International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 33253349 Comparing outcomes: the KISS principle 529 529 EN W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC Amsterdam, Amsterdam, The Netherlands 2723 10.4193/Rhin20.806 Not availale

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32679584 Outcomes of microdebrider-assisted versus radiofrequency-assisted inferior turbinate reduction surgery: a systematic review and meta-analysis of interventional randomised studies 530 537 EN A.A. Mirza Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia, and Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia T.A. Alandejani Department of Surgery-Division of Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, and Department of Surgery-Division of Otolaryngology, Ministry of the National Guard â€" Health Affairs, Jeddah, Saudi Arabia, and King Abdullah International Medical Research Center, Jeddah, Saudi Arabia H.Y. Shawli Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine,University of Jeddah, Jeddah, Saudi Arabia M.S. Alsamel Department of Otolaryngology, Head and Neck Surgery, King Fahad General Hospital, Jeddah, Saudi Arabia M.O. Albakrei Department of Otolaryngology, Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia H.M. Abdulazeem Department of Sport and Health Sciences, Technische Universität, München, München, Germany 2549 10.4193/Rhin19.350 BACKGROUND: The microdebrider technique was introduced in clinical practice to provide a better outcome in nasal obstruction caused by inferior turbinate hypertrophy. We conducted this systematic review to evaluate the effectiveness of this technique, by comparison with the radiofrequency-assisted modality. METHODOLOGY: PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched to retrieve relevant randomised studies published prior to November 2019. Randomised Trials in English that studied the difference between the two techniques among adult patients were eligible for the current review. Data extraction and study inclusion were guided by PRISMA guidelines. The outcome measures were visual analogue scale (VAS, 0-10) for nasal obstruction, anterior active rhinomanometry, and acoustic rhinometry. A meta-analysis was carried out to quantify the difference between the two techni- ques, for each measured outcome. RESULTS: Seven randomised trials were included and quantitatively analysed in this meta-analysis. Our analysis revealed that the microdebrider-assisted technique demonstrated significantly better VAS (0-10) for nasal obstruction scores in early and late posto- perative follow-up. Whilst no difference was noted using the objective measurements (rhinomanometry and acoustic rhinometry) at early follow-up, microdebrider-assisted technique showed superior results in long-term follow-up, as evidenced using anterior active rhinomanometry. CONCLUSIONS: The microdebrider-assisted technique results in a better outcome, particularly in long-term follow-up, when compa- red with radiofrequency.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32720936 The Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS): a new CT-based scoring system grading the extent of surgery 538 543 EN S. Reitsma Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands G.F.J.P.M. Adriaensen Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands M.E. Cornet Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands R.M. van Haastert Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands M.H. Raftopulos Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands 2555 10.4193/Rhin20.165 BACKGROUND: A debate is ongoing on the role of the extent of sinus surgery in disease control in chronic rhinosinusitis (CRS). The newly developed Amsterdam Classification on Completeness of Endoscopic Sinus Surgery (ACCESS) score provides a way to quantify extent of surgery. This study aimed to validate the ACCESS scoring system and to report its interrater agreement compared to the widely used Lund-Mackay (LM) scoring system. METHODOLOGY: Forty hand-picked anonymized computed tomography scans of sinuses of patients with varying pathology and degree of previous sinus surgery were independently scored by six rhinologists. Interrater agreement was determined by the intraclass correlation (ICC) statistic. RESULTS: The interrater agreement of the ACCESS score was excellent, comparable to the LM score. The ACCESS interrater agreement was not influenced by degree of opacification or diagnosis. The ACCESS score reliably measured predicted differences induced by sinus surgery. CONCLUSIONS: the ACCESS score is an easy-to-use valid tool to assess extent of sinus surgery with an excellent interrater agreement. Further validation in a random group of CRS cases is required.