International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 30367720 From prevention to optimal treatment in chronic rhinosinusitis 305 306 EN P.W. Hellings Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium, Euforea, Brussels, Belgium 1849 10.4193/Rhin18.404 Prevention of chronic rhinosinusitis remains a true societal challenge, as prevention of this highly prevalent non-communicable disease will significantly reduce socio-economic costs and improve the overall well-being of the large group of affected individuals. In alignment with the health priorities of national governments, prevention and cost-effective health care should be embraced by the Rhinologic community.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 30052695 Prevention of chronic rhinosinusitis 307 315 EN C. Hopkins ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom P. Surda ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom F. Bast ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom R. Hettige ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom A. Walker ENT Department, Guys and St Thomas Hospitals, SE1 9RT London, United Kingdom P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Leuven, Belgium 1825 10.4193/Rhin17.027 Prevention of chronicity of disease and minimising its impact with individualized treatment is a fundamental tenet of precision medicine. A review of the literature has been undertaken to explore how this may apply to chronic rhinosinusitis (CRS). Prevention may be thought of across 3 main domains. Primary prevention of CRS focuses on the avoidance of exposure to environmental factors associated with increased incidence of disease. This includes avoidance of tobacco smoke and occupational toxins. Although allergic rhinitis, respiratory infections and gastro-oesophageal reflux have been shown to be risk factors, there is no evidence as yet that treatment of these conditions is associated with reduced incidence of CRS. Secondary prevention of CRS is concerned with detecting a disease in its earliest stages, intervening to achieve disease and symptom control and preventing future exacerbations. Evidence based guidelines facilitate early diagnosis and appropriate use of medical and surgical interventions. In the future the use of endotypes to direct optimal is like to allow more clinically and cost-effective use of current and emerging treatments, such as monoclonal antibodies. Tertiary prevention aims to minimise the impact of an ongoing illness or injury that has lasting effects. Anxiety and depression have been shown to be associated with symptom amplification and may require treatment. The role of disease-related factors such as the role of the microbiome and osteo-neogenesis in the development of chronicity, and the development of severe combined upper airway disease needs further research.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 29719025 Correlation between Excessive Daytime Sleepiness (EDS) and self-reported and objective nasal characteristics 316 322 EN K.M. Hoven Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen Norway H.J. Aarstad Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen Norway B. Bjorvatn Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen Norway E.H. Lundemo Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen Norway S.K. Steinsvåg Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen Norway 1807 10.4193/Rhin17.203 BACKGROUND: The aim of the present study was to explore the relationship between excessive daytime sleepiness (EDS), Peak Nasal Inspiratory Flow (PNIF), and patient reported symptoms from the nose. METHOLOGY: Six hundred and fifty one consecutive patients referred to a hospital on suspicion of sleep related breathing disorder (SRBD) were included in the study. Daytime sleepiness was assessed by Epworth Sleepiness Scale (EpSS). Nasal airflow was measured with Peak Nasal Inspiratory Flow (PNIF). Symptoms of sino-nasal dysfunction and diseases were graded on Visual Analogue Scales (VAS). RESULTS: EpSS score was not correlated with nasal flow as measured by PNIF or nasal obstruction - VAS scores. There were significant associations between daytime sleepiness and patient-reported VAS-scores on nasal discharge, headache, coughing, general health and to some extent sneezing when age, gender, BMI and reported co-morbidity levels were adjusted for. CONCLUSION: A clinical implication of this is that patients with EDS may be evaluated and treated for sino-nasal disease, while medical and surgical measures to open the nose per se may not be effective therapeutic options. A scientific implication is that the relationship between SRBD and sino-nasal disease should be further investigated.