International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 Chronic rhinosinusitis disease control as a metric for guiding treatment 193 193 EN Ahmad Sedaghat Cincinnati, OH, USA Claire Hopkins London, UK 2517 10.4193/Rhin

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 31930219 Validity of systemic antibiotics and systemic corticosteroid usage for chronic rhinosinusitis as metrics of disease burden 194 199 EN K.M. Phillips Department of Otolaryngology, Stanford University, Stanford, CA, USA M.M. Speth Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland E.T. Shu Department of Otolaryngology, Harvard Medical School, Boston, MA, USA R. Talat Department of Otolaryngologyâ€"Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, 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 Otolaryngologyâ€"Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2233 10.4193/Rhin19.248 BACKGROUND: The frequencies of systemic antibiotics and oral corticosteroids taken for chronic rhinosinusitis (CRS) indicate poor CRS disease control. We sought to determine the validity and responsiveness of these metrics as reflections of CRS disease burden. METHODOLOGY: One hundred and eighty-seven patients undergoing medical management for CRS were recruited. Participants were assessed at two time points: enrollment and a follow-up appointment three to nine months later. At each time point, CRS related antibiotic and oral corticosteroid usage in the previous three months was measured, while general and disease-specific quality of life (QOL) was measured using the visual analog scale of the 5-dimension EuroQol questionnaire (EQ-5D VAS) and the 22-item Sinonasal Outcome Test (SNOT-22), respectively. RESULTS: The frequency of CRS-related antibiotics and oral corticosteroids use was cross-sectionally correlated with EQ-5D VAS and SNOT-22 at the corresponding time points. For participants reporting usage of these medications at enrollment, there was a decrease of 1 course per 3 months for both CRS-related antibiotics and oral corticosteroids. Change in CRS-related antibiotics from enrollment to follow-up was correlated with change in both EQ-5D and SNOT-22 over the same timeframe. The change in CRSrelated oral corticosteroids was correlated with change in both EQ-5D VAS and SNOT-22). These correlations were stronger in the subset of patients who had a change in these metrics over the study period. CONCLUSIONS: The frequencies of CRS-related antibiotic use and oral corticosteroid use are valid and responsive measures of CRS disease burden.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32478337 Autonomic dysfunction as an independent risk factor for uncontrolled inflammation in chronic rhinosinusitis following functional endoscopic sinus surgery 200 207 EN W.C. Chen Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Tajen University College of Pharmacy and Health care, Pingtung, Taiwan W.C. Lin Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan C.H. Yang Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan C.N. Wu Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan S.D. Luo Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2224 10.4193/Rhin19.238 BACKGROUND: Chronic rhinosinusitis (CRS) is a multi-factorial disorder that causes systemic symptoms beyond rhinologic symptoms alone. A possible association between autonomic nervous system (ANS) dysfunction and CRS has been identified; however, few studies have confirmed this observation. In this study, we prospectively measured changes in ANS dysfunction symptoms following functional endoscopic sinus surgery (FESS) and explored the impact of ANS dysfunction on surgical outcomes of CRS. METHODOLOGY: Patients diagnosed with CRS who consented to surgical intervention were included prospectively. All patients completed the Sino-nasal Outcome Test-22 (SNOT-22) and the 31-item Composite Autonomic Symptom Score (COMPASS 31) questionnaires before the operation and during the follow-up period. Clinical demographic data, Lund-Mackay, and modified Lund-Kennedy scores were recorded and measured. RESULTS: A total of 102 patients were enrolled. The median SNOT-22 and COMPASS 31 scores significantly improved following FESS from 43.0 to 14.0 and 21.0 to 11.2 (all P less than 0.001), respectively. FESS led to a significant reduction in the prevalence of various ANS dysfunction symptoms. In multivariate analyses, revision surgeries (odds ratio [OR] 5.012, 95% confidence interval [CI] 1.52416.489; P=0.008), CRS with nasal polyps (OR 4.071, 95% CI 1.454-11.40; P=0.008), and higher Pre-FESS COMPASS 31 scores (OR 1.043, 95% CI 1.003-1.084; P=0.036) were independent risk factors for uncontrolled inflammation following FESS. CONCLUSIONS: ANS dysfunction symptoms are prevalent in CRS and higher preoperative COMPASS 31 scores correspond with poor surgical outcomes. Following FESS, the majority of ANS dysfunction symptoms can be alleviated. Further investigations are required to explore the possible mechanism of how ANS is involved in the pathogenesis of CRS.