International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33821858 Smell is the sense of memory and desire 113 113 EN W.J. Fokkens ENT Department, AmsterdamMC, Amsterdam, the Netherlands 2762 10.4193/Rhin21.802

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33760909 Nonpharmacological interventions to reduce respiratory viral transmission: an evidence-based review with recommendations 114 132 EN E. Yuen Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA J. Fried Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA C. Salvador Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA D.A. Gudis Columbia University Irving Medical Centre, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA R.J. Schlosser Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA S.A. Nguyen Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA E.A. Brennan Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA N.R. Rowan The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA 2759 10.4193/Rhin20.563 BACKGROUND: Viral respiratory infections are a leading cause of worldwide mortality and exert the potential to cause global socioeconomic crises. However, inexpensive, efficacious, and rapidly deployable strategies to reduce viral transmission are increasingly important in the setting of an ongoing pandemic, though not entirely understood. This article provides a comprehensive review of commonly employed nonpharmacological interventions to interrupt viral spread and provides evidence-based recommendations for their use. METHODOLOGY: A systematic review of three databases was performed. Studies with defined endpoints of subjects receiving one of five interventions (nasal washing, gargling, personal protective equipment (PPE), social distancing, and hand hygiene) were included. An evidence-based review of the highest level of evidence, with recommendations, was created in accordance with a previously described, rigorous, iterative process. RESULTS: Fifty-four primary studies were included. The most commonly studied intervention was hand hygiene, followed by PPE, gargling, saline nasal washing, and social distancing. CONCLUSIONS: Mask use and hand hygiene are strong recommendations for prevention of viral transmission. Donning gloves, gowns, and eye protection are a recommendation in healthcare settings. Saline nasal washing and gargling are options in selected populations. Although an aggregate level of evidence is not provided, the authors recommend social distancing.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33078172 A systematic review of olfactory related questionnaires and scales 133 143 EN P. Han The Key laboratory of Cognition and Personality, Ministry of Education, Chongqing, China; Faculty of Psychology, Southwest University, Chongqing, China T. Su The Key laboratory of Cognition and Personality, Ministry of Education, Chongqing, China M. Qin The Key laboratory of Cognition and Personality, Ministry of Education, Chongqing, China H. Chen The Key laboratory of Cognition and Personality, Ministry of Education, Chongqing, China; Faculty of Psychology, Southwest University, Chongqing, China T. Hummel Interdisciplinary Centre Smell and Taste, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 2695 10.4193/Rhin20.291 PURPOSE: Although neglected by science for a long time, the sense of olfaction has received increasing attention from research areas including psychology, neuroscience, clinical medicine and nutrition. With the rise of psychophysical and neuroimaging re- search into olfaction, psychometric tools (e.g. questionnaires and scales) are the basis for the quantitative exploration of inter-in- dividual variability regarding olfactory related responses. The current systematic review is to summarize existing olfaction related questionnaires and/or scales. METHODS: Peer-reviewed literature on scales and questionnaires related to perception of odors were searched from online databa- ses (PubMed, Web of Science and PsycINFO). Twenty-one articles that meet the following criteria were included in the review: “hu- man species�, “no physical odor stimuli� and “describing the original development of the tool�, and “with specific focus on olfaction or odor related responses or behaviors�. The psychometric properties, advantages and possible disadvantages were discussed. RESULTS: Existing psychometric measures focus on various aspects of olfactory related responses and behaviors, including af- fective experiences of odor perception, awareness and attitude towards olfaction, olfactory function and the quality of life change due to olfactory dysfunction, and the ability to create vivid mental odor images. While most of them have been tested to have good reliability and validity, some were relatively time-consuming due to the number of questionnaire items. Besides, although many measures have been used in clinical populations, few have provided information on the predictive validity regarding effecti- veness of clinical intervention on changes of certain responses or behaviors. SUMMARY: The current review provides an overview of olfactory related questionnaires and scales, highlighting the emotional and affective impact of olfaction and the impact on quality of life due to olfactory dysfunction. With growing interest in olfaction as an important sense, the development and use of psychometrically sound measurements in conjunction with objective assess- ments will advance our understanding of human olfaction and olfactory dysfunction. The review provides a guide for researchers and clinicians alike to select olfactory scales suitable for olfactory research with different experimental purposes and specific samples.