International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 29166424 The future in Rhinology: from local treatment, to monoclonals and influencing the microbiome 289 290 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1761 10.4193/Rhin17.404 Over the last few decades, rhinology has been one of the most dynamic and progressive areas of ENT. We have not experienced such an intense period of development since the introduction of nasal corticosteroids in the 1970s.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28988258 Moving beyond descriptions of diversity: clinical and research implications of bacterial imbalance in chronic rhinosinusitis 291 297 EN B. Wagner Mackenzie School of Medicine, Department of Surgery, The University of Auckland, Auckland, New Zealand D.W. Waite Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia M. Hoggard School of Biological Sciences, The University of Auckland, Auckland, New Zealand M.W. Taylor School of Biological Sciences, The University of Auckland, Auckland, New Zealand and Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand K. Biswas School of Medicine, Department of Surgery, The University of Auckland, Auckland, New Zealand R.G. Douglas School of Medicine, Department of Surgery, The University of Auckland, Auckland, New Zealand 1704 10.4193/Rhin17.135 Chronic rhinosinusitis (CRS) is a debilitating disease which affects 5-16% of the general population and involves long-term inflammation of the sinonasal cavity. While microbial involvement in the pathogenesis of CRS has long been suspected, the exact role of microbes remains unclear. Recent application of cultivation-independent, molecular methods has provided much new information, taking advantage of developments in both laboratory- and bioinformatics-based analyses. The aim of this mini-review is to present a variety of available bioinformatics approaches, such as data classification techniques and network analyses, with proven applications in other aspects of human microbiome health and disease research. The uses of molecular techniques in the clinical setting are still in its infancy, but these tools can further our understanding of microbial imbalance during chronic disease and help guide effective patient treatment. The mini-review emphasises ways in which CRS bacterial gene-targeted sequencing data can progress beyond descriptive summaries and toward unlocking the mechanisms by which bacterial communities can be markers for sinus health.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 29166426 Rhinology Future Debates, an EUFOREA Report 298 304 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands C. Bachert Upper Airways Research Laboratory, ENT Department, Ghent University, Belgium M. Bernal-Sprekelsen Hospital Clinic, ENT-Department, Universidad de Barcelona Medical School, Spain J. Bousquet University Hospital of Montpellier, Montpellier, France M. Djandji Medical Affairs, Sanofi Genzyme, Cambridge, MA, USA A. Dorenbaum Allakos, San Carlos, CA, USA D. Hakimi-Mehr BioInspire Technologies, Palo Alto, CA, USA S. Hendry RVP and GM Europe, Entellus Medical Inc, Minneapolis, MN, USA C. Hopkins Guys and St Thomas Hospital, and Kings College, London, UK A. Leunig Rhinology Center Munich, Germany L. Mannent Research and Development, Sanofi, Chilly Mazarin, France D. Mucha Fiagon Ag Medical Technologie, Hennigsdorf, Germany M. Onerci Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey B. Pugin EUFOREA- European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium S. Toppila-Salmi Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland P. Rowe Global Medical Affairs, Immunology and Inflammation, Sanofi Genzyme, Bridgewater, NJ, USA S.F. Seys EUFOREA- European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium S. Stimson Intersect ENT, Menlo Park, CA, USA A. Strzembosz International Medical Affairs, Medtronic ENT, Tolochenaz, Switzerland P.W. Hellings Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands and Department of Otorhinolaryngology, University Hospitals Leuven, Belgium 1763 10.4193/Rhin17.221 The first Rhinology Future Debates was held in Brussels in December 2016, organized by EUFOREA (European Forum for Research and Education in Allergy and Airways diseases). The purpose of these debates is to bring novel developments in the field of Rhinology to the attention of the medical, paramedical and patient community, in a highly credible and balanced context. For the first time in Rhinology, a peer to peer scientific exchange with key experts in the field of rhinology and key medical colleagues from leading industries let to a brainstorming and discussion event on a number of hot issues in Rhinology. Novel developments are presented by key experts from industry and/or key thought leaders in Rhinology, and then followed by a lively debate on the potential positioning of new developments in care pathways, the strengths and weaknesses of the novel development(s), and comparisons with existing and/or competing products, devices, and/or molecules. As all debates are recorded and distributed on-line with limited editing (www.rhinology-future.com), EUFOREA aims at maximizing the education of the target groups on novel developments, allowing a critical appraisal of the future and a more rapid implementation of promising novel tools, techniques and/or molecules in clinical practise in Europe. The next Rhinology Future debate will be held in Brussels in December 2017.