International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28604844 Blocked noses 97 98 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, the Netherlands 1592 10.4193/Rhin10.4193/Rhin.17.402 This issue of our Journal contains interesting papers about blocked noses. Nasal obstruction is one of the most common reasons that patients visit their doctors, general practitioners and otorhinolaryngologists alike and has a significant impact on the quality of life of patients. Blockage is an important outcome of disease not only in nasal disease, but also in rhinosinusitis.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28434017 Recurrent epistaxis: predicting risk of 30-day readmission, derivation and validation of RHINO-ooze score 99 105 EN A. Addison Otorhinolaryngology, John Radcliffe Hospital, Oxford, Headley Way, United Kingdom C. Paul Otorhinolaryngology, John Radcliffe Hospital, Oxford, Headley Way, United Kingdom R. Kuo Otorhinolaryngology, John Radcliffe Hospital, Oxford, Headley Way, United Kingdom A. Lamyman Otorhinolaryngology, John Radcliffe Hospital, Oxford, Headley Way, United Kingdom P. Martinez-Devesa Otorhinolaryngology, John Radcliffe Hospital, Oxford, Headley Way, United Kingdom R. Hettige Otorhinolaryngology, John Radcliffe Hospital, Oxford, Headley Way, United Kingdom 1576 10.4193/Rhin16.259 BACKGROUND: To derive and validate a predictive scoring tool (RHINO-ooze score) with good sensitivity and specificity in identifying patients with epistaxis at high risk of 30 day readmission and to enable risk stratification for possible definitive intervention. METHODS: Using medical databases, we searched for factors influencing recurrent epistaxis. The information ascertained together with our analysis of retrospective data on patients admitted with epistaxis between October 2013 and September 2014, was used as the derivation cohort to develop the predictive scoring model (RHINO-ooze score). The tool was validated by performing statistical analysis on the validation cohort of patients admitted with epistaxis between October 2014 and October 2015. Multiple linear regressions with backwards elimination was used to derive the predictive model. The area under the curve (AUC), sensitivity and specificity were calculated. RESULTS: 834 admissions were encountered within the study period. Using the derivative cohort (n= 302) the RHINO-ooze score with a maximum score of 8 from five variables (Recent admission, Haemorrhage point unidentified, Increasing age over 70, posterior Nasal packing, Oral anticoagulant) was developed. The RHINO-ooze score had a chi-square value of 99.72 with a significance level of smaller than 0.0001 and hence an overall good model fit. Comparison between the derivative and validation groups revealed similar rates of 30-day readmission between the cohorts. The sensitivity and specificity of predicting 30-day readmission in high risk patients with recurrent epistaxis (RHINO-ooze score equal/larger than 6) was 81% and 84%, respectively. CONCLUSIONS: The RHINO-ooze scoring tool demonstrates good specificity and sensitivity in predicting the risk of 30 day readmission in patients with epistaxis and can be used as an adjunct to clinical decision making with regards to timing of operative intervention in order to reduce readmission rates.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28501886 Rhinophototherapy in chronic rhinosinusitis: a double blind randomized placebo-controlled trial 106 112 EN N. Dulguerov Department of OtoRhinoLaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland N. Guinand Department of OtoRhinoLaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland D. Courvoisier Division of Oral and Maxillofacial Surgery, Geneva University Hospital, Geneva, Switzerland B.N. Landis Department of OtoRhinoLaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland J.S. Lacroix Faculty of medicine, Geneva Medical University, Geneva, Switzerland C. Hauser Private practice, Geneva, Switzerland 1586 10.4193/Rhin16.063 BACKGROUND: This study evaluated the efficacy of rhinophototherapy in patients with chronic rhinosinusitis (CRS) without nasal polyps. METHOD: In this randomized double-blind, placebo-controlled trial, CRS patients (n=50) received either mixed visible and ultraviolet (UVA and UVB) light source application (mUV/VIS) or visible light alone that served as placebo. Both groups were treated for 3 weeks. RESULTS: Results in the rhinophototherapy and placebo group were not significantly different and failed to reduce patient-reported outcomes measures (Rhinosinusits Disability Index, Visual Analogic Scale of symptom severity) and objective scores (rhinomanometry, olfactory thresholds, nasal Nitic Oxide concentrations), immediately and one month after treatment. CONCLUSIONS: The present data suggest that rhinophototherapy is not an efficient treatment for chronic rhinosinusitis without nasal polyps.