International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 27236249 Phenotyping, endotyping and clinical decision-making 97 98 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands 1460 10.4193/Rhin16.402 We have exiting times in the treatment of chronic rhinosinusitis (CRS). The last year has brought us a number of new ideas and publications to help in decision-making in daily practice. In the first issue of this year, Claire Hopkins and co-authors identified the most important outcomes for patients, public and practitioners that should be evaluated in studies on health interventions for CRS. In this issue of the journal, a group of experts tried to define appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis. Appropriate indications for endoscopic sinus surgery (ESS) are currently poorly defined and the lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates. Using the Delphi method a total of 624 clinical scenarios (half CRSsNP and half CRSwNP) were ranked. The study clearly states that this group of experts indicates that ESS can only be indicated after medical treatment has failed with patients still having significant symptoms (SNOT-22 over 20) and at least some abnormalities at CT scan.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26800862 Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations 99 104 EN D. Lal Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA A.A. Jategaonkar University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA L. Borish Departments of Medicine and Microbiology, University of Virginia, Charlottesville, VA, USA L.R. Chambliss Division of Maternal Fetal Medicine, St. Josephs Hospital and Medical Center, Phoenix, AZ, USA S.H. Gnagi Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, AZ, USA P.H. Hwang Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA M.A. Rank Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Phoenix, AZ, USA J.A. Stankiewicz Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, USA V.J. Lund Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom 1434 10.4193/Rhin15.228 BACKGROUND: Management of rhinosinusitis during pregnancy requires special considerations. OBJECTIVES: 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. METHODS: The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. RESULTS: Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. CONCLUSIONS: The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26702453 Endoscopic sinus surgery and musculoskeletal symptoms 105 110 EN J. Rimmer ENT Department, Monash Health, Melbourne, Australia M. Amin ENT Department, Mater Misericordiae University Hospital, Dublin, Ireland W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands VJ. Lund Professorial Unit, Royal National Throat Nose and Ear Hospital, London, United Kingdom 1422 10.4193/Rhin15.217 BACKGROUND: Endoscopic sinus surgery is a common surgical procedure, with low morbidity for patients. Studies have shown that endoscopic and laparoscopic surgeons have a significant risk of developing musculoskeletal symptoms, with potential adverse effects on their careers as well as patient care. We aimed to identify the prevalence of such symptoms, and any associated risk factors relating to surgical technique, in European rhinologists. METHODOLOGY: An online survey was distributed to all members of the European Rhinologic Society and data collected for statistical analysis. The relevant literature was reviewed, and ergonomic recommendations made. RESULTS: There were 250 responses, with nearly 80% of surgeons experiencing musculoskeletal symptoms. The neck and back were the most common site of symptoms, in approximately 60% of cases. There were significant correlations between musculoskeletal symptoms and the number of procedures performed each year, operating in a standing position, and operating without a monitor. CONCLUSIONS: There is a high prevalence of musculoskeletal symptoms in endoscopic sinus surgeons, which appears to be particularly related to posture during surgery. Surgeons need to be more aware of the risk factors, and good ergonomic habits should be encouraged to try and reduce the development of such symptoms.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26800771 Using postoperative SNOT-22 to help predict the probability of revision sinus surgery 111 116 EN L. Rudmik Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada Z.M. Soler Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA C. Hopkins Department of ENT, Guy s and St Thomas NHS Trust, London, United Kingdom 1432 10.4193/Rhin15.284 BACKGROUND: There is a need to develop a patient-level strategy to identify those at higher risk of requiring revision ESS since this may assist clinicians in tailoring their postoperative management. This study evaluated whether identifying changes in the post- operative 22-item Sinonasal Outcome Test (SNOT-22) can help identify patients at increased risk of needing revision sinus surgery for refractory chronic rhinosinusitis (CRS). METHODS: 668 CRS patients undergoing primary ESS with complete 60-month follow-up were evaluated in this prospective, longitudinal cohort study. Outcomes were evaluated in an unselected cohort and a low-risk cohort, which was comprised of patients without a history of asthma or aspirin sensitivity. RESULTS: Failing to achieve an improvement of greater than one minimal clinically important difference (MCID; 9 points) at 3 months after primary ESS and a deterioration of greater than one MCID (ie. over 9 points) from the 3- to 12-month follow-up periods was associated with an increased risk of revision ESS in both the unselected and low-risk CRS cohorts. CONCLUSION: Outcomes from this study suggest that identifying MCID changes in the SNOT-22 score within 12 months after primary ESS can identify patients at increased risk for needing revision surgery.