International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37956416 "Recurrence� in rhinology 481 481 EN S. Reitsma Department of Otorhinolaryngology, Amsterdam UMC, Location Academic Medical Centre, Amsterdam, The Netherlands 3135 10.4193/Rhin23.906

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37453133 Clinical predictors of polyps recurring in patients with chronic rhinosinusitis and nasal polyps: a systematic review and meta-analysis 482 497 EN DH Kim Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea JS Han Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea GJ Kim Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea MA Basurrah Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia SH Hwang Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea 3092 10.4193/Rhin23.136 Background: Identification of perioperative risk factors for recurrent nasal polyps (RNPs) is important for selection of further treatment and determination of appropriate follow-up period. However, the relative prognostic significance of these risk factors has not been investigated. Methodology: We compared the nasal symptoms, endoscopic polyp and Lund-Mackey computed tomography scores, and the laboratory and pathological findings of RNP and non-RNP patients. The risk of bias was assessed using the Newcastle-Ottawa scale. Results: Patients with poor nasal symptom scores and olfactory dysfunctions and high Lund-Mackey computed tomography scores were at higher risk of postoperative RNPs, as were those with allergic conditions and elevated tissue and serum eosinophil levels. The tissue neutrophil counts/percentages were significantly lower in the RNP than the other group. The tissue eosinophil level was of higher diagnostic utility than the serum eosinophil level. The RNP diagnostic odds ratio afforded by the tissue eosinophil count or percentage was 54.1247. The area under the receiver operating characteristic curve was 0.936. The sensitivity and specificity were 0.8809 and 0.8834, respectively. Conclusion: The tissue eosinophil level reliably predicts RNP after endoscopic sinus surgery.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37772881 Platelet-rich plasma for the treatment of COVID-19 related olfactory dysfunction: a systematic review 498 507 EN B. AlRajhi College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia and King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia O.A. Alrodiman College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia A.F. Alhuzali College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia and King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia H. Alrashed Jouf University, College of Medicine, Aljouf, Saudi Arabia Y.A. Alrodiman Alfaisal University, Riyadh, Saudi Arabia B. Alim Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Madina, Saudi Arabia 3117 10.4193/Rhin23.168 Introduction: Olfactory Dysfunction (OD) is a prevalent issue with a significant number of cases attributed to COVID-19. This systematic review aimed to evaluate the effectiveness of platelet-rich plasma (PRP) in the treatment of COVID-19 related OD, including anosmia, hyposmia, and parosmia. Methods: A comprehensive literature search was conducted using Medline, Scopus, Directory of Open Access Journals (DOAJ), and Google Scholar from inception until December 22, 2022. The eligibility criteria were confirmed COVID-19 patients with OD, whether it was measured objectively and/or subjectively, who received PRP treatment. The study followed a pre-specified protocol registered in PROSPERO (ID: CRD42023386803) and adhered to PRISMA guidelines. Results: Four studies that enrolled 233 patients were included. The degree of improvement was assessed using threshold-discrimination-identification (TDI) scores at baseline and 1 and 2 months after PRP injection. Parosmia was assessed using the Visual Analog Scale (VAS) scores. Treatment of OD with PRP injections resulted in variable degrees of improvement. However, PRP injections can be considered safe, effective, and promising therapeutic options, as revealed by pooled studies. Conclusions: This systematic review indicated that PRP may be an effective treatment for COVID-19 related OD. However, additional large-scale studies are required to further investigate PRP efficacy in the treatment of OD following COVID-19.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37703531 Overall and disease-specific survival of sinonasal adenoid cystic carcinoma: a systematic review and meta-analysis 508 518 EN T. Mauthe Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland D. Holzmann Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland M.B. Soyka Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland S.A. Mueller Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland P. Balermpas Department of Radiation Oncology, University Hospital of Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland U. Held Department of Biostatistics at Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland S.N. Freiberger Department of Biostatistics at Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland N.J. Rupp Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland C.M. Meerwein Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland and Faculty