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32441709 Evaluation of the effect of endoscopic partial middleturbinectomy surgery on the quality of life of patients with chronic rhinosinusitis and nasal polyps 208 212 EN M.M. Delarestaghi Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran S. Rajaeih Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran F.D. Firouzabadi ENT and Head and Neck Research Center, The Five Senses Institute, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran M. Jamali ENT and Head and Neck Research Center, The Five Senses Institute, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran M. Roomiani ENT and Head and Neck Research Center, The Five Senses Institute, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran M.D. Firouzabadi ENT and Head and Neck Research Center, The Five Senses Institute, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran F. Memari Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran H. Jahandideh Department of Otolaryngology-Head and Neck Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran 2231 10.4193/Rhin19.258 BACKGROUND: Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease. Endoscopic sinus surgery is recommended as a standard method when medical treatment fails. The effectiveness of various complementary surgical methods such as endoscopic partial middle-turbinectomy is controversial in the improvement of CRS symptoms in these patients. This study aimed to investigate the effect of endoscopic partial middle-turbinectomy on the quality of life (QOL) of patients with chronic rhinosinusitis and nasal polyps (CRSwNP) in Iran. METHOD: Ninety patients with CRSwNP of grades 3 and 4 were randomly assigned to either an intervention (45 patients) or control group (45 patients). In the control group, endoscopic sinus surgery without middle turbinectomy was performed and in the intervention group, endoscopic partial middle-turbinectomy was performed in addition to endoscopic sinus surgery. To evaluate the outcomes, the SNOT-22 QOL questionnaire was used, and the results were analyzed using SPSS version 24. RESULTS: Most of the patients were male and had a mean age of 39 years. The mean SNOT-22 QOL questionnaire scores were 49.13±16.72 and 52.51±16.95 before surgery in the control and intervention groups respectively, which did not show any significant difference. In contrast, after endoscopic surgery these scores changed to 28.46±12.38 and 11.13±5.55 in the control and intervention groups, respectively < and there was a significant difference between both groups. Although there was a significant improvement in both groups, the patients in the intervention group experienced more improvement than the control group (41.4 (±16.46) vs 30.7 (±18.27), respectively CONCLUSION: According to this study, it appears that the use of endoscopic partial middle-turbinectomy in addition to endoscopic sinus surgery improves CRS symptoms and the QOL of patients compared with endoscopic sinus surgery alone.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32415826 Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps 213 217 EN E.S. Lourijsen Department of otorhinolaryngology, Amsterdam UMC, location AMC, the Netherlands W.J. Fokkens Department of otorhinolaryngology, Amsterdam UMC, location AMC, the Netherlands S. Reitsma Department of otorhinolaryngology, Amsterdam UMC, location AMC, the Netherlands 2508 10.4193/Rhin19.468 BACKGROUND: European direct and indirect cost data is missing for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). This study was aimed to establish the economic burden of CRSwNP based on a Dutch cohort of patients. METHODS: A cross-sectional study was performed in adult patients with CRSwNP (N=115) to calculate mean annual direct medical costs and indirect costs per patient with CRSwNP. Outpatient visits, general practitioner visits, first aid visits, hospitalisation and patient travel expenses were measured with the iMTA medical consumption questionnaire. Missed workdays (absenteeism) and decreased productivity during paid work (presenteeism) or during daily life were measured with the and the iMTA productivity cost questionnaire. RESULTS: Total direct costs were €1501 per patient/year, primarily due to outpatient department visits and hospitalisation. Indirect costs were €5659 per patient/year, with productivity losses as major cost expense. CONCLUSION: Adult patients with CRSwNP have higher indirect costs than direct costs and this forms a substantial burden to society. Total annual costs of patients with CRSwNP are estimated to be 1,9 billion/year in the Netherlands.