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Chronic rhinosinusitis exacerbations are differentially associated with lost productivity based on asthma status 323 329 EN K.M. Phillips Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA R.W. Bergmark Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA L.P. Hoehle Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA D.S. Caradonna Department of Otolaryngology, Harvard Medical School, Boston, MA, USA S.T. Gray Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA A.R. Sedaghat Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA 1812 10.4193/Rhin18.033 BACKGROUND: The frequency of chronic rhinosinusitis (CRS) exacerbations is an independent predictor of quality of life. The objective of this study was to evaluate if increased CRS exacerbations predict decreased productivity. METHODS: Cross-sectional study of adult CRS patients. Number of patient-reported CRS-related antibiotic and oral corticosteroids courses and sinus infections in the past three months were used as metrics for acute exacerbations of CRS (AECRS). Productivity loss was measured by asking participants the number of lost days of work or school due to CRS in the past three months. Associations were sought between lost productivity and AECRS, controlling for clinical and demographic characteristics. RESULTS: 371 participants were recruited. 28.8% of study participants had comorbid asthma. The mean number of lost days of productivity due to CRS in the last three months was 1.5 for asthmatic participants and 2.4 for non-asthmatic participants. In asthmatics, CRS-related lost productivity was significantly associated with number of CRS-related antibiotics used (and oral corticosteroids used, with a trend for sinus infections. No AECRS metric was significantly associated with lost productivity in non-asthmatics. However, when focusing on non-asthmatics reporting missed days of work or school due to CRS, we found statistically significant associations between AECRS metrics and lost productivity. CONCLUSIONS: The frequency of AECRS is associated with CRS-related lost productivity in asthmatics and in the subset of non-asthmatics with moderate CRS-related productivity losses.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 30076701 Olfactory training changes electrophysiological responses at the level of the olfactory epithelium 330 335 EN T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany G. Stupka Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany S.C. Poletti Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 1832 10.4193/Rhin17.163 BACKGROUND: Olfactory training (OT) has been shown to increase olfactory performance in healthy subjects and patients with post-traumatic or post-infectious olfactory loss. Morphological correlates such as olfactory bulb volume increase and gray matter changes suggest central changes in olfactory brain areas following olfactory exposure. Some evidence from animal studies indicates peripheral changes upon OT whereas no such data exist in humans. This study explores the question whether changes in olfaction following OT are associated with alterations of the electro-olfactogram (EOG) derived from the olfactory epithelium. METHODOLOGY: We compared electrophysiological EOG responses to a pleasant, rose-like odor (phenylethyl alcohol, PEA) and to an unpleasant odor (rotten eggs, H2S) in patients and controls. EOG were recorded in smell impaired patients before and after OT for a period of 4-6 months. RESULTS: EOG recordings following PEA and H2S stimulation were significantly more often obtained in controls than in patients. OT was associated with a significantly higher number of EOG recordings. CONCLUSIONS: OT is associated with an increase in EOG responses implicating stimulus-induced plasticity to start at the level of the olfactory epithelium.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 30052693 Chitosan films promote formation of olfactory neurospheres and differentiation of olfactory receptor neurons 336 342 EN S.T. Li Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 1 Jen-Ai Road, Taipei 100, Taiwan T.H. Young Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 1 Jen-Ai Road, Taipei 100, Taiwan C.T. Wang Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan T.W. Huang Department of Electrical Engineering, College of Electrical and Communication Engineering, Yuan Ze University, Taoyuan, Taiwan 1830 10.4193/Rhin17.155 BACKGROUND: Olfactory dysfunction significantly impairs the life quality of patients. Therefore, a model needs to be developed for anosmia. Chitosan is a biodegradable natural polysaccharide that has been widely studied for regenerative purposes in the nervous system. However, whether chitosan promotes differentiation of olfactory receptor neurons or regulates formation