International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 39909717 Recognizing the critically important role of our reviewers 289 289 EN A.R. Sedaghat Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, United States of America W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 3099 10.4193/Rhin23.904

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37083127 Intranasal antihistamines in the treatment of idiopathic non-allergic rhinitis: a systematic review and meta-analysis 290 296 EN N. Khoueir Department of Otolaryngologyâ€"Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon M. G. Khalaf Department of Otolaryngologyâ€"Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon R. Assily Department of Otolaryngologyâ€"Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon S. Rassi Department of Otolaryngologyâ€"Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon W.A. Hamad Department of Otolaryngologyâ€"Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Ashrafieh, Beirut, Lebanon 3075 10.4193/Rhin21.380 BACKGROUND: Idiopathic rhinitis (IR), previously known as vasomotor rhinitis (VMR), is the most common type of non-allergic rhinitis (NAR) which affects around 100 million people worldwide. The treatment of patients with IR is not standardized. Intranasal antihistamines (INAH) are potent drugs in the treatment of allergic rhinitis but are frequently prescribed in the treatment of IR. This systematic review of the literature and meta-analysis aims to assess the effects of INAH on IR. METHODOLOGY: A comprehensive review of the literature was conducted on Medline, Embase and Cochrane library. Randomized, controlled trials and non-randomized comparative parallel group trials comparing INAH to placebo or different INAHs were included. The primary outcome was the change in disease specific quality of life questionnaires, total nasal symptom score (TNSS). The secondary outcomes were other reported nasal symptom scores, individual symptom scores and adverse events. RESULTS: Six trials out of 987 assessing a total of 675 participants were deemed relevant for inclusion. Compared to placebo, INAH decreased total nasal symptom scores. One study also reported reduction of symptoms recorded on a visual analogue scale. There was no difference between the INAHs in terms of efficacy. Bitter taste sensation was the most frequently reported adverse event. CONCLUSIONS: INAHs seem to have benefit over placebo on nasal symptoms improvement in the treatment of NAR. No superiority between INAHs was identified.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37219052 Clinical manifestations, management, and outcomes of primary silent sinus syndrome: a systematic review 297 311 EN L. Michelle Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA A.T. Du Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA A. Abiri Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA E.C. Kuan Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA, USA 3080 10.4193/Rhin23.028 INTRODUCTION: Silent sinus syndrome (SSS) is a rare disorder of the maxillary sinus, which may present with orbital symptoms. Most reports of silent sinus syndrome are limited to small series or case reports. This systematic review comprehensively characterizes the various clinical presentations, management, treatment, and outcomes in patients with SSS. METHODS: A systematic literature search of the PubMed, Cochrane, Web of Science, and Scopus databases. Inclusion criteria were studies describing the presentation, management, or treatment of SSS or chronic maxillary atelectasis. RESULTS: One hundred fifty-three articles were included in the final review (n=558 patients). Mean age at diagnosis was 38.8 ± 14.1 years, with a relatively even distribution among sexes. Enophthalmos and/or hypoglobus were the most frequent symptoms, along with diplopia, headache, or facial pressure/pain. Most patients (87%) underwent functional endoscopic sinus surgery (FESS), and 23.5% received orbital floor reconstruction. Post-treatment, patients had significant reductions in enophthalmos (2.67 ± 1.39 vs. 0.33 ± 0.75 mm) and hypoglobus (2.22 ± 1.43 vs. 0.23 ± 0.62 mm). Most patients (83.2%) achieved partial or total resolution of clinical symptoms. CONCLUSIONS: SSS has a variable clinical presentation, with enophthalmos and hypoglobus being most common. FESS with or without orbital reconstruction are effective treatments to address the underlying pathology and structural deficits.