: During a 4-year period, 368 patients and 410 relatives were recruited to the study. Although we were unable to recruit two close relatives for every patient, we were able to calculate nasal polyp prevalence within families as being 19.2%. Compared with the prevalence of nasal polyps among individuals in a general Swedish population from the same geographical area, the relative risk for polyps among relatives was almost five times higher. CONCLUSION: This study strongly indicates that heredity is a factor of importance for development of nasal polyps.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Olfactory cleft opacity and CT score are predictive factors of smell recovery after surgery in nasal polyposis 29 34 EN C. Vandenhende-Szymanski 1 Department of Otorhinolaryngology and Head and Neck surgery, Huriez Hospital, University of Lille, France B. Hochet Department of Otorhinolaryngology and Head and Neck surgery, Huriez Hospital, University of Lille, France D. Chevalier Department of Otorhinolaryngology and Head and Neck surgery, Huriez Hospital, University of Lille, France G. Mortuaire Department of Otorhinolaryngology and Head and Neck surgery, Huriez Hospital, University of Lille, France 1285 10.4193/Rhin14.160 OBJECTIVES: To assess subjective improvement of olfactory function following endoscopic sinus surgery (ESS) in chronic rhinosinusitis associated with nasal polyps (CRSwNP) and to analyse factors of recovery with the European Test of Olfactory Capabilities (ETOC). METHODS: We carried out a prospective study of 30 patients with CRSwNP from November 2011 to April 2013. The ETOC was filled the day before surgery and in the short term follow-up. Sixteen suprathreshold odorants with a detection task and a forced choice verbal identification task were tested. RESULTS: The mean composite score (MCS) improved at 3 and 6 months. The preoperative MCS was correlated to the Lund-Mackay score and to the olfactory cleft opacification on preoperative computed tomography (CT) scan. Multivariate linear regression modelling of patients with preoperative anosmia showed that the olfactory recovery at 3 months was predicted by the preoperative Lund-Mackay score and the age, and at 6 months by the preoperative Lund-Mackay score. CONCLUSION: With a convenient psychophysical test, we showed that olfactory cleft opacification and CT scan score could be predictive factors of olfaction disorder severity and improvement after ESS in CRSwNP. These results need to be strengthened in the long term with a larger panel of patients.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Treatment outcomes of midfacial segment pain: experience from the Liverpool multi-disciplinary team facial pain clinic 35 40 EN S.C. Leong Department of Otolaryngology - Head and Neck Surgery Royal Liverpool University Hospital, Liverpool, United Kingdom L. Lazarova Department of Otolaryngology - Head and Neck Surgery Royal Liverpool University Hospital, Liverpool, United Kingdom H.K. Tsang Department of Anesthesiology and Pain Management, Royal Liverpool University Hospital, Liverpool, United Kingdom G. Banhegyi Department of Otolaryngology - Head and Neck Surgery Royal Liverpool University Hospital, Liverpool, United Kingdom 1291 10.4193/Rhin14.156 OBJECTIVES: Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined to the midface cor- responding to the second division of the trigeminal nerve. This review presents treatment outcomes of MSP patients managed at the Multi-disciplinary Team (MDT) Facial Pain Clinic in Liverpool. METHODOLOGY: Prospective clinical outcome performed in a tertiary referral centre for complex facial pain syndromes. MAIN OUTCOME MEASURES: Sino-Nasal Outcome Test (SNOT). Clinical "success" was defined as an improvement in total SNOT score of >9 points and a reduction of the ear-facial symptoms sub-domain score by ≥50% from baseline. RESULTS: The average age of the cohort was 49 years, with an average follow-up of 12 months. The overall pre-treatment total SNOT-22 score was 59.5 which improved significantly to 42 at latest follow-up. Although the average scores of all sub-domains improved, only the ear-facial symptoms and psychological issues sub-domains achieved statistical significance. When the criterion for success was applied, nine patients fulfilled this definition at an average of 12 months follow-up. The baseline total SNOT score in this cohort improved from 60.6 to 19.7. Half of these patients achieved success within 18 months of commencing treatment and the probability of attaining success at long-term follow-up was high. CONCLUSIONS: Treatment of midfacial segment facial pain is complex and requires follow-up to achieve any meaningful clinical outcome.