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32692786 Endotypes of chronic rhinosinusitis with nasal polyps with and without NSAID â€" intolerance 544 549 EN U.C. Steiner Department of Immunology, University Hospital Zurich, Zurich, Switzerland S. Bischoff Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and University of Zurich, Zurich, Switzerland A. Valaperti Department of Immunology, University Hospital Zurich, Zurich, Switzerland K. Ikenberg Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland J. Starzyk Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and University of Zurich, Zurich, Switzerland S. Bucher Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and University of Zurich, Zurich, Switzerland L.M. Bachmann Medignition â€" Healthcare Innovations, Zurich, Switzerland M.B. Soyka Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital and University of Zurich, Zurich,Switzerland 2553 10.4193/Rhin19.423 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2-dominated inflammatory disease of the upper air- ways. A subgroup of patients with CRSwNP suffer from intolerance to nonsteroidal anti-inflammatory drugs (NSAID) and develop NSAID-exacerbated respiratory disease (NERD). The aim of the study was to compare the cytokine based inflammatory endotype of nasal secretions of CRSwNP patients with and without NSAID intolerance. METHODS: Nasal secretions were collected from twenty-six patients suffering from CRSwNP, thirteen with NERD and thirteen without NSAID intolerance. As control, nasal secretions were collected from fifteen healthy donors. Tryptase and ten human cyto- kines were analyzed: interleukin (IL)-4, IL-5, IL-6, IL-8, IL-12p70, IL-13, IL-17A, IL-23, IFN-g, and TNF-a by a cytokine multiple array on a Luminex 200 platform. RESULTS: Grade of polyposis and frequency of polyp surgery was more severe in NERD- compared to non-NERD patients. IL-6 and IL-5 in CRSwNP was significantly increased compared to healthy participants. IL-5 and IL-13 were significantly increased in subjects suffering from NERD compared to CRSwNP patients without NERD. CONCLUSION: We identified IL-13 as a possible specific biomarker in nasal secretions of patients with NERD, which allows us to differentiate between CRSwNP with vs. without NERD. The characterization of inflammatory endotypes in CRSwNP enables the introduction of the best available therapy in the context of precision medicine.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 33021606 Add-on effect of clarithromycin to oral steroids as post- operative therapy for chronic rhinosinusitis with nasal polyps: a randomised controlled trial 550 558 EN C-F. Lin Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan M-C. Wang Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;Institute of Public Health and Community Medicine Research Centre, National Yang-Ming University, Taipei, Taiwan A.T. Merton Department of Otolaryngology, Vicente Sotto Memorial Medical Centre, Cebu, Philippines N-H. Ho Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan P-S. Wu Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan A. T-W. Hsu Department of Biostatistics and Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Y-P. Wang Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; School of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan 2687 10.4193/Rhin19.325 BACKGROUND: Evidence is lacking regarding the efficacy of macrolides and oral corticosteroids in chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS). Therefore, we examined the benefits of adding clarithromycin to oral pred- nisolone as post-ESS medical therapy in patients with CRSwNP. METHODS: In this randomised, double-blind, placebo-controlled trial, patients were enrolled and allocated to three study groups receiving different post-ESS medical therapies: group A (placebo for 14 weeks), group B (oral prednisolone [15 mg twice daily] for 2 weeks, followed by placebo for 12 weeks), and group C (oral prednisolone [15 mg twice daily] for 2 weeks, followed by clari- thromycin [500 mg daily] for 12 weeks). All enrolled patients received the perioperative care following a routine protocol, which included oral amoxicillin/clavulanate, and intranasal corticosteroid spray. The baseline and post-operative visual analogue scale (VAS) scores, Sino-nasal Outcome Test (SNOT-22) scores, and Lund-Kennedy endoscopy scores (LKES) were determined as the primary outcomes. RESULTS: One hundred twenty-six patients who received ESS for bilateral CRSwNP were randomised into group A (n=43), B (n=42), or C (n=41). Compared to groups A and B, group C showed greater VAS and SNOT-22 score improvement at 12 weeks after ESS. Group C showed significantly better LKES than did groups A and B at 8, 12, and 24 weeks after ESS. On stratifying the LKES results according to the presence/absence of tissue eosinophilia, greater add-on effects of clarithromycin were observed in the patient subgroup without tissue eosinophilia. CONCLUSIONS: Adding low-dose clarithromycin to oral corticosteroids as post-ESS therapy was well tolerated and showed benefi- cial subjective and objective outcomes in patients with CRSwNP, especially those without tissue eosinophilia.