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28687814 The persistence of intracellular Staphylococcus aureus in the sinuses: a longitudinal study 305 311 EN J. Ou Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, South Australia, Australia A. Bassiouni Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, South Australia, Australia A. Drilling Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, South Australia, Australia A.J. Psaltis Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, South Australia, Australia S. Vreugde Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, South Australia, Australia P.J. Wormald Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, South Australia, Australia 1600 10.4193/Rhin16.218 BACKGROUND: Staphylococcus aureus (S. aureus) can reside within the sinonasal mucosa in chronic rhinosinusitis patients and causes recurrent infections. Within the host cell, S. aureus can evade host immune detection enabling its own survival. We hypothesise that S. aureus can persist within the sinonasal epithelium for a prolonged period without immune activation. METHODOLOGY: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) undergoing two sinus surgeries were included. Immunohistochemistry and Haematoxylin and Eosin stains were used to determine intracellular S. aureus (ICSA) status and inflammatory cell count, respectively. One-way ANOVA and paired t-tests were performed for comparison between ICSA subgroups and within each subgroup, respectively. RESULTS: Histopathological specimens from 34 patients (68 procedures) were included. ICSA positivity (ICSA+) was seen in 43 specimens (63.2%) from 26 (76%) patients. 18 (52.9%) of those were ICSA+ in both operations while 8 (23.5%) patients were ICSA+ in only one of the operations. 8 (23.5%) patients were ICSA negative in both operations. There was no difference in the number of eosinophils, lymphocyte and neutrophils between ICSA subgroups. CONCLUSIONS: This study demonstrated that S. aureus is found intracellularly within CRSwNP tissue at multiple time points without an increase in the number of eosinophils, lymphocytes and neutrophils. This finding supports our hypothesis that ICSA is able to escape from host detection and resides within the sinonasal mucosa despite intense treatment.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28821888 Risk factors for epistaxis in patients followed in general practices in Germany 312 318 EN D.U. Seidel Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, Solingen, Germany L. Jacob Faculty of Medicine, University of Paris 5, Paris, France K. Kostev Epidemiology, QuintilesIMS, Frankfurt, Germany A.M. Sesterhenn Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, Solingen, Germany 1633 10.4193/Rhin17.105 BACKGROUND: The goal of the present study was to analyze the risk factors for epistaxis in patients followed in general practices in Germany. METHODS: The current study sample included patients aged 18 years or older who received a first epistaxis diagnosis between January 2012 and December 2016 (index date). Epistaxis patients and controls without epistaxis were matched (1:1) on the basis of age, gender, insurance status and physician. RESULTS: A total of 16,801 patients with epistaxis and 16,801 control subjects were included in this study. Of the subjects, 53.2% were men, and the mean age was 59.6 years (SD=21.2 years). Epistaxis was found to be positively associated with hypertension, obesity, chronic sinusitis, other disorders of the nose and nasal sinuses, anxiety disorder, and adjustment disorder (ORs ranging from 1.13 to 1.44). Epistaxis was also associated with the prescription of vitamin K antagonists, preparations from the heparin group, platelet aggregation inhibitors excluding heparin, direct thrombin inhibitors, direct factor Xa inhibitors, other antithrombotic agents, selective serotonin reuptake inhibitors and nasal steroids (ORs ranging from 1.15 to 3.55). CONCLUSIONS: Overall, epistaxis risk is increased by multiple medical and psychiatric disorders. Several antithrombotic and nasal steroid therapies are also associated with this risk.