International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 38279902 Treatment advances in rhinology 1 1 EN B.N. Landis University of Geneva, Geneva, Switzerland 3155 10.4193/Rhin24.901

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37814591 Dexmedetomidine supplementation for surgical field enhancement in endonasal surgery: a systematic review and meta-analysis 2 12 EN R.B. Giffoni Department of Health, State University of Feira de Santana, Feira de Santana, BA, Brazil J. Arguelles-Hernandez Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA M.E.P. Dalmaschio Centro Universitário do Espirito Santo, Colatina, ES, Brazil P.O. Quintana Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brazil A.D. Lima Division of Postgraduate of Medical Sciences, University of Brasilia, Brazil 3121 10.4193/Rhin23.281 Background: Dexmedetomidine has been shown to effectively control intraoperative bleeding and improve surgical field visualization. However, its value in endonasal surgeries remains a matter of debate. Methodology: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for studies comparing dexmedetomidine with placebo in endonasal surgeries. Outcomes included bleeding, operative time (OT), surgeon’s satisfaction, postoperative pain (POP), and nausea/vomiting (PONV). For statistical analysis, we used RevMan 5.4.1, and assessed heterogeneity with I2 statistics. Results: We included a total of 1386 patients from 22 studies. In the placebo group, there was higher bleeding volume, whereas the dexmedetomidine group showed lower scores on the Fromme-Boezaart scale. Additionally, the surgeon satisfaction risk ratio (RR) increased, and OT was reduced in the dexmedetomidine group. The dexmedetomidine group had lower incidences of POP and PONV. Conclusions: In endonasal surgeries, dexmedetomidine was associated with improvements in surgical field visualization as evidenced by reduced intraoperative bleeding and postoperative morbidities.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37905726 Biases related to periostin levels in chronic rhinosinusitis with nasal polyposis: a systematic review 13 22 EN O.A. Alanzi Deptartment of Otorhinolaryngology Head and Neck Surgery, Dammam Health Network, Dammam, Kingdom of Saudi Arabia W.F. AlBlaies Deptartment of Otorhinolaryngology Head and Neck Surgery, Dammam Health Network, Dammam, Kingdom of Saudi Arabia I.A. Elnadif Deptartment of Otorhinolaryngology Head and Neck Surgery, Dammam Health Network, Dammam, Kingdom of Saudi Arabia M.G. Riga Deptartment of Otorhinolaryngology Head and Neck Surgery, Dammam Health Network, Dammam, Kingdom of Saudi Arabia 3129 10.4193/Rhin23.220 BACKGROUND: The role of periostin in the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) has been debated in the literature, with several authors proposing periostin as a potential biomarker or theurapeutical target. However, the mechanisms regulating the systematic or local periostin production in both CRSwNP patients and controls remain elusive. METHODOLOGY: Any factors reported to affect periostin expression in polyp tissue samples, nasal mucosa samples, serum and nasal secretions were considered as primary outcomes in this systematic review. Interactions or synergistic effects between bias factors were considered as secondary outcomes. RESULTS: Eosinophilic CRSwNP, large polyp size and radiological severity were found to be high-risk, positive bias factors for periostin levels in polyp tissue samples, while the role of atopy and asthma has been debated. Immunotherapy and eosinophilic endotype were identified as biases for serum periostin measurements, while steroids and non-steroidal anti-inflammatory drug exacerbated respiratory disease remain of unclear risk. Bronchal asthma, eosinophilic endotype and immunotherapy have been reported to bias periostin measurements in nasal secretions. CONCLUSIONS: The relevant literature is extremely limited and little is actually known about the intrinsic or extrinsic factors affecting periostin measurements. The synthesis of the existing literature should be done with cautiousness.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37902657 Surgical treatment of nasopharyngeal cancer - a consensus recommendation from two Chinese associations 23 34 EN R. You Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China Y.P. Liu Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China X.Z. Chen Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Province Key Laboratory of Radiation Oncology, Hangzhou, P. R. China J.H. Chen Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, P. R. China J.Y.W. Chan Department of Surgery, LKS Faculty of Medicine, The University of Hong, Hong Kong, P. R. China J.G. Fang Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, P. R. China; Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, P. R. China C.S. Hu Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China Y.Q. Han Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, P. R. China F. Han Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P. R. China G.Y. Hu Department of Oncology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, P. R. China Y. Jiang Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P. R. China W.H. Jiang Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China L. Kong Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, P. R. China J.G. Li Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China Q. Lin Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, P. R. China Y. Liu Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China