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32175529 Retronasal olfactory testing using candies sent by post and for screening purposes: a feasibility study 218 225 EN G. Besser Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria D. Tianxiang Liu Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria B. Prem Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria D. Iabloncsik Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria E. Pablik Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Austria C.A. Mueller Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria B. Renner Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany; Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany 2362 10.4193/Rhin19.230 BACKGROUND: The olfactory system is able to detect external odours through the orthonasal- and internal odours through the retronasal route. Flavour perception strongly relies on the sense of smell and this back route. In contrast to orthonasal, retronasal olfactory tests (ROT) are less frequently applied, although testing should be recommended for several reasons. The aim of the present investigation was to propose a suitable form of ROT for home-testing (and postal distribution) and evaluate a retronasal screening test. METHODOLOGY: Initially, 111 participants were tested using a 27-item version of the Candy Smell Test (CST). Fifty-four participants performed retesting, of which 25 subjects did so in a home-setting being supplied with professionally packed “candy-chains”. Seven candies were chosen by means of hit rate differences in normosmics and severely hyposmics/anosmics. The 7-CST is designed in a non-forced-choice fashion with same seven flavours to choose from. RESULTS: For the 27-item CST both groups (subjects performing home-testing and those performing retesting at the clinic) showed highly significant test-rest-reliabilities. The 7-CST was capable of discriminating healthy from diseased subjects when being tested in 116 healthy subjects and 47 patients suffering from olfactory dysfunction. CONCLUSION: The CST is suitable for home-testing and postal distribution. The new 7-item CST can be valuable for rapidly revealing anosmics. These findings help in further standardizing ROT, may encourage rhinologists to more routinely evaluate retronasal olfactory abilities and pave the way for larger epidemiologic studies also in regard to food preferences and nutritional behaviour.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32077449 Omalizumab in patients with NSAIDs-exacerbated respiratory disease 226 232 EN U. Forster-Ruhrmann Department of Oto-Rhino-Laryngology, Campus Virchow-Klinikum, Charite â€" Universitatsmedizin Berlin, Berlin, Germany; Department of Oto-Rhino-Laryngology, Campus Mitte, Charite - Universitatsmedizin Berlin, Berlin, Germany D. Stergioudi Department of Oto-Rhino-Laryngology, Campus Virchow-Klinikum, Charite â€" Universitatsmedizin Berlin, Berlin, Germany; Department of Oto-Rhino-Laryngology, Campus Mitte, Charite - Universitatsmedizin Berlin, Berlin, Germany G. Pierchalla Department of Oto-Rhino-Laryngology, Campus Virchow-Klinikum, Charite â€" Universitatsmedizin Berlin, Berlin, Germany; Department of Oto-Rhino-Laryngology, Campus Mitte, Charite - Universitatsmedizin Berlin, Berlin, Germany J.W. Fluhr Clinic for Dermatology, Venerology and Allergy, Charite - Universitatsmedizin Berlin, Berlin, Germany K.-C. Bergmann Clinic for Dermatology, Venerology and Allergy, Charite - Universitatsmedizin Berlin, Berlin, Germany H. Olze Department of Oto-Rhino-Laryngology, Campus Virchow-Klinikum, Charite â€" Universitatsmedizin Berlin, Berlin, Germany; Department of Oto-Rhino-Laryngology, Campus Mitte, Charite - Universitatsmedizin Berlin, Berlin, Germany 2354 10.4193/Rhin19.318 BACKGROUND: The association of acetylsalicylic acid (ASA) intolerance, chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, or chronic urticaria is known as NSAID-exacerbated respiratory disease (N-ERD). N-ERD patients often suffer from recurrent nasal polyps, severe asthma or also from urticaria. The aim of the present study was to retrospectively analyze the clinical efficacy of anti-IgE