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32692786 The clinical outcomes of medical therapies in chronic rhinosinusitis are independent of microbiomic outcomes: a double-blinded, randomised placebo-controlled trial 559 567 EN L.M. Cherian Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia A. Bassiouni Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia C.M. Cooksley Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia S. Vreugde Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia P-J. Wormald Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia A.J. Psaltis Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia 2552 10.4193/Rhin20.055 BACKGROUND: Oral and topical corticosteroids, and antibiotics form the mainstay medical treatment of chronic rhinosinusitis (CRS). Clinical outcomes vary depending on the chosen therapy, resident microbiome and disease phenotype. We conducted a double- blinded, placebo-controlled Randomised Controlled Trial (RCT) to investigate effects of medical therapy on clinical outcomes and associated microbiome shifts. METHODOLOGY: Fifty eligible patients (CRS with and without polyps) were treated for 3 weeks after randomisation into 3 arms: na- mely oral prednisolone, topical budesonide irrigations and oral doxycycline; each with appropriate placebo. Clinical scoring and microbiome swabs were performed on enrolment, at treatment completion and 3-weeks post treatment completion. Microbiome analysis was performed using the llumina-MiSeq next generation sequencing platform and QIME-2 pipeline. RESULTS: Significant improvement in clinical scores was observed in prednisolone and budesonide arms at treatment completion but not with antibiotic. Sub-group analysis showed more pronounced effects in patients with polyposis. Corynebacterium and Staphylococcus species predominated, with variable bacterial relative abundance among different treatments at all time-points. The only significant microbiome finding was an increase in bacterial diversity in topical budesonide group immediately after treatment, which returned to baseline 3-weeks post treatment. CONCLUSION: Clinical improvement was significant with oral and topical steroid but not empirical antibiotic. Although there were some associated microbiome changes with the various treatments, we could not ascertain the consistency of these and whether they do have a clinical significance at all.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32609104 Co-morbid anxiety and depression impacts on the correlation between symptom and radiological severity in patients with chronic rhinosinusitis* 568 573 EN D. Ranford Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom C. Tornari Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom A. Takhar Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom N. Amin Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom M. Alainin Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom C. Hopkins Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom P. Surda Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, United Kingdom 2539 10.4193/Rhin20.075 BACKGROUND: Previous studies have reported that there is little correlation between sino-nasal outcome test (SNOT-22) score in chronic rhinosinusitis (CRS) and objective radiological scoring, although conclusions vary. We aimed to investigate whether comorbid anxiety and depression, which are highly prevalent in patients with CRS may cause symptom amplification and account for the lack of correlation in previous studies. METHODOLOGY: 100 patients with CRS were evaluated using the General Anxiety Disorder-7 (GAD-7), Patient Health Question- naire-9 (PHQ-9) and SNOT-22 questionnaires as well as the Lund Mackay Score (LMS). RESULTS: Overall correlation analysis did not show a significant relationship between SNOT-22 and LMS scores. Subgroup analysis of patients who do not suffer with anxiety and depression showed a significant correlation between SNOT-22 and LMS scores. The nasal domain of the SNOT-22 showed strongest correlation to LMS in this patient group. We also observed a significant difference in both median SNOT-22 and LMS between patients who suffered both anxiety and depression and patients without either co- morbidity. CONCLUSION: When CRS patients who do not have anxiety and depression are analysed in isolation, or when these conditions are controlled in a multivariable regression, there is a significant correlation between radiological findings and symptom score. This correlation is absent in patients with co-morbid anxiety and depression. Anxiety and depression should be considered in patients in whom there is a mismatch in symptom and radiological disease severity as it is associated with symptom amplification.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32662778 Extended approach or usage of nasoseptal flap is a risk factor for olfactory dysfunction after endoscopic anterior skullbase surgery: results from 928 patients in a single tertiary center 574 580 EN M. Y. Seo Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea; Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea D-H. Nam Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea D-S. Kong Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S.H. Lee Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea Y. Noh Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Y.G. Jung Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea H.Y. Kim Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S-K. Chung Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea K.E. Lee Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea S.D. Hong Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2546 10.4193/Rhin20.020 BACKGROUND: The aim of this study was to compare olfactory function change in patients who underwent endoscopic skull-base surgery. METHODOLOGY: A total of 928 patients were included in this retrospective study. Olfactory function was measured using the non- validated Likert scale (0â€"100), the Cross-Cultural Smell Identification Test (CC-SIT) and the butanol threshold test (BTT). Patients were divided into two groups: an endoscopic trans-sellar approach group (ETA, n = 768) and an extended endoscopic endonasal approach group (EEEA, n = 160). The ETA group was sub-divided into Nasoseptal flap (NSF) and no NSF groups. RESULTS: Non-validated olfactory function significantly worsened in the EEEA and ETA-NSF groups compared with that in the ETA- no NSF group for at least 6 months post-operatively. Validated olfactory impairment (BTT and CC-SIT) was also significantly worse in the EEEA and NSF groups compared with that in the ETA-no NSF group 3 months post-operatively. Additionally, the degrees of non-validated and validated olfactory deterioration were not significantly different between the EEEA and ETA-NSF groups. We also found that CC-SIT score changes were significantly impaired in tuberculum sellae meningioma patients than in craniopharyn- gioma patients. CONCLUSIONS: We conclude that NSF was the key factor that led to olfactory impairment after endoscopic skull-base surgery.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32812016 Microarray analysis of primary epithelial and fibroblast cells in chronic rhinosinusitis without nasal polyps 581 587 EN S.L. Ball Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, United Kingdom S.J. Cockell Bioinformatics Support Unit, Faculty of Medical Sciences, Newcastle University, United Kingdom J.A. Wilson Department of Otolaryngology Head and Neck Surgery, Newcastle upon Tyne, United Kingdom D.A. Mann Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, United Kingdom A.J. Fisher Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, United Kingdom 2562 10.4193/Rhin19.319 Background: Chronic rhinosinusitis is an inflammatory condition with an as yet unknown pathophysiology. We aimed to detect clusters of differentially regulated genes in the epithelial and fibroblast cells of patients with Chronic Rhinosinusitis without nasal polyposis (CRSsNP) and healthy controls. Methodology: Carefully phenotyped CRSsNP and healthy control participants were recruited. Primary cultures of isolated epithelial and fibroblast cells were established. Whole transcriptome analysis of the cells was performed using microarrays and replicated with quantitative RT-PCR and immunohistochemistry. Results: Fibroblast cells from CRSsNP patients showed a significant upregulation (more than 2x) of the transcription factor NFE2L3 when compared to healthy controls by microarray with multiple hypothesis testing correction, qRT-PCR and immunohistochemistry. Conclusions: Here we have utilized microarray analysis to search for differentially expressed genes in isolated patient derived epithelial and fibroblast cells. The transcription factor NFE2L3 has been shown to be upregulated in fibroblast cells consistent with increasing evidence that fibroblasts play a key role in tissue specific inflammation within the paranasal sinuses.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32720938 Role of lncRNA-ENST00000412010 in regulating nasopharyngeal cancer cell survival 588 596 EN Y. Cheng Department of Otolaryngology, Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China H. Peng Department of Otolaryngology, Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China X-Q. Lu Department of Otolaryngology, Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China C-Q. Liang Department of Otolaryngology, Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China J-P. Fan Department of Otolaryngology, Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China H-H. Liu Department of Otolaryngology, Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China 2557 10.4193/Rhin19.341 BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare tumor with highly recurrent and lack of effective treatment. Long non- coding RNAs (lncRNAs) have been reported to play roles in various cancers including NPC. METHODS: In the current study, two cell lines of NPC (CNE-2Z and 5-8F cells) were transfected with short hairpin RNA (shRNA) targeting lncRNA-ENST00000412010 (shlncRNA) or control shRNA (shControl). Cell proliferation, survival, in vitro colony formation, and in vivo xenograft tumor formation were then investigated. RESULTS: The study found that cells transfected with shlncRNA grew significantly slower than the cells transfected with shControl as measured on day 5; increased in Annexin V expression; decreased in colony formation; and smaller in xenograft tumor size on day 45. Expression of DNA damage-inducible transcript 3, dual specificity protein phosphatase 5, insulin receptor substrate 1, interleukin-6, and tribbles homolog 3 genes was significantly up-regulated in the cells transfected with shlncRNA, while gene expression of matrix metalloproteinase-7 and cyclin-dependent kinase 4 inhibitor B was significantly down-regulated in the cells transfected with shlncRNA. Immunoblotting assay confirmed DUSP5 protein was significantly increased while proteins of MMP-7 and CDKN2B were significantly lower in the cells lacking lncRNA than that of the control cells. CONCLUSIONS: These findings suggested that lncRNA-ENST00000412010 plays a role in modulating NPC survival and tumorigenesis through regulating molecules associated with cell cycle and protein phosphatase.