International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 30153688 Entering a new era of Predictive Medicine in Rhinology 97 98 EN P.W. Hellings Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium 1809 10.4193/Rhin18.402 The June 2018 issue of Rhinology paves the way for real-life implementation of Precision Medicine in Rhinology, with Predictive Medicine in the center of attention. Physicians treating patients with rhinologic disorders might find it extremely interesting to find reports on predictors of success of medical or surgical interventions. Prediction of success of treatment is crucial to allow the patient become an active partner in the decision-making process of medical or surgical treatment. Defining the clinical phenotype of patients with chronic rhinosinusitis responding well to either revision surgery or long-term oral macrolide treatment represents a true challenge.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29396958 Higher prevalence of nasal polyposis among textile workers: an endoscopic based and controlled study 99 105 EN R. Veloso-Teles Department of Otorhinolaryngology, Cova da Beira Hospital Centre (CHCB), Covilha, Portugal R. Cerejeira Department of Otorhinolaryngology, Cova da Beira Hospital Centre (CHCB), Covilha, Portugal R. Roque-Farinha Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal C. von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark 1779 10.4193/Rhin17.228 BACKGROUND: There is a deficit of reliable epidemiologic studies exploring the prevalence of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Recent data suggests that occupational dust exposure may be involved in its physiopathology. OBJECTIVES: To compare the prevalence of nasal polyposis (NP) in a group of workers with occupational dust exposure (textile workers) and in a control group (retail store workers). METHODS: Cross-sectional study with a random sample of textile and retail store employees. Clinical data was gathered through a systematic interview, which included RhinoQOL and CAT questionnaires. A systematic endoscopic nasal examination was performed using a 0 degree rigid endoscope. Lund-Kennedy endoscopic score was determined for each participant. Statistical analysis was performed with SPSS. RESULTS: 316 participants were included in the study, i.e. 215 textile workers and 101 retail store workers. NP was found in 19 subjects among textile workers and none in the control group. The prevalence of NP increased by age strata and by years of dust exposition. Polypoid degeneration of the middle turbinate was more prevalent in the exposed group with Lund-Kennedy scoring also higher. RhinoQOL and CAT questionnaires had both significantly higher scores among textile employees. Previous medical diagnosis of atopic diseases or chronic lower airway diseases did not differ between exposed and control groups or even between subjects with and without NP. CONCLUSIONS: These results point to an important correlation between occupational dust exposure and NP occurrence.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29396959 Mucocele formation after frontal sinus obliteration 106 110 EN F.S. Hansen Dept. of Otorhinolaryngology, Central Military Hospital, Utrecht, The Netherlands N.A. van der Poel Dept. of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands N.J.M. Freling Dept. of Radiology, Academic Medical Centre, Amsterdam, The Netherlands W.J. Fokkens Dept. of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1781 10.4193/Rhin17.187 BACKGROUND: A possible complication of frontal sinus obliteration with fat is the formation of mucoceles. We studied the prevalence of mucoceles as well as and the need for revision surgery. METHODS: Retrospective case review of forty consecutive patients undergoing frontal sinus obliteration from September 1995 to February 2012 for chronic rhinosinusitis (26), frontal mucocele (12) or frontal osteoma (2) with an average follow up of 80 months (range 15-218). MRI of the paranasal sinuses was performed in all. Outcome measures included MRI signs of mucocele formation in the obliterated frontal sinus, revision surgery, symptom burden. RESULTS: Magnetic resonance imaging (MRI) showed potential postoperative frontal sinus mucoceles in 6/40 patients. In 3 patients (7.5%) a revision operation was performed, revealing mucoceles in two cases. A wait and scan-policy in the other 3 patients confirmed the presence of a mucocele in 1 of these patients. The majority of patients (33/40, 83%) was asymptomatic at the last follow up. CONCLUSION: The prevalence of mucoceles and revision rate in this series was 7.5% (3/40). MRI can improve detection rate and reduce / avoid unnecessary revision surgery after frontal sinus obliteration.