International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31837217 The advantage of sytematic reviews and meta-analysis 401 401 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands 2200 10.4193/Rhin19.406

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31329812 Total intravenous anaesthesia versus inhaled anaesthesia for endoscopic sinus surgery: a meta-analysis of randomized controlled trials 402 410 EN N.R. Kolia Department of Otolaryngology Head and Neck Surgery, University of Rochester, Rochester, NY, USA L.-X. Man Department of Otolaryngology Head and Neck Surgery, University of Rochester, Rochester, NY, USA 1926 10.4193/Rhin19.171 BACKGROUND: Total intravenous anaesthesia (TIVA) with propofol, compared to inhaled anaesthesia (IA), has been proposed to reduce bleeding and improve surgical field quality during endoscopic sinus surgery (ESS), but prior meta-analyses have not been conclusive. We performed an updated meta-analysis to determine the benefit of TIVA versus IA during ESS. METHODOLOGY: PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing TIVA versus IA. Demographic and outcome data were extracted from articles meeting selection criteria and analysed. RESULTS: We included 12 RCTs for a total of 560 patients. Preoperative characteristics were similar between the two groups. Compared to IA, TIVA improved surgical visibility, estimated blood loss (EBL), and operative time. In a subgroup analysis with remifentanil as the short-acting opioid, TIVA improved surgical visibility, EBL, and operative time. These benefits were not seen with fentanyl as the short-acting opioid. CONCLUSIONS: TIVA with propofol, in comparison to IA, may improve surgical field quality, reduce blood loss, and decrease operative time for ESS. Remifentanil is the preferred short-acting opioid for TIVA in ESS.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31403138 Revision adenoidectomy in children: a meta-analysis 411 419 EN C.-H. Lee Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan W.-C. Hsu Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan J.-Y. Ko Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University T.-H. Yeh Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University M.-T. Lin Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan K.-T. Kang Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan 1937 10.4193/Rhin19.101 BACKGROUND: To estimate the rate of revision surgery after previous adenoidectomy in children and to compare the rate of revision adenoidectomy in children with different conditions and by using different surgical techniques. METHODOLOGY: The study protocol was registered on PROSPERO (CRD42018107877). Two authors independently searched databases, specifically PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords used were “adenoids,� “adenoidectomy,� “reoperation,� “revision,� and “regrowth.� The revision rate was pooled using a random-effect model. Subgroup analyses were conducted for children based on different settings, countries, risks of bias, and surgical techniques. RESULTS: A total 16 studies with 95 727 children were analyzed (mean age: 4.69 (1.62) years; 60% boys; sample size: 5983 patients). Five studies had a low risk of bias, 10 studies had a moderate risk of bias, and one study had a high risk of bias. The rate of revision adenoidectomy was 1.9%. Ages at initial surgery and follow-up were not significantly associated with revision surgeries. The revision rate was not significantly different in children receiving surgeries in different settings (single center vs multicenter vs population-based, country (non-United States vs United States, and risk of bias. Moreover, surgical techniques, such as curettage, suction cautery, microdebridement, and coblation did not significantly affect revision rates in children who received adenoidectomy. CONCLUSIONS: Revision surgery was undertaken with a frequency of 1.9% in children who underwent adenoidectomy. A lack of strong evidence exists to correlate surgical techniques with revision rate in pediatric adenoidectomy.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records 420 429 EN C. Hopkins ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK E. Williamson Department of Medical Statistics, London School of Hygiene S. Morris Department of Applied Health Research, University College London, London, UK C.S. Clarke Department of Primary Care and Population Health, UCL, London, UK M. Thomas University of Southampton, Southampton, UK H. Evans Department of Medical Statistics, London School of Hygiene P. Little University of Southampton, Southampton, UK V.J. Lund Ear Institute, UCL, London, UK H. Blackshaw Ear Institute, UCL, London, UK A. Schilder Ear Institute, UCL, London, UK C. Philpott Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Founda tion Trust, Great Yarmouth, UK J. Carpenter ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; Institute of Health Informatics, UCL, London, UK S. Denaxas Department of Medical Statistics, London School of Hygiene on behalf of the MACRO programme team 1952 10.4193/Rhin19.136 BACKGROUND: The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. METHODS: We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). RESULTS: From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. CONCLUSIONS: While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31545327 Quality of life impairment due to chronic rhinosinusitis in asthmatics is mediated by asthma control 430 435 EN K.M. Phillips Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA R. Talat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA D.S. Caradonna Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA S.T. Gray Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA A.R. Sedaghat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA 1979 10.4193/Rhin19.207 BACKGROUND: Chronic rhinosinusitis (CRS) and asthma, when comorbid, may influence each other’s disease course and decrease quality of life (QOL). Our objective was to determine if poorer asthma control due to CRS symptoms could be a mechanism for decreased QOL in asthmatic CRS patients. METHODS: A total of 120 asthmatic CRS patients were recruited. CRS symptom burden was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and patient-reported CRS symptom control, general health-related QOL was measured using the visual analog scale of the 5-dimensional EuroQol quality of life survey (EQ-5D VAS), and asthma control was measured using the Asthma Control Test (ACT). Association was sought between these outcome measures. A mediation model was created and validated to show that asthma control mediated the association between CRS symptom burden and decreased general health-related QOL. RESULTS: ACT score was associated with SNOT-22, EQ-5D VAS was associated with SNOT-22 score, and EQ-5D VAS was associated with ACT score. A statistically significant mediation effect for ACT score in the association between SNOT-22 and EQ-5D VAS), which represented 22.1% of the total effect of SNOT-22 on EQ-5D VAS, was identified. Similar findings were made for patientreported CRS symptom control instead of SNOT-22 score. CONCLUSIONS: In asthmatic CRS patients, a sizeable portion of CRS impact on QOL is indirectly mediated through the effect of CRS on poorer asthma control which may then drive decreased QOL.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31309201 Minimal unilateral peak nasal inspiratory flow correlates with patient reported nasal obstruction 436 443 EN I. Volstad Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway T. Olafsson Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway E.A. Steinsvik Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway F.A. Dahl Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway I. Skrindo Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway G. Bachmann-Harildstad Department of Otorhinolaryngology, Akershus University Hospital, Lorenskog, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway 1915 10.4193/Rhin19.178 BACKGROUND: Nasal septoplasty is a common surgical procedure, but a significant number of patients report equal, or some even worsened, symptom load postoperatively. Rhinologists struggle to find objective tests that adequately reflects disease burden. This study aimed to evaluate the correlation between the PNIF measurement of the most obstructed side with patient reported outcomes. METHODS: Bilateral and unilateral PNIF measurements were performed before and after topical decongestion in 528 patients scheduled for surgery due to nasal obstruction. Subjective outcomes were measured using Nasal Obstruction VAS and SNOT-22 with subdomains. Correlations between subjective and objective measurements were calculated and further explored using multivariate regression analyses. RESULTS: Significant negative correlations between PNIF and patient reported outcomes were found. Both bilateral and minimal unilateral PNIF correlations with NO-VAS were equal and stronger than correlations with SNOT-22 including subdomains concerning problems with nasal obstruction. Minimal unilateral PNIF did not show statistically significant gender difference. Topical decongestion decreased statistical correlations. CONCLUSIONS: The minimal unilateral PNIF shows a statistically significant but weak negative correlation with preoperative patient reported nasal obstruction, and values do not differ between genders. Clinical evaluation of patients presenting complaints of nasal obstruction could be supported by minimal unilateral PNIF.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 Optico-carotid recess and anterior clinoid process pneumatization â€" proposal for a novel classiï¬�cation and uniï¬�ed terminology: an anatomic and radiologic study 444 450 EN A. Andrianakis Department of Otorhinolaryngology, Medical University of Graz, Austria P.V. Tomazic Department of Otorhinolaryngology, Medical University of Graz, Austria A. Wolf Department of Otorhinolaryngology, Medical University of Graz, Austria F. Anderhuber Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University Graz, Austria C. Gerstenberger Department of Otorhinolaryngology, Medical University of Graz, Austria U. Pilsl Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University Graz, Austria H. Stammberger Department of Otorhinolaryngology, Medical