Y.H. Liu Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, P. R. China Y.T. Lu Department of Otorhinolaryngology, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University, Shenzhen, P. R. China W.T. Ng Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, P. R. China P.K. Man Department of Otorhinolaryngology, Centro Hospitalar C.S. Januario Macau, Macau, P. R. China J.W. Sun Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital, University of Science and Technology of China, Hefei, P. R. China L. Tao ENT Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, P. R. China J.L. Yi Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China X.D. Zhu Department of Radiation Oncology, The Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, P.R. China W.P. Wen Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China M.Y. Chen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China D.M. Han Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, P. R. China; Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, P. R. China 3123 10.4193/Rhin23.054 Background: Surgical treatment is playing an increasingly important role in the management of nasopharyngeal carcinoma (NPC). This consensus focuses on the indications for optimal surgery, and surgical methods in the whole process of treatment for NPC to provide a useful reference to assist these difficult clinical decisions. Methodology: A thorough review of available literature on NPC and surgery was conducted by the Association for the prevention and treatment of nasopharyngeal carcinoma in China, international exchange and promotion Association for medicine and healthcare, and the Committee on nasopharyngeal cancer of Guangdong provincial anticancer association. A set of questions and a preliminary draft guideline was circulated to a panel of 1096 experienced specialists on this disease for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the experts in two authoritative medical science and technology academic groups in the prevention and treatment of NPC in China for review and reconsideration. Results: The initial round of questions showed variations in clinical practice even among similar specialists, reflecting the lack of high-quality supporting data and resulting difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of surgery, including indications and surgical approaches. Conclusion: By standardizing the surgical indications and practice, we hope not only to improve the surgical outcomes, but also to highlight the key directions of future clinical research in the surgical management of NPC.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37838940 Treatment adherence to olfactory training: a real-world observational study 35 45 EN M. Haas Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria J. Raninger Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria J. Kaiser 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 3122 10.4193/Rhin23.207 Background: Olfactory training (OT) is considered an effective intervention for most causes of smell loss and is recommended as a long-term treatment. However, the treatment adherence of OT remains unclear. This study aims to identify the frequency and causalities for lack of adherence to OT. Methods: In this prospective study, 53 patients previously diagnosed with olfactory dysfunction (OD), who were recommended to perform OT, were enrolled. Patients underwent olfactory testing using Sniffin’ Sticks for threshold, discrimination, and identification (TDI) and a subjective numeric rating scale (NRS) at a baseline and follow-up visit. In addition, patients answered a six-item treatment adherence questionnaire. The primary outcome measures were clinically relevant improvements according to the TDI (≥5.5) and NRS (≥1) scores. Results: Out of 53 patients, 45 performed OT. Among patients who performed OT, 31% discontinued the use of OT on their own due to a self-perceived improvement, while 51% discontinued use due to lack of improvements in olfaction. In these patients, the average duration of OT use was five months. After controlling for baseline duration of OD, baseline TDI score and smell loss aetiologies, discontinuing OT due to a lack of self-perceived improvement remained significantly associated with worse TDI and NRS outcomes at follow-up. Conclusions: Our data show that therapeutical adherence to OT is low, regardless of patients’ perception of olfactory function. Olfactory improvement leads to decreased training due to satisfaction, while lack of improvement leads to non-adherence based on disappointing subjective outcome. Patients should be advised to perform OT consistently.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37847818 Olfactory training in normosmic individuals: a randomised controlled trial 46 54 EN I.T. Heian Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Otolaryngology, Head and Neck Surgery, Molde Sjukehus, Helse Møre og Romsdal, Molde, Norway; Department of Research and Innovation, Helse Møre and Romsdal, Norway W.M. Thorstensen Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway T.A. Myklebust Department of Research and Innovation, Helse Møre and Romsdal, Norway T. Hummel Smell and Taste Clinic, Department of Otolaryngology, Universitätsklinikum, Technische Universität Dresden, Germany S. Nordgård Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway M. Bratt Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway A.S. Helvik Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway 7 Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway 3125 10.4193/Rhin23.229 Background: Even if olfactory training (OT) is a well-established