International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 30194452 Delivering better results for patients through core outcomes, measuring evidence and patient participation 193 194 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands 1838 10.4193/Rhin18.403 Nasal obstruction is one of the most frequent and bothersome symptoms in rhinosinal disease. Although we are able to measure nasal airflow, the correlation between the feeling of nasal obstruction and objective measurements has been shown to be average at most. A significant proportion of the European population has a more or less deviated nasal septum and deviated septa have received a lot of attention from otorhinolaryngologists. In sharp contrast is the amount of hard evidence concerning septoplasty with or without turbinate surgery.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29656301 Septoplasty for nasal obstruction due to a deviated nasal septum in adults: a systematic review 195 208 EN M.M.H.T. van Egmond Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud university medical center Nijmegen, the Netherlands M.M. Rovers Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud university medical center Nijmegen, the Netherlands A.H.J. Tillema Radboud University Medical Library, Radboud Institute for Health Sciences, Radboud university medical center Nijmegen, the Netherlands N. van Neerbeek Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud university medical center Nijmegen, the Netherlands 1806 10.4193/Rhin18.016 BACKGROUND: The status of current evidence for the effectiveness of septoplasty is unclear. This systematic review evaluates the effectiveness of a) septoplasty (with or without concurrent turbinate surgery) versus non-surgical management, and b) septoplasty with concurrent turbinate surgery versus septoplasty alone, for nasal obstruction due to a deviated nasal septum in adults. METHODOLOGY: Eligible for inclusion were randomised controlled trials and non-randomised designs comparing treatment strategies. Risk of bias was assessed using Cochrane's tool. Standardised mean differences and risk differences with 95% confidence intervals were calculated. Substantial heterogeneity between included studies did not allow meta-analyses. RESULTS: No studies were found comparing septoplasty (with or without concurrent turbinate surgery) to non-surgical management, but 11 articles were included to compare septoplasty with concurrent turbinate surgery to septoplasty alone. Five studies described both subjective and objective outcomes; six studies reported one or the other. Risk of bias was overall high. Although outcomes generally improved after treatment, eight out of nine studies on subjective measures and five out of seven studies on objective measures found no additional benefit of turbinate surgery. CONCLUSIONS: Despite the routine application of septoplasty in clinical practice, the current body of evidence does not support firm conclusions on its effectiveness.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29466477 mySinusitisCoach: patient empowerment in chronic rhinosinusitis using mobile technology 209 215 EN S.F. Seys European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium J. Bousquet Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France C. Bachert Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands I. Agache Faculty of Medicine, Transylvania University, Brasov, Romania M. Bernal-Sprekelsen Department of Otorhinolaryngology, Hospital Clinic Universitari, Barcelona, Spain I. Callebaut Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium L.O. Cardel Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden S. Carrie ENT Department, Freeman Hospital, Newcastle upon Tyne, UK P. Castelnuovo ENT Department, Ospedale Di Circolo E Fondazione Macchi, Varese, Italy R. Cathcart ENT Department, Cumberland Infirmary, Carlisle, Cumbria, UK J. Constantinidis 2nd Academic ENT department, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece L. Cools Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium M. Cornet Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands G. Clement ENT Department, AZ Damiaan, Oostende, Belgium J.C. de Sousa Community Health, Life and Health Sciences Research Institute, School of Health Sciences, Univerity of Minho, Portugal T. Cox ENT Department, Jessa hospital, Hasselt, Belgium M. Doulaptsi Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece P. Gevaert Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium C. Hopkins ENT Department, Guys and St Thomas NHS Foundation Trust, London, United Kingdom V. Hox Departement dOtorhinolaryngologie, Cliniques Universitaires Saint-Luc, Belgium T. Hummel Smell and Taste Clinic, ENT Department, Technische Universitat Dresden, Dresden, Germany W. Hosemann ENT Department, University of Greifswald, Germany R. Jacobs Department of Otorhinolaryngology, Head and Neck Surgery, General Hospital Sint-Blasius, Dendermonde, Belgium