International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34331531 News from Rhinology Journal 329 329 EN W.J. Fokkens Department of ENT, Amsterdam Medical Center, Amsterdam, the Netherlands 2912 10.4193/Rhin21.804

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 Achieving the best method to classify Eosinophilic Chronic Rhinosinusitis: a systematic review 330 339 EN M.D.C. Toro Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, Sao Paulo, Brazil M.A. Antonio Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, Sao Paulo, Brazil M.G. Alves dos Reis Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, Sao Paulo, Brazil M.S. de Assumpcao Pulmonary physiology lab, Pediatrics Investigation Center, Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil E. Sakano Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, Sao Paulo, Brazil 2818 10.4193/Rhin20.512 BACKGROUND: Chronic Rhinosinusitis is currently classified into eosinophilic and non-eosinophilic, according to the histologic quantification of the number of eosinophils in nasal mucosa biopsy. There is a lack of unanimous histopathologic criteria and methodology for this classification and no consensus regarding a cut-off point for Eosinophils per High power field. METHODOLOGY: A systematic electronic search was performed on BVS, PUBMED, PUBMED PMC, SCOPUS, WEB OF SCIENCE, EMBASE, COCHRANE and PROQUEST databases looking for studies that reported a cut point for classification of Eosinophilic Chronic Rhinosinusitis (eCRS), and data concerning methodology of classification was extracted. RESULTS: We identified 142 studies that reported 29 different cut-off values for classification of eCRS, and different methods of histologic analysis. Out of these studies 13 reported their own methodology to establish the cut-off point, and used different reference standards as polyp recurrence, asthma and allergy, immunocytochemistry, quality of life index, standard deviation of the control population and cluster analysis. CONCLUSIONS: Further studies are needed to determine a precise cut-off point, especially international multicentered cluster analysis. Moreover, methodologic standardization of biopsy and analysis is needed to certify comparable results. Multiple biopsy sites, densest cellular infiltration area examination and oral steroids restriction at least four weeks before sampling are advisable.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 Is postoperative nasal packing after septoplasty safe? A systematic review and meta-analysis of randomized controlled studies 340 351 EN C.K. Titirungruang Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand N. Charakorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand B. Chaitusaney Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand P. Hirunwiwatkul Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2823 10.4193/Rhin21.057 Objectives: To systemically review and compare post-septoplasty complications between total nasal packing and other techniques. Methodology: We searched electronic databases (PubMed, Scopus, and Cochrane Library) and additional sources. The most recent search was on November 30th, 2020. Randomized controlled trials (RCTs) comparing adverse events after post-septoplasty nasal packing versus other techniques were included. The outcomes were adverse events, including respiratory distress, oxygen desaturation, pain severity, bleeding, hematoma, sleep disturbance, infection, crusting, epiphora, dysphagia, perforation, adhesion, and residual septal deviation. Results: There were 47 studies (4,087 participants) in this systematic review. Nasal packing was more likely to cause adverse events than other techniques. There were significant increases in respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. There were no statistically significant differences in oxygen desaturation, bleeding, hematoma, infection, perforation, and residual septal deviation. Subgroup analysis found that trans-septal suture was less likely to cause post-operative complications compared with total nasal packing. Conclusion: Nasal packing after septoplasty was more likely to cause adverse events, including respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. Furthermore, there were no benefits of nasal packing in preventing bleeding, hematoma, and residual septal deviation when compared with other techniques. Routine nasal packing after septoplasty should be avoided. Trans-septal suture should be considered instead.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34180463 Clinical effectiveness of house dust mite immunotherapy in mono- versus poly-sensitised patients with allergic rhinitis: a systematic review and meta-analysis 352 359 EN J.Y. Kim Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, Korea 2 Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Korea D. Hwang Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea M. Jang Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea C.S. Rhee Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea; Graduate School of Immunology, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, and Sensory Organ Research Institute, Seoul National University Biomedical Research Center, Seoul, Korea D.H. Han Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea 2828 10.4193/Rhin20.588 Selecting an appropriate allergen-specific immunotherapy (AIT) regimen for polysensitised allergic rhinitis (AR) patients is challenging for clinicians. Although previous studies showed comparable effectiveness of single-allergen AIT with house dust mite (HDM) extract between monosensitised and polysensitised AR patients, there is no systematic review and meta-analysis demonstrating the comparable effectiveness of HDM AIT. In this meta-analysis, we analysed nine studies to compare the clinical effectiveness of HDM AIT. The primary outcome was nasal symptom score and secondary outcomes were medication and quality of life scores. The changes in nasal symptom score after HDM AIT did not significantly differ between monosensitised and polysensitised patients. The clinical effectiveness of HDM AIT regarding medication and quality of life score was not significantly different between monosensitised and polysensitised patients). In conclusion, single-allergen AIT with HDM extract showed comparable clinical effectiveness between polysensitised and monosensitised patients with AR.