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32645120 Occupational exposure and the risk of new-onset chronic rhinosinusitis â€" a prospective study 2013-2018 597 604 EN U. K. E. Clarhed Department of Otorhinolaryngology, Head & Neck Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden H. Johansson Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia M. Veel Svendsen Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway K. Torén Occupational and Environmental Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden A. K. MÞller Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway J. Hellgren Department of Otorhinolaryngology, Head & Neck Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden 2544 10.4193/Rhin20.104 BACKGROUND: The aetiology behind chronic rhinosinusitis (CRS) is still poorly understood. The aim of this study was to investigate the association between the onset of CRS and several common occupational exposures over time. METHODOLOGY: An adult random population from Telemark, Norway, comprising 7,952 subjects, who answered a comprehensive respiratory questionnaire including questions on CRS and occupational exposure first in 2013 and again in 2018. RESULTS: New-onset CRS during the five-year follow-up was independently associated with occupational exposure to hair-care products, cleaning agents among women, super glue, strong acids, cooking fumes and wood dust. CONCLUSION: In this random population cohort from Norway, exposure to several common occupational agents, such as hair-care products, super glue and wood dust, was associated with the onset of CRS. It is important that physicians who see patients with CRS inquire about workplace exposure.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32830809 Nasal chemosensory tests: biomarker between dementia with Lewy bodies and Parkinson disease dementia 605 609 EN C. Foguem Auban Moët Hospital, 137 rue de l’hôpital, 51200 Epernay, France;University of Burgundy, 21000 Dijon, France M. Lemdani Faculty of Pharmaceutical and Biological Sciences, EA 2694, University of Lille, 3, rue du Professeur Laguesse, 59006 Lille,France C. Huart Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium;Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium 2585 10.4193/Rhin20.072 BACKGROUND: Dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD) are progressive and disabling neurodegenerative disorders, which are often misdiagnosed due to theirs overlapping clinical and paraclinical features. Nevertheless, their adequate management requires an accurate differential diagnosis. The main aim of this study was to investigate the usefulness of olfactory and trigeminal nasal testing for the differential diagnosis between DLB and PDD. METHODS: Odor thresholds to three odorants differentially activating the olfactory and trigeminal systems were assessed in patients with DLB, PDD and healthy controls (n = 20 per group). RESULTS: Odor thresholds were significantly different between the three groups of subjects. More precisely, we found that DLB patients had significantly lower detection threshold performances compared to PDD patients. Moreover, using a standard canonical discriminant analysis, we confirmed a plain differentiation between the three groups. CONCLUSIONS: The current study highlights that DLB patients have very poor olfactory and trigeminal detection threshold performances, which are significantly lower, compared to PDD patients. These results suggest that olfactory testing, using odorants that stimulate both the olfactory and trigeminal systems, could constitute an interesting biomarker and contribute to the differential diagnosis of PDD and DLB patients. Further researches, notably on olfacto-trigeminal interactions, are warranted in these populations to support our findings.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32926010 Azithromycin for chronic eosinophilic rhinosinusitis with nasal polyp: a placebo-controlled trial 610 617 EN I.S. de Oliveira Post Graduate Program in Surgery and Ophthalmology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil A.F. Guimaraes Resident Physician of Craniomaxillofacial Surgery of the Hospital das Clínicas, UFMG, Belo Horizonte, Minas Gerais, Brazil G.F. Arantes Pêgas Undergraduate student of the Department of General Pathology, UFMG, Belo Horizonte, Minas Gerais,Brazil C.J. Machado Department of Preventive and Social Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil G.D. Cassali Department of General Pathology, UFMG, Belo Horizonte, Minas Gerais, Brazil P.F. Tormin Borges Crosara Department of Ophthalmology and Otolaryngology, UFMG, Belo Horizonte, Minas Gerais, Brazil F. Barbosa Nunes Department of Ophthalmology and Otolaryngology, UFMG, Belo Horizonte, Minas Gerais,Brazil H.M. Gonçalves Becker Department of Ophthalmology and Otolaryngology, UFMG, Belo Horizonte, Minas Gerais,Brazil R.E. Santos Guimarães Department of Ophthalmology and Otolaryngology, UFMG, Belo Horizonte, Minas Gerais,Brazil 2662 10.4193/Rhin20.071 BACKGROUND: Chronic eosinophilic rhinosinusitis with nasal polyps (CRSwNP eosinophilic) is characterised by the formation of benign and bilateral nasal polyps. We aimed to compare the effectiveness of azithromycin as an immunomodulator with the use of a placebo in patients presenting