of neurospheres in the olfactory system remains unexplored. METHODOLOGY: Olfactory neuroepithelial cells were isolated from embryonic wistar rats on day 17, and cultured on controls and chitosan films for 12 days. The effects of treatment were assessed using immunocytochemistry, quantitative polymerase chain reaction and western blots following culturing. The substrate of poly-L-lysine-co-laminin was adopted as a control. RESULTS: In contrast to the flat layer on controls, olfactory neuroepithelial cells form olfactory neurospheres on chitosan films with steadily increasing diameter. The olfactory neurospheres contain basal cells, as well as immature and mature olfactory receptor neurons. The expression level of olfactory marker protein is higher on chitosan films than those on controls in gene and protein levels, and the olfactory transduction elements also express a similar trend. Mature olfactory receptor neurons are found predominantly at the periphery of the olfactory neurospheres. CONCLUSIONS: Chitosan films not only facilitate formation of olfactory neurospheres, but also promote differentiation of olfactory receptor neurons. Chitosan is a potential biomaterial to establish an in vitro culture model to treat olfactory dysfunction in future.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours 343 350 EN H.M. Druce Ear Nose and Throat Care P.C., Somerville, NJ 08876, USA D.L. Ramsey Procter and Gamble, Personal Health Care Division, Mason, OH 45040, USA S. Karnati Procter and Gamble, Personal Health Care Division, Mason, OH 45040, USA A.N. Carr Procter and Gamble, Cincinnati, OH 45221, USA 1811 10.4193/Rhin17.150 BACKGROUND: Nasal congestion, often referred to as stuffy nose or blocked nose is one of the most prevalent and bothersome symptoms of an upper respiratory tract infection. Oxymetazoline, a widely used intranasal decongestant, offers fast symptom relief, but little is known about the duration of effect. METHODOLOGY: The results of 2 randomized, double-blind, vehicle-controlled, single-dose, parallel, clinical studies (Study 1, n=67; Study 2, n=61) in which the efficacy of an oxymetazoline (0.05% Oxy) nasal spray in patients with acute coryzal rhinitis was assessed over a 12-hour time-period. Data were collected on both subjective relief of nasal congestion (6-point nasal congestion scale) and objective measures of nasal patency (anterior rhinomanometry) in both studies. RESULTS: A pooled study analysis showed statistically significant changes from baseline in subjective nasal congestion for 0.05% oxymetazoline and vehicle at each hourly time-point from Hour 1 through Hour 12 (marginally significant at Hour 11). An objective measure of nasal flow was statistically significant at each time-point up to 12 hours. Adverse events on either treatment were infrequent. The number of subjects who achieved an improvement in subjective nasal congestion scores of at least 1.0 was significantly higher in the Oxy group vs. vehicle at all hourly time-points on a 6-point nasal congestion scale. CONCLUSIONS: This study shows for the first time, that oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Influence of number of drugs on olfaction in the elderly 351 357 EN G. Ottaviano Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy E. Savietto Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences, University of Padova, Padova, Italy A. Bertocco Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy P. Maculan Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy G. Sergi Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy A. Martini Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy E. Manzato Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy G. Marioni Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy 1817 10.4193/Rhin17.152 BACKGROUND: The etiology of age-related olfactory loss is still unclear, but it has been claimed that polypharmacotherapy may contribute to olfactory dysfunction, particularly in the elderly, who are more likely to need multiple drugs. The present pilot study investigated the relationship between smell and the number and type of drugs taken in a group of elderly. METHODOLOGY: 50 elderly volunteers (over 64 years old) who were healthy from the sinonasal standpoint (SNOT-22 under 1) and had no cognitive impairments [Mini Mental State Examination (MMSE over 18) were administered the Screening 12 test and tested on their n-butanol olfactory threshold. Their olfactory performance was then connected with the number and type of drugs participants used. RESULTS: The mean age of the included volunteers was 74 plus/minus 7 years. No association emerged between odor identification and number of drugs taken. The number of drugs taken correlated directly with a worse olfactory