International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 31127931 EPOS2020 and beyond 161 161 EN P.W. Hellings Clinical Department of Otorhinolaryngology, Head and Neck Surgery, Leuven, Belgium 1892 10.4193/Rhin19.403 The EPOS2020 Steering group is proud to introduce the EPOS2020 logo, the key goals, the core stakeholders, the planned methodology and the dissemination strategies for EPOS2020. This article is an introduction to the EPOS2020 project and presents the ambitions goals of the latest European Position Paper on Rhinosinusitis including new and expanded areas of research, novel insights into the pathophysiology and molecular diagnosis leading to better endotyping of patients, precision medicine in chronic rhinosinusitis (CRS), integrated care pathways and mobile health technology in CRS. New concepts for dissemination of the guideline using Internet and social media are being presented, and will improve impact of EPOS2020 in daily practice.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30810118 EPOS2020: development strategy and goals for the latest European Position Paper on Rhinosinusitis 162 168 EN W. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands M. Desrosiers Department of ORL-HNS, Universite de Montreal, Montreal, Canada R. Harvey Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia C. Hopkins Ear, Nose and Throat Department, Guys and St. Thomas' Hospital, London, United Kingdom J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain C. Philpott Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital, Great Yarmouth, UK I. Alobid Rhinology and Skull Base Unit, ENT Department, Hospital Clinic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain W.T. Anselmo-Lima Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil C. Bachert Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden F. Baroody Department of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, IL, USA M. Bernal-Sprekelsen ENT Department Hospital Quironsalud, University of Valencia, Valencia, Spain C. von Buchwald Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Hospital, Copenhagen, Denmark A. Cervin Department of Otolaryngology, Head and Neck Surgery, Royal Brisbane and Women’s Hospital; Faculty of Medicine, University of Queensland, Brisbane, Australia N. Cohen Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece L. De Gabory Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU de Bordeaux, Hopital Pellegrin, Centre F-X Michelet, Bordeaux, France R. Douglas Department of Surgery, The University of Auckland, Auckland, New Zealand P. Gevaert Department of Otorhinolaryngology, Ghent University, Ghent, Belgium A. Hafner University of Zagreb, Faculty of Pharmacy and Biochemistry, Zagreb, Croatia P. Hellings Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands; Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium; Department of Otorhinolaryngology, Head and G. Joos Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium L. Kalogjera ENT Department, Zagreb School of Medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia R. Kern Department of Otolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA A. Knill Patient representative, Opuscomms, London, UK J. Kocks Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore B.N. Landis Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland J. Limpens Medical Information Specialist, Medical Library, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands S. Lebeer Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium O. Lourenco FCS â€" UBI Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal P.M. Matricardi Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany C. Meco Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey; Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria L. O Mahony Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland S. Reitsma Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands D. Ryan Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Optimum Patient Care, Cambridgeshire, UK R. Schlosser Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, USA B. Senior UNC Otolaryngology, Head and Neck Surgery, Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery and Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA T. Smith Division of Rhinology and Sinus - Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA T. Teeling Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands P.V. Tomazic Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria S. Toppila-Salmi Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland D.Y. Wang Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore D. Wang Rhinology Division, ENT Department; Eye and ENT Hospital, Fudan University, Shanghai, China L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China V. Lund Royal National Throat, Nose and Ear Hospital, UCLH, London, UK 1878 10.4193/Rhin17.253 BACKGROUND: The European Position Papers on Rhinosinusitis from 2005, 2007 and 2012 have had a measurable impact on the way this common condition with high impact on quality of life is managed around the world. EPOS2020 will be the latest iteration of the guideline, addressing new stakeholders and target users, presenting a summary of the latest literature and evolving treatment