International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28865115 Paving the future of rhinosinusitis care 193 194 EN P.W. Hellings Rhinology Journal Amsterdam, the Netherlands 1636 10.4193/Rhin17.403 Novel insights into the pathophysiology of chronic rhinosinsusitis (CRS) will lead to endo-type driven treatment and reduce oral corticosteroid treatment.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28492609 The risk of osteoporosis in oral steroid treatment for nasal polyposis: a systematic review 195 201 EN L. Winblad Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark C.G. Larsen Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark K. Håkansson Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark B. Abrahamsen Department of Medicine, Holbaek Hospital, DK-4300 Holbaek, Odense Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, DK-5000 Odense C, Denmark C. von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark 1583 10.4193/Rhin15.367 BACKGROUND: Systemic glucocorticoids are often used in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), and osteoporosis is a well-known complication to steroid treatment, associated with significant morbidity. Nevertheless, the burden of steroid induced osteoporosis is unknown in patients with CRSwNP. We aimed to assess the risk of acquiring osteoporosis caused by oral steroids in patients with CRSwNP, and provide recommendations on future research and guidelines. METHODOLOGY: Cochrane Review Database, EMBASE, Ovid Medline, and PubMed were searched for studies including adult patients with CRSwNP treated with oral steroids. Outcomes were Bone Mineral Density (BMD) and prevalence of fractures in relation to dose and duration of oral steroids. In addition, we reviewed general guidelines for treatment with oral steroids. RESULTS: We identified two studies (n=243) that met the inclusion criteria. Doses and durations of oral steroids were over 5 mg/day for more than 3 months and 1 mg/kg body weight/day for 6 to 10 days for 4 or more courses/year. The prevalence of low bone mass was 39% and 61%, respectively. It was not possible to quantify the overall risk of osteoporosis induced by oral steroids from the studies. No studies evaluated prevalence of fracture. CONCLUSIONS: Registry studies and randomized controlled trials would be needed to assess the risk of osteoporosis in CRSwNP patients and future guidelines should include recommendations regarding preventive treatment and recommendations on doses and durations of oral steroids.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28501885 EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis 202 210 EN P.W. Hellings Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium C.A. Akdis Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Christine-Kuhne Center for Allergy Research and Education, Davos, Switzerland C. Bachert Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium J. Bousquet Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France B. Pugin European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium G. Adriaensen Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands R. Advani Health Education North West, Manchester, UK I. Agache Faculty of Medicine, Transylvania University, Brasov, Romania C. Anjo Department of Otorhinolaryngology, Hospital Sao Jose, Hospital Centre of Central Lisbon, Lisbon, Portugal R. Anmolsingh Department of Otorhinolaryngology, Wigan Wrightington and Leigh NHS Foundation Trust, Wigan, UK E. Annoni Medtronic Inc. T. Bieber Department of Dermatology and Allergy, Christine Kuhne-Center for Allergy Research and Education, Friedrich-Wilhelms-University, Bonn, Germany A. Bizaki University of Tampere, Finland I. Braverman Hillel Yaffe Medical Center, Hadera Technion Faculty of Medicine, Haifa, Israel I. Callebaut Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium J.A. Castillo Vizuete Respiratory Medicine, Hospital Universitario Quiron Dexeus, Barcelona, Spain T. Chalermwatanachai Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium R. Chmielewski Department of Otolaryngology, Military Institute of Aviation Medicine, Warsaw, Poland C. Cingi Department of Otolaryngology, Head and Neck Surgery, University of Eskisehir Osmangazi, Eskisehir, Turkey L. Cools Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium C. Coppije European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium M.E. Cornet Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands I. De Boeck Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium E. De Corso Agostino Gemelli Hospital Foundation, Catholic University