M. Jorissen Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium B.N. Landis Unite de Rhinologie-Olfactologie, Service dOto-Rhino-Laryngologie et de Chirurgie cervico-faciale, Hopitaux Universitaires de Geneve, Geneve, Suisse A. Leunig ENT Department, Ludwig Maximilians University Munich, Germany V.J. Lund UCL and Honorary Consultant ENT Surgeon, UCLH, UK J. Mullol IDIBAPS, Hospital Clinic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain M. Onerci ENT Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey S. Palkonen European Federation of Allergy and Airways Diseases Patients Associations (EFA), Brussels, Belgium I. Proano European Federation of Allergy and Airways Diseases Patients Associations (EFA), Brussels, Belgium E. Prokopakis ENT Department, Jessa hospital, Hasselt, Belgium D. Ryan Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK H. Riechelmann Universitatsklinik fur Hals- Nasen- Ohrenheilkunde Innsbruck, Austria J. Saevels Association of Pharmacists in Belgium, Brussels, Belgium C. Segboer Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands K. Speleman ENT Department, AZ Sint-Jan, Bruges, Belgium E.A. Steinsvik Department of Otorhinolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway P. Surda Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece P.V. Tomazic Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria O. Vanderveken ENT Department, University Hospital of Antwerp, Wilrijk, Belgium L. Van Gerven Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium T. Van Zele Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium B. Verhaeghe ENT Department, Sint-Jozefskliniek, Izegem, Belgium K. Vierstraete ENT Department, AZ Groeninge, Kortrijk, Belgium S. Vlaminck ENT Department, AZ Sint-Jan, Bruges, Belgium J. Wilkinson Pharmaceutical Group of the European Union, Brussels, Belgium S. Williams International Primary Care Respiratory Group, Aberdeen, UK B. Pugin European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium P.W. Hellings European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium 1786 10.4193/Rhin17.253 Mobile health technology is emerging to take a prominent position in the management of chronic diseases. These technologies aim at enhancing patient empowerment via education and self-management. To date, of all the different apps available for patients with sinus disease, none were developed by medical experts dealing with chronic rhinosinusitis (CRS). The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) has undertaken a multi-stakeholder approach for designing, developing and implementing a tool to support CRS patients in monitoring their symptoms and to provide patients with a digital support platform containing reliable medical information about their disease and treatment options. mySinusitisCoach has been developed by medical experts dealing with CRS in close collaboration with patients, primary care physicians and community pharmacists, meeting the needs of both patients and health care providers. From a research perspective, the generation of real life data will help to validate clinical studies, patient stratification and improve understanding of the socio-economic impact of CRS, thereby paving the way for better treatment strategies.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 Multivariate analysis of inflammatory endotypes in recurrent nasal polyposis in a Chinese population 216 226 EN B. Wei ENT Department, West China Hospital, Sichuan University, Chengdu, China F. Liu ENT Department, West China Hospital, Sichuan University, Chengdu, China J. Zhang The Upper Airway Research Laboratory, West China Hospital, Sichuan University, Chengdu, China Y. Liu ENT Department, West China Hospital, Sichuan University, Chengdu, China J. Du ENT Department, West China Hospital, Sichuan University, Chengdu, China S. Liu ENT Department, West China Hospital, Sichuan University, Chengdu, China N. Zhang Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Belgium C. Bachert Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Belgium J. Meng ENT Department, West China Hospital, Sichuan University, Chengdu, China 1810 10.4193/Rhin17.240 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical problem due to its propensity for recurrence. However, data on the frequency of CRSwNP recurrence after surgery in China are rare. METHODS: 78 CRSwNP patients undergoing functional endoscopic sinus surgery were followed-up for 8 years and classified into recurrent and non-recurrent groups. A cluster analysis of the CRSwNP based on inflammatory endotypes was performed, and the endotypes were secondarily matched with clinical phenotypes. RESULTS: The recurrence rate of CRSwNP in Southwest China was 21.8% over 8 years post-surgery. The CRSwNP was classified into 4 clusters: cluster 1 (higher expression of IL-5, IgE, and ECP and high positivity rate for SE-IgE); cluster 2 (higher concentrations of IL-6, IL-8 and MPO); cluster 3 (higher concentrations of TNF-alpha; and IFN-gamma); and cluster 4 (higher expression of IL-17). Cluster 1 (type-2 inflammation) exhibited the highest recurrence rate, co-morbid asthma and atopy. Notably, the ECP/MPO ratio increased significantly in patients with non-type-2 recurrent CRSwNP 8 years after the first surgery. CONCLUSION: Different inflammatory endotypes of CRSwNP exhibited clearly different prognoses. The type-2 subgroup had high recurrence and co-morbid asthma rates comparable to the rates reported in Western countries.