International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35680150 Unmet needs in biological treatment of CRS 161 161 EN W.J. Fokkens Department of Otolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands 3006 10.4193/Rhin22.903

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35230355 Ethical dilemmas associated with the introduction of biologic treatments in chronic rhinosinusitis with nasal polyps 162 168 EN C. Hopkins ENT Department, Guy’s Hospital, London, United Kingdom 2977 10.4193/Rhin21.477 This review considers ethical dilemmas which may present when introducing the use of biologic treatments alongside existing treatments in the management of chronic rhinosinusitis with nasal polyps. Biologic therapies offer hope to patients with diseases recalcitrant to conventional therapies but are often significantly more expensive. Reducing the need for surgery may act as a disincentive for use within surgical specialities, while reimbursement for administration has the potential to encourage inappropriate use. Any treatment should be used considering the principles of beneficence (offering the most effective treatment to the patient) and non-maleficence (minimising the risk of harm); the challenges of comparing the different available treatment options are considered. Patient autonomy should be involved a process of shared decision making, but when a third-party payor is involved they may seek to place restrictions on access to treatments that limit the choice of both patient and physician. Such decisions are often based on the cost-effectiveness of novel treatments relative to standard of care; published models suggest that at current market prices, biologics are less cost-effective in all groups that standard care. Social justice (fair distribution of limited healthcare resources) therefore may mandate rationing of access. To this end, working as part of professional organisations or research groups, physicians often produce guidelines that help to identify those in greatest need of novel treatments. The challenges in creating and applying these guidelines are also considered.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35403178 Endoscopic grading systems for nasal polyps: are we comparing apples to oranges? 169 176 EN P.G. Djupesland Optinose AS, Oslo Science Park, Oslo, Norway S. Reitsma Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands C. Hopkins Department of Otorhinolaryngology, Guy's Hospital, London, UK A.R. Sedaghat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A. Peters Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands 2982 10.4193/Rhin21.401 Endoscopic grading of nasal polyps (NP) is typically a coprimary endpoint in clinical trials evaluating treatments for chronic rhinosinusitis with nasal polyps (CRSwNP). However, a consensus on the most effective way to grade nasal polyps has not been reached. Different scales have been used, hampering the interpretation of data across trials. This review compares the characteristics of NP grading systems used in registration trials for approved NP treatments. These fundamental differences in grading systems make quantitative comparison of outcomes between trials inaccurate and potentially misleading. In lieu of a universal grading system, reporting the baseline distribution of polyp grades (unilateral and/or summed/total grades), as well as changes from baseline over time by baseline grade may help improve interpretability of outcomes and reduce inaccuracy when attempting cross-trial comparisons and making therapeutic decisions.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35233583 Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis 177 187 EN C.-C. Lee Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan C.-C. Huang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan T.-J. Lee Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan Y.-C. Wang Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan Y.-T. Liu Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan T.-W. Chang Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan A.P.-H. Huang Institute of Polymer Science and Engineering, National Taiwan University, Taipei City, Taiwan; Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan C.