treatment for individuals with olfactory dysfunction, the effect on individuals with normosmia remains uncertain. In this randomised controlled trial, we explore how OT with different exposure lengths affect olfactory function in individuals with normosmia. Methodology: Two hundred normosmic individuals were randomly assigned to one of two intervention groups performing OT with different exposure lengths or to a control group. The OT groups did OT twice daily for three months, sniffing four different odours (eucalyptus, lavender, mint, and lemon) for 10 seconds per bottle during either a total of 40 seconds (standard OT) or 4 minutes (extended OT), while the control group did not perform any OT. Olfactory function was assessed using a 48-item Sniffin Sticks test at baseline, after the intervention, and after one year. Results: We found no significant effect of OT in either of the intervention groups on any aspect of olfaction after intervention or at follow-up. There was no association between sex, age, allergic rhinitis, education or olfactory scores at baseline, and changes in olfactory function after OT. The extended OT group performed significantly fewer training sessions compared to those in the standard OT group. Conclusions: OT had a limited effect on olfactory function in individuals with normosmia. Further, the superiority of a more extended OT is not supported by this study, and shorter training sessions seem to improve compliance with OT.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37772802 Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study 55 62 EN M.M. Miyake Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil and Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil F.C.P. Valera Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil R.B. Martins Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil I.M. Compagnoni Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil M.Z. Fantucci Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil A.A.B. Murashima Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil L.E.C.M. da Silva Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil T.M. de Lima Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil M.V.O. de Souza Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil S.R. Melo Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil R.L.L. Dolci Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil C.G. Floriano Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil C.A.C. de Campos Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil M. Nakanishi University of Brasilia, Brasília, DF, Brazil G.S.M. Freire University of Brasilia, Brasília, DF, Brazil A.L. Valente University of Brasilia, Brasília, DF, Brazil M.A. Fornazieri State University of Londrina, Londrina, PR, Brazil J.L.B. da Silva State University of Londrina, Londrina, PR, Brazil L.K. Anzolin State University of Londrina, Londrina, PR, Brazil M.J.A. Issa Mater Dei Hospital, Belo Horizonte, MG, Brazil T.V. Souza Mater Dei Hospital, Belo Horizonte, MG, Brazil B.A. Lima Mater Dei Hospital, Belo Horizonte, MG, Brazil G.D. SantAnna Santa Casa de Misericórdia Hospital de Porto Alegre, Porto Alegre, RS, Brazil C.B. Abreu Santa Casa de Misericórdia Hospital de Porto Alegre, Porto Alegre, RS, Brazil E. Sakano State University of Campinas. Campinas, SP, Brazil A.J. Cassettari State University of Campinas. Campinas, SP, Brazil M.A.G. Avelino Federal University of Goias, Goiânia, GO, Brazil M.C. Gonçalves Federal University of Goias, Goiânia, GO, Brazil L.A. de Camargo Federal University of Goias, Goiânia, GO, Brazil F.R. Romano Hospital Moriah, São Paulo, SP, Brazil R.D. Alves Hospital Moriah, São Paulo, SP, Brazil R. Roithmann Lutheran University of Brazil, Canoas, RS, Brazil N.K. Redeker Lutheran University of Brazil, Canoas, RS, Brazil L.L.B. Filho Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil C.S. Dassi Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil A.T.O. Meurer Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil D.M. Garcia Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil D.C. Aragon Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil M.S. Tepedino State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil A.C.S. Succar State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil P.M. Vianna State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil M.C.J. dos Santos IPO Hospital, Curitiba, PR, Brazil R.H.R. Filho IPO Hospital, Curitiba, PR, Brazil E.M. Kosugi Federal University of São Paulo, São Paulo, SP, Brazil J.F. Villa Federal University of São Paulo, São Paulo, SP, Brazil L.L. Gregorio Federal University of São Paulo, São Paulo, SP, Brazil O.B. Piltcher Hospital de Clínicas Porto Alegre, RS, Brazil C.D. Meotti Hospital de Clínicas Porto Alegre, RS, Brazil E. Tamashiro Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil E. Arruda Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil W.T. Anselmo Lima Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil 3115 10.4193/Rhin23.116 Background: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. Methods: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. Results: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. Conclusion: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37772829 Trigeminal cold receptors and airflow perception are altered in chronic rhinosinusitis 63 70 EN C. Migneault-Bouchard Department of Anatomy, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada K. Lagueux Department of Medical Biology, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada J.W. Hsieh Rhinology-Olfactology