threshold and with a worse MMSE score, meaning a worse cognitive status. Odor identification significantly worsened with age. Comparing those volunteers taking only one drug known to not influence olfaction with another sub-group of volunteers taking five or more drugs, it was evident that subjects taking only one drug scored significantly better in olfactory threshold test and MMSE, and marginally better in olfactory identification test. For what concerns the difference between male and female volunteers, no difference in olfactory test result was shown, both for threshold and identification. Univariate analysis showed a direct correlation between the consumption of calcium channel blockers, beta-blockers, acetylsalicylic acid and olfactory threshold, meaning a worse sense of smell. Acetylsalicylic acid also correlated inversely with odor identification, meaning again a worse sense of smell, and so did potassium-sparing diuretics. Multivariate analysis showed that MMSE scores correlated with a better sense of smell, that is a lower olfactory threshold, and that beta-blockers and acetylsalicylic acid negatively affected olfactory threshold, meaning a worse sense of smell. Acetylsalicylic acid also correlated inversely with odor identification, meaning again a worse sense of smell. CONCLUSIONS: The number of drugs taken demonstrated to be significantly correlated with a worse olfactory threshold and worse MMSE. Larger studies on elderly volunteers are needed to confirm these preliminary findings.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Horizontal lateral lamella as a risk factor for iatrogenic cerebrospinal fluid leak. Clinical retrospective evaluation of 24 cases 358 363 EN A. Preti Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy F. Mozzanica Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy R. Gera Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy S. Gallo Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy J. Zocchi Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy F. Bandi Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy G. Guidugli Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy F. Ambrogi Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy A. Yakirevitch Department of Otorhinolaryngology - Head and Neck Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel A. Schindler Department of Biochemical and Clinical science Luigi Sacco, University of Milan, Milan, Italy A. Dragonetti Department of Otolaryngology, Ospedale Niguarda, Milan, Italy P. Castelnuovo Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy F. Ottaviani Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy 1808 10.4193/Rhin18.103 BACKGROUND: Several authors highlighted the limitations of the Keros classification system in predicting intracranial entry risk. Recently, our group proposed a new classification system based on the angle formed between the lateral lamella of the cribriform plate (LLCP) and the continuation of an horizontal plane passing through the cribriform plate (Gera classification). The aim of this study was to analyze whether the risk of iatrogenic cerebrospinal fluid leak (CSF-L) was better predicted by Keros or Gera classification. METHODOLOGY: The pre-operative CT scans of 24 patients (CSF-L group) who suffered from iatrogenic CSF-L during endoscopic sinus surgery (ESS) were compared to those obtained from a group of 100 patients who underwent uneventful ESS (control group). The skull base measurements as well as the distribution of Keros and Gera classes in the 2 groups were analyzed. RESULTS: No difference in the distribution of Keros classes or in the depth of the cribriform plate between CSF-L and control group were demonstrated. On the contrary, significant differences in the distribution of Gera classes and in the degree of the angle formed by the LLCP and the continuation of the horizontal plane passing through the cribriform plate were found. In particular, according to Gera classification system, 19 out of 24 patients in the CSF-L group were considered at risk for iatrogenic CSF-L. CONCLUSIONS: Gera classification system might be more sensitive to anatomical variations associated with CSF-L than the Keros one, further suggesting the application of the former during the preoperative CT scan evaluation.