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26934470 Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study. 117 128 EN L. Rudmik Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada Z.M. Soler Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina; Charleston, SC, USA C. Hopkins Department of ENT, Guys and St Thomas NHS Trust, London, United Kingdom R.J. Schlosser Ralph H. Johnson VA Medical Center, Charleston, SC, USA A. Peters Department of Internal Medicine, Northwestern University Allergy Division, Chicago, IL, USA A.A. White Division of Allergy and Immunology, Scripps Clinic, La Jolla, CA, USA R.R. Orlandi Division of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands R. Douglas Department of Surgery, University of Auckland, Auckland, New Zealand T.L. Smith Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA 1441 10.4193/Rhin16.023 INTRODUCTION: Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. METHODS: The RAND/UCLA appropriateness methodology was performed. An international, multi-disciplinary panel of 10 experts in CRS was formed and completed two rounds of a modified Delphi ranking process along with a face-to-face meeting. RESULTS: A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is equals or is greater than 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score equals or is greater than 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is equals or is greater than 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score equals or is greater than 20. CONCLUSION: This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment option during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment option and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high quality, patient-centered care to patients with CRS.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 27017484 Stratification of SNOT-22 scores into mild, moderate or severe and relationship with other subjective instruments 129 133 EN S. Toma ENT Dept, Kennington Road, Willesborough, Ashford, Kent, United Kingdom C. Hopkins ENT Dept, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom 1443 10.4193/Rhin15.072 AIMS AND OBJECTIVES: The European Position Paper on Rhinosinusitis and Nasal Polyps provides treatment algorithms based on the mild/moderate/severe (MMS) classification. To date there has been no statistically validated stratification of the SNOT-22 score according to this classification. METHODS: 65 consecutive patients diagnosed with CRS completed a SNOT-22, VAS and rated their symptoms according to MMS and impact on quality of life. RESULTS: The median SNOT 22 scores varied between the 3 MMS categories. The interquartile ranges for the respective MMS groups were: Mild 8-17, Moderate 22.5-48, Severe 54-83. Median values for the respective MMs groups were: Mild 12, Moderate 36 and Severe 66. 15.38 % of patients in the Mild category, 95.24% in the Moderate category and 100% in the Severe category feel their QoL is affected. There was a strongly positive correlation between the SNOT-22 and VAS scores. CONCLUSION: We propose a statistically validated definition for stratification of the SNOT-22, with Mild being defined on the SNOT-22 score as 8-20 inclusive, Moderate as between 20-50 and Severe as over 50.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 27172454 A case-control study of medical, psychological and socio-economic factors influencing the severity of chronic rhinosinusitis 134 140 EN C. Philpott Norwich Medical School, University of East Anglia, Norwich, UK S. Erskine Norwich Medical School, University of East Anglia, Norwich, UK C. Hopkins ENT Department, Guys and St Thomas NHS Foundation Trust, London, UK E. Coombes Norwich Medical School, University of East Anglia, Norwich, UK N. Kara ENT Department, Darlington Memorial Hospitals NHS Foundation Trust, Darlington, UK V. Sunkareneni ENT Department, Royal Surrey County Hospital, Surrey, UK S. Anari ENT Department, Heart of England NHS Foundation Trust, Birmingham, UK M. Salam ENT Department, Ipswich Hospital NHS Trust, Ipswich, UK A. Farboud ENT Department, Betsi Cadwaladr University Health Board Wrexham Maelor Hospital, Wrexham, UK 1446 10.4193/Rhin15.272 BACKGROUND: Chronic rhinosinusitis (CRS) is a common and debilitating disorder. Little is known about the epidemiology of this disease. The aims of the study were to identify differences in socio-economic variables and quality of life between patients with chronic rhinosinusitis and healthy controls, to identify any significant associations between CRS and other medical co-morbidities, psychiatric disease or environmental exposure and to explore the experience of CRS from the perspective