International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26970345 Sinus surgery: optimal surgery, optimal outcome? 1 2 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands 1440 10.4193/Rhin543E1 Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness irrespective of BMI. The OSAS was also not correlated with the severity of rhinosinusitis, SNOT-20 score, nasal obstruction score, en- doscopic score, CT score, and smell function. It could be an argument for FESS although unfortunately the authors did not report whether the OSAS decreased after FESS.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26970247 Role of corticosteroids in Functional Endoscopic Sinus Surgery - a systematic review and meta-analysis 3 19 EN V. Pundir Ear Nose and Throat Department, Academic Medical Centre, Amsterdam, the Netherlands J. Pundir Department of Obstetrics and Gynaecology, Barts Health NHS Trust, United Kingdom G. Lancaster Department of Mathematics and Statistics, Fylde College, Lancaster University, Lancaster, United Kingdom S. Baer Department of Otorhinolaryngology, East Sussex Healthcare NHS Trust, Conquest Hospital, United Kingdom P. Kirkland Department of Otorhinolaryngology, East Sussex Healthcare NHS Trust, Conquest Hospital, United Kingdom M. Cornet Ear Nose and Throat Department, Academic Medical Centre, Amsterdam, the Netherlands E.S. Lourijsen Ear Nose and Throat Department, Academic Medical Centre, Amsterdam, the Netherlands C. Georgalas Ear Nose and Throat Department, Academic Medical Centre, Amsterdam, the Netherlands W.J. Fokkens Ear Nose and Throat Department, Academic Medical Centre, Amsterdam, the Netherlands 1333 10.4193/Rhin15.079 BACKGROUND: The aim of our study is to systematically review the existing evidence on the role of corticosteroids in patients undergoing functional endoscopic sinus surgery (FESS). METHODOLOGY: Systematic search of MEDLINE (1950- 2014), EMBASE (1980-2014), metaRegister, Cochrane Library and ISI conference proceedings was carried out. RESULTS: Eighteen randomised controlled trials with 1309 patients were included. Use of local and/or systemic corticosteroids with FESS was reported in four categories; operative, anaesthesia related, post-operative outcomes and risk of recurrence. Meta-analysis for operative outcomes demonstrated that, mean operative time (MD -10.70 minutes; 95% CI -15.86, -5.55; P <0.0001) and mean estimated blood loss (MD -28.32 mls; 95% CI -40.93, -15.72; P <0.0001) was significantly lower; and surgical field quality (MD -0.81; 95% CI -1.32, -0.30; P = 0.002) was significantly better in corticosteroid group. Meta-analysis showed that post-operative endoscopic scores (SMD -0.39; 95% CI -0.60, -0.17; P = 0.0004) were significantly better in corticosteroid group compared to no corticosteroid group. There was no increase in risk of sinusitis (RR 0.64; 95% CI 0.32, 1.30; P = 0.22) between use of corticosteroids and no corticosteroids; There was no significant difference in recurrence risk of chronic rhinosinusitis (CRS) in mixed population studies (RR 0.77; 95% CI 0.35, 1.70; P = 0.52) between the two groups but analysis of studies reporting on chronic rhinosinusitis with nasal polyps (CRSwNP) (RR 0.64;95% CI 0.45,0.91;P=0.01) showed significant difference in favour of the corticosteroid group. CONCLUSION: Pre-operative use of local and/or systemic corticosteroids in FESS, results in significantly reduced blood loss, shorter operative time and improved surgical field quality. Studies are limited on the intra-operative use of corticosteroids to reduce postoperative pain. Postoperative corticosteroids improve postoperative endoscopic scores in CRS and recurrence rates in cases of CRSwNP.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26569006 Identifying the most important outcomes for systematic reviews of interventions for rhinosinusitis in adults: working with Patients, Public and Practitioners 20 26 EN C. Hopkins Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom C. Philpott University East Anglia, Norwich and James Paget Hospital, Great Yarmouth, United Kingdom S. Crowe Crowe Associates, Thame, United Kingdom S. Regan Crowe Associates, Thame, United Kingdom A. Degun UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, United Kingdom I. Papachristou Department of Applied Health Research, UCL, London, United Kingdom A.G.M. Schilder UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, United Kingdom 1418 10.4193/Rhin15.199 INTRODUCTION: Promoting the assessment of health interventions using outcomes that matter to patients and practitioners is a key principle of Cochrane. Cochrane UK therefore commissioned the OMIPP project: Outcomes that are Most Important for Patients, Public and Practitioners to identify the outcomes they felt most important and should be evaluated in Cochrane reviews of health interventions for Chronic Rhinosinusitis (CRS). METHODOLOGY: Using direct emailing, social media and printed cards, an online survey was distributed to a wide range of people involved in the care of patients with CRS. Patients and practitioners were asked to list the 3 outcomes from treatments most important to them. Responses were analysed through development of a thematic framework based on the data. RESULTS: Two hundred and thirty-five people completed the survey; 155 practitioners and 80 patients. Respondents provided 653 suggestions of important outcomes. 