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29476191 Characteristics of macrolide responders in persistent post-surgical rhinosinusitis 111 117 EN G.M. Oakley Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA J.M. Christensen Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia R. Sacks Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia P. Earls Department of Anatomical Pathology, St. Vincents Hospital, Sydney, Australia R.J. Harvey Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia 1789 10.4193/Rhin17.049 INTRODUCTION: The anti-inflammatory effects of long term low dose macrolide therapy have shown benefit in the management of diffuse panbronchiolitis. Dramatic responses to macrolide in the upper airway are seen but our understanding of the patient phenotype predisposing to macrolide response in chronic rhinosinusitis (CRS) is poor. METHODS: A case control study was performed in a tertiary level rhinology practice of consecutive chronic rhinosinusitis patients placed on a 3-month low dose macrolide therapy after failing at least 3 months of corticosteroid irrigation therapy post-endoscopic sinus surgery. Patients were defined as a macrolide responder when having near normal endoscopy after a 3-month period of clarithromycin treatment. Patient characteristics of smoking, asthma, atopy status, revision surgery, symptom severity (SNOT-22) along with biomarkers from serum and tissue histopathology results were compared between groups. RESULTS: Of twenty-eight consecutive macrolide treated patients, 19 responders were compared to 9 non-responders. The groups were similar in age, female gender, non-smoking, asthma, and atopy. Macrolide response was associated with a lack of tissue eosinophilia (more than 10/HPF) and lower serum eosinophilia. Neutrophil expression was similar in tissue and serum. Squamous metaplasia was overexpressed in non-responders. CONCLUSION: Low tissue and serum eosinophilia, and absence of tissue squamous metaplasia may predict a CRS phenotype suitable to a trial of long-term macrolide therapy when surgery and topical therapy has failed.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29509831 Eustachian tube symptoms are frequent in chronic rhinosinusitis and respond well to endoscopic sinus surgery 118 121 EN A. Maniakas Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, QC, Canada M. Desrosiers Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, QC, Canada M.H. Asmar Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, QC, Canada M. Al Falasi Department of Otolaryngology-Head and Neck Surgery, Tawam Hospital, United Arab Emirates L.M. Endam Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, QC, Canada C. Hopkins Department of Ear, Nose and Throat, Guys and St Thomas Hospital, London, United Kingdom C. Philpott Norwich Medical School, University of East Anglia, Norwich, United Kingdom S. Erskine Norwich Medical School, University of East Anglia, Norwich, United Kingdom R. Smith Norwich Medical School, University of East Anglia, Norwich, United Kingdom S. Kilty Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, Ottawa, ON, Canada 1795 10.4193/Rhin17.165 BACKGROUND: Symptoms of Eustachian tube (ET) dysfunction are seldom assessed in patients with chronic rhinosinusitis (CRS). The Sino-Nasal Outcome Test (SNOT-22) quality-of-life tool includes two questions that specifically screen for symptoms of ET dysfunction (Ear Fullness; Ear Pain). OBJECTIVE: The purpose of this study was to determine the extent to which these ET symptoms were present in patients with CRS, and whether these symptoms respond to endoscopic sinus surgery (ESS). METHODOLOGY: SNOT-22 data collected prospectively at time of recruitment into IRB-approved clinical trials or case-control studies in CRS was pooled to provide a cross section of the frequency and severity of ET dysfunction. When applicable to the trials, the SNOT-22 was repeated at least 3 months following ESS. RESULTS: Five trials rendering 131 patients were available for assessment. The control group comprised of 251 participants from two case-control studies. Ear Fullness of equal/greather than 1 was reported in 80/131 CRS patients compared to 45/251 control patients. Ear Pain of equal/greather than 1 was reported in 39/131 CRS patients compared to 33/251 control patients. Following ESS, mean Ear Fullness and Ear Pain scores decreased to 1.17 and 0.73, respectively. CONCLUSION: Symptoms suggestive of ET dysfunction are frequent in CRS, and for most patients the symptoms will decrease post-ESS to a level comparable with a non-CRS population. Patients whose ET symptoms do not respond to ESS may represent a target population for emerging therapeutic options for ET dysfunction.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29055966 Comparison between unilateral PNIF and rhinomanometry in the evaluation of nasal cycle 122 126 EN A.L. Pendolino Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy E. Nardello Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy V.J. Lund Ear Institute, University College London, London, UK P. Maculan Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences, University of Padova, Padova, Italy A. Martini Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy G. Ottaviano Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy 1738 10.4193/Rhin17.168 BACKGROUND: Human unilateral nasal airflow shows spontaneous changes over a period of hours due to the alternating congestion and decongestion of the venous sinuses within the nasal turbinates and nasal septum. The aim of the present study was to compare PNIF and unilateral PNIF with nasal resistances measured by means of AAR in the evaluation