International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 28013326 Chronic rhinosinusitis: New understanding of specific and general Quality of life scores 289 291 EN A. Slovick ERS juniors M. Cornet ERS juniors P. Surda ERS juniors P.V. Tomazic ERS juniors 1520 10.4193/Rhin16.404 Our goal in treating chronic rhinosinusitis (CRS) is to reduce sinonasal symptoms and improve quality of life (QoL). In patients with CRS, sinonasal symptoms have a significant impact on QoL. Various validated measures exist to quantify QoL such as the 22-item Sinonasal Outcomes Test (SNOT- 22) and MSNOT-20 Young Persons Questionnaire (MSYPQ) specific to CRS, while others measure general QoL, such as the EuroQol 5-Dimensional general health-related QoL survey (EQ5D).

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27591836 A systematic review of anti-thrombotic therapy in epistaxis 292 391 EN K.M. Musgrave Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom J. Powell Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom 1476 10.4193/Rhin16.040 There is limited guidance available to clinicians regarding the management of antithrombotic therapy during epistaxis, whilst there has been an increase in the use of anticoagulation and antiplatelet therapy. In addition, the introduction of direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, over the last decade has significantly increased the complexity of managing the anticoagulated epistaxis patient. We undertook a systemic literature review investigating potential management strategies for each class of anti-thrombotic therapy during epistaxis. A PubMED and Cochrane Library search was performed on 10/03/16 using, but not limited to, the search terms epistaxis, nosebleed, nose bleeding, nasal haemorrhage, nasal bleeding AND each of the following search terms: antithrombotic, anticoagulant, antiplatelet, aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban, apixaban and tranexamic acid. This yielded 3815 results, of which 29 were considered relevant. Other sources such as national and international guidelines related to the management of anti-thrombotics were also utilised. We present the findings related to the management of each class of anti-thrombotic therapy during epistaxis. Overall we found a lack of evidence regarding this topic and further high quality research is needed. This is an area growing in complexity and the support of colleagues in Haematology and Cardiology is increasingly important.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27556896 Saline irrigations following sinus surgery - a controlled, single blinded, randomized trial 302 310 EN A.I. Giotakis Department of Otorhinolaryngology, Medical University of Innsbruck, Austria E.M. Karow Siemens and Co, Arzbacher Str. 78, 56130 Bad Ems, Germany M.O. Scheithauer Department of Otorhinolaryngology, Head and Neck Surgery, University of Ulm, Germany R. Weber Department of Otorhinolaryngology, Clinical Centre Karlsruhe, Germany H. Riechelmann Department of Otorhinolaryngology, Medical University of Innsbruck, Austria 1470 10.4193/Rhin16.026 BACKGROUND: Chronic rhinosinusitis (CRS) is a common health problem. If medical treatment fails, endonasal sinus surgery is a valuable treatment option. A thorough postsurgical treatment is needed including, among others, nasal saline irrigations (NSI). In this prospective, controlled, single blinded, randomized trial, we aimed to evaluate efficacy of nasal saline irrigations following endonasal sinus surgery in CRS-patients with nasal polyps. METHODOLOGY: We examined patient's nasal symptoms, general quality of life and postoperative condition of the mucosa. We also investigated whether or not NSI reduced the number of missed workdays after surgery (MWD). Patients were randomized into an irrigation and non-irrigation arm. RESULTS: Following treatment, mean nasal sum-score in the irrigation arm was 4.4 and in the non-irrigation arm it was 6.3. Accordingly, mean general sum-score in the irrigation arm was 2.5 and in the non-irrigation arm 4.8. Thus, nasal irrigation led to a more pronounced improvement of nasal and general symptoms than in the non-irrigation arm. No differences were observed in postoperative condition of mucosa or number of MWD. CONCLUSIONS: Nasal irrigation improves symptoms score after ESS in patients with CRSwNP.