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28434016 Chronic rhinosinusitis and mood disturbance 113 119 EN S.E. Erskine Norwich Medical School, University of East Anglia, Norwich, United Kingdom C. Hopkins Guys and St Thomas NHS Foundation Trust, London, United Kingdom A. Clark Norwich Medical School, University of East Anglia, Norwich, United Kingdom S. Anari ENT Department, Heart of England NHS Foundation Trust, Birmingham, United Kingdom A. Robertson ENT Department, Southern General Hospital, Glasgow, Scotland, United Kingdom S. Sunkaraneni ENT Department, Royal Surrey County Hospital, Guildford, United Kingdom J.A. Wilson Otolaryngology, Head and Neck Surg. Institute of Health and Society, Newcastle University, Newcastle, United Kingdom J. Beezhold Norwich Medical School, Norwich, United Kingdom C.M. Philpott Norwich Medical School, University of East Anglia, Norwich, United Kingdom 1575 10.4193/Rhin16.111 BACKGROUND: This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors that influence the onset and severity of chronic rhinosinusitis (CRS). The aim of this analysis is to determine whether those with CRS are more likely to report psychiatric morbidity and in particular mood disturbance compared with healthy controls. METHODS: CRES consists of a study-specific questionnaire regarding demographic and socioeconomic factors and past medical history as well as a nasal symptom score (SNOT-22) and SF-36 (QoL - quality of life tool). Both of these tools contain mental health or emotional well-being domains. Participants were specifically asked whether they had ever consulted with their General Practitioner for anxiety or depression. Questionnaires were distributed to patients with CRS attending ENT outpatient clinics at 30 centres across the United Kingdom from 2007-2013. Controls were also recruited at these sites. Patients were divided into subgroups of CRS according to the absence/presence of polyps (CRSsNPs/CRSwNPs) or allergic fungal rhinosinusitis (AFRS). RESULTS: Consultations with a family physician for depression or anxiety were higher amongst those with CRS than controls, but this was only significant for those with CRSsNPs. Odds ratio (OR) for CRSsNPs vs controls: 1.89; OR for CRSwNPs: 1.40. Patients with CRS showed significantly higher mental health morbidity than controls across the mental health and emotional wellbeing domains of the SF-36 and SNOT-22. Mean difference in the mental health domain of SF-36 was 8.3 for CRSsNPs and 5.3 for CRSwNPs. For the emotional domain of SNOT-22, differences were 7.7 and 6.3 respectively. CONCLUSIONS: Depression and anxiety are significantly more common in patients with CRS compared to healthy controls, especially in those with CRSsNPs. This added mental health morbidity needs consideration when managing these patients in primary and secondary care settings.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28029166 Influence of cooling face masks on nasal air conditioning and nasal geometry 120 125 EN J. Lindemann Department of Otorhinolaryngology, University of Ulm, Ulm, Germany T. Hoffmann Department of Otorhinolaryngology, University of Ulm, Ulm, Germany A. Koehl Department of Otorhinolaryngology, Hospital of Magdeburg, Magdeburg, Germany E.M. Walz Department of Otorhinolaryngology, University of Ulm, Ulm, Germany F. Sommer Department of Otorhinolaryngology, University of Ulm, Ulm, Germany 1532 10.4193/Rhin16.212 INTRODUCTION: Nasal geometries and temperature of the nasal mucosa are the primary factors affecting nasal air conditioning. Data on intranasal air conditioning after provoking the trigeminal nerve with a cold stimulus simulating the effects of an arctic condition is still missing. The objective was to investigate the influence of skin cooling face masks on nasal air conditioning, mucosal temperature and nasal geometry. METHODS: Standardized in vivo measurements of intranasal air temperature, humidity and mucosal temperature were performed in 55 healthy subjects at