of the nasal cycle. METHODS: PNIF, unilateral PNIF and AAR measurements were randomly performed in 20 non-smokers, non-asthmatic volunteers, with a SNOT 22 score lower than 1. Nasal measurements were done four times in a single day at 08.30, 11.00, 13.30 and 16.00. The correlation between PNIF, unilateral PNIF and nasal resistances was studied. The pattern of nasal airflow for each subject was also analyzed. RESULTS: A significant negative correlation between PNIF-lPNIF-rPNIF and respectively AAR-lAAR-rAAR was found. Only 1 subject did not show nasal cycle, while all the rest were equally distributed between a reciprocal pattern of the nasal cycle, or an in-phase changes of the nasal cycle, both at PNIF and AAR. CONCLUSIONS: Nasal cycle can be easily assessed by means of PNIF. In fact, AAR and PNIF showed a reasonable correlation in the measurement of nasal cycle, although PNIF offered a lower variability. Reciprocal and in-phase patterns of the nasal cycle were equally distributed in our population.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29550854 Parkinson disease in eldery patients: lessons from odour detection thresholds on olfacto-trigeminal interaction 127 132 EN C. Foguem Auban Moet Hospital, Epernay, France M. Lemdani Faculty of Pharmaceutical and Biological Sciences, University of Lille II, Lille, France C. Huart Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium 1800 10.4193/Rhin17.106 BACKGROUND: Human nasal chemosensation is mediated by two separate, though interacting sensory pathways: the trigeminal and olfactory systems. Trigeminal sensitivity and olfacto-trigeminal interactions have not yet been well studied in idiopathic Parkinsons disease (IPD). OBJECTIVES: The aim of this study was to assess odour detection thresholds in elderly IPD patients, and compare them to the odour detection thresholds of healthy controls. Finally, we investigated potential interactions between trigeminal and olfactory sensitivity. METHODS: 89 IPD patients aged over 65 and 89 matched healthy participants were enrolled in the study. Odour detection thresholds to 3 stimuli differentially activating olfactory and trigeminal afferents (Phenyl-ethyl alcohol, n-Butanol and Pyridine) were assessed, using an ascending staircase, binary forced-choice procedure. RESULTS AND CONCLUSION: Detection threshold scores were able to discriminate between elderly IPD and controls. Pyridine was less effective than the two other odorants, suggesting that trigeminal pathway is less impaired than the olfactory system. We found that the detection thresholds were significantly different between IPD patients with good autonomy, and patients with impaired autonomy.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29353289 The new agreement of the international RIGA consensus conference on nasal airway function tests 133 143 EN K. Vogt University of Latvia, Center of Experimental Surgery, Riga, Latvia G. Bachmann-Harildstad Department of otorhinolaryngology, Akershus University Hospital and Institute of Clinical Medicine, Akershus University Hospital, Oslo University, Lorenskog, Norway A. Lintermann Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Aachen, Germany A. Nechyporenko Kharkiv National University of Radio Electronics, Department of Biomedical Engineering, Kharkiv, Ukraine F. Peters Ruhr-Universitat Bochum, Mechanical Engineering, Fluid Mechanics, Bochum, Germany K.D. Wernecke Charite-Universitatsmedizin Berlin, Berlin, Germany 1777 10.4193/Rhin17.084 The report reflects an agreement based on the consensus conference of the International Standardization Committee on the Objective Assessment of the Nasal Airway in Riga, 2nd Nov. 2016. The aim of the conference was to address the existing nasal airway function tests and to take into account physical, mathematical and technical correctness as a base of international standardization as well as the requirements of the Council Directive 93/42/EEC of 14 June 1993 concerning medical devices. Rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow, Odiosoft-Rhino, optical rhinometry, 24-h measurements, computational fluid dynamics, nasometry and the mirrow test were evaluated for important diagnostic criteria, which are the precision of the equipment including calibration and the software applied; validity with sensitivity, specificity, positive and negative predictive values, reliability with intra-individual and inter-individual reproducibility and responsiveness in clinical studies. For rhinomanometry, the logarithmic effective resistance was set as the parameter of high diagnostic relevance. In acoustic rhinometry, the area of interest for the minimal cross-sectional area will need further standardization. Peak nasal inspiratory flow is a reproducible and fast test, which showed a high range of mean values in different studies. The state of the art with computational fluid dynamics for the simulation of the airway still depends on high performance computing hardware and will, after standardization of the software and both the software and hardware for imaging protocols, certainly deliver a better understanding of the nasal airway flux.