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 The effect of the titanium butterfly implant on nasal patency and quality of life 364 369 EN S.J.A.C. van den Broek Departement of Otorhinolaryngology, Radboudumc Nijmegen, the Netherlands N. van Heerbeek Departement of Otorhinolaryngology, Radboudumc Nijmegen, the Netherlands 1813 10.4193/Rhin17.213 OBJECTIVE: The titanium butterfly implant seems to be a powerful technique to repair nasal valve insufficiency. However, the effect of these implants on nasal patency and quality of life has been controversial due to a lack of evidence. The purpose of this study is to evaluate the objective and subjective effect of the titanium butterfly implant on nasal patency and corresponding quality of life. METHODS: Nasal patency and quality of life of 32 patients undergoing a titanium butterfly implant were evaluated by measuring peak nasal inspiratory flow (PNIF) and completing three validated questionnaires: the NOSE, SNOT-22 and GBI, before surgery, six weeks and six months after surgery. RESULTS: The mean PNIF increased significant after 6 weeks, as well as after 6 months. Both the NOSE and SNOT-22 questionnaire scores showed a significant decrease at both post-operative measurements. The GBI indicated a significant increase at 6 weeks and 6 months. There were no significant differences between both of the post-operative measurements. CONCLUSION: This is the first study indicating that the titanium butterfly implant provides a significant and clinically relevant increase in nasal patency and corresponding quality of life in patients with nasal valve insufficiency.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 TSLP regulates eotaxin-1 production by nasal epithelial cells from patients with eosinophilic CRSwNP 370 377 EN W.W. Wang Schools of Medicine and Nursing Sciences, Huzhou University Location: No.759, Huzhou City, Zhejiang Prov, China D.M. Lu Schools of Medicine and Nursing Sciences, Huzhou University Location: No.759, Huzhou City, Zhejiang Prov, China M. Zheng Fujian Medical University, Location: No.88, Jiaotong Road, Fuzhou City, Fujian Prov, China J.G. Zhang Schools of Medicine and Nursing Sciences, Huzhou University Location: No.759, Huzhou City, Zhejiang Prov, China B. Zhang Schools of Medicine and Nursing Sciences, Huzhou University Location: No.759, Huzhou City, Zhejiang Prov, China 1815 10.4193/Rhin17.045 BACKGROUND: Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is characterized by Th2-skewed inflammation with eosinophilic infiltration. Thymic stromal lymphopoietin (TSLP) promotes the development of allergic inflammation. Although increased TSLP is found in eCRSwNP, little is known about whether TSLP regulates eotaxin-1 production, a potent eosinophil chemoattractant that recruits and activates eosinophils. Objective: The aim of this study was to investigate the effects and mechanisms of TSLP in eotaxin-1 production in the eosinophilic inflammation of eCRSwNP. METHODS: Human nasal epithelial cells (HNECs) from eCRSwNP patients were stimulated with recombinant human TSLP in the presence or absence of CYT387 (Janus kinase 1/2 inhibitor). Phosphorylated signal transducer activator of transcription 3 (p-STAT3) was measured by using immunocytochemistry. Eotaxin-1 expression was determined by using real-time PCR. Western blotting was used to detect the levels of p-STAT3 and eotaxin-1 protein. RESULTS: The treatment with TSLP induced STAT3 phosphorylation in HNECs, and promoted p-STAT3 nuclear translocation, leading to a time-dependent increase of eotaxin-1 expression. However, these effects were attenuated by CYT387 pretreatment. CONCLUSION: TSLP regulated eotaxin-1 production in HNECs via JAK1/2-STAT3 signaling, which might contribute to the eosinophilic inflammation of eCRSwNP.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Histopathological features of antrochoanal polyps in Chinese patients 378 385 EN P. Jin Department of Otolaryngology, The Second Affiliated Hospital, Shandong University, Jinan, China X. Zi Department of Otolaryngology, The Second Affiliated Hospital, Shandong University, Jinan, China T.C. Charn Department of Otolaryngology, Sengkang General Hospital and Singapore General Hospital, Singapore, Singapore J. Liu Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore Y. Yan Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore L. Shi Department of Otolaryngology, The Second Affiliated Hospital, Shandong University, Jinan, China H. Zhang Department of Otolaryngology, The Second Affiliated Hospital, Shandong University, Jinan, China D. Wang Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore 1819 10.4193/Rhin18.057 BACKGROUND: The pathogenesis and etiology of antrochoanal polyps (ACP) are unclear. The aim of this study is to characterize the features of inflammatory cellular infiltration, the epithelial remodeling patterns and their associations to clinical parameters in ACP. METHODS: A detailed histological study employing classic immunohistochemistry was performed. 