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33320116 Change in olfactory function after septoplasty. A systematic review and meta-analysis 144 150 EN A. Grabosky Medical Graduate, University of Barcelona, Barcelona, Spain P. Mackers Department of Otorhinolaryngology, Hospital del Mar, Barcelona, Spain C. Langdon Rhinology and Skull base Unit, Department of Otorhinolaryngology, Hospital Cli�nic, Universitat de Barcelona. IDIBAPS Barcelona, Spain; Centre for Biomedical Research on Respiratory Diseases (CIBERES). Barcelona, Spain I. Alobid Rhinology and Skull base Unit, Department of Otorhinolaryngology, Hospital Cli�nic, Universitat de Barcelona. IDIBAPS Barcelona, Spain; Centre for Biomedical Research on Respiratory Diseases (CIBERES). Barcelona, Spain 2728 10.4193/Rhin20.252 BACKGROUND: Septoplasty is one of the most frequently performed surgeries. However, there remains a question as to the effect of such intervention on the sense of smell. This study aims to examine the available evidence regarding the effect of septoplasty on the sense of smell. METHODS: A database search was performed using PubMed, ScienceDirect, Google Scholar and The Cochrane Library databases from January 1990 to February 2020. Search terms included smell, olfaction, odor, septum, septoplasty, and septorhinoplasty. A meta-analysis was performed with 12 studies that provided sufficient data on change in olfaction. RESULTS: 14 studies met the inclusion criteria, and 2 additional studies were included manually; comprising a total of 996 patients and 25 controls. Significant improvement in olfactory test scores was observed in all tests. Pre- and postoperative differences in means were 0.63 for BSIT, 0.80 for CCCRC test, 1.16 for odor threshold, 1.43 for odor discrimination, and 1.18 for odor identification. CONCLUSIONS: Septoplasty seems to improve olfactory function. However, the outcome of this intervention is discrete and not equal for all patients, so further randomized trials are needed to confirm current findings.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33459728 State-of-the-art overview on biological treatment for CRSwNP 151 163 EN P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Otorhinolaryngology, University Hospital Ghent, Laboratory of Upper Airway Research, Ghent, Belgium;Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Centre (AMC), Amsterdam, the Netherlands E. Verhoeven Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium W.J. Fokkens Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Centre (AMC), Amsterdam, the Netherlands 2750 10.4193/Rhin20.570 BACKGROUND: The majority of patients with uncontrolled severe CRSwNP, asthma and atopic dermatitis share a similar T helper 2 type inflammation linked to their underlying phenotype. This discovery has triggered new research around treatments targeting specific cytokines driving inflammation in CRSwNP like IL-4, IL-13, IL-5 and IgE. Biologicals are increasingly tested as additional tre- atment for patients suffering from severe chronic rhinosinusitis with nasal polyps (CRSwNP). Their efficacy has been demonstrated in multiple studies. All studies differ in terms of baseline characteristics of included patients and outcome parameters analysed. AIMS: A comparative analysis of the efficacy of reported biologicals for CRSwNP based on the published data for phase 2 and 3 studies. The aim was to provide a comprehensive overview across the different biologicals and outcome parameters. METHODS: In a first step we critically selected out of all available phase 2 and 3 clinical trials the ones containing the most rigorous and compatible study designs. Meaning studies that comply with a need for a clear definition of CRSwNP, at least two administra- tion doses, comparable timeframes and the same outcome parameters studied. This assessment was performed using a PRISMA search. We retained 7 studies with significant data for dupilumab, mepolizumab and omalizumab. In a second step the effect-sizes of treatment with those biologicals were compared for the most important outcome parameters both patient relevant (nasal con- gestion, smell loss and SNOT-22 scores) and patient irrelevant (CT scan Lund-Mackay, smell test and nasal polyp scores). Therapy duration of 16 to 25 weeks was chosen for evaluation of efficacy. RESULTS: A direct comparison of efficacy between dupilumab, mepolizumab and omalizumab is challenging given differences in inclusion criteria, outcome parameters and time-points of analyses. We have been able to conclude that effect sizes of dupilumab, mepolizumab and omalizumab seem large enough to reflect a major reduction in symptom burden as experienced by patients suffering from refractory CRSwNP. The effect size of dupilumab on both patient relevant and patient irrelevant parameters of smell loss are clearly significant and reflect the clinical experience of major reduction of smell impairment in treated patients. CONCLUSION: Despite the heterogeneity of protocols, dosages and time-points of analyses of biological trials in CRSwNP, this over- view highlights outcomes of biological treatment in CRSwNP in a comprehensive way. Real-life registries, comparative trials and/ or endotype-driven treatment plans are needed to provide the answers to the multiple questions that are still open today.