of Medicine, University of Zurich, Zurich, Switzerland 3112 10.4193/Rhin23.204 This meta-analysis aims to investigate the outcome of sinonasal adenoid cystic carcinoma (snAdCC). We followed PRISMA guidelines and included studies reporting 5-year overall survival (OS) rates for snAdCC. Eligible studies were identified through a literature search and assessed using JBI critical appraisal checklist. A total of 17 studies were included comprising 2259 patients (mean age: 58.1 years, 52.7% female, 47.3% male). The meta-analysis demonstrated that the 5-year OS, 10-year OS, and 5-year disease-free survival (DFS) were 68%, 40%, and 47.2%, respectively. Descriptive statistics on study level showed high rates of locally advanced tumor stages at diagnosis: 23% cT3, 53% cT4, 3.4% N+, and 4.2% M+. 29.7% of the tumors were in the nasal cavity, 67.6% in the paranasal sinuses. The maxillary, ethmoid, sphenoid, and frontal sinus were affected in 50.9%, 7.2%, 4%, and 0.5%, of cases. A combination of surgery and radiotherapy was used in 45.4% of the patients and 19.3% of patients received surgery only. In conclusion, these findings emphasize the significance of thorough surveillance for individuals with snAdCC to identify any potential recurrence or progression of the disease.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37804121 Consensus criteria for chronic rhinosinusitis disease control: an international Delphi Study 519 530 EN A.R. Sedaghat Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA W.J. Fokkens Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands V.J. Lund Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Belgium R.C. Kern Department of Otorhinolaryngology, Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA S. Reitsma Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands S. Toppila-Salmi Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Finland and Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland M. Bernal-Sprekelsen Department of ORL, Hospital Clinic, University of Barcelona, Spain J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Cl�nic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain P. Gevaert Department of Otorhinolaryngology, Ghent University, Ghent, Belgium T. Teeling Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands I. Alobid Rhinology and Skull Base Unit, ENT Department, Hospital Cl�nic de Barcelona, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, CIBERES, Barcelona, Spain W.T. Anselmo-Lima Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil F.M. Baroody Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children’s Hospital, Chicago, IL, USA A. Cervin Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women’s Hospital; Faculty of Medicine, University of Queensland, Brisbane, Australia and Department of Clinical Sciences, Lund University, Lund, Sweden N.A. Cohen Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece L. De Gabory Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU de Bordeaux, H�pital Pellegrin, Centre F-X Michelet, Bordeaux, France M. Desrosiers Department of ORL-HNS, Université de Montréal, Montreal, Canada R.J. Harvey Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia L. Kalogjera Department of Otorhinolaryngology/Head and Neck Surgery, Zagreb School of Medicine; University Hospital Center �Sestre milosrdnice�, Zagreb, Croatia A. Knill Patient representative, Sinus UK, London, UK B.N. Landis Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland C. Meco Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey and Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria C.M. Philpott Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK and Norfolk and Waveney ENT Service, James Paget University Hospital, Great Yarmouth and Norfolk and Norwich University Hospital, Norwich, UK D. Ryan Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK and International Primary Care Respiratory Group, Edinburgh, Scotland, UK R.J. Schlosser Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA B.A. Senior Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA T.L. Smith Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health P.V. Tomazic Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria L. Zhang Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China and Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China and Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases, Beijing Key Laboratory of Nasal Diseases, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China and Research Unit of Diagnosis and T C. Hopkins Department of Otolaryngology and Head Neck Surgery, Guys and St Thomas’ Hospital, London, UK 3118 10.4193/Rhin23.335 Background: Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. Methods: Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. Results: Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items. Conclusions: Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37453138 The relationship of sinus opacification, olfaction and dupilumab efficacy in patients with CRSwNP 531 540 EN S.E. Lee Division of Otolaryngology - Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA N. Amin Clinical Sciences Global Development, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA L.P. Mannent Global Clinical