International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36821821 “Co(o)horts” in rhinology 97 97 EN S. Reitsma Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands 3061 10.4193/Rhin23.902

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 37023247 Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis 98 107 EN H.H. Kariyawasam Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK and Rhinology Section, Royal National ENT Hospital, London, UK D.P. Chandrasekharan University College London, London, UK T. Jacques Department of Otolaryngology, St George’s University Hospital, London, UK P. Stokes Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia M. Dziadzio Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK and University College London, London, UK S.B. Gane Rhinology Section, Royal National ENT Hospital, London, UK and University College London, London, UK D. Langan Great Ormond Street Institute of Child Health, University College London, London, UK J. Rimmer Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia and Department of Surgery, Monash University, Melbourne, Australia and Department of Otolaryngology Head and Neck Surgery, St Vincent’s Hospital Melbourne, Australia 3072 10.4193/Rhin22.412 Background: Chronic rhinosinusitis with nasal polyps is often severe, debilitating and difficult to treat. Biologics that target key inflammatory pathways have the potential to treat this disease; this study aimed to evaluate their effectiveness. Methodology: Systematic review and meta-analysis of randomised controlled trials of biologics in chronic rhinosinusitis with nasal polyps. Primary outcomes were extent of disease, objective disease severity and disease-specific quality of life, with outcomes measured at different end-of-treatment timepoints in different studies (range 16-52 weeks). Results: Eleven trials were identified with 2035 participants. Ten studies reported change in polyp size, estimating a reduction of -1.25 in the treatment group. Six studies reported reduction in Lund-Mackay score where the pooled mean difference was -4.90. Five studies included peak nasal inspiratory flow with a pooled mean difference of 33.54, indicating improved nasal airflow. Seven studies reported change in olfactory score with an overall pooled effect of 6.56 suggesting improved olfaction. The SNOT-22 score in nine studies gave an overall pooled effect of -14.53, indicating improved quality of life. Conclusions: Biologics can be effective in treating nasal polyps, with reduction in polyp size and extent of disease, and improved sense of smell and quality of life. There is significant heterogeneity in the outcomes for individual biologics, highlighting the need for further studies.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36716382 Evaluating treatment response to mepolizumab in patients with severe CRSwNP 108 117 EN C. Hopkins Department of ENT, Guy’s Hospital and St Thomas’ Hospital, King’s College London, UK J.K. Han Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA V.J. Lund Royal National Throat, Nose and Ear Hospital, UCLH NHS Trust, London, UK C. Bachert Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium W.J. Fokkens Department of Otolaryngology, Amsterdam University Medical Center, Location AMC, Amsterdam, Netherlands Z. Diamant Department of Microbiology Immunology and Transplantation, KU Leuven, Catholic University of Leuven, Belgium; Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Clinical Pharmacy and Pharmacololgy, University Medical Center Groningen, Groningen, the Netherlands J. Mullol Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain A.R. Sousa Clinical Sciences, Respiratory, GSK, GSK House, Brentford, UK S.G. Smith Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA S. Yang Value Evidence and Outcomes, GSK, Collegeville, PA, USA B. Mayer Clinical Statistics, GSK, GSK House, Brentford, Middlesex, UK S.W. Yancey Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA R.H. Chan Clinical Sciences, Respiratory, GSK, GSK House, Brentford, UK S.E. Lee Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA 3057 10.4193/Rhin22.200 BACKGROUND: The SYNAPSE study (NCT03085797) demonstrated that mepolizumab decreased nasal polyp (NP) size and nasal obstruction in patients with chronic rhinosinusitis with NP (CRSwNP). METHODS: SYNAPSE, a randomized, double-blind study, included patients with recurrent, refractory, severe CRSwNP, eligible for repeated surgery despite receiving standard of care (SoC). Patients received 4-weekly mepolizumab 100 mg or placebo subcutaneously plus SoC for 52 weeks. This post hoc analysis further characterized treatment responses and association with patient characteristics. The proportion of patients meeting any and each of five response criteria indicating improvement in disease-specific quality of life, NP size, nasal obstruction, loss of smell, and overall symptoms at Weeks 24 and 52, were assessed in subgroups: 1) no surgery; 2) neither surgery nor systemic corticosteroids (SCS). RESULTS: Of 407 patients in the intention-to-treat population, 381 and 343 patients had no sinus surgery by Weeks 24 and 52, respectively. More mepolizumab- versus placebo-treated patients without surgery by Weeks 24 and 52 met each response criteria. Of the mepolizumab-treated patients without surgery by Week 24, 109 (55%) responded across ≥ 3 criteria, increasing to 126 (67%) by Week 52. Similar response trends were seen for patients with neither surgery nor SCS by Weeks 24 and 52. At either timepoint, there were no major differences in baseline characteristics between mepolizumab-treated full- (5/5 categories) and non-responders (0/5 categories). CONCLUSIONS: Most patients who completed SYNAPSE required neither surgery nor SCS use and in addition achieved a progressive and sustained clinical response to mepolizumab underscoring the therapeutic benefits of mepolizumab in severe CRSwNP.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36715436 Dose-dependent relationship between nocturnal gastroesophageal reflux and chronic rhinosinusitis in a middle-aged population: results from the SCAPIS pilot 118 123 EN J. Bergqvist Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden M. Bove Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Otorhinolaryngology, NU Hospital Group, Trollhättan, Sweden A. Andersson COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden L. Schiöler Occupational and Environmental Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden J. Hellgren Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3055 10.4193/Rhin22.297 BACKGROUND: Gastroesophageal reflux (GER) has been associated with several upper- and lower-airway diseases. It would be plausible if nightly occurring reflux via laryngopharyngeal reflux (LPR) might affect the upper airways. Still, the role of nocturnal gastroesophageal reflux (nGER) in chronic rhinosinusitis (CRS) is not fully established. The aim of this population-based study was to investigate the association between nGER and CRS. METHODOLOGY: This cross-sectional population-based study comprises 1,111 randomly selected subjects from Gothenburg, Sweden, aged 50-64 years. The study is based on self-reported validated questionnaires. CRS was defined according to EPOS criteria. nGER was reported in relation to frequency. RESULTS: CRS was more common among subjects with nGER than in those without (13 vs. 4.8%). There was a dose-response association between the frequency of nGER episodes and the risk of having CRS. In the logistic regression adjusted for (age, sex, BMI, educational level, smoking, and asthma). CRS was associated with nGER, OR 1.43 and the odds ratio increased if episodes were reported “almost every night”, OR 4.6. CONCLUSIONS: The study shows an association between nocturnal GER and CRS in a middle-aged population. The revealed dose dependency supports, though does not prove causality.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36480330 Relationship of chronic rhinosinusitis with Sjögren’s syndrome, systemic lupus erythematosus, and ankylosing spondylitis 124 131 EN I.H. Lee Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea D.-K. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea; Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea 3047 10.4193/Rhin22.300 BACKGROUND: Several studies have demonstrated the association between chronic rhinosinusitis (CRS) and autoimmune diseases. However, there are few long-term longitudinal studies on this relationship. Therefore, we investigated the association between CRS and the risk of a subgroup of autoimmune disease using a representative nationwide cohort sample. METHODOLOGY: We investigated the association between CRS and autoimmune diseases, including Sjögren’s syndrome, systemic lupus erythematosus, and ankylosing spondylitis. A total of 15,130 CRS patients and 30,260 patients without CRS were enrolled after 1:2 propensity score matching. A Cox proportional hazards model was used to analyse the hazard ratio (HR) of CRS for autoimmune disease. RESULTS: The incidence of Sjögren’s syndrome, systemic lupus erythematosus, and ankylosing spondylitis was 0.55, 0.10, and 0.48 per 1000 person-years, respectively. Among autoimmune diseases, the risk of Sjögren’s syndrome in CRS patients was significantly increased to an adjusted HR (aHR) of 1.70, whereas we could not detect any significant risk of developing systemic lupus erythematosus or ankylosing spondylitis. In the subgroup analysis according to CRS phenotype, the adjusted HR of developing Sjögren’s syndrome was greater in CRS patients without nasal polyps) than in CRS patients with nasal polyps. CONCLUSIONS: Our study suggests that CRS without nasal polyps is associated with an increased incidence of Sjögren’s syndrome diagnosis compared to CRS without nasal polyps. Additionally, there was no association between CRS and systemic lupus erythematosus or ankylosing spondylitis, regardless of CRS phenotype.