modalities, and formulating clear recommendations based on all available evidence. METHODOLOGY: Based on the AGREE II framework, this article demonstrates how the EPOS2020 steering group will address six key areas to ensure consistency in quality and presentation of information in the latest rhinosinusitis clinical practice guideline: scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; recommendations and applicability; editorial independence. RESULTS: By analysing the guidance from AGREE II, we formulated a detailed development strategy for EPOS2020. We identify new stakeholders and target users and ratify the importance of patient involvement in the latest EPOS guideline. New and expanded areas of research to be addressed are highlighted. We confirm our intention to use mixed methodologies, combining evidence-based medicine with real life studies; when no evidence can be found, use Delphi rounds to achieve clear, inclusive recommendations. We also introduce new concepts for dissemination of the guideline, using Internet and social media to improve accessibility. CONCLUSION: This article is an introduction to the EPOS2020 project, and presents the key goals, core stakeholders, planned methodology and dissemination strategies for the latest version of this influential guideline.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30506068 Novel roles for nasal epithelium in the pathogenesis of chronic rhinosinusitis with nasal polyps 169 179 EN Marjolein E. Cornet Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands Katriina Kostamo Otorhinolaryngology, Kymenlaakso Central Hospital, Kotka, Finland Albert B. Rinia Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands Aeilko H. Zwinderman Clinical epidemiology, Academic Medical Center, Amsterdam, the Netherlands Danielle van Egmond Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands Esther J.J. de Groot Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands Wytske J. Fokkens Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands Cornelis M. van Drunen Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands 1857 10.4193/Rhin18.128 BACKGROUND: Airway epithelial cells have a well-accepted role in the regulation of local inflammatory processes in allergic and innate defence responses. However, their role the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) is unclear. The objective was to investigate whether potential differences in the mRNA expression profile of nasal epithelia from healthy individuals and from CRSwNP patients would shed new light on disease mechanisms. METHODS: Primary epithelial cells from nasal polyps of 24 affected individuals and from middle turbinates of 9 healthy controls were obtained using magnetic beat assisted isolation and were used for expression profiling using the Human Genome U133 Plus 2.0 Genechip Array. RESULTS: Multiple gene probes corresponding to 27 genes showed an aberrant expression profile in polyp epithelial cells compared to healthy controls. Most of these genes are linked to pathogenic mechanisms seen in neoplasm formation, including changes in cell-cell adhesion, metabolic processes, cell cycle control, and differentiation. Remarkably, our data additionally suggest a role for maternally expressed genes in the pathogenesis of CRSwNP and reveal two distinct states of polyp epithelium that could not be linked to the presence or absence of atopy in patients or to the level of eosinophilia or neutrophilia of the polyp. CONCLUSIONS: Our data suggest new roles for nasal epithelium in the pathogenesis of CRSwNP.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30610832 National prospective observational study of inpatient management of adults with epistaxis â€" a National Trainee Research Collaborative delivered investigation 180 189 EN INTEGRATE (UK National ENT research trainee network) on its behalf: Nishchay Mehta Department of Otolaryngology, National Throat Nose and Ear Hospital, London, UK Kara Stevens Department of Medical Statistics, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, United Kingdom Matthew E. Smith Department of Otolaryngology, Cambridge University hospitals NHS Foundation Trust Cambridge, United Kingdom Richard J. Williams Department of Otolaryngology, Institute of Naval Medicine, Gosport, United Kingdom Matthew Ellis Department of Otolaryngology, Newcastle University Hospital New Castle, United Kingdom John C. Hardman Department of Otolaryngology, The Royal Marsden Hospital, London, United Kingdom Claire Hopkins Department of Otolaryngology, King's College, London, United Kingdom 1863 10.4193/Rhin18.239 BACKGROUND: There is a paucity of high-quality evidence relating to the management of epistaxis severe enough to require admission to a hospital. Previous studies of interventions for epistaxis have suffered from small sample sizes. They lacked the power to allow analysis of the effect of an intervention on epistaxis control that is independent of the condition severity or additional interventions given. OBJECTIVE: To determine the effect of specialist treatments on the successful management of severe epistaxis METHODOLOGY: Secondary analysis of data collected from a national multi-centre audit of patients with epistaxis over 30 days in 2016. Data were entered prospectively, and patients were followed up for 30 days following hospital discharge. 