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28687815 Postoperative long-term morbidity of extended endoscopic maxillectomy for inverted papilloma 319 325 EN G. Bertazzoni Department of Otorhinolaryngology, University of Brescia, Brescia, Italy R. Accorona Department of Otorhinolaryngology, University of Brescia, Brescia, Italy A. Schreiber Department of Otorhinolaryngology, University of Brescia, Brescia, Italy G. Pietrobon Department of Otorhinolaryngology, University of Insubria, Varese, Italy A. Karligkiotis Department of Otorhinolaryngology, University of Insubria, Varese, Italy E. Fazio Department of Otorhinolaryngology, University of Insubria, Varese, Italy P. Castelnuovo Department of Otorhinolaryngology, University of Insubria, Varese, Italy P. Nicolai Department of Otorhinolaryngology, University of Brescia, Brescia, Italy 1601 10.4193/Rhin17.035 BACKGROUND: Extended endoscopic maxillectomy (Sturmann-Canfield procedure) allows full visualization of the maxillary sinus by sectioning the lacrimal duct and removing the medial part of the anterior maxillary wall. The aim of this study is to evaluate the morbidity of Sturmann-Canfield procedure in patients treated for inverted papilloma. METHODOLOGY: The clinical records of all patients treated with a Sturmann-Canfield procedure for inverted papilloma from October 2000 to September 2015 at two teaching hospitals were reviewed. All patients were evaluated by nasal endoscopy and lacrimal system patency was assessed. Pre-maxillary cutaneous sensitivity was tested with a Semmes-Weinstein aesthesiometer and thermic stimulation. The SNOT-22 questionnaire was administered. Patients were also asked to report any other post-surgical complaints. RESULTS: Fifty-nine patients were identified. Mean follow-up after surgery was 66.3 months. Mean SNOT-22 score was 5.94 (range 0-20); the majority of patients (86%) had a SNOT-22 symptom score of 3 or lower. Mucocoele occurred in 3 (5%) cases. Lacrimal pathway obstruction was observed in 7 (12%) patients. Fourteen (24%) patients complained of paraesthesia in the malar area; hypoesthesia was present in only 5 (8%) cases. Hypoesthesia in the region innervated by the anterior superior alveolar nerve was detected in 17 (29%) patients. One patient reported a slight depression of paralateronasal soft tissues. CONCLUSIONS: Although nasal function outcomes and the results from SNOT-22 questionnaires were favourable, a high rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention, including the possibility of negative aesthetic sequelae, should be discussed during preoperative counselling.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28887880 Allergy rhinitis: similarities and differences between children and adults 326 331 EN A. Izquierdo-Dominguez Servicio de Alergologia, Consorci Sanitari de Terrassa and Clinica Diagonal, Barcelona, Spain I. Jauregui Servicio de Alergologia, Hospital de Basurto, Bilbao, Spain A. del Cuvillo Unidad de Rinitis y Asma, UGC ORL, Hospital de Jerez, Cadiz, Spain J. Montoro Unidad de Alergia, Hospital Universitario Arnau de Vilanova, Facultad de Medicina, Universidad Catolica de Valencia San Vicente Martir, Valencia, Spain I. Davila Servicio de Inmuno-Alergia, Hospital Clinico, Salamanca, Spain J. Sastre Servicio de Alergia, Fundacion Jimenez Diaz, Madrid, Spain J. Bartra Servicio de Neumologia y Alergia, Hospital Clinic i Universitari, Institut d Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain M. Ferrer Departamento de Alergia, Clinica Universitaria Navarra, Pamplona, Spain I. Alobid Unitat de Rinologia i Clinica de l Olfacte, Servei d Otorinolaringologia, Hospital Clinic, IDIBAPS, Centro de Investigacion Biomedica em Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain J. Mullol Institut d Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Unitat de Rinologia i Clinica de l Olfacte, Servei d Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Centro de Investigacion Biomedica en Red en Enfermedades Respiratorias A.L. Valero Servicio de Neumologia y Alergia, Hospital Clinic i Universitari; Institut d Investigacions Biomediques August Pi i Sunyer (IDIBAPS); and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain 1640 10.4193/Rhin17.074 BACKGROUND: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of studies have described AR, no studies compared children and adult AR populations. The objective was to compare the AR characteristics between two AR cohorts of children and adults. METHODS: Two AR cohorts (children and adults) from Spain were studied through observational cross-sectional multicentre studies. AR was classified based on classical (allergen exposure), original (o-ARIA), and modified (m-ARIA) ARIA criteria. AR was evaluated by Total 4-Symptoms Score (T4SS), and disease severity by Visual Analogue Scale (VAS, 0-100 mm). AR comorbidities were also evaluated. RESULTS: A total of 5,405 patients (1,275 children, 4,130 adults) were studied. According to symptoms duration, intermittent AR was more frequent in children than in adults. Using o-ARIA severity, more children than adults had moderate/severe AR while, using m-ARIA, more children than adults had severe AR. T4SS was higher in adults than in children. Moreover, VAS was also higher in adults than in children. In addition, asthma atopic dermatitis and conjunctivitis were more associated to children than adults with AR, the frequency of this comorbidities increasing according to higher severity. CONCLUSIONS: AR in children was more intermittent, severe, with less symptoms but with more comorbidities than in adults. These results suggest AR has similarities but also significant differences between children and adults.