International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36598030 Changing habits 1 1 EN W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands 3052 10.4193/Rhin23.901

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36173148 Therapeutic options of post-COVID-19 related olfactory dysfunction: a systematic review and meta-analysis 2 11 EN V. Asvapoositkul Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand J. Samuthpongtorn Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand S. Aeumjaturapat Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand S. Chusakul Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand K. Seresirikachorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand J. Kanjanaumporn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand 3028 10.4193/Rhin22.221 Background: Olfactory dysfunction is a typical post-COVID-19 presentation, affecting patients' quality of life. There are currently multiple treatment options in this group of patients such as oral and intranasal corticosteroids, olfactory training, oral vitamin-mineral supplementation, amongst others. This meta-analysis aims to consolidate existing evidence for current therapies in patients with persistent olfactory dysfunction related to COVID-19 infection and evaluate the possible role of corticosteroid add-on therapy in olfactory training. Methodology: A systematic review and meta-analysis to study current treatments/interventions for olfactory dysfunction in post-COVID-19 infection were conducted. Data were pooled for the meta-analysis. The outcomes include subjective or objective olfactory assessment major and minor adverse reactions. Results: Eleven studies (1414 participants) were included in this review, with six studies (916 participants) then assessed for the meta-analysis. Combined treatment of intranasal corticosteroid (INCS) with olfactory training (OT) has no benefit over OT monotherapy from both a VAS score improvement and identification component of Sniffin' Sticks test standpoint. In addition, there were no differences in improvement of TDI score between combined oral corticosteroid (OCS) with OT therapy compared to OT alone. Olfactory function was, however, significantly improved after OT. Conclusion: There were no significant differences in the improvement of olfactory scores in combination INCS+OT or OCS+OT therapies compared to OT monotherapy. However, there is improvement in olfactory function after OT.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36323438 Persisting chemosensory dysfunction in COVID-19 - a cross-sectional population-based survey 12 23 EN S. Winkelmann Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany A. Korth Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany B. Voss Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany M.A. Nasr Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany N. Behrend Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany A. Pudszuhn Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany V.M. Hofmann Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany P. Schendzielorz Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany C. Maetzler Neurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany A. Hermes Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany C. Borzikowsky Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany T. Bahmer Division of Pneumology, Department of Medicine 1, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany W. Lieb Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany S. Schreiber Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany S. StÃśrk Comprehensive Heart Failure Center and Dept. Internal Medicine I, University Hospital Würzburg, Würzburg, Germany F.A. Montellano Comprehensive Heart Failure Center and Dept. Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Würzburg, Würzburg, Germany M. Witzenrath Department of Infectious Diseases and Respiratory Medicine, Charité â€" Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany T. Keil Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany M. Krawczak Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany M. Laudien Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany on behalf of the NAPKON study group 3037 10.4193/Rhin22.176 Background: Chemosensory dysfunction (CD) has been reported as a common symptom of SARS-CoV-2 infection, but it is not well understood whether and for how long changes of smell, taste and chemesthesis persist in infected individuals. Methodology: Unselected adult residents of the German federal state of Schleswig-Holstein with Polymerase Chain Reaction (PCR)-test-confirmed SARS-CoV-2 infection were invited to participate in this large cross-sectional study. Data on the medical history and subjective chemosensory function of participants were obtained through questionnaires and visual analogue scales (VAS). Olfactory function (OF) was objectified with the Sniffin’ Sticks test (SST), including threshold (T), discrimination (D) and identification (I) test as well as summarized TDI score, and compared to that in healthy controls. Gustatory function (GF) was evaluated with the suprathreshold taste strips (TS) test, and trigeminal function was tested with an ampoule containing ammonia. Results: Between November 2020 and June 2021, 667 infected individuals (mean age: 48.2 years) were examined 9.1 months, on average, after positive PCR testing. Of these, 45.6% had persisting subjective olfactory dysfunction (OD), 36.2% had subjective gustatory dysfunction (GD). Tested OD, tested GD and impaired trigeminal function were observed in 34.6%, 7.3% and 1.8% of participants, respectively. The mean TDI score of participants was significantly lower compared to healthy subjects. Significant associations were observed between subjective OD and GD, and between tested OD and GD. Conclusion: Nine months after SARS-CoV-2 infection, OD prevalence is significantly increased among infected members of the general population. Therefore, OD should be included in the list of symptoms collectively defining Long-COVID.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36717267 Olfactory stimulation may modulate the sensation of nasal patency 24 31 EN Y.-T. Chao Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan A. Nakov Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany S. Poletti Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Department of Otorhinolaryngology, Inselspital, Bern, Switzerland T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 3039 10.4193/Rhin22.333 Background: The sensation of nasal patency can be induced by inhaling menthol, which predominantly produces trigeminal stimulation. It remains unclear whether olfactory stimulation can also induce or modulate the sensation of nasal patency. Methodology: A total of 118 participants (normosmia: n=67, olfactory dysfunction: n=51) were exposed to four odors in a randomized order: 1) phenylethanol (PEA), 2) menthol, 3) a mixture of PEA and menthol, 4) nearly odorless propylene glycol. The odors were presented by nasal clips. After the nasal clip had been removed, the participants rated relative nasal patency (RNP) from - 50 to +50, and their peak nasal inspiratory flow (PNIF) was measured. Repeated measures analysis of variance was used to examine the difference of RNP and PNIF among the four conditions and the influence of olfactory function. Results: The RNPs, other than PNIFs, differed between the four conditions. Menthol induced the highest RNP, followed by the mixed solution, PEA and the odorless condition. Normosmic participants, but not those with olfactory dysfunction, responded to PEA significantly higher than odorless condition with regard to RNP. The correlation analysis showed that the better the subjective or measured olfactory performance, the greater the PEA-induced sensation of nasal patency. Conclusions: A specific olfactory stimulant that selectively induces olfactory perception can also evoke and modulate the sensation of nasal patency. Hence, patients might benefit from exposing themselves to odors in order to relieve the annoying nasal obstruction.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36272169 Prevalence of olfactory dysfunction in D614G, alpha, delta and omicron waves: a psychophysical case-control study 32 38 EN L.A. Vaira Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy J.R. Lechien Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS. Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head Neck Surgery, Elsan Hospital, Paris, France G. Deiana Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy G. Salzano Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Department of Maxillofacial Surgery, University of Naples “Federico II”, Naples, Italy F. Maglitto Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; Department of Maxillofacial Surgery, University of Naples “Federico II”, Naples, Italy P. Piombino Department of Maxillofacial Surgery, University of Naples “Federico II”, Naples, Italy A. Mazzatenta Neurophysiology, Olfaction and Chemoreception Laboratory, Physiology and Physiopathology Section, Neuroscience, Imaging and Clinical Sciences Department, ‘G. d’Annunzio’ University of Chieti-Pescara, Chieti Scalo, Italy P. Boscolo-Rizzo Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy C. Hopkins King’s College, London, UK; British Rhinological Society (President), London, UK G. De Riu Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy 3033 10.4193/Rhin22.294 Background: The purpose of this study was to compare the prevalence of olfactory dysfunction (OD) at different stages of the COVID-19 pandemic by evaluating subjects diagnosed with SARS-CoV-2 infection during the Omicron wave with psychophysical tests and comparing the results with those obtained from patients infected during the D614G, Alpha and Delta waves and with those of a control group. Methodology: The