of the Sacred Heart, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Rome, Italy G. De Greve Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium M. Doulaptsi Laboratory of Clinical Immunology, KU Leuven, Belgium R. Edmiston Health Education North West, Manchester, UK S. Erskine Norwich Medical School, University of East Anglia, UK E. Gevaert Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium P. Gevaert Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium K. Golebski Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands C. Hopkins ENT Departments, Guys and St Thomas Hospitals NHS Trust, London and James Paget University Hospital, Gorieston, United Kingdom V. Hox Departement Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Belgium C. Jaeggi European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium G. Joos Department of Respiratory Medicine, Ghent University, Belgium S. Khwaja Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK A. Kjeldsen Department Of Otorhinolaryngology, Odense University Hospital, Denmark L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany M. Koennecke University Hospital Schleswig-Holstein, Campus Lubeck, Department of Otorhinolaryngology, Lubeck, Germany I. Kortekaas Krohn Laboratory of Clinical Immunology, KU Leuven, Belgium O. Krysko Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium B.N. Kumar Department of Otolaryngology-Head and Neck, WWL NHS Foundation Trust and NIHR CRN, Greater Manchester, UK C. Langdon Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Clinical and Experimental Respiratory Immunology, IDIBAPS, Barcelona, Spain B. Lange Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK G. Lekakis Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium P. Levie ENT Clinic Messidor, Brussels, Belgium E. Lourijsen Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands V.J. Lund Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom K. Martens Laboratory of Clinical Immunology, KU Leuven, Belgium R. Mő;sges Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany J. Mullol Clinical and Experimental Respiratory Allergy, IDIBAPS, CIBERES. Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain T.D. Nyembue Department of OtoRhinoLaryngology, University of Kinshasa, Congo S. Palkonen European Federation of Allergy and Airways Diseases Patients Associations (EFA), Brussels, Belgium C. Philpott Norwich Medical School, University of East Anglia, UK J. Pimentel Hospital de Egas Moniz and Hospital da Luz, Lisbon, Portugal A. Poirrier ENT department, University Hospital of Liege, Belgium A.C. Pratas Norwich Medical School, University of East Anglia, UK E. Prokopakis Department of Otorhinolaryngology, University of Crete School of Medicine, Greece L. Pujols Clinical and Experimental Respiratory Allergy, IDIBAPS, CIBERES. Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain P. Rombaux Departement d Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Belgium C. Schmidt-Weber Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany C. Segboer Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands I. Spacova Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium J. Staikuniene Lithuanian Universitys of health sciences, Department of Immunology and allergology, Kaunas, Lithuania B. Steelant Laboratory of Clinical Immunology, KU Leuven, Belgium E.A. Steinsvik Department of Otorhinolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway A. Teufelberger Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium L. Van Gerven Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium K. Van Gool Private practice, Antwerpen, Belgium R. Verbrugge ALK, The Netherlands B. Verhaeghe Department of Otorhinolaryngology, Sint-Jozefskliniek, Izegem, Belgium P. Virkkula Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland S. Vlaminck Department of Otorhinolaryngology, AZ St. Johns Hospital, Bruges, Belgium E. Vries-Uss ALK, The Netherlands M. Wagenmann Department of Otorhinolaryngology, University Hospital Dusseldorf, Dusseldorf, Germany T. Zuberbier Comprehensive Allergy-Centre-Charite, Department of Dermatology and Allergy, Charite-Universitatsmedizin Berlin, Germany S.F. Seys European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands 1591 10.4193/Rhin17.028 The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28647751 Chronic rhinosinusitis severity is associated with need for asthma-related systemic corticosteroids 211 217 EN K.M. Phillips Department of Otolaryngology, Harvard Medical School, Boston, MA, USA L.P. Hoehle Department of Otolaryngology, Harvard Medical School, Boston, MA, USA