Development, Sanofi, Chilly-Mazarin, France C. Bachert Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany, and International Airway Research Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, and Upper Airways Research Laboratory and Department of Otorhinolaryngology, Ghent University, Ghent, Belgium G. Gross Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA S.H. Cho Division of Allergy-Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA A. Praestgaard Department of Biostatistics, Sanofi, Cambridge, MA, USA S. Siddiqui Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA S. Nash Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA S. Kamat Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA A.H. Khan Global Medical Affairs, Sanofi, Chilly-Mazarin, France J.A. Jacob Nara Global Medical Affairs, Sanofi, Bridgewater, NJ, USA 3095 10.4193/Rhin22.220 Background: Loss of sense of smell is one of the most burdensome symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP) but its relationship to sinus disease on imaging is unclear. Dupilumab improves sense of smell and radiographic severity of sinus disease in patients with CRSwNP. We investigated the relationship of sinus opacification severity and loci to olfactory impairment and dupilumab efficacy in patients with CRSwNP from the SINUS-24/SINUS-52 (NCT02912468/NCT02898454) studies. Methods: Sinus opacification was evaluated using the Lund-Mackay computed tomography (LMK-CT) score and sense of smell using patient-reported loss of smell (LoS) score, University of Pennsylvania Smell Identification Test (UPSIT) score and the 22-item Sino-Nasal Outcome Test (SNOT-22) smell/taste item. Results: At baseline, 95% of patients (688/724) had impaired sense of smell and opacification was extensive across all sinuses. Greater olfactory impairment was associated with greater opacification, especially in the ethmoid, sphenoid and frontal sinuses. At Week 24, reductions in LMK-CT total score and ethmoid and sphenoid sinus scores with dupilumab were weakly correlated with improvements in sense of smell assessed by LoS, UPSIT and SNOT-22 smell/taste item. More dupilumab than placebo patients achieved clinically meaningful improvement in LMK-CT total score at Week 24 and Week 52. Conclusion: Radiographic disease severity on imaging was associated with smell outcomes in this cohort. Opacification of the ethmoid, sphenoid and frontal sinuses was associated with severe smell loss. These data suggest that dupilumab effects on smell may be partly mediated through reduced sinus inflammation.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37602858 Serum metabolomics identifies uric acid as a possible novel biomarker for predicting recurrence of chronic rhinosinusitis with nasal polyps 541 551 EN S. Xie Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anat C. Zhang Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anat Z. Xie Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anat J. Zhang Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anat H. Zhang Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anat W. Jiang Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China; Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anat 3109 10.4193/Rhin23.236 Background: Metabolomics has proven to be a valuable tool in gaining new insights into disease progression and prognosis, the specific metabolic alterations in the serum of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) patients remain unknown. This study aims to explore the serum metabolomic profiles of recurrent CRSwNP and identify potential predictive biomarkers. Methods: A prospective, single-center study was conducted on CRSwNP patients prior to endoscopic sinus surgery. Serum samples were subjected to untargeted metabolomic profiling. Patients were followed up for over 2 years and categorized into recurrence and non-recurrence groups. Metabolite differences between the two groups were compared, and the identified differentially regulated metabolites were subsequently validated in a large clinical cohort. Results: 67 CRSwNP patients completed the follow-up schedule, with 47 classified into the non-recurrent group and 20 into the recurrent group. Significant differences were found in the metabolomic profiles between both groups, and serum uric acid (SUA) showed promising predictive potential for postoperative recurrence in both positive and negative ion models. A validation cohort comprising 398 non-recurrent and 142 recurrent CRSwNP patients was recruited, and a significant elevation in SUA levels was observed in recurrent cases. Patients were stratified into tertiles based on the distribution of baseline SUA levels. Multivariate Cox regression analysis showed that higher tertiles of SUA were associated with an increased risk of CRSwNP recurrence compared to lower tertiles, even after adjusting for potential confounding factors. The receiver operating characteristic curve and Kaplan-Meier survival analysis highlighted that elevated SUA levels exhibited potential predictive values for postoperative recurrence. Conclusion: Serum metabolic signatures might predict postoperative recurrence in CRSwNP patients. Increased SUA concentrations were found to be associated with a higher risk of future postoperative recurrence in CRSwNP, independent of traditional risk factors.