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33395453 Association between olfactory function and quality of life in patients with olfactory disorders: a multicenter study in over 760 participants 164 172 EN L-q. Zou Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany; Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany M.S. Otte Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne,Germany T. Bitter Department of Otorhinolaryngology, University Hospital Jena, Jena, Germany G. Besser Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria C.A. Mueller Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria A. Welge-Lüssen Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsspital Basel, Basel, Switzerland O.C. Bulut Department of Otorhinolaryngology, SLK Kliniken Am Gesundbrunnen,Heilbronn, Germany; Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Germany Ö. Göktas HNO Zentrum am Kudamm, Berlin, Germany S. Negoias Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsspital Basel, Basel, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital, Bern, Bern, Switzerland S-b. Li Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany 2749 10.4193/Rhin20.403 BACKGROUND: This cross-sectional, multi-centric study aimed to investigate the differences in quality of life among patients with olfactory dysfunction (OD) of different origin, and to identify factors associated with olfactory-related quality of life (QOL). METHODS: Seven hundred sixty-three adults were recruited from 8 Smell & Taste clinics in Germany, Switzerland, and Austria. Olfactory-related QOL was assessed by the Questionnaire of Olfactory Disorders (QOD). Olfactory function was assessed with the “Sniffin’ Sticks� test; self-assessment was performed with visual analog scales. RESULTS: Patients with post-infectious and post-traumatic OD showed poorer olfactory-related QOL than patients with sinonasal and idiopathic OD. The olfactory-related QOL was positively associated with the Sniffin’ Sticks test score, self-assessed olfactory function, disease duration, and age, with younger olfactory dysfunction patients showing lower QOL. Female patients presented with poorer olfactory-related QOL. In addition, the results showed that self-assessment of olfactory function explained more of the variance in olfactory-related QOL than olfactory function evaluated by the Sniffin’ Sticks test. CONCLUSIONS: In addition to the psychophysical testing results, several factors such as disease cause, disease duration, sex, or self- assessed olfactory dysfunction should be taken into account when assessing the individual severity of the smell loss.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33129200 Subepithelial neutrophil infiltration as a predictor of the surgical outcome of chronic rhinosinusitis with nasal polyps 173 180 EN D-K. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital and Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea; Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon, Republic of Korea H-S. Lim Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea K.M. Eun Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea Y. Seo Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea J.K. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea Y.S. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea M-K. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea S. Jin Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea S.C. Han Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea D.W. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea 2701 10.4193/Rhin20.373 BACKGROUND: Neutrophils present as major inflammatory cells in refractory chronic rhinosinusitis with nasal polyps (CRSwNP), regardless of the endotype. However, their role in the pathophysiology of CRSwNP remains poorly understood. We investigated factors predicting the surgical outcomes of CRSwNP patients with focus on neutrophilic localization. METHODS: We employed machine-learning methods such as the decision tree and random forest models to predict the surgical outcomes of CRSwNP. Immunofluorescence analysis was conducted to detect human neutrophil elastase (HNE), Bcl-2, and Ki-67 in NP tissues. We counted the immunofluorescence-positive cells and divided them into three groups based on the infiltrated area, namely, epithelial, subepithelial, and perivascular groups. RESULTS: On machine learning, the decision tree algorithm demonstrated that the number of subepithelial HNE-positive cells, Lund-Mackay (LM) scores, and endotype (eosinophilic or non-eosinophilic) were the most important predictors of surgical outcomes in CRSwNP patients. Additionally, the random forest algorithm showed that, after ranking the mean decrease in the Gini index or the accuracy of each factor, the top three ranking factors associated with surgical outcomes were the LM score, age, and number of subepithelial HNE-positive cells. In terms of cellular proliferation, immunofluorescence analysis revealed that Ki-67/HNE-double positive and Bcl-2/HNE-double positive cells were significantly increased in the subepithelial area in refractory CRSwNP. CONCLUSION: Our machine-learning approach and immunofluorescence analysis demonstrated that subepithelial neutrophils in NP tissues had a high expression of Ki-67 and could serve as a cellular biomarker for predicting surgical outcomes in CRSwNP patients.