-C. Chuang Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan 2969 10.4193/Rhin21.348 Background: Whether endoscopic surgery for sellar/parasellar disease causes significant deficits in olfactory function remains unclear. We aimed to systematically review the olfactory outcomes in such settings based on the evidence up to date. Methods: PubMed, EMBASE, and CENTRAL were searched through February 1, 2021. Included studies were limited to endoscopic surgery for sellar/parasellar disease with follow-up olfactory function measured by standardized olfactory testing methods or subjective assessment. The primary outcome was the change in olfactory function after surgery assessed by standardized olfactory testing methods. The secondary outcome was the change in subjective olfactory function. Random-effects model was used in obtaining combine effects. Study quality was assessed using the Newcastleâ€"Ottawa scale. Sensitivity analysis was carried out using the leave-one-out approach, and publication bias was assessed using Egger’s test. Results: The results show no significant difference in olfaction assessed by standardized olfactory testing methods at 1â€"3 months post-surgery (880 patients in 16 studies) or at 6â€"12 months post-surgery (1320 patients in 16 studies) compared to pre-surgery, whereas a significantly lower subjective olfaction at 3 months was observed. In addition, the lack of significant change in olfaction as assessed by standardized olfactory testing methods was observed regardless of whether patients were treated with or without the nasoseptal flap (NSF) harvesting. Heterogeneity and publication bias were observed, whereas sensitivity analysis showed the meta-analysis results are robust. Conclusion: The findings of this updated systematic review and meta-analysis support the conclusion that endoscopic surgery for sellar and parasellar pathology may pose no greater risk of olfactory dysfunction. In addition, the current evidence does not support there is an increased risk of diminished olfaction among patients treated with NSF during surgery.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35901492 The COVANOS trial â€" insight into post-COVID olfactory dysfunction and the role of smell training 188 199 EN M. Lechner ENT Department, Barts Health NHS Trust, London, UK; UCL Cancer Institute, University College London, London, UK; Division of Surgery and Interventional Science, University College London, London, UK J. Liu UCL Cancer Institute, University College London, London, UK N. Counsell CRUK and UCL Cancer Trials Centre, University College London, London, UK D. Gillespie UCL Cancer Institute, University College London, London, UK D. Chandrasekharan ENT Department, Barts Health NHS Trust, London, UK N.H. Ta Norwich Medical School, University of East Anglia, Norwich, UK K. Jumani ENT Department, Barts Health NHS Trust, London, UK R. Gupta ENT Department, Barts Health NHS Trust, London, UK S. Rao-Merugumala ENT Department, Barts Health NHS Trust, London, UK J. Rocke ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK C. Williams ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK A. Tetteh ENT Department, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK R. Amnolsingh Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK S. Khwaja Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK R.L. Batterham Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK C.H. Yan Department of Otolaryngology-Head and Neck Surgery, University of San Diego School of Medicine, San Diego, USA T.A. Treibel National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew’s Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK J.C. Moon National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew’s Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK J. Woods The Norfolk Smell and Taste Clinic, Norfolk R. Brunton ENT Department, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK J. Boardman Fifth Sense, UK S. Paun ENT Department, Barts Health NHS Trust, London, UK N. Eynon-Lewis ENT Department, Barts Health NHS Trust, London, UK B.N. Kumar ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK S. Jayaraj ENT Department, Barts Health NHS Trust, London, UK C. Hopkins ENT Department, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK C. Philpott Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK V.J. Lund Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK 2983 10.4193/Rhin21.470 Background: Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted. Methodology: We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants. Results: 218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia. Conclusions: Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35174812 Gustatory dysfunction in patients with olfactory dysfunction and the associated factors 200 206 EN M.-S. Rha Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea H.-J. Cho Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; The Korea Mouse Phenotyping Center, Yonsei University College of Medicine, Seoul, Republic of Korea J.-H. Yoon Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; The Korea Mouse Phenotyping Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Global Research Laboratory for Allergic Airway Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea S.J. Moon Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Republic of Korea and Taste Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea C.