R.W. Bergmark Department of Otolaryngology, Harvard Medical School, Boston, MA, USA A.P. Campbell Department of Otolaryngology, Harvard Medical School, Boston, MA, USA D.S. Caradonna Department of Otolaryngology, Harvard Medical School, Boston, MA, USA S.T. Gray Department of Otolaryngology, Harvard Medical School, Boston, MA, USA A.R. Sedaghat Department of Otolaryngology, Harvard Medical School, Boston, MA, USA 1597 10.4193/Rhin17.029 BACKGROUND: Chronic rhinosinusitis (CRS) is highly prevalent in patients with asthma. However, no study has evaluated the effect of CRS severity on asthma-related oral corticosteroid use - a marker of poor asthma control and prognosis. We therefore sought to evaluate the association between CRS severity and asthma-related oral corticosteroid use. METHODOLOGY: Prospective cross-sectional study of 110 adult asthmatic CRS patients. CRS severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy score. Number of asthma-related courses of oral corticosteroids in the past year was queried at enrollment. Association was sought between metrics for CRS severity and asthma-related oral corticosteroids use in the last year. Receiver operating characteristic (ROC) curves defined whether SNOT-22 or endoscopy scores could be used for detecting asthma-related oral corticosteroid use. RESULTS: The mean SNOT-22 score was 44.9 (standard deviation [SD] : 23.3) and mean endoscopy score was 4.1 (SD: 3.0). The mean number of asthma-related oral corticosteroid courses taken in the last year was 1.1 (SD: 1.9). SNOT-22, but not endoscopy score, was associated with requiring at least one course of asthma-related oral corticosteroids in the last year (odds ratio = 1.03, 95%CI: 1.02 - 1.06, p=0.003), which translates to an odds ratio of 2.0 for a 21-point increase in SNOT-22. ROC analysis identified equally optimal SNOT-22 scores of greater than 32 (sensitivity: 88.1%, specificity: 41.2%) or greater than 65 (sensitivity: 38.1%, specificity: 91.2%) for detecting the need for at least one course of oral corticosteroids within the past year. CONCLUSIONS: CRS symptom severity is associated with past asthma-related oral corticosteroid use. SNOT-22 scores may be used as a versatile tool to screen for past asthma-related oral corticosteroid use in asthmatic CRS patients - i.e. those at greatest risk from their asthma - with either high sensitivity or high specificity.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28492612 A prospective, randomized clinical study comparing drug eluting stent therapy and intranasal corticoid steroid therapy in the treatment of patients with chronic rhinosinusitis 218 226 EN R. Taulu Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland A.J. Bizaki Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland J. Numminen Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland M. Rautiainen Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland 1582 10.4193/Rhin16.070 OBJECTIVES: To conduct the first prospective, randomized controlled clinical trial comparing the efficacy of a drug-eluting stent (DES) (the Relieva StratusTM MicroFlow Spacer) and topical intranasal corticosteroid therapy in patients with chronic rhinosinusitis (CRS). METHODS: Sixty-three adult patients with ethmoiditis were randomized into either the DES group (n=34) or nasal spray group (n=29). The main outcome variable was the Sinonasal Outcome Test 22, Visual Analogue Scale, nasal endoscopy, rhinometric measurements were performed at the beginning of the study, after three months and six months of follow-up. RESULTS: Both treatments significantly improved quality of the life with no significant difference being found between the two groups. The VAS score decreased in both groups: improvements were significant at three and six months in the nasal spray group, but in the DES group a significant difference was noted only at three months. There was a statistically significant increase in total nasal cavity volumes in the corticosteroid spray group, but not in the DES group. CONCLUSION: We found that patients benefitted from DES and the corticosteroid nasal spray. We could not find any significant difference between the treatments, except the greater increase in the total nasal cavity volumes favouring the nasal spray group. Because of the very good results for the nasal spray and the much higher material and operating room costs associated with DES, we cannot recommend the use of DES over nasal spray as a monotherapeutic treatment for CRS.