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37243690 Developing a core outcome set for clinical trials in olfactory disorders: a COMET initiative 312 319 EN C. Philpott James Paget University Hospital, Great Yarmouth, United Kingdom K. Kumaresan James Paget University Hospital, Great Yarmouth, United Kingdom A.W. Fjaeldstad Flavour Clinic, University Clinic for Flavour, Balance and Sleep, Department of Otorhinolaryngology, Regional Hospital Gødstrup, Denmark A. Macchi ENT University of Insubria, Italian Academy of Rhinology, Varese, Italy G. Monti Department of Biomedicine, Aarhus University, Denmark J. Frasnelli Department of Anatomy, Université du Québec à Trois-Rivières, Canada I. Konstantinidis 2nd ORL Department, Aristotle University, Thessaloniki, Greece J. Pinto Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, IL, USA J. Mullol Rhinology Unit and Smell Clinic, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain J. Boardman Fifth Sense UK Charity, Bicester, United Kingdom J. VodiÄŤka Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital and University of Pardubice, Czech Republic; Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital and Faculty of Heath Studies, University of Pardubice, Czech Republic E. Holbrook Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA V.R. Ramakrishnan Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indiana M. Lechner Division of Surgery and Interventional Science and UCL Cancer Institute, University College London and Barts Health NHS Trust, United Kingdom T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden Germany 3082 10.4193/Rhin22.116 STATEMENT OF PROBLEM: Evaluating the effectiveness of the management of Olfactory Dysfunction (OD) has been limited by a paucity of high-quality randomised and/or controlled trials. A major barrier is heterogeneity of outcomes in such studies. Core outcome sets (COS) â€"standardized sets of outcomes that should be measured/reported as determined by consensusâ€"would help overcome this problem and facilitate future meta-analyses and/or systematic reviews (SRs). We set out to develop a COS for interventions for patients with OD. METHODS: A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders’ views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed patients and healthcare practitioners to individually rate the outcomes in terms of importance on a 9-point Likert scale. RESULTS: After 2 rounds of the iterative eDelphi process, the initial outcomes were distilled down to a final COS including subjective questions (visual analogue scores, quantitative and qualitative), quality of life measures, psychophysical testing of smell, baseline psychophysical testing of taste, and presence of side effects along with the investigational medicine/device and patient’s symptom log. CONCLUSIONS: Inclusion of these core outcomes in future trials will increase the value of research on clinical interventions for OD. We include recommendations regarding the outcomes that should be measured, although future work will be required to further develop and revalidate existing outcome measures.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37515811 Efficacy and safety of switching between biologics in chronic rhinosinusitis with nasal polyps or N-ERD* 320 327 EN F.F. Brkic Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria D.T. Liu Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria R. Klimbacher Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria N.J. Campion Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria T.J. Bartosik Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria E. Vyskocil Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria V. Stanek Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria A. Tu Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria T. Arnoldner Department of Dermatology, General Hospital and Medical University of Vienna, Vienna, Austria C. Bangert Department of Dermatology, General Hospital and Medical University of Vienna, Vienna, Austria K. Gangl Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria J. Eckl-Dorna Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria S. Schneider Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna, Austria 3102 10.4193/Rhin22.408 Background and objective: The effectiveness of biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) is well-established. However, real-world experience on the effectiveness of transitioning between two monoclonal antibodies is scarce. Therefore, we aimed to analyze the safety and efficacy of antibody switching in treatment of chronic rhinosinusitis. Methods: All patients with CRSwNP or nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD) requiring a switch between biologics were retrospectively studied. Analysis included changes in polyp size, quality of life parameters, asthma control, and side effects. Results: Out of 195 patients treated with biologics for CRSwNP or N-ERD in our center, 23 (11.8%) required transition to a different monoclonal antibody. The majority switched from omalizumab to dupilumab (17/23, 73.9%), mostly due to inadequate symptom control. Nine out of these 17 patients (52.9%) were switched without a washout period. All patients showed significant improvement in nasal polyp score, asthma control test and sino-nasal outcome test-22 after changing to dupilumab. Keratoconjunctivitis sicca was the side-effect (4.3%) reported after the switch from omalizumab to dupilumab, which lead to termination of therapy in one patient. Due to limited sample size, other antibody transitions were reported in a descriptive manner. Conclusion: The transition to dupilumab is an effective option in patients with inadequate treatment response or side-effects of omalizumab in nasal polyposis. Our preliminary results indicate that a wash-out period may not be necessary when switching between biologics, however, these findings require further investigations. Other monoclonal antibody transitions also show promising results, but warrant validations in larger cohorts due to small patient samples in our study.