defined detection sites before and after wearing a cooling face mask. Measurements of skin temperature, rhinomanometry and acoustic rhinometry were accomplished. RESULTS: After wearing the face mask the facial skin temperature was significantly reduced. Intranasal air temperature did not change. Absolute humidity and mucosal temperature increased significantly. The acoustic rhinometric results showed a significant increase of the volumes and the cross-sectional areas. There was no change in nasal airflow. CONCLUSIONS: Nasal mucosal temperature, humidity of inhaled air, and volume of the anterior nose increased after application of a cold face mask. The response is mediated by the trigeminal nerve. Increased mucosal temperatures as well as changes in nasal geometries seem to guarantee sufficient steady intranasal nasal air conditioning.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28060383 Clinimetric properties of the Glasgow Health Status Inventory, Glasgow Benefit Inventory, Peak Nasal Inspiratory Flow, and 4-Phase Rhinomanometry in adults with nasal obstruction 126 134 EN M.M.H.T. van Egmond Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands N. van Heerbeek Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands E.L.M. ter Haar Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands M.M. Rovers Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands 1534 10.4193/Rhin16.296 BACKGROUND: The validity of many measurement instruments frequently used in rhinology is unknown. This study describes clinimetric properties of well-known subjective and objective outcomes, i.e., the Glasgow Health Status Inventory, Glasgow Benefit Inventory, Peak Nasal Inspiratory Flow, and 4-Phase Rhinomanometry, in adults with nasal obstruction. METHODOLOGY: Construct validity and responsiveness were determined in 111 patients. Inter-rater and intra-rater reliability were analysed in 30 patients. We assessed content validity by interviewing patients and ENT-surgeons; construct validity by comparing hypothesised associations to calculated correlations between the outcomes; inter-rater reliability by having two researchers perform objective measurements in the same patients; intra-rater reliability by having one rater administer all instruments twice within a two-week interval; and responsiveness by comparing patients scores at baseline and three months after septoplasty or non-surgical management. RESULTS: All instruments demonstrated adequate content validity, inter-, and intra-rater reliability. Analyses of construct validity yielded low Pearsons correlations between the subjective and objective outcomes. Comparing septoplasty to non-surgical management, only the Glasgow Health Status Inventory scores were different between the two groups (mean difference 10.4, 95% CI 6.9 - 13.9). CONCLUSION: All measurement instruments scored appropriately on content validity and reliability, but only the subjective GHSI scored well on responsiveness.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28064338 Nasal closure for severe hereditary haemorrhagic telangiectasia in 100 patients. The Lund modification of the Young's procedure: a 22-year experience 135 141 EN V.J. Lund Royal National Throat Nose and Ear Hospital, London, United Kingdom Y. Darby Royal National Throat Nose and Ear Hospital, London, United Kingdom J. Rimmer Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia M. Amin Mater Hospital, Dublin, Ireland S. Husain The National University of Malaysia, Kuala Lumpur, Malaysia 1535 10.4193/Rhin16.315 INTRODUCTION: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disease characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. The nosebleeds can be life-threatening and in these circumstances, radical treatment is required. METHODS: Since 1994, closure of the nose has been undertaken to prevent severe nasal bleeding in patients meeting specific selection criteria. Outcome data collected on this cohort pre- and post-operatively is available for analysis. RESULTS: From a cohort of 515 HHT patients, 100 have undergone nasal closure, bilateral ab initio in 81%. Fifty patients completed pre- and post-operative epistaxis severity questionnaires and provided information on post-operative problems and 28 completed a Glasgow Benefit Inventory (GBI). Overall most patients derived significant benefit from the procedure with complete cessation of nasal bleeding in 94%, a highly significant improvement in the epistaxis score and a mean GBI score of 53.4. Loss of smell and taste was the most frequent post-operative complaint. CONCLUSION: HHT can be associated with life-threatening epistaxis significantly affecting patients quality of life. Permanent prevention of airflow is associated with complete or near-total cessation of epistaxis in the majority of patients.