antibody treatment with omalizumab in patients with confirmed N-ERD. METHODS: In the open trial with patients receiving verum patients with CRSwNP, confirmed N-ERD by oral or nasal ASA challenges, asthma or chronic urticaria were included in the study. Rhinological and pulmonary parameters were evaluated before and after 3, 6 and 9 months of therapy by rhinological questionnaires (CRS VAS-scores and RSOM-31), nasal polyp (NP)-, ACT-scores and FEV1 values. Urticaria activity was monitored clinically. N-ERD patients with aspirin desensitization were included as control group (follow-up 9 months). RESULTS: In the omalizumab group 16 patients were included (10 female, 6 male, mean age 51 yrs). CRS symptoms, RSOM-31- and NP-score decreased significantly following omalizumab therapy compared to baseline. The ACT-score (MV 16.5 to 20.6) and FEV1values (MV 80 % to 89 %) improved significantly. No urticaria symptoms were reported after 3 months. Oral prednisolone therapy was required in one case and a repeated nasal sinus surgery in an additional case due to progression of NP. In the control group (8 female, 8 male, mean age 45 yrs) the NP-score was unchanged. CONCLUSIONS: Omalizumab is an effective therapy option in N-ERD patients in a 9 month study period.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 31904029 Predisposing factors of rhinitis medicamentosa: what can influence drug discontinuation? 233 240 EN E. De Corso “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy R.F. Mastrapasqua “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy L. Tricarico “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy S. Settimi “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy T. Di Cesare “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy D.A. Mele “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy L. Trozzi “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy G. Salonna “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy G. Paludetti “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy J. Galli “A. Gemelli” Hospital Foundation, IRCCS, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Catholic University of the Sacred Heart. Rome, Italy 2230 10.4193/Rhin19.295 BACKGROUND: the primary end point of our study was to define risk factors and identify the underlying conditions that may have led to the abuse of vasoconstrictors in rhinitis medicamentosa. Moreover, we analysed factors that may influence the vasoconstrictors discontinuation. METHODOLOGY: this was a prospective case-control observational study. Cases and controls were evaluated at the baseline in order define factors that may have influenced onset of rhinitis medicamentosa. They were re-evaluated at 3 months to verify symptoms control and drug discontinuation. Finally, they underwent a phone call questionnaire after 12 months regarding drug discontinuation. A potential bias of our study is that evaluating discontinuation we included subjects treated differently according to the main diagnosis. RESULTS: patients with rhinitis medicamentosa were more frequently smokers than controls, they had higher mean HAMA scores and positive psychiatric diseases history. Additionally, we frequently detected a local inflammation at nasal cytology in patients with rhinitis medicamentosa. A significant improvement in all nasal symptoms scores was observed in cases and controls but 29.4% of cases did not discontinue the vasoconstrictors. Two major factors negatively influenced discontinuation: positive nasal cytology and pathological HAMA score. CONCLUSION: we observed that positive local inflammation, anxiety and smoking habit correlate positively with vasoconstrictors abuse. In addition, we demonstrated that anxiety and local inflammation were the most important factors impairing drug discontinuation.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32091032 Sustained effects of intralymphatic pollen-specific immunotherapy on Japanese cedar pollinosis 241 247 EN T. Terada Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan S. Omura Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan Y. Kikuoka Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan M. Suzuki Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan Y. Inaka Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan T. Inui Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan M. Matsuda Laboratory of Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka, Japan T. Nabe Laboratory of Immunopharmacology, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka, Japan R. Kawata Department of Otolaryngology, Head and