International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 From epithelial cell cultures to quality of life of the surgeon 97 98 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands 1322 10.4193/Rhin53E2 This issue of the journal shows the variety of research in our field. From very basic research evaluating the role of epithelial cells in upper airway inflammation to quality of life research not only of our patients but this time also of the rhinologists themselves. Epithelial cells are among the first responders to invading allergens and microbes, and mount an immediate innate immune response. Defects in the innate response and the barrier function of the epithelium seem to play an important role in diseases like allergic rhinitis (AR) and chronic rhinosinusitis (CRS).

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Exposure to cold and acute upper respiratory tract infection 99 106 EN R. Eccles Common Cold Centre and Healthcare Clinical Trials, Cardiff School of Biosciences, Cardiff University, United Kingdom J.E. Wilkinson Unilever Discover Colworth Park Sharnbrook, Bedfordshire, United Kingdom 1304 10.4193/Rhin14.239 The incidence of acute upper respiratory tract viral infections (URTI) is directly correlated to air temperature with most URTI occurring seasonally in cold weather. This review looks at four types of cold exposure and examines the evidence and possible mechanisms for any relationship to URTI. The effects of cold are discussed as: 1) Chilling of the nose and upper respiratory tract by breathing cold air, 2) Chilling of the mouth and upper digestive tract by ingestion of cold drinks and food, 3) Acute chilling of the body surface, and, 4) Chilling of the body as a whole with a fall in body temperature, hypothermia. Some studies were found to support a relationship between breathing cold air and chilling the body surface with the development of URTI, although this area is controversial. No evidence was found in the literature to support any relationship between ingestion of cold drinks and food and URTI, and similarly no evidence was found to link hypothermia and URTI.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia 107 115 EN A. Cardesin Rhinology Unit, Dept. of Otorhinolaryngology, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona), Spain C. Pontes Clinical Pharmacology Unit, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona), Spain R. Rosell Rhinology Unit, Dept. of Otorhinolaryngology, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona), Spain Y. Escamilla Rhinology Unit, Dept. of Otorhinolaryngology, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona), Spain J. Marco Dept. of Anaesthesia, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona), Spain M.J. Escobar Dept. of Anaesthesia, Hospital de Sabadell, Institut Universitari Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona), Spain M. Bernal-Sprekelsen Dept. of Otorhinolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain 1298 10.4193/Rhin14.185 BACKGROUND: Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding. METHODS: A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care. RESULTS: A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups. CONCLUSION: The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 FESS, fingers and other things - you are not alone! 116 121 EN M. Amin Professorial Unit, The Royal National Throat, Nose and Ear Hospital, University College London, London, United Kingdom J. Rimmer Professorial Unit, The Royal National Throat, Nose and Ear Hospital, University College London, London, United Kingdom A. Swift Aintree University Hospitals, United Kingdom P. White NHS Tayside, Perth, United Kingdom V.J. Lund Professorial Unit, The Royal National Throat, Nose and Ear Hospital, University College London, London, United Kingdom 1301 10.4193/Rhin14.179 BACKGROUND: The objectives of the study were: firstly, to determine the prevalence and severity of musculoskeletal symptoms attributed to the use of endoscope or body posture during endoscopic sinus surgery (ESS) among members of the British Rhinological Society (BRS); and secondly, to review the available literature and highlight posture recommendations during ESS. METHODOLOGY: The study design consisted of a cross-sectional survey carried out among members of the BRS. The survey was distributed electronically and data was collected for statistical analysis. RESULTS: A total of 82 members responded to the questionnaire (22.4%); 78 respondents (94%) answered the main questions in the survey regarding the symptoms attributed to the use of endoscope or body posture during ESS. Fifty-three respondents (64%) completed all 19 questions. 