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28315920 Bacterial immune evasion via an IL-10 mediated host response, a novel pathophysiologic mechanism for chronic rhinosinusitis 227 233 EN J.S. Schwartz Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada S. Al-Mot Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, Canada M.F. Endam Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, Canada S. Alromaih Department of Otolaryngology -Head and Neck Surgery, Faculty of Medicine King Saud University, Riyadh, Saudi Arabia J. Madrenas Department of Microbiology and Immunology, McGill University, Montreal, Canada M. Desrosiers Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada 1546 10.4193/Rhin16.199 BACKGROUND: Staphylococcus aureus is a frequently implicated pathogen in chronic rhinosinusitis (CRS). S. aureus may promote commensalism by downregulating pro-inflammatory T cell host responses via an IL-10 mediated pathway. This finding, coupled with the observation that S. aureus and CD8+ T cell numbers are inversely correlated in CRS mucosa, suggests that S. aureus may evade immune destruction via IL-10 induction. To support this hypothesis, we evaluated i) whether IL-10 levels differ in CRS compared to controls (CTL) using microarray and immunohistochemistry and ii) whether IL-10 levels correlate with S. aureus and CD8+ T cell levels. METHODOLOGY: Sinus epithelial brush samples from 12 patients undergoing ESS for CRS and 10 CTLs underwent microarray analysis of IL-10 gene expression. Microarray results were verified on simultaneously obtained surgical biopsy samples by immunohistochemistry staining for IL-10. Potential mechanisms were assessed by immunohistochemistry for CD8+ T cells and S. aureus. RESULTS: IL-10 gene expression was significantly higher in CRS vs CTL subjects at the time of surgery. Immunohistochemistry confirmed increased levels of intraepithelial IL-10. A strong inverse correlation was observed between intraepithelial IL-10 and CD8+ T cell levels as was intraepithelial IL-10 and S. aureus. CONCLUSION: Elevated IL-10 levels in sinus mucosa may be a potential pathophysiologic feature of CRS in association with a significant downregulation of host CD8+ T cell levels. While S. aureus is believed to play a role in IL-10 induction, a comparatively weaker relationship between S. aureus and IL-10 levels suggests other bacterial species may also induce IL-10 production as a common survival strategy in CRS.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28667737 Periostin as a marker of mucosal remodelling in chronic rhinosinusitis 234 241 EN J.A. Ebenezer Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia J.M. Christensen Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia B.G. Oliver Woolcock Institute, University of Sydney, Sydney, Australia R.A. Oliver Surgical and Orthopaedic Research laboratory, UNSW, Sydney, Australia G. Tjin Woolcock Institute, University of Sydney, Sydney, Australia J. Ho Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia A.R. Habib Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia J. Rimmer Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia R. Sacks Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia R.J. Harvey Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia 1599 10.4193/Rhin16.215 BACKGROUND: Although extracellular matrix (ECM) proteins are associated with irreversible lower airway changes, the relationship with upper airway remodelling which occurs during chronic rhinosinusitis (CRS) is poorly understood. This study assessed the expression of ECM proteins periostin, fibulin-1, fibronectin and collagenIV in nasal mucosa of patients with and without histologic features of remodelling. METHODS: A cross-sectional study of sinonasal mucosal biopsies taken from patients, undergoing surgery for CRS was performed, where patients were grouped according to remodelling, defined by basement membrane thickening (BMT over 7.5 micrometer) and subepithelial fibrosis. An overall view and three random fields of immunostained tissue sections that included epithelium, basement membrane and submucosa, were imaged using Zeiss Zen software. The area and intensity of positive staining were scored by two blinded observers, using a 12-point ordinal scale of weak to strong. RESULTS: 65 patients (47.6 +/- 13.4years, 44.6% female) were assessed. Patients were grouped as controls 26.2%, BMT/no fibrosis 38.5% or BMT and fibrosis 33.8%. Stronger grade of periostin expression was associated with remodelling changes and tissue eosinophilia over 10/HPF. Fibulin-1, fibronectin and collagenIV did not differ. CONCLUSION: Periostin expression was associated with the presence of BMT, fibrosis and tissue eosinophilia and may identify patients undergoing remodelling changes.