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36602548 Development and multicenter validation of a novel radiomics-based model for identifying eosinophilic chronic rhinosinusitis with nasal polyps 132 143 EN K-Z. Zhu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, P.R. China C. He Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, P.R. China Z. Li Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China P-J. Wang Department of Otolaryngology-Head and Neck Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, P.R. China S-X. Wen Department of Otolaryngology-Head and Neck Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, P.R. China K-X. Wen Department of Otolaryngology-Head and Neck Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, P.R. China J-Y. Wang Department of Otolaryngology-Head and Neck Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, P.R. China J. Liu Department of Otolaryngology-Head and Neck Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, P.R. China H. Xiao Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, P.R. China C-L. Guo Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, 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; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, P.R. China J-H. Zhang Department of Radiology, 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; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, P.R. China M. Zeng Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, 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; Insititue of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China; Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, P.R. China 3053 10.4193/Rhin22.361 BACKGROUND: Reliable noninvasive methods are needed to identify endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) to facilitate personalized therapy. Previous computed tomography (CT) scoring system has limited and inconsistent performance in identifying eosinophilic CRSwNP. We aimed to develop and validate a radiomics-based model to identify eosinophilic CRSwNP. METHODS: Surgical patients with CRSwNP were recruited from Tongji Hospital and randomly divided into training (n = 232) and internal validation cohort (n = 61). Patients from two additional hospitals served as external validation cohort-1 (n = 84) and cohort-2 (n = 54), respectively. Data were collected from October 2013 to May 2021. Eosinophilic CRSwNP was determined by histological criterion. The least absolute shrinkage and selection operator and the logistic regression (LR) algorithm were used to develop a radiomics model. Univariate and multivariate LR were employed to build models based on CT scores, clinical characteristics, and the combination of radiological and clinical characteristics. Model performance was evaluated by assessing discrimination, calibration, and clinical utility. RESULTS: The radiomics model based on 10 radiomic features achieved an area under the curve (AUC) of 0.815 in the training cohort, significantly better than the CT score model based on ethmoid-to-maxillary sinus score ratio with an AUC of 0.655. The combination of radiomic features and blood eosinophil count had a further improved performance, achieving an AUC of 0.903. The performance of these models was confirmed in all validation cohorts with satisfying predictive calibration and clinical application value. CONCLUSIONS: A CT radiomics-based model is promising to identify eosinophilic CRSwNP. This radiomics-based method may provide novel insights in solving other clinical concerns, such as guiding personalized treatment and predicting prognosis in patients with CRSwNP.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36351168 Extreme weather conditions influence the frequency of epistaxis-related emergency room visits 144 152 EN M. Haas Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria M. Lucic Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria F. Pichler Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria F.F. Brkic Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria D. Riss Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria C.A. Mueller Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria D.T. Liu Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria 3040 10.4193/Rhin22.342 Background: Climate change has been associated with an increase in extreme weather conditions. The aim of this study was to identify environmental factors and the effect of extreme weather events (95th percentile) on the risk for epistaxis-related emergency room visits (EV). Methods: A total of 2179 epistaxis-related EVs were identified between 2015 and 2018. A distributed lag non-linear model was fitted to investigate the relationship between extreme weather conditions and the total number of epistaxis-related EVs per day. Cumulative relative risk (cRR) is defined as the cumulated daily risk of EV for epistaxis within a stated period after an extreme weather condition compared to the risk of EV at the median value of that weather condition. Results: At a mean daily temperature of 27°C (P95), cRR for epistaxis-related EV was 2.00. At a relative humidity of 39% (P5), cRR was highest on day 3 at 1.59, while extremely high humidity (92%, P99) led to a decreased cRR of 0.7 on day 1. Intense precipitation of 24mm (P99) reduced the cRR on day 3 to 0.38. For prolonged extreme conditions over three days, extremely low wind speed, as well as both high and low atmospheric pressure events, diminished cRR. Conclusions: Extreme temperatures, relative humidity, and precipitation, as well as extended periods of extreme wind speeds and atmospheric pressure, significantly impact cRR for epistaxis-related EVs.