Neck Surgery, Osaka Medical College, Osaka, Japan 2356 10.4193/Rhin19.301 BACKGROUND: Intralymphatic immunotherapy (ILIT) for allergic patients requires only a few intralymphatic injections of the allergen. However, the effectiveness and safety for Japanese cedar pollinosis are unclear. The objectives of this study were to clarify whether and how long ILIT is effective for pollinosis, and its safety. METHODS: In an open pilot investigation followed by a double-blind, placebo-controlled study, patients with Japanese cedar pollinosis received 3 intralymphatic inguinal injections of the pollen extracts before the first pollen season. The symptom medication score (SMS), nasal provocation testing and scoring visual analogue scale (VAS) were assessed after the first-third seasons. RESULTS: (1) Although mild adverse events were induced at the injected site, severe adverse events were not noted. (2) During the latter part of the first season, ILIT-treated patients (n=12) tended to show improved SMS compared to placebo-treated (n=6) without statistical significance. When assessed by nasal provocation testing and VAS scoring after the first season, the effectiveness of ILIT was significant. (3) The effects of ILIT continued until the second or third season. (4) Neither allergen-specific antibodies nor Treg/Breg cells changed in the peripheral blood. CONCLUSIONS: ILIT was safe and effective for Japanese cedar pollinosis. The clinical effects remained for 1-2 years.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32441707 Prediction of malignant sinonasal inverted papilloma transformation by preoperative computed tomography and magnetic resonance imaging 248 256 EN L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China; Department of Otolaryngology Head and Neck Surgery, Beijing DiTan Hospital, Capital Medical University, Beijing, PR China G. Fang Department of Otolaryngology Head and Neck Surgery, Beijing DiTan Hospital, Capital Medical University, Beijing, PR China W. Yu Department of Radiology, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China B. Yang Department of Radiology, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China C. Wang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China L. Zhang Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China 2359 10.4193/Rhin19.240 BACKGROUND: Accurate preoperative prediction of the malignant transformation of sinonasal inverted papilloma (SNIP) is essential for radical resection of tumours and prevention of recurrence. We here explored the predictive value of preoperative computed tomography (CT) and magnetic resonance imaging (MRI). METHODOLOGY: The study was performed on 268 patients with SNIP with (n = 78) or without (n = 190) coexistent malignant transformation. We used univariate and multivariate logistic regression analysis method to screen for independent risk factors, and established a nomogram model. Finally, using receiver operating characteristic curves, we assessed the diagnostic value of the independent risk factors for malignant transformation of SNIP. RESULTS: We identified bone erosion on CT, change in convoluted cerebriform pattern (CCP) on MRI, and washout-type time intensity curve (TIC) of dynamic contrast-enhanced (DCE)-MRI were independent predictors of malignant transformation of SNIP. The scores of these three independent risk factors from the nomogram model were 10, 7 and 8, respectively. The area under the receiver operating characteristic curve for predicting SNIP malignancy was 0.954 for the nomogram model, 0.826 for bone erosion, 0.776 for washout-type TIC, and 0.810 for CCP mutation. CONCLUSIONS: Of the independent risk factors and related combination identified, the nomogram model based on bone destruction on CT, CCP mutation on MRI, and washout-type TIC of DCE-MRI had the best predictive value for malignant transformation of SNIP.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32238994 Quantification of airflow in the sinuses following functional endoscopic sinus surgery 257 265 EN J. Siu Department of Surgery, The University of Auckland, Auckland, New Zealand J. Dong School of Engineering, RMIT University, Melbourne, Australia K. Inthavong School of Engineering, RMIT University, Melbourne, Australia Y. Shang School of Engineering, RMIT University, Melbourne, Australia R.G. Douglas Department of Surgery, The University of Auckland, Auckland, New Zealand 2450 10.4193/Rhin19.387 BACKGROUND: Despite functional endoscopic sinus surgery (FESS) being the standard of care in medically recalcitrant chronic rhinosinusitis (CRS), its effect on sinus ventilation