International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32902518 Rhinology on the move despite Covid-19! 417 417 EN P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Leuven, Belgium 2652 10.4193/Rhin20.805

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 Scoping review of chronic rhinosinusitis proteomics 418 429 EN S.S.-T. Kao Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia A. Bassiouni Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia M. Ramezanpour Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia N. Chegeni Flinders Proteomic Facility, Department of Human Physiology, Flinders University, Bedford Park, Australia A.D. Colella Flinders Proteomic Facility, Department of Human Physiology, Flinders University, Bedford Park, Australia T.K. Chataway Flinders Proteomic Facility, Department of Human Physiology, Flinders University, Bedford Park, Australia P.J. Wormald Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia S. Vreugde Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia A.J. Psaltis Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia 2524 10.4193/Rhin20.034 BACKGROUND: Progressive advances in proteomic technology has improved our understanding of the chronic rhinosinusitis (CRS) pathogenesis and endotypes. This scoping review aims to present a comprehensive and descriptive analysis of nasal mucosa and mucus proteome of CRS patients. METHODOLOGY: Studies investigating the proteome of nasal mucosa and mucus from healthy and CRS patients via mass spectrometry were included. Critical appraisal of methodological quality was conducted with extraction of protein lists. Gene set enrichment analysis (GSEA) was performed on studies including CRS patients. RESULTS: 2962 proteins were identified in the 21 studies included in this review. Eleven studies investigated the nasal mucus proteome and ten studies investigated the nasal mucosa proteome. Studies demonstrated heterogeneity in patients, sampling and mass spectrometry methodology. Samples from CRS patients suggested a trend in enrichment of immune system and programmed cell death pathways. Increased expression of proteins involved in cellular components including the cytoskeleton and adherens junctions was also present in CRS. CONCLUSIONS: Alterations in the healthy sinonasal proteome may lead to the increased immunological, metabolic and tissue remodeling processes observed in CRS. However, it is difficult to draw significant conclusions from the GSEA due to the heterogeneity present in the limited literature available. These findings allow us to direct further research to better understand CRS pathogenesis and its endotypes.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32626853 Self-reported alteration of sense of smell or taste in patients with COVID-19: a systematic review and meta-analysis on 3563 patients 430 436 EN D. Borsetto Department of Otolaryngology, Guys and St. Thomas Hospital NHS Foundation Trust, London, United Kingdom C. Hopkins Department of Otolaryngology, Guys and St. Thomas Hospital NHS Foundation Trust, London, United Kingdom V. Philips University of Cambridge Medical Library, Cambridge, United Kingdom R. Obholzer Department of Otolaryngology, Guys and St. Thomas Hospital NHS Foundation Trust, London, United Kingdom G. Tirelli Section of Otorhinolaryngology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy J. Polesel Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy P. Boscolo-Rizzo Department of Neurosciences, Section of Otorhinolaryngology, University of Padova, Treviso, Italy 2541 10.4193/Rhin20.185 BACKGROUND: Emerging reports suggest that new onset of smell or taste loss are potential early clinical markers of SARS-CoV-2 infection, but it remains unclear as to what extent. Therefore, the purpose of this study is to systematically assess the prevalence of self-reported altered sense of smell or taste in patients with confirmed SARS-CoV-2 infection, overcoming the limitations of individual studies by meta-analysis of pooled data. METHODS: The databases Medline, Embase, Web of Science, Scopus and MedRxiv's set were searched from inception to the 4th May 2020. This study was conducted following the PRISMA checklist. RESULTS: 18 studies met the eligibility criteria out of the 171 initially screened citations. The overall prevalence of alteration of the sense of smell or taste was 47% , but estimates were 31% and 67% in severe and mild-to-moderate symptomatic patients, respec- tively. The loss of smell and taste preceded other symptoms in 20% of cases and it was concomitant in 28%. CONCLUSIONS: Based on this meta-analysis, we recommend self-isolation and testing, where possible, for patients complaining smell or taste impairment during COVID-19 pandemic in order to prevent spread of disease and propose the inclusion of loss of smell and taste as recognized symptoms of SARS-CoV-2 in the World Health Organization and other relevant regulatory body’s lists.