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29561920 The symptom burden of autonomic dysfunction is positively associated with chronic rhinosinusitis status 227 233 EN W.C. Chen Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Y.T. Chang Department of Neurology, Cognition and Aging Centre, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan S.F. Chen Department of Neurology, Cognition and Aging Centre, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan W.C. Lin Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Y.Y. Su Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan S.D. Luo Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 1804 10.4193/Rhin18.005 BACKGROUND: Dysregulation of the autonomic system can affect sinonasal physiological function and may exacerbate the symptom burden associated with rhinosinusitis. However, the association between autonomic dysfunction and chronic rhinosinusitis (CRS) has seldom been studied. Here, we investigated the relationship between autonomic dysfunction and CRS. METHODS: Patients with CRS who failed medical treatment were prospectively enrolled. All patients underwent pre-operative examinations and completed questionnaires, including the reflux symptom index (RSI) and the Sino-nasal Outcome Test-22 (SNOT-22). Autonomic dysfunction was scored using the 31-item Composite Autonomic Symptom Score (COMPASS 31), a validated simple instrument used to evaluate dysautonomia. RESULTS: We prospectively enrolled a total of 89 CRS patients, including 37 with polyps (CRSwNP) and 52 without polyps (CRSsNP). The most common dysautonomic symptoms were dry eye, dry mouth, postural dizziness, and a sensation of excessive fullness after meals. Significant positive correlations were evident between COMPASS 31 and SNOT-22 scores in CRSwNP patients. CRS-associated symptoms, including cough, post-nasal drip, sleep, and psychological dysfunction, were correlated with the level of autonomic dysfunction. CONCLUSIONS: We found a positive correlation between the symptom burdens of autonomic dysfunction and CRSwNP. The relationship between autonomic dysfunction and CRS is highly complex; further work is needed.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29626844 Self-reported anxiety and depression unchanged after endoscopic sinus surgery for chronic rhinosinusitis 234 240 EN K.N. Adams Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, USA T.A. Schuman Department of Otolaryngology, Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA C.S. Ebert Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, USA W. You Department of Biostatistics, University of North Carolina at Chapel Hill, NC, USA M.O. Tomoum Department of Otolaryngology, Head and Neck Surgery, Tanta University, Tanta, El-Gharbiya, Egypt B.A. Senior Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, USA 1805 10.4193/Rhin17.238 BACKGROUND: Prior research has established that anxiety and depression, as measured by the Hospital Anxiety Depression Score (HADS), are strongly correlated with disease-specific quality of life (Rhinosinusitis Disability Index - RSDI) in chronic rhinosinusitis (CRS). We hypothesized that anxiety and depression would decrease after functional endoscopic sinus surgery (FESS), and furthermore that HADS would predict improvement in RSDI following surgery. METHODOLOGY: The study cohort from 2014 consisted of 99 CRS patients who underwent nasal endoscopy, RSDI, and HADS evaluation. The cohort was segregated by whether or not they underwent FESS and an updated HADS was administered. For 44 surgical patients, pre- and post-operative RSDI (n=38), Lund-Kennedy (LK) (n=34) and HADS (n=18) scores were compared. Delta RSDI was compared between patients with varying levels of anxiety and depression. RESULTS: Lund-Kennedy scores improved from 5.8 ± 4.1 to 3.2 ± 2.6 following surgery, as did total RSDI (39.3 ± 26.8 to 24.6 ± 29.2). Total HADS (9.8 ± 6.4 to 11.3 ± 7.4) and depression and anxiety subscores were unchanged. Linear regression did not reveal a correlation between HADS and change in RSDI following FESS. Delta RSDI was not significantly different between patients with varying levels of anxiety and depression. CONCLUSIONS: Despite improvements in objective evidence of sinonasal inflammation (LK) and disease-specific quality of life (RSDI), neither depression nor anxiety improved after FESS, nor did the magnitude of psychological comorbidity predict post-operative improvement in quality of life. Improvement in RSDI was not different among patients with varying levels of anxiety and depression. Levels of depression and anxiety may be hard-wired, and therefore not influenced by changes in objective or perceived sinonasal disease burden.