has not been fully characterized. Airflow simulations can help improve our understanding of how surgical strategies affect post-surgical sinus ventilation. METHODS: Eight postoperative sinonasal cavity models were reconstructed from a wide spectrum of CRS patients who had undergone FESS. Computational fluid dynamics modeling of steady-state, laminar, inspiratory airflow was performed. Ventilation was quantified and observed for all the sinuses in each model. RESULTS: Sinus aeration was enhanced following FESS, particularly in the maxillary and ethmoid sinuses. The degree of improvement was related to the extent of surgery performed. This finding was accentuated at a higher inhalational flow rate of 15L/min. The relationship between ostium size and corresponding sinus inflow was stronger for the maxillary and sphenoid sinuses. Maxillary inflow reached 50% in a mega-antrostomy patient, while negligible flow occurred in the frontal sinuses for except one whom had undergone a modified Lothrop procedure. CONCLUSIONS: This study has quantified sinus airflow in the largest set of post-FESS patients to date, to show that with increasing extensive surgery, the sinus and nasal cavity become more interconnected and functionally interdependent. Accordingly, sinus ventilation is improved. This may have important consequences for pre- and post-surgical assessment and planning, and on predicting how drug delivery treatments and devices can be designed to target the postoperative sinuses.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32441708 Using 3D printed sinonasal models to visualize and optimize personalized sinonasal sinus irrigation strategies 266 272 EN K. Zhao Department of Otolaryngology- Head and Neck Surgery, The Ohio State University, Columbus, OH, USA K. Kim Department of Otolaryngology- Head and Neck Surgery, The Ohio State University, Columbus, OH, USA J.R. Craig Department of Otolaryngology- Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA J.N. Palmer Department of Otolaryngology- Head and Neck Surgery, Perelmann School of Medicine at University of Pennsylvania, Philadelphia, PA, USA 2365 10.4193/Rhin19.314 BACKGROUND: Topical sinus irrigations (neti-pot, squeeze bottles) play a critical role in the management of sinonasal disease. However, due to intricate nasal anatomy, penetration of topical irrigations to targeted sinus regions may be highly variable, and difficult to objectively predict. Variables, including head positions, injection angles, flow rates, etc. may vary significantly depending on the individual’s anatomy. OBJECTIVE: The purpose of this study was to propose a novel idea: using a 3D printed model of sinonasal cavities to visualize and develop a patient-specific irrigation strategy. METHODS: As a proof of concept, 3D replicas of one patient’s sinonasal cavities pre- and post-surgery were printed with a Form2 SLA 3D printer based on their CT scans. The setup included rubber/silicon seals attached to the model’s nostrils to create a watertight seal with the irrigation device and food color dye added for better visualization of irrigation results. RESULTS: Irrigations were performed on the 3D models with various head positions, injection angles, and flow rates, and were successful to determine the optimal strategy to targeted sinuses. Significant differences were observed between different targeted sinuses and between pre and post-surgery models. CONCLUSION: With more affordable 3D printing, this technology may potentially improve patient care and patient education, allowing clinicians and patients to develop a personalized irrigation strategy and have visual confirmation.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32147672 The global transcriptomic signature in sinonasal tissues reveals roles for tissue type and chronic rhinosinusitis disease phenotype 273 283 EN A. Bassiouni Department of Otolaryngology, University of Adelaide, Adelaide, Australia J. Ou Department of Otolaryngology, University of Adelaide, Adelaide, Australia A. Schreiber Australian Cancer Research Foundation (ACRF) Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide, Australia; School of Biological Sciences, University of Adelaide, Adelaide, Australia; School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia J. Geoghegan Australian Cancer Research Foundation (ACRF) Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide, Australia A. Tsykin Australian Cancer Research Foundation (ACRF) Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide, Australia A.J. Psaltis Department of Otolaryngology, University of Adelaide, Adelaide, Australia P.