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28492610 Nasal cytology in children: scraping or swabbing? 242 250 EN C. Pipolo Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy S. Bianchini Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy S. Barberi Department of Pediatrics, ASST Fatebenefratelli, Sacco, Milan, Italy M. Landi Gruppo pediatrico di cure primarie Asl To1, Turin, Italy E. D'Auria Department of Pediatrics, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy E. Fuccillo Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy M. Gaffuri Otolaryngology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan P. Marchisio Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy C. Rosazza Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy A.M. Saibene Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy M. Gelardi Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy S. Torretta Otolaryngology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan 1585 10.4193/Rhin16.287 Nasal cytology has become a valuable tool in the assessment of a multitude of nasal pathologies in children. Collection methods differ significantly and even though the use of the nasal curette is regarded as the most reliable in adults, most practitioners use the nasal swab in children. However, no studies have validated the reliability and supposed better tolerability of the latter. We have compared these two sampling methods regarding their tolerability and analysed the diagnostic accuracy of the cotton nasal swab (NSW) to identify nasal cytotypes and rhinitis phenotypes, using nasal scraping (NSC) for comparison. In a multicentric prospective study we recruited 208 children and performed nasal cytology by means of NSW and NSC. Microscopic evaluating of the nasal cytotypes was performed and tolerability of NSW and NSC was tested. Our data revealed a significantly inferior diagnostic accuracy of NSW compared to NSC regarding reliability and cell counts. Our study is the first to shed light on the role of the sampling tools for pediatric nasal cytology. We documented a poor diagnostic accuracy of NSW, thus suggesting using only the nasal curette in clinical practice. Furthermore, tolerability did not differ between the two, refuting the common thesis that swabs are to be preferred when doing nasal cytology in children.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28624844 The effect of endoscopic sinus surgery on quality of life and absenteeism in patients with chronic rhinosinuitis - a multi-centre study 251 261 EN P. Sahlstrand-Johnson Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Lund University, Skane University Hospital, Malmo, Sweden C. Hopkins Department of Otolaryngology, Guys and St Thomas Hospital, London, United Kingdom B. Ohlsson Lund University, Skane University Hospital, Division of Internal Medicine, Malmo, Sweden M. Ahlner-Elmqvist Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden 1594 10.4193/Rhin16.126 BACKGROUND: Chronic rhinosinusitis with and without nasal polyps (CRSw/sNP) are common conditions decreasing health-related quality of life (HRQOL). Individual symptoms capable of predicting outcome after endoscopic sinus surgery (ESS) are poorly defined, and the indirect costs of CRS is rarely reported in Europe. METHODOLOGY: Patients with CRSw/sNP admitted for ESS were prospectively enrolled. Patients completed the 22 Sinonasal Outcome Test (SNOT-22), the short-form 36-item questionnaire (SF-36), a Visual Analogue Scale (VAS) and reported CRS-related absenteeism pre- and post-operatively. RESULTS: 181 patients were included. The SNOT-22 score diminished from 51.8 (48.7-55.0) pre-operatively to 33.0 (29.2-36.8) at 6 months. 64% achieved a clinically important improvement in the SNOT-22. SF-36 scores improved statistically significantly in all domains except Role Emotional. The VAS score halved from 68 (65-71) to 34 (29-39) at 6 months post-operatively. A pre-operative SNOT-22 score over 20 implied a greater chance of score improvement after 6 months. A multivariate model identified individual items associated with SNOT-22. Further, patients that had lees than 12 months of sinus disease derived greatest benefit. CRS-related absenteeism dropped from 8-14 days to 1-7 days 12 months after ESS. CONCLUSIONS: This prospective study showed that ESS significantly improved the HRQOL and decreased absenteeism of patients with CRSw/sNP. Shorter duration of disease and Need to blow nose and Blockage/congestion of nose of SNOT-22 were identified as predictive factors for good surgical outcome.