International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26688859 Rhinology in the forefront of European political attention 289 289 EN W.J. Fokkens AMC, Amsterdam, the Netherlands P.W. Hellings AMC, Amsterdam, the Netherlands 1420 10.4193/Rhin15.E4 On Oct. 14, 2015, a symposium on Precision Medicine in Allergy and Airways Diseases took place in the European Parliament in Brussels. The burden of disease in patients with rhinitis and rhinosinusitis was brought to the attention of European policy makers and different stakeholders involved in patient care, highlighting the high prevalence of allergic rhinitis and rhinosinusitis reaching epidemic proportions, the major socio-economic consequences and the impact uncontrolled disease despite evidence-based treatment. The Commissioner of Health and Food Safety of Europa, Vytenis Andriukaitis, as well as the presidents of large European Academies and Associations agreed upon the fact that a joint action plan is needed to arrest the epidemic of allergy and chronic airways diseases in Europe via joining forces between patient organizations, health care professionals and researchers.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26275683 Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials 290 302 EN N. Ahmadi Rhinology and Skull Base Applied Medical Research Centre, University of New South Wales, Sydney, NSW, Australia K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand L. Kalish Otolaryngology and Head and Neck Surgery, Concord Hospital and University of Sydney, Sydney, NSW, Australia R. Sacks Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia K. Tumuluri Department of Ophthalmology Westmead Adult and Childrens Hospitals, Liverpool Hospital, Sydney, NSW, Australia G. Wilcsek Department of Ophthalmology Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia R. Harvey Rhinology and Skull Base Applied Medical Research Centre, University of New South Wales, Sydney, NSW, Australia 1331 10.4193/Rhin15.020 BACKGROUND: Intranasal corticosteroids (INCS) are prescribed for the long-term prophylactic treatment of inflammatory upper airway conditions. Although some systemic absorption can occur via topical routes, the clinical relevance is controversial. The effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity (LO) are well established, but the impact of the INCS is less well defined. This study aims to systematically review the literature for evidence of adverse occular events with INCS use. METHODOLOGY: A systematic review of literature from Medline and Embase databases (January 1974 to 21st of November 2013) was performed. Using the PRISMA guidelines, all controlled clinical trials of patients using INCS, that reported original measures of IOP, LO, glaucoma or cataract incidences were included. Studies with adjuvant administration of oral, inhaled and intravenous steroids were excluded. RESULTS: 665 articles were retrieved with 137 were considered for full-text review. Of these, 116 (85%) were literature reviews and two were case reports. 19 studies (10 RCTs, 1 case-control, 8 case series) were included for the qualitative review, of which 18 reported data on IOP and 10 on cataract/LO. None (n=0) of the 10 RCT reporting data on glaucoma or IOP demonstrated changes in IOP compared to control. Also none (n=0) of the 6 RCTs reporting cataract or lens opacity demonstrated changes compared to control. CONCLUSION: Data from studies with low levels of bias, do not demonstrate a clinically relevant impact of INCS on neither ocular pressure, glaucoma, lens opacity nor cataract formation.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26688860 European symposium on precision medicine in allergy and airways diseases: report of the European Union parliament symposium (October 14, 2015) 303 307 EN A. Muraro European Academy of Allergy and Clinical Immunology (EAACI) W.J. Fokkens European Rhinologic Society (ERS) S. Pietikainen Interest Group on Allergy and Asthma of the European Parliament D. Borrelli Interest Group on Allergy and Asthma of the European Parliament I. Agache European Academy of Allergy and Clinical Immunology (EAACI) J. Bousquet Allergic Rhinitis and its Impact on Asthma (ARIA) and Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing V. Costigliola European Medical Association (EMA) G. Joos European Respiratory Society (ERS) V.J. Lund European Rhinologic Society (ERS) L.K. Poulsen European Academy of Allergy and Clinical Immunology (EAACI) D. Price Respiratory Effectiveness Group (REG) C. Rolland European Federation of Allergy and Asthma Patients Organisations (EFA) T. Zuberbier Global Allergy and Asthma European Network (Ga2len) P.W. Hellings European Academy of Allergy and Clinical Immunology (EAACI) 1421 10.4193/Rhin15.400 On 14 October 2015, the European Academy of Allergy and Clinical Immunology (EAACI), the European Rhinologic Society (ERS) and the European Medical Association (EMA) organized a symposium in the European Parliament in Brussels on Precision Medicine in Allergy and Airways Diseases, hosted by MEP David Borrelli and with active participation of the European Respiratory So- ciety (ERS), the European Federations of Allergy and Airways Diseases Patients Associations (EFA), the Global Allergy and Asthma European Network (Ga2len), Allergic Rhinitis and Its Impact on Asthma (ARIA) and the Respiratory Effectiveness Group (REG). MEP Sirpa Pietikainen, Chair of the European Parliament Interest Group on Allergy and Asthma, underlined the importance of the need for a better diagnostic and therapeutic approach for patients with Allergies and Chronic Airways Diseases, and encouraged a joint initiative to control the epidemic of Allergy and Asthma in Europe. The socio-economic impact of allergies and chronic airways diseases cannot be underestimated, as they represent the most frequently diagnosed chronic non-communicable diseases in the EU. Despite the fact that 30% of the total European population is nowadays suffering from allergies and asthma, more than half of these patients are deprived from adequate diagnosis and treatment. Precision Medicine represents a novel approach in medicine, embracing 4 key features: personalized care based on molecular, immunologic and functional endotyping of the disease, with participation of the patient in the decision making process of therapeutic actions, and taking into account predictive and preventive aspects of the treatment. Implementation of Precision Medicine into clinical practice may help to achieve the arrest of the Epidemic of Allergies and Chronic Airways Diseases. This report summarizes the key messages delivered during the symposium by the speakers, including the EU Commissioner for Health and Food Safety Vitenys Andriukaitis. The Commissioner underscored the need for optimal patient care in Europe, supporting joint action plans for disease prevention, patient empowerment and cost-effective treatment strategies leading to a better health status of European citizens.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26301431 Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience 308 316 EN F. Ferreli Department of Otorhinolaryngology, University of Insubria, Varese, Italy M. Turri-Zanoni Department of Otorhinolaryngology, University of Insubria, Varese, Italy F.R. Canevari Department of Otorhinolaryngology, SS Antonio Biagio e Cesare Arrigo Hospital of Alessandria, Italy P. Battaglia Department of Otorhinolaryngology, University of Insubria, Varese, Italy M. Bignami Department of Otorhinolaryngology, University of Insubria, Varese, Italy P. Castelnuovo Department of Otorhinolaryngology, University of Insubria, Varese, Italy D. Locatelli Department of Neurosurgery, Civic Hospital, Legnano, Italy 1332 10.4193/Rhin14.309 BACKGROUND: The management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS) is currently a balancing act between the surgical decompression of neural structures, radiotherapy and a wait-and-see policy. METHODS: We undertook a retrospective review of 56 cases of NFPA with CS invasion treated through an endoscopic endonasal approach (EEA) between 2000 and 2010. The Knosp classification was adopted to describe CS involvement using information from preoperative MRI and intraoperative findings. Extent of resection and surgical outcomes were evaluated on the basis of postoperative contrast-enhanced MRI. Endocrinological improvement and visual outcomes were assessed according to the most recent consensus criteria. RESULTS: EEA was performed using direct para-septal, trans-ethmoidal-sphenoidal or trans-ethmoidal-pterygoidal-sphenoidal ap- proach. Visual outcomes improved in 30 (81%) patients. Normalization or at least improvement of previous hypopituitarism was obtained in 55% of cases. A gross total resection was achieved in 30.3% of cases. The recurrence-free survival was 87.5%, with a mean follow-up of 61 months (range, 36-166 months). No major intraoperative or postoperative complications occurred. DISCUSSION: EEA is a minimally-invasive, safe and effective procedure for the management of NFPA invading the CS. The extent of CS involvement was the main factor limiting the degree of tumor resection. The EEA was able to resolve the mass effect, preser- ving or restoring visual function, and obtaining adequate long-term tumor control.