58% and 59% of the 78 respondents reported suffering from pain and stiffness respectively. We found positive correlations between musculoskeletal symptoms and operating in the standing position and musculoskeletal symptoms and age. CONCLUSION: This survey reveals a high prevalence of musculoskeletal symptoms, attributed to ESS and body posture during surgery, among the British rhinologists who responded to the survey. ESS is evidently physically demanding on the surgeon with potential personal health hazards. This emphasizes the need to increase awareness among surgeons, familiarize ourselves with good operating posture habits and new ergonomic instruments and to create a drive to change operating theatre culture in an attempt to reduce these health risks.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Sinonasal morbidity following tumour resection with and without nasoseptal flap reconstruction 122 128 EN R.J. Harvey Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia J. Malek Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia M. Winder Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia A. Davidson Australian School of Advanced Medicine, Macquarie University, Sydney, Australia T. Steel Department of Neurosurgery, St Vincent’s Hospital, Sydney, Australia N. Mrad Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia H. Barham Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia A. Knisely Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia C. Teo Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia 1308 10.4193/Rhin14.247 BACKGROUND: Sinonasal function can be affected by multiple treatment modalities but surgical techniques, such as the nasoseptal flap or Draf 3 procedure, have been implicated in poor post-treatment function. Prior studies have rarely used comparable populations and this study aims to assess the impact of surgical technique, mainly the nasoseptal flap, on sinonasal function in a group of comparable patients. METHODS: A prospective cohort of patients undergoing endoscopic surgery for sinonasal and skull base tumours was studied. Patients were analysed according to whether a nasoseptal flap was used. Other treatment factors included; use of the Draf 3, radiotherapy, removal of olfactory apparatus and dural resection. The Sinonasal Outcome Test 22 (SNOT22), a nasal symptom score (NSS), global function score and nasal obstruction scores were recorded pre and post treatment. RESULTS: One hundred and eighteen patients were assessed. Forty-two patients had a nasoseptal flap. Perioperative radiotherapy was higher in the nasoseptal group, as was dural resection and the need to remove the olfactory apparatus. Despite this, there was no significant difference in SNOT22 scores and NSS. Radiotherapy was detrimental to sinonasal function with SNOT22 and NSS. CONCLUSION: The use of a nasospetal flap in surgery does not affect patient quality of life and sinonasal function after endoscopic tumour resection. Pathology is a better predictor of morbidity, with loss of function from radiotherapy or resection of functional areas such as the olfactory apparatus having a greater impact.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 26030035 Simulated postnasal mucus fails to reproduce the symptoms of postnasal drip in rhinitics but only in healthy subjects 129 134 EN J. Rimmer St Vincents Clinic, Woolcock Institute of Medical Research, Sydney University, Sydney, Australia J. Hellgren Department of Otorhinolaryngology, University of Gothenburg, Gothenborg, Vaestra Goetaland, Sweden R.J. Harvey St Vincents Clinic, Woolcock Institute of Medical Research, Sydney University, Sydney, Australia 1307 10.4193/Rhin14.210 BACKGROUND: Post nasal drip (PND) is a very common symptom associated with upper respiratory tract disorders. While easy to visualise, the concept of PND due to an increased volume of secretions which move from the posterior nasal choanae into the posterior nasopharynx/oropharynx may be overly simplistic. PND could also be associated with altered viscosity of nasal secre- tions. An alternative hypothesis is that the sensation of PND is due to mucosal inflammation resulting in heightened cough or irritant throat sensory dysfunction. The impact of viscous secretions on the symptoms of PND is assessed. METHODS: Healthy subjects and rhinitis patients were recruited. Patients were asked about PND symptoms with a 9 item PNDSS questionnaire at baseline and after the insertion of two different viscosities of artificial mucus utilising hydroxypropyl methylcel- lulose at 1% and 4%. RESULTS: Sixty six patients were recruited. As expected, rhinitics had an increased sense of PND compared to healthy subjects at baseline. However, only healthy subjects could detect the increased viscosity of secretions and where rhinitics failed to respond. Cough was not induced in either group. CONCLUSION: The mechanisms of PND in chronic patients and those with rhinitis are likely to have other aetiologies other than simply increased or more viscous secretions.