International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32812534 How a small virus changed our world and the special role of anosmia 305 305 EN W.J. Fokkens ENT Department, Amsterdam Medical Center, Amsterdam, The Netherlands 2561 10.4193/Rhin20.804

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32452470 The use of throat packs in ear, nose and throat, oral and dental surgery: a systematic review 306 313 EN C.R. Anderson The Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Rd, Kings Cross, London, WC1X 8DA, United Kingdom Y. Premakumar Chelsea and Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, United Kingdom A.V. Navaratnam Northwick Park Hospital, Watford Rd, Harrow HA1 3UJ, United Kingdom M. Rouhani West Middlesex Hospital, Twickenham Rd, Isleworth TW7 6AF, United Kingdom A. Singh Northwick Park Hospital, Watford Rd, Harrow HA1 3UJ, United Kingdom 2512 10.4193/Rhin19.308 BACKGROUND: Throat packs are placed around the airway in patients undergoing upper airway surgical procedures under general anaesthetic to prevent aspiration or ingestion of blood, and consequent chest infections or postoperative nausea and vomiting (PONV). There is no definitive evidence for this, and each time a pack is placed, it risks being retained and obstructing the upper airway. This study aimed to determine whether throat packs are of benefit to patients undergoing upper airway surgical procedures. METHODS: Medline, Embase and Central were searched from conception to 15th January 2018 using individualised search strategies. A systematic search of multiple databases was undertaken using custom strategies to identify all relevant randomised controlled trials. Screening, risk of bias assessment and data extraction were undertaken independently by two authors. Primary outcomes included throat pain and PONV. Secondary outcomes included any adverse event documented. RESULTS: Thirteen papers were eligible for inclusion. No studies reported any instances of retained throat packs. Ten studies assessed the effect of throat packs on post-operative throat pain, with four papers showing a significantly higher incidence of pain when throat packs were used. One study showed throat pain to be slightly, but significantly, worse 24 hours post-surgery when a pack was not used. No paper showed throat packs to be of benefit in preventing PONV. CONCLUSION: The study was limited by methodological flaws of included trials, overall relatively low numbers of patients and difficulty in contacting authors to clarify information and obtain raw data. However, this systematic review found no evidence to support the use of throat packs. This supports the proposal that there is no indication for the routine use of throat packs in ENT, maxillofacial and dental procedures.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32251491 Nasal fluid cytology and cytokine profiles of eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyps 314 322 EN Z. Zhu Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China W. Wang Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China X. Zhang Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China X. Wang Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Y. Zha Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Y. Chen Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China L. Zhou Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China W. Lv Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China 2451 10.4193/Rhin19.275 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease with different clinical characteristics and different treatment responsiveness. The aims of this study were to compare the nasal fluid cytology and cytokines between eosinophilic CRSwNP (eCRSwNP) and non-eosinophilic CRSwNP (neCRSwNP) and establish a new multivariate model to predict eCRSwNP before surgery to improve personalized treatment for CRSwNP patients. METHODS: Eighty-six consecutive patients with CRSwNP and sixteen healthy controls were recruited in this study. Nasal fluid (NF) was collected from all subjects and nasal polyp tissue was collected during the surgery. The differential cell counts and concentrations of IL-6, IL-8, TNF-α and IL-10 in NF were measured. Univariate and multivariate logistic regression were used to identify predictors for eCRSwNP. RESULTS: There were more inflammatory cells in NF of CRSwNP than controls. The eosinophil percentage was significantly higher in eCRSwNP than neCRSwNP and controls. The level of IL-8 was significantly higher in neCRSwNP than in eCRSwNP and controls. Blood eosinophilia, nasal fluid eosinophilia, higher total ethmoid score / total maxillary score (E/M ratio) and higher visual analogue scale (VAS) score of CRS were associated with eCRSwNP, the area under receiver operating characteristic curve (AUC) was 0.800, 0.755, 0.703 and 0.648, respectively. Using the coefficients of multivariate regression, we set up a scoring system to predict eCRSwNP with three of the variates and the AUC was 0.883. CONCLUSION: ECRSwNP, neCRSwNP and healthy controls demonstrated different cytology and cytokine profiles in NF. A new preoperational multivariate prediction model for eCRSwNP with NF eosinophilia, blood eosinophilia and higher E/M ratio was established.