73% concerned symptoms of CRS, (nasal discharge or drip, facial pain, nasal blockage, headache, impaired sense of smell, congestion and breathing difficulties); 9% concerned quality of life, 4% reducing the need for further treatment and 4% side effects of treatment. Objective measurements of disease formed only 3% of responses. There was high level of agreement between patients and practitioners. Of 10 current Cochrane reviews on CRS, 9 include symptomatic outcomes identified by our survey as most important to patients and healthcare practitioners. CONCLUSIONS: We have identified outcomes that both patients and their doctors consider should be included in reviews evaluating treatments of rhinosinusitis. We recommend that primary outcomes in future reviews focus on symptom-based outcomes. The ability to extract these data from relevant trials is dependent upon their inclusion in trials, and so it is important that building on this work a core outcome set for rhinosinusitis research is developed.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26970101 Automated assessment of intranasal trigeminal function 27 31 EN T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany C. Kaehling Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany F. Grosse Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany 1327 10.4193/Rhin15.002 BACKGROUND: The intranasal trigeminal system is a key player in the perception of intranasal airflow. Why it has not been studied very well may be due to the lack of techniques that allow for fast, reliable and inexpensive routine investigation of the system. The basis of the current study is the notion that - within limits - the intranasal trigeminal system detects the overall mass of a stimulus and not just its concentration. Thus, changing the duration of the stimulus at a given concentration has a similar effect as changing its concentration. METHODOLOGY: Ninety-nine normosmic subjects participated [48 women and 51 men; mean (range) age = 45 years (20-88 years)]. In addition, 50 patients with olfactory loss were investigated once (28 women, 22 men; mean age 58 years, SD = 14 years; age range 24-88 years; causes of olfactory loss: viral infections n = 22, head trauma n = 8, chronic sinunasal disease n = 3, idiopathic n = 17). CO2-stimuli with various durations (multiples of 50 ms) were presented through a standard bilateral nasal cannula at an interval of 10 s; stimulus duration was increased by 50 ms from one stimulus presentation to the next, until the subject pushed a button indicating a painful sensation. This was the basis for automated assessment of CO2-pain responsiveness. RESULTS: This current study had four main findings: (1) Using the new, automated device CO2 pain responsiveness can be measured reliably, (2) CO2 pain responsiveness correlates with olfactory function, (3) as with olfaction, women are more sensitive to CO2 , and CO2 - pain responsiveness also correlates with aging, (4) CO2 - pain responsiveness is lower in patients with olfactory loss compared to normosmic, healthy controls, even when controlling for age. CONCLUSION: We have demonstrated that the current approach is a reliable and valid measure of intranasal trigeminal function.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26713321 The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study 32 37 EN O. Kayiran MS Baltalimani Bone D. Training and Research Hospital, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey C. Calli Ekol ENT Hospital, Department of Ear, Nose and Throat, Izmir, Turkey 1428 10.4193/Rhin15.177 INTRODUCTION: Success and satisfactory results in rhinoplasty are established not only with flawless surgery but also with meticulous perioperative care. Pain stays at the centre of these circumstances. Besides, several contributing perioperative factors such as periorbital edema and ecchymosis play key role on the patients' comfort. METHODS: Septorhinoplasty was carried out in 50 patients between February and May 2014 under general anesthesia. Local anesthesia with lidocaine and adrenaline combination was done prior to incision. Following the procedure, silicone gel packs were applied. One periorbital region was cooled after surgery whereas the opposite site was left uncooled. Periorbital edema-ecchmosis and pain intensity were graded and noted 1 hour, 1 day, 3 days, 1 week and 1 month after surgery. RESULTS: Cold application seriously reduced postoperative edema and ecchymosis at the first week (p=0.001 for the first 3 days and p=0.006 at first week). Pain was reduced with cooling not on the first hour (p&gt;0.05), but on the forthcoming days throughout the first week (p<0.005). Operation time revealed that primary cases were carried out quicker than revisional surgery. Moreover, pain scores were found lower in primary cases than revisions, especially in the first 3 days. These finding were approved statistically. CONCLUSION: Cooling of the periorbital region reduces edema and ecchymosis as well as pain; however 3 days of use is enough after rhinoplasty. One hour after surgery, cooling does not affect the pain but reduce edema and ecchymosis.