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28888024 Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty 332 338 EN K. Parthasarathi 1. Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia 2. St Vincents Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia J.M. Christensen Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia R. Alvarado Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia H.P. Barham 1. Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; 3. Department of Otolaryngology Head and Neck Surgery, Louisiana State University, New Orleans, Louisiana, Unite R. Sacks Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia R.J. Harvey 1. Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; 2. St Vincents Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; 4. Facult 1645 10.4193/Rhin16.210 BACKGROUND: Inferior turbinate procedures are applied to relieve medically refractory nasal obstruction. However, the nature of congestion differs between allergic(AR) and non-allergic rhinitis(NAR). This study compares surgical outcomes between AR and NAR patients. METHODOLOGY: A case-control study of patients undergoing turbinate with or without septoplasty surgery for nasal obstruction was performed. Patient reported outcomes were: nasal obstruction, global nasal function(GNF), and sino-nasal outcome test(SNOT-22) with rhinitis, facial symptom, sleep and psychological sub-scores. Nasal peak inspiratory flow(NPIF) assessed nasal airflow. Measurements were obtained preoperatively and 3 months postoperatively. RESULTS:190 patients were assessed. AR had worse obstruction and worse GNF. All outcomes improved post-surgery; nasal obstruction, GNF, SNOT-22, rhinitis-symptoms, facial-symptoms, sleep-function, psychological-function and NPIF. GNF improvement was greater in AR. NPIF improvement was similar between groups. CONCLUSIONS: Both AR and NAR patients gained benefit from surgery to relieve nasal obstruction. AR patients demonstrate greater improvement in GNF score but allergy management may contribute to this.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28689218 Allergic inflammation is exacerbated by allergen-induced type 2 innate lymphoid cells in a murine model of allergic rhinitis 339 347 EN L. Lin Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China F. Dai Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China J.J. Wei Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China X.Y. Tang Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China Z. Chen Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China G.B. Sun Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China 1602 10.4193/Rhin17.065 BACKGROUND: Group 2 innate lymphoid cells (ILC2s) represent a new innate effector leukocyte population that mediates type-2 immune response. However, the contribution of ILC2s to allergic rhinitis (AR) is currently not well defined. OBJECTIVE: To evaluate the potential existence and function of allergen-induced ILC2s in the experimental AR. METHODS: We established a murine model of AR using ovalbumin (OVA) and aluminium hydroxide. The OVA-induced ILC2s were sorted and purified from the mouse nasal-associated lymphoid tissue (NALT). Then, we assessed ILC2s responses to mouse recombinant interleukin (rmIL)-25, anti-IL17RB antibody and CC chemokine ligand (CCL) 25 in the culture. After that, we adoptively transferred the NALT-derived ILC2s alone or plus rmIL-25 or anti-IL17RB antibody to the murine model of AR to investigate their role in the nasal allergic inflammation. RESULTS: We showed that ILC2s could be induced by OVA in the NALT of AR model. They were induced to secrete IL-5 and IL-13 by rmIL-25, and blocking of IL17RB contributed to the decreased production of these cytokines in the culture. We found that CCL25 induced the NALT-derived ILC2s migration through CC chemokine receptor 9 on ILC2s in vitro. Numbers of sneezing and nasal rubbing as well as counts of invasive eosinophils were all enhanced after the adoptive transfer of cultured ILC2s in vitro. The expressions of IL-5, IL-13, IL-25 and CCL25 in the NLF of allergic mice were also increased. CONCLUSION: These findings show that ILC2s play a proinflammatory role in the murine AR model, and also highlight ILC2s as a new target in the future AR therapy.