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32175530 Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery 323 332 EN N.R. Rowan Division of Rhinology and Sinus Surgery, Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA Z.M. Soler Division of Rhinology and Sinus Surgery, Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA J.C. Mace Oregon Health and Science University, Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/ Skull Base Surgery, Portland, OR, USA M.P. Camilon Division of Rhinology and Sinus Surgery, Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA C. Palmer Division of Rhinology and Sinus Surgery, Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA R.H. Jones Division of Rhinology and Sinus Surgery, Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA T.L. Smith Oregon Health and Science University, Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/ Skull Base Surgery, Portland, OR, USA R.J. Schlosser Division of Rhinology and Sinus Surgery, Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, USA 2363 10.4193/Rhin19.412 BACKGROUND: Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS. METHODOLOGY: Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty. RESULTS: Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty. CONCLUSIONS: Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32219224 The Burden of Non-steroidal anti-inflammatory exacerbated respiratory disease from the patient’s perspective â€" a qualitative analysis of posts from the Samter’s Society 333 340 EN M.C. Alanin Guy’s Hospital, London, United Kingdom T. Laidlaw Translational Research in Allergy, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA The SamterÃ˘â‚¬â„˘s Society C. Hopkins Guy’s Hospital, London, United Kingdom; King’s College London, United Kingdom 2445 10.4193/Rhin19.430 BACKGROUND: A subset of patients with chronic rhinosinusitis with nasal polyps and asthma have non-steroidal anti-inflammatory drug exacerbated respiratory disease (N-ERD). Typically, these patients often have more difficult to treat symptoms of both chronic rhinosinusitis and asthma. They also have higher rates of revision after endoscopic sinus surgery. In this paper we aim to include the patient’s perspective of living with N-ERD. METHODS: In this qualitative study, three months of posts from the Samter’s Society Support Group on social media were screened and analysed. RESULTS: Thematic analysis revealed eight main themes with subthemes in relation to patient interpretations when living with NERD. Main themes included symptom severity, quality of life, biological treatment options, diet, surgery, medical treatment, lack of awareness of N-ERD, conflicts between medical professionals and the importance of the support group. CONCLUSIONS: This study adds to the growing body of evidence that many patients with N-ERD are living with uncontrolled disease which has significant impact on their quality of life. In addition, it has identified important themes that are relevant to know for doctors treating these patients. The results are also important for future research purposes. Finally, it has highlighted the importance of patient advocacy groups in providing support to patients living with chronic disease.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32415827 Sinonasal outcome test-22 and peak nasal inspiratory flow â€"valuable tools in obstructive sleep apnoea 341 348 EN C. Bengtsson Department of Surgical Sciences, Otorhinolaryngology, Head and Neck Surgery, Uppsala University, Uppsala, Sweden L. Jonsson Department of Surgical Sciences, Otorhinolaryngology, Head and Neck Surgery, Uppsala University, Uppsala, Sweden J. Theorell-Haglow Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden M. Holmstrom Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska University Hospital, Huddinge, Sweden C. Janson Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden E. Lindberg Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden 2509 10.4193/Rhin19.189 BACKGROUND: Sinonasal complaints contribute to low adherence to continuous positive airway pressure (CPAP) treatment. We aimed to investigate sinonasal health in obstructive sleep apnoea (OSA) patients, using the sinonasal outcome test-22 (SNOT-22), and to analyse whether SNOT-22 is affected by CPAP adherence. We also aimed to investigate whether peak nasal inspiratory flow (PNIF) was able to predict adherence to CPAP. METHODS: The study population comprised 197 OSA patients (60 females) initiating CPAP treatment. The SNOT-22, PNIF and the Epworth Sleepiness Scale were assessed at baseline and follow-up. One-night polygraphy, the Hospital Anxiety and Depression Scale, peak expiratory flow and health-related issues were assessed at baseline. At follow-up, the patients were categorised into adherent (more than 4 hours/night) and non-adherent (less than 4 hours/night) to CPAP treatment. RESULTS: The average time for following up CPAP treatment was (mean plus or minus SD) 24.0 plus or minus 23.9 days and it did not differ significantly between the groups. The SNOT-22 score was elevated among all OSA patients, 36.1 plus or minus 19.4. There was a larger improvement in the SNOT-22 score at follow-up among adherent CPAP users compared with non-adherent users (-10.4 plus or minus 13.9 vs. -3.2 plus or minus 15.4). A PNIF value of less than 100 litres/min increased the risk of non-adherence to CPAP with an adjusted odds ratio (OR) of 2.40 ((95% CI 1.16-5.00)). CONCLUSIONS: The SNOT-22 was elevated in patients with OSA, indicating a considerable sinonasal disease burden. The SNOT-22 improved with good CPAP adherence. A low PNIF value was able to predict poor CPAP adherence. Both the SNOT-22 and PNIF can be valuable tools in the evaluation of OSA patients and in the management of CPAP treatment.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32285046 Aerodynamic impact of total inferior turbinectomy versus inferior turbinoplasty â€" a computational fluid dynamics study 349 359 EN J. Siu Department of Surgery, The University of Auckland, Auckland, New Zealand K. Inthavong Mechanical and Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria, Australia Y. Shang Mechanical and Automotive Engineering, School of Engineering, RMIT University, Bundoora, Victoria, Australia S. Vahaji School of Engineering, Deakin University, Waurn Ponds, Victoria, Australia R.G. Douglas Department of Surgery, The University of Auckland, Auckland, New Zealand 2457 10.4193/Rhin20.011 BACKGROUND: The aim of this study was to investigate using computational fluid dynamics (CFD) the effects on nasal aerodynamics of two different techniques for reducing the inferior turbinate. This may assist in surgical planning to select the optimal procedure. METHODS: Virtual surgery using two techniques of turbinate reduction was performed in eight nasal airway obstruction patients. Three bilateral nasal airway models for each patient were compared: 1) Pre-operative 2) Bilateral inferior turbinoplasty 3) Bilateral total inferior turbinate resection (ITR). Two representative healthy models were included. CFD modeling of airflow was performed under steady-state, laminar, inspiratory conditions. RESULTS: Nasal airway resistance was slightly more reduced following ITR compared to turbinoplasty due to loss of the pressure gradient at the head of the IT. Turbinoplasty resulted in ventilation, pressure and wall shear stress profiles closer to those of healthy models. A more prominent jet-like course of the main flow stream was observed inferiorly in the ITR group. CONCLUSIONS: Nasal air conditioning was significantly altered following IT surgery. Overall differences between the groups were small and are unlikely to bear influence on nasal function in normal environments. Further studies using a larger number of patients and healthy subjects are required, attempting to establish a clinical correlation with long-term outcomes such as the perception of nasal patency, mucosal crusting and drying, and air conditioning in different environments. Since a large proportion of IT mucosa remains following turbinoplasty, future dependence on topical therapy should also be considered.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32812533 Analysis of expression profiling data suggests explanation for difficulties in finding biomarkers for nasal polyps 360 367 EN E.J. Lee Centre for Personalized Medicine, Linköping University, Linköping, Sweden D.R. Gawel Centre for Personalized Medicine, Linköping University, Linköping, Sweden S. Lilja Centre for Personalized Medicine, Linköping University, Linköping, Sweden X. Li Centre for Personalized Medicine, Linköping University, Linköping, Sweden S. Schäfer Centre for Personalized Medicine, Linköping University, Linköping, Sweden O. Sysoev Division of Statistics and Machine Learning, Department of Computer and Information Science, Linköping University, Sweden H. Zhang Division of Statistics and Machine Learning, Department of Computer and Information Science, Linköping University, Sweden M. Benson Division of Statistics and Machine Learning, Department of Computer and Information Science, Linköping University, Sweden 2560 10.4193/Rhin19.407 BACKGROUND: Identification of clinically useful biomarkers for Nasal Polyposis in chronic rhinosinusitis (CRSwNP) has proven dif-ficult. We analyzed gene expression profiling data to find explanations for this. METHODS: We analyzed mRNA expression profiling data, GSE36830, of six uncinate tissues from healthy controls and six NP from CRSwNP patients. We performed Ingenuity Pathway Analysis (IPA) of differentially expressed genes to identify pathways and predicted upstream regulators. RESULTS: We identified 1,608 differentially expressed genes and 177 significant pathways, of which Th1 and Th2 activation pathway and leukocyte extravasation signaling were most significant. We identified 75 upstream regulators