International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35926101 â€œWho is it?â€ in rhinology 241 241 EN S. Reitsma Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands 3013 10.4193/Rhin22.911

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35379997 As-needed intranasal corticosteroid spray for allergic rhinitis: a systematic review and meta-analysis 242 251 EN M.P. Hoang Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam W. Chitsuthipakorn Center of Excellence in Otolaryngology-Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Otolaryngology, College of Medicine, Rangsit University, Bangkok, Thailand K. Seresirikachorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand 2992 10.4193/Rhin21.355 Background: As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with allergic rhinitis (AR) who have suboptimal symptom control. This systematic review aimed to assess the effectiveness of as-needed INCS for treating AR. Methodology: Systematic searches for randomized controlled trials studying the effects of as-needed INCS compared to regular INCS, as-needed antihistamine, or placebo were performed. Primary outcomes were total nasal symptom score (TNSS) and disease-specific quality of life (DSQoL). Results: Eight studies (882 participants) met the criteria. Regular use of INCS showed greater improvements than as-needed INCS in TNSS, DSQoL, nasal peak inspiratory flow, sneezing, and nasal congestion scores with small effect sizes. There were no differences between regular and as-needed INCS usage for ocular symptoms, symptom-free days, nasal itching, and rhinorrhea scores. As-needed INCS was superior to as-needed antihistamine and placebo with medium effect sizes. There were no differences in risk of adverse events between the groups in all three comparisons. Conclusions: Regular use of INCS improved total nasal symptoms score and DSQoL better than as-needed INCS. However, as-needed INCS improved TNSS better than as-needed antihistamine and placebo. The effects of as-needed INCS were closer to regular INCS usage than to placebo or as-needed AH usage.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35230356 Investigating the secondary care system burden of CRSwNP in sinus surgery patients with clinically relevant comorbidities using the HES database 252 260 EN C. Hopkins Guyâ€™s and St. Thomasâ€™ Hospital, Kings college, London, UK S. Conlon Sanofi Genzyme UK, Reading, UK S. Chavda IQVIA, London, UK R. Hudson Sanofi Genzyme UK, Reading, UK R. Rout Sanofi Genzyme UK, Reading, UK 2979 10.4193/Rhin21.264 Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic condition that can adversely affect quality of life for patients. There is no cure for CRSwNP, and patients may require intermittent systemic corticosteroids (SCS) and surgery in addition to intranasal treatment throughout their lifetime. This places a significant burden on the NHS which can be compounded by comorbid conditions such as asthma or NSAID-exacerbated respiratory disease (NERD). Patients with comorbidities are likely to experience higher rates of surgery and more secondary care visits. The aim of this study was to evaluate revision rates and the associated burden for patients with CRSwNP undergoing surgery and compare this to sub-cohorts of patients with comorbidities. Materials and Methods: This study has utilised the Hospital Episodes Statistics (HES) database across a ten-year time period (April 2010 to March 2020) to investigate the NHS resource use attributable to CRSwNP for all patients with the condition who have undergone sinus surgery, and to examine the burden of clinically relevant sub-groups. Results: Our results showed that 101,054 patients underwent at least one sinus surgery in relation to their nasal polyps, with Kaplan Meier survival analysis estimating that the 10-year probability of revision is between 71-90% for comorbid patients, and 51% for non-comorbid patients. Patients with a relevant comorbid condition in addition to their CRSwNP were up to 4.7 times more likely to undergo at least one revision surgery during the ten-year analytical time window when compared to patients without a comorbidity. Further to this, comorbid patients had a higher tariff associated with their CRSwNP care across the analytical time window and were therefore likely to be more costly to the healthcare system. Conclusions: In conclusion, this study demonstrates that there is a high burden attached to CRSwNP-related sinus surgery and that comorbidities are a key driver of NHS resource use.