33 ACPs, 49 classic bilateral nasal polyps (BNP) and 50 controls were obtained. The histological patterns and inflammatory cells infiltration were evaluated and analyzed for associations with clinical characteristics. RESULTS: Less severe epithelial hyperplasia and goblet cell hyperplasia were found in ACP compared to BNP. In ACP, 87.9% of cases demonstrated neutrophilia. Elevated proportions of macrophages and CD8+ T cells, and elevated infiltration of mast cells was observed. Eosinophil infiltration was found to be positively corelated with a history of asthma; macrophages proportion was analyzed to have a significantly negative correlation with epithelial hyperplasia and goblet cell hyperplasia; the infiltration of CD8+ T cell and squamous metaplasia were found to have a positive correlation. CONCLUSION: Inflammation potentially has important roles in ACP. ACP may differ in its pathogenesis from classic bilateral nasal polyps

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits 386 392 EN A. Santamaria-Gadea Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain M. Lopez-Chacon Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain C. Langdon Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain L. Van Gerven Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium M. Valls-Mateus Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain M. Bernal - Sprekelsen Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain I. Alobid Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain 1821 10.4193/Rhin18.036 BACKGROUND: The nasal floor and inferior meatus (NFIM) flap represents an available option for the reconstruction of a septal perforation (SP). This study explores the feasibility of repairing SPs using a modified simple and extended (including inferior turbinate) NFIM flap. METHODS: An anatomic study was achieved in fresh frozen cadaveric specimens to measure the area and lengths of NFIM flap. The repair of SP with simple and extended NIFM flaps was performed in some of these cadaveric specimens. Preoperative radiological evaluation of CT scans allowed studying the reconstruction limits of the simple or extended NFIM flap. A cohort of patients with SP who underwent reconstruction with an NFIM flap was also included. RESULTS: Complete SP repair with NFIM was achieved in all specimens (n=10). In 38 fresh cadaveric specimens, coronal and sagittal lengths and area of simple NFIM flaps were smaller than in extended NFIM flaps. The radiological analysis of 75 CT scans revealed that the septal height could be reconstructed with a simple and extended NFIM flap. Complete SP repair wasachieved in 5 patients (4 male, mean age 57.4 years) using modified NFIM flaps. CONCLUSION: The simple or expanded NFIM flap represents a feasible option to repair small or medium-sized perforations located at the lower 1/3 or 3/4 of the nasal septum.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 30098234 Primary surgical treatment of nasal vestibule cancer - therapeutic outcome and reconstructive strategies 393 399 EN K. Zaoui Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany P.K. Plinkert Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany P.A. Federspil Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany 1834 10.4193/Rhin17.157 OBJECTIVE: The treatment strategy of squamous cell carcinoma of the nasal vestibule (SCCNV) is controversial. The objective of this study is to investigate the role of surgery, which is the preferred treatment option at our institution. DESIGN: This was a monocentric prospective study of patients that were diagnosed with SCCNV between 2005 and 2013. MATERIAL AND METHODS: Twenty-six patients were included. Tumors were staged using the UICC (7th edition) TNM classification of nasal cavity cancer and the classification proposed by Wang. The primary treatment was surgery in all patients. Survival data were statistically analyzed using the Kaplan-Meier method. The median follow-up time was 6 years. RESULTS: Using the UICC classification, 9/26 tumors were staged as pT1 (35%), 7/26 as pT2 (27%), and 10/26 as pT4a (39%). Using the classification by Wang, 9/26 tumors were staged as pT1 (35%), 15/26 as pT2 (58%), and 2/26 as pT3 (8%). Reconstruction was performed using an implant-retained prosthesis in 50% of patients and by plastic surgery in the remaining 50%. Only 2/26 patients (8%) needed adjuvant radiation therapy. The five-year recurrence-free survival (RFS) was 86.7%, disease-specific survival was 96.2% and overall survival was 91.8% after five years. CONCLUSION: Surgery in SCCNV gives an excellent prognosis and minimized the need for radiotherapy.