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37066680 Blood eosinophils to direct oral corticosteroid treatment for patients with nasal polyps â€" an open label, non-inferiority, randomized control trial 328 337 EN J. Deng Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Z. Wang Institute of Otorhinolaryngology and Shenzhen Key of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital, Shenzhen, China Z. Xu Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Y. Lai Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China R. Zheng Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China W. Gao Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China J. Shi Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Y. Sun Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China 3073 10.4193/Rhin22.328 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disorder. We aimed to evaluate the value of blood eosinophil count (BEC) for guiding oral corticosteroid therapy for CRSwNP. METHODS: Subjects with CRSwNP were entered into a 2:1 randomized biomarker-directed corticosteroid versus standard therapy study base on the principle of potential benefits to patients. Subjects in the standard arm received oral prednisone (30mg/day) alone for 7 days, whereas in the biomarker-directed arm, prednisone (30mg/day), or nasal steroid spray (budesonide 256ug/day) was given according to the BEC which was measured to define eosinophil-high and -low CRSwNP (BEC ≥ and < 0.37×109/L, respectively). The primary outcome was the total nasal symptom scores (TNSS) of the two arms with the non-inferiority margin of 1.8. Secondary outcomes included nasal polyp size scores (NPSS) and SNOT-22. Patients were followed up the day after last dose of treatment. RESULTS: A total of 105 subjects with CRSwNP were randomized into the biomarker-directed therapy group or the standard care group. The biomarker therapy demonstrated non-inferiority compared to standard care. There were no between-group differences for TNSS, NPSS and SNOT-22 improvements after treatment. Comparisons of TNSS, SNOT-22 and NPSS revealed no significant difference in terms of the effectiveness ratios of the biomarker-directed therapy and the standard care. CONCLUSION: A biomarker-directed strategy using the BEC can be used to direct corticosteroid therapy without increasing treatment failure or worsening of symptoms in patients with CRSwNP.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37083114 Eosinophil-derived TGFβ1 controls the new bone formation in chronic rhinosinusitis with nasal polyps 338 347 EN S. Jo Hanyang University Institute for Rheumatology Research (HYIRR), Hanyang University, Seoul, Republic of Korea S.H. Lee Hanyang University Institute for Rheumatology Research (HYIRR), Hanyang University, Seoul, Republic of Korea H-R. Jo Hanyang University Institute for Rheumatology Research (HYIRR), Hanyang University, Seoul, Republic of Korea S. Weon Hanyang University Institute for Rheumatology Research (HYIRR), Hanyang University, Seoul, Republic of Korea C. Jeon Hanyang University Institute for Rheumatology Research (HYIRR), Hanyang University, Seoul, Republic of Korea M.K. Park Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea T-H. Kim Hanyang University Institute for Rheumatology Research (HYIRR), Hanyang University, Seoul, Republic of Korea; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea S.H. Cho Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea 3074 10.4193/Rhin22.439 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by chronic eosinophilic inflammation and new bone formation (NBF). These processes may be associated with each other in the pathogenesis and influence the severity and prognosis of the disease. However, it is still unclear how eosinophilic inflammation is involved in the NBF. METHODOLOGY: Sinus bone cells were isolated from ethmoid bone tissues of patients with CRSwNP and controls. Transforming growth factor beta 1 (TGFβ1) and alkaline phosphatase (ALP) expression in sinus bone cells was determined using quantitative RTâ€"PCR, immunoblotting, and immunohistochemistry. The co-localization of TGFβ1 with eosinophils was assessed by immunofluorescence staining. Sinus bone cells were co-cultured with eosinophils (Eol-1 cell line), which were differentiated with butyrate, to measure the osteoblast differentiation activity of sinus bone cells. RESULTS: TGFβ1 expression was increased in sinus bone tissues and correlated with CT scores in CRSwNP. TGFβ1 was also increased in the submucosa of CRSwNP and co-localized predominantly with eosinophils compared with neutrophils Differentiated Eol-1 cells-derived TGFβ1 increased ALP expression in sinus bone cells. Treatment with a TGFβ1 inhibitor attenuated TGFβ1-induced ALP expression and staining in sinus bone cells of CRSwNP, leading to loss of bone formation. CONCLUSIONS: Eosinophil-derived TGFβ1 was enriched in the submucosa of CRSwNP, which induced ALP expression in sinus bone cells and NBF. Therefore, eosinophil-derived TGFβ1 may mediate aberrant bone remodeling in CRSwNP.