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 Trigeminal endonasal perception â€" an outcome predictor for septoplasty 437 443 EN S. Bischoff Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland S.C. Poletti Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Smell and Taste Clinic, Department of Otorhinolaryngology, ‘Technische Universitat Dresden’, Dresden, Germany; Department of Otorhinolaryngology-Head and Neck Surgery, University of Tubingen, Tubingen, Germany S. Kunz Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland S.-Y. Kiessling Department of Otorhinolaryngology Head and Neck Surgery, Kantonsspital St.Gallen, St.Gallen, Switzerland D. Hinder Department of Otorhinolaryngology Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Switzerland A. Dreher Swiss Institute of Asthma and Allergy Research (SIAF), University of Zurich, Davos Switzerland C.A. Akdis Swiss Institute of Asthma and Allergy Research (SIAF), University of Zurich, Davos Switzerland M.B. Soyka Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland 2523 10.4193/Rhin19.292 BACKGROUND: No adequate test exists to predict outcome after septoplasty. Despite adequate surgery, patients still might experience nasal breathing impairment. The aim of this study was to determine if pre-operative trigeminal sensitivity can predict satisfaction after septoplasty. METHODS: Single centre prospective cohort study in tertiary referral centre with follow-up time of 6 weeks postoperatively. Patients scheduled for septoplasty or septorhinoplasty with turbinoplasty were consecutively selected the day before surgery. Standard preoperative examinations (acoustic rhinometry and Sniffin’ Sticks 12 test), the evaluation of nasal obstruction on a visual analogue scale (VAS) and the trigeminal lateralisation task were performed before and 6 weeks after surgery. Biopsies were taken during surgery and TRPV1 mRNA expression was measured by PCR. RESULTS: Thirty patients were included with a median age of 29 years and equal gender distribution. Trigeminal perception and sensation of nasal obstruction showed a significant correlation: preoperative lateralisation test scores, representing endonasal trigeminal sensitivity, correlated significantly with the mean VAS change scores, which demonstrate subjective improvement. A lateralisation test score of 31.5 and more had a sensitivity of 88% to predict an improvement of more than 3 VAS points. Additionally, high TRPV1 mRNA expression was linked with good postoperative VAS scores. CONCLUSION: The preoperative evaluation of the trigeminal sensitivity could improve patients’ selection for septoplasty with a higher rate of satisfaction. Endonasal trigeminal sensitivity is directly linked with subjective outcome. Therefore, patients with low trigeminal sensitivity should undergo septoplasty only after thorough counselling.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32369537 T helper 2 inflammatory markers are associated with recurrence in chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery 444 450 EN G. Mortuaire Otorhinolaryngology â€" Head and Neck Department, Huriez Hospital, CHU Lille, France; Lille Inflammation Research International Center - Inserm U995, University of Lille, France I. Gengler Otorhinolaryngology â€" Head and Neck Department, Huriez Hospital, CHU Lille, France C. Carpentier Otorhinolaryngology â€" Head and Neck Department, Huriez Hospital, CHU Lille, France C. Szymanski Otorhinolaryngology â€" Head and Neck Department, Huriez Hospital, CHU Lille, France C. Chenivesse Pneumology and Allergology Department, Calmette Hospital, CHU Lille, 59000 Lille, France G. Lefevre Otorhinolaryngology â€" Head and Neck Department, Huriez Hospital, CHU Lille, France; Lille Inflammation Research International Center - Inserm U995, University of Lille, France; Medicine and Clinical Immunology Department, National Reference Center of Hypereosinophilic Syndromes, CHU Lille, France 2466 10.4193/Rhin19.439 BACKGROUND: Despite maximum medical treatment and endoscopic sinus surgery (ESS), chronic rhinosinusitis with nasal polyps (CRSwNP) can require revision surgery. With a growing literature on the diversity of cytokine inflammation patterns in CRSwNP, an endotype-driven approach could lead to the identification of cytokine profiles that predict recurrence. METHODS: A monocentric longitudinal study was carried out until June 2019 following CRSwNP patients who underwent surgery for the first time between December 2010 and January 2012. The biomarker profiles were established on blood and nasal secretions at the time of the first surgery (Interleukin (IL)-5, IgE, IgA, eosinophilic cationic protein (ECP) and eosinophilic- derived neurotoxin (EDN)). Profiles were compared between the patients still controlled by medical treatment and the patients requiring revision surgery during the course of the follow-up period. RESULTS: Among the 48 patients initially enrolled in our study, 8 required revision surgery (16,7%). Clinical features (asthma, allergy, aspirin intolerance, active smoking) and levels of blood markers measured at the time of the first surgery were comparable between the 2 groups of patients. Levels of IL-5, IgE and ECP in nasal secretions were significantly increased in the group of patients needing revision surgery. CONCLUSIONS: Based on simple approach of nasal secretions sampling, we showed that a predominant T helper 2 proteins expression profile can be associated with recurrent CRSwNP after ESS. Initial immunoprofiling in CRSwNP disease may contribute to better predict the therapeutic response to optimal medical and surgical treatment, and help define the role of innovative targeted treatment, beside corticosteroids and ESS.