of CRS sufferers. METHODS: Participants were recruited from ENT clinics from 30 centres across the UK. They completed a study-specific questionnaire considering environmental, medical and socio-economic factors, and SF-36 and SNOT-22 scores. All participants with CRS were diagnosed by a clinician and categorised as having CRS (with polyposis, without polyposis or allergic fungal rhinosinusitis (AFRS)). Controls included family and friends of those attending ENT outpatient clinics and hospital staff who had no diagnosis of nose or sinus problems and had not been admitted to hospital in the previous 12 months. RESULTS: A total of 1470 study participants (1249 patients and 221 controls) were included in the final analysis. Highly significant differences were seen in generic and disease-specific quality of life scores between CRS sufferers and controls; mean SNOT-22 score 45.0 for CRS compared with 12.1 amongst controls. There were no clear differences in socioeconomic variables including social class, index of multiple deprivation and educational attainment between cases and controls. Common comorbidities with a clear association included respiratory and psychiatric disorders, with a higher frequency of reported upper respiratory tract infections. CONCLUSIONS: CRS is associated with significant impairment in quality of life and with certain medical co-morbidities. In contrast to other common ENT disorders, no socioeconomic differences were found between patients and controls in this study.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26702454 Th2 biased upper airway inflammation is associated with an impaired response to viral infection with Herpes simplex virus 1 141 149 EN F. Lan Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium X.D. Wang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China H.J. Nauwynck Laboratory of Virology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium G. Holtappels Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China S.L. Johnston Airway Disease Infection Section, National Heart N.G. Papadopoulos Allergy Department, 2nd Pediatric Clinic, University of Athens, Greece C. Bachert Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium N. Zhang Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium 1423 10.4193/Rhin15.213 BACKGROUND: We aimed to elucidate possible differences in antiviral defense in chronic rhinosinusitis with nasal polyps (CRSwNP) mucosal tissue compared to healthy mucosal tissue (HMT) upon herpes simplex virus 1 (HSV1) exposure. METHODOLOGY: HMT and CRSwNP samples were infected with HSV1. We visualized the virus location by immunofluorescence and monitored invasion by a score. The mediators Interferon (IFN)-α, IFN-β, IFN-λ, IFN-γ, Interleukin (IL)-6, IL-1β, Tumor necrosis factor (TNF)-α, IL-17, IL-5, IL-10 were measured in culture supernatants at baseline and at 24h, 48h and 72h after virus incubation. RESULTS: CRSwNP mucosal tissue showed a significant deficit in IFN-γ and IL-17 release within 24 to 72 hours after infection in comparison to HMT, at the same time releasing significantly more pro-inflammatory cytokines including IL-1β and TNF-α. These findings were associated with significantly higher viral invasion scores at 48 and 72 h in CRSwNP mucosa compared to those for the HMT. CONCLUSIONS: We demonstrate for the first time in a human ex-vivo mucosal model that the inadequate response of CRSwNP may be associated with a deeper intrusion of viruses into the mucosal tissue, and may contribute to more and longer symptoms upon acute infection, but also to the persistence of inflammation in CRSwNP tissue.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26747641 Cellular phenotyping of chronic rhinosinusitis with nasal polyps 150 159 EN H. Lou Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, PR China Y. Meng Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, PR China Y. Piao Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, PR China N. Zhang Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium C. Bachert Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium C. Wang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, PR China L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, PR China 1430 10.4193/Rhin15.271 BACKGROUND: Defining the phenotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) with prognosis may lead to delivery of personalized treatment. This study aimed to identify cellular phenotypes of CRSwNP using cluster analysis and define an algorithm for different clusters associated with polyp recurrence. METHODS: Overall, 366 patients with CRSwNP were enrolled in this retrospective analysis. Eighteen variables, including clinical characteristics and tissue/peripheral inflammatory cells assessments, were selected for factor analysis. Unsupervised cluster analysis was performed after variables reduction and standardization and differences in polyp recurrence during follow-up for a minimum of 24 months were analysed among clusters. Discriminant analysis was further used to develop a clinically useful algorithm for predicting clustering. RESULTS: Five phenotypic clusters were identified. Clusters 1 and 2 were plasma cell-dominant and lymphocyte-dominant phenotypes, respectively. Cluster 3 revealed a mixed inflammatory pattern. Cluster 4 was characterized by infiltration of predominantly neutrophils. Cluster 5 was characterized by a marked tissue eosinophilia and highest recurrence rate of 98.5%. The clinical algorithm predicted clustering with 93.7% accuracy. CONCLUSIONS: Chinese CRSwNP patients may be classified into five phenotypes with different polyp recurrence rates, based on the presence of predominantly plasma cells, lymphocytes, neutrophils, eosinophils or mixed inflammatory cells in polyps.