-J. Wormald Department of Otolaryngology, University of Adelaide, Adelaide, Australia S. Vreugde Department of Otolaryngology, University of Adelaide, Adelaide, Australia 2360 10.4193/Rhin19.403 BACKGROUND: RNA sequencing (RNA-Seq) allows the characterization of a global transcriptomic signature in a least-biased fashion, but few studies have applied this method to investigate the pathophysiology of CRS. METHODS: We collected mucosal tissue samples from 6 CRS without nasal polyps (CRSsNP), 6 CRS with nasal polyps (CRSwNP), and 6 control patients. Additional matched polyp samples were collected from the 6 CRSwNP patients. RNA was extracted and sequenced on the Illumina HiSeq-2500. Differential gene expression and pathway analyses were performed. RESULTS: CRSsNP showed evidence of upregulated interferon-mediated immunity, MHC-class-I mediated antigen presentation, CXCR3 binding, neutrophil chemotaxis and degranulation, and potential downregulation of genes related to cilia movement and production. CRSwNP polyp tissue showed upregulation of B-cell mediated immune responses, but reduced expression of genes related to epithelial morphogenesis and haemostasis. Polyps also showed a generalized reduction of positive gene regulation. The sinonasal transcriptomic signature was largely determined by tissue type (polyp versus mucosa) and disease phenotype, with minimal signal originating from the individual patient. CONCLUSION: RNA-Seq is a useful tool to explore the complex pathophysiology of CRS. Our findings stress the importance of tissue selection in molecular research utilizing sinonasal tissue, and demonstrate the limitation of the sNP/wNP paradigm (and the importance of endotyping). On the other hand, classical CRSsNP/wNP disease phenotypes played some role in determining the global transcriptomic signature, and should not be hastily discarded. The value of RNA-Seq-described transcriptomic signatures in exploring endotypes is yet to be explored in future studies.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32251491 HPV may not play a role in all lacrimal transitional cell papilloma 284 288 EN H. Jones University Hospitals Southampton NHSFT, UK S. Gane Royal National Throat, Nose and Ear Hospital, London, UK J. Rimmer Department of ENT, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia K. Cuschieri The Scottish Human Papilloma Virus Reference Laboratory, UK V.J. Lund Royal National Throat, Nose and Ear Hospital, London, UK 2452 10.4193/Rhin19.283 BACKGROUND: Tumours of the lacrimal duct apparatus (LDA) are rare and heterogenous but knowledge of their aetiology is important for the rhinologist. A link between transitional cell papilloma/carcinoma (TCP/TCC) and human papilloma virus (HPV) has been suggested in previous studies. We aimed to add to this body of evidence by submitting 16 LDA tumour samples from our tertiary referral centre for HPV analysis. METHODOLOGY: All LDA tumour samples stored in the University College London tissue bank were submitted for HPV analysis by centralised nucleic acid extraction and HPV genotyping via a sensitive polymerase chain reaction (PCR). RESULTS: Only one of six transitional cell papillomas tested positive for HPV. Two of three transitional cell carcinomas returned HPV 16 positive results. Two inverted papillomas submitted were also HPV positive. CONCLUSIONS: Previously published literature has suggested a strong link between HPV and neoplasia of the lacrimal system. HPV has previously been demonstrated in all TCP and TCC. This is in contrast to our data, particularly for transitional cell papilloma where, in the largest sample of transitional cell papilloma in the literature thus far, we did not find a strong association with HPV. This casts doubt on the role of HPV in the papillomatous process in the lacrimal apparatus.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32441710 Personal protection and delivery of rhinologic and endoscopic skull base procedures during the COVID-19 outbreak 289 294 EN L. Van Gerven University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck Surgery, Leuven, Belgium P.W. Hellings University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck Surgery, Leuven, Belgium; University of Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Academic Medical Center Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands T. Cox Jessa Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Hasselt, Belgium W. Fokkens Academic Medical Center Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands C. Hopkins Guy’s and St Thomas’ Hospitals, Department of Otorhinolaryngology, London, United