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32542237 Zinc-depletion associates with tissue eosinophilia and collagen depletion in chronic rhinosinusitis 451 459 EN M. Suzuki Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia; Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan M. Ramezanpour Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia C. Cooksley Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia T.J. Lee Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia B. Jeong Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia S. Kao Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia T. Suzuki Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan A.J. Psaltis Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia Y. Nakamaru Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan A. Homma Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan P.J. Wormald Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia S. Vreugde Department of Surgery - Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA, Australia 2530 10.4193/Rhin19.383 BACKGROUND: Zinc plays an important role in many biological processes. Reduced zinc levels have been found in chronic rhinosinusitis (CRS) patients, however, its role in the pathophysiology of this disease remains unknown. This study examined zinc levels in the serum, mucus and tissue from CRS patients in relation to collagen content and eosinophil infiltration. The effect of zinc depletion on inflammatory cytokine production and collagen synthesis was assessed in vitro. METHODOLOGY: Zinc levels were determined in serum, mucus and tissue from controls, CRS with (CRSwNP) and without nasal polyps (CRSsNP) patients. Tissue zinc levels, collagen and inflammatory cell infiltration was examined using zinquin assays, immunofluorescence and histology on Tissue Micro Arrays. Cytokine expression and collagen synthesis was evaluated in zinc depleted primary human nasal epithelial cells (HNECs) and primary fibroblasts. RESULTS: CRSwNP patients showed reduced tissue zinc levels in correlation with a reduction in collagen content, and increased eosinophil numbers. Zinc depletion of HNECs and fibroblasts induced the production of pro-inflammatory cytokines and MUC5AC and reduced collagen secretion. CONCLUSIONS: These results suggest mucosal zinc depletion associates with tissue eosinophilia and collagen depletion in CRSwNP and induces pro-inflammatory cytokine expression and reduction of collagen synthesis in vitro.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32427228 Squeeze bottle versus syringe nasal saline irrigation for persistent allergic rhinitis - a randomized controlled trial 460 464 EN P. Piromchai Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand P. Kasemsiri Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand W. Reechaipichitkul Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2511 10.4193/Rhin19.308 BACKGROUND: Nasal irrigation is widely used as an adjunctive treatment for allergic rhinitis. There is little evidence regarding the efficacy of the devices used in this procedure. The objective of this study was to evaluate the efficacy of the squeeze bottle nasal saline irrigation in persistent allergic rhinitis patients compared with a syringe. METHODOLOGY: We included patients between 18- and 60-years old presenting with persistent allergic rhinitis. All patients were instructed to perform nasal irrigation twice daily for four weeks. The patients were randomly assigned to use either the squeeze bottle nasal irrigation or a syringe for nasal irrigation. Symptoms score, physical examination results, satisfaction scores and adverse events were collected. RESULTS: There were 116 patients enrolled in the study, 58 of whom used the squeeze bottle nasal irrigation system and 58 of whom used a syringe. During a four-week follow-up, improvements in patients' nasal symptom scores for rhinitis symptoms were significantly greater in the group treated with the squeeze bottle. However, the physical examination score was no statistically significant difference. No adverse events were reported. The overall satisfaction scores for both devices were excellent. CONCLUSIONS: This study supports the regular use of nasal irrigation with a positive-pressure device, particularly a squeeze bottle, as an effective adjunctive treatment for allergic rhinitis. It is effective for reducing allergic rhinitis symptoms and can be used by patients with good compliance and minimal side effects.