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29476192 EPOS2012 has better specificity compared to IDSA2012 for diagnosing acute bacterial rhinosinusitis 241 244 EN K. Seresirikachorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand W. Chitsuthipakorn Department of Otolaryngology, Sawanpracharak Hospital, Nakhonsawan, Thailand W. Ruksakul Department of Otolaryngology, Nakhonpathom Hospital, Nakhonpathom, Thailand S. Chusakul Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand J. Kanjanaumporn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand S. Aeumjaturapat Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 1790 10.4193/Rhin17.261 BACKGROUND: Acute bacterial rhinosinusitis (ABRS) is a subtype of acute rhinosinusitis (ARS). To prevent excessive antibiotic prescribing, clinical criteria for diagnosing ABRS are presented in two major international guidelines from European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2012) and the Infectious Diseases Society of America (IDSA2012). This study aims to assess accuracy of these criteria. METHODOLOGY: Patients with ARS were recruited. Clinical features were collected including discolored nasal discharge, facial pain, fever, double sickening, symptoms persisting longer than 10 days, and elevated serum C reactive protein (CRP) and erythrocyte sedimentation rate (ERS). Using middle meatal bacterial culture as a reference, accuracy of EPOS2012 and IDSA2012 criteria were analyzed. RESULTS: Eighty-eight patients (age 43.2+/-14.5 years, 67% female) with ARS were recruited. Using the two criteria for diagnosing ABRS, EPOS2012 and IDSA2012 have sensitivity of 50% (95%CI: 38%-62%) versus 69% (95%CI: 57%-79%), specificity of 63% (95%CI: 43%-79%) versus 46% (95%CI: 28%-65%), and accuracy of 53% versus 63%, respectively. CONCLUSION: Both EPOS2012 and IDSA2012 had modest accuracy. EPOS2012 had less sensitivity but a better specificity compared to IDSA2012. This suggests that IDSA2012 diagnostic criteria may contribute to inappropriate use of antibiotics due to poorer specificity.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29476616 Upregulation of extraneuronal TRPV1 expression in chronic rhinosinusitis with nasal polyps 245 254 EN E. Tóth Department of Oto-Rhino-Laryngology Head and Neck Surgery, Hungarian Defense Forces, National Health Center, Budapest, Hungary T. Tornóczky Department of Pathology, University of Pécs Medical School, Pécs, Hungary J. Kneif Department of Pathology, University of Pécs Medical School, Pécs, Hungary A. Perkecz Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary K. Katona Department of Pathology, University of Pécs Medical School, Pécs, Hungary Z. Piski Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University of Pécs Medical School, Pécs, Hungary Ã� Kemény Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary I. Gerlinger Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University of Pécs Medical School, Pécs, Hungary J. Szolcsányi Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary J. Kun Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary E. Pintér Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Pécs, Hungary 1791 10.4193/Rhin17.108 BACKGROUND: Chronic rhinosinusitis (CRS) is a multifactorial upper airway disease with unclear etiology. Neuronal Transient Receptor Potential Vanilloid 1 (TRPV1) and Ankyrin 1 (TRPA1) channels have been implicated in the pathogenesis of CRS. We aimed to detect the expression of extraneuronal TRPV1 and TRPA1 receptors in nasal polyp (NP) tissue samples. METHODOLOGY: Samples were obtained from fourty-two CRS pateints with nasal polyp and sixteen healthy controls to measure receptor gene expression by quantitative PCR, protein localization by immunohistochemistry and cytokine profile by multiplex bead immunoassay. RESULTS: Non-neuronal TRPV1, TRPA1 receptors were expressed in biopsy samples of NP. A population of mast cells and macrophages were immunopositive for TRPV1 and TRPA1. A fraction of plasma cells expressed TRPV1 but not TRPA1 and neither receptor was present on eosinophils. The local gene expression of extraneuronal TRPV1, TRPA1 receptors was also proven. TRPV1 mRNA levels were significantly increased in CRSwNP patients with asthma and allergic rhinitis compared to their NP counterparts. CONCLUSIONS: Elevated TRPV1 levels in comorbid asthma and allergy may have a function in CRSwNP. Subpopulation-specific TRPV1 presence on plasma and mast cells can indicate delicate roles in regulating activation and release of inflammatory mediators.