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26702455 Intranasal atomised dexmedetomidine optimises surgical field visualisation with decreased blood loss during endoscopic sinus surgery: a randomized study 38 44 EN H. Qiao Department of Anesthesiology, The Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China J. Chen Department of Anesthesiology, The Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China W. Li Department of Anesthesiology, The Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China X. Shen Department of Anesthesiology, The Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China 1424 10.4193/Rhin15.085 BACKGROUND: Safe and effective endoscopic sinus surgery (ESS) depends on distinct surgical visibility. Various interventions are proposed to reduce intranasal bleeding. This study investigated whether intranasal atomised dexmedetomidine (DEX) provided optimal surgical conditions and decreased blood loss. METHODS: ASA I or II patients undergoing ESS were randomly assigned to receive either 2 μg/kg intranasal DEX (group D) or the same volume of saline (group N) 15 min before induction. Lund-Mackay (LM) scores represented the extent of the preoperative surgical lesion and were obtained based on the computed tomographic scans. Estimated blood loss was recorded. The visibility of the surgical field was rated by surgeons on a numerical rating scale (NRS) or assessed using Boezaart score. RESULTS: Median blood loss in groups D and N was 75 and 100 ml, respectively. NRS and Boezaart score for surgical condition were lower in group D than in group N. LM score showed a positive correlation between NRS and Boezaart score in group N but not in group D. CONCLUSION: Intranasal atomised DEX resulted in improved surgical conditions with less bleeding during ESS despite the severity of the preoperative surgical lesion.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26462295 A new extension to the Taste Strips test 45 50 EN A. Wolf Department of Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Austria O. Illini Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria D. Uy Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria B. Renner Institute of Experimental and Clinical Pharmacology, University of Erlangen-Nurnberg, Krankenhausstr. 9, 91054 Erlangen, Germany C.A. Mueller Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria 1395 10.4193/Rhin14.266 OBJECTIVE: Assessment of gustatory function in human subjects using the 'taste strips' test is an easy and validated procedure. The aim of this study was to extend this test in order to detect subjects with superior gustatory sensitivity. METHODS: The investigation included 134 subjects (29.5±12.6 years, range 18-84 years) with normal gustatory function. Four concentrations of sweet, sour, salty, and bitter were augmented with additional low concentrations (sweet: 25/12.5mg/ml sucrose; sour: 27/15mg/ml citric acid; salty: 6.4/2.6mg/ml sodium chloride, bitter: 0.15/0.06mg/ml quinine hydrochloride), resulting in a maximum extended taste score (ETS) of 24. RESULTS: The mean ETS was 14.5 ± 3.2. Specifically, it was 4.5 ± 1.2 for sweet, 2.8 ± 1.0 for sour, 4.0 ± 1.3 for salty, and 3.2 ± 1.2 for bitter. In contrast to the original version of the taste strips test, no ceiling effect was observed. Cluster analysis separated three groups of subjects by ETS, whereas test scores derived from the original four concentrations were insufficient to discriminate the subgroup with higher gustatory sensitivity. CONCLUSIONS: The extended taste strips test seems to be a useful tool for the detection of patients with low gustatory thresholds for sweet, sour, salty, or bitter taste.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26501134 Common airborne fungi induce species-specific effects on upper airway inflammatory and remodelling responses 51 55 EN E.L. Sproson Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom K.M. Thomas Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom L.C. Lau Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom P.G. Harries Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom P.H. Howarth Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom R.J. Salib Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom 1397 10.4193/Rhin14.278 OBJECTIVE: Whilst the exact cause of chronic rhinosinusitis (CRS) remains elusive, it is clear that both inflammation and remodelling are key disease processes. Environmental fungi have been linked to airway inflammation in CRS; however, their role in the pathogenesis of this condition remains controversial. The current consensus suggests that whilst fungi may not be directly causative, it is likely that CRS patients have deficits in their innate and potentially acquired immunity, which in turn may modify their ability to react to fungi. This study used a nasal polyp explant tissue stimulation model to study the inflammatory and remodelling responses related to challenge with common airborne fungal species. METHODS: Ex vivo nasal polyp tissue from six well phenotyped CRSwNP patients undergoing functional endoscopic sinus surgery was stimulated with 1, 10 and 100 μg/ml of Alternaria alternata, Aspergillus niger, Cladosporium sphaerospermum and Penicillium notatum and compared with unchallenged polyp tissue as control. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of pro-inflammatory cytokines interleukin-6 (IL-6), granulocyte macrophage colony stimulating factor (GM-CSF) and tumour necrosis factor-α (TNF-α); and pro-remodelling cytokines transforming growth factor-b1 (TGF-b1), and basic fibroblast growth factor (bFGF) in the polyp supernatant. RESULTS: Aspergillus niger stimulation increased pro-inflammatory cytokines TNF-α, GM-CSF and IL-6 whilst having little effect on the remodelling cytokines bFGF and TGF-b1. In contrast, stimulation with Cladosporium sphaerospermum, Alternaria alternata and Penicillium notatum reduced pro-inflammatory cytokines TNF-α and IL-6, but induced a dose-dependent increase in remodelling cytokines TGF-b1 and bFGF. CONCLUSIONS: This study shows that common airborne fungi induce species-specific effects on the upper airway inflammatory and remodelling responses. These findings provide further immunological evidence of a disease-modifying role for fungi in CRS.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26567471 Factors associated with Allergic Rhinitis in Colombian subpopulations aged 1 to 17 and 18 to 59 56 67 EN A. Peñaranda Division of Otorhinolaryngology, Fundacion Santa Fe de Bogotá, Bogotá, Colombia E. Garcia Division of Paediatric Allergies, Fundacion Santa Fe de Bogotá, Bogotá, Colombia A.M. Barragan Research Department, Fundacion Cardioinfantil, Instituto de Cardiologia, Bogotá, Colombia M.A. Rondon Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia A. Perez Division of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Austin, TX, United States M.X. Rojas Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia L. Caraballo Institute for Immunological Research, University of Cartagena, Cartagena, Colombia R.J. Dennis Research Department, Fundacion Cardioinfantil, Instituto de Cardiologia, Bogotá, Colombia 1419 10.4193/Rhin14.234 BACKGROUND: Several studies have shown variations in the prevalence of allergic rhinitis (AR) around the world, and different potential predisposing factors. More studies are needed on risk factors, specifically in developing countries. This study explored the association of several factors and AR among urban residents in six cities of Colombia. METHODOLOGY: A cross-sectional study and a nested case-control study were carried out between 2009 and 2010 involving two Colombian subpopulations: children/adolescents and adults. Cases were affirmative respondents to "In the past 12 months, have you (or your child) had a problem with sneezing or a running or blocked nose, when you (or your child) did not have a cold or the flu?" "Controls" were subjects who never had been diagnosed with asthma, AR or atopic eczema by a physician, and whom did not report any symptoms in the past twelve months. Weighted logistic regression was used to assess the association of different factors with case/control status. RESULTS: Factors associated with AR in children/adolescents were family history of AR, acetaminophen consumption and high socioeconomic status. Among adults, family history of asthma, AR and atopic eczema, and cetaminophen consumption were associated with AR. Consumption of cereals among children/adolescents and eating eggs among adults showed protective associations. CONCLUSIONS: Our findings suggest the presence of previously unknown cultural, environmental and family factors associated with the presence of AR in Colombia.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26501135 The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis 68 74 EN O.A. Ivanchenko Polyclinic No.121, Moscow Healthcare Department, Moscow, Russia S.A. Karpishchenko Ear, Nose and Throat Clinic and Department, Pavlov First State Medical University, Saint Petersburg, Russia R.S. Kozlov Institute of Antimicrobial Chemotherapy, State Medical Academy, Smolensk, Russia O.I. Krechikova Institute of Antimicrobial Chemotherapy, State Medical Academy, Smolensk, Russia I.V. Otvagin Otolaryngology Clinic, State Medical Academy, Smolensk, Russia O.N. Sopko Ear, Nose and Throat Clinic and Department, Pavlov First State Medical University, Saint Petersburg, Russia G.Z. Piskunov Otolaryngology Clinic, Russian Medical Academy of Postgraduate Education, Moscow, Russia A.S. Lopatin Polyclinic No.1, Medical Department, Business Administration of the President of the Russian Federation, Moscow, Russia 1416 10.4193/Rhin15.018 AIM: This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis. METHODOLOGY: 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture. RESULTS: A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively. CONCLUSIONS: The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26702456 The impact of chronic rhinosinusitis on sleep-disordered breathing 75 79 EN R.S. Jiang Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan K.L. Liang Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan C.H. Hsin School of Medicine, Chung Shan Medical University, Taichung, Taiwan M.C. Su School of Medicine, Chung Shan Medical University, Taichung, Taiwan 1425 10.4193/Rhin15.204 BACKGROUND: The nose plays an important role in sleep quality. Very little is known about sleep problems in patients with chronic rhinosinusitis (CRS). The aim of this study was to investigate the impact of CRS on sleep-disordered breathing. METHODOLOGY: CRS patients who underwent functional endoscopic sinus surgery were collected between July 2010 and May 2015. Before surgery, they filled 20-item Sino-Nasal Outcome Test and Epworth Sleepiness Scale questionnaires, were asked about the severity of nasal obstruction, and received acoustic rhinometry, smell test, an endoscopic examination, sinus computed tomography, and a one-night polysomnography. Sleep quality was evaluated in these patients and was correlated with the severity of rhinosinusitis. RESULTS: One hundred and thirty-nine CRS patients were enrolled in the study. Among them, 38.1% complained of daytime sleepiness, and this sleep problem was correlated with the symptom of nasal obstruction. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 64.7% of the patients, but there was no correlation with the severity of rhinosinusitis. Nasal polyps did not worsen sleep problems in the CRS patients. CONCLUSIONS: This study showed that CRS patents had a high prevalence of OSAS, and worse OSAS in CRS patients was not correlated with the severity of rhinosinusitis.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26697778 Chronic anosmia induces depressive behavior and reduced anxiety via dysregulation of glucocorticoid receptor and corticotropin-releasing hormone in a mouse model 80 87 EN S. Ahn Department of Pharmacology and Biological Sciences, Seoul National University College of Medicine, Republic of Korea H.W. Shin Department of Pharmacology and Biological Sciences, Seoul National University College of Medicine, Republic of Korea U. Mahmood Seoul National University College of Natural Sciences, Republic of Korea R. Khalmuratova Department of Pharmacology and Biological Sciences, Seoul National University College of Medicine, Republic of Korea S.Y. Jeon Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea H.R. Jin Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea J.S. Choi Department of Psychiatry, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea H.S. Kim Department of Pharmacology and Biological Sciences, Seoul National University College of Medicine, Republic of Korea D.W. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea 1427 10.4193/Rhin15.209 BACKGROUND: Olfactory loss is highly prevalent, and comorbid mood disorders are common. Considering olfactory input is highly interconnected with the limbic system, and that the limbic system manages mood, it is predictable that impairments in the sense of smell may result in mood changes. METHODOLOGY: Chronic olfactory deficits were induced by repeated intranasal irrigation of ZnSO4 for 12 weeks in BALB/c mice. H&E staining, OMP staining, and potato chip finding test were performed to confirm olfactory loss. Tail suspension, forced swim, and splash tests were performed to evaluate depression, as well as open field, elevated plus maze tests were applied to assess anxiety. The mRNA levels of glucocorticoid receptor (GR) and corticotropin releasing hormone (CRH) were measured by real-time PCR to confirm relevant molecular changes. RESULTS: Disruption of the olfactory epithelium and olfactory loss was confirmed in histological studies and potato chip finding test. Behavioral tests show that the chronic anosmic state caused increased depression and reduced anxiety. PCR data showed that mRNA levels of GR in the hypothalamus and CRH in the amygdala were significantly decreased. CONCLUSIONS: These results propose that ZnSO4-induced chronic anosmia can cause a depressive and anxiolytic state via decreased hypothalamic GR and amygdalar CRH.

International Rhinologic Society Rhinology 0300-0729 54 1 2016 3 1 26747431 Three-dimensional analysis of the accuracy of optic and electromagnetic navigation systems using surface registration in live endoscopic sinus surgery 88 94 EN C.M. Chang Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan F.S. Jaw Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan W.C. Lo Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan K.M. Fang Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan P.W. Cheng Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan 1429 10.4193/Rhin15.131 BACKGROUND: This study presents the first report in the same patients on the time efficiency of surface registration as well as the navigational accuracy using optic and electromagnetic tracking systems. METHODS: Thirty patients with bilateral chronic paranasal pansinusitis underwent endoscopic sinus surgery. After surface registration, the surgeries were performed on one side using optic navigation guidance and on the other side using electromagnetic navigation guidance. The intraoperative measurements performed included the time taken for the surface registration and surgical procedure on each side, as well as the navigation errors at the different locations. RESULTS: The time for surface registration was significantly longer in the optic navigation group than the electromagnetic group. A comparison of the navigation errors along the 3 axes showed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions in the optic navigation group as well as the electromagnetic group. CONCLUSIONS: The procedure for surface registration in both optic and electromagnetic guidance is efficient and convenient. The accuracy of both navigation systems is comparable and within acceptable ranges for clinical use. In addition, the best accuracy was measured in the medial-lateral direction compared with the other two axes.