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28214913 Assessment of efficacy and safety of the herbal medicinal product BNO 1016 in chronic rhinosinusitis 142 151 EN J. Palm Rothenbach, Germany I. Steiner Posnan, Poland D. Abramov-Sommariva Bionorica SE, Neumarkt, Germany A. Ammendola Bionorica SE, Neumarkt, Germany S. Mitzenheim Bionorica SE, Neumarkt, Germany H. Steindl Bionorica SE, Neumarkt, Germany M. Wonnemann Bionorica SE, Neumarkt, Germany C. Bachert Ghent University Hospital, Ghent, Belgium 1544 10.4193/Rhin16.103 BACKGROUND: The objective of this clinical trial (CRS-02) was to assess the efficacy, safety and tolerability of two dosages of the herbal medicinal product BNO 1016 (Sinupret extract) in patients with chronic rhinosinusitis (CRS). METHODOLOGY: 929 patients suffering from CRS were enrolled in this randomised placebo-controlled trial with a treatment period of 12 weeks. The primary endpoint was the mean Major Symptom Score (MSS) in week 8 and week 12 compared to placebo. Secondary endpoints included further MSS related parameters and responder rates over time. Pharmacoeconomic endpoints were also analysed. Finally, safety and tolerability were evaluated. RESULTS: Sinupret extract was not superior over placebo regarding the primary endpoint. However, the results of the secondary endpoints showed a clear trend towards superior efficacy. Therefore, additional post-hoc sensitivity analyses were performed in patients with a baseline MSS over 9 and persistence of disease more than 1 year diagnosed by specialists in otorhinolaryngology. Those patients significantly benefited from Sinupret extract. Therapy was superior for the primary endpoint analysis. Patients were less impaired with respect to work and daily activities. A good safety and tolerability of Sinupret extract was assured in all patients. CONCLUSIONS: Sinupret extract can safely be administered in patients with CRS. Although the primary endpoint of the study was not significant, a post-hoc subgroup analysis in patients whose disease was diagnosed by a specialist revealed a pronounced treatment effect. Effects in that subgroup were even stronger with longer disease persistence and stronger severity.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28501884 The effect of systemic treatments on periostin expression reflects their interference with the eosinophilic inflammation in chronic rhinosinusitis with nasal polyps 152 160 EN E. De Schryver Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium L. Derycke Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium L. Calus Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium G. Holtappels Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium P.W. Hellings Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium T. Van Zele Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium C. Bachert Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium P. Gevaert Upper Airways Research Laboratory, Department Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium 1589 10.4193/Rhin16.314 BACKGROUND: Periostin is a recently discovered biomarker for eosinophilic inflammation. Chronic rhinosinusitis with nasal polyps is a T-helper 2-skewed chronic inflammatory airway disease. Medical treatments aim to relieve symptoms and maintain clinical control by interfering with the inflammatory cascade. The effect on nasal and serum periostin levels is however yet unknown. We aimed to evaluate the effect of omalizumab, mepolizumab, methylprednisolone and doxycycline on nasal and systemic periostin expression. METHODS: This study is based on 3 previously published trials. Nasal and systemic periostin were assessed in CRSwNP patients, randomly assigned to receive doxycycline (n=14), methylprednisolone (n=14), mepolizumab (n=20) or omalizumab (n=15). There was a control group for each treatment scheme. Doxycycline (200 mg on the first day, followed by 100 mg once daily) and methylprednisolone (32-8 mg once daily) were administered during 20 days; mepolizumab was injected at baseline and at 4 weeks. Omalizumab was injected every 2 or 4 weeks, following the official drug leaflet. RESULTS: Methylprednisolone and omalizumab significantly reduced serum periostin levels at 4 and 8 weeks, respectively, after the start of the treatment. The effect of methylprednisolone was transient. Nasal periostin levels decreased significantly after 8 weeks of treatment with mepolizumab. The periostin expression is in accordance with the previously reported effect on the eosinophilic inflammation and clinical outcome. CONCLUSION: All treatment options distinctly influence periostin expression, reflecting the interference with the local or systemic eosinophilic inflammatory cascade.