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29466476 PD-L1 is a positive prognostic factor in squamous cell carcinoma of the nasal vestibule 255 260 EN D. Vital Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Zurich, Switzerland D. Holzmann Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Zurich, Switzerland G.F. Huber Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Zurich, Switzerland H. Moch Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Zurich, Switzerland G.B. Morand Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Zurich, Switzerland K. Ikenberg Department of Pathology and Molecular Pathology, Zurich University Hospital and University of Zurich, Zurich, Switzerland 1788 10.4193/Rhin17.215 BACKGROUND: Aim was to analyse the role of PD-L1 in squamous cell carcinomas of the nasal vestibule. Advanced squamous cell carcinoma of the nasal vestibule is a highly aggressive tumour. The role of PD-L1 expression is unclear in this tumour type. METHODOLOGY: Forty-six patients diagnosed between 1995 and 2014 were analyzed. Baseline characteristics and outcome were correlated to immunohistochemical staining of PD-L1. PD-L1 positivity of tumour cells and tumour infiltrating immune cells (TIIC) was defined by any staining of more than 1% of the tumour cells. RESULTS: PD-L1 expression was interpretable in 31 of 46 patients (67.4%). PD-L1 positivity was present in 14 (45.2%) patients tumour cells and 17 (54.8%) patients TIIC. PD-L1 positivity of tumour cells was associated with a favourable disease free survival (p=0.019). CONCLUSIONS: Positivity for PD-L1 in tumour cells is a prognostic factor in squamous cell carcinoma of the nasal vestibule and might enable a patient-tailored treatment.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29561922 The presence of Interleukin-13 in nasal lavage may be a predictor of nasal polyposis in pediatric patients with cystic fibrosis* 261 267 EN J. Manji Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Childrens Hospital, Vancouver, British Columbia, Canada A. Thamboo Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Childrens Hospital, Vancouver, British Columbia, Canada M. Tacey Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia C. Garnis Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada N.K. Chadha Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Childrens Hospital, Vancouver, British Columbia, Canada 1801 10.4193/Rhin17.007 BACKGROUND: Sinonasal disease is a common feature of cystic fibrosis (CF) and can cause significant morbidity in these patients. Our objective was to determine if CF individuals with concomitant nasal polyposis (NP) express a unique profile of inflammation and if so, whether these inflammatory cytokine mediators have predictive value in identifying these individuals for prompt management by an Otolaryngologist. METHODOLOGY: Nasal lavage samples and clinical outcomes of disease severity were obtained from thirty-eight pediatric CF individuals. Participants were subdivided based on the presence or absence of NP. Nasal lavage samples were analyzed on a panel of seventeen cytokine targets using a Bio-Plex Luminex assay. A Perl Permutation test with correction for multiple hypotheses was performed to identify uniquely expressed cytokines between CF individuals with NP (CFwNP) and those without (CFsNP). RESULTS: Thirty-five patients were included in the analysis. Cytokines IL-13 and GM-CSF were uniquely expressed in the CFwNP group when compared to the CFsNP group. Logistic regression analysis demonstrated a significant association of IL-13 with NP. CONCLUSION: In children diagnosed with CF, the level of IL-13 in nasal lavage samples could potentially serve as a non-invasive clinical tool in predicting NP in this population, and a target for future immunotherapy.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29509830 The accessibility of topical treatment in the paranasal sinuses on operated cystic fibrosis patients assessed by scintigraphy 268 273 EN K. Aanaes Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Denmark M.C. Alanin Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Denmark K.G. Nielsen Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark M. Moller Jorgensen Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark C. von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Denmark N. Hoiby Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark H.K. Johansen Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark H.H. Johannesen Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark J. Mortensen Department of Clinical Medicine, Faculty of Health and Medical Sciences, The Panum Institute, University of Copenhagen, Denmark 1796 10.4193/Rhin17.243 BACKGROUND: Nasal irrigations with antibiotics are used to eradicate Pseudomonas aeruginosa from the upper airways in patients with cystic fibrosis (CF) and thereby avoid lung colonisations; nevertheless, the efficacy is uncertain. METHODOLOGY: The aim of this study was to investigate the accessibility and durability of solutions in the sinuses before and after sinus surgery. The participants irrigated their noses with