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27315942 A cross sectional analysis of a case-control study about quality of life in CRS in the UK; a comparison between CRS subtypes 311 315 EN S. Erskine Norwich Medical School, University of East Anglia, Norwich, UK C. Hopkins ENT Department, Guy s and St Thomas NHS Foundation Trust, London, UK N. Kumar ENT Department, Writington, Wigan and Lee NHS Foundation Trust, Wigan, UK J. Wilson Head and Neck Surg. Institute of Health and Society, Newcastle University, Newcastle, UK A. Clark Norwich Medical School, University of East Anglia, Norwich, UK A. Robertson ENT Department, Southern General Hospital, Glasgow, UK N. Kara ENT Department, Darlington Memorial Hospitals NHS Foundation Trust, Darlington, UK V. Sunkaraneni ENT Department, Royal Surrey County Hospital, Surrey, UK S. Anari ENT Department, Heart of England NHS Foundation Trust, Birmingham, UK C. Philpott Norwich Medical School, University of East Anglia, Norwich, UK 1463 10.4193/Rhin15.361 BACKGROUND: The Sinonasal Outcome Test (SNOT-22) has been used as a patient reported outcome measure to grade symptom severity before and after treatment for chronic rhinosinusitis (CRS). METHODOLOGY: This analysis uses data from the CRS Epidemiology Study (CRES). The overarching aim of CRES was to determine factors that influence the onset and severity of CRS. A study-specific questionnaire including SNOT-22 was distributed to patients with CRS attending ENT clinics across 30 centres in the United Kingdom. The aim of this analysis was to compare SNOT-22 scores between those with different types of CRS to determine any differences present in the total score or the subdomains and to assess whether any differences varied according to gender. RESULTS: There were a total of 1249 CRS participants in the following subgroups: CRS without nasal polyps (CRSsNPs) (n=553), CRS with nasal polyps (CRSwNPs) (n=651), allergic fungal rhinosinusitis (AFRS) (n=45). Since there were differing gender ratios in each subgroup, males and females were analysed separately. The mean and standard deviation for SNOT-22 was: males CRSsNP 41.1 (21.0), CRSwNP 41.7 (20.5); females CRSsNP 49.6 (19.7), CRSwNP 49.5 (22.9). In the nasal domain, those with CRSwNP scored more highly than those with CRSsNP; for males 18.1 (8.1) vs. 15.9 (7.9); for females 19.6 (8.0) vs 16.7 (7.5). CONCLUSIONS: Patients with CRSwNPs report higher symptom scores in the nasal domain of SNOT-22 than those with CRSsNPs with women in both subgroups reporting higher total scores than men.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27665614 Symptoms of chronic rhinosinusitis differentially impact general health-related quality of life 316 322 EN L.P. Hoehle Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA K.M. Phillips Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA R.W. Bergmark Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA D.S. Caradonna Department of Otolaryngology, Harvard Medical School, Boston, MA, USA S.T. Gray Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA A.R. Sedaghat Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA 1479 10.4193/Rhin16.211 BACKGROUND: The degree to which different sinonasal symptoms contribute to the overall quality of life (QOL) detriment in chronic rhinosinusitis (CRS) patients remains unknown. In this study we sought to characterize the effect of different CRS symptoms on the general health-related QOL in patients. METHODOLOGY: We performed a prospective cross-sectional study of 131 adult patients with CRS. Sinonasal symptoms were evaluated using the 22-item Sinonasal Outcomes Test (SNOT-22) and general health-related QOL was evaluated using the EuroQol 5-Dimensional general health-related QOL survey (EQ5D) and visual analog scale (EQ5D-VAS). Health utility values (HUV) were determined using responses to the EQ5D. SNOT-22 scores were broken down into subdomain scores for sleep, nasal, otologic/facial pain and emotional function symptoms. RESULTS: The otologic/facial pain subdomain score consistently had the largest impact on EQ5D-VAS and HUV. After otologic/facial pain, the sleep subdomain score had the second largest effect while the nasal subdomain score had the least impact on general health-related QOL. CONCLUSIONS: Different types of CRS symptoms - most prominently otologic/facial pain and sleep-related symptoms - and their underlying pathophysiologic mechanisms may differentially affect the general health-related QOL detriment associated with CRS. These findings raise the possibility that treatment of the various symptoms associated with CRS may lead to differential improvement in general-health related QOL.