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 25910474 Comparative analysis of cytokine release from epithelial cell cultures of the upper airway 135 141 EN A. Shiozawa Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan M. Miwa Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan N. Ono Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan H. Homma Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan M. Hirotsu Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan K. Ikeda Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan 1284 10.4193/Rhin14.078 INTRODUCTION: Upper airway epithelial cells show a multi-potential ability to produce a variety of cytokines/chemokines in the steady-state and under external stimuli. OBJECTIVE: To compare various cytokines/chemokines released from primary cultures of human nasal epithelial cells (HNECs) derived from healthy controls and subjects with allergic rhinitis (AR), chronic rhinosinusitis with nasal polyps (CRSwNPs) in non- stimulated and IL-17A-stimulated conditions. METHODS: The supernatants derived from HNECs of healthy control, AR, CRSwNPs were used to measure 20 of cytokines/chemo- kines in the non-stimulated and IL-17A-stimulated conditions. RESULTS: AR and CRSwNPs showed significant up-regulation in the release of IL-6, IL-33, and thymic stromal lymphopoietin (TSLP), and the release of IL-6, TSLP, granulocyte macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor α (TNFα) in comparison with normal controls, respectively. Secretion of GM-CSF and TNFα were enhanced in patients with nasal polyps as compared with AR. Stimulation with IL-17A enhanced the secretion of IL-8 and granulocyte-colony stimulating factor (G-CSF) in the normal control, IL-6 and IL-8 in AR, and IL-6, TSLP, G-CSF, GM-CSF and TNFα in nasal polyps. CONCLUSION: Epithelial cells derived from AR and CRSwNPs showed up-regulation of secretion of several cytokines/chemokines both in the steady state and after IL-17A stimulation, which may contribute to the inflammatory responses of AR and CRSwNPs.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Nasopharyngeal biopsy in adults: a large-scale study in a non endemic area 142 148 EN S. Abu-Ghanem Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel N.N. Carmel Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel G. Horowitz Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel M. Yehuda Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel M. Leshno Faculty of Management, Tel Aviv University, Tel-Aviv, Israel Y. Abu-Ghanem Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel D.M. Fliss Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel A. Abergel Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel 1286 10.4193/Rhin14.130 BACKGROUND: Limited data exist on the referral criteria for endoscopic-guided nasopharyngeal biopsy to rule out nasopharyngeal malignancy among adults in a non-endemic area. METHODS: Retrospective study of all adult patients that had been referred to our outpatient clinic to undergo endoscopic-guided nasopharyngeal biopsy to exclude nasopharyngeal malignancy between 1/2006-10/2013. All medical consultation referral letters were reviewed, and statistical analyses were conducted to evaluate clinically significant predictors (demographics, clinical manife- stations, nasopharyngeal endoscopic findings) for nasopharyngeal malignancy. RESULTS: A total of 470 patients (470 nasopharyngeal biopsies, 54.9% males and 66% smokers) were included. The most common pathological result was adenoid/lymphoid hyperplasia (76.2%). The overall negative rate of all biopsies for malignancy was 94.2%. Twenty-seven patients had nasopharyngeal malignancy: 22 had squamous cell carcinoma and 5 had non-Hodgkin's lymphoma. Advanced age, cervical mass, and suspicious nasopharyngeal mass were independent risk factors for nasopharyngeal malignancy on univariate and multivariate analyses. CONCLUSIONS: Nasopharyngeal biopsy may safely be avoided in adults living in a non-endemic area for NPC who are free of the risk factors of advanced age, the presence of a cervical mass, and suspicious nasopharyngeal mass.