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33006331 The Olfactory Cleft Endoscopy Scale: a multi-institutional validation study in chronic rhinosinusitis 181 190 EN R.J. Schlosser Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC, USA T.L. Smith Division of Rhinology and Sinus Surgery, Oregon Health Services University, Portland, OR, USA J.C. Mace Division of Rhinology and Sinus Surgery, Oregon Health Services University, Portland, OR, USA J.A. Alt University of Utah, Salt Lake City, UT, USA D.M. Beswick University of Colorado, Aurora, CO, USA J.L. Mattos University of Virginia, Charlottesville, VA, USA V. Ramakrishnan University of Colorado, Aurora, CO, USA C. Massey University of Colorado, Aurora, CO, USA Z.M. Soler Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC, USA 2667 10.4193/Rhin20.307 BACKGROUND: Olfactory dysfunction (OD) associated with chronic rhinosinusitis (CRS) remains quite challenging. Instruments to precisely assess olfactory cleft anatomy and their association with olfaction are needed. METHODS: The olfactory cleft endoscopy scale (OCES) was used to assess the olfactory cleft in healthy control subjects and a cohort of patients with CRS. Psychophysical and psychosocial olfactory function were assessed and correlations with OCES scores were measured. RESULTS: Control subjects and subjects with CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) were enrol- led. OCES correlated with both psychophysical and psychosocial olfaction, as measured by threshold, discrimination and identi- fication (TDI) scores and Questionnaire on Olfactory Disorders (QOD-NS) scores for all case and control subjects combined. OCES improved in both CRS groups postoperatively with the highest correlation seen in postoperative olfaction in CRSwNP patients. CRS patients who achieve near perfect OCES and sinus endoscopy scores after surgery have olfactory metrics that are indistin- guishable from controls regardless of polyp status. CONCLUSIONS: The OCES is a valid olfactory-specific measure that demonstrates strong validity and provides complimentary infor- mation to traditional sinus endoscopy to aid in our understanding of OD associated with CRS.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33346253 Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery 191 204 EN T.E. Topczewski Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain A.D. Somma Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain; Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain D. Culebras Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain L. Reyes Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain J. Torales Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain A. Tercero Institut Cli�nic de Neurociències (ICN), Department of Neurology, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain C. Langdon Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain I. Alobid Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain R. Torne Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain P. Roldan Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain A. Prats-Galino Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain J. Enseñat Institut Cli�nic de Neurociències (ICN), Department of Neurological Surgery, Hospital Cli�nic de Barcelona, Universidad de Barcelona, Barcelona, Spain 2745 10.4193/Rhin20.064 OBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesions that were managed via an EEA, as well as the specific anatomy of each case. METHODS: All patients were treated in a single center by a multidisciplinary surgical team between 2015 and 2019. Before surgery, a dedicated anatomical analysis of the brainstem safe entry zone was performed, and proper surgical planning was carried out. Neurophysiological monitoring was used in all cases. Anatomical dissections were performed in three human cadaveric heads using 0° and 30° endoscopes, and specific 3D reconstructions were executed using Amira 3D software. RESULTS: All lesions were located at the level of the ventral brainstem. Specifically, one mesencephalic cavernoma, two pontine ca- vernomas, one pontine gliomas, and one medullary diffuse midline glioma were reported. Cerebrospinal fluid leak was the major complication that occurred in one case (medullary diffuse midline glioma). From an anatomical standpoint, three main safe entry zones were used, namely the anterior mesencephalic zone (AMZ), the peritrigeminal zone (PTZ, used in two cases), and the olivar zone (OZ). Reviewing the literature, 17 cases of various brainstem lesions treated using an EEA were found. CONCLUSIONS: To our knowledge, this was the first preliminary clinical series of intrinsic brainstem lesions treated via an EEA presented in the literature. The EEA can be considered a valid surgical alternative to traditional transcranial approaches to treat selected intra-axial brainstem lesions located at the level of the ventral brainstem. To achieve good results, surgery must involve comprehensive anatomical knowledge, meticulous preoperative surgical planning, and intraoperative neurophysiological moni- toring.