1402 adults admitted for inpatient management of epistaxis were identified in 113 participating UK hospitals, with data entered prospectively during the 30-day audit window. Exposure variables assessed included treatment instigated at first ENT review, intervention strategy during hospitalization, disease factors (e.g. severity), patient risk factors (e.g. co-morbidities, medications) and treatment factors (grade of doctor, therapies initiated during hospital stay). Main Outcomes include treatment time (time from first ENT review to time haemostasis was achieved and patient was safe for hospital discharge) and 30-day hospital readmission rate. RESULTS: 834 patients had sufficient data for inclusion. Patients who did not receive nasal cautery at first specialist review had a treatment time greater than double the time of those who were cauterised: Adjusted ratio (aR) 2.5 (95% CI 1.7-3.3), after controlling for age, bleeding severity, and whether they received a nasal pack or not. Only 30% of patients received management that complied with new national guidance, but those that did were 87% more likely to be achieve haemostasis before those that did not, even after controlling for bleeding severity. Type of treatment, whether initial intervention or management strategy, did not affect 30-day re-attendance. CONCLUSIONS: Analysis of national audit data suggest that cautery at first specialist review, and management according to national guidance can reduce hospital treatment times without compromising 30-day re-attendance. Future work should investigate why early nasal cautery is infrequently used, and how service delivery can be optimised to allow widespread implementation of evidence-based management for epistaxis.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30609424 The sinonasal mycobiota in chronic rhinosinusitis and control patients 190 199 EN M. Hoggard School of Biological Sciences, The University of Auckland, Auckland, New Zealand M. Zoing School of Medicine, The University of Auckland, Auckland, New Zealand K. Biswas School of Medicine, The University of Auckland, Auckland, New Zealand M.W. Taylor School of Biological Sciences, The University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand R.G. Douglas School of Medicine, The University of Auckland, Auckland, New Zealand 1864 10.4193/Rhin18.256 BACKGROUND: While bacterial associations with chronic rhinosinusitis (CRS) are increasingly well described, fewer studies have examined the fungal component of the sinonasal microbiota. Here we present a study of the sinonasal mycobiota in a cohort of 144 patients (106 patients with CRS and 38 controls). METHODOLOGY: Fungal communities were characterised by analysis of mucosal swab samples of the left and right middle meatuses via ITS2 marker amplicon sequencing on the Illumina MiSeq platform. Fungal associations with previously published bacterial community and inflammatory cytokine and cell data for this cohort (collected at the same intra-operative time point) were also investigated. RESULTS: Malassezia spp. were ubiquitous and often highly predominant. Season of sampling explained more of the variability in the data than any of the clinical parameters. The predominant Malassezia sp. was distinct in patients with cystic fibrosis compared to those without. However, distinctions in the mycobiota were not evident between any other patient groupings assessed, and few fungal-bacterial or fungal-inflammatory associations were observed. CONCLUSIONS: This study confirms the prominent place of Malassezia spp. within the upper respiratory tract. Overall, few distinctions between patient groups were evident, and these data lend further support to the hypothesis that fungal community types may have no direct causative association with idiopathic CRS. Additional studies incorporating a broader array of inflammatory markers are required to assess whether these ubiquitous fungi nonetheless play an exacerbating role in some sensitive individuals.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30629049 Is atomised intranasal cocaine systemically absorbed during endoscopic sinus surgery? 200 205 EN D.E. Page Monash Health, Melbourne, Australia J. Rimmer Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia M. Keane Monash Health, Melbourne, Australia S. Manikappa Monash Health, Melbourne, Australia D. Butzbach Forensic Science, South Australia, Australia C. Giddings Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia 1870 10.4193/Rhin18.207 BACKGROUND: In order to perform endoscopic sinus surgery (ESS) safely and efficiently, preparation of the nasal mucosa with vasoconstrictor agents is crucial to minimise bleeding. There is no single best method, although traditionally cocaine has been the agent of choice. However, there have been concerns over the potential for systemic side effects when applied topically. With this concern in mind, there exists limited contemporary research looking at cocaine absorption in the context of ESS. This study aims to determine the amount and duration of systemic cocaine absorption after intranasal atomised administration of modified Moffett’s solution prior to ESS. METHODOLOGY: Twelve adults