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29292416 Outcomes of sphenopalatine and internal maxillary artery ligation inside the pterygopalatine fossa for posterior epistaxis 144 148 EN K. Piastro Division of Otolaryngology / Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York, NY, USA R. Scagnelli Albany Medical College, Albany, New York , NY, USA N. Gildener-Leapman Division of Otolaryngology / Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York, NY, USA C.D. Pinheiro-Neto Division of Otolaryngology / Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, New York, NY, USA 1771 10.4193/Rhin17.212 OBJECTIVE: Analysis of the efficacy of sphenopalatine artery (SPA) and internal maxillary artery (IMAX) ligation within the pterygopalatine fossa to control posterior epistaxis. METHODS: Demographic and clinical data were collected in sixty-two consecutive patients who had SPA/IMAX ligation surgery. Clinical outcomes such as re-bleed rates and complications were acquired. RESULTS: A total of 62 patients were studied. Thirty-eight percent of patients had previously undergone silver nitrate nasal cautery for epistaxis. Nine patients had undergone previous attempt of SPA procedure or embolization in other services. Two patients returned to the operating room for anterior ethmoid ligation. There was one mortality within 30 days of surgery. Follow up ranged from 3 months to 56 months (median= 28 months). CONCLUSIONS: Dual SPA and IMAX ligation is effective in the control of difficult epistaxis cases, even in those patients with prior surgical intervention.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29306957 Analysis of taste function in patients before and after cochlear implant surgery 149 154 EN U. Walliczek-Dworschak Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany C.M. Knauer Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany D. Murbe Saxonian Cochlear Implant Center/Division of Phoniatrics and Audiology, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany A. Mainka Saxonian Cochlear Implant Center/Division of Phoniatrics and Audiology, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany 1772 10.4193/Rhin17.178 BACKGROUND: Cochlear implantation (CI), the standard therapy for rehabilitation of severe to profound sensorineural hearing loss, exhibits taste dysfunction as a possible postoperative complication. This study aimed to investigate possible postoperative changes in taste and in addition baseline taste function in CI candidates. METHODOLOGY: We included 61 patients (32 male, 29 female) planned to undergo CI surgery and 23 healthy controls (8 male, 15 female). Gustatory function was measured using a chemosensory quasi-threshold test (taste strips) and electrogustometry (EGM). To exclude possible effects of olfaction on taste, olfactory function was tested by means of the Sniffin Sticks odor identification test. Furthermore, the density of fungiform papillae (fPAP) was analyzed. Measurements were taken pre- and 2-4 weeks postoperative. RESULTS: Preoperative taste function and fPAP density was reduced in CI patients compared to controls. The fPAP density correlated significantly with the total taste score, EGM scores and age. Postoperative taste function decreased significantly, whereas EGM scores and fPAP density did not significantly change. Also baseline olfactory function in CI candidates was decreased, whereas no significant change of olfactory function was found post-surgery. CONCLUSION: CI candidates exhibited taste and olfactory dysfunction already preoperatively. Furthermore, a significant decrease in taste scores after CI surgery was detected.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29306958 Case-control study of endoscopic polypectomy in clinic (EPIC) versus endoscopic sinus surgery for chronic rhinosinusitis with polyps 155 157 EN S.J. Kilty Department of Otolaryngology - Head and Neck Surgery, The University of Ottawa, Ottawa, Canada A. Lasso The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada L. Mfuna-Endam Department of Otolaryngology, Hotel-Dieu Hospital, Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, Canada M.Y. Desrosiers Department of Otolaryngology, Hotel-Dieu Hospital, Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, Canada 1773 10.4193/Rhin17.115 INTRODUCTION: Endoscopic Polypectomy In Clinic (EPIC) is a recently described deescalated form of endoscopic sinus surgery (ESS) performed in the outpatient clinic for patients with chronic rhinosinusitis with polyps (CRSwNP). The quality of life benefit of EPIC in comparison to ESS is not known. The purpose of this study was to determine if the disease specific quality of life measured with the SNOT-22 attained with EPIC is similar to that attained with ESS for patients with CRSwNP. METHODS: A multi-institutional observational case-control study was performed to evaluate quality of life improvement in patients treated with ESS and EPIC for CRSwNP with a 3 month follow-up. Predicted probability of undergoing EPIC was calculated by fitting a logistic regression model using clinically relevant variables. EPIC patients were matched to ESS patients in a 1:1 fashion. RESULTS: 24 pairs were analyzed after matching. There was no statistical difference in the post-treatment SNOT-22 scores or proportion of patients achieving a minimal clinically important difference. CONCLUSIONS: In appropriate CRSwNP patients, the EPIC procedure may provide disease specific quality of life improvement similar to that seen with patients who undergo traditional ESS.