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34254060 Anxiety and depression risk in patients with allergic rhinitis: a systematic review and meta-analysis 360 373 EN J. Rodrigues Otorhinolaryngology Department, Centro Hospitalar Universitario de S. Joao, EPE, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS â€" Center for Health Technology and Services Research, University of Porto, Porto, Portugal F. Franco-Pego CINTESIS â€" Center for Health Technology and Services Research, University of Porto, Porto, Portugal; MEDCIDS â€" Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal B. Sousa-Pinto CINTESIS â€" Center for Health Technology and Services Research, University of Porto, Porto, Portugal; MEDCIDS â€" Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal J. Bousquet Charite, Universitatsmedizin Berlin, Humboldt-Universitat zu Berlin, Berlin, Germany; Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin Institute of Health, Berlin, Germany; MACVIA-France, Montpellier, France K. Raemdonck Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS â€" Center for Health Technology and Services Research, University of Porto, Porto, Portugal; CESPU â€" Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), Gandra, Portugal R. Vaz Otorhinolaryngology Department, Centro Hospitalar Universitario de S. Joao, EPE, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS â€" Center for Health Technology and Services Research, University of Porto, Porto, Portugal 2909 10.4193/Rhin21.087 Background: Allergic diseases appear to be associated with mood disorders. However, particularly regarding allergic rhinitis (AR), such association has not been adequately systematically reviewed. Therefore, we conducted a systematic review and meta-analysis to quantify the association between AR and depression and anxiety. Methodology: We performed an electronic search of PubMed, Web of Science and Scopus for observational studies assessing the association between AR and depression and anxiety. Such association was quantified by means of random-effects meta-analysis, with estimation of pooled odds ratio (OR). Sources of heterogeneity were explored by subgroup analysis. Results: We included a total of 24 primary studies, of which 23 assessed depression and 11 assessed anxiety. Of these, 12 studies presented OR from multivariable regression models and were included in our meta-analysis. AR was associated with higher odds of depression and anxiety. Conclusions: AR appears to be associated with high risk of depression and anxiety. While our results point to the importance of mental comorbidities among patients with AR, longitudinal studies are needed adopting uniform definitions and presenting results stratified by AR severity.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34185823 The potential role of biological treatment of chronic rhinosinusitis with nasal polyps: a nationwide cohort study 374 379 EN P.R.G. Eriksen Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark K.K. Jakobsen Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark K. AanÃ�s Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark V. Backer Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark C. von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark 2829 10.4193/Rhin20.480 Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) can be a challenge to treat despite appropriate pharmacological therapy and endoscopic sinus surgery. With the introduction of biological treatment, costs will increase. In this study, we determine the number of patients with CRSwNP treated with endoscopic sinus surgery and revision surgery and thereby fulfil the main criterion for treatment with biologics in the newest European guidelines. Furthermore, we estimate a potential number of recipients of biologics nationwide. Methods: All adult patients registered in the Danish National Patient Registry as having undergone first endoscopic sinus surgery for CRSwNP from 2012â€"2018 were included. The number of operations, surgery dates, and comorbidities were extracted. The Kaplan-Meier method was used to calculate the revision rate over time. Revision surgery was used as a surrogate to determine the pool of potential recipients of biologics, as these would fulfil the eligibility criteria and ensure the necessary cost-effectiveness. Results: A total of 4667 operated patients with CRSwNP were included out of a population of 4.7 million adults (incidence 14/100,000 person-years). Approximately 18% (120 per year) was estimated to have revision surgery within seven years. The median time to revision surgery was 22 months. Of all analysed patients, 21% had registered asthma and/or allergic rhinitis, while these diseases were registered in 34% of patients treated with revision surgery. Conclusion: In Denmark, an average of 120 operated patients annually will have revision surgery within seven years and may benefit from treatment with biologics as an alternative option to revision surgery.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34282809 Occupational exposure influences control of disease in patients with chronic rhinosinusitis 380 386 EN D.A.E. Dietz de Loos Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands S. Ronsmans Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium M.E. Cornet Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands P.W. Hellings Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands; Department of Otorhinolaryngology â€" Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium V. Hox Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ENT and Dermatology, UCLouvain, Brussels, Belgium W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands S. Reitsma Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands 2911 10.4193/Rhin21.091 Background: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear correlation between occupational exposure and the number of ESS. Methods: In this cross-sectional study we tested the hypothesis that occupational exposure is a risk for undergoing ESS. We sent questionnaires enquiring occupational exposure in patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). An expert assessed blindly the reported work exposures to inhaled agents. The relationship between occupational exposure on undergoing ESS was analysed. Results: Among all patients who underwent ESS (n=343), 30% reported a relevant occupational exposure, which is significantly higher than the 4.8% found among CRS patients that underwent no prior sinus surgery (n=21). Besides occupational exposure, self-reported doctor-diagnosed asthma were independent variables contributing to the chance of undergoing ESS. Conclusion: In our study we confirm occupational exposure as a risk factor for uncontrolled CRS, if defined by undergoing ESS. In CRS patients with uncontrolled symptoms, despite maximal conservative therapy, the clinician should explore the possible contribution of occupational exposure.