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Effects of handedness on olfactory event-related potentials in a simple olfactory task 149 153 EN M. Gottschlich Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 1287 10.4193/Rhin14.204 The purpose of the present study was to re-investigate the influence of handedness on simple olfactory tasks to further clarify the role of handedness in chemical senses. Similar to language and other sensory systems, effects of handedness should be expected. Young, healthy subjects participated in this study, including 24 left-handers and 24 right-handers, with no indication of any major nasal or health problems. The two groups did not differ in terms of sex and age (14 women and 10 men in each group). They had a mean age of 24.0 years. Olfactory event-related potentials were recorded after left or right olfactory stimulation with the rose-like odor phenyl ethyl alcohol (PEA) or the smell of rotten eggs (hydrogen sulfide, H2S). Results suggested that handedness has no major influence on amplitude or latency of olfactory event-related potentials when it comes to simple olfactory tasks.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Chicken or the egg: the dilemma of allergic rhinitis versus adenoid hypertrophy 154 159 EN E. Eren Izmir Katip Celebi University, Ataturk Research and Education Hospital, Department of Otolaryngology Head and Neck Surgery, Izmir, Turkey S. Arslanoglu Izmir Katip Celebi University, Ataturk Research and Education Hospital, Department of Otolaryngology Head and Neck Surgery, Izmir, Turkey S.B. Erdem Izmir Behcet Uz Children Hospital, Department of Pediatric Allergy, Izmir, Turkey T. Nacaroglu Izmir Behcet Uz Children Hospital, Department of Pediatric Allergy, Izmir, Turkey C.S. Karkiner Izmir Behcet Uz Children Hospital, Department of Pediatric Allergy, Izmir, Turkey D. Can Izmir Behcet Uz Children Hospital, Department of Pediatric Allergy, Izmir, Turkey K. Onal Izmir Katip Celebi University, Ataturk Research and Education Hospital, Department of Otolaryngology Head and Neck Surgery, Izmir, Turkey 1294 10.4193/Rhin14.003 BACKGROUND: There is no consensus as to whether allergic rhinitis (AR) is a cause of adenoid hypertrophy (AH). This study evaluated the role of allergy in AH, and it explored the role of nasal endoscopy and the history of diagnosing AR in children empirically. MATERIALS AND METHODS: This study enrolled 155 children consecutively in İzmir Behçet Uz Children's Hospital between January and September 2013. RESULTS: Of the patients, 101 (65.2%) had a positive skin prick test. Multiple allergen sensitivity was identified in 76 (75.2%) of these patients. The history items of itching and sneezing had predictive value for empirically diagnosing AR in children. Of the nasal examination findings, only the nasal secretion characteristics had significant predictive value. AH and AR had a significant negative correlation. CONCLUSION: In this study, AH and AR were inversely related. The characteristics of the nasal secretions, itching, sneezing, were predictors of AR in children.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Are measurements of peak nasal flow useful for evaluating nasal obstruction in patients with allergic rhinitis? 160 166 EN G.M. Martins de Oliveira Department of Physiotherapy, Faculdade Leao Sampaio, Recife-PE, Brazil J.A. Rizzo Department of Clinical Medicine and Post-Graduation Program in Health Sciences, Hospital das Clinicas and Universidade Federal de Pernambuco, Brazil P.A.M. Camargos Health Sciences Center, Universidade Federal de Sao Joao del Rei, Brazil E.S.C. Sarinho Mother and Child Department and Post-Graduation Program in Health Sciences, Universidade Federal de Pernambuco, Brazil 1299 10.4193/Rhin14.048 BACKGROUND: Nasal obstruction is one of the most bothering allergic rhinitis (AR) symptoms and there is a need for objective parameters to complement clinical evaluation due to blunted perception in many patients. In this study we compare measures of peak nasal inspiratory flow (PNIF) and peak nasal expiratory flow (PNEF) in patients with AR and in individuals without nasal symptoms and correlate them with the perception of nasal obstruction. METHODS: A comparative cross-sectional study was conducted in 64 AR patients and 67 individuals without nasal symptoms aged between 16 and 50 years. All subjects had PNIF and PNEF measures and subjective evaluations of nasal obstruction were done through a visual analogue scale (VAS) and a symptoms questionnaire. RESULTS: The results show a lower PNIF and PNEF in AR patients compared to controls. There was no correlation between VAS score and PNIF and PNEF. There was a weak inverse correlation between PNIF and symptoms score. CONCLUSION: Objective measures of nasal obstruction, especially PNIF, can give useful informations on aspects of the disease dif- ferent from those obtained from the patient's perception.