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28887879 Orbital floor fracture repair: the endonasal approach 348 354 EN T. Kuhnel Department of Otorhinolaryngology, University of Regensburg, Germany H. Jagle Department of Ophthalmology, University of Regensburg, Germany W. Hosemann Department of Otorhinolaryngology, University of Greifswald, Germany R. Weber Department of Otorhinolaryngology, Stadtisches Klinikum Karlsruhe, Germany V. Vielsmeier Department of Otorhinolaryngology, University of Regensburg, Germany 1642 10.4193/Rhin16.334 To avoid the dangers associated with lower eyelid approaches to the orbital floor and to improve visualization, we propose an endoscopic procedure for orbital floor fracture reduction and osteosynthesis using endonasal access via the medial maxillary sinus wall. The technique of endoscopic, endonasal transantral surgery is described, together with a retrospective analysis of 17 patients who had undergone this surgical procedure in the Department of Otorhinolaryngology, University of Regensburg, between July 2013 and June 2016. Fractures without infraorbital margin involvement were successfully repaired and enophthalmos and/or diplopia were corrected in all cases. The endonasal approach described here allows orbital floor fractures to be repaired without injury to the eyelid apparatus. Visualization, in particular across the orbital floor as far as the palatine process, appears to be superior to that achieved with other approaches. The increased time required for the procedure and the difficulties of manipulation within a confined space are offset by rapid wound healing without ocular swelling and a minimal risk of complications.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28888026 Regional recurrence in a case series of patients with carcinoma of the nasal cavity - therapeutic implications 355 362 EN T. Hussain Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University of Duisburg-Essen, Germany S. Mattheis Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University of Duisburg-Essen, Germany N. Dominas Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University of Duisburg-Essen, Germany B. Hoing Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University of Duisburg-Essen, Germany S. Lang Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University of Duisburg-Essen, Germany B.A. Stuck Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University of Duisburg-Essen, Germany 1643 10.4193/Rhin17.088 INTRODUCTION: Surgery is the primary treatment option for squamous cell carcinomas of the nasal cavity (NCSCC). Nodal involvement is rare at the time of initial diagnosis, and the role of diagnostic neck dissection as well as potential adjuvant irradiation of the neck remains controversial. The objective of this study was to assess the oncologic outcomes of patients with NCSCC with special emphasis on cervical lymph node treatment and recurrence. METHODS: 37 previously untreated patients were included in this study. Demographic data, tumor characteristics, therapeutic management, and clinical outcome were analyzed. RESULTS: Patients with advanced stage tumors were slightly overrepresented in this study and overall 3-year disease-free survival was 63%. A surgical treatment approach was pursued in 89% (n=33) of patients. After total rhinectomy, there were no cases of local recurrence. Overall, 12% (n=4) of all surgically treated patients developed local recurrence. While in 45% of patients (n=15), neck dissection was performed at the time of tumor resection, initial lymph node metastasis was histologically confirmed in only 6% (n=2) of surgically treated patients. Cervical lymph node recurrence occurred in 18% (n=6) of patients, predominantly those with advanced stage tumors, despite prior treatment of the neck. CONCLUSION: Excellent local control is achievable for patients with NCSCC, especially with radical tumor resection. While cervical lymph node metastasis is rare at the time of diagnosis, regional lymph node recurrence needs to be taken into consideration when planning therapy and follow-up. Multimodal treatment of the neck may be required for patients with advanced stage tumors.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28888025 Comparison of different endoscopic scoring systems in patients with chronic rhinosinusitis: reliability, validity, responsiveness and correlation 363 368 EN L. Zhang Department of Otorhinolaryngology, Ningbo No. 2 Hospital, Ningbo, China L.H. Zhang Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China 1644 10.4193/Rhin17.109 OBJECTIVES: Previous studies have proposed various endoscopic scoring systems to assess disease severity of patients with chronic rhinosinusitis (CRS). However, those assessments have not been validated. This study was designed to assess the Modified Lund - Kennedy (MLK) and the discharge, inflammation, and polyps/oedema (DIP) endoscopic scoring systems in patients with CRS. METHODS: A prospective study including 144 patients who underwent functional endoscopic sinus surgery (FESS). All