whose activity was predicted to be upregulated. These included regulators of known pathogenic and therapeutic relevance, like IL-4. However, only seven of the 75 regulators were actually differentially expressed in NP, namely CSF1, TYROBP, CCL2, CCL11, SELP, ADORA3, ICAM1. Interes-tingly, these did not include IL-4, and four of the seven were receptors. This suggested a potential explanation for the discrepancy between the predicted and observed expression levels of the regulators, namely that the receptors, and not their ligands, were upregulated. Indeed, we found that 10 receptors of key predicted upstream regulators were upregulated, including IL4R. CONCLUSION: Our findings indicate that the difficulties in finding specific biomarkers for CRSwNP depend on the complex underly-ing mechanisms, which include multiple pathways and regulators, each of which may be subdivided into multiple components such as ligands, soluble and membrane-bound receptors. This suggests that combinations of biomarkers may be needed for CRSwNP diagnostics.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32199023 EGFR mutation and HPV infection in sinonasal inverted papilloma and squamous cell carcinoma 368 376 EN V.N. Cabal Dept Head and Neck Oncology, Instituto de Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain M. Menendez Dept Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain B. Vivanco Dept Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain S. Potes-Ares Dept Head and Neck Oncology, Instituto de Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain C. Riobello Dept Head and Neck Oncology, Instituto de Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain L. Suarez-Fernandez Dept Head and Neck Oncology, Instituto de Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain R. Garcia-Marin Dept Head and Neck Oncology, Instituto de Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain V. Blanco-Lorenzo Dept Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain F. Lopez Dept Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain C. Alvarez-Marcos Dept Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain J.L. Llorente Dept Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain M.A. Hermsen Dept Head and Neck Oncology, Instituto de Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain 2422 10.4193/Rhin19.371 BACKGROUND: To evaluate the involvement of EGFR signalling and HPV infection in a cohort of inverted sinonasal papilloma (ISP) and sinonasal squamous cell carcinoma (SNSCC) and their value for prognosis and clinical treatment. METHODS: We analysed 55 ISP, 14 SNSCC associated with ISP (SNSCC-isp) and and 60 SNSCC not associated with ISP (SNSCC-novo) for EGFR gene mutation and copy number gain, protein expression of EGFR and phosporylated EGFR (pEGFR), and HPV-infection and KRAS mutation. Findings were correlated to clinico-pathological and follow-up data. RESULTS: We found EGFR exon 20 mutations in 38% (7/18) ISP, in 50% (6/12) SNSCC-isp and in 5% (1/19) SNSCC-novo. EGFR was expressed in 92% of ISP, while pEGFR was observed in 54% (21/39). SNSCC-isp and SNSCC-novo demonstrated comparable expression of EGFR (57% and 33%) and of pEGFR (44% and 38%). We observed an inverse relation between EGFR exon 20 mutation and pEGFR expression. Four of 39 (10%) ISP carried HPV-16. Oncogenic HPV was detected in 3/12 (25%) SNSSC-isp and in 1/8 (13%) SNSCC-novo. KRAS mutations were not detected in any of the samples. HPV infection was inversely correlated with pEGFR expression but not with EGFR mutation. ISP with EGFR activation by mutation or by phosphorylation had longer ISP-free survival, however, neither EGFR exon 20 mutation, pEGFR expression nor HPV infection demonstrated prognostic value in SNSCC. CONCLUSIONS: EGFR exon 20 mutation is frequent in ISP and SNSCC-isp, while activation of EGFR through phosphorylation also plays an important role. Our data indicate that a large proportion of SNSCC patients could benefit from therapy with modern EGFR inhibitors.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32352451 "Tailored" approach to selected recurrent cranio-cervical chordomas: experience and lessons learned 377 383 EN I. Dallan ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy M. de Notaris Department of Neurosurgery, Hospital "G. Rummo", Benevento, Italy M. Verstegen Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands G. Fiacchini ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy C. Cambi ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy V. Seccia ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy M. Caniglia Department of Neurosurgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy W. van Furth Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands 2463 10.4193/Rhin19.302 BACKGROUND: Among chordoma patients, recurrent cases are by far more complex to be managed, and cranio-cervical junction (CCJ) localizations represent a particular challenge due to the complexity of the anatomical region which makes it difficult to obtain a radical