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32291418 The role of peak nasal and oral inspiratory flow in the evaluation of patients with sleep-related breathing disorders 465 470 EN G. Ottaviano Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy A.L. Pendolino Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy E. Nardello Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy M. Pollis Department of Neurosciences DNS, Odontostomatology Institute, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences, University of Padova, Padova, Italy R. Marchese-Ragona Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy 2458 10.4193/Rhin19.417 BACKGROUND: Sleep-related breathing disorders (SRBD) are common reported disorders in the adult population. The nose plays an important role in the development of SRBD; thus, the measurement of nasal respiratory function remains an important step in the management of these patients. Peak nasal inspiratory flow (PNIF) is a useful tool to assess nasal airflow and it has recently been studied together with peak oral inspiratory flow (POIF). Objective: The aim of the present study was to evaluate the role of PNIF and POIF in an adult population of patients affected by SRBD. METHODOLOGY: Seventy consecutive adult patients with SRBD were included in the present study. All patients were evaluated with home-based sleep studies (type III), PNIF, POIF, SNOT-22 questionnaire, Epworth Sleepiness Scale test and VAS for nasal obstruction. RESULTS: Although PNIF and POIF showed to correlate with each other, no correlations were observed between Apnea Hypopnea index (AHI) and PNIF, POIF or NPI (PNIF/POIF). A further analysis showed a marginal correlation between SNOT- 22 and AHI and between SNOT-22 and POIF. Furthermore, in a multivariate analysis, also POIF marginally correlated with some of the sleep- related SNOT-22 items. CONCLUSIONS: In the present study neither PNIF nor POIF were found to be associated with OSAS severity. However, POIF values correlated better than PNIF with sleep related symptoms suggesting that POIF could be a more useful parameter for upper airway assessment in patients with SRBD. In addition, a correlation between OSAS severity, in terms of AHI, and SNOT-22 total score has been reported.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32333750 “U-Sniff” - the international odor identification test for children: an extension of its normative database and study of global reliability 471 476 EN L. Zou Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China A. Dworschak Abteilung für Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität, Dresden, Germany R. Alizadeh ENT and Head and Neck Research Center and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran S.K. Kamrava ENT and Head and Neck Research Center and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran M. Alwashahi ENT Division, Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman M.A. Bock Otorrinolaringologa, Hospital General Barrio Obrero, Asuncion, Paraguay S. Boesveldt Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands B. Singh Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway I. Brusevold Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway V. Voznessenskaya Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russia T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany V.A. Schriever Abteilung für Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität, Dresden, Germany 2461 10.4193/Rhin19.355 BACKGROUND: To extend the previous study by Schriever and colleagues from 2018 providing normative data and re-investigating the reliability for U-Sniff test in children in additional countries. METHODOLOGY: A total of 388 children (196 boys, 192 girls) from eight countries (China, Germany, Iran, Netherlands, Norway, Oman, Paraguay, and Russia) participated in this study. The children were recruited from public local schools in those particular countries. The odor identification ability was evaluated using the U-Sniff test, a 12-item odor identification test developed for children. In addition, reliability was examined using test-retest design in the children for each country. RESULTS: The mean U-Sniff test score across all children was 10.3 ± 1.7 points. Normative data were established. A high test-retest reliability of the U-Sniff test was demonstrated across the eight participating countries. CONCLUSIONS: The U-Sniff test for children exhibits a high test-retest reliability on a global scale.