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27394715 The in vitro effect of xylitol on chronic rhinosinusitis biofilms 323 328 EN R. Jain Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand T. Lee Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand T. Hardcastle Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand K. Biswas Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand F. Radcliff Department of Molecular Medicine and Pathology, The University of Auckland, Grafton, Auckland, New Zealand R. Douglas Department of Surgery, The University of Auckland, Grafton, Auckland, New Zealand 1466 10.4193/Rhin15.380 INTRODUCTION: Biofilms have been implicated in chronic rhinosinusitis (CRS) and may explain the limited efficacy of antibiotics. There is a need to find more effective, non-antibiotic based therapies for CRS. This study examines the effects of xylitol on CRS biofilms and planktonic bacteria. METHODS: Crystal violet assay and spectrophotometry were used to quantify the effects of xylitol (5% and 10% solutions) against Staphylococcus epidermidis, Pseudomonas aeruginosa, and Staphylococcus aureus. The disruption of established biofilms, inhibition of biofilm formation and effects on planktonic bacteria growth were investigated and compared to saline and no treatment. RESULTS: Xylitol 5% and 10% significantly reduced biofilm biomass (S. epidermidis), inhibited biofilm formation (S. aureus and P. aeruginosa) and reduced growth of planktonic bacteria (S. epidermidis, S. aureus, and P. aeruginosa). Xylitol 5% inhibited formation of S. epidermidis biofilms more effectively than xylitol 10%. Xylitol 10% reduced S. epidermidis planktonic bacteria more effectively than xylitol 5%. Saline, xylitol 5% and 10% disrupted established biofilms of S. aureus when compared with no treatment. No solution was effective against established P. aeruginosa biofilm. CONCLUSIONS: Xylitol has variable activity against biofilms and planktonic bacteria in vitro and may have therapeutic efficacy in the management of CRS.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27395040 Prevalence and risk factors of chronic rhinosinusitis in South Korea according to diagnostic criteria 329 335 EN J.H. Kim Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea C. Cho Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea E.J. Lee Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea Y.S. Suh Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea B.I. Choi Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea K.S. Kim Department Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea 1467 10.4193/Rhin15.157 BACKGROUND: We aimed to compare the prevalence and risk factors of chronic rhinosinusitis (CRS) using two different diagnostic criteria with the same statistical data from the Korean National Health and Nutrition Examination Survey in 2009. METHODS: Symptom-based CRS was defined as CRS diagnosed by questionnaires related to nasal symptoms. Endoscopy-based CRS was defined based on endoscopic findings and nasal symptoms of symptom-based CRS. RESULTS: The overall prevalence of CRS based on the different diagnostic criteria was as follows: symptom-based CRS was 10.78% (797 of 7,394) and endoscopy-based CRS was 1.20% (88 of 7,343). Comparing symptom-based CRS to endoscopy-based CRS showed slight agreement (kappa = 0.183 (0.150-0.216, 95% confidence interval)). Allergic rhinitis was identified as a common risk factor for CRS based on the two diagnostic criteria. CONCLUSIONS: The prevalence and risk factors of CRS were quite different from each other according to the different criteria, even in the same population. Therefore, it would be important to consider what specific diagnostic criteria have been adopted in the studies comparing the prevalence of CRS.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27213721 Clinical implications of serum galactomannan measurement in patients with acute invasive fungal rhinosinusitis 336 341 EN H.J. Cho Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Republic of Korea S.D. Hong Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea H.Y. Kim Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea S.K. Chung Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea H.J. Dhong Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 1459 10.4193/Rhin15.186 BACKGROUND: Acute invasive fungal rhinosinusitis (AIFR) is an aggressive opportunistic infection with a high mortality rate. Recently, non-invasive techniques have been introduced for diagnosis of invasive fungal disease. The purpose of this study is to evaluate the diagnostic significance of serum galactomannan measurement in patients with AIFR. METHODOLOGY: We conducted a