Kingdom V. Hox Cliniques Universitaires Saint-Luc, Department of Otorhinolaryngology, Head and Neck Surgery, Brussels, Belgium M. Jorissen University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck Surgery, Leuven, Belgium A. Schuermans University Hospitals Leuven, Department of Infection Control and Epidemiology, Leuven, Belgium; KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium P. Sinonquel University Hospitals Leuven, Department of Gastro-enterology and Hepatology, Leuven, Belgium K. Speleman Sint-Jan Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Bruges, Belgium V. Vander Poorten University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck Surgery, Leuven, Belgium; University Hospitals Leuven, Department of Oncology, section Head and Neck Oncology, Leuven, Belgium K. Van Gool University Hospital Antwerp, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp, Belgium T. Van Zele University of Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium I. Alobid Hospital Clinic Barcelona, Rhinology Unit and Smell Clinic, ENT Department, Centro Medico TEKNON, Barcelona, Spain 2453 10.4193/Rhin20.119 On March 11th 2020, the World Health Organization (WHO) declared COVID-19 pandemic, with subsequent profound impact on the entire health care system. During the COVID-19 outbreak, activities in the rhinology outpatient clinic and operation rooms are limited to emergency care only. Health care practitioners are faced with the need to perform rhinological and skull base emergency procedures in patients with a positive or unknown COVID-19 status. This article aims to provide recommendations and relevant information for rhinologists, based on the limited amount of (anecdotal) data, to guarantee high-quality patient care and adequate levels of infection prevention in the rhinology clinic.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32277751 Presentation of new onset anosmia during the COVID-19 pandemic 295 298 EN C. Hopkins Guy’s and St Thomas’ Hospitals, London, United Kingdom; King’s College, London, United Kingdom P. Surda Guy’s and St Thomas’ Hospitals, London, United Kingdom N. Kumar Edge Hill University Medical School, Orsmkirk, United Kingdom 2456 10.4193/Rhin20.116 INTRODUCTION: Anosmia has not been formally recognised as a symptom of COVID-19 infection. Growing anecdotal evidence suggests increasing incidence of cases of anosmia during the current pandemic, suggesting that COVID-19 may cause olfactory dysfunction. The objective was to characterise patients reporting new onset anosmia during the COVID-19 pandemic METHODOLOGY: Design: Survey of 2428 patients reporting new onset anosmia during the COVID-19 pandemic. Setting: Volunteer sample of patients seeking medical advice of recent onset self-diagnosed loss of sense of smell RESULTS: 2428 surveys were completed within 7 days; 64% respondents were under 40. The majority of respondents reported onset of their anosmia in the last week. Of the cohort, 17% did not report any other symptom thought to be associated with COVID-19. In patients who reported other symptoms, 51% reported either cough or fever and therefore met current guidelines for self-isolation. CONCLUSIONS: Anosmia is reported in conjunction with well-reported symptoms of coronas virus, but 1 in 6 patients with recent onset anosmia report this as an isolated symptom. This might help identify otherwise asymptomatic carriers of disease and trigger targeted testing. Further study with COVID-19 testing is required to identify the proportion of patients in whom new onset anosmia can be attributed to COVID-19.

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32240279 Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? 299 301 EN S.B. Gane Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom C. Kelly AbScent, 14 London Road, Andover, Hampshire, United Kingdom C. Hopkins Guy’s and St Thomas’ Hospitals, London, United Kingdom 2449 10.4193/Rhin20.114

International Rhinologic Society Rhinology 0300-0729 58 3 2020 6 1 32319971 Anosmia as a prominent symptom of COVID-19 infection 302 303 EN F. Heidari Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran E. Karimi Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran M. Firouzifar Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran P. Khamushian Internal Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran R. Ansari Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran M. Mohammadi Ardehali Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran F. Heidari Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran 2459 10.4193/Rhin20.140