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36375133 Identifying a sphenoid sinus fungus ball using a nomogram model 153 160 EN Y.H. Fan Department of Medical Education, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan P.W. Wu Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan Y.L. Huang Department of Anatomic Pathology, Chang Gung Memorial Hospital and 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 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 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 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; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan 3041 10.4193/Rhin22.329 Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36479866 Fluticasone propionate suppresses the SARS-CoV-2 induced increase in respiratory epithelial permeability in vitro 161 169 EN K. Martens Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium; Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium E. Vanhulle KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium A.-S. Viskens Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium P.W. Hellings Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium;University Hospitals Leuven, Clinical Department of Otorhinolaryngology, Head and Neck Surgery, Leuven, Belgium;Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands K. Vermeire KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium 3045 10.4193/Rhin22.223 BACKGROUND: Disruption of the nasal epithelial barrier is believed to play a role in Coronavirus Disease-2019 (COVID-19) outcomes. Fluticasone propionate has been shown to restore the nasal epithelial barrier in allergic rhinitis to the level of healthy controls. The therapeutic potential of nasal steroid sprays in COVID-19 has recently been reported. However, further insight into the mode of action is warranted. OBJECTIVES: To explore the in vitro mechanisms of the preventive potential of fluticasone propionate in SARS-CoV-2 infection. METHODS: Human air liquid interface cultures of Calu-3 cells and primary nasal epithelial cells isolated from healthy donors were used to investigate the preventive effect of fluticasone propionate on SARS-CoV-2 induced barrier disruption, virus replication and ACE2 expression. RESULTS: 48 hours pre-treatment with fluticasone propionate prevented the SARS-CoV-2 induced increase in fluorescein isothiocyanate-dextran 4 kDa permeability and reduced infection with SARS-CoV-2. Pre-treatment with fluticasone propionate also decreased ACE2 expression in SARS-CoV-2 infected Calu-3 cells. Conclusion: Fluticasone propionate pre-treatment prevented SARS-CoV-2 increased epithelial permeability, reduced ACE2 expression and SARS-CoV-2 infection, underscoring the therapeutic potential of fluticasone propionate in the context of COVID-19.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36752359 Rhinological procedures result in minimal generation of aerosols 170 179 EN E. Sanmark University of Helsinki, Faculty of Medicine, Helsinki, Finland; Helsinki University Hospital, Department of Otorhinolaryngology and Phoniatrics â€" Head and Neck Surgery, Helsinki, Finland L-M. A.H. Oksanen University of Helsinki, Faculty of Medicine, Helsinki, Finland; Helsinki University Hospital, Department of Otorhinolaryngology and Phoniatrics â€" Head and Neck Surgery, Helsinki, Finland N. Rantanen University of Helsinki, Faculty of Medicine, Helsinki, Finland; Helsinki University Hospital, Department of Otorhinolaryngology and Phoniatrics â€" Head and Neck Surgery, Helsinki, Finland P. Virkkula University of Helsinki, Faculty of Medicine, Helsinki, Finland; Helsinki University Hospital, Department of Otorhinolaryngology and Phoniatrics â€" Head and Neck Surgery, Helsinki, Finland A. Geneid University of Helsinki, Faculty of Medicine, Helsinki, Finland; Helsinki University Hospital, Department of Otorhinolaryngology and Phoniatrics â€" Head and Neck Surgery, Helsinki, Finland 3060 10.4193/Rhin22.108 BACKGROUND: COVID-19 and other respiratory infections spread through aerosols produced in respiratory activities and in certain surgical procedures considered as aerosol-generating procedures (AGP). Due to manipulation of the upper airway mucosa, rhinosurgery has been considered a particular risk for spread of respiratory infections. Our aim was to assess staff exposure to aerosols during common rhinosurgical procedures METHODS: Staff exposure to generated particle concentrations and