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26345107 Endoscopic treatment of inverted papilloma attached in the frontal sinus/recess 317 324 EN G.F.J.P.M. Adriaensen Department of Otorhinolaryngology, Academic Medical Centre (AMC), Amsterdam, the Netherlands M.W. van der Hout Department of Otorhinolaryngology, Academic Medical Centre (AMC), Amsterdam, the Netherlands S.M. Reinartz Department of Otorhinolaryngology, Academic Medical Centre (AMC), Amsterdam, the Netherlands C. Georgalas Department of Otorhinolaryngology, Academic Medical Centre (AMC), Amsterdam, the Netherlands W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre (AMC), Amsterdam, the Netherlands 1348 10.4193/Rhin14.177 BACKGROUND: Inverted papilloma (IP) is a benign sinonasal tumour for which endoscopic surgery, with complete removal of the underlying and surrounding mucoperiosteum at the attachment site followed by drilling and/or coagulation of this area, is the treatment of choice. This can be challenging in the frontal sinus. OBJECTIVES: To report on the outcome of treatment for IPs involving the frontal sinus. To propose the possible use of topical 5-fluorouracil 5% (5-FU) in the postoperative management of challenging IPs. METHODS: This is a retrospective cohort evaluation of patients with IPs attached in the frontal sinus or in the frontal recess and growing into the frontal sinus. Data on primary or revision surgery, uni- or bilaterality, attachment site, surgical procedure, 5-FU usage, recurrence and follow-up are provided. The end points are disease-free follow-up in months and recurrence. RESULTS: Twenty cases, including fifteen revision cases, were retrieved over a period of ten years. All cases were treated endoscopically. Two cases recurred (10%) and the intervention was repeated. In eight cases, 5-FU was applied at the end of surgery. None of these cases recurred. The mean follow-up after the last intervention was 42 months (standard deviation (SD) 22.1). CONCLUSION: IP involving the frontal sinus is a surgical challenge that can be successfully addressed endoscopically. The topical application of 5-FU could have a place in postoperative treatment when it is difficult to be absolutely sure that all diseased mucoperichondrium or mucoperiosteum at the attachment site(s) has been completely removed.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26362673 Smoking effects on quality of life of allergic rhinitis patients after sublingual immunotherapy 325 331 EN M. Katotomichelakis 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 A. Daniilidi Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece D. Cassimos Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece C. Kourousis Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece T. Vogiatzaki Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece V. Danielides Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Evros, Greece 1349 10.4193/Rhin14.245 BACKGROUND: Although tobacco smoking is of great concern, there is no evidence for the effects of smoking on quality of life (QoL) results after sublingual immunotherapy (SLIT). OBJECTIVE: This study aims tο explore any association between smoking habits (duration and quantity) and QoL results after SLIT in allergic rhinitis (AR). METHODOLOGY: One hundred and sixty three patients following SLIT for AR were participated. SLIT efficacy related to smoking was prospectively evaluated by means of validated widely used QoL questionnaires, either for assessing psychology (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short Form-36) ones, pre- and immediately upon cessation of SLIT. Smoking habits were expressed in pack-years. RESULTS: Significant improvement of total symptoms score (T5SS) and of all QoL questionnaires' results were observed in our patients' group, both for smokers and non smokers. The comparison of changes between smokers and non smokers, controlling for the effect of all patients' characteristics, showed that there was no significant differences on improvement values. Additionally multivariate linear regression analysis revealed that the effect of pack-years on the QoL scales was not significant. CONCLUSIONS: Our results suggest that smoking habits (quantity of daily smoking and duration) do not influence the success of SLIT with regards to QoL outcomes.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26410357 Spreader grafts: functional or just aesthetical? 332 339 EN R. Xavier Department of Otolaryngology and Head and Neck Surgery, Hospital da Arrabida, Porto, Portugal S. Azeredo-Lopes Department of Biostatistics and Informatics, Nova Medical School, Universidade Nova de Lisboa, and CEAUL, Lisbon, Portugal A. Papoila Department of Biostatistics and Informatics, Nova Medical School, Universidade Nova de Lisboa, and CEAUL, Lisbon, Portugal 1352 10.4193/Rhin13.069 OBJECTIVE: Spreader grafts are commonly used in rhinoplasty to achieve an aesthetic improvement of the nose or a functional improvement of the nasal airway. Currently, the aesthetic role of spreader grafts is well established. The functional effect of these grafts, however, has been controversial due to the lack of studies clearly demonstrating an increase on nasal airflow assigned to spreader grafts. The purpose of this study is to evaluate the effect of spreader grafts on nasal breathing. METHODS: Nasal