with CRSwNP concomitant with asthma and aspirin intolerance after 3 months of treatment and at a 1-year follow-up. METHODOLOGY: We performed a randomised, double-blind, placebo-controlled trial. Patients received 500 mg azithromycin orally three times/week for 12 weeks. Improvement was evaluated by staging, the Sino-Nasal Outcome Test (SNOT-22), and nasal polyp biopsy. Data collected at pretreatment and 3 months posttreatment were compared. Quality of life was evaluated at the 1-year follow-up. RESULTS: Twenty-seven and 21 patients were treated with azithromycin and a placebo, respectively. The medication was well tolerated overall. Twenty patients (74%) in the azithromycin group and three patients (14%) in the placebo group were not refer- red for surgery at the end of the 3-month treatment. Regarding subjective improvement, there was a median decrease only in the azithromycin group, and the between-group difference was significant. SNOT-22 improvement was maintained in the azithromy- cin group at the 1-year follow-up. CONCLUSIONS: Azithromycin could be considered a therapeutic option for patients presenting with CRSwNP concomitant with asthma and aspirin intolerance.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32991658 EUFOREA treatment algorithm for allergic rhinitis 618 622 EN P.W. Hellings KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands; G. Scadding RNENT Hospital, Huntley Street, London, UK C. Bachert Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Division of ENT diseases, CLINTEC, Karolinska Institute, University of Stockholm, Sweden;Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital, Guangzhou, China L. Bjermer Dept of Respiratory Medicine and Allergology, Skane Uni- versity Hospital, Lund, Sweden G.W. Canonica Personalized Medicine Asthma and Allergy Clinic, Humanitas University and Research Hospital, Milan, Italy, and SANI-Severe Asthma Network Italy L.O. Cardell Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; A.S. Carney Ear, Nose, and Throat (ENT) Department, Flinders Univer- sity, Bedford Park, South Australia, Australia J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece L. Deneyer European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium Z. Diamant Dept of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Dept Clin Pharm and Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands S. Durham Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom P. Gevaert Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium R. Harvey Rhinology and Skull Base, Applied medical research center, University of New South Wales, Sydney, Australia; Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia C. Hopkins Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom A. Kjeldsen Department of Otorhinolaryngology Head and Neck surgery, Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany; Mainz University Allergy Center, Mainz, Germany V.J. Lund Royal National Throat, Nose and Ear Hospital, UCLH, London, UK D. Price Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore; J. Rimmer Monash Health, Monash University, Melbourne, Australia D. Ryan Usher institute, University of Edinburgh, Edinburgh, UK G. Roberts The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, United Kingdom;NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton, Southampton, United Kingdom P. Sahlstrand-Johnson Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Skåne University Hospital, Malmö, Sweden S. Salmi Helsinki University Hospital, Helsinki, Finland M. Samji Imperial College London, London, UK G. Scadding Royal Brompton and Ha- refield NHS Trust, London, UK P. Smith Clinical Medicine, Griffith University, Southport, QLD, Australia A. Steinsvik Department of Otorhinolaryngo- logy, Oslo University Hospital, Rikshospitalet, Oslo, Norway M. Wagenmann Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany S. Seys 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece U. Wahn Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Charite, Berlin, Germany W.J. Fokkens Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands 2664 10.4193/Rhin20.246

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32812014 Comparison of COVID-19 and common cold chemosensory dysfunction 623 625 EN C. Huart Cliniques universitaires Saint-Luc, Brussels, Belgium C. Philpott The Norfolk Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK I. Konstantinidis 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece A. Altundag Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey K.L. Whitcroft UCL Ear Institute, University College London, London, UK E.M.C. Trecca Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy M. Cassano Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy Ph. Rombaux Cliniques universitaires Saint-Luc, Brussels, Belgium T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 2564 10.4193/Rhin20.251 Anosmia constitutes a prominent symptom of COVID-19. However, anosmia is also a common symptom of acute colds of various origins. In contrast to an acute cold, it appears from several questionnaire-based studies that in the context of COVID-19 infection, anosmia is the main rhinological symptom and is usually not associated with other rhinological symptoms such as rhinorrhoea or nasal obstruction. Until now, no study has directly