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34333577 Efficacy and safety of retrobulbar amphotericin B injection in invasive fungal rhinosinusitis with orbital invasion patients* 387 392 EN P. Arreenich Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand P. Saonanon Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand S. Aeumjaturapat Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand S. Chusakul Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand J. Kanjanaumporn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2914 10.4193/Rhin21.070 Background: At present, there is no consensus for optimal orbital infection management in invasive fungal rhinosinusitis patients. This is the first retrospective cohort study aimed to determine efficacy and side effects of the retrobulbar amphotericin B injection for orbital management in invasive fungal rhinosinusitis patients. Methodology: A retrospective chart review was conducted from 2005 to 2020. Thirty-six patients (forty-two orbits) diagnosed with invasive fungal rhinosinusitis with orbital invasion, treated with or without retrobulbar amphotericin B injection, were included in the study. Results: There were a total of 36 patients in the study, 12 patients received retrobulbar amphotericin B injection and 24 did not. There was no significant difference in orbital exenteration and death between two groups. Visual acuity change at the 3rd month was significantly better in the exposure group. There was a significant difference in the overall clinical outcome at 3rd month and 12th month. There was no report of severe side effects in all patients. Conclusions: Retrobulbar amphotericin B injection showed significant efficacy in stabilizing or even improving visual acuity without any side effects. This procedure should be considered as adjunctive treatment.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34129661 Development of a Self-reported Olfactory Dysfunction Questionnaire (SODQ) to screen olfactory disorders in China 393 397 EN X. Liu Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University J. Huang Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China P. Tian Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University J. Hu Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China L. Zou Chemical Senses and Mental Health Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China 2826 10.4193/Rhin21.028 Background: The diagnosis of olfactory dysfunction is challenging given the negligence during routine physical examination, inconvenience of diagnosis in clinical practice, and the inattention to cross-cultural adaptability. The study aimed to develop and validate a simple and effective self-reported olfactory dysfunction questionnaire (SODQ) for the initial screening of clinical olfactory disorders in China. Methods: A total of 121 subjects participated in the study; of these, 96 subjects completed the T&T olfactometer test and 12-item questionnaire, and 25 participants were retested using the SODQ after one week. The T&T olfactometer test examined the olfactory function and the questionnaire measured the ability to perceive common odors in daily life. We evaluated the factor structure, reliability, validity, and discriminative ability of the SODQ. Results: The final version of the SODQ consisted of 10 items with one factor. Testâ€"retest and internal consistency were excellent. Convergent validity of the questionnaire with the T&T olfactory test was high. Furthermore, the discrimination ability was high for the questionnaire with an area under the curve of 0.95 and a cut-off point of 22. Conclusions: The SODQ is a brief, valid, and repeatable tool that has the potential to effectively screen for clinical olfactory disorders from a subjective perspective.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34185822 Preemptive analgesia for endoscopic sinus surgery: a retrospective study 398 401 EN D. Nakashima Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan E. Mori Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan T. Takeda Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan Y. Hosokawa Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan S. Takaishi Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan K. Omura Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan H. Kojima Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan N. Otori Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan 2830 10.4193/Rhin20.624 Background: Chronic rhinosinusitis (CRS) is a common disease, and endoscopic sinus surgery (ESS) is widely performed. However, there is no consensus regarding postoperative pain control after ESS, and postoperative opioid abuse is a problem in many countries. Acetaminophen is reportedly effective for postoperative pain control. Preemptive analgesia has received more attention lately, wherein pain is prevented before it occurs. In this study, we assessed the use of acetaminophen for preemptive analgesia during the perioperative period in ESS. Methodology: This is a retrospective study of 175 patients who underwent ESS, septoplasty, and bilateral inferior turbinate mucosal resection at our hospital from April 2016 to February 2018. In total, 82 patients received 1,000 mg of acetaminophen during surgery and 4 hours after the first dose, while 93 patients did not receive it routinely. We compared these two groups. The primary outcome was the need to use additional analgesics prescribed by the ward physician and the secondary outcomes included postoperative pain, postoperative bleeding, reoperation, blood pressure, and body temperature. Results: The use of additional oral and intravenous analgesics was significantly reduced in the patients who received acetaminophen perioperatively. Conclusion: Preemptive analgesia during the perioperative period of ESS could lead to satisfactory postoperative pain control.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 3408506 Sniffin’ Sticks Screening 12 test: Presentation of odours on filter paper improves the recognition rate 402 404 EN K. Wirkner LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany A. Hinz Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany M. Loeffler LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany C. Engel LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany 2825 10.4193/Rhin21.074 To the Editor: Monitoring of olfactory function and diagnosis of olfactory disorders using the pen-based �Sniffin' Sticks test� is problematic during the SARS-CoV-2 pandemic due to hygienic concerns. The aim of this study was to find out whether the results of olfactory testing obtained by presenting odours on a single-use filter paper is identical to performing the test by presenting the odour pens according to the manufacturer’s manual.

International Rhinologic Society Rhinology 0300-0729 59 4 2021 8 1 34333578 Association between body composition indices and prevalence of chronic rhinosinusitis in Koreans* 405 408 EN K. Lee Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea K. Kim Department of Public Health, Graduate School, Korea University, Seoul, South Korea S.H. Lee Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea T.H. Kim Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea 2915 10.4193/Rhin20.665