radioactively marked saline and were evaluated using a dynamic SPECT/CT scan. The preoperative and postoperative (after 30 days) examinations were compared. RESULTS: Twelve CF patients were included. In 10 out of the 24 scanned maxillary sinuses an improvement was seen postoperatively compared with the preoperative fluid volume. Notably, in 7 out of the 24 sinuses the mucosa was so swollen postoperatively that no fluid was detected. Ten patients had developed their frontal sinuses. We observed no fluid in the frontal or sphenoid sinuses, neither before nor after surgery. At best, a mean of 23% of the maxillary sinuses were filled with fluid; thus, all sinuses had postoperatively areas of the mucosa that did not have contact with the fluid. A mean of 76% of the initial volume was present after 30 min in the maxillary sinuses. CONCLUSION: Fluid-depositing using nasal irrigation will not sufficiently or not at all get in contact with all the sinus mucosa despite of sinus surgery. Thus, the efficacy of topical deposition of antibiotics is presumably reduced.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29509829 Fluorescein transit test time as a tool to assess lacrimal pump function after diode laser transcanalicular dacryocystorhinostomy and external dacryocysto-rhinostomy 274 278 EN E.D. Feijo Department of Oculoplastic Surgery of the Ophthalmology Hospital of Anapolis, Goias, Brazil R.M. Limongi Department of Oculoplastic Surgery of the Federal University of Goias, Goias, Brazil S. Matayoshi Department of Oculoplastic Surgery of the University of Sao Paulo, Sao Paulo, Brazil 1797 10.4193/Rhin17.254 BACKGROUND: Dacryocystorhinostomy (DCR) is the gold standard surgical treatment for nasolacrimal duct obstruction. External DCR is the traditional approach (EXT-DCR); however, the advent of minimally invasive surgeries and the development of optic fiber and laser technologies have made it possible to perform laser transcanalicular DCR (T-DCR), a minimally invasive procedure. This study measured the fluorescein transit time (FTT) after EXT-DCR or T-DCR to evaluate the lacrimal drainage and lacrimal pump function after these two types of DCR. SUBJECTS AND METHODS: A cross-sectional study of 50 patients who underwent EXT-DCR (EXT-DCR Group) or T-DCR (T-DCR Group), who were anatomically patent upon irrigation, with a minimum 6 months of follow up. The patients' FTT was measured; it was defined as the time from the instillation of the dye into conjunctival sac to its free flow from the rhinostomy site. This evaluation was performed through nasal endoscopy performed intranasally with a blue filter that enabled the faster detection of fluorescein from the ostium site. The mean FTTs of the two groups were compared using the two-sided Student's unpaired t-test. Other variables such as sex, age, previous lacrimal sac size, and the site and shape of the rhinostomy were evaluated to determine their possible relationships with FTT. RESULTS: The EXT-DCR group had 80% female patients at a mean age of 58 years. The T-DCR group had the same percentage of female patients (80%) and a mean age of 56 years. The mean FTT group was 47.48 sec in the EXT-DCR and 33.04 sec in the T-DCR group. Functional success was 88% in both groups. CONCLUSION: FTT in the DCR-T Group was significantly lower than in the EXT-DCR Group. No other variables exhibited a statistically significant correlation with FTT. Lacrimal drainage was found to be better after T-DCR than after EXT-DCR, results which show that this procedure could prevent lacrimal pump damage.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29561921 Nasal symptoms, epithelial injury and neurogenic inflammation in elite swimmers 279 287 EN B. Steelant Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium V. Hox Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium L. Van Gerven Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium E. Dilissen Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium E. Dekimpe Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium A. Kasran Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium S. Aertgeerts Academic Center for General Practice, KU Leuven, Leuven, Belgium V. Van Belle Flemish Swimming Federation, Merelbeke, Belgium K. Peers Sport Medical Advice Centre, University Hospitals Leuven, Belgium L.J. Dupont Laboratory of Pneumology, KU Leuven, Leuven, Belgium P.W. Hellings Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium D.M. Bullens Pediatric Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium S.F. Seys Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium 1802 10.4193/Rhin17.167 BACKGROUND: A high burden of lower airway symptoms is found in elite swimmers. To what extent elite swimmers suffer from upper airway symptoms and how these associate with nasal inflammation is less clear. We here aimed to evaluate upper airway symptoms and nasal inflammation in elite athletes. METHODOLOGY: Elite swimmers, indoor athletes and