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 25756077 A computational study of functional endoscopic sinus surgery and maxillary sinus drug delivery 41 49 EN M.R. Wofford Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA J.S. Kimbell Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA D.O. Frank-Ito Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA V. Dhandha Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA K.A. McKinney Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA G.M. Fleischman 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 B.A. Senior Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA 1302 10.4193/Rhin13.065 BACKGROUND: Topical medication is increasingly used following functional endoscopic sinus surgery (FESS). Information on particle sizes that maximise maxillary sinus (MS) delivery is conflicting, and the effect of antrostomy size on delivery is unclear. The purpose of this study was to estimate antrostomy and particle size effects on topical MS drug delivery. METHODOLOGY: Sinonasal reconstructions were created from a pre- and a post-FESS CT scan in each of four chronic rhinosinusitis patients. Additional models were created from each post-FESS reconstruction representing four alternative antrostomy sizes. Airflow and particle deposition were simulated in each reconstruction using computational fluid dynamics for nebulised and sprayed delivery. RESULTS: MS ventilation and drug delivery increased following FESS, the largest virtual antrostomy led to greatest delivery, and MS delivery was sensitive to particle size. Particles within a 5-18 μm and 5-20 μm size range led to peak MS deposition for nebulised and sprayed particles, respectively. Post-FESS increases in drug delivery varied across individuals and within individuals by the type of antrostomy created. CONCLUSION: Our findings suggest that FESS, particularly with larger antrostomies, improves topical drug delivery, and that certain particle sizes improve this delivery. Further research is needed to contextualise these findings with other post-surgical effects.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 25756078 Accuracy of a questionnaire for identifying respiratory allergies in epidemiological studies 49 53 EN R. Pedotti Neuroimmunology and Neuromuscular Disorders Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy L. Losappio Department of Allergology and Immunology, Niguarda Ca Granda Hospital, Milan, Italy M. Farinotti Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy D. Preziosi Department of Allergology and Immunology, Niguarda Ca Granda Hospital, Milan, Italy I. Tramacere Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy C. Stafylaraki Department of Allergology and Immunology, Niguarda Ca Granda Hospital, Milan, Italy A. Mascheri Department of Allergology and Immunology, Niguarda Ca Granda Hospital, Milan, Italy G. Filippini Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy E.A. Pastorello Department of Allergology and Immunology, Niguarda Ca Granda Hospital, Milan, Italy 1276 10.4193/Rhin14.047 BACKGROUND: The assessment of allergic asthma (AA) and allergic rhinitis (AR) in epidemiological studies is often challenging. We performed a cross-sectional study to test the accuracy of a Questionnaire aimed at Identifying subjects with Respiratory Allergy (QIRA) in a simple and fast way. METHODS: One hundred-thirty subjects, 18-76 years of age, admitted consecutively at the Allergy Center of the Niguarda Ca' Granda Hospital of Milan were included. The questionnaire (index test) investigated the presence of AA and AR with seven questions enquiring history of symptoms, diagnosis made by a doctor, allergy tests performed, and treatments. After completing the questionnaire, all subjects were subsequently diagnosed by an allergist (reference standard). RESULTS: The accuracy of the questionnaire for the diagnosis of AA and AR was high (sensitivity 94.7% [95% confidence interval CI: 74.0-99.9] and specificity 99.1% [95% CI 95.1-100.0] for AA; sensitivity 82.8% [95% CI 71.3-91.1] and specificity 98.5% [95% CI 91.8-100.0] for AR). CONCLUSION: The questionnaire significantly distinguished subjects with respiratory allergy from those without. The QIRA represents a valid and accurate tool for classifying subjects as having or not AA and/or AR in epidemiological studies.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Quality of life after septorhinoplasty measured with the Functional Rhinoplasty Outcome Inventory 17 (FROI-17) 54 58 EN O.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 S. Prochnow Department of Otolaryngology, University of Heidelberg, Germany C. Kuhnt Department of Otolaryngology, University of Heidelberg, Germany I. Baumann Department of Otolaryngology, University of Heidelberg, Germany 1290 10.4193/Rhin14.008 BACKGROUND: Quality of life measurements in septorhinoplasty patients so far have taken place only to a small extent. The aim of the present study was a prospective measurement of disease-specific quality of life with a newly developed and validated instrument, the Functional Rhinoplasty Outcome Inventory 17 (FROI-17). METHODS: The patients completed the FROI-17 and the Rhinoplasty Outcome Evaluation (ROE) as disease-specific instruments preoperatively as well as 12 months postoperatively. As a general instrument, the Short Form 36 Health Survey (SF-36) was used. Furthermore, additional general questions were answered at both time points. RESULTS: Out of the 103 patients, 69 patients (32 men, 37 women) responded after 12 months (response rate 67%). Thirteen patients (18%) were not satisfied with the result of surgery. However, all scales of FROI-17 and also ROE showed a significant postoperative improvement of subjective assessments by the patients. In the SF-36, this was true in 2 out of 8 scales (mental health and role-functioning physical). Furthermore, we found significant correlations between the FROI-17 and the SF-36 scales but not between the ROE and the SF-36 scales. CONCLUSION: The disease-specific quality of life was significantly improved by septorhinoplasty. FROI-17 scales detect more functional aspects compared with the ROE thus establishing significant correlations with general quality of life measured by SF-36. The application of both FROI-17 and ROE in future clinical trials in septorhinoplasty patients is recommended.