retrospective case-control study of 28 patients with AIFR and 36 fungus ball (FB) patients. We evaluated clinical, laboratory, and pathologic findings along with disease course. RESULTS: In 28 patients with AIFR, there were 21 cases of invasive aspergillosis (IA) and 7 cases of invasive mucormycosis (IM). The control group was comprised of 36 patients with FB. The three-group analysis showed a statistically significant difference among the groups. At the cut-off value of 0.48, the sensitivity and specificity were 71.4% and 93.0%, respectively. Comparison of mean serum galactomannan levels in 5 non-survivors and 9 survivors at initial measurement showed no significant difference, but that became significantly different 1 week later. Statistical analysis showed that the levels of serum galactomannan decreased significantly according to the measurement-point in within survivor-group analysis. The difference in between survivor-groups analysis was also significant. CONCLUSION: Serum galactomannan measurement seems useful for early diagnosis and discrimination of fungal species in patients with AIFR. In addition, clinical outcomes may be related to the levels and patterns of serum galactomannan, especially in IA. The appropriate measurement of galactomannan might be helpful in treating the patients at high risk for AIFR.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27591949 A comparison of minimal cross sectional areas, nasal volumes and peak nasal inspiratory flow between patients with obstructive sleep apnea and healthy controls 342 347 EN M.H.S. Moxness Department of Otolaryngology, Aleris Hospital and the Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway V. Bugten Department of Otolaryngology/Head and Neck Surgery, St. Olavs Hospital and the Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway W.M. Thorstensen Department of Otolaryngology/Head and Neck Surgery, St. Olavs Hospital and the Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway S. Nordgård Department of Otolaryngology/Head and Neck Surgery, St. Olavs Hospital and the Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway G. Bruskeland Department of sleep disorders, Aleris Hospital, Oslo, Norway 1477 10.4193/Rhin16.085 BACKGROUND: The differences in nasal geometry and function between OSA patients and healthy individuals are not known. Our aim was to evaluate the differences in nasal geometry and function using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) between an OSA population and healthy controls. METHODOLOGY: The study was designed as a prospective case-control study. Ninety-three OSA patients and 92 controls were enrolled from 2010 to 2015. The minimal cross-sectional area (MCA) and the nasal cavity volume (NCV) in two parts of the nose (MCA0-3/NCV0-3 and MCA3-5.2/NCV3-5.2) and PNIF were measured at baseline and after decongestion. RESULTS: The mean MCA0-3 in the OSA group was 0.49 cm2; compared to 0.55 cm2 in controls. The mean NCV0-3 correspondingly was 2.51 cm3 compared to 2.73 cm3 in controls. PNIF measured 105 litres/minute in the OSA group and 117 litres/minute in the controls. CONCLUSIONS: OSA patients have a lower minimum cross-sectional area, nasal cavity volume and peak inspiratory flow compared to controls. Our study supports the view that changes in the nasal cavity may contribute to development of OSA.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27592074 Managing nasal valve compromise patients with nasal dilators: objective vs. subjective parameters 348 354 EN G. Lekakis Department of Otorhinolaryngology, Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium E. Dekimpe Department of Otorhinolaryngology, Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium B. Steelant Department of Microbiology and Immunology, KU Leuven, Belgium P.W. Hellings Department of Otorhinolaryngology, Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium 1478 10.4193/Rhin16.192 INTRODUCTION: Patients suffering from nasal obstruction due to nasal valve compromise may benefit from a nasal dilator. Several devices for widening of the external/internal nasal valve region can be applied endonasally (Airmax, Nasanita, Nozovent) or externally (Breathe Right). MATERIALS AND METHODS: 100 patients suffering from nasal obstruction due to external or internal nasal valve compromise were involved in this study. All patients were evaluated for nasal obstruction with visual analogue scores (VAS) and peak nasal inspiratory flow (PNIF) measurements before and after the application of 4 nasal dilators. They were offered to choose 2 out of 