undergoing ESS were enrolled. Modified Moffett’s solution containing 100 mg cocaine hydrochloride and 1 mg of adrenaline was administered topically 5 minutes prior to surgery. Serum cocaine and the cocaine degradation product, benzoylecgonine, were measured at specific time points up to 12 hrs post administration. RESULTS: Peak plasma cocaine concentration occurred between 60 and 120 minutes post-administration (range 13-31 micrograms/L). The mean peak plasma concentration was 20.35 micrograms/L occurring at 120 minutes post-administration. Benzoylecgonine was detected in 11 subjects at 60 minutes post-administration and in all subjects 12 hours post-administration of cocaine. CONCLUSIONS: This study demonstrates that there are low levels of systemic absorption of cocaine when administered in an atomised modified Moffett’s formulation prior to endoscopic sinus surgery.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30778427 Anatomic variations of the paranasal sinuses in the general pediatric population 206 212 EN O. Cohen Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel M. Adi Department of Radiology, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel Y. Shapira-Galitz Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel D. Halperin Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel M. Warman Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel 1876 10.4193/Rhin18.193 BACKGROUND: The prevalence of sinuses’ anatomic variations in the healthy pediatric population has not been studied. The study describes the prevalence of known anatomic variations with regard to gender and age in this population. METHODS: A single academic institute observational cohort study. A total of 200 head CT scans were reviewed, subdivided into five equal age subgroups (0-4.99; 5-7.99; 8-10.99; 11-13.99; 14-17 years), with an equal male to female ratio. Different subgroups were randomly assigned to two senior residents (100 CTs each). A senior rhinologist and radiologist were randomly selected to review 100 CTs each. Consensus was reached after a joint review. Each CT was evaluated for the presence of sinuses and the following variations: deviated septum, frontoethmoidal, infraorbital, posterior-ethmoid cells (Kuhn, Haller, and Onodi cells, respectively) and concha bullosa. Definitions were made according to the European Position on Rhinosinusitis 2012. RESULTS: Gender did not affect sinus development or anatomical variations. The frontal and sphenoid sinuses were significantly less developed in the 0-4.99 years group. The point prevalence of concha bullosa and deviated septum significantly increased with age. The point prevalence of Haller cells demonstrated borderline significance among age groups, with children 0-4.99 demonstrating the lowest point prevalence. A significant association was found between the existence of Haller cells to Kuhn and Onodi cells. CONCLUSIONS: Anatomical variations should be expected in the pediatric population. Familiarity with their point prevalence and associations may assist pediatric endoscopic sinus surgery planning.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30556065 The prevalence and characteristics of local allergic rhinitis in Poland 213 218 EN Andrzej Bozek Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia, Katowice, Poland Wojciech Scierski Clinical Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia, Katowice, Poland Beata Ignasiak Outpatient Clinic PMR, Swietochlowice, Poland Jerzy Jarzab Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia, Katowice, Poland Maciej Misiolek Clinical Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia, Katowice, Poland 1862 10.4193/Rhin18.137 BACKGROUND: Local allergic rhinitis (LAR) is found in some patients with typical symptoms but who have negative skin prick tests and negative IgE to aeroallergens while presenting with positive nasal provocation tests for proper allergens. Little information about the clinical characteristics and prevalence of LAR has been published. The aim of this study was to determine the prevalence and characteristics of LAR in patients with symptoms of chronic rhinitis. METHODS: In total, 680 patients out of 3400 pre-screened subjects with chronic rhinitis who were at least 5 years old were included from 17 sites in Poland in the study protocol. The following medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR) and non-allergic (NAR) rhinitis were explored and compared. RESULTS: In total, 621 patients were examined. LAR was diagnosed in 109 (17.6%) patients; AR was diagnosed in 251 (40.4%) patients; and NAR was diagnosed in 261 (42%) patients. In the LAR group, younger, non-smoker patients with allergies to D. pteronyssinus or grass pollen were predominant. Polysensitization was more prevalent in AR patients than in LAR patients. Bronchial asthma was at a similar level in patients diagnosed with AR (38%) and LAR (35%) but was significantly less prevalent in patients diagnosed with NAR (16%). The mean age of disease onset was similar between patients with AR and LAR (17.6 plus or minus 4.8 yrs), and it was significantly lower than that in patients with NAR (24.5 plus or minus 6.9 yrs, p less than 0.05). CONCLUSIONS: LAR is a significantly understudied problem in patients of various ages with chronic nasal symptoms. Patients with LAR and AR have similar clinical phenotypes.