International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 36166836 Treating objective outcome measures of chronic rhinosinusitis: are we making the patient or ourselves feel better? 321 321 EN A.R. Sedaghat Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 3027 10.4193/Rhin22.905

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 35438689 Correlation of polyp grading scales with patient symptom scores and olfaction in chronic rhinosinusitis: a systematic review and meta-analysis 322 334 EN S.S. Jeong Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Albert Einstein College of Medicine, Bronx, NY, USA T. Chen Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA S.A. Nguyen Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA T.S. Edwards Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA R.J. Schlosser Department of Otolaryngology â€" Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA 2996 10.4193/Rhin22.011 Background: Various nasal polyp (NP) scoring systems have been proposed and used in the literature. However, no single system has been identified as superior. Correlations between NP scoring systems and patient symptoms, quality of life (QOL) or olfaction vary widely. Methods: A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Any study examining endoscopy scores and symptom, QOL or olfaction measures in cross sectional manner or after therapeutic intervention were included. Results: This review identified 55 studies for a pooled meta-analysis of Lund-Kennedy (LK-NP) polyp scores (N = 6), Meltzer scores (N = 6), Nasal polyp scores (NPS; N = 19), Total polyp score (TPS; N=8) Lilholdt scores (N = 8), Olfactory cleft endoscopy score (OCES; N =4), Discharge, inflammation, polyp/edema score (DIP; N = 2), and Perioperative sinus endoscopy score (POSE; N = 2). Meta-regression assessed correlations between NP grading systems and SNOT-22, nasal congestion scores, total nasal symptom scores (TNSS), and Smell Identification Test-40 (SIT40). None of the NP grading systems correlated significantly with any symptom, QOL or olfactory metric. In intervention studies of surgery or monoclonal antibody treatment, changes in NPS scores did not correlate with any patient reported outcome measure (PROM) or olfactory outcomes. Conclusion: Current NP endoscopic scoring systems are not associated with PROMs such as SNOT-22, nasal congestion scores, and TNSS as well as objective measures of olfaction. NP grading systems with improved clinical utility are needed.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 35726828 Features of inhalant allergy on nasal endoscopy: a systematic review and meta-analysis 335 346 EN G. Osie Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia K. Wegrecki Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia R. Alvarado Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia R.G. Campbell Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia L. Kalish Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia; Faculty of Medicine, University of Sydney, Australia J. Rimmer Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Woolcock Institute, University of Sydney, Australia; Faculty of Medicine, Notre Dame University, Sydney, Australia R. Sacks Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia; Faculty of Medicine, University of Sydney, Australia R.J. Harvey Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia 3007 10.4193/Rhin22.066 Background: Nasal endoscopy is increasingly accessible to ENT surgeons. The characteristics of the allergic upper airway are not well recognised. Methodology: MEDLINE (1946-2021), EMBASE (1974-2021), and the Cochrane Library were searched on 16th November 2021 to identify articles that reported endoscopic findings of patients with documented allergy who had undergone nasal endoscopy. The review followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Meta-analysis was performed by pooling sensitivities and specificities using the hierarchical summary receiver operating characteristics model. Results: A total of 4108 articles were identified, of which 15 manuscripts met the inclusion criteria. The included studies involved 4660 patients who had undergone nasal endoscopy. Middle turbinate (diffuse/polypoid) oedema (sensitivity 58.0%, specificity 84.5%), watery secretions (sensitivity 65.7%, specificity 76.5%), inferior turbinate hypertrophy (sensitivity 86.2%, specificity 32.2%), and unspecified turbinate hypertrophy (sensitivity 82.0%, specificity 42.9%) were identified as the features with the highest predictive value of inhalant allergy. Conclusions: Diffuse or polypoid oedema of the middle turbinate or watery secretions seen on nasal endoscopy can be a useful adjunct in the identification and diagnosis of inhalant allergy. These clinical features should be part of the diagnostic workup for patients that includes a clinical history and surrogate markers of allergic sensitisation from the skin and serum.