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33459729 P-glycoprotein inhibition with verapamil overcomes mometasone resistance in Chronic Sinusitis with Nasal Polyps 205 211 EN M.S. Taha Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America; The Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, MA, United States of America; The Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt A. Nocera Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America; The Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, MA, United States of America; A. Workman Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America M.M. Amiji The Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, MA, United States of America B.S. Bleier Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America 2751 10.4193/Rhin20.551 BACKGROUND: P-glycoprotein (P-gp) is a membrane efflux pump which is overexpressed in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and promotes Type 2 inflammation. Glucocorticoids (GC) are substrates of P-gp suggesting that overexpression may additionally contribute to GC resistance in CRSwNP. This study aims to determine whether P-gp inhibition using verapamil enhances mometasone retention and efficacy in nasal polyp explants. METHODOLOGY: IRB approved study in which organotypic polyp explants were exposed to mometasone (4.15 μg/mL) and verapa- mil (125 μg/mL) as mono and combination therapy. The effect of verapamil on mometasone tissue retention over time was deter- mined using HPLC. The effect of verapamil on mometasone anti-inflammatory function was determined using ELISA for secreted IL-5. Groups were compared using Kruskal-Wallis test. RESULTS: P-gp expression strongly and significantly inversely correlated with mometasone retention 1hr after exposure, with a ne- arly 6-fold reduction in tissue retention between the lowest and highest P-gp expressing polyp explants. P-gp inhibition reversed this effect and significantly improved mometasone retention at 1hr relative to mometasone alone. The combination of mome- tasone and verapamil significantly reduced IL-5 secretion relative to vehicle control and outperformed either treatment alone. CONCLUSIONS: Our study confirms that P-gp contributes to mometasone resistance. This P-gp mediated resistance was successfully reversed by addition of the P-gp inhibitor verapamil. Verapamil further significantly enhanced the anti-inflammatory effect of mometasone when given as a combination therapy.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33821857 A comparative study of two grading systems for epistaxis in hereditary haemorrhagic telangiectasia 212 218 EN O.J. Jorgensen Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Medical Faculty, University of Oslo, Oslo, Norway J. Steineger Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Medical Faculty, University of Oslo, Oslo, Norway G. Bachmann-Harildstad Department of Otorhinolaryngology, Akershus University Hospital and Institute of Clinical Medicine, Akershus University Hospital, Oslo University, Lorenskog, Norway S. Dheyauldeen Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Medical Faculty, University of Oslo, Oslo, Norway 2764 10.4193/Rhin20.540 BACKGROUND: Different institutions use different grading systems for hereditary haemorrhagic telangiectasia (HHT)-associated epistaxis. It is important to have a universal, standardized grading system to compare and evaluate the effectiveness of different treatment options. We introduced the “Intensity, Frequency and need for Blood Transfusion� (IFT) grading system for HHT-associated epistaxis in 2008. Hoag et al. proposed the “Epistaxis Severity Score� (ESS) for the International HHT foundation in 2010. This study aimed to evaluate the potential correlation between the ESS and IFT grading systems. METHODS: The study included 354 simultaneous reports using the IFT and ESS from 106 patients. The correlation between the ESS, IFT and haemoglobin levels was measured using Pearson’s correlation coefficient. The ESS and IFT were scored simultaneously by the patient and doctor in 48 cases to evaluate if there was a discrepancy in the scoring applied by either set of responders. RESULTS: The measured correlation between the two grading systems was good (0.75). The grade of epistaxis reported by patients and doctors respectively showed no significant difference. Both the IFT and ESS grading systems correlate significantly to the haemoglobin level. CONCLUSIONS: Both the IFT and ESS scores correlate to each other, and their results are comparable. Whether the IFT or ESS scoring was performed by the patient or doctor had no significant impact.

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33377891 Novel oral anticoagulation treatment is not associated with recurrent or severe epistaxis 219 221 EN D. Runggaldier Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland;University of Zurich, Switzerland V. Schindler University of Zurich, Switzerland;Division of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland Y. Luo Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland; University of Zurich, Switzerland T. Kleinjung Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland; University of Zurich, Switzerland M.B. Soyka Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland; University of Zurich, Switzerland 2748 10.4193/Rhin20.541

International Rhinologic Society Rhinology 0300-0729 59 2 2021 4 1 33377890 Parosmia is prevalent and persistent amongst those with COVID-19 olfactory dysfunction 222 224 EN E. Cook Guy’s and St. Thomas’ NHS Hospital Foundation Trust, London, UK C.E. Kelly AbScent, Andover, Hampshire, UK D.L. Burges Watson Faculty of Medical Sciences, Newcastle University, Newcastle, UK C. Hopkins Guy’s and St. Thomas’ NHS Hospital Foundation Trust, London, UK 2746 10.4193/Rhin20.532