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35934318 Twelve-year long-term postoperative outcomes in patients with chronic rhinosinusitis with nasal polyps 261 269 EN C. Arancibia Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain C. Langdon Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain; Institut d Investigacions BiomÃ¨diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de InvestigaciÃ³n BiomÃ©dica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain J. Mullol Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain; Institut d Investigacions BiomÃ¨diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de InvestigaciÃ³n BiomÃ©dica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain I. Alobid Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Spain; Institut d Investigacions BiomÃ¨diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de InvestigaciÃ³n BiomÃ©dica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain 2981 10.4193/Rhin21.148 Background: Evidence regarding long-term postoperative follow-up of chronic rhinosinusitis with nasal polyps (CRSwNP) patients is scarce in the literature. The objective of the present study was to report long-term 12-year postoperative outcomes for CRSwNP patients. Methods: CRSwNP patients were prospectively followed after endoscopic sinus surgery. Sinonasal symptoms, nasal polyp score (NPS), Barcelona Smell Test 24 (BAST-24), Lund-Mackay Score (LMS), and Medical Outcome Study Short Form-36 (SF-36) questionnaire were assessed before and 12 years after surgery. Results: At long-term follow-up (median, 12 years), a strong improvement was noted for all patients (N=76) in nasal symptoms score, NPS, BAST-24, and LMS scores compared with baseline. No long-term improvement in SF-36 was found. Conclusion: Patients with CRSwNP have a long-term 12-year postoperative improvement in nasal symptoms, polyp size, computed tomography, and olfaction.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 p120 regulates E-cadherin expression in nasal epithelial cells in chronic rhinosinusitis 270 281 EN X.-L. Li Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Q.-M. Feng Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China H.-N. Yang Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China J.-W. Ruan Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Y.-F. Kang Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Z.-E. Yu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China J.-X. Liu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China A.-N. Chen Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Y.-H. Cui Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Z. Liu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China X. Lu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China 3004 10.4193/Rhin21.276 Background: The epithelial barrier plays an important role in the regulation of immune homeostasis. The effect of the immune environment on E-cadherin has been demonstrated in previous studies. This discovery prompted new research on the targeting mechanism of E-cadherin in chronic rhinosinusitis (CRS). Methods: E-cadherin and p120 expression was determined by quantitative RTâ€"PCR, and western blot. The interaction between E-cadherin and p120 was assessed by immunofluorescence staining and coimmunoprecipitation assays. Human nasal epithelial cells (HNECs) were cultured with submerged methods and transfected with p120-specific small interfering RNA. In other experiments, HNECs differentiated with the air-liquid interface (ALI) method were stimulated with various cytokines and Toll-like receptor (TLR) agonists. The barrier properties of differentiated HNECs were determined by assessing fluorescent dextran permeability. Results: E-cadherin and p120 expression was decreased in HNECs from patients with CRS, and the p120 protein expression level was positively correlated with that of E-cadherin. Two isoforms of p120 (p120-1 and p120-3) were expressed in HNECs, with p120-3 being the main isoform. Knocking down p120 in HNECs cultured under submerged conditions significantly reduced the E-cadherin protein expression. The Rac1 inhibitor NSC23766 reversed the protein expression of E-cadherin in p120 knockdown experiments. Inflammatory mediators, including IL-4, TNF-Î±, TGF-Î²1, LPS and IFN-Î³, reduced E-cadherin and p120 protein expression and increased paracellular permeability. Dexamethasone abolished the downregulation of E-cadherin and p120 caused by inflammatory mediators. Conclusions: p120 is involved in regulating E-cadherin protein expression in CRS. Dexamethasone may alleviate the reduction in E-cadherin and p120 protein expression caused by inflammatory mediators.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35608041 Disease control in chronic rhinosinusitis: a qualitative study of patient perspectives 282 292 EN V. Walker Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA M. Trope Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA A.A. Tichavakunda Department of Education Leadership, School of Education, University of Cincinnati, Cincinnati, OH, USA M.M. Speth Department of Otorhinolaryngology, Kantonsspital Aarau, Aarau, Switzerland A.R. Sedaghat Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA K.M. Phillips Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA 3000 10.4193/Rhin21.448 Background: The definition of disease control in chronic rhinosinusitis (CRS) is an active area of study. However, investigations have not engaged CRS patients in how they think about disease control. This study seeks to understand the patient perspective on CRS disease control. Methods: Qualitative phenomenological study using constant comparative methodology was applied. The