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 30052694 Quality of life after nasal cancer resection - surgical versus prosthetic rehabilitation 400 406 EN K. Zaoui Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany H.M. Thielen Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany M. Plath Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany I. Baumann Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany P.K. Plinkert Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany P.A. Federspil Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Germany 1829 10.4193/Rhin18.030 BACKGROUND: Nose reconstruction following resection of nasal carcinomas is controversial. The objective of this study is to investigate the effect of surgical reconstruction versus prosthetic rehabilitation on patient quality of life (QOL). DESIGN: This was a monocentric prospective study of patients diagnosed with nasal carcinoma from 2003 to 2013. QOL was evaluated using two organ-specific questionnaires (Rhinoplasty Outcome Evaluation [ROE] and the Functional Rhinoplasty Outcome Inventory-17 [FROI-17]) and a generic questionnaire, the Short-Form 36 Health Survey (SF-36). Material and Methods: Sixty-four patients were included. Patients completed the ROE, FROI-17, and SF-36 questionnaires after nasal reconstruction. Questionnaires were completed by 62.8% of the 51 alive patients. RESULTS: Recurrence-free survival (RFS) was 89.9%, disease-specific survival was 94.5%, and overall survival was 75.5% after five years according to the Kaplan-Meier method. Considering initial tumor stage, early stage patients had a significantly higher self-confidence score in FROI-17 subgroup analysis. In contrast, advanced stage patients showed a significantly higher score for social functioning in SF-36. Prosthetically fitted patients scored highly on the ROE questionnaire showing a high degree of aesthetic satisfaction. Surgically reconstructed patients showed a high degree of self-confidence on the FROI-17 questionnaire. However, the organ-specific ROE and FROI-17 scores were not significantly different between patients who received surgical reconstruction and prosthetic rehabilitation after oncological resection. When comparing the rehabilitation method as a function of tumor stage, there was significantly better score for physical functioning in early stage surgically reconstructed patients in the SF-36, but no significant differences in organ-specific QOL. CONCLUSION: Surgical reconstruction and prosthetic rehabilitation after nasal cancer resection have the same effect on organ- and non-organ-specific QOL.

International Rhinologic Society Rhinology 0300-0729 56 4 2018 12 1 Sinonasal inverted papilloma recurrence rates and evaluation of current staging systems 407 414 EN W. Mak Division of Otolaryngology, University of British Columbia, St. Pauls Sinus Centre, Vancouver, British Columbia, Canada D. Webb Division of Otolaryngology, University of British Columbia, St. Pauls Sinus Centre, Vancouver, British Columbia, Canada S. Al-Salihi Division of Otolaryngology, University of British Columbia, St. Pauls Sinus Centre, Vancouver, British Columbia, Canada A. Dadgostar Division of Otolaryngology, University of British Columbia, St. Pauls Sinus Centre, Vancouver, British Columbia, Canada A. Javer Division of Otolaryngology, University of British Columbia, St. Pauls Sinus Centre, Vancouver, British Columbia, Canada 1822 10.4193/Rhin18.039 BACKGROUND: Sinonasal inverted papillomas (SNIPs) are benign epithelial growths with high recurrence rates after surgical management. This study aims to evaluate SNIP recurrence rates after endoscopic surgery and to provide a comparison of published staging systems. METHODS: This chart review evaluated primary and revision SNIP cases from January 2008 to December 2016 at a tertiary sinus centre. Data was collected on patient demographics, origin site, surgical approaches, follow-up duration, recurrence, and smoking history. Each case was staged using Krouse, Oikawa, Cannady, Han, and Kamel systems. RESULTS: 52 primary and 22 revision SNIP patients had a mean follow-up of 42.3 (range:3-55) months. 11 primary cases (21.1%) and 5 revision cases (22.7%) had recurrences. Primary and revision cases had a mean time to recurrence of 24.0 (range:3-55) and 14.6 (range:10-20) months respectively. Smoking history had an OR of 0.63 (CI 95%: 0.18-2.22) for recurrence. The age group of 20-39 years featured the highest rates of recurrence. Patient groups defined by each staging system were compared by Kaplan-Meier survival analyses and logrank tests. Chi-squared values for Krouse, Oikawa, Cannady, Han, and Kamel systems were 6.73, 7.02, 6.19, 8.23 and 3.29, respectively. CONCLUSION: Recurrence rates found in this study are comparable to published literature. No statistical significance was found to associate smoking with recurrence. Han and Cannady staging systems were found to define patient groups that correlated well with recurrence. Staging systems should play a role in the management of SNIPs, especially to identify patients requiring additional post-surgical monitoring.