study included adult patients diagnosed with SARS-CoV-2 infection. Depending on the time of diagnosis, the subjects were divided into four study groups: D614G; Alpha, Delta and Omicron variant groups. A group of uninfected individuals was used as control. All subjects underwent psychophysical evaluation of the olfactory function with the Connecticut Chemosensory Clinical Research Center olfactory test (D614G and Alpha groups) or the extended version of the Sniffin'Sticks test (Delta, Omicron and control groups). Results: 372 cases (134 D614G group, 118 Alpha group, 32 in Delta group and 88 Omicron group) were recruited and evaluated within 10 days of infection, alongside 80 controls. Patients self-reported olfactory loss in 72.4% of cases in the D614G group, in 75.4% of cases in the Alpha group, in 65.6% of cases in the Delta group and in 18.1% in the Omicron group. Psychophysical evaluation revealed a prevalence of OD: 80.6%, 83.0%, 65.6% and 36.3% in the D614G, Alpha, Delta and Omicron group respectively. The differences between the D614G, Alpha and Delta groups were not statistically significant. The Omicron group demonstrated a significantly lower prevalence of OD than the other variants but still significantly higher than the controls. Conclusions: During the Omicron wave OD was less prevalent than during the D614G, Alpha and Delta periods. One-third of patients have reduced olfactory function on psychophysical evaluation during the Omicron wave. Our results should be considered with caution as the VOC has not been determined with certainty.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36240497 Measuring control of disease in Chronic Rhinosinusitis; assessing the correlation between SinoNasal Outcome Test-22 and Visual Analogue Scale item scores 39 46 EN D.A.E. Dietz de Loos Department of Otorhinolaryngology, Isala Hospital, Zwolle, The Netherlands; Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands M.E. Cornet Department of Otorhinolaryngology, Alrijne Hospital, Leiden, The Netherlands C. Hopkins Department of Otorhinolaryngology, Guys and St Thomas Hospitals NHS Trust, London, United Kingdom 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 3030 10.4193/Rhin21.275 Background: In chronic rhinosinusitis (CRS), aim of treatment is control of disease. EPOS2020 suggests the use of visual analogue scale (VAS) measurements on several symptoms. We aim to determine if individual VAS items can be replaced by widely used SinoNasal Outcome Test-22 (SNOT-22) items when determining control of disease, to avoid using double measurements and to stimulate its use in clinical practice. Methods: Analyses were made on correlations between individual SNOT-22 scores and symptom-specific questions from consecutive patients with CRS visiting our tertiary referral rhinologic clinic for the first time. Results: 157 CRS patients were included. Correlations of individual items were strong (r greater than 0.8). Best parity in sensitivity, specificity, positive predicting value, negative predicting value, odds ratio and Receiver Operating Characteristic curves were found in individual item score of VAS greater than 5 and SNOT item-score ≥3. This cut off is valid for measuring control of disease, combining several nasal, facial pain and sleep symptoms (controlled, partially controlled and uncontrolled). Conclusion: There is strong correlation between individual items measured as SNOT or VAS. For the definition of CRS disease control, as proposed in EPOS2020, the use of symptoms specific SNOT ≥3 is predictive of VAS greater than 5.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36306524 Sleep impairment in patients with empty nose syndrome 47 53 EN C.-C. Huang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan C.-C. Lee School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan P.-W. Wei Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngologyâ€"Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan C.-C. Chuang School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan Y.-S. Lee Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan P.-H. Chang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan C.-C. Huang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan C.-H. Fu Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan T.-J. Lee Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China 3038 10.4193/Rhin22.117 Background: Empty nose syndrome (ENS) is characterized by paradoxical nasal obstruction that usually occurs after turbinate surgery. Patients with ENS may also experience significant psychiatric symptoms and sleep dysfunction, which negatively affect the quality of life of affected subjects. This study aimed to evaluate sleep impairment and sleepiness in patients with ENS. Methods: Patients with ENS and control participants were recruited prospectively. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Epworth Sleepiness Scale (EpSS), and modified sleep quality index (MSQI) were used to evaluate the participants before and after nasal surgery. Results: Forty-eight patients with ENS and forty-eight age- and sex-matched control subjects were enrolled. The SNOT-25, ENS6Q, EpSS, and MSQI scores in the ENS group were all significantly higher than those in the control group before and after surgery. After surgery, ENS patients all exhibited significant improvements in SNOT-25, ENS6Q, EpSS, and MSQI scores. Regression analysis revealed that SNOT-25 score was a significant predictor of EpSS and MSQI in preoperative evaluations. ENS patients experiencing daytime sleepiness suffered from significantly more “dryness of nose” and “suffocation” than those not experiencing daytime sleepiness. Conclusions: Patients with ENS experienced significantly impaired sleep quality and sleepiness. Nasal reconstruction surgery improved the sleep quality of ENS patients. The severity of sleep dysfunction is associated with the severity of ENS symptoms. Recognizing individuals with significant sleep impairment and sleepiness and providing appropriate management are critical issues for ENS patients.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36278985 The role of TAS2R38 genotype in surgical outcomes and culturable bacteria in chronic rhinosinusitis with or without nasal polyps 54 60 EN G. Yılmaz Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey H. Eyigor Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey O.E. Gur Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey T. Kalkan Medical Genetics, Antalya Training and Research Hospital, Antalya, Turkey N. Gur Microbiology, Antalya Training and Research Hospital, Antalya, Turkey O.T. Selcuk Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey G. Ozturk Yılmaz Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey E.A. Cetinkaya Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey 3034 10.4193/Rhin22.118 Background: Recent studies reported the relationship between genetic variations and TAS2R38, which is a bitter taste receptor expressed in the cilia of human sinonasal epithelial cells, among the predisposing factors playing role in immune response to upper respiratory tract bacterial infection. The present study aims to examine the relationship of TAS2R38 genotype with the active microorganism and the effect of genotype on the surgical outcomes among chronic rhinosinusitis patients. Methodology: 34 patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis with or without polyps (23 CRSwNP, 11 CRSsNP) and 30 patients undergoing septoplasty surgery for isolated nasal septum deviation were included. All the patients were genotyped for TAS2R38. Scoring was made using endoscopic Modified Lund-Kennedy and radiological Lund-Mackay systems preoperatively. Sino-Nasal Outcome Test with 22 items (SNOT-22) was implemented preoperatively and postoperatively. Nasal swab culture samples were taken intraoperatively from CRS patients and the active microorganism were isolated. Results: In the TAS2R38 genotyping of the study group, PAV/PAV was found in 32.4% of patients, PAV/AVI in 47.1%, and AVI/AVI in 20.6%. In the control group, PAV/PAV was found in 26.7%, PAV/AVI in 36.7%, and AVI/AVI in 36.7%. In the study group, there was no statistically significant difference between the CRS and CRS subgroups in terms of TAS2R38 genotype distributions. The changes in patients' preoperative and postoperative SNOT-22 scores were similar between the genotypes. Proliferation was detected in culture in the whole AVI-AVI group, 81.8% of PAV-PAV group, and 56.3% of PAV-AVI group but the difference was not found to be statistically significant. The proliferation level of Staphylococcus epidermidis by TAS2R38 genotype was found to be statistically significantly higher among patients, who had AVI-AVI genotype, in CRSwNP. Conclusions: We did not find a statistically significant relationship between the TAS2R38 genotype and CRS subtype, sinonasal bacterial infection risk increase and surgical success rate in CRS patients. Long-term and large-scale studies are needed, which are to be carried out by individual genotyping and sequencing to provide more information on the effects of these genetic variants.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36286011 Salvage endoscopic surgery for skull base osteoradionecrosis in nasopharyngeal carcinoma patients: A prospective, observational, single-arm clinical study 61 70 EN Q. Dai Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China Y.-X. Shi Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China H.-K. Zhang Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China X.-L. Song Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China Q. Liu Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China K.-Q. Zhao Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China J.-Y. Yang Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China L. Wang Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China X.