-H. Kim Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; The Korea Mouse Phenotyping Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Medical Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea 2966 10.4193/Rhin21.309 Background: Little is known about the occurrence of gustatory dysfunction (GD) in relation to different aetiologies of olfactory dysfunction (OD) as assessed by psychophysical chemosensory tests. The aim of this study was to analyse gustatory function in patients with OD and to investigate clinical factors associated with GD. Methods: A total of 742 individuals who underwent both olfactory and gustatory function tests at a tertiary medical centre from November 2019 to March 2021 were retrospectively enrolled. Olfactory and gustatory function were assessed by the YSK olfactory and gustatory function tests, respectively. Patients with OD were classified into four groups according to the aetiology: sinonasal disease, post-infection OD (PIOD), post-traumatic OD (PTOD), and others. Secondary outcomes included age, sex, smoking history, and alcohol history. Results: Among the 488 patients with OD, 93 (19.1%) showed GD and 395 (80.9%) had normal gustatory function. Only 25 (9.8%) among 254 individuals with normosmia showed GD. Analyses of these frequencies revealed a significant association between OD and GD. In addition, the taste score was significantly lower in patients with OD than individuals with normosmia. The frequency of GD was significantly higher in patients with PTOD (53.6%) than in those with OD of other aetiologies (sinonasal disease, 6.7%; PIOD, 13.0%; others, 24.4%). In the multivariate analysis, age �55 years and PTOD were associated with a high frequency of GD among patients with OD. Conclusions: The current study show that GD is significantly associated with OD. In particular, GD is more common in patients with PTOD than in those with OD of other aetiologies.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35398877 A follow-up on quantitative and qualitative olfactory dysfunction and other symptoms in patients recovering from COVID-19 smell loss 207 217 EN K Ohla Helmut-Schmidt-University, University of the Armed Forces Hamburg, Germany; Firmenich SA, Satigny, Switzerland; The Pennsylvania State University, USA M.G. Veldhuizen Mersin University, Turkey T. Green The Hebrew University of Jerusalem, Israel M.E. Hannum Monell Chemical Senses Center, Philadelphia, USA A.J. Bakke The Pennsylvania State University, USA S.T. Moein Institute for Research in Fundamental Sciences (IPM), Iran A. Tognetti Karolinska Institutet, Stockholm, Sweden E.M. Postma Wageningen University and Research, the Netherlands R. Pellegrino Monell Chemical Senses Center, Philadelphia, USA D.L.D. Hwang The University of Queensland, Australia J. Albayay University of Trento, Italy S. Koyama Indiana University, USA A.A. Nolden University of Massachusetts, Amherst, USA T. Thomas-Danguin INRAE, CSGA, France C. Mucignat-Caretta University of Padova, Italy N.S. Menger University of Tübingen, Germany I. Croijmans Utrecht University, the Netherlands L. Ã-ztürk Mersin University, Turkey H. Yanık Mersin University, Turkey D. Pierron CNRS, France V. Pereda-Loth Université Toulouse III, France A. Nunez-Parra University of Chile, Chile A.M. Martinez Pineda Université Toulouse III, France D. Gillespie University College London, UK M.C. Farruggia Yale University, USA C. Cecchetto University of Padova, Italy M.A. Fornazieri Universidade Estadual de Londrina, Brazil C. Philpott University of East Anglia, UK V. Voznessenskaya Severtsov Institute of Ecology and Evolution, Moscow, Russia K.W. Cooper University of California, Irvine, USA P. Rohlfs Dominguez Universidad del PaÃ�s Vasco, Euskal Herriko Unibertsitatea, Spain O. Calcinoni private practice, VMPCT, Italy J. de Groot Radboud University, the Netherlands S. Boesveldt Wageningen University and Research, the Netherlands S. Bhutani San Diego State University, USA E.M. Weir The Pennsylvania State University, USA C. Exten The Pennsylvania State University, USA P.V. Joseph National Institutes of Health, NINR, NIAAA, USA V. Parma Monell Chemical Senses Center, Philadelphia, USA J.E. Hayes The Pennsylvania State University, USA M.Y. Niv The Hebrew University of Jerusalem, Israel 2993 10.4193/Rhin21.415 Background: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection. Methods: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. Results: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2. Conclusions: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 Low pH nasal rinse solution enhances mupirocin antimicrobial efficacy 218 228 EN K. Hon Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia S. Liu Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia C. Cooksley Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia S. Vreugde Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia A.J. Psaltis Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia 2978 10.4193/Rhin21.495 Background: Chronic rhinosinusitis (CRS) is a common condition negatively impacting a patient’s quality of life. It has been hypothesized that bacterial biofilms are involved in the pathogenesis of CRS due to their persistence and difficulty to eradicate with conventional antibiotic