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32369538 Systematic endoscopic assessment of bleeding sites in severe epistaxis: the role of the S-point and the superior epistaxis 477 481 EN C.N. Loures Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil T.C. Castro Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil G.R. Luz-Matsumoto Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil V.S. Siebert Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil L.S. Lacerda Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil M.V. Miranda Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil M.S. Tepedino Botafogo Polyclinic, Department of Otorhinolaryngology, Rio de Janeiro, RJ, Brazil L. Balsalobre Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil; Edmundo Vasconcelos Hospital Complex, Otorhinolaryngology, Sao Paulo, SP, Brazil A.C. Stamm Edmundo Vasconcelos Hospital Complex, Otorhinolaryngology, Sao Paulo, SP, Brazil E.M. Kosugi Federal University of Sao Paulo (UNIFESP-EPM), Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo, SP, Brazil 2467 10.4193/Rhin19.466 BACKGROUND: Systematic endoscopic assessment (SEA) of bleeding sites is critical for topodiagnosis and treatment of severe epistaxis, which is not limited to the posterior region. A bleeding site originating from the ethmoidal vasculature, the S-point, has recently been described. The aim of this study is to ascertain the prevalence of each bleeding site in severe epistaxis using a SEA protocol that includes the S-point. METHODOLOGY: Prospective longitudinal study of 51 severe epistaxis patients who underwent 53 SEA under general anesthesia from April 2018 through March 2019. SEA consisted of use of a rigid nasal endoscope; no reduction in blood pressure; no use of topical vasoconstrictor; systematic search of all regions of the nose. Bleeding sites were assigned to either superior or posterior epistaxis. RESULTS: At least one bleeding site was identified in 37 evaluations (69.8%). The S-point was the most common bleeding site (28.3%), followed by the lateral middle turbinate (9.4%), non-S-point upper septum (7.5%), nasal roof (7.5%), and upper lateral wall (7.5%). Superior epistaxis was identified in the most of cases (27 SEA, 50.9%), whereas only 14 SEA (26.4%) identified posterior epistaxis â€" fewer than the 16 SEA that did not identify any bleeding sites (30.2%). There were two recurrences (3.8%). CONCLUSIONS: Systematic endoscopic assessment effectively identified bleeding sites in 69.8% of severe epistaxis. The S-point was the most common bleeding site identified (28.3%). Finally, superior epistaxis corresponded to more than half of the identified bleeding sites, demonstrating the importance of examining this region judiciously in patients with severe epistaxis.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32396149 Comparison of a purely endoscopic three-layer technique versus pericranial flap for reconstruction of anterior skull base defects after sino-nasal tumor resection: assessment of postoperative frontal lobe sagging and frontal lobe falling 482 488 EN G. Fiacchini Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy S. De Santi Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy D. Trico Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy C. Cambi Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy V. Seccia First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy L. Cristofani-Mencacci Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy S. Berrettini Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy L. Bruschini Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy M. Scarano Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy I. Dallan Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Azienda Ospedaliero Universitaria Pisana, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Pisa, Italy 2470 10.4193/Rhin19.431 BACKGROUND: The evolution of endoscopic skull base approaches has enabled surgeons to manage selected skull base tumors through a transnasal endoscope-assisted approach. On the other side, more extensive lesions may require a combined cranioendoscopic approach. In this paper, we analysed and compared the incidence of frontal lobe sagging after endoscopic multilayer (EM) reconstruction versus pericranial flap (PF) reconstruction. METHODOLOGY: Subjects were selected retrospectively according to specific inclusion and exclusion criteria. The degree of frontal lobe sagging after surgery was calculated based on the most inferior position of the frontal lobe relative to the nasion-sellar line defined on preoperative and postoperative imaging. A positive value signified upward displacement, and a negative value represented frontal lobe sagging. RESULTS: Twenty subjects were enrolled in our study. In the EM technique group the average frontal lobe displacement was -2,34 ± 1,55 mm. The average postoperative frontal lobe sagging was -0,45 ± 8,92 mm in subjects reconstructed with the PF. The skull base defect size correlated with the degree of frontal lobe sagging in subjects reconstructed with the PF, but not in the other group and when merging the two groups. CONCLUSIONS: In conclusion, the EM technique and the PF reconstruction showed a good reliability for the closure of anterior skull base defects. Moreover the PF seemed to prevent frontal lobe sagging but, for larger skull base defects, it could be useful to be combined with other autologous or heterologous materials to avoid the frontal lobe falling.