resection. METHODOLOGY: We report our personal experience in treating four patients with recurrent CCJ chordoma with “personalized” multiportal and eventually multistage approaches. CONCLUSIONS: Endoscopic endonasal approaches have gained widespread acceptance and are considered the workhorse in most cases of craniocervical junction chordomas. Nonetheless, in some cases of recurrence, or in presence of very lateralized lesions/ anatomical variations midline approaches are either contraindicated or very difficult to perform. In all these cases it seems reasonable to consider a versatile strategy including different approaches, modulating the surgical needs with different answers and solutions offered by the different routes. In other words to personalize as much as possible the approach, being creative and not dogmatic.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32333751 Rhinology Future Debates 2018, a EUFOREA Report 384 393 EN E. Prokopakis Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece A. Vardouniotis ENT Department, St Mary’s Treatment Centre, Portsmouth, UK C. Bachert Ghent University Hospital, Ghent, Belgium J. Bousquet University Hospital, Montpellier, MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France S. Carrie ENT Department, Newcastle upon Tyne NHS Hospitals FT, Newcastle upon Tyne, UK P. Castelnuevo Department of Otorhinolaryngology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo, Varese, Italy J. Constantinidis 1st Department of Otorhinolaryngology, Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece W. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands C. Hopkins ENT Department, Guy's and St Thomas' Hospital, London, UK A. Leunig Rhinology Center, ENT-Clinic Bogenhausen, Dr. Gaertner GmbH, Munich, Germany G. Molteni Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy J. Mullol Clinical and Experimental Respiratory Immunoallergy, Hospital Clínic, IDIBAPS, Barcelona, Spain G. Scadding The Royal National Throat Nose and Ear Hospital, London, UK G. Marien European Forum for Research and Education in allergy and Airway Diseases (EUFOREA), Brussels, Belgium M. Doulaptsi Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece P. Hellings Ghent University Hospital, Ghent, Belgium; 1st Department of Otorhinolaryngology, Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece; Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium 2460 10.4193/Rhin19.455 The third Rhinology Future Debates was organized by the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) in 2018 in Brussels. Experts from different specialties and countries, alongside patients, health policy makers and industry representatives discussed relevant topics in Rhinology, in an attempt to improve current clinical practices, through implementation of precision medicine, by empowering patients’ participation and the use of eHealth tools. The debates which are available on-line (www.rhinology-future.com) dealt with 5 topics in Rhinology: the adoption of allergen-specific immunotherapy (AIT) by implementing change management strategies, the needs and obstacles in care delivery in respiratory diseases, 3D technology in nose and sinus surgery, ambulatory nasal surgery, and clinical evidence for efficacy of biologicals in CRSwNP and asthma. This report summarizes the outcomes of the brainstorming sessions highlighting novel approaches and unmet needs in the field of respiratory diseases by focusing on integrated care pathways.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32386285 Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers â€" A systematic review of the literature, case series, and recommendations for clinical assessment and management 394 399 EN M. Lechner Whipps Cross University Hospital, Barts Health NHS Trust, UK; UCL Cancer Institute, University College London, London, UK D. Chandrasekharan Whipps Cross University Hospital, Barts Health NHS Trust, UK K. Jumani Whipps Cross University Hospital, Barts Health NHS Trust, UK J. Liu UCL Cancer Institute, University College London, London, UK S. Gane Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK V.J. Lund Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK C. Philpott The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK; Norwich Medical School, University of East Anglia, Norwich, UK S. Jayaraj Whipps Cross University Hospital, Barts Health NHS Trust, UK 2469 10.4193/Rhin20.189 BACKGROUND: Healthcare workers are at the forefront of the ongoing COVID-19 pandemic and are at high risk for both the contraction and subsequent spread of virus. Understanding the role of anosmia as an early symptom of infection may improve monitoring and management of SARS-CoV2 infection. METHODOLOGY: We conducted a systematic review of the literature of SARS-CoV2 infection/COVID-19 and anosmia to help inform management of anosmia in healthcare works. We report a case series of healthcare workers, who presented with a loss of sense of smell secondary to COVID-19 infection to demonstrate management principles. RT-PCR was used to