breathing of 72 consecutive patients undergoing rhinoplasty was evaluated by measuring peak nasal inspiratory flow (PNIF) before surgery and six months after surgery. RESULTS: The mean preoperative PNIF of the 72 patients included in this study was 79.44 l/min and the mean postoperative PNIF was 110.42 l/min (p < 0.001). In 37 patients of this study no spreader grafts were used. In this group of patients the mean PNIF values changed from 73.24 l/min before surgery to 99.46 l/min after surgery. In the group of 35 patients in whom spreader grafts were used the mean PNIF values changed from 86.00 l/min before surgery to 122.00 l/min after surgery. The increase in the mean PNIF value after rhinoplasty was slightly higher in the group of patients with spreader grafts than in the group of patients without spreader grafts. The difference in the postoperative increase of PNIF between these two groups of patients, however, is not statistically significant. CONCLUSIONS: This study suggests that patients undergoing rhinoplasty have a statistically significant improvement in nasal breathing after surgery. However, patients receiving spreader grafts in a non-randomized way do not have statistically significant greater benefit than those who do not.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 Follow-up of Thalidomide treatment in patients with Hereditary Haemorrhagic Telangiectasia 340 344 EN A. Hosman Amsterdam Medical Centre, the Netherlands C.J.J. Westermann Department of Pulmonary Medicine, St Antonius Hospital, Nieuwegein, the Netherlands R. Snijder Department of Pulmonary Medicine, St Antonius Hospital, Nieuwegein, the Netherlands F. Disch Department of ENT Medicine, St Antonius Hospital, Nieuwegein, the Netherlands C.L. Mummery Department of Anatomy and Embryology, Leiden University Medical Centre, the Netherlands J.J. Mager Department of Pulmonary Medicine, St Antonius Hospital, Nieuwegein, the Netherlands 1324 10.4193/Rhin14.289 BACKGROUND: Patients with a hereditary vascular disorder called Rendu-Osler-Weber syndrome (Hereditary Haemorrhagic Telangiectasia, HHT) haemorrhage easily due to weak-walled vessels. Haemorrhage in lungs or brain can be fatal but patients suffer most from chronic and prolonged nosebleeds (epistaxis), the frequency and intensity of which increases with age. Several years ago, it was discovered serendipitously that the drug Thalidomide had beneficial effects on the disease symptoms in several of a small group of HHT patients: epistaxis and the incidence of anaemia were reduced and patients required fewer blood transfusions. In addition, they reported a better quality of life. However, Thalidomide has significant negative side effects, including neuropathy and fatigue. METHODS: We followed up all HHT patients in the Netherlands who had been taking Thalidomide at the time the original study was completed to find out (i) how many had continued taking Thalidomide and for how long (ii) the nature and severity of any side-effects and (iii) whether side-effects had influenced their decision to continue taking Thalidomide. RESULTS: Only a minority of patients had continued taking the drug despite its beneficial effects on their symptoms and that the side effects were the primary reason to stop. CONCLUSION: Despite symptom reduction, alternative treatments are still necessary for epistaxis in HHT patients and a large-scale clinical trial is not justified although incidental use in the most severely affected patients can be considered.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26275402 Pilot study of DNA methylation in the pathogenesis of chronic rhinosinusitis with nasal polyps 345 352 EN Y.B. Zheng Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China Y. Zhao Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China L.Y. Yue Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China P. Lin Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China Y.F. Liu Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China J.M. Xian Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China G.Y. Zhou Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University. No.37 Guo Xue Xiang, Chengdu, Sichuan, China D.Y. Wang Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Five Lower Kent Ridge Crescent, Singapore 1328 10.4193/Rhin14.086 BACKGROUND: DNA methylation has been implicated in the pathogenesis of allergy and atopy. This study aimed to identify whether DNA methylation also plays an important role in the pathogenesis of nasal polyps (NP). METHODOLOGY: NP tissues were obtained from 32 patients with chronic rhinosinusitis with bilateral NP. Biopsies of inferior turbinate mucosa (ITM) were taken from 18 patients who underwent rhinoseptoplasty (control group). The methylated genes, which were detected by DNA methylation microarray, were validated by methylation-specific polymerase chain reaction, bisulphite