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29306960 Decreased electrogustometric taste sensitivity in patients with acquired olfactory dysfunction 158 165 EN P. Han Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany M. Georgi Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany M. Cuevas Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Haehner Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany V. Gudziol Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany T. Hummel Interdisciplinary Center on Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 1774 10.4193/Rhin17.186 BACKGROUND: Cross-modal chemosensory dysfunction between olfaction and gustation is not well known. METHODOLOGY: 180 participants were classified into three groups (60 with olfactory dysfunction, 60 with gustatory dysfunction and 60 healthy controls without chemosensory dysfunction). Olfactory functions were obtained with Sniffin Sticks; gustatory function was measured by suprathreshold gustatory stimuli (taste sprays) and a quasi-threshold measure of taste function (taste strips) for five taste qualities (sweet, salty, sour, bitter and umami). Electric taste threshold was measured using electrogustometry (EGM). In addition, group differences in dietary behaviors were investigated with a specifically designed questionnaire. RESULTS: Patients with olfactory dysfunction had increased electric taste thresholds and decreased scores for the umami taste strip test as compared to healthy controls. Overall there was no major difference between patients with chemosensory dysfunction and healthy controls regarding dietary behaviors, although some patients certainly exhibited dietary problems. Importantly, patients with taste loss, but not patients with smell loss, exhibited a higher degree of depression than controls. CONCLUSION: Patients with olfactory dysfunction showed decreased taste sensitivity which suggested an interaction between the chemical senses taste, trigeminal function, and olfaction. This provides the basis for including both smell and taste psychophysical assessment in clinical practices. In addition, patients with taste loss appeared to suffer most from chemosensory dysfunction.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29550855 Occurrence of occult CSF leaks during standard FESS procedures 166 171 EN S. Bucher Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland A. Kugler Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland E. Probst Department of Immunology, University of Zurich and University Hospital Zurich, Zurich, Switzerland L. Epprecht Department of Immunology, University of Zurich and University Hospital Zurich, Zurich, Switzerland R.R. Stadler Department of Immunology, University of Zurich and University Hospital Zurich, Zurich, Switzerland D. Holzmann Department of Immunology, University of Zurich and University Hospital Zurich, Zurich, Switzerland M.B. Soyka Department of Immunology, University of Zurich and University Hospital Zurich, Zurich, Switzerland 1799 10.4193/Rhin17.117 OBJECTIVE: To determine the incidence of occult cerebrospinal fluid leaks (CSF) after functional endoscopic sinus surgery (FESS) and to evaluate the diagnostic performance of beta2-transferrin in blood-contaminated conditions. STUDY DESIGN: Prospective cohort study. METHODS: An analysis of 57 intraoperative samples using hydrogel 6 beta2-transferrin assay after FESS was undertaken. In case of CSF positive samples and continuing rhinorrhea, reanalysis after more than 1 year was conducted. In-vivo analysis of a primary spontaneous CSF leak sample took place to verify difficulties in detecting beta2-transferrin in blood-contaminated settings. Own titrations were performed to evaluate detection limits of CSF by beta2-transferrin and beta-trace protein assays in these settings. RESULTS: An incidence of 13% for occult CSF leaks after FESS was found. In blood-contaminated conditions, routine beta2-transferrin assays showed low sensitivity. In over 1 year follow-up, all samples were negative for CSF and none of them developed clinical relevant CSF leaks or meningitis. CONCLUSION: Occult and clinically irrelevant CSF leaks do occur in a significant proportion of patients during and shortly after FESS. Intra- and postoperatively, routine beta2-transferrin assays show low sensitivity. They should not be used in these settings. The clinical course of patients with occult CSF leaks indicated possibility of an uneventful follow-up.