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28492608 Sinonasal symptom-related sleep disorders before and after surgery for nasal polyposis 262 268 EN D.T. Nguyen University hospital of Nancy, Department of Otorhinolaryngology, Head and Neck Surgery, Nancy, France F. Arous Faculty of medicine, University of Lorraine, France P. Gallet University hospital of Nancy, Department of Otorhinolaryngology, Head and Neck Surgery, Nancy, France M. Felix-Ravelo University hospital of Nancy, Department of Otorhinolaryngology, Head and Neck Surgery, Nancy, France P.L. Nguyen-Thi University hospital of Nancy, Plateforme dAide a la Recherche Clinique, PARC. Unite ESPRI, BioBase. Methodologie, Reglementation, Biostatistique, Nancy, France C. Rumeau University hospital of Nancy, Department of Otorhinolaryngology, Head and Neck Surgery, Nancy, France R. Jankowski University hospital of Nancy, Department of Otorhinolaryngology, Head and Neck Surgery, Nancy, France 1584 10.4193/Rhin16.016 BACKGROUND: Patients with nasal polyposis (NP) complain of several sinonasal symptoms that impact their sleep and quality of life. However, data on sleep disorders related to NP symptoms, before and after surgery, is poor. The aim of the present study was to analyze sleep complaints related to each NP symptom, before and after surgery, using the Dynachron questionnaire. METHODOLOGY: 63 patients operated for NP were included in this prospective study. They filled the DyNaChron questionnaire one day before surgery (V0), 6 weeks (V1) and 7 months (V2) after surgery. The self-ratings (0-10 point visual analog scale) of nasal obstruction, anterior rhinorrhea, postnasal discharge, cough and 5 items related to sleep disturbances, due to each symptom of chronic nasal dysfunction, were extracted from the questionnaire and analyzed. RESULTS: There was significant improvement of symptoms and symptom-related sleep disturbance scores at V1 and V2 compared to baseline scores. Before surgery, moderate/severe sleep disorders that patients attributed to nasal obstruction (the patient thinks it is due to nasal obstruction rather than a clinical test to show nasal obstruction) or anterior rhinorrhea were reported in two thirds of patients, postnasal discharge in one half, and chronic cough in one third. After surgery, less than 10% of patients reported moderate/severe sleep disorders at V1. There was a mild increase of patients who rated moderate/severe sleep disorders at V2 in comparison to V1. The correlation between scores of nasal obstruction and its impacts on sleep quality was weak before surgery and strong afterwards. CONCLUSION: Nasalization improved sleep quality significantly at 6 weeks and at 7 months after surgery. However, there was a mild increase of complaints related to postnasal discharge and cough at 7 months after surgery.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28865140 The comparison of nasal surgery and CPAP on daytime sleepiness in patients with OSAS 269 273 EN M. Tagaya Department of Otorhinolaryngology, Shirakabe clinic, Nagoya, Japan H. Otake Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan K. Suzuki Department of Otorhinolaryngology, Suzuki ENT clinic, Nagoya, Japan F. Yasuma Department of Internal Medicine, National Hospital Organization Suzuka Hospital, Suzuka, Japan H. Yamamoto Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan A. Noda Department of Biomedical Sciences, Chubu University, Kasugai, Japan Y. Nishimura Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan M. Sone Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan T. Nakashima Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan S. Nakata Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya University, Nagoya, Japan 1637 10.4193/Rhin17.026 OBJECTIVE: Residual sleepiness after continuous positive airway pressure (CPAP) is a critical problem in some patients with obstructive sleep apnea syndrome (OSAS). However, nasal surgery is likely to reduce daytime sleepiness and feelings of unrefreshed sleep. The aim of this study is to clarify the effects of nasal surgery and CPAP on daytime sleepiness. METHODOLOGY: This is a retrospective and matched-case control study. The participants were consecutive 40 patients with OSAS who underwent nasal surgery (Surgery group) and 40 matched patients who were treated with CPAP (CPAP group). RESULTS: In the Surgery group, although the nasal surgery did not decrease either apnea or hypopnea, it improved oxygenation, the quality of sleep. In the CPAP Group, the CPAP treatment reduced apnea and hypopnea, and improved oxygenation, quality of sleep. The degree of relief from daytime sleepiness was different between the two groups. The improvement of Epworth Sleepiness Scale was more significant in the Surgery Group than those in the CPAP Group (Surgery from 11.0 to 5.1, CPAP from 10.0 to 6.2). DISCUSSION: These findings suggest that the results of the nasal surgery is more satisfactory for some patients with OSAS than CPAP on daytime sleepiness.