research team conducted 10, one-on-one interviews with CRS patients ranging from 22 to 55 minutes in length. The content of the interview protocol was determined through iterative discussion amongst all authors. Two authors served as coders to identify recurrent themes. Themes were analyzed for meaning and conclusions were summarized. Results: Three recurring themes determined from patients were that (1) use of the terminology â€œcontrolâ€ adequately represents this phenomenon, (2) components of control could be classified into four main themes relating to CRS symptomatology, exacerbation of comorbid disease, quality of life and acute exacerbations of CRS, and (3) when patients deem their CRS is uncontrolled they are more willing to escalate their treatment to include escalating their daily maintenance regimen, seeking otolaryngology referral, taking rescue medication or undergoing endoscopic sinus surgery. Conclusions: CRS patients consider their daily symptoms, the severity and frequency of CRS exacerbations, impact on quality of life as well as exacerbation of comorbid disease when thinking about their disease control. Disease control is a goal of treatment for patients and uncontrolled disease motivates patients to seek further treatment. Physicians should explore all components of CRS control when considering disease status and need for further treatment.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35926120 Smell, taste and trigeminal function: similarities and differences between results from home tests and examinations in the clinic 293 300 EN Z. Li Smell and Taste Clinic, Department of Otorhinolaryngology, â€œTechnische UniversitÃ¤tâ€ Dresden, Dresden, Germany S. Stolper Smell and Taste Clinic, Department of Otorhinolaryngology, â€œTechnische UniversitÃ¤tâ€ Dresden, Dresden, Germany J. Draf Smell and Taste Clinic, Department of Otorhinolaryngology, â€œTechnische UniversitÃ¤tâ€ Dresden, Dresden, Germany A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, â€œTechnische UniversitÃ¤tâ€ Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, â€œTechnische UniversitÃ¤tâ€ Dresden, Dresden, Germany 3016 10.4193/Rhin21.430 Background: This study aimed to examine an easy-to-conduct home chemosensory test as a screening tool prior to clinical testing and to investigate the associations between home and clinical tests. Methods: We examined 200 participants who performed a chemosensory test including subjective ratings as well as psychophysical smell, taste and trigeminal function tests at their homes. Following that, they were invited to the clinic for standardized testing using the Sniffinâ€™ sticks test for assessment of olfactory function, taste sprays and strips for taste function, and a lateralization test for trigeminal function. Results: The home smell test correlated well with the Sniffinâ€™ sticks test. The home test had acceptable sensitivity for detecting smell loss (sensitivity of 67% at a specificity of 92%). The home test could distinguish between patients with olfactory loss and healthy controls. In contrast, the home tests for taste and trigeminal function did not provide valid results. When comparing home and clinical smell and taste tests older age and olfactory loss were the most influencing confounders in various models, while participants who had olfactory loss and admitted to drink alcohol regularly were more likely to have consistency between home and clinical smell measurements. Conclusions: Although the standardized psychophysical tests are valid and reliable and should be recommended, simple methods used at home could reflect the patients' information to some degree and provide useful data prior to clinical testing. The present home chemosensory test allows motivated individuals to screen their olfactory function in a simple way at home. Results from smell tests, but not from tests of taste or trigeminal function, obtained at home correlate with tests obtained at the clinic. Moreover, tests conducted at home or in the clinic have confounders that should be considered by researchers and clinicians.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35753020 Identification and enjoyment of food items is reduced in dysosmic subjects: a pilot study 301 307 EN J.J. Allensworth Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA R.J. Schlosser Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA Z.M. Soler Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA 3009 10.4193/Rhin21-311 Background: Although dysosmia affects a significant proportion of the adult population, there are a paucity of studies addressing its impact on flavor perception and food enjoyment. This study aimed to assess flavor perception and food enjoyment in subjects with and without dysosmia, comparing performance of items considered olfactory-dominant or trigeminal-dominant. Methods: Adult subjects prospectively underwent Sniffin' Sticks olfactory testing from which threshold, discrimination, and identification (TDI) scores were used to identify dysosmic (TDI over 31) and normosmic subjects (TDI under 31). Forced-choice, blinded flavor identification