compared smell and taste function between COVID-19 patients and patients with other causes of upper respiratory tract infection (URTI) using valid and reliable psychophysical tests. In this study, we aimed to objectively assess and compare olfactory and gustatory functions in 10 COVID-19 patients (PCR diagnosed, assessed on average 2 weeks after infection), 10 acute cold (AC) patients (assessed before the COVID-19 outbreak) and 10 healthy controls, matched for age and sex. Smell performance was assessed using the extended “Sniffin’ Sticks” test battery (4), while taste function was assessed using “taste strips” (5). Receiver Operating Characteristic (ROC) curves were built to probe olfactory and gustatory scores in terms of their discrimination between COVID-19 and AC patients. Our results suggest that mechanisms of COVID-19 related olfactory dysfunction are different from those seen in an AC and may reflect, at least to some extent, a specific involvement at the level of central nervous system in some COVID-19 patients. In the future, studies to assess the prevalence of persistent anosmia and neuroanatomical changes on MRI correlated to chemosensory function, will be useful to understand these mechanisms.

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 33078171 Effect of the tongue-in-groove technique on the smile form 626 628 EN A. Mohebbi ENT and Head and Neck Research center and department, The five senses Institute, Iran University of Medical Sciences, Tehran, Iran F. Dehghani Firouzabadi ENT and Head and Neck Research center and department, The five senses Institute, Iran University of Medical Sciences, Tehran, Iran M. Dehghani Firouzabadi ENT and Head and Neck Research center and department, The five senses Institute, Iran University of Medical Sciences, Tehran, Iran M. Roomiani ENT and Head and Neck Research center and department, The five senses Institute, Iran University of Medical Sciences, Tehran, Iran 2697 10.4193/Rhin20.246

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 32926008 Comparing nasal physiology after superior ethmoidal and traditional endoscopic anterior cranial base approaches 629 631 EN V. Patel Division of Otolaryngology / Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA R. Viswanathan Albany Medical College, Albany, NY, USA R. Ruffner Division of Otolaryngology / Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA M. Peris-Celda Department of Neurosurgery, Albany Medical Center, Albany, NY, USA;Adjunct Assistant Professor, Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA C.D. Pinheiro-Neto Division of Otolaryngology / Head and Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA; Department of Neurosurgery, Albany Medical Center, Albany, NY, USA 2661 10.4193/Rhin20.325

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 33078170 Antero-medial maxillary sinus angle is an additional predictive factor for enhanced visibility during pre-lacrimal window approach 632 634 EN A. Andrianakis Department of Otorhinolaryngology, Medical University of Graz, Austria C. Holzmeister Department of Otorhinolaryngology, Medical University of Graz, Austria A. Wolf Department of Otorhinolaryngology, Medical University of Graz, Austria P. Kiss Department of Otorhinolaryngology, Medical University of Graz, Austria U. Moser Department of Otorhinolaryngology, Medical University of Graz, Austria A. Redzic Department of Otorhinolaryngology, Medical University of Graz, Austria P.V. Tomazic Department of Otorhinolaryngology, Medical University of Graz, Austria 2696 10.4193/Rhin20.330

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 33006330 Odor perception depends on airflow, odor solubility and intranasal application site 635 637 EN B. Chen Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China A. Pfister Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany P. Nahrath Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 2666 10.4193/Rhin20.393

International Rhinologic Society Rhinology 0300-0729 58 6 2020 12 1 33006589 Locally advanced nasal pyramid squamous cell carcinoma: our 15 years’ experience in a series of 35 total rhinectomies 638 640 EN J. Bouaoud Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France; Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France N. Benmoussa Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France Q. Hennocq Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France J-F. Honart Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France I. Breuskin Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France P. Gorphe Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France O. Casiraghi Department of Pathology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France M. Classe Department of Pathology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France P. Blanchard Department of Radiation Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France F. Janot Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France F. Kolb Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif,France N. Leymarie Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France S. Temam Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France A. Moya-Plana Department of Head and Neck Surgical Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France 2670 10.4193/Rhin20.381