-C. Sun Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China H.-M. Yu Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, PR China; Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor (2018RU003), Chinese Academy of Medical Sciences; Beijing, 200031, PR China 3035 10.4193/Rhin22.303 Background: Postradiation skull base osteoradionecrosis (ORN) is a severe complication that occurs after radiotherapy in patients with nasopharyngeal carcinoma (NPC) that can severely affect quality of life (QOL) and be life threatening. Only 13.4%â€"28.6% of patients can be cured by traditional repeated endoscopic debridement. Here, we introduced salvage endoscopic surgery for skull base ORN patients and evaluated its clinical efficacy. Methods: This was a prospective, observational, single-arm clinical study. Clinical data from 18 skull base ORN patients who underwent radical endoscopic necrectomy followed by reconstruction using a septal pedicled mucosal flap or temporal muscle flap were included in the study. The endpoint was an overall survival (OS) of 2 years. The numeric rating scale (NRS) scores for pain and foul odor were analyzed to determine the efficacy and safety of this surgery. Results: A total of 21 patients were recruited, 18 of whom completed the study and were analyzed. All surgeries were successfully performed. During the 2-year study, the OS rate of the entire cohort was 75%. The median NRS score for pain decreased from 6.44±2.62 to 0.50 ±0.71, and the NRS score for foul odor decreased from 1.89±1.08 to 1 after surgery. Conclusions: Salvage endoscopic necrectomy followed by construction using a septal pedicled mucosal flap or temporal muscle flap is a novel, safe, and effective treatment for ORN in patients with NPC. Clinical trial registration: This study was approved by the independent ethics committee of the Eye, Ear, Nose and Throat Hospital of Fudan University (IEC No. 2019095-1). Written informed consent was obtained from all patients. The study was registered with the Chinese Clinical Trial registry (ChiCTR2000029327).

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36597891 Quality of life after operative treatment of sinonasal inverted papilloma â€" a prospective study 71 76 EN S. Viitasalo Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland H. Sintonen Department of Public Health, University of Helsinki, Helsinki, Finland M. Lilja Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland M. HytÃśnen Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland L.M. Aaltonen Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 3051 10.4193/Rhin22.255 Background: Studies assaying morbidity related to sinonasal inverted papilloma (SNIP) and its treatment are lacking. We evaluated how operative treatment of SNIP affects patients’ health-related quality of life (HRQoL) and symptoms. Methods: We prospectively recruited consecutive patients (n=52) operated for SNIP at Helsinki University Hospital, between years 2016 and 2019. In total, 42 patients filled in the 15D, a generic HRQoL instrument and a symptom questionnaire preoperatively and at 1 year and at 2 years postoperatively. The 15D HRQoL scores were compared to those of age- and sex-standardized general population. Results: Patients’ mean baseline score for discomfort and symptoms (one of the 15D dimensions) was significantly better compared to general population, but this difference faded postoperatively. Frequency of epistaxis, nasal obstruction, lowered sense of smell, headache, tinnitus and epiphora decreased significantly during follow-up whereas frequency of numbness of the face or mouth increased. Difference in the mean 15D score of the patients compared with general population was insignificant at baseline and at 1 year and at 2 years postoperatively. Conclusions: Measured by a generic HRQoL questionnaire, the mean score for discomfort and symptoms deteriorated after operative treatment of SNIP. Despite a relief of many symptoms, care should be taken when operating a benign tumour, as surgery may cause morbidity.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36527736 Radiation-induced cancer after treatment for nasopharyngeal carcinoma: a study from a high prevalence area 77 84 EN X. Cao Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China and Department of Critical Care Medicine, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong C. Wang Department of Surgical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China Z.C. Lin Department of Medical Records, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China X. Lyu Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China 3050 10.4193/Rhin22.281 Background: Radiation-induced cancer (RIC) is a late complication in patients who have been treated for nasopharyngeal carcinoma (NPC). The comparison of index anatomic location, index histological type, and survival of RIC in patients with NPC after different radiotherapy modalities (intensity-modulated radiotherapy [IMRT], 3-dimensional conformal radiotherapy [3D-CRT], and conventional 2D radiotherapy) is currently unavailable. Methodology: A total of 38,565 patients with NPC who received curative-intent radiotherapy at Sun Yat-sen University Cancer Center between January 1986 and December 2017 were reviewed. A total of 141 patients who developed RIC and fulfilled the study criteria were included. Categorical variables were compared by the χ2 test or Fisher’s exact test. Kaplan-Meier curves were used to evaluate overall survival. Cox proportional hazards models were used to examine the independent significance of RIC treatment. Results: Among IMRT, 3D-CRT, and conventional 2D radiotherapy, the incidence of mandible RIC was higher in patients who received 3D-CRT (0.07%) than in those who received IMRT (0%). The proportion of mandible RICs was higher in patients who received 3D-CRT (16.667%) than in those who received IMRT (0%) and conventional 2D radiotherapy (3.529%). Regarding the histological type, the incidence of squamous cell carcinoma (SCC) was higher in patients who received conventional 2D radiotherapy (0.266%) than in those who received 3D-CRT (0.175%); patients who received IMRT had a higher proportion of SCC than those who received 3D-CRT/conventional 2D radiotherapy (86.4% vs. 41.7% vs. 74.2%); the incidence of sarcoma was higher in patients who received 3D-CRT (0.175%) than in those who received IMRT (0.025%); and the proportion of sarcoma was higher in patients who received 3D-CRT (41.667%) than in those who received IMRT (6.818%) and conventional 2D radiotherapy (17.647%). Patients who received surgery for RICs had better survival than those who received no surgery (64.49 vs. 12.42 months). In the univariate and multivariate analyses, surgery was an independent prognostic factor for overall survival. Conclusions: Our results have implications for long-term follow-up of RIC, multidisciplinary management, and patient counseling of RIC after nasopharyngeal carcinoma treatment by treating clinicians.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36507741 The EUFOREA pocket guide for chronic rhinosinusitis 85 89 EN P.W. Hellings KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Nethe W.J. Fokkens Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland R. Orlandi Rhinology and Skull Base, Department of Otorhinolaryngology, Hospital Clinic, Universidad de Barcelona, Centro Médico Teknon, Barcelona, Spain G.F. Adriaensen Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland I. Alobid Rhinology and Skull Base, Department of Otorhinolaryngology, Hospital Clinic, Universidad de Barcelona, Centro Médico Teknon, Barcelona, Spain F.M. Baroody The University of Chicago Medicine, Chicago, IL, United States L. Bjermer Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden B.A. Senior Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA A. Cervin The university of Queensland Centra for Clinical Research, Herston, Australia; Royal Brisbane and Women’s Hospital, Brisbane, Australia N.A. Cohen Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece E. De Corso Department of Otolaryngology Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica Sacro Cuore, Rome, Italy M. Desrosiers Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Canada Z. Diamant KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden; Department Clinical Pharmacy and Pharmacology, University Groningen, University Medical Center Groningen, Groningen, the Netherlands R.G. Douglas Department of Surgery, The University of Auckland, New Zealand S. Gane Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom P. Gevaert University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium J.K. Han Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, Virginia, USA R.J. Harvey Rhinology and Skull Base, Applied Medical Research Center, Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, Virginia, USA; Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia C. Hopkins Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom R.C. Kern Department of Otolaryngology, Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA B.N. Landis Hopitaux Universitaires de Geneve, Genève, Genève, Switzerland J.T. Lee Brigham and Women’s Hospital, Harvard Medical School, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Section of Rhinology and Skull Base Surgery, Massachusetts, USA S.E. Lee Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA A. Leunig Rhinology Center, Munich and ENT-Clinic, Munich, Germany V.J. Lund Royal National Throat, Nose and Ear Hospital, UCLH, London, UK M. Bernal-Sprekelsen Department of Otorhinolaryngology, hospital clinic Barcelona, Spain J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain C. Philpott NIHR UCLH Biomedical research Centre, London, UK; Ear Institute, University College London, London, UK E. Prokopakis Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece S. Reitsma Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland D. Ryan Usher institute, University of Edinburgh, Edinburgh, UK S. Salmi Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland; Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland G. Scadding Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom R.J. Schlosser Department of Otolaryngology â€" Head and Neck surgery, Medical University of South Carolina, Charleston, SC, USA A. Steinsvik Røa ENT Clinic, Oslo, Norway P.V. Tomazic Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria E. Van Staeyen University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium T. Van Zele University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium O. Vanderveken Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium; Multidisciplinary Sleep Disorder Center, Antwerp University Hospital, Edegem, Antwerp, Belgium A-S. Viskens KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium D. Conti EUFOREA, Academic Manager M. Wagenmann Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany 3049 10.4193/Rhin22.344 Chronic rhinosinusitis (CRS) is known to affect around 5 % of the total population, with major impact on the quality of life of those severely affected (1). Despite a substantial burden on individuals, society and health economies, CRS often remains underdiagnosed, under-estimated and under-treated (2). International guidelines like the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) (3) and the International Consensus statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR) (4) offer physicians insight into the recommended treatment options for CRS, with an overview of effective strategies and guidance of diagnosis and care throughout the disease journey of CRS.

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36150154 Determination of the chronic upper airway inflammatory phenotype using a symptom-score-based algorithm 90 92 EN W. Backaert KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium B. Steelant KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium I. Guler KU Leuven, Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium K. Talavera KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research; VIB-KU Leuven Center for Brain and Disease Research, Leuven, Belgium M. Jorissen University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, Leuven, Belgium R. Schrijvers KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; KU Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, Leuven, Belgium; University hospitals Leuven, Department of General Internal Medicine, Leuven, Belgium P.W. Hellings KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; U Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Academic Medical Center, Department of Otorhinolaryngology, Amsterdam, The Netherlands L. Van Gerven KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, Leuven, Belgium 3017 10.4193/Rhin22.141

International Rhinologic Society Rhinology 0300-0729 61 1 2023 February 1 36286227 The burden of olfactory dysfunction during the COVID-19 pandemic in the United Kingdom 93 96 EN M. Lechner Division of Surgery and Interventional Science, University College London, London, UK; UCL Cancer Institute, University College London, London, UK; ENT Department, Barts Health NHS Trust, 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 Division of Surgery and Interventional Science, University College London, London, UK N.H. Ta Norwich Medical School, University of East Anglia, Norwich, UK K. Jumani Division of Surgery and Interventional Science, University College London, London, UK R. Gupta Division of Surgery and Interventional Science, University College London, 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 Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK C.H. Yan Department of Otolaryngology, 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 and Waveney ENT Service, UK R. Brunton ENT Department, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK J. Boardman Fifth Sense, UK M. Hatter Medical University of South Carolina, Charleston, SC, USA M. Abdelwahab Medical University of South Carolina, Charleston, SC, USA F.C. Holsinger Medical University of South Carolina, Charleston, SC, USA R. Capasso Medical University of South Carolina, Charleston, SC, USA J.V. Nayak Medical University of South Carolina, Charleston, SC, USA P.H. Hwang Medical University of South Carolina, Charleston, SC, USA Z.M. Patel Medical University of South Carolina, Charleston, SC, USA S. Paun Division of Surgery and Interventional Science, University College London, London, UK N. Eynon-Lewis Division of Surgery and Interventional Science, University College London, London, UK B.N. Kumar ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK S. Jayaraj Division of Surgery and Interventional Science, University College London, 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 Hospitals NHS Trust, London, UK 3036 10.4193/Rhin22.232