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37115706 Tissue eosinophilia and computed tomography features in paediatric chronic rhinosinusitis with nasal polyps requiring revision surgery 348 357 EN 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 C-H. Chiu School of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan Y-L. Huang Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, National Tsing-Hua University, Hsinchu, Taiwan; School of Medicine, National Tsing-Hua University, Hsinchu, Taiwan Y-S. Fan Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Education, Chang Gung Memorial Hospital and 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 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 P-H. Chang Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, 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 3077 10.4193/Rhin22.435 BACKGROUND: Endoscopic sinus surgery (ESS) is an effective and safe treatment modality for medically recalcitrant chronic rhinosinusitis (CRS) in the paediatric population, especially in older children or those with nasal polyposis (CRSwNP). We aimed to elucidate the inflammatory pattern and clinical characteristics of CRSwNP related to revision surgery after ESS in a paediatric population. METHODS: We retrospectively enrolled 146 patients with bilateral CRSwNP. Twenty-two patients had recurrent nasal polyps that required revision surgery. The clinical characteristics, computed tomography (CT) features, tissue eosinophil count, and immunoactivity of signature cytokines in the two groups were analysed. RESULTS: Tissue eosinophil infiltration and immunoreactivity of eosinophilic cationic protein and IL-5 in the sinus mucosa were higher in patients that required revision surgery. The revision surgery group was significantly younger and had positive aeroallergen test results, higher total Lund-Mackay scores, and ethmoid/maxillary sinus ratio on CT images than those without revision surgery. A nomogram was developed to predict the probability of the requirement of revision surgery according to the logistic regression analysis results. CONCLUSIONS: We developed a nomogram model using clinical characteristics, tissue eosinophilia, and CT features for the preoperative identification of patients vulnerable to revision surgery in paediatric CRSwNP. This could help clinicians predict the probability of recurrence and perform intensive postoperative adjunct therapy and follow-up.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37219028 Latent class analysis of structured histopathology in prognosticating surgical outcomes of chronic rhinosinusitis with nasal polyps in Singapore 358 367 EN X. Xu Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore J.E. Seet Department of Pathology, National University Hospital, Singapore Q.V. Yap Department of Pathology, National University Hospital, Singapore S.S. Chao Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore M.K.T. Thong Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore D.Y. Wang Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Y.K. Ong Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore 3079 10.4193/Rhin22.455 BACKGROUND: Structured histopathology profiling is recommended when reporting chronic rhinosinusitis with nasal polyp (CRSwNP) tissue. The objective of this study is to identify features in structured histopathology that predict outcome after functional endoscopic sinus surgery (FESS) in a cohort of CRSwNP patients from Singapore. METHODS: Latent class analysis was performed on structured histopathology reports of 126 CRSwNP patients who had undergone FESS. Outcome measures were polyp recurrence, need for systemic corticosteroids, revision surgery or biologics, and disease control at 2 years post-FESS. RESULTS: Three classes were identified. Class 1 was characterised by mild, predominantly lymphoplasmacytic inflammation. Class 2 comprised of 100 eosinophils/HPF, hyperplastic seromucinous glands, mucosal ulceration and mucin containing eosinophil aggregates and Charcot-Leyden crystals. Classes 2 and 3 were significantly associated with uncontrolled disease at 2 years post-FESS. Class 3 was additionally associated with the need for systemic corticosteroids. CONCLUSIONS: Eosinophil count, degree of inflammation, predominant inflammatory type, hyperplastic seromucinous glands, mucosal ulceration and mucin containing eosinophil aggregates and Charcot-Leyden crystals predicted need for systemic corticosteroids and uncontrolled disease at 2 years post-FESS. The presence of &gt;100 eosinophils/HPF should be reported, as this subset of tissue eosinophilia was associated with less favourable outcomes after FESS.