Unit, Department of Otorhinolaryngology â€" Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland M. Cyr Department of Medical Biology, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada B.N. Landis Rhinology-Olfactology Unit, Department of Otorhinolaryngology â€" Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland J. Frasnelli Department of Anatomy, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada and Rhinology-Olfactology Unit, Department of Otorhinolaryngology â€" Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland 3116 10.4193/Rhin23.128 Background: In chronic rhinosinusitis (CRS), nasal obstruction can often be explained by anatomical deformities, polyps, or congested nasal mucosa. However, in cases with little deformity or inflammation, perceived nasal obstruction may result from reduced airflow perception caused by an alteration of the intranasal trigeminal system. The aim of this study was to assess this association. Methodology: We performed a prospective case-control study of 15 CRS patients, 18 patients with a deviated nasal septum (DNS) and 16 healthy controls. We assessed olfactory function using the Sniffin’ Sticks test and Visual Analog Scales (VAS). We used the Trigeminal Lateralization Task (TLT) with eucalyptol and cinnamaldehyde to examine intranasal trigeminal function. Further, we assessed nasal patency with Peak Nasal Inspiratory Flow and VAS. Finally, we measured protein levels of trigeminal receptors (TRPM8, TRPA1 and TRPV1) and inflammatory markers (IL-13, INF-γ and eosinophils) in CRS and DNS patients’ mucosal biopsies using Western Blots. Results: CRS patients had significantly lower olfactory function than DNS and healthy controls. They also had significantly lower TLT scores for eucalyptol than both other groups. CRS patients had significantly lower nasal patency than controls; for DNS patients this was limited to subjective measures of nasal patency. In line with this, CRS patients exhibited significantly higher levels of sTRPM8-18 than DNS patients. Conclusions: Intranasal trigeminal function is decreased in CRS patients, possibly due to the overexpression of short isoforms of TRPM8 receptors.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37805987 The effects of priming on rhinologic patient reported outcome measures: a randomized controlled trial 71 81 EN N. Yang Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital- Columbia University Irving Medical Center, New York, NY, USA A. Waytz Department of Management and Organizations, Kellogg School of Management- Northwestern University, Evanston, IL, USA Z.M. Soler Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA J.B. Overdevest Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital- Columbia University Irving Medical Center, New York, NY, USA D.A. Gudis Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital- Columbia University Irving Medical Center, New York, NY, USA 3119 10.4193/Rhin23.172 Background: Patient-reported outcome measures (PROMs) are questionnaires designed to assess a patient’s perception of their medical condition. The 22-item Sino-Nasal Outcomes Test (SNOT-22), the Rhinosinusitis Disability Index (RSDI) and the mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) are validated PROMs commonly used to assess rhinologic conditions. The objective of this study is to determine if responses on these PROMs may be influenced by priming respondents with positive or negative health-related questionnaires. Methods: Nine hundred patients were prospectively randomized to one of nine groups. Groups A, D and G were positively primed prior to completing the SNOT-22, the RSDI and MiniRQLQ, respectively. Groups B, E, and H were negatively primed. Groups C, F, and I served as control groups, completing the PROMs without priming. Priming was performed by administering a survey designed to make patients think about their health-related quality of life in a positive or negative way. Results: Patients who were primed negatively had statistically significantly worse scores on the SNOT-22, RSDI and MiniRQLQ when compared to patients who were primed positively. When compared to the control group, patients who were primed negatively had statistically worse scores on the SNOT-22 and RSDI. There was no significant difference in scores between the positive priming and the control groups for any PROM. Conclusions: Priming subjects regarding their health-related quality of life impacts their responses on rhinologic PROMs. Further study is required to understand the clinical and research implications of this novel finding and to clarify the optimal manner for administering and interpreting PROMs.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37805988 Reasons for rejection of rhinoplasty seeking patients: a multicentre observational study 82 87 EN G. De Greve Department of Otorhinolaryngology and Head and Neck Surgery, UZ Leuven, Leuven, Belgium G.F.J.P.M. Adriaensen Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, Thessaloniki, Greece E. Prokopakis Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece G. Lekakis Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium and Department of Otorhinolaryngology Head and Neck Surgery, Hospital Moliere Longchamp, Brussel, Belgium P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium amd Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands and Department of Head and Skin, University of Ghent, Ghent, Belgium 3120 10.4193/Rhin22.378 Background: To date, research on preoperative patient selection has mainly focused on patient personality, with body dysmorphic disorder (BDD) being the