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28492611 The effect of topical treatments for CRS on the sinonasal epithelial barrier 161 169 EN M. Ramezanpour Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, South Australia A. Rayan Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, South Australia J.L.P. Smith School of Biology, Faculty of Science and Engineering, Flinders University of South Australia, Adelaide, South Australia S. Vreugde Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, South Australia 1581 10.4193/Rhin16.284 BACKGROUND: Several topical treatments are used in the management of Chronic Rhinosinusitis (CRS), some of which the safety and efficacy has yet to be determined. The purpose of this study was to investigate the effect of commonly used topical treatments on the sinonasal epithelial barrier. METHODS: Normal saline (0.9% Sodium Chloride), hypertonic saline (3% Sodium Chloride), FESS Sinu-Cleanse Hypertonic, FLO Sinus Care and Budesonide 1 mg/ 2 ml were applied to the apical side of air-liquid interface (ALI) cultures of primary human nasal epithelial cells (HNECs) from CRS patients (n=3) and non-CRS controls (n=3) for 24 hours. Epithelial barrier structure and function was assessed using trans-epithelial electrical resistance (TEER), measuring the passage of Fluorescein Isothiocyanate labelled Dextrans (FITC-Dextrans) and assessing the expression of the tight junction protein Zona Occludens-1 (ZO-1) using immunofluorescence. Toxicity was assessed using a Lactate Dehydrogenase (LDH) assay. Data was analysed using ANOVA, followed by Tukey HSD post hoc test. RESULTS: Hypertonic solution and budesonide significantly increased TEER values in CRS derived HNECs. In contrast, FESS Sinu-Cleanse Hypertonic significantly reduced TEER 5 minutes after application of the solution followed by an increase in paracellular permeability of FITC-Dextrans (30 minutes) and increased LDH levels 6 hours after application of the solution. CONCLUSIONS: Our findings confirm that isotonic and hypertonic saline solutions do not compromise epithelial barrier function in vitro but underscore the importance of examining safety and efficacy of over-the-counter wash solutions.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28235979 Anterior maxillary wall and lacrimal duct relationship - CT analysis for prelacrimal access to the maxillary sinus 170 174 EN D. Simmen Center for Otorhinolaryngology, Head and Neck Surgery, Hirslanden Clinic, Zurich, Switzerland N. Veerasigamani Center for Otorhinolaryngology, Head and Neck Surgery, Hirslanden Clinic, Zurich, Switzerland H.R. Briner Center for Otorhinolaryngology, Head and Neck Surgery, Hirslanden Clinic, Zurich, Switzerland N. Jones Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Queens Medical Centre, Nottingham, United Kingdom B. Schuknecht Medical Radiological Institute MRI, Zurich, Switzerland 1545 10.4193/Rhin16.318 BACKGROUND: The distance between the anterior wall of the maxillary sinus and the nasolacrimal duct shows a large individual variation. METHODOLOGY: To evaluate the feasibility of accessing the maxillary sinus through a prelacrimal window access (PLWA), a series of 100 paranasal CT scans from adult patients was analysed retrospectively. The distance between the anterior maxillary wall and the anterior border of the lacrimal duct (= prelacrimal window) were measured in 200 sides. RESULTS: A distance of more the 7 mm was found in 12.5% maxillary sinuses and would enable straight forward PLWA. A distance between smaller than 7mm and larger than 3mm was present in 56.5% of sinuses, and would make surgical access more demanding. In 31.5% of maxillary sinuses the distance was smaller than or equal to 3mm and in these patients this approach would be difficult without transecting the nasolacrimal duct. CONCLUSION: Only in 12.5% of sinuses a prelacrimal endoscopic access is readily feasible, while in 56.5% temporary tear sac dislocation is required and in 31.5% lacrimal sac dislocation is always needed along with a significant amount of bone removal to enable PLWA.