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37690065 Olfactory and taste dysfunctions caused by COVID-19: a nationwide study 552 560 EN T. Miwa Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan E. Mori Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan R. Sekine Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan Y. Kimura Department of Otolaryngology, Tokyo Metropolitan Ebara Hospital, Tokyo, Japan M. Kobayashi Department of Otorhinolaryngology, Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan H. Shiga Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan K. Tsuzuki Department of Otorhinolaryngology, Head and Neck Surgery, Hyogo Medical University, Hyogo, Japan M. Suzuki Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University, Aichi, Japan K. Kondo Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan I. Suzaki Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Showa University, Tokyo, Japan G. Inokuchi Department of Otolarygology, Head and Neck Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan T. Aiba Department of Otorhinolaryngology, Osaka City Juso Hospital, Osaka, Japan K. Chujo Department of Otorhinolaryngology, St. Luke s International Hospital, Tokyo, Japan S. Yagi-Nakanishi Department of Otorhinolaryngology, Kanazawa Municipal Hospital, Ishikawa, Japan T. Tsukatani Department of Otorhinolaryngology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan H. Nakanishi Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University, Aichi, Japan M. Nishijo Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, Japan Y. Iinuma Department of Infectious Diseases, Kanazawa Medical University, Ishikawa, Japan A. Yokoyama Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan 3111 10.4193/Rhin23.034 Background: Olfactory dysfunctions (OD) and taste dysfunctions (TD) are widely recognized as characteristic symptoms of COVID-19; however, the frequency and mode of occurrence has varied depending on the viral mutation. The prevalence and characteristics of OD/TD in Japan have not been definitively investigated. The purpose of this study is to assess the prevalence of OD/TD in Japan during the Alpha variant epidemic, and measure symptom prolongation at 6 months and 1 year later following initial infection. Methods: Patients treated for COVID-19 between February to May 2021 were evaluated for OD/TD symptoms and provided with a QOL questionnaire. Olfactory tests and taste tests were performed using Open Essence and Taste Strips, respectively. Results: Among the 251 COVID-19 patients who participated, 119 underwent both olfactory and taste tests. Prevalence of subjective OD and TD at the time of survey was 57.8% and 40.2%, respectively. After 12 months, the prevalence fell to 5.8% for OD and 3.5% for TD. Among the OD/TD patients, 36.6% experienced parosmia, and 55.4% experienced parageusia. Prevalence of parosmia and parageusia was higher at 6 and 12 months than at the time of survey. Patients with long-lasting disease reported qualitative dysfunctions and scored significantly higher in food-related QOL problems. Most patients who were aware of their hyposmia had low scores on the olfactory test (83.1%). In contrast, only 26.7% of patients who were aware of their hypogeusia had low scores on the taste test. Conclusions: The prevalence of COVID-19-related OD and TD at the time of survey was 57.8% and 40.2%, respectively. Subjective symptoms of OD and TD persisted for one year in 5.8% and 3.5% of patients, respectively. More than half of the patients with OD or TD complained of qualitative dysfunction and a decrease in their QOL related to eating and drinking. Most patients with TD did not have true TD, but rather developed flavour disorders associated with OD. This conclusion is supported by the finding that patients with subjective OD had low scores on the olfactory test, whereas most patients with subjective TD had normal scores on the taste test.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37566791 Impact of azole antifungal treatment on outcome in acute invasive fungal rhinosinusitis with orbitocranial involvement: a surgical perspective 561 567 EN I. Tessler Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel R. Shemesh Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel G. Sherman Pediatric Infectious Diseases Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel E. Soudry Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Israel S.C.A. Chen Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, Australia and Sydney Medical School, The University of Sydney, Australia O. Ziv Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel S. Kordeluk Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel D. Bar-On Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Israel I. Novikov Biostatistics and Biomathematics unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel A. Yakirevitch Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 3107 10.4193/Rhin23.082 Purpose: To provide real-life data on azole treatment outcomes and the role of surgery in the current management of invasive fungal rhinosinusitis complicated by orbitocranial fungal infection (OCFI). Methods: Data