most studied. Despite the many reasons for not planning a rhinoplasty, no data are available on the nature of these reasons. Our aim is to conduct a multicentre international observational study on the reasons for rejection of patients seeking rhinoplasty in 5 tertiary rhinoplasty care centres. Methods: Surgeons documented the reasons for not scheduling a rhinoplasty in consecutive patients who consulted them between January 2021 and March 2022 using a predefined list of reasons for rejection. Surgeons were also asked to report on the patient attitudes after rejection, and about the advice given to patients in the event of refusal. Results: 186 patients seeking rhinoplasty were included. Multiple reasons for rejection were present in 76% of patients, with a mean of 2.9 reasons for rejection per patient. Overall, patient-related factors were most frequently associated with rejection (64.3%), followed by nose-related factors (28.4%), surgeon-related factors (6.0 %) and surgery-related factors (1.3%). The presence of severe BDD symptoms was reported in only 11.3% of the rejected patients. Patients rejected for rhinoplasty were advised to reconsider the surgery (32.8 %) and/or were referred to another surgeon (32.8%). No further action was taken in 39.8% of the patients. Of the patients who were rejected, most had a neutral (39.2 %) or positive (37.1 %) attitude in relation to the lack of rhinoplasty planning. Conclusion: This study highlights the variety of reasons for which patients seeking rhinoplasty are not considered good candidates for a rhinoplasty, with patient-related factors being more prevalent than nose-related and other factors. Increasing awareness on the impact of adequate patient selection for rhinoplasty may contribute to better outcomes in rhinoplasty.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37864411 LINC01094 promotes human nasal epithelial cell epithelial-to-mesenchymal transition and pyroptosis via upregulating HMGB1 88 100 EN Z. Liu Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China Y. Fu Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China W. Huang Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China C. Li Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China X. Wei Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China J. Zhan Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China J. Zheng Department of Otorhinolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, P.R. China 3127 10.4193/Rhin23.184 Background: Excessive epithelial-to-mesenchymal transition (EMT) of nasal epithelial cells (NECs) play a prominent role in chronic rhinosinusitis with nasal polyps (CRSwNP) pathogenesis. Long intergenic non-coding RNA 01094 (LINC01094) was previously reported to be overexpressed in CRSwNP, while the regulatory mechanism by which LINC01094 regulates CRSwNP progression remains unclear. Our study aimed to investigate the role of LINC01094 in CRSwNP development. Methods: hNEC were isolated from tissues of controls and CRSwNP patients and stimulated with interleukin (IL)-13. 3-(4, 5-Dimethylthiazolyl2)-2, 5-diphenyltetrazolium bromide (MTT) assay was employed to analyze hNEC viability. Flow cytometry was employed to analyze pyroptosis. Immunofluorescence was employed to analyze Snail nuclear translocation. The interactions between LINC01094, fused in sarcoma (FUS) and high mobility group box-1 (HMGB1) were analyzed by RNA immunoprecipitation (RIP) and RNA pull-down assays. Results: LINC01094 and EMT-related proteins were markedly upregulated in nasal polyp tissues of CRSwNP. LINC01094 knockdown inhibited IL-13-induced hNEC EMT and pyroptosis. LINC01094 promoted HMGB1 expression in CRSwNP by binding with FUS. HMGB1 promoted Snail nuclear import in GSK-3β phosphorylation-dependent manner. Conclusion: LINC01094 facilitated hNEC EMT and pyroptosis in CRSwNP by activating the HMGB1/GSK-3β/Snail axis, which suggested that LINC01094 might serve as a biomarker and therapeutic target in CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37864409 The influence of inhibitors of apoptosis proteins (IAPs) on chronic rhinosinusitis with nasal polyps 101 110 EN I.M. Passos Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil E. Tamashiro Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil M.Z. Fantucci Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil A.A.B. Murashima Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil L.E.C.M. Silva Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil D.M. Garcia Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil F.M. Faria Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Brazil R.B. Martins Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Brazil E. Arruda Department of Cell and Molecular Biology and Pathogenic Bioagents, Ribeirão Preto Medical School, University of São Paulo, Brazil W.T. Anselmo-Lima Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil F.C.P. Valera Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil 3126 10.4193/Rhin23.160 Background: Inhibitors of apoptosis proteins (IAPs) modulate the inflammatory process, and may facilitate the formation of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to observe if IAPs were differently expressed between patients with CRSwNP and controls, and to correlate the expression of IAPs with some inflammatory markers, as with the response to nasal corticosteroids in patients with CRSwNP. Methodology: We obtained nasal biopsies from patients with CRSwNP (n=27) and controls (n=16). qRT-PCR measured the expression of IAPs and caspases, while Luminex assay measured the concentration of