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Scar hinge flap for inner lining reconstruction of full-thickness defects on the ala of the nose 167 170 EN S. Hessam Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany M. Sand Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany D. Georgas Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany T. Kassa Department of Dermatology and Venereology, Mekelle University, College of Health Sciences, Mekelle, Ethiopia F.K. Bechara Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany 1296 10.4193/Rhin14.164 BACKGROUND: Reconstruction of inner lining of the nose often requires complex surgical procedures. METHODOLOGY: To evaluate the scar hinge flap as an alternative reconstruction technique, 21 patients with full-thickness defects of the ala who received a scar hinge flap were retrospectively analysed. RESULTS: Twenty-one patients were included. The average defect size was 1.9 cm2. Cartilage grafts were used in 11 patients. For skin reconstruction the scar hinge flap was covered by local flaps, interpolated melolabial flaps, full-thickness skin grafts, or paramedian forehead flaps. The mean follow-up was 10.7 months. No severe complications were observed. CONCLUSIONS: The scar hinge flap is a safe and simple technique for reconstruction of the inner lining of the nose although it is limited being a two-stage procedure.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 The effects of different radiofrequency energy magnitudes on mucociliary clearance in cases of turbinate hypertrophy 171 175 EN A. Karatas Ear Nose and Throat Clinic, Haseki Training and Research Hospital, Istanbul, Aksaray, Turkey M. Salviz Ear Nose and Throat Clinic, Haseki Training and Research Hospital, Istanbul, Aksaray, Turkey B. Dikmen Ear Nose and Throat Clinic, Haseki Training and Research Hospital, Istanbul, Aksaray, Turkey T. Yuce Ear Nose and Throat Clinic, Haseki Training and Research Hospital, Istanbul, Aksaray, Turkey G. Acar Ear Nose and Throat Clinic, Haseki Training and Research Hospital, Istanbul, Aksaray, Turkey 1295 10.4193/Rhin14.130 BACKGROUND: Radiofrequency ablation (RFA) application is a commonly used technique for the treatment of inferior turbinate hypertrophies. As the number of RFA applications has increased, some problems have been reported regarding the patient discomfort. The most frequent problems among these are the extended turbinate crusting and nasal obstruction. METHODS: Patients who received RFA were divided into two groups based on the applied energy value during the employment of the technique. Each group was including 30 patients. The patients in the first group received 8 watts and those in the second received 12 watts of energy. Saccharin transport times (STT) were measured four times. First a baseline measurement was performed followed by measurements on the 15th, 30th, and 45th days after the initial procedure. Nasal obstruction was twice assessed by peak nasal inspiratory flow (PNIF) measurements, which were taken both before the procedure and on the 45th day after the procedure. Turbinate surface crustings that were observed for more than 15 days were considered as an extended turbinate crusting. RESULTS: The STT and PNIF measurements taken before the procedure were not significantly different between the two groups. Postprocedure STT measurements were significantly higher than the preprocedure measurements taken in both groups, and were stable within the physiological range. The STT increase in Group II was significantly greater than in Group I. Postprocedure PNIF values in both groups were significantly higher than the preprocedure values. Group II had showed a significantly higher rate of crusting. CONCLUSION: Higher magnitudes of energy elongate the healing process of the turbinate tissue and they affect more extensively the mucociliary clearance. Elongation of the healing process of the turbinate tissue may increase the rate of postprocedural complications such as turbinate surface crusting.