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure 59 65 EN T.R. Karlsson Sahlgrenska University Hospital, Gothenburg, Sweden M. Shakeel Department of Otolaryngology - Head and Neck Surgery, University of Aberdeen, Aberdeen Royal Infirmary Aberdeen, Scotland, United Kingdom M. Supriya Department of Otolaryngology - Head and Neck Surgery, University of Aberdeen, Aberdeen Royal Infirmary Aberdeen, Scotland, United Kingdom B. Ram Department of Otolaryngology - Head and Neck Surgery, University of Aberdeen, Aberdeen Royal Infirmary Aberdeen, Scotland, United Kingdom K.W. Ah-See Department of Otolaryngology - Head and Neck Surgery, University of Aberdeen, Aberdeen Royal Infirmary Aberdeen, Scotland, United Kingdom 1272 10.4193/Rhin12.059 OBJECTIVE: Septoplasty is an accepted and common surgical intervention to improve the nasal airway. However, the role of concomitant surgery on the inferior turbinate remains debated. This study aims to investigate if the inferior turbinate surgery at the time of septoplasty would impact on the likelihood of revision nasal surgery - septoplasty or septorhinoplasty. STUDY DESIGN: Retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction over 12 years (1998 - 2010) at Aberdeen Royal Infirmary. METHODS: Patients were identified from the theatre log books and were excluded if they underwent any other nasal procedure. Data collected include demographics, type of primary surgery, and grade of surgeon along with revision nasal surgery in this cohort. RESULTS: 2168 eligible patients with a mean age of 39 years were investigated. Two groups were identified: Group A, with 788 patients who underwent septoplasty only, and Group B, in which 1380 patients underwent septoplasty with concomitant inferior turbinate reduction. The majority of operations were performed by the surgeons in training. The incidence of revision surgery was 5.1 % (21 revision septoplasties and 19 corrective septorhinoplasties) in Group A compared to 2.2 % (20 revision septoplasties and 10 corrective septorhinoplasties) in Group B. CONCLUSION: Based on this study, it would appear that concomitant inferior turbinate reduction may decrease the likelihood of revision nasal surgery.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Comparison of acoustic rhinometry and nasal inspiratory peak flow as objective tools for nasal obstruction assessment in patients with chronic rhinosinusitis 66 74 EN E.K. Proimos ENT Department, Chania General Hospital, Chania, Crete, Greece D.E. Kiagiadaki ENT Department, Chania General Hospital, Chania, Crete, Greece T.S. Chimona ENT Department, Chania General Hospital, Chania, Crete, Greece F.G. Seferlis ENT Department, Chania General Hospital, Chania, Crete, Greece N.J. Maroudias ENT Department, New Ionian General Hospital, Athens, Greece C.E. Papadakis ENT Department, Chania General Hospital, Chania, Crete, Greece 1271 10.4193/Rhin13.203 BACKGROUND: Chronic rhinosinusitis (CRS) is a disease with increasing incidence, characterized by persistent symptoms and negative impact on patient's quality of life. Nasal inspiratory peak flow (NIPF) and acoustic rhinometry (AR) were studied and compared as assessment tools for CRS with or without nasal polyps (NP), as well as, in follow up monitoring of conservative medical treatment. OBJECTIVES: Seventy-eight patients were prospectively studied. Objective assessment included NIPF and AR at baseline and at 4 and 8 weeks after onset medical treatment. Measurements were studied in correlation with Sinonasal Outcome Test-22 (SNOT-22) questionnaire, Visual Analogue Scale (VAS) and endoscopic appearance score (EAS). RESULTS: Both NIPF and AR improved significantly, after medical treatment. NIPF score reflected CRS symptoms' improvement according to SNOT-22 total score at the end of treatment protocol, showing moderate to strong correlation with nasal obstruction VAS grading during the treatment period. AR measures were associated with EAS in all sets of examinations and correlated moderately with VAS scoring at 8 weeks. CONCLUSION: NIPF and AR were proven to be promising methods for objective evaluation and monitoring of nasal obstruction based on different aspects of nasal physiology in patients with CRS.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Sinonasal malignancies in Sweden 1960-2010; a nationwide study of the Swedish population 75 80 EN A. Elliot Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden M. Jangard Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden L. Marklund Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden N. Hakansson Institute of Environmental Medicine Karolinska Institutet, Stockholm, Sweden P. Dickman Institute of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden L. Hammarstedt-Nordenvall Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden P. Stjarne Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden 1282 10.4193/Rhin14.070 INTRODUCTION: Sinonasal malignancies (SNM) are rare and the prognosis is generally poor. Recently, a change in incidence for SNM has been reported. In this study, we investigated population-based