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 Sinonasal mucosal melanomas: defining profiles for better survival outcomes 347 356 EN M.J. Rojas-Lechuga Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain J.R. Gras-Cabrerizo Otorhinolaryngology Head-Neck Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain F.X. Aviles-Jurado Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain; Head Neck Clínic, University and Research Grants Management Agency (AGAUR), 2017-SGR-01581; and Center for Biomedical Research Network on Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain J. Malvehy Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain A.M. Arance Oncology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain P. Castillo Pathology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain A. Barreiro Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain S. Podlipnik Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain M. Lopez-Chacon Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain I. Alobid Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain M. Bernal-Sprekelsen Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain S. Puig Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain C. Langdon Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain 3005 10.4193/Rhin21.251 Background: Sinonasal mucosal melanoma is an aggressive malignancy with a 5-year survival rate ranging from 20% to 39%. Despite the evolving surgical and radiotherapy techniques, and introduction of immune-checkpoint inhibitor therapy, overall survival rates remain poor. Methodology: A retrospective cohort study was conducted at the Hospital Clínic de Barcelona and the Hospital de la Santa Creu i Sant Pau between 1984 and 2020; primary outcome measures were 3 and 5-year melanoma-specific survival (MSS). Kaplan-Meier survival analysis and Cox proportional hazards model were performed to identify predictors of survival. Results: Fifty patients were included, the mean age was 70.4, MSS at 3 and 5 years was 51.2%, and 29.5%, respectively. The median follow-up was 39.6 months during which 46% presented locoregional recurrence and 36%, metastasis. The univariate and multivariate analyses found as survival predictors the N category, the treatment received, the surgical margins and the mitotic index. Conclusions: We found an overall 5-year MSS of 29.5%. Those patients with intention-to-cure (stages III and IVa) treated by surgery that were N0 at diagnosis, with < 10 mitoses per HPF showed a 5-year MSS rate of 74.1%. More studies will be needed to adequately define the patients’ profiles that will benefit from a better survival outcome.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 35726849 A surgical protocol for sinogenic brain abscess: the Oxford experience and a review of the literature 357 367 EN F. Bandino ENT Department, Oxford University Hospital, Oxford, UK R. Thota ENT Department, Oxford University Hospital, Oxford, UK A.L. Pendolino ENT Department, Royal National ENT K. Chaidas ENT Department, Oxford University Hospital, Oxford, UK S. Jeyaretna Neurosurgical Department, Oxford University Hospital, Oxford, UK T. Lawrence Neurosurgical Department, Oxford University Hospital, Oxford, UK P. Martinez-Devesa ENT Department, Oxford University Hospital, Oxford, UK A. Qureishi ENT Department, Oxford University Hospital, Oxford, UK 3008 10.4193/Rhin22.070 Background: Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes. Methodology: Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020. Results: Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks. Conclusions: In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 35818923 Usefulness of bilateral mucoplasty plus reboot surgery in severe type-2 chronic rhinosinusitis with nasal polyps 368 376 EN R. Moreno-Luna Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain D.I. Martin-Jimenez Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain M.A. CallejÃłn-Leblic Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain J. Gonzalez-Garcia Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain J.M. Maza-Solano Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain C. Porras-Gonzalez Molecular Biology and Biomedicine department. Hospital Universitario Virgen de la Macarena, Seville, Spain A. Del Cuvillo-Bernal Rhinology and Asthma Unit, ENT Department, Hospital de Jerez, Jerez de la Frontera, CÃˇdiz, Spain S. Sanchez-Gomez Rhinology Unit, Department of Otolaryngology, Hospital Universitario Virgen de la Macarena, Seville, Spain 3011 10.4193/Rhin22.131 Background: Although extended endoscopic sinus surgery (ESS) constitutes an alternative approach in patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), the surgical techniques proposed so far do not allow for an optimal control of the disease. This study introduces bilateral mucoplasty as a complementary technique to extended ESS such as reboot surgery, analyzing its benefits in healing and quality of life (QoL). Methods: Patients diagnosed with severe Type-2 CRSwNP were selected for a prospective cohort study in two surgery groups: reboot surgery plus bilateral mucoplasty versus reboot surgery only. In the first group, an autologous endonasal mucosal graft from the nostril floor was placed bilaterally onto the ethmoidal roof. Endoscopic, radiological and QoL outcomes were compared before and one year after surgery between the two groups using Modified Lund Kennedy (LKM), Meltzer and Lund Mackay (LM) scores, and the Sino-Nasal Outcome Test 22 (SNOT-22). Results: 64 patients with homogeneous baseline characteristics were included: 17 patients underwent a reboot surgery plus a bilateral mucoplasty and 47 a reboot surgery only. LKM, Meltzer and SNOT-22 scores showed significant differences before and after surgery in both groups, with higher improvement in the mucoplasty group. A greater mean improvement of 20.5 ± 6.4 points in SNOT-22 change was associated with bilateral mucoplasty. Conclusion: Bilateral mucoplasty plus reboot surgery constitutes a useful surgical resource in Type-2 CRSwNP patients, showing improved endoscopic, radiological and QoL outcomes one year after surgery. Further studies are needed to determine their long-term benefits.