cytokines. Unpaired parametric tests and Principal Component Analysis (PCA) were used for statistical analysis. Results: We observed lower expression of IAP genes (XIAP, BIRC2/IAP1, and BIRC3/IAP2) in CRSwNP patients compared to controls, and we identified that patients with bad response to corticosteroids presented lower levels of BIRC2/IAP1, XIAP, BCL2, CASP9, and IL-17, and higher levels of CASP7 and TGF-β. Conclusions: IAPs expression was downregulated in CRSwNP, and was associated with poorer response to nasal corticosteroids. The present findings suggest the importance of IAPs as a link between environment and the host inflammatory responses, and this pathway could be explored as a potential new target therapy for patients with CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37865935 Role of serum eosinophil cationic protein in distinct endotypes of chronic rhinosinusitis 111 118 EN P.C. Tsai Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan T.J. Lee Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan P.H. Chang Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan C.H. Fu Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan 3128 10.4193/Rhin23.170 Background: Serum eosinophil cationic protein (ECP) levels affect the surgical outcome of chronic rhinosinusitis (CRS) with nasal polyps. Primary CRS can be classified into type 2 (T2) and non-T2. We aimed to differentiate the role of serum ECP levels in surgical outcomes between the distinct endotypes of primary CRS. Methods: We prospectively enrolled patients with bilateral primary CRS who underwent surgical treatment with postoperative follow-up for at least 12 months. Endotyping and serum parameter measurements were completed within 1 week before surgery. Results: In total, 113 patients were enrolled, including 65 with T2 CRS and 48 with non-T2 CRS. Patients in the T2 CRS group with uncontrolled CRS had significantly higher serum ECP levels than those in patients in the non-T2 CRS group. An optimal cut-off value was obtained at 17.0 μg/L using the receiver operating characteristic curve, attaining a sensitivity of 91.7% and specificity of 56.6%. Multivariate logistic regression analysis showed that a higher serum ECP level was an independent factor for postoperative uncontrolled disease. The hazard ratio was 11.3 for the T2 group, with serum ECP levels over 17.0 μg/L. In the non-T2 group, no parameters were significantly correlated with postoperative uncontrolled CRS. Conclusions: Serum ECP levels appear to be a feasible predictor of postoperative uncontrolled disease in patients with T2 CRS as preoperative serum ECP levels >17.0 μg/L in these patients have an approximately 16.7-fold increased risk of postoperative uncontrolled disease and should be closely monitored.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 38009901 Determinants of the microbiome spatial variability in chronic rhinosinusitis 119 126 EN J. Szaleniec Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland V. Bezshapkin Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland A. Krawczyk Department of Molecular Medical Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland K. Kopera Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland B. Zapała Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Krakow, Poland; Jagiellonian University Hospital in Krakow, Krakow, Poland T. Gosiewski Department of Molecular Medical Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland T. Kosciolek Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland; Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland 3140 10.4193/Rhin22.423 BACKGROUND: The sinus microbiome in patients with chronic rhinosinusitis (CRS) is considered homogenous across the sinonasal cavity. The middle nasal meatus is the recommended sampling site for 16S rRNA sequencing. However, individuals with unusually high between-site variability between the middle meatus and the sinuses were identified in previous studies. This study aimed to identify which factors determine increased microbial heterogeneity between sampling sites in the sinuses. METHODOLOGY: In this cross-sectional study samples for 16S rRNA sequencing were obtained from the middle meatus, the maxillary and the frontal sinus in 50 patients with CRS. The microbiome diversity between sampling sites was analysed in relation to the size of the sinus ostia and clinical metadata. RESULTS: In approximately 15% of study participants, the differences between sampling sites within one patient were greater than between the patient and other individuals. Contrary to a popular hypothesis, obstruction of the sinus ostium resulted in decreased dissimilarity between the sinus and the middle meatus. The dissimilarity between the sampling sites was patient-specific: greater between-sinus differences were associated with greater meatus-sinus differences, regardless of the drainage pathway patency. Decreased spatial variability was observed in patients with nasal polyps and extensive mucosal changes in the sinuses. CONCLUSIONS: Sampling from the middle meatus is not universally representative of the sinus microbiome. The differences between sites cannot be predicted from the patency of communication pathways between them.

International Rhinologic Society Rhinology 0300-0729 62 1 2024 February 1 37516987 Do people stop conducting olfactory training when their olfaction recovers? 127 128 EN M. Pieniak Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany and Institute of Psychology, University of Wroclaw, Wroclaw, Poland T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 3105 10.4193/Rhin23.140