sequencing, real-time polymerase chain reaction and immunohistochemistry. RESULTS: DNA methylation microarray identified 8,008 CpG islands in 2,848 genes. One hundred and ninety-eight genes were found to have a methylated signal in the promoter region in NP samples compared with ITM samples. The four top genes that changed, COL18A1, EP300, GNAS and SMURF1, were selected for further study. The methylation frequency of COL18A1 was significantly higher in NP samples than in ITM samples. CONCLUSIONS: DNA methylation might play an important role in the pathogenesis of NP. Promoter methylation of COL18A1 was found to be significantly increased in NP tissues, further studies are necessary to confirm the significance of these epigenetic factors in the mechanisms underlying the development or persistence of NP.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26275466 Berberine reduce allergic inflammation in a house dust mite allergic rhinitis mouse model 353 358 EN B.Y. Kim Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea H.R. Park Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea H.G. Jeong Ahngook Pharm. RAD center, Korea S.W. Kim Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea 1329 10.4193/Rhin15.028 BACKGROUND: Berberine (Ber), used widely as an antibacterial, antifungal, and anti-inflammatory drug, has long been used as a gastrointestinal remedy in Chinese traditional medicine. Recent reports have suggested that Ber suppresses Th17 responses that was mediated by direct actions on T cells and thymic stromal lymphopoietin production in primary mast cells. It has been suggested that Ber may be useful in treating allergic response. The purpose of this study was to assess the effects of Ber treatment on allergic inflammation in an allergic rhinitis mouse model and to examine the underlying mechanism(s). METHODS: BALB/c mice were divided into control, Derf with no treated (Derf), Ber treated, and Ber with anti-C25 monoclonal antibody treated (Ber + anti-CD25) groups. All mice, with the exception of the control group, were sensitized with an intraperitoneal i.p. injection of Dermatophagoides farinae (Derf). Mice in the Ber and Ber + anti-CD25 group were treated intranasally with 10 #181;g/mL. Then, 1 week after sensitization, all mice were challenged intranasally with 20 #181;g Derf for 5 consecutive days. Mice in the anti-CD25 group were treated intraperitoneally with 250 #181;g anti-CD25 monoclonal antibody 1 day before the first intra-nasal challenge with Derf. Allergic symptom scores, eosinophil counts, and serum Derf-specific IgE levels were measured. T-bet, GATA-3, interferon-g (IFN-γ), interleukin (IL)-10, IL-13, and Foxp3 expression was examined by real-time polymerase chain reaction and Western blotting. CD4+CD25+Foxp3+ T cells were assessed by flow cytometry. RESULTS: Symptom scores, serum Derf-specific IgE levels, GATA-3 mRNA levels, T-bet mRNA levels, and tissue eosinophil counts were decreased in the Ber versus the Derf group. In the Ber + anti-CD25 group, serum IL-10 levels were decreased versus the control, Derf, and Ber groups. In the Ber + anti-CD25 mAb groups, Foxp3 mRNA levels were decreased versus the control group. In the Ber group, Foxp3 mRNA levels were increased versus the control group. In the Ber group, the percentage of CD4+CD25+Foxp3+ T cells was increased versus the Derf group. The percentage of CD4+CD25+Foxp3+ T cells was increased in the Ber versus the Derf groups. CONCLUSIONS: In our study, Ber reduced allergic inflammation significantly. Moreover, our findings suggest that the mechanism of action of Ber may be via CD4+CD25+Foxp3+ Treg cells, possibly through not only by increasing their numbers but also altering their function.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26397160 IFRD1 gene polymorphisms are associated with nasal polyposis in cystic fibrosis patients 359 364 EN A. Baldan Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy A.R. Lo Presti Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy F. Belpinati Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy C. Castellani Verona Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy M.D. Bettin Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy L. Xumerle Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy P.R. Pignatti Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy G. Malerba Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy C. Bombieri Department of Life and Reproduction Sciences, Section of Biology and Genetics, University of Verona, Italy 1351 10.4193/Rhin14.229 BACKGROUND: Nasal polyposis (NP) is an inflammatory disease of the upper nasal airways frequently present in CF patients. Interferon-Related Developmental Regulator 1 (IFRD1) gene was reported as a possible modifier of CF lung disease severity. Three IFRD1 SNPs were analyzed to investigate a possible effect on the development of NP in CF patients. METHODS AND PATIENTS: The DNA of 143 patients with CF (40 with and 103 without NP) was purified from peripheral blood samples. IFRD1 SNPs (rs7817, rs3807213, rs6968084) were genotyped by restriction enzyme analysis. RESULTS: The T allele of the common polymorphisms rs7817 and the rs7817-rs3807213 haplotype were associated with NP (p = 0.002 and 0.004, respectively). CONCLUSIONS: These results showed the association of the IFRD1-rs7817 polymorphism with NP in CF patients.