age-matched controls were recruited. Upper airway symptoms were assessed by sino-nasal outcome test (SNOT)-22 questionnaire. Visual Analogue score (VAS) for nasal symptoms as well as neurogenic and inflammatory mediators in nasal fluid were assessed at baseline, immediately and 24-hours after sport-specific training. The effect of hypochlorite on nasal epithelial cells was evaluated in vitro. RESULTS: Baseline SNOT-22 and VAS for nasal itch and impaired smell were significantly higher in swimmers compared to controls. Nasal substance P and uric acid levels were increased in elite swimmers 24-hours after swimming compared to baseline. In elite swimmers, uric acid levels 24-hours post-exercise correlated with baseline SNOT-22. As increased symptoms and inflammation were found in swimmers but not in indoor athletes, we hypothesized that hypochlorite exposure might be the underlying mechanism. In vitro, the highest dose of hypochlorite decreased nasal epithelial cell integrity and induced release of uric acid. CONCLUSION: Upper airway symptoms are frequently reported in elite swimmers. Intensive swimming resulted in a delayed increase of epithelial injury and neurogenic inflammation.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29509828 Lower airway flow influences peak nasal inspiratory flow in school-aged children 288 296 EN H. Pite Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal L. Pimenta Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal A.C. Henriques Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal I. Marques Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal C. Camarinha Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal A.V. Lourenco Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal I. Almeida Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal L.M. Borrego Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal M. Morais-Almeida Allergy Center, CUF Descobertas Hospital and CUF Infante Santo Hospital, Lisbon, Portugal 1798 10.4193/Rhin17.229 BACKGROUND: Rhinitis and asthma frequently coexist. Peak nasal inspiratory flow (PNIF) objectively evaluates nasal obstruction. Lower airway flow's impact on PNIF has seldom been analysed in children. We aimed to study the associations between PNIF and: 1)forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in children with allergic rhinitis and asthma and healthy controls; 2)allergic rhinitis and asthma control subjective evaluation. METHODS: Sequential assessments of PNIF before and after nasal decongestion and spirometry with bronchodilation test were performed in 65 children (6-12 years) with allergic rhinitis and asthma, and 24 gender, age-matched healthy controls. The Control of Allergic Rhinitis and Asthma Test in children (CARATkids) was used for control assessment. Associations were investigated by multiple linear regression models. RESULTS: Baseline and decongested PNIF correlated with baseline and post-bronchodilation FEV1 and PEF, observed independently of rhinitis and asthma diagnosis. The best model for PNIF included PEF, age and gender. No association was found between PNIF and CARATkids scores, except for nasal obstruction self-report. CONCLUSION: In school-aged children, besides age and gender, PEF values should ideally be known to interpret PNIF values. PNIF can be complementary to subjective control assessment in children with allergic rhinitis and asthma.

International Rhinologic Society Rhinology 0300-0729 56 3 2018 9 1 29561919 Reconstruction of frontal defects with calvarial grafts 297 302 EN S. Dova Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece P.D. Karkos Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece J. Constantinidis Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece 1803 10.4193/Rhin17.185 BACKGROUND: There are many options for the reconstruction of frontal sinus wall defect resulting from injury, neoplastic lesions and aesthetic deformities. These mainly include autogenous grafts, allogenous grafts, and alloplastic materials. The aim of the present study is to report the advantages of using autogenous calvarial bone grafts over other reconstruction techniques, in the reconstruction of frontal defects. METHODS: We describe 16 consecutive cases of anterior frontal sinus defects between 2004 and 2015, in which calvarial bone grafts were used. Medical records were retrospectively analysed to evaluate graft survival. RESULTS: Bone defects were caused by injury (3), aesthetic deformities (2), external frontal sinus surgeries (2), tumours (6: three osteomas, two fibrous dysplasias, one squamous cell carcinoma), and osteomyelitis (3). There were no significant complications during harvesting, and morbidity was minimal. Furthermore, at one and five-year follow-up, no graft resorption or rejection was noted, and cosmetic results were satisfactory. CONCLUSIONS: Our results indicate that calvarial bone graft is an appropriate material to use in anterior frontal sinus reconstruction.