testing was performed using 8 flavor extracts and 8 real-food purees of either trigeminal- or olfactory-dominant flavor profile. Food enjoyment was quantified using visual analog scales. Results: Forty-one subjects were enrolled, including 20 dysosmics and 21 normosmics, with no difference in age or gender. Compared with normosmics, dysosmic subjects had significantly lower identification of extracts and purees. Among dysosmics, overall identification of trigeminal-dominant extracts and foods was higher than olfactory-dominant extracts and foods. Compared with normosmics, dysosmic subjects reported significantly reduced enjoyment of olfactory-dominant extracts and foods; however, there was no significant difference in enjoyment of trigeminal-dominant extracts or foods. Conclusions: Identification and enjoyment of food items is reduced in dysosmic subjects, with the greatest impact in olfactory items. These findings suggest that diet modification might lead to greater enjoyment in those with dysosmia.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35475433 Outcomes of intubation and endoscopic DCR in functional nasolacrimal duct obstruction 308 312 EN Y. Shapira Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia C. Macri Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia E. Usmani Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia A.J. Psaltis Department of Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia; Department of Otolaryngology Head and Neck Surgery, Central Adelaide Health Network, Adelaide, SA, Australia W.O. Chan Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia D. Selva Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia; Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia 2997 10.4193/Rhin22.047 Background: To ascertain the success of lacrimal intubation and DCR in alleviating epiphora due to functional nasolacrimal duct obstruction (FNLDO). Methods: Consecutive adult patients with epiphora attending a tertiary lacrimal clinic from May 2010 to February 2021 were reviewed to identify cases with FNLDO. FNLDO was defined as epiphora with the exclusion of alternate causes of watering on clinical examination, patent lacrimal syringing, normal DCG, and post-sac delay on DSG. Epiphora resolution and improvement rates in FNLDO were compared between lacrimal intubation and endo-DCR. Results: 23 endo-DCRs (20 patients, 65% females, mean age 68.9Â±12.2) and 41 intubations (29 patients, 61.2% females, mean age 65.0Â±14.1) performed in FNLDO were included. Resolution of epiphora was achieved in 15 of the DCR procedures (median follow-up 9 months) compared to 14 of intubations (median follow-up 10 months). Significant epiphora improvement (i.e., either improvement or resolution) was noted in 21 DCRs and 24 intubations. Seven patients undergoing intubation as the primary procedure had endo-DCR performed following the intubation. Among respondents to a phone questionnaire, 53.8% who had endo-DCR (median 69 months) and 50% that had intubation (median 28 months) reported significant improvement in epiphora. Conclusions: Improvement in epiphora due to FNLDO was approximately 59% in intubations, while the success of endo-DCR was higher (91%). The long-term results of these interventions warrant further investigation.

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35243484 Ratings of trigeminal stimulation in patients with olfactory loss 313 315 EN R. Sekine Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan A. HÃ¤hner Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany M. Laudien Department of Otorhinolaryngology, University of Kiel, Kiel, Germany E. Mori Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 2980 10.4193/Rhin21.483

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35926110 Reply to Letter to the editor concerning â€œAchieving the best method to classify Eosinophilic Chronic Rhinosinusitis: a systematic reviewâ€ 316 317 EN M.D.C. Toro Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, SÃ£o Paulo, Brazil M.S. de AssumpÃ§Ã£o Pulmonary physiology lab, Pediatrics Investigation Center, Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas, Campinas, SÃ£o Paulo, Brazil M.A. Antonio Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, SÃ£o Paulo, Brazil E. Sakano Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, SÃ£o Paulo, Brazil 3014 10.4193/Rhin22.911

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35652339 Determining a cut-off value for eosinophilic chronic rhinosinusitis 318 319 EN C. Wang Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China L. Zhang Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China 3003 10.4193/Rhin22.090

International Rhinologic Society Rhinology 0300-0729 60 4 2022 8 1 35926112 Reply to Letter to the editor concerning â€œDetermining a cut-off value for eosinophilic chronic rhinosinusitis" 320 320 EN M.D.C. Toro Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, SÃ£o Paulo, Brazil E. Sakano Department of Ophthalmology and Otorhinolaryngology, University of Campinas (Unicamp), Faculty of Medical Sciences, Campinas, SÃ£o Paulo, Brazil 3015 10.4193/Rhin22.912