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28026838 Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery 274 280 EN I. Gengler Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France L. Carpentier Lille Inflammation Research International Center - Inserm U995, Universite de Lille, Lille, France X. Pasquesoone Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France D. Chevalier Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France G. Mortuaire Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France 1530 10.4193/Rhin16.251 OBJECTIVES: To identify predictive factors of readmission after day-case rhinologic surgery. METHODS: A 2-year retrospective chart review of patients scheduled for ambulatory sinonasal surgery in a tertiary medical center was conducted. The operating room and the anesthetic files were screened to identify demographic data, types of procedure, comorbidities and post-operative complications. RESULTS: From January 2014 to January 2016, 924 outpatient sinonasal procedures were identified. The overall readmission rate within the 30-postoperative days was 5.1% (2.9% for overnight hospital stay, 2.2% for unplanned post procedure visit to the hospital via the emergency room, or directly to the surgical unit within 30 days of discharge). Age at least 50 years, surgical duration at least 80 min, endoscopic sinus surgery procedures and postoperative nasal packing were identified as negative predictive factors of readmission. CONCLUSION: Careful scheduling of those higher-risk patients undergoing sinonasal surgery and appropriate postoperative observation should be implemented to improve healthcare quality in an outpatient setting.

International Rhinologic Society Rhinology 0300-0729 55 3 2017 9 1 28647750 Misdiagnosed paranasal gossypiboma: a 10-year experience with 21 cases at a tertiary center 281 287 EN P.Z. Wu Department of Otorhinolaryngology, The First Affiliated Hospital, Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Peoples Republic of China W. Sun Department of Otorhinolaryngology, The First Affiliated Hospital, Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Peoples Republic of China Y.H. Wen Department of Otorhinolaryngology, The First Affiliated Hospital, Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Peoples Republic of China R.Q. Ma Department of Otorhinolaryngology, The First Affiliated Hospital, Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Peoples Republic of China X.L. Zhu Department of Otorhinolaryngology, The First Affiliated Hospital, Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Peoples Republic of China W.P. Wen Department of Otorhinolaryngology, The First Affiliated Hospital, Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Peoples Republic of China 1598 10.4193/Rhin16.341 BACKGROUND: Different from rhinoliths, the paranasal gossypiboma is a foreign body, such as a surgical sponge, left in the nasal cavity. It is a rare, frequently misdiagnosed disease that has rarely been reported. We summarize its clinical characteristics, management, and possible risk factors. METHODOLOGY: We reviewed medical records of confirmed paranasal gossypibomas at a tertiary medical center between 2005 and 2015. Clinical symptoms, age, sex, anatomic sites, endoscopic photography, computed tomography, intraoperative findings, and past medical history were reviewed. RESULTS: The study included 21 patients, each of whom had ultimately undergone two operations. Among them, 20 underwent endoscopic nasal surgery in primary hospitals, and 15 had been misdiagnosed during the second surgery. The average interval to discovery of a retained foreign body was 200 days. Predominant occurrence sites were the maxillary and ethmoid sinuses. Computed tomography showed paranasal gossypiboma as a heterogeneous cystic lesion with a thin calcified shell. CONCLUSIONS: A history of endoscopic nasal surgery, especially performed at a primary hospital, is a warning sign for clinicians. Computed tomography can add to the warning by showing a heterogeneous cystic lesion with a thin calcified shell. Clinicians should be aware of these characteristics to avoid misdiagnosing paranasal gossypiboma.