4 for a trial period of 1 month. Subsequently, patients were reassessed and asked about their willingness to continue using the dilators, as well as the reasons for discontinuation. RESULTS: There was a significant decrease of VAS scores and improvement in PNIF with the dilators in situ compared to baseline. After 4 weeks, 67% of patients were willing to continue using at least one of the chosen dilators. The reasons for discontinuation were local irritation, inappropriate fit, preference for a permanent solution like surgery, and no relief of symptoms. CONCLUSION: Nasal dilators represent a valuable option in the therapeutic approach of nasal valve compromise, with endonasal dilators achieving higher increase in PNIF in comparison with external nasal dilators.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27262342 Type and severity of septal deviation are not related with the degree of subjective nasal obstruction 355 360 EN S. Verhoeven Department of Otolaryngology-Head and Neck Surgery, ZNA Middelheim Hospital, Antwerp, Belgium B. Schmelzer Department of Otolaryngology-Head and Neck Surgery, ZNA Middelheim Hospital, Antwerp, Belgium 1461 10.4193/Rhin15.226 BACKGROUND: Septoplasty is a frequently performed operation by otolaryngologists to relieve nasal obstruction complaints. When objective measurements tools are not available, preoperative decision-making is based on careful clinical examination. Our aim was to evaluate the relationship between type and severity of septal deviation and patient-reported nasal obstruction. METHODOLOGY: 196 Patients of a general otolaryngology population were included. Patients indicated subjective nasal obstruction experienced during the past 1 month on a Visual Analog Scale (VAS). Patients underwent clinical examination to evaluate type and severity of septal deviation. We compared clinical examination findings with patients VAS. RESULTS: We did not find a statistical difference of VAS score between the different types and severities of septal deviation. In 33.9% of the cases without septal deviation, there was a corresponding VAS score of 0. In 26,8% of the cases with septal deviation, there was no complaint of nasal obstruction (VAS = 0). In 7,4% of the cases, there was moderate to severe nasal obstruction complaint (VAS over 4) though no septal deviation was found. CONCLUSIONS: These results demonstrate that patient-reported nasal obstruction varies greatly among patients with similar type of deviation and similar degree of deviation. Classification of septal deviation into type and severity cannot predict the degree of subjective nasal obstruction. Therefore, the decision to proceed to septoplasty has to be thoughtful, with as much as information, based on the combination of patients history, clinical examination, surgeons experience and cautious interpretation of objective measurement tools.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27213612 Design and assessment of an anatomical diagram for sinonasal malignant tumour resection 361 367 EN P.L. Bastier ENT and Head and Neck Surgery Department, Bordeaux University Hospital, Bordeaux, France L. de Gabory ENT and Head and Neck Surgery Department, Bordeaux University Hospital, Bordeaux, France 1457 10.4193/Rhin15.355 BACKGROUND: The aim of our work was to design and assess the comprehensibility of an anatomical diagram for recording surgical and pathological results after the removal of sinonasal malignant tumours by endoscopic endonasal surgery. METHODOLOGY: To create the first version of the diagram, we determined the functional and technical specifications for its use. The anatomical structures that appear on it were selected from the pathological reports of previous interventions. The comprehensibility of the diagram was tested by two successive multicentre labelling tests. Successive modifications led to the creation of a definitive version of the diagram. RESULTS: A diagram of the sinonasal cavities in exploded view was created from 47 selected anatomical structures. Labelling tests led to modifying the diagram by the overall restructuring and removal of the least recognized structures. In the labelling test of version 2, the mean global identification rate was 97.1 plus/minus 4.9% for 36 participants and all tested structures achieved a specific identification rate equal to or greater than 75%. CONCLUSIONS: This diagram of the sinonasal cavities is a comprehensible validated tool that allows the resection and invasion of sinonasal malignant tumours to be recorded. This three-dimensional diagram facilitates the understanding of the size, location and extensions of tumours. It may improve case presentations and communication in multidisciplinary team meetings.