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29396957 Study of the relation between medial orbitofrontal artery and anterior skull base performed by computed tomography angiography 172 177 EN H.C. Patricio Otorhinolaryngology Department of the University of Sao Paulo (USP), SP and University of Extreme South of Santa Catarina (UNESC), SC, Brazil A. Felippu Felippu Institute of Otorhinolaryngology, SP, Brazil C.D. Pinheiro-Neto Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA L.U. Sennes Otorhinolaryngology Department of the University of Sao Paulo (USP), SP, Brazil 1778 10.4193/Rhin17.121 BACKGROUND: The aims of this study were to analyze the relationships between the medial orbitofrontal artery (MOFA) and the anterior skull base (ASB) including anatomical endonasal landmarks using computed tomography angiography (CTA). METHODS: We studied 52 CTAs using OsiriX software. All CTAs were placed in the same anatomical position. MOFA was identified in the sagittal and coronal plane and its correlation with ASB was analyzed. The distance between the MOFA and landmarks for endonasal surgery were obtained, determining the high risk areas for its injury. RESULTS: After arising from the anterior cerebral artery, the MOFA dives inferiorly towards the ASB, close to the midline (average distance of 1.5 mm), approaching the planum sphenoidale (average distance of 1.8 mm) and then ascends away from the ASB as it runs anteriorly, with an average distance of 4.4 mm in the region of the anterior wall of the sphenoid sinus and 12 mm in the region of the anterior ethmoid artery. CONCLUSIONS: The MOFA has an intimate relationship with the ASB and nasal cavity; the regions with the highest risk of surgical trauma are between the posterior ethmoid and the planum sphenoidale.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29447326 Prospective study on the outcome of the sphenoid drill out procedure 178 182 EN T. Van Zele Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium B. Pauwels Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium F. Dewaele Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium P. Gevaert Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium C. Bachert Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium 1782 10.4193/Rhin17.078 BACKGROUND: Chronic sphenoid sinusitis refractory to both medical therapy and sphenoidotomy requires a more extended intervention based on the principles of salvage surgery. Our aim is to describe the sphenoid drill out technique as a sphenoid salvage intervention and to outline its implications on clinical outcome and quality of life. METHODOLOGY: 12 patients with chronic sphenoiditis undergoing a sphenoid drill out procedure were examined by nasal endoscopy preoperatively and postoperatively for one year. Preoperative and postoperative quality of life questionnaires (RSOM-31 and SF-36) were obtained. RESULTS: All but one patient had a completely patent neostium without scar formation. No major complications occurred after this procedure. All patients reported at least an improvement of their symptoms, 50% of patients were even symptom free at one year after surgery. The median postoperative RSOM-31 score was significantly lower than the preoperative score. Both the physical component summary (PCS) and the mental component summary (MCS) of the SF-36 score improved significantly. None of the patients needed a revision procedure. CONCLUSION: Sphenoid drill out is a safe and effective technique with a high success rate. In patients with chronic sphenoid sinusitis refractory to medical therapy and surgery it could be a valid alternative to revision sphenoidotomy.

International Rhinologic Society Rhinology 0300-0729 56 2 2018 6 1 29447325 Long-term results after restoring nasal tip support using auricular cartilage as an intercrural columellar strut graft: the "I-Beam" technique 183 188 EN E. Novoa Department of Otorhinolaryngology, Head, Neck and Facial Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland D. Simmen ORL-Zentrum, Center for Rhinology, Skull Base Surgery and Facial Plastic Surgery, The Hirslanden Clinic, Zurich, Switzerland H.R. Briner ORL-Zentrum, Center for Rhinology, Skull Base Surgery and Facial Plastic Surgery, The Hirslanden Clinic, Zurich, Switzerland C. Schlegel Department of Otorhinolaryngology, Head, Neck and Facial Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland 1785 10.4193/Rhin17.184 BACKGROUND: The lack of nasal tip support resulting in poor protection and projection of the nose is a common cause of nasal obstruction and cosmetic impairment. Although septal cartilage is preferred for restoration of nasal tip support, there is often not enough septal cartilage available. We describe an intercrural columellar strut graft in a circumferential soft tissue pocket: the I-Beam technique. METHODOLOGY: In this cohort study over an 8-year period the clinical and biometrical long-term results after restoration of nasal tip support with an autologous auricular cartilage graft, the I-Beam technique, is evaluated. RESULTS: Out of the 72 consecutive septorhinoplasties with the I-Beam technique, we studied 66 patients in the median long-term follow-up of 89 months. In all patients a significant improvement in nasal tip projection was found. A functional improvement in nasal breathing was achieved in 86%. The overall satisfaction with the I-Beam graft was of 83%. No deterioration in smell perception was found after surgery. CONCLUSIONS: The I-Beam technique using back-to-back sutured autologous auricular cartilage is a safe and effective technique and gives long-term structural support and enhances tip projection.