size distributions between 0.3 μm and 10 μm were measured during rhinosurgery using an optical particle sizer without any additional collection methods. Similarly measured aerosol exposure during coughing (a commonly used risk reference for aerosol generation) and the operating room’s background concentration were chosen as reference values. RESULTS: Altogether 16 common rhinological surgeries (septoplasties and endoscopic sinus surgery) were measured. The use of suction produced significantly lower aerosol concentration compared to coughing. Low aerosol generation was observed during injection anaesthesia of the nasal mucosa. Instrument comparison revealed that the microdebrider produced fewer aerosols than cold dissection in particles of 1-5 μm and >5 μm. CONCLUSIONS: Common rhinosurgeries do not seem to generate as high aerosol concentration exposures as previously believed. Rather, the observed aerosol exposure is lower or similar to exposures during coughing. Therefore, the classification of common rhinosurgeries as AGPs should be re-assessed or possibly discarded.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36745102 Transcriptional analysis of nasal polyps fibroblasts reveals a new source of pro-inflammatory signaling in CRSwNP 180 189 EN C. Porras-GonzÔlez Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital/FISEVI, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, CSIC, Seville, Spain J.M. Palacios-García Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital/FISEVI, Seville, Spain S. SÔnchez-Gómez Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital/FISEVI, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, CSIC, Seville, Spain J.M. Maza-Solano Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital/FISEVI, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, CSIC, Seville, Spain G. Alba Department of Medical Biochemistry, Molecular Biology and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain V. SÔnchez-Margalet Department of Medical Biochemistry, Molecular Biology and Immunology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain O. Palomares Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain A. Del Cuvillo Rhinology and Asthma Unit, ENT Department, University Hospital of Jerez, Jerez de la Frontera, Cadiz, Spain J.A. Cordero-Varela Bioinformatics and Computational Biology Facility, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, CSIC, Seville, Spain R. Moreno-Luna Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital/FISEVI, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, CSIC, Seville, Spain J.L. Muñoz-Bravo Clinical Analysis Service, General University Hospital of Elche, Alicante. Foundation for the Promotion of Health and Biomedical Research in the Valencia Region (FISABIO), Valencia, Spain 3059 10.4193/Rhin22.309 BACKGROUND: Fibroblasts and others mesenchymal cells have recently been identified as critical cells triggering tissue-specific inflammatory responses. Persistent activation of fibroblasts inflammatory program has been suggested as an underlying cause of chronic inflammation in a wide range of tissues and pathologies. Nevertheless, the role of fibroblasts in the emergence of chronic inflammation in the upper airway has not been previously addressed. We aimed to elucidate whether fibroblasts could have a role in the inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODOLOGY: We performed whole-transcriptome microarray in fibroblast cultured from CRSwNP samples and confirmed our results by qRT-PCR. We selected patients without other associated diseases in upper airway. To investigate shifts in transcriptional profile we used fibroblasts from nasal polyps and uncinate mucosae from patient with CRSwNP, and fibroblasts from uncinate mucosae from healthy subjects as controls. RESULTS: This study exposes activation of a pro-inflammatory and pro-fibrotic transcriptional program in nasal polyps and CRSwNP fibroblasts when compared to controls. Our Gene-set Enrichment Analysis (GSEA) pointed to common up-regulation of several pro-inflammatory pathways in patients-derived fibroblasts, along with higher mRNA expression levels of cytokines, growth factors and extracellular matrix components. CONCLUSIONS: Our work reveals a potential new source of inflammatory signaling in CRSwNP. Furthermore, our results suggest that deregulated inflammatory signaling in tissue-resident fibroblasts could support a Type-2 inflammatory response. Further investigations will be necessary to demonstrate the functionality of these novel results.

International Rhinologic Society Rhinology 0300-0729 61 2 2023 4 1 36259677 On the Cottle areas and the proposal for a new classification of septal areas 190 192 EN O. Garaycochea Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain; Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain I. Alobid Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES, Barcelona University. Barcelona, Spain; Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain 3032 10.4193/Rhin22.229