University of Graz, Austria 1918 10.4193/Rhin19.194 BACKGROUND: The aims of this study were to propose a novel and uniï¬�ed classiï¬�cation system of the optico-carotid recess (OCR) and anterior clinoid process (ACP) pneumatization, determine their frequency in a Caucasian population and measure the size of the OCR. METHODOLOGY: A total of 200 specimen (400 sphenoid sinuses) were evaluated in a separate anatomic cadaveric study (n=100) and radiologic study (n=100) by using sphenoidal sinus cast and computed tomography (CT) scan. OCR was divided according to its location to the optic nerve into sub-optical and latero-optical OCR grade I-III. RESULTS: An OCR was found in 39% of the samples (78/200) and in 19% (38/200) it occurred bilaterally. Both, sub-optical and latero-optical OCR were identiï¬�ed in 14% of the sides (58/400), with a mean length and depth of 6.9 mm; 7.7 mm and 2.3 mm, 7.1 mm, respectively. We determined the pneumatized ACP frequency with 23% (46/200) and deï¬�ned 3 uniï¬�ed different types of pneumatization. CONCLUSIONS: The OCR is a reliable landmark to identify the optico-carotid region in endoscopic sphenoid sinus surgery, and can even be visualized by CT. Hence, preoperative investigation of the sphenoid region is mandatory. In our opinion, the classiï¬�cation presented in this study can be useful in order to avoid surgical complications.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31403136 Broncho-vaxom alleviates persistent allergic rhinitis in patients by improving Th1/Th2 cytokine balance of nasal mucosa 451 459 EN Q. Meng Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China P. Li Department of Otorhinolarygology Head and Neck Surgery, Fifth Hospital, Guangzhou Medical University, Guangzhou, China Y. Li Department of Otorhinolaryngology Head and Neck Surgery, The Second People’s Hospital of Shunde, Foshan, China J. Chen Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China L. Wang Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China L. He Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China J. Xie Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China X. Gao Department of Otorhinolaryngology Head and Neck Surgery, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China 1938 10.4193/Rhin19.161 BACKGROUND: Probiotics are mainly distributed in the mucosal system and have the ability to enhance mucosal barrier function and regulate immune responses. Broncho-Vaxom (BV), as a probiotic, has been applied to patients suffering from respiratory tract infections, but its potential effectiveness in allergic rhinitis (AR) has not been evaluated in human. This study aimed to investigate the clinical efficacy of BV in patients with persistent AR and to elucidate the underlying cellular mechanisms. METHODS: Sixty patients with AR were enrolled to this study and were randomly assigned to the BV group (n=30) and the placebo group (n=30). Changes of clinical symptoms and laboratory parameters of allergic inflammation were measured at baseline visit, immediately after BV treatment, four weeks, and eight weeks after the BV treatment. RESULTS: After BV treatment, medication score in the BV group was significantly decreased compared with placebo group, along with a significant drop of the total nasal symptom score and the individual nasal symptom scores (itching score: 23.72±5.32%; nasal rhinorrhea score: 18.59±4.83%; sneezing score: 23.08±4.98%). The levels of IL-4 and IL-13 in nasal lavage were diminished remarkably while the level of INF-γ was markedly increased in the BV group. This rendered a significant reduction of the ratio of IL-4/INF-γ. Moreover, a decrease of eosinophils in nasal smear was observed after BV treatment. The BV-induced favorable changes sustained for at least four to eight weeks post BV treatment. CONCLUSION: Oral administration of BV offers remarkable and sustained efficacy in alleviating AR symptoms and may be considered as an alternative therapeutic strategy for patients with persistent AR. BV acts by improving the overall mucosal immunity via restoring and maintaining the normal Th1/Th2 cytokine balance as an underlying cellular/signaling mechanism.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31407726 Self-perception of olfactory dysfunction is associated with history of Traumatic Brain Injury: post-hoc analysis from the OLFACAT survey 460 468 EN C. Langdon Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Sinonasal Inflammatory and Olfactory Research Group (INGENIO), IRCE, IDIBAPS, Barcelona, Catalonia, Spain; Centre for Biomedical Research on Respiratory Diseases (CIBERES), Spain I. Alobid Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Sinonasal Inflammatory and Olfactory Research Group (INGENIO), IRCE, IDIBAPS, Barcelona, Catalonia, Spain; Centre for Biomedical Research on Respiratory Diseases (CIBERES), Spain L. Quinto Institut de Salut Global de Barcelona (ISGlobal) de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, Catalonia, Spain A. Valero Centre for Biomedical Research on Respiratory Diseases (CIBERES), Spain; Allergy Section, Department of Pneumology and Allergy, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain C. Picado Centre for Biomedical Research on Respiratory Diseases (CIBERES), Spain; Allergy Section, Department of Pneumology and Allergy, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain C. Marin Sinonasal Inflammatory and Olfactory Research Group (INGENIO), IRCE, IDIBAPS, Barcelona, Catalonia, Spain; Centre for Biomedical Research on Respiratory Diseases (CIBERES), Spain J. Mullol Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Sinonasal Inflammatory and Olfactory Research Group (INGENIO), IRCE, IDIBAPS, Barcelona, Catalonia, Spain; Centre for Biomedical Research on Respiratory Diseases (CIBERES), Spain 1939 10.4193/Rhin18.295 BACKGROUND: Traumatic brain injury (TBI) is one of the main causes of smell loss. However, epidemiological studies evaluating the incidence in general population are scarce. The aim of this analysis is to investigate the prevalence of TBI-induced olfactory dysfunction (OD) in a general-based population study. METHODOLOGY: A cross-sectional population-based survey was distributed to general population (260,000 households) through the newspaper. The survey included four microencapsulated odorants (smell test) to assess smell loss and two self-administered questionnaires (odour description and epidemiology/health status). Participants were divided into two groups, with or without a history of TBI. RESULTS: From 10,783 returned surveys, 9,348 were analysed. The survey profile was a 43-year old woman with medium-high educational level, living in a city. The overall prevalence of TBI was 5% (N=464, 44.5±14.1 years old, 57% females). Recorded causes of TBI were traffic, domestic, or work accidents. Subjects with TBI reported a poorer subjective smell self-perception compared to non-TBI participants, and a decreases ability to identify mercaptan (odour added to gas used in cities). Although, using the smell test, both groups showed similar smell capacities. CONCLUSIONS: Subjects with TBI history report a higher frequency of self-perceived OD, and a decrease ability to smell the odour added to domestic gas. Having said that, the prevalence of OD, according to the smell test, was similar in both groups.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31502597 What drives depression in empty nose syndrome? A Sinonasal Outcome Test-25 subdomain analysis 469 476 EN C.-C. Huang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan P.-W. Wu Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngologyâ€"Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan C.-H. Fu Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan C.-C. Huang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan P.-H. Chang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan C.-L. Wu Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan T.-J. Lee Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China 1940 10.4193/Rhin19.085 BACKGROUND: Empty nose syndrome (ENS) is a debilitating disorder characterised by paradoxical nasal obstruction after excessive surgical excision of nasal tissues. ENS negatively impacts the quality of life (QOL) and psychological status of patients. This study aimed to determine the associations among disease-specific QOL impairments and the severity of anxiety and depression before and after surgery in ENS patients. METHODS: A total of 68 ENS patients were prospectively recruited and underwent submucosal Medpor implantation. QOL impairments and the severity of anxiety and depression were evaluated using the Sinonasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) 1 day before and 6 months after surgery. RESULTS: The BDI-II and BAI scores were significantly associated with the total score and ear/facial symptoms, psychological dysfunction, sleep dysfunction, and empty nose symptoms domains of the SNOT-25. Surgery improved disease-specific and psychological symptoms. Post-operative changes in the BDI-II score were correlated with changes in the total score and sleep dysfunction and empty nose symptoms domains of the SNOT-25. A SNOT-25 total score of greater than 60, sleep dysfunction domain score of greater than 18, and empty nose symptoms domain score of greater than 14 were good predictors of moderate-to-severe depression. CONCLUSIONS: ENS symptoms are associated with psychological burden and could be good predictors of moderate-to-severe depression. Targeted symptom improvement could reduce the psychological burden.

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31497802 Comment on the European position paper on diagnostic tools in rhinology â€" computational fluid dynamics 477 478 EN E. Wong Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney Medical School, Australia K. Inthavong School of Engineering, RMIT University, Melbourne, Australia N. Singh Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney Medical School, Australia 1963 10.4193/Rhin19.269

International Rhinologic Society Rhinology 0300-0729 57 6 2019 12 1 31497801 Reply to the letter by Wong et al. 479 479 EN J. Rimmer Department of Otolaryngology Head and Neck Surgery, Monash Health, Department of Surgery, Monash University, Melbourne, Australia 1964 10.4193/Rhin19.296.1