therapy. Hence, the topical delivery of antibiotics via nasal rinse solution has gained a lot of attention due to the ability to deliver higher local concentrations, with less systemic absorption and side effects. This study investigates the efficacy of mupirocin dissolved in the 3 most commonly used sinus rinses in Australia Neilmed (isotonic saline), Flo Sinus Care (sodium chloride, sodium bicarbonate, potassium chloride, glucose anhydrous and calcium lactate and Pentahydrate) and FloCRS (sodium chloride, potassium chloride and xylitol). Methods: Planktonic and biofilm cultures of S. aureus (ATCC25923, 2 methicillin-resistant S. aureus (MRSA) (C222 and C263), and 2 methicillin-susceptible S. aureus (MSSS) (C311 and C349) clinical isolates) were treated with mupirocin dissolved in three sinus rinses (Neilmed, Flo Sinus Care and FloCRS with different pH). To establish whether pH was a significant factor in determining antibiotic activity, experiments with Flo CRS were performed both at pH 5.64 and elevated pH 7.7. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined for planktonic cells. The biofilm biomass and metabolic activity were assessed by using crystal violet assay and alamarBlue assay respectively. Results: The combination of mupirocin in low pH (pH 5.64) sinus rinse (FloCRS) had the highest efficacy in reducing the growth of S. aureus in both the planktonic and biofilm forms. Mupirocin diluted in FloCRS (pH 5.64) showed a significantly higher reduction in both biomass and metabolic activity than that was observed when mupirocin was diluted in Neilmed, Flo Sinus Care or FloCRS (pH 7.7). Conclusion: The choice of irrigant solution for topical mupirocin delivery appears to be important for antimicrobial activity. The delivery of mupirocin via low pH FloCRS could be useful in eliminating S. aureus biofilms present on the sinus mucosa of patients with CRS.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35229832 Individual symptom visual analogue scale severity scores for determining EPOS guideline-based chronic rhinosinusitis disease control 229 235 EN K.M. Phillips Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA K.W. Singerman Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A.R. Sedaghat Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2975 10.4193/Rhin21.446 Background: The goal of this study was to determine how to translate visual analogue scale (VAS) symptom scores to the binary, descriptive symptom scales used in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria for chronic rhinosinusitis (CRS) disease control. Methods: 309 CRS patients were recruited. All patients rated their burden of 5 symptoms (nasal blockage, rhinorrhea/postnasal drip, facial pain/pressure, smell loss, sleep disturbance or fatigue) using the binary EPOS descriptive symptom scales and a VAS (on a scale of 0 to 10). In addition, participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and rated their overall CRS disease control as �controlled�, �partly controlled� or �uncontrolled�. Results: Symptom burdens measured by VAS, binary descriptive EPOS scale and SNOT-22 were associated with worsening CRS disease control reported by participants. Each symptom had a distinct VAS score cut-off that strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale. However, the predictive ability of VAS for rhinorrhea/ postnasal drip was disparately worse than the other 4 symptoms. When considering all symptom data simultaneously, a VAS score higher than 3.5 strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale for all 5 symptoms. Conclusions: A VAS symptom score of higher than 3.5 translates to the uncontrolled option in the binary, descriptive symptom scale of the EPOS control criteria. The rhinorrhea/postnasal drip descriptive symptom scale translates disparately worse to VAS scores and may be considered for revision in future criteria.

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35230357 European Rhinologic Society meeting 2021. Safe in person meeting in times of COVID-19 236 237 EN W.J. Fokkens Department of Otolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands C. Meco Department of ORL-HNS, Ankara University Medical School, Ankara, Turkey and Department of ORL-HNS, Salzburg Paracelsus Medical University, Salzburg, Austria J. Constantinidis 1st Dept of ORL, Head and Neck Surgery, Aristotle University, Thessaloniki, Greece N. Zhang Upper Airways Research Laboratory, Ghent University, Ghent, Belgium C. Hopkins Guy’s and St Thomas’ Hospital, Great Maze Pond, London, UK 2976 10.4193/Rhin21.476

International Rhinologic Society Rhinology 0300-0729 60 3 2022 6 1 35229831 Reactions received by smell loss patients after revealing their dysfunction 238 240 EN M.K. Mahmut Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Food, Flavour and Fragrance Lab, School of Psychological Sciences, Macquarie University, Sydney, Australia M. Rosbach Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 2974 10.4193/Rhin21.360