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26702457 Peak nasal inspiratory flow and peak expiratory flow. Upright and sitting values in an adult population 160 163 EN G. Ottaviano Department of Neurosciences, Otolaryngology section, University of Padova, Padova, Italy G.K. Scadding Ear Institute, University College London, London, United Kingdom V. Iacono Department of Neurosciences, Otolaryngology section, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences, University of Padova, Padova, Italy A. Martini Department of Neurosciences, Otolaryngology section, University of Padova, Padova, Italy V.J. Lund Ear Institute, University College London, London, United Kingdom 1426 10.4193/Rhin15.180 BACKGROUND: Nasal obstruction is correlated with a decreased quality of life . An easy way to evaluate nasal patency is the peak nasal inspiratory flow (PNIF) measurement. Normal PNIF values have been published by many authors. However, some authors evaluated volunteers in a sitting position, while others have measured PNIF values in standing volunteers. Body position has been shown to influence pulmonary function, with differences between sitting and upright positions. As nasal and pulmonary flows are strictly related, the present pilot study tried to establish whether PNIF/PEF changed with body position in adults. METHODOLOGY: PNIF and PEF were measured in sitting and standing positions with the order of testing randomized in 76 healthy volunteers, 30 male (40 ± 16 years). RESULTS: In the group as a whole between sitting and upright position, PEF was significantly different (p=0.009), while PNIF showed a trend towards a significant difference (p=0.10). CONCLUSIONS: The present study, although showing a generally positive effect of the standing position on PEF values, does not show a clear effect on PNIF.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26874896 Primary school children often underestimate their nasal obstruction 164 169 EN F. Occasi Department of Pediatrics, University La Sapienza, Rome, Italy M. Duse Department of Pediatrics, University La Sapienza, Rome, Italy T. Vittori Department of Pediatrics, University La Sapienza, Rome, Italy A. Rugiano Department of Pediatrics, University La Sapienza, Rome, Italy G. Tancredi Department of Pediatrics, University La Sapienza, Rome, Italy G. De Castro Department of Pediatrics, University La Sapienza, Rome, Italy L. Indinnimeo Department of Pediatrics, University La Sapienza, Rome, Italy A.M. Zicari Department of Pediatrics, University La Sapienza, Rome, Italy 1435 10.4193/Rhin15.120 BACKGROUND: No consensus has ever been reached about the correlation between nasal resistance and the subjective sensation of nasal patency. The aim of the present study was to better de ne whether primary school and secondary school aged children correctly estimate their nasal obstruction. MATERIALS AND METHODS: Two hundred eighty four children (168 males and 116 female) aged between 6 and 14 years (9.5+2.9 years) a ected by Pediatric Allergic Rhinitis underwent Rhinomanometry and they were considered as correctly estimating their nasal obstruction when the grade of nasal patency corresponded to the severity of the NOSE score, overestimating when the grade of nasal patency was smaller than 1 when compared to the severity of the score, underestimating when the grade of nasal patency was larger than 1 when compared to the severity of the score. RESULTS: Correlation between NOSE score and nasal patency was statistically significant (r -0.74; p smaller than 0.001). Children between 6 and 9 years of age underestimate (43.7%) and children over 12 overestimate (34.7%) their symptoms more frequently than children among other age ranges (p smaller than 0.001). CONCLUSION: Although NOSE score approximately allow to quantify nasal obstruction, in children, especially between 6 and 9 years of age, an objective measurement of nasal patency should be performed to better define the therapeutic approach.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 27017331 Long term effects of olfactory training in patients with post-infectious olfactory loss 170 175 EN I. Konstantinidis Smell and Taste Clinic, 2nd Academic ORL Department, Aristotle University, Thessaloniki, Greece E. Tsakiropoulou Smell and Taste Clinic, 2nd Academic ORL Department, Aristotle University, Thessaloniki, Greece J. Constantinidis Smell and Taste Clinic, 2nd Academic ORL Department, Aristotle University, Thessaloniki, Greece 1442 10.4193/Rhin15.264 BACKGROUND: There is evidence of the effectiveness of repeated exposure to odours on short-term olfactory function. The aim of this study was to assess the long-term effects of olfactory training. METHODS: We conducted a prospective study of 111 patients with post-infectious