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27316224 Intranasal sodium citrate solution improves olfaction in post-viral hyposmia 368 374 EN K.L. Whitcroft Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany C. Merkonidis ENT Department, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, United Kingdom M. Cuevas Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany A. Haehner Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany C. Philpott Norwich Medical School, University of East Anglia, Norwich, United Kingdom T. Hummel Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany 1465 10.4193/Rhin16.054 BACKGROUND: Calcium plays an integral role in olfactory signal transduction, including feedback inhibition. Sodium citrate acts as a calcium sequestrant and when applied intranasally, reduces free calcium available for feedback inhibition, which should theoretically improve olfaction. We aimed to investigate the utility of intranasal sodium citrate in improving the olfactory function of hyposmic patients, by performing this prospective placebo controlled, single-blind trial. METHODOLOGY: Monorhinal olfactory testing for odour identification and threshold was performed in hyposmic patients using Sniffin Sticks, before and after treatment. Treatment consisted of one-off sodium citrate solution application to the olfactory cleft. Sodium chloride solution was applied to the contralateral olfactory cleft, which therefore acted as placebo control. Patients were blinded to the side of sodium citrate application, and side of treatment was randomized between patients. RESULTS: 57 patients participated, aged 22-79. Causes of hyposmia included: post-viral (7); posttraumatic (10); sinonasal disease (30) and idiopathic (10). Compared with placebo, there was significant improvement in the identification scores of participants with post-viral hyposmia, following sodium citrate treatment. No significant change in olfactory function occurred for either identification or threshold in any other aetiological subgroup. CONCLUSIONS: Intranasal sodium citrate may be of benefit to patients with post-viral hyposmia.

International Rhinologic Society Rhinology 0300-0729 54 4 2016 12 1 27421303 Olfactory function in patients with hyposmia compared to healthy subjects - An fMRI study 374 381 EN R. Pellegrino Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Hähner Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany V. Bojanowski Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany C. Hummel Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany J. Gerber Department of Neuroradiology, TU Dresden, Dresden, Germany T. Hummel Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 1468 10.4193/Rhin16.098 BACKGROUND: Individuals with hyposmia, or the partial loss of smell, represent a large sector (15 %) of the population that is likely to grow with the current aging population; however, our understanding to how hyposmics centrally process odors is still not clear. One popular non-invasive tool for in vivo imaging of biological activity among human brains has been function magnetic resonance imaging (fMRI) which uses blood-oxygenation level dependent (BOLD) signal as an indirect measurement. Therefore, the aim of this study was to understand differences in olfaction processing between patients with hyposmia and healthy controls using functional magnetic resonance imaging (fMRI). METHODOLOGY: Eleven hyposmic and 12 healthy, normosmic subjects were exposed to two different food-related odors (coffee and peach) during a block-designed fMRI session. Additionally, odor perception qualities were rated for each odor throughout the scanning session. RESULTS: The activations of the normosmic group were localized in typical olfactory areas (insula, orbitofrontal cortex [OFC], limbic system and amygdala). The hyposmic group showed similar regions of activation (insula, OFC, limbic system), however, less activation was found in the amygdala, left anterior cingulate and right OFC, but higher activation was shown in the right parahippocampal and both the left and right posterior cingulate gyrus which are assumed to play an important role in the processing and remembrance of memories. CONCLUSIONS: These results indicate similar central olfactory processing among groups, yet subjects with partial loss may attempt to compensate smell impairment with odor memory or higher motivation to smell.