confirm COVID-19 positivity and psychophysical testing of olfaction was performed using the British version of the University of Pennsylvania Smell Identification Test, UPSIT. RESULTS: The systematic literature search returned 31 articles eligible for inclusion in the study and informed our recommendations for clinical assessment and management. All three healthcare professionals who presented with loss of sense of smell subsequently tested positive for SARS-CoV-2. Psychophysical testing of olfaction using the UPSIT confirmed mild and moderate microsmia in two, respectively, and normosmia at day 17 in one. CONCLUSIONS: Olfactory (± gustatory) dysfunction is indicative of COVID-19 infection and thus has important implications in the context of healthcare workers, or key workers in general, who work in close contact with others if not recognised as suffering from COVID. This leads to a potentially higher likelihood of spreading the virus. In conjunction with our literature review these findings have helped with creating recommendations on the assessment and management of olfactory dysfunction during the ongoing COVID-19 pandemic, both for healthcare workers and patients.

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32338254 Olfactory and rhinological evaluations in SARS-CoV-2 patients complaining of olfactory loss 400 401 EN G. Ottaviano Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy M. Carecchio Department of Neurosciences, Neurological Section, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences and Department of Mathematics Tullie Levi-Cijita, University of Padova, Padova, Italy R. Marchese-Ragona Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy 2462 10.4193/Rhin20.136

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32352450 Sniffing out the evidence; It’s now time for public health bodies recognize the link between COVID-19 and smell and taste disturbance 402 403 EN J.R. Lechien COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium C. Hopkins Guys and St Thomas NHS Foundation Trust, London, UK S. Saussez Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Universite Libre de Bruxelles, Brussels, Belgium 2464 10.4193/Rhin20.159

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32533768 Time scale for resolution of olfactory dysfunction in COVID-19 404 405 EN M.M. Speth Klinik fur Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland T. Singer-Cornelius Klinik fur Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland M. Oberle Institute for Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland I. Gengler Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA S.J. Brockmeier Klinik fur Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland A.R. Sedaghat Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2528 10.4193/Rhin20.227

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32542238 Acute smell and taste loss in outpatients: all infected with SARS-CoV-2? 406 409 EN M. Renaud Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France A. Leon Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France G. Trau Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France L. Fath Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France S. Ciftci Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France Y. Bensimon Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France A. Venkatasamy Department of Radiology 1, University Hospital of Strasbourg, France C. Debry Department of Otolaryngology, Head and Neck Surgery, University Hospital of Strasbourg, France; INSERM Unit 1121, Strasbourg, France 2531 10.4193/Rhin20.199

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32533767 How I do it: Surgical management of maxillary sinus hemangiomas via prelacrimal approach 410 415 EN L.V. Tran Department of Otolaryngology Head and Neck Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Vietnam; Department of Rhinology, Ear Nose Throat Hospital of Ho Chi Minh city, Ho Chi Minh city, Vietnam L.T. Le Department of Rhinology, Ear Nose Throat Hospital of Ho Chi Minh city, Ho Chi Minh city, Vietnam P.J. Wormald Department of Surgery - Otolaryngology Head and Neck Surgery, Adelaide University, Adelaide, Australia 2527 10.4193/Rhin20.178

International Rhinologic Society Rhinology 0300-0729 58 4 2020 8 1 32533766 The effect of olfactory training on olfactory bulb volumes in patients with idiopathic olfactory loss 413 415 EN M.K. Mahmut Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Food, Flavour and Fragrance Lab, Department of Psychology, Macquarie University, Sydney, Australia M. Musch Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany P. Han Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Faculty of Psychology, Southwest University, Chongqing, China; Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing, China N. Abolmaali Department of Radiology, Municipal Hospital and Academic Teaching Hospital of the Technical University Dresden, Dresden Friedrichstadt, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 2526 10.4193/Rhin20.223