olfactory dysfunction. Two groups of patients performed olfactory training for 16 and 56 weeks, respectively, and were compared with a control group. The training was performed twice daily using four odours (phenyl ethyl alcohol, eucalyptol, citronellal, eugenol). Olfactory testing was performed by means of the Sniffin Sticks test as a baseline assessment and then every 8 weeks for 56 weeks. Subjective ratings were performed using a visual analogue scale (0-100). RESULTS: Both training groups presented significantly higher scores than the controls. The long-term group had better results than the short-term group. Short-term training patients sustained their improvement within the follow-up period. Subsets analysis showed that training patients mainly increased identification and discrimination. Subjective ratings were in accordance with the olfactory test results. CONCLUSION: Long-term olfactory training seems to be associated with better results in patients with post-infectious olfactory loss than a short-term scheme. Short-term training provides sustainable results at 56 weeks follow-up assessment.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 26874999 The increasing incidence of paranasal organizing hematoma: a 20-year experience of 23 cases at a single center 176 182 EN J.S. Kim Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea J.S. Oh Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea S.H. Kwon Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea 1436 10.4193/Rhin15.158 BACKGROUND AND OBJECTIVES: Sinonasal organized hematoma is a rare, benign disease that can be locally aggressive and may be mistaken for malignancy. Because of its rarity, the clinical characteristics are not well known. The aim of this study is to investigate the distinguishing features of organized hematoma with an emphasis on incidence change. MATERIALS AND METHODS: In this retrospective study, we reviewed the records of 23 patients with organized hematoma con rmed histopathologically among 5,378 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1995 to December 2014 at a tertiary care center. Clinical symptoms, endoscopic photography, computed tomography, and operative ndings were reviewed. We also reviewed the relevant literature. Age, sex, site, origin subsite and histopathology were investigated. A statistical review was performed using R 3.1.2 to examine incidence change. RESULTS: The most common complaint was frequent epistaxis and nasal obstruction (52.1%). Of the 23 patients, eight were women and 15 were men with an age range of 18 to 75 years. (mean 38.9 years). Nine of these hematomas occurred on the right side and 14 on the left side. The predominant occurrence site was the antrum (65%), followed by the septum (17.3%), inferior turbinate (8%), and ethmoid sinus (8%). The incidence steadily increased over 20 years. CONCLUSION: Investigation of the clinical characteristics and incidence change of organized hematoma can provide useful information. Through analysis of the 23 cases in our study, the age distribution was found to be bimodal and the incidence of organizing hematoma was observed to steadily increase. Clinicians should be aware of these characteristics to avoid misdiagnoses of malignant tumors.

International Rhinologic Society Rhinology 0300-0729 54 2 2016 6 1 Safety of human olfactory mucosal biopsy for the purpose of olfactory ensheathing cell harvest and nerve repair: a prospective controlled study in patients undergoing endoscopic sinus surgery 183 191 EN P.J. Andrews Department of Rhinology and Facial Plastic Reconstructive Surgery, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom A.L. Poirrier ENT Department, University Hospital of Liege, Sart-Tilman B35, Liege, Belgium V.J. Lund Department of Rhinology and Facial Plastic Reconstructive Surgery, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom D. Choi Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom 1452 10.4193/Rhin15.365 BACKGROUND: Nasal olfactory mucosa is an accessible source of olfactory ensheathing cells for spinal cord regeneration. However, safety of the biopsy technique and the effects on sense of smell and nasal function have not been robustly assessed in the form of a prospective controlled study. METHODOLOGY: National Health Service ethical approval was granted for this study of 131 patients. The primary outcome measure was olfactory function and the secondary outcomes included postoperative complication rates as well as the SNOT 22, NOSE scale scores and surgeon reported (Lund-Kennedy score) nasal function outcomes. RESULTS: 65 patients underwent functional endoscopic sinus surgery (FESS) and superior turbinate biopsy, and 66 patients underwent FESS only as the control group. There was no significant difference in complication rates between the two groups. All Olfactory function outcomes were unaffected following olfactory biopsy. We demonstrated that the patients quality of life and nasal patency as well as surgeon reported outcome measurements remain unaffected following olfactory harvesting. CONCLUSIONS: We have uniquely provided level 2a evidence for the safety of endoscopic biopsy of olfactory mucosa, which does not affect nasal function or the sense of smell compared to standard FESS without biopsy.