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32478337 Faster olfactory adaptation in patients with olfactory deficits: an analysis of results from odor threshold testing 489 494 EN B. Chen Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany M.K. Mahmut Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany; Food, Flavour and Fragrance Lab, Department of Psychology, Macquarie University, Sydney, Australia T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany 2518 10.4193/Rhin19.465 BACKGROUND: Patients with olfactory deficits often report rapid and lasting olfactory adaptation compared to the time when they had normal olfactory function. However, this phenomenon receives little scientific attention. This retrospective study aimed to compare the patterns of olfactory adaptation in normosmic controls and patients with olfactory impairment by analyzing the trajectory of turning points in odor threshold tests based on the staircase technique. METHODS: 4120 subjects (1684 hyposmia, 1742 anosmia and 694 normosmic controls) were included in this study. Their odor threshold, odor discrimination and odor identification ability were assessed using the Sniffin’ Sticks. We analyzed the trajectory of turning points in the odor threshold test. RESULTS: Current results suggested that patients with hyposmia needed significantly more trials to reach the final threshold scores than controls and anosmic group, and controls needed more trials than anosmic group. The difference between the first turning point and final threshold scores in the anosmic group was significantly larger than in the hyposmia group and in controls. CONCLUSION: People with poor olfaction seem to adapt faster to olfactory stimuli. The trajectory of turning points in odor threshold test may serve as an indicator of olfactory adaptation and function of olfactory receptors. Olfactory adaptation may provide a new tool in the assessment of subtle olfactory loss.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32478338 High-mobility group box 1 protein induces epithelialmesenchymal transition in upper airway epithelial cells 495 505 EN H.J. Min Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Chung-Ang University Hospital, Seoul, Republic of Korea J.W. Choe Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea K.S. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea J.H. Yoon The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea 3 The Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Republic of Korea 4 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea C.H. Kim The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea 2521 10.4193/Rhin18.281 BACKGROUND: In the treatment of rhinosinusitis, nasal polyps are a major problem, and the epithelial-to-mesenchymal transition (EMT) process is considered pivotal in their development. Although various studies have addressed the role of high mobility group box 1 (HMGB1) nuclear protein in this setting, its impact on EMT has yet to be evaluated. Our aim was the pathogenic mechanism of HMGB1 in EMT and EMT-induced upper respiratory nasal polyps. METHODS: We investigated the EMT-related effects of HMGB1 in human nasal epithelial (HNE) cells using western blot analysis, transepithelial-electrical resistance (TEER) testing, wound healing assay, and immunofluorescence. HNE cells were incubated in a low-oxygen environment to evaluate the role of HMGB1 in hypoxia-induced EMT. Further support for our in vitro findings was obtained through murine models. Human nasal polyps and nasal lavage fluid samples were collected for western blotting, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA). RESULTS: HMGB1 increased mesenchymal markers and decreased epithelial markers in HNE cells. Hypoxia-induced HMGB1 in turn induced EMT, apparently through RAGE signaling. We verified HMGB1-induced EMT in the upper respiratory epithelium of mice by instilling intranasal HMGB1. In testing of human nasal polyps, HMGB1 and mesenchymal markers were heightened, whereas epithelial markers were reduced, compared with tissue controls. CONCLUSION: HMGB1 secretion in nasal epithelium may be a major pathogenic factor in upper respiratory EMT, contributing to nasal polyps.