participants were asked to finish SNOT-22, Lund-Mackay CT score and endoscopic examination evaluations before surgery and at 6 months after surgery. Endoscopic examination videos were evaluated using 3 scoring systems by two blinded rhinologists. The scores were compared in terms of responsiveness, validity, reliability and correlation with other scores. RESULTS: The MLK and DIP endoscopic scoring systems showed high test-retest reliability and inter-rater reliability. All endoscopic scoring systems showed significant differences between the scores recorded at each time point (all P lower than 0.90 when compared with the Lund - Kennedy (LK) endoscopic scoring system and showed a statistically significant difference in discriminant validity between symptomless and symptomatic cases. The MLK and DIP systems showed high correlations with other subject assessments and no correlation with SNOT-22. CONCLUSION: MLK and DIP exhibit substantial responsiveness, validity and reliability. MLK and DIP may be well suited for clinical and research use.

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 28988259 A straight choice: avoiding septal re-deviation using titanium plates. A 16 year retrospective patient follow-up evaluation 369 375 EN J.M. Godoy S. Department of Otolaryngology - Head and Neck Surgery, Clinica las Condes, Santiago, Chile J.M. Godoy San Diego, CA, USA A. Godoy San Francisco, CA, USA C. Revelo San Diego, CA, USA 1705 10.4193/Rhin17.020 BACKGROUND: To propose a new surgical technique for fixing the nasal septum to the midline, for long term prevention of nasal obstruction, in secondary and select cases of primary septoplasty. METHODOLOGY: Retrospective study, within hospital medical center. Patients: Two hundred and twenty two patients who underwent septoplasty. Data collection occurred consecutively between March 1st of 2000 and May 1st 2016. Twenty six percent females and seventy four percent males. MAIN OUTCOME MEASURES: Patterns of septal deformity, materials used for titanium plates, surgical results, symptom improvement, and surgical complications were investigated. RESULTS: A total of 222 patients were included in this study. 163 patients (73%) had no previous nasal surgery. Fifty nine patients (27%) presented with a previous nasal surgery. Sixteen year follow up included more than 90% of patients and resulted in an overall 2.7% revision rate. CONCLUSIONS: The use of titanium plate for septoplasty has shown to be simple, safe, and easy to learn technique in both secondary and select cases of primary septoplasty. Most importantly the results indicate a long term prevention of the

International Rhinologic Society Rhinology 0300-0729 55 4 2017 12 1 29055142 The fate of the bone graft in cerebrospinal fluid rhinorrhea endoscopic repair for idiopathic intracranial hypertension: a retrospective case series analysis 376 381 EN A.D. Workman Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA R.M. Carey Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA A.K. Parasher Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA E.C. Kuan Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA J. Godovchik Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA J.T. Glicksman Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA D.W. Kennedy Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA J.N. Palmer Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA N.D. Adappa Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA 1736 10.4193/Rhin17.147 INTRODUCTION: Idiopathic intracranial hypertension (IIH) is a common cause of spontaneous cerebrospinal fluid (CSF) leaks necessitating surgical intervention, and grafting of septal, mastoid, or turbinate bone over the defect is increasingly performed to strengthen the repair of the primary defect. However, the postoperative fate of these grafted bone fragments is largely unknown. METHODOLOGY: We performed a retrospective study of patients at the University of Pennsylvania undergoing repair of spontaneous CSF leaks secondary to IIH. Preoperative and postoperative CTs were analyzed to determine the integration status of the transplanted bone. RESULTS: Fourteen patients with IIH and spontaneous CSF leak were analyzed, with a mean postoperative imaging follow-up period of four years. Thirteen patients (93%) had bone present on CT imaging, with 11 of these patients displaying evidence of bone integration. Two patients (14%) had a recurrent CSF leak in the same area, including the patient with absence of bone on imaging follow-up. CONCLUSIONS: Bone grafts frequently incorporate when used for repair of spontaneous CSF leaks associated with IIH. The rate of incorporation is comparable to bone grafts used for other etiologies of CSF leak, despite the increased pressure on the repair site. Any rigid repair of the leak site should likely be accompanied by treatment of the underlying intracranial hypertension to avoid leak recurrence.