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37515817 Validation of modular endoscopic medial maxillectomies for inverted papilloma of the maxillary sinus 368 375 EN A. Vinciguerra Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France D. Mattavelli Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy M. Turri-Zanoni Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy M. Ferrari Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy A. Schreiber Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy V. Rampinelli Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy I. Dohin Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy M. Valentini Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy V. Pontillo Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France P. Gaudioso Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy A. Karligkiotis Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy S. Atallah Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France F. Chatelet Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France T. Saccardo Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy C. Piazza Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy B. Verillaud Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France P. Nicolai Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy P. Castelnuovo Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy P. Herman Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France 3103 10.4193/Rhin23.035 Background: Treatment of inverted papilloma of the maxillary sinus (IPMS) has a lower success rate compared to other IPs. As such, its correct management generally needs trans-nasal endoscopic medial maxillectomy (EMMs) for adequate resection. The aim of this manuscript is to describe outcomes and major prognostic factors of a cohort of patients with IPMS who were treated with EMM. Methodology: In this multicentric study, patients affected with IPMS and treated with EMMs were included. The site of origin of the IPMS were studied as well as the type of EMM performed. The histological features (IP vs dysplasia), type of mucosal resection (total vs. pedicle oriented), and post-operative complications were analyzed. Results: 310 patients were included (212 primary and 98 recurrent cases). After a mean follow-up of 45.4 months, 15 patients experienced recurrence (4.8%) due to the application of EMMs tailored to the surgical insertion point. Dysplasia was significantly associated with a higher risk of recurrence. The rates of early and late complications were 11.6% and 11.9%, respectively. Conclusions: IPMS resection via tailored EMM is associated with excellent disease control, thus excluding the systematic use of extended EMMs, which can however be justified in case of dysplastic IPMS given its significant impact on recurrence.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37092341 Validation of a three-dimensionally printed simulator for training in endoscopic sinonasal surgery 376 382 EN S.C. Leong Department of Otorhinolaryngology â€" Head and Neck Surgery, Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, United Kingdom A. Strzembosz Medtronic ENT, Tolochenaz, Switzerland N.C. Tan Department of Otorhinolaryngology â€" Head and Neck Surgery, Royal Cornwall Hospitals NHS Trust, United Kingdom 3076 10.4193/Rhin22.442 BACKGROUND: The ability to incorporate different materials in the construction of 3-D printed models has resulted in the ability to mimic a variety of anatomical structures such as cartilage, mucosa and bone. The aim of this study was to evaluate the face and content validities of a model as a training tool for endoscopic sinus surgery. METHODS: Twenty-six delegates and ten teaching faculty members were invited to complete a post-hoc questionnaire survey. The survey consisted of a 22-question 5-point Likert scale to assess the model's realism (face validity) and its effectiveness as a training tool (content validity). RESULTS: Over 80% of the delegates agreed or strongly agreed that the appearance of anatomical structures within the model was realistic and mimicked actual sinus anatomy. In addition, a similar proportion agreed or strongly agreed that the application of instruments on the composite materials of the model realistically mimicked bone. All faculty agreed that the model was useful to develop hand-eye coordination and was a useful training tool for endoscopic sinus surgery. Overall, the sinus model received high scores regarding its use for training surgeons, especially to develop camera and instrument handling skills. CONCLUSION: The results of this study suggest that otolaryngology doctors in their early or intermediate stage of training would benefit most from a clinical-based modular programme. The model requires further development in areas such as the realism of mucosa, incorporation of sinonasal pathology and having more complex anatomy to be useful for the training of more advanced surgeons.

International Rhinologic Society Rhinology 0300-0729 61 4 2023 8 1 37334677 Comment on "Analyzing various factors in the association between olfaction and perceived nasal patency" by Chao et al. including reply. 383 384 EN A.D. DiPalma Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA A. Sood Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA D. Lehman Department of Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA 3087 10.4193/Rhin23.154