trends for SNM in Sweden. METHODS: We identified 3,221 patients from the Swedish National Cancer Registry diagnosed with primary malignancies arising from the nasal cavity, paranasal sinuses, or both, during the period 1960 through 2010. Incidence, gender and age, anatomical sites and relative survival were investigated. RESULTS: The incidence for SNM decreased except for sinonasal malignant melanoma (SNMM) and adenoid cystic cancer (even though a very small group) during the study period. More than 50 % of the malignancies involved the nasal cavity. The five-year relative survival was highest for adenoid cystic cancer followed by adenocarcinoma. SNMM and undifferentiated carcinoma had the poorest prognosis. CONCLUSION: We found that the incidence for SNM has decreased during the study period 1960 through 2010, except for SNMM that has increased.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 The natural history of community-acquired common colds symptoms assessed over 4-years 81 88 EN T.J. Witek Healthcare Innovation and Technology Laboratory at Columbia University in The City of New York, NY 10032 USA D.L. Ramsey Procter and Gamble, Personal Health Care Division, Mason, OH 45040, USA A.N. Carr Procter and Gamble, Personal Health Care Division, Mason, OH 45040, USA D.K. Riker On Point Advisors, LLC, PO Box 5450, Chattanooga, TN 37406, USA 1280 10.4193/Rhin14.149 BACKGROUND: The common cold is the most frequently experienced infection among humans, but limited data exist to characterize the onset, duration, severity and intersection of symptoms in community-acquired colds. A more complete understanding of the symptom frequency and burden in naturally occurring colds is needed. METHODOLOGY: We characterized common cold symptoms from 226 cold episodes experienced by 104 male or female subjects. Subjects were enrolled in the work environment in an attempt to start symptom evaluation (frequency and severity) at the earliest sign of their cold. We also assessed the symptom that had the greatest impact on the subject by asking them to identify their single most bothersome symptom. RESULTS: Symptom reporting started within 24 hours of cold onset for most subjects. Sore throat was a harbinger of the illness but was accompanied by multiple symptoms, including nasal congestion, runny nose and headache. Cough was not usually the most frequent symptom, but was present throughout the cold, becoming most bothersome later in the cold. Nasal congestion, pain (eg, sore throat, headache, muscle pains) or feverishness and secretory symptoms (eg, runny nose, sneezing), and even cough, were simultaneously experienced with high incidence over the first 4 days of illness. The single most bothersome symptom was sore throat on day 1, followed by nasal congestion on days 2-5 and cough on days 6 and 7. CONCLUSION: There is substantial overlap in the appearance of common cold symptoms over the first several days of the common cold. Nasal congestion, secretory and pain symptoms frequently occur together, with cough being somewhat less prominent, but quite bothersome when present. These data establish the typical symptomatology of a common cold and provide a foundation for the rational treatment of cold symptoms typically experienced by cold sufferers.

International Rhinologic Society Rhinology 0300-0729 53 1 2015 3 1 Even cognitively well-functioning adults are unaware of their olfactory dysfunction: Implications for ENT clinicians and researchers 89 94 EN E. Wehling Department of Biological and Medical Psychology, University of Bergen, Norway A.J. Lundervold Department of Biological and Medical Psychology, University of Bergen, Norway T. Espeset Department of Psychology, University of Oslo, Norway I. Reinvang Department of Psychology, University of Oslo, Norway A. Bramerson Department of Otorhinolaryngology, Central Hospital, Skovde, Sweden S. Nordin Department of Psychology, Umea University, Sweden 1300 10.4193/Rhin14.081 BACKGROUND: Past findings of an impact of cognitive impairment on awareness of olfactory dysfunction, and high prevalence of age-associated cognitive impairment motivated the present study of whether middle-aged and elderly adults are unaware of an olfactory dysfunction despite being carefully screened for cognitive impairment. METHODOLOGY: The sample included 203 Norwegian participants, aged 46-79 years, 134 women and 69 men, who underwent comprehensive neuropsychological assessment for screening of cognitive impairment. Subjective assessment of olfactory function ("How would you estimate your sense of smell?") was compared with outcome on objective assessment of olfactory function with the Scandinavian Odor Identification Test, which in the present study was shown to be valid for use on Norwegian populations. RESULTS: We found that 79% of this cognitively healthy sample with objectively assessed olfactory dysfunction reported normal olfactory function (57% of functionally anosmics reported normal function). In contrast, only 9% with objectively assessed normal olfactory function reported olfactory dysfunction. CONCLUSION: A large proportion of cognitively well-functioning middle-aged and elderly adults with an olfactory dysfunction are unaware of their dysfunction. The ENT physician who suspects that the sense of smell may be compromised should, in addition to an anamnesis, assess the patient's olfactory function objectively.