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 A brain-lesion pattern based algorithm for the diagnosis of posttraumatic olfactory loss 365 370 EN J. Lő;tsch Institute of Clinical Pharmacology, Goethe - University, Frankfurt am Main, Germany N. Reither Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany V. Bogdanov Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Hähner Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Ultsch DataBionics Research Group, University of Marburg, Marburg, Germany K. Hill Department of Neuroradiology, TU Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 1326 10.4193/Rhin15.010 BACKGROUND: Brain areas processing olfactory information exhibit functionally relevant morphological dynamics. This suggests the exploitation of anatomical information in the diagnosis of an olfactory dysfunction. Following previous identifications of olfactory eloquent areas such as the olfactory bulbs and tracts, we focused at a brain-morphology based algorithm for establishing the diagnosis of olfactory loss following brain injury. METHODOLOGY: Forty-one patients with a history of head trauma dated back 40 ± 39 months, and additional 23 patients without head trauma, were assessed for damages in 11 olfaction-relevant brain areas using magnetic resonance imaging (MRI). Olfactory function was derived from the use of a standardized, reliable and validated olfactory test. An olfactory diagnostic algorithm was derived following classification and regression tree analysis of the brain lesion pattern. RESULTS: Subjects were assigned to olfactory diagnoses of anosmia, hyposmia or normosmia. These diagnoses were predictable at an accuracy of 62.3 % from the degree of damage in the olfactory bulb and in the left temporal lobe pole. The main diagnosis algorithm addressed the presence of anosmia, which could be predicted from the degree of damage in these brain areas at an accuracy of 81.3 %. CONCLUSIONS: We independently reproduced previously identified brain regions in which morphological damage is associated with olfactory loss. Based on this reproduction, an algorithm was developed for the diagnosis of anosmia from central-nervous damage. Thus, we introduce a morphological component to the olfactory diagnosis that specifically addresses clinical cases of olfactory loss following head trauma.

International Rhinologic Society Rhinology 0300-0729 53 4 2015 12 1 26275583 Intranasal insulin influences the olfactory performance of patients with smell loss, dependent on the body mass index: A pilot study 371 378 EN V. Schő;pf Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria K. Kollndorfer Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria M. Pollak Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria C.A. Mueller Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria J. Freiherr Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany 1330 10.4193/Rhin15.065 BACKGROUND: The application of intranasal insulin in healthy humans has been linked to improved memory function, reduced food intake, and increased olfactory thresholds. There has also been some correlation between the morbidities associated with central nervous system (CNS) insulin resistance, such as type II diabetes mellitus, Alzheimer's disease, obesity, and impaired odour recognition. Given that impaired odour recognition is an important component of olfactory performance, mechanisms that govern these effects may account for impaired olfactory functions in anosmic patients. METHODOLOGY: Ten patients with post-infectious olfactory loss received intranasal administration of 40 IU insulin or a placebo solution, as well as olfactory performance tests before and after administration. RESULTS: When administered insulin, patients exhibited an immediate performance improvement with regard to olfactory sensitivity and olfactory intensity ratings. In addition, more odours were correctly identified. Furthermore, an improvement in the odour identification task was detected in patients with higher body mass index. CONCLUSION: Results of this pilot study shed light on the link between cerebral insulin level and an impaired sense of smell. This research line might provide a better understanding of olfactory loss in relation to eating and dietary behavior, and could offer opportunities to develop faster therapeutic intervention for patients with olfactory dysfunction.