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 New insights into tip supporting structures. Consequences for nasal surgery 506 515 EN M. Popko Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland E.H. Huizing c/o Department of Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands D.J. Menger Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, The Netherlands S.A.M.W. Verlinde-Schellekens Department of Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands S. Mackaaij Department of Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands R.L.A.W. Bleys Department of Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands 2532 10.4193/Rhin19.349 BACKGROUND: Knowledge of tip supporting structures is crucial for successful rhinoplastic surgery. The aim of this study was to provide detailed anatomical and histological descriptions of the tip supporting structures. METHODS: Serial coronal sections of the entire external noses from seven cadavers were studied after staining by Mallory-Cason and Verhoeff-Van Gieson procedures. RESULTS AND CONCLUSIONS: We found no histological evidence of ligaments between the cartilaginous- and bony parts of the nasal skeleton, and between the skin and the nasal skeleton. Instead, we found a perichondrial-periosteal lining within the soft tissue envelope. The main tip supporting and shaping structures are: septal and lobular cartilages, premaxillae, and the soft tissue envelope including the periosteal-perichondrial envelope/membrane. These findings may have clinical relevance in functional and aesthetic rhinoplasties.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32584331 FID Score: an effective tool in Hereditary Haemorrhagic Telangiectasia - related epistaxis* 516 521 EN F. Pagella Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy E. Maiorano Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy E. Matti Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy C. Tinelli Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy A. De Silvestri Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy S. Ugolini Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy R. Lizzio Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy C. Olivieri Molecular Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Italy A. Pusateri Otorhinolaryngology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy G. Spinozzi Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 2537 10.4193/Rhin20.078 BACKGROUND: Hereditary haemorrhagic telangiectasia (HHT) is a rare disease characterized by a multisystemic vascular dysplasia and epistaxis, that is the most common cause of disability and social impairment. Patient management strictly depends on the severity of this symptom; therefore, it is of paramount importance for the clinicians to effectively grade epistaxis severity. The aim of this report was to validate the Frequency, Intensity and Duration score (FID) for grading epistaxis severity in patients with HHT; we studied repeatability and external validity comparing FID score with Epistaxis Severity Score (ESS). METHODS: This is a descriptive, observational study that included 264 adult HHT patients with epistaxis. Diagnosis of HHT was established with Curaçao criteria or positivity at genetic testing. Nosebleed severity was evaluated according to the FID score and the ESS. The first 30 patients were included in the validation of the FID score, which was graded on days 0, 1, 3 and 7. In the remaining 234 patients, a comparison between the ESS and FID score was performed. RESULTS: The statistical analysis performed in order to validate the FID score showed very good agreement between scores calculated on different days; analysis comparing the FID score with the ESS revealed a high correlation between the two grading systems. CONCLUSIONS: The FID score is a quick, easy and precise tool for evaluating HHT-related epistaxis and could be a possible alternative to the ESS. The FID score meets the need for an intuitive and smart grading system that is easy to manage in clinicians’ hands.

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 33129201 The toll of noninfected CRS patients to the COVID-19 pandemic 522 523 EN L. Klimek Centre for Rhinology and Allergology, Wiesbaden, Germany J. Hagemann Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany A. Alali Centre for Rhinology and Allergology, Wiesbaden, Germany M. Spielhaupter ORL Clinic, Taunusstein, Germany T. Huppertz Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany K. HÃśrmann Mannheim University Hospital, Mannheim, Germany C. Matthias Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany 2702 10.4193/Rhin20.250

International Rhinologic Society Rhinology 0300-0729 58 5 2020 10 1 32683438 Predominance of an altered sense of smell or taste among long-lasting symptoms in patients with mildly symptomatic COVID-19 524 525 EN P. Boscolo-Rizzo Section of Otorhinolaryngology, University of Padova, Treviso, Italy J. Polesel Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy G. Spinato Section of Otorhinolaryngology, University of Padova, Treviso, Italy A. Menegaldo Section of Otorhinolaryngology, University of Padova, Treviso, Italy C. Fabbris Section of Otorhinolaryngology, University of Padova, Treviso, Italy L. Calvanese Section of Otorhinolaryngology, University of Padova, Treviso, Italy D. Borsetto Guy’s and St Thomas’ Hospitals, London, United Kingdom C. Hopkins Guy’s and St Thomas’ Hospitals, London, United Kingdom 2550 10.4193/Rhin20.263