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30688317 Free nasal floor mucosal grafting after endoscopic total ethmoidectomy for severe nasal polyposis: a pilot study 219 224 EN R. Moreno-Luna Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain J. Gonzalez-Garcia Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain J.M. Maza-Solano Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain E. Molina-Fernandez Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain C.D. Pinheiro-Neto Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA A. Del Cuvillo Bernal Rhinology and Asthma Unit, ENT Department, Hospital de Jerez, Jerez de la Frontera, Cadiz, Spain C. Langdon Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Clinical and Experimental, Respiratory Immunology, IDIBAPS, Hospital Clinic i Universitari, Barcelona, Spain S. Sanchez-Gomez Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain 1872 10.4193/Rhin18.178 BACKGROUND: We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation. RESULTS: Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty. CONCLUSION: Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30964471 Cold dry air provocation is a reliable diagnostic tool in nonallergic rhinitis 225 230 EN Y. Huang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China H. Lou Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China C. Wang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China; Department of Allergy, Beijing TongRen 1888 10.4193/Rhin18.187 BACKGROUND: No diagnostic criteria have been available for nonallergic rhinitis (NAR) to this point in time. Nonspecific nasal hyperresponsiveness (NHR), which could be efficiently assessed by cold dry air (CDA) provocation, is an essential feature of NAR. Thus, this study’s purpose was to assess the diagnostic value of CDA provocation in discriminating patients with NAR from healthy individuals. METHODS: CDA provocation was performed among 13 healthy volunteers and 15 NAR patients. Nasal symptom scores, total nasal volume (TNV), total nasal resistance (TNR) and minimal cross-sectional area (MCA) were checked before and after the provocation. Non-paramedic tests and receiver operating characteristic (ROC) curves were used in data evaluation. RESULTS: Subjects in the NAR group showed significantly larger changes after CDA provocation in total nasal symptom score (TNSS) and nasal congestion score compared with healthy volunteers, while the change for rhinorrhea score was comparable. Similarly, significant differences in the change of MCA and TNV were witnessed between both groups. We built a predictive model for NAR, Y = minus 3.285 plus 2.520 times the difference of TNR (%) plus 1.027 times the difference of TNSS minus 6.542 times the difference of TNV (%), whose area under curve was 0.93. According to the Youden index, the criterion was set to be Y greater than -0.52, when its sensitivity and specificity were 93.3% and 84.6%, respectively. CONCLUSIONS: With superior patient-friendliness, safety and efficacy, we successfully performed the first NAR predictive model in the Chinese population, based on a short protocol of CDA provocation, by means of both subjective scores and objective tests (acoustic rhinometry and rhinomanometry).

International Rhinologic Society Rhinology 0300-0729 57 3 2019 6 1 30739126 Nasal self-packing for epistaxis in Hereditary Hemorrhagic Telangiectasia increases quality of life 231 239 EN F. Droege Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany C. Lueb Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany K. Thangavelu Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany B.A. Stuck Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Marburg, Philipps-Universität Marburg, Marburg, Germany S. Lang Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany U. Geisthoff Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Marburg, Philipps-Universität Marburg, Marburg, Germany 1875 10.4193/Rhin18.141 STATEMENT OF PROBLEM: Hereditary hemorrhagic telangiectasia (HHT) is characterized by recurrent epistaxis that can lead to a feeling of losing control. We assessed potential benefits and side effects of different nasal packings used by patients themselves. METHOD OF STUDY: An online-questionnaire in English and German was used to analyze nasal self-packings. RESULTS: 588 of the 915 respondents suffered from HHT with most of them having moderate or severe epistaxis. Almost two thirds of the patients had already treated themselves with nasal packings. While one quarter used non-pneumatic nasal packings (NPNP) or pneumatic nasal packings (PNP), nearly half of the patients took only tissues to stop the bleeding. Patients with severe epistaxis used PNP more often than NPNP. Using nasal packings, most patients could stop their nosebleeds after a while. Patients using PNP reported the feeling of losing control less often and significant improvements in quality of life with a positive GBI. CONCLUSIONS: Our study showed that most patients with HHT using nasal self-packings could stop the bleeding after a while. Nasal self-packing is a user-friendly and secure method leaving patients more self-confident and independent.