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Adaptation and validation of the Spanish version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale 176 180 EN F. Larrosa Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Alt Penedes, Barcelona, Spain J. Roura Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Quiron, Barcelona, Spain M.J. Dura Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain M. Guirao Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Alt Penedes, Barcelona, Spain A. Alberti Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Alt Penedes, Barcelona, Spain I. Alobid Rhinology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic, Barcelona University, Barcelona, Spain 1310 10.4193/Rhin14.137 BACKGROUND: The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific, self-completed questionnaire for assessing quality of life related to nasal obstruction or its treatment in patients with septal deviation. The aim of this study was to validate the Spanish adaptation of the NOSE, thus allowing comparison across studies and international multicenter projects. METHODOLOGY: Multicenter prospective instrument validation study. Guidelines for the cross-cultural adaptation process from the original English language scale into a Spanish language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version ("NOSE-e" for "NOSE-español") were assessed in 58 consecutive patients undergoing septoplasty (both before and 3 months after surgery) and 58 matched asymptomatic controls. RESULTS: Test-retest reliability and internal consistency reliability were adequate. The NOSE-e demonstrated satisfactory construct validity. Positive correlations between the NOSE-e scores and the score of a visual analog scale measuring the subjective sensation of nasal obstruction were found. The instrument showed excellent between-groups discrimination and high response sensitivity to change. CONCLUSIONS: The Spanish version of the NOSE (NOSE-e) is a valid tool for measuring the subjective severity of nasal obstruction, and its use is recommended.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 Current therapeutic protocols for chronic granulomatous fungal sinusitis 181 187 EN V. Rupa Department of ENT, Christian Medical College, Vellore, India S. Maheswaran Department of ENT, Christian Medical College, Vellore, India J. Ebenezer Department of ENT, Christian Medical College, Vellore, India S.S. Mathews Department of ENT, Christian Medical College, Vellore, India 1309 10.4193/Rhin14.183 BACKGROUND: The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial. AIM: To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol. METHODOLOGY: Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status. RESULTS: Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up. CONCLUSION: Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

International Rhinologic Society Rhinology 0300-0729 53 2 2015 6 1 26030044 Computed tomography imaging study of the superior attachment of the uncinate process 188 191 EN B. Netto Graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil O.B. Piltcher School of Medicine, UFRGS, Porto Alegre, RS, Brazil C.D. Meotti Department of Otorhinolaryngology, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil J. Lemieszek Department of Radiology, HCPA, Porto Alegre, RS, Brazil G.R. Isolan Department of Neurosurgery, HCPA, Porto Alegre, RS, Brazil 1311 10.4193/Rhin14.174 BACKGROUND: The superior attachment of the uncinate process (SAUP) is an important landmark in the nasofrontal recess, but its anatomical distribution is still unclear. The objective of this study was to assess the location and number of superior attachments of the uncinate process on computed tomography (CT) images. METHODOLOGY: A cross-sectional, retrospective study conducted at the Department of Radiology, Hospital de Clínicas de Porto Alegre, Brazil. Sinus CT scans of adult patients with no history of sinonasal surgery, craniofacial fractures, malignant neoplasms, or malformations were examined for identification of the site of SAUP. RESULTS: 152 CT scans (304 sides) were assessed. The SAUP was appropriately identified in 292 sides (96%). Six distinct SAUP patterns were identified: to the lamina papyracea or anterior ethmoidal cells (193, 63.48%); to the middle turbinate (19, 6.25%); to the skull base (19, 6.25%); to the lamina papyracea and middle turbinate (29, 9.53%); to the lamina papyracea and skull base (29, 9.53%); and to the skull base and middle turbinate (3, 0.98%). CONCLUSION: The site of superior attachment of the uncinate process is highly variable, but is in contact with the lateral nasal wall in 82.5% of the cases.