was collected retrospectively from a chart review from four participating centers and a systematic literature review. The study group included patients with OCFI treated with azole antifungals. The control cases were treated with other antifungal agents. The cranial and orbital involvement degree was staged based on the imaging. The extent of the surgical resection was also classified to allow for inter-group comparison. Results: There were 125 patients in the azole-treated group and 153 in the control group. Among the patients with OCFI cranial extension, 23% were operated on in the azole-treated group and 18% in the control group. However, meninges and brain resection were performed only in the controls (11% of patients) and never in the azole antifungals group. Orbital involvement required surgery in 26% of azole-treated cases and 39% of controls. Despite a more aggressive cranial involvement, azole-treated patients' mortality was significantly lower than in controls, with an OCFI-specific mortality rate of 21% vs. 52%. A similar, though not statistically significant, trend was found for the extent of the orbital disease and surgery. Conclusion: Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate. This finding suggests we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37594057 Ultrasound for management of pediatric nasal fractures 568 573 EN R. Noy Department of Otolaryngology â€" Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Technion â€" Israel Institute of Technology, Haifa, Israel N. Gvozdev Department of Otolaryngology â€" Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Technion â€" Israel Institute of Technology, Haifa, Israel A. Ilivitzki Department of Radiology, Rambam Health Care Campus, Haifa, Israel; Technion â€" Israel Institute of Technology, Haifa, Israel N. Nasrallah Pediatric Emergency Medicine Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel A. Gordin Department of Otolaryngology â€" Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Technion â€" Israel Institute of Technology, Haifa, Israel 3108 10.4193/Rhin23.176 Background: Nasal bone fractures are common in children but can be challenging to diagnose accurately in the first days due to swelling and tenderness. While X-rays and computed tomography have limitations, ultrasound may be a radiation-free and cost-effective alternative for diagnosing and treating nasal fractures. Methods: A prospective cohort study at a tertiary referral hospital between 2021-2023. Children who had sustained nasal trauma were included. A radiologist and a non-radiologist blindly reviewed ultrasound scans, and the results were compared to the physical examination performed by a senior otolaryngologist. If closed reduction was necessary, ultrasound was employed during the procedure. The primary outcome was the assessment of nasal fractures in children using ultrasound; Secondary outcomes included success rates for closed reduction and test reliability. Results: Of the 50 children (mean age: 11 years, interquartile range: 6-15 years, 36 [72%] males), 22 (44%) were clinically diagnosed with a nasal fracture. Interobserver reliability for nasal fracture by ultrasound was 92%, with a Cohen's kappa coefficient of Î�=0.91. The sensitivity and specificity of ultrasound in detecting nasal fractures were 90% and 89%, respectively, with positive and negative predictive values of 86% and 93%, respectively. Closed reduction was performed on 18 children, with (n=11) or without (n=7) ultrasound, with the former showing better alignment results (82% vs. 71%). Conclusions: Ultrasound has a high negative predictive value in identifying nasal fractures in children with swollen noses during presentation. This enables to avoid further unnecessary referrals and interventions. Ultrasound-guided closed reduction of nasal fractures demonstrates improved outcomes; however, further large-scale randomized studies are required to validate our findings.

International Rhinologic Society Rhinology 0300-0729 61 6 2023 12 1 37659066 SimLife®, a new dynamic model for endoscopic sinus and skull base surgery simulation 574 576 EN F. Carsuzaa Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France M. Fieux Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie cervico-faciale, Pierre Bénite cedex F-69310, France M. Legré Service ORL et chirurgie cervico-faciale, Institut Arthur Vernes, Paris, France X. Dufour Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France J.P. Faure ABS Lab, Université de Poitiers, Poitiers, France D. Oriot ABS Lab, Université de Poitiers, Poitiers, France L. Fath Service d’ORL, de chirurgie cervico faciale, Avenue Moli�re, H�pital de Hautepierre, H�pitaux Universitaires de Strasbourg, Strasbourg, France S. Bartier Service d’ORL, de chirurgie cervico faciale, H�pital Henri Mondor, Assistance Publique des H�pitaux de Paris, Créteil, France M. Alexandru Service d’Orl et chirurgie cervico-faciale, Assistance Publique-H�pitaux de Paris (AP-HP), Université Paris-Saclay, H�pital Bic�tre, le Kremlin-Bic�tre, France J. Danion ABS Lab, Université de Poitiers, Poitiers, France V. Favier Département d’ORL, chirurgie cervico faciale et maxillo-faciale, H�pital Gui de Chauliac, CHU de Montpellier, Montpellier, France 3110 10.4193/Rhin23.230