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 35856790 Analysis of predisposing factors in unilateral maxillary sinus fungal ball: the predictive role of odontogenic and anatomical factors 377 383 EN J.G. Doo Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea; Department of Medicine, Graduate school, Kyung Hee University, Seoul, Korea H.K. Min Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea G.W. Choi Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea S.W. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea J.-Y. Min Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Seoul, Korea 3012 10.4193/Rhin22.175 Background: The pathogenesis of maxillary sinus fungal ball (MSFB) is explained by aerogenic and odontogenic factors. We evaluated the predisposing factors, including intranasal anatomical and dental factors for increased diagnostic accuracy. Methodology: In this study, 117 patients who underwent endoscopic sinus surgery for unilateral MSFB were included. Preoperative computed tomography (CT) scans were used to analyze the presence of anatomical variations (anterior and posterior nasal septal deviation (NSD), concha bullosa (CB), infraorbital cell (haller cell), paradoxical middle turbinate, everted uncinate process and MS size). Dental factors including history of dental procedures and findings on CT scans were reviewed. Results: Anterior and posterior NSD toward non-affected side were significantly associated with the presence of FB. The presence of CB and infraorbital cell was higher in the non-affected side rather than in the lesion side. Compared to non-affected MS, FB-presence MS was shallower and had a larger height to depth ratio. The presence of dental history was significantly higher on FB-presence MS than non-affected MS. In multivariable analysis, posterior NSD toward non-affected side, dental history increased the aOR of MSFB, while the presence of CB and infraorbital cell decreased the aOR of MSFB. Conclusions: The occurrence of MSFB seems to be associated with ipsilateral odontogenic factors, followed by anatomic variations including posterior NSD toward non-affected side and absence of CB and infraorbital cell.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 36150155 Prevalence of Chronic Rhinosinusitis with Nasal Polyps in Catalonia (Spain): a retrospective, large-scale population-based study 384 396 EN I. Sanchez-Collado Research Institute for Evaluation and Public Policies, Universitat Internacional de Catalunya (UIC), Barcelona, Catalonia, Spain T. Mora Research Institute for Evaluation and Public Policies, Universitat Internacional de Catalunya (UIC), Barcelona, Catalonia, Spain R. Munoz-Cano Allergy Section, Pneumology and Allergy Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain; IRCE - Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain; ARADyAL - Instituto de Salud Carlos III, Madrid, Spain P. Ribo Allergy Section, Pneumology and Allergy Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain; IRCE - Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain A. Valero Allergy Section, Pneumology and Allergy Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain 3025 10.4193/Rhin21.364 Background: Studies on the prevalence of chronic rhinosinusitis (CRS) with nasal polyps (NP) in general-based populations are scarce in Europe and worldwide. We performed a retrospective population-based observational cohort study of 30,189 adult patients diagnosed with NP in Catalonia (Spain). Methodology: Adult individuals (≥18 years old) with a diagnosis of NP established by medical records at different health care levels (primary, hospital, and emergency) from the Catalan Health System (CHS) were included. Socio-demographic characteristics, prevalence, overall and by age and gender, disease severity, multi-morbidities, and biomarkers of type-2 inflammation were evaluated, together with appropriate medical treatment (AMT) and Endoscopic Sinus Surgery (ESS). Results: In general population and severity sub-populations, the overall diagnosed NP prevalence was 0.49% and higher for males than females (0.60% vs 0.39%, p less than 0.0016). The prevalence for the severe NP population was 0.12%. The NP prevalence increased with age, the highest being at ≥ 60 years old for both gender and severity groups. Asthma (40.1%), acute rhinosinusitis (41.1%), and allergic rhinitis (32.1%) were among the most frequent comorbid respiratory diseases. ESS was performed in 15.4% of NP patients. Type 2 inflammation was present in 83.8% of the NP population and was more frequent in severe than non-severe (87.1% vs 82.7%, p less than 0.0001) patients and in those with respiratory multi-morbidities (91%). Conclusions: This is the first large-scale population-based NP epidemiology study conducted in Spain, including severity based on undergoing medical and surgical treatment and type 2 inflammation. Although the prevalence data are lower than in previous European studies, the large NP cohort studied represents an essential strength of the results.

International Rhinologic Society Rhinology 0300-0729 60 5 2022 10 1 35818924 Single-stage endoscopic-assisted eye sparing resection with primary orbital reconstruction for sinonasal malignancy 397 400 EN J. Collins Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom A. Takhar Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom R. Niziol Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom A. Fry Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom R. Oakley Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom C. Hopkins Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom P. Surda Department of Otolaryngology and Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom 3010 10.4193/Rhin22.114