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28434014 Prospective open-label evaluation of long-term low-dose doxycycline for difficult-to-treat chronic rhinosinusitis with nasal polyps 175 180 EN A.C. Pinto Bezerra Soter Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil T.F. Bezerra Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil R. Pezato Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil T.R. Teles Abdo Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil R.M. Pilan Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil F.R. Pinna Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil P. Gevaert Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Ghent, Belgium T. van Zele Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Ghent, Belgium C. Bachert Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Ghent, Belgium R.L. Voegels Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil 1579 10.4193/Rhin15.291 BACKGROUND: This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP). METHODS: This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count. RESULTS: There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment. CONCLUSION: These findings suggest that doxycycline may have a beneficial role for CRSwNP patients, especially for patients without asthma, NERD or high levels of serum IgE before treatment.

International Rhinologic Society Rhinology 0300-0729 55 2 2017 6 1 28434015 Low lymphatic vessel density associates with chronic rhinosinusitis with nasal polyps 181 191 EN A. Luukkainen Haartman institute, University of Helsinki, Helsinki, Finland M. Seppälä Haartman institute, University of Helsinki, Helsinki, Finland J. Renkonen Haartman institute, University of Helsinki, Helsinki, Finland R. Renkonen Haartman institute, University of Helsinki, Helsinki, Finland J. Hagstrő;m Haartman institute, University of Helsinki, Helsinki, Finland H. Huhtala Faculty of Health Sciences, University of Tampere, Tampere, Finland M. Rautiainen Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland J. Myller Department of Otorhinolaryngology, Paijat-Hame Central Hospital, Lahti, Finland T. Paavonen Department of Pathology, University of Tampere, Tampere, Finland A. Ranta Department of Surgery, Tampere City Hospital, Tampere, Finland T. Torkkeli Department of Otorhinolaryngology, Mikkeli Central Hospital, Mikkeli, Finland S. Toppila-Salmi Haartman institute, University of Helsinki, Helsinki, Finland 1580 10.4193/Rhin16.007 OBJECTIVES: Chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP) and antrochoanal polyps (ACP) are different upper airway inflammation phenotypes with different pathomechanisms. In order to understand the development of tissue edema, the present study aimed to evaluate lymphatic vessel density in CRSsNP, CRSwNP and ACP. MATERIALS AND METHODS: 120 retrospective nasal and maxillary sinus specimens were stained immunohistochemically with a von Willebrand factor polyclonal antibody recognizing vascular and lymphatic endothelium, and with a podoplanin monoclonal antibody recognizing lymphatic endothelium. Vessels were studied by microscopy in a blinded fashion, and the vessel density and the relative density of lymphatic vessels were calculated. Patient characteristic factors and follow-up data of in average 9 years were collected from patient records. RESULTS AND CONCLUSION: In the nasal cavity, the low absolute and relative density of vessels and of lymphatic vessels was associated with CRSwNP and ACP tissues compared to control inferior turbinate. This was observed also in the inflammatory hotspot area. In the maxillary sinus, lower absolute and relative density of lymphatic vessels associated with the CRSwNP phenotype. High lymphatic vessel density in polyp tissue associated with the need for revision CRS-surgery. As a conclusion, low density of lymphatic vessels distinguished patients with CRSwNP not only in the hotspot area of polyp tissue, but also in maxillary sinus mucosa. Yet, higher lymphatic vessel density seems to associate with polyp recurrence. Further studies are still needed to explore if formation of nasal polyps could be diminished by intranasal therapeutics affecting lymphangiogenesis.