International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38775081 Definitions for chronic rhinosinusitis: just more words or is there meaning? 257 257 EN A.R. Sedaghat Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 3176 10.4193/Rhin24.903

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38217624 Comparison of nasal valve dysfunction treatment outcomes for temperature-controlled radiofrequency and functional rhinoplasty surgery: a systematic review and meta-analyses 258 270 EN J.K. Han Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA J. Perkins Independent Clinical Researcher, Sunnyvale, CA, USA D. Lerner Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA M.T. Yim Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health, Shreveport, LA, USA L.E. Ishii Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA 3151 10.4193/RhinRhin23.261 BACKGROUND: Nasal valve dysfunction (NVD) is a substantial contributor to nasal airway obstruction. Minimally-invasive temp-erature-controlled radiofrequency (TCRF) treatment of the nasal valve is available and comparison with surgical techniques is warranted. METHODOLOGY: Databases: Medline (PubMed), Embase, Cochrane Library. Population: adults with preprocedural nasal obstruction symptom evaluation (NOSE) score ≥45. Treatment effects were derived from a random effects model and reported as weighted mean difference in NOSE score between baseline; 3, 6, and 12 months postprocedure. RESULTS: Of 2529 initial articles, 5 studies describing TCRF treatment and 63 studies describing functional rhinoplasty were included. Pooled effect sizes for TCRF treatment and functional rhinoplasty were comparable in all analyses. CONCLUSIONS: TCRF treatment of the internal nasal valve for NVD was associated with sustained effects comparable to functional rhinoplasty addressing the nasal valve only, rhinoplasty without concomitant turbinate treatment, and all rhinoplasty.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38353499 Prelacrimal window approach to the maxillary sinus: a systematic review and meta-analysis of the literature 271 286 EN A. Machado Department of Otolaryngology, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal J. Pereira Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal F. Alvarez Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal H.R. Briner ORL-Zentrum, Hirslanden Klinik, Zurich, Switzerland D. Simmen ORL-Zentrum, Hirslanden Klinik, Zurich, Switzerland 3158 10.4193/Rhin23.296 BACKGROUND: The prelacrimal window approach (PLWA) is a minimally invasive surgical technique that has been proposed as an alternative to the traditional approaches to access the maxillary sinus. METHODOLOGY: A systematic review with meta-analysis was performed following PRISMA guidelines and identified 368 articles for initial review of which 14 (610 participants) met the criteria for meta-analysis. Four databases, including PubMed, Google Scholar, Web of Science and Scopus, were searched to identify relevant articles. Two independent reviewers conducted the eligibility assessment for the included studies. Methodology quality and risk of bias were evaluated by New Castle Ottawa scale. The outcomes assessed were recurrence of the pathology, postoperative morbidity including epiphora, dry nose, facial, gingival numbness, epistaxis or local infection. RESULTS: The present data suggest a significant reduction in the recurrence rate of maxillary sinus pathology following PLWA when compared to conventional surgery (endoscopic medial maxillectomy, endoscopic sinus surgery and the Caldwellâ€"Luc operation). The rates of epiphora, facial or gingival numbness, epistaxis or infection requiring intervention, were not significantly different between the procedures. CONCLUSIONS: Maxillary sinus pathology can be effectively treated using the PLWA technique, as it has been shown to result in a lower recurrence rate compared to conventional surgeries.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38217529 EPOS2020/EUFOREA expert opinion on defining disease states and therapeutic goals in CRSwNP 287 298 EN W.J. Fokkens Department of Otorhinolarynogology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherlands E. De Corso Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli Universitary Hospital Foundation, IRCSS, Rome, Italy V. Backer Department of Otorhinolaryngology, Head and Neck surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark M. Bernal-Sprekelsen Department of Otorhinolaryngology, University of Barcelona, Department of Otorhinolaryngology, Clinic Barcelona, Spain L. Bjermer Department of Respiratory Medicine and Allergology, Lund University, Skåne University Hospital, Lund, Sweden C. von Buchwald Department of Otorhinolaryngology, Head and Neck surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark A. Chaker Department of Otorhinolaryngology and Center for Allergy and Environment (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany Z. Diamant Department of Otorhinolaryngology and Center for Allergy and Environment (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Microbiology Immunology and Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium; Department of Clinical Pharmacy and Pharmacology, UMCG, Groningen, The Netherlands; Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skåne University Hospital Lund, Sweden; D P. Gevaert Laboratory of Upper Airways Research, Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium J. Han Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, VI, USA C. Hopkins Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom V. Hox Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany V.J. Lund Professorial Unit, Ear Institute, University College London, United Kingdom S. Lee Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA A. Luong Department of Otorhinolaryngology, Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain A. Peters Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA O. Pfaar Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany S. Reitsma Department of Otorhinolarynogology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherlands S. Toppila-Salmi Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki , Finland G.K. Scadding Division of infection and Immunity, University College London, United Kingdom A.R. Sedaghat Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A-S. Viskens Laboratory of Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium M. Wagenmann Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium 3150 10.4193/Rhin23.415 Severe chronic rhinosinusitis with nasal polyps (CRSwNP), a form of diffuse bilateral (usually type 2) CRS, is a debilitating disease with a significant impact on quality of life (QoL). With novel knowledge and treatment options becoming available, there is a growing need to update or revise key definitions to enable communication across different specialties dealing with CRS, and to agree on novel goals of care in CRSwNP. The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) and EPOS expert members discussed how to measure treatment responses and set new treatment goals for CRSwNP. In this paper a consensus on a list of definitions related to CRSwNP is provided: control, remission, cure, recurrence/exacerbation, treatable traits, remodeling, progression, and disease modification. By providing these definitions, the involved experts hope to improve communication between all stakeholders involved in CRSwNP treatment for use in routine care, basic and clinical research and international guidelines aimed to harmonize and optimize standard of care of patients with CRSwNP in the future.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38372647 Nasal hyperreactivity in allergic rhinitis and chronic rhinosinusitis with polyps: a role for neuronal pathways 299 309 EN W. Backaert KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium B. Steelant KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium T. Wils KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium Z. Qian KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium E. Dilissen KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium A-C. Jonckheere KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium B. Boonen KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research, Leuven, Belgium; VIB, Center for Brain and Disease Research, Leuven, Belgium M. Jorissen University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Leuven, Belgium R. Schrijvers KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; KU Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, Leuven, Belgium; University Hospitals Leuven, Department of General Internal Medicine, Leuven, Belgium D. M. A. Bullens KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Paediatrics, Leuven, Belgium K. Talavera KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research, Leuven, Belgium; VIB, Center for Brain and Disease Research, Leuven, Belgium P.W. Hellings KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium;U Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium;Academic Medical Center, Department of Otorhinolaryngology, Amsterdam, The Netherlands L. Van Gerven KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium;KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Leuven, Belgium 3159 10.4193/Rhin23.287 BACKGROUND: Nasal hyperreactivity (NHR) is prevalent in all chronic upper airway inflammatory phenotypes, including allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Although NHR in patients with non-allergic rhinitis is mediated by neuronal pathways, AR and CRSwNP are mainly characterized by type 2 inflammation. METHODS: Eighteen healthy controls and 45 patients with symptomatic AR/CRSwNP underwent a cold, dry air (CDA) provocation test for objective diagnosis of NHR. Before and after, questionnaires were filled out and nasal secretions and biopsies were collected. Markers for neurogenic inflammation (substance P, calcitonin gene-related peptide, neurokinin A), epithelial activation (IL-33), and histamine were measured in secretions by ELISA; and expression of neuronal markers PGP9.5, TRPV1, and TRPM8 was studied in biopsies by RT-q-PCR. Effects of histamine on TRPV1/A1 were studied with Ca2+-imaging using murine trigeminal neurons. RESULTS: CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/patients CDA-provocation reduced peak nasal inspiratory flow (PNIF) of patients with subjective NHR but not of non-NHR controls/patients. Subjective (subjectively reported effect of CDA) and objective (decrease in PNIF) effects of CDA were significantly correlated. Levels of neuropeptides and histamine in nasal secretions and mRNA expression of PGP9.5, TRPV1, and TRPM8 correlated with CDA-induced PNIF-reduction. CDA-provocation induced an increase in IL-33-levels. Both TRPV1 and TRPA1 expressed on afferent neurons were sensitized by exposure to histamine. CONCLUSION: NHR is not an on/off phenomenon but spans a continuous spectrum of reactivity. A neurogenic inflammatory background and increased histamine-levels are risk factors for NHR in AR/CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38217847 Two-year outcomes of radiofrequency device treatment of the nasal valve for nasal airway obstruction 310 319 EN S.L. Silvers Madison ENT and Facial Plastic Surgery, New York, NY, USA C.M. McDuffie ENT Associates of Texas, McKinney, TX, USA D.M. Yen Specialty Physician Associates, Bethlehem, PA, USA J.N. Rosenthal ENT and Allergy Associates of Florida, Coral Springs, FL, USA S.E. Davis Breath Clear Institute, Torrance, CA, USA J.K. Han Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VI, USA 3153 10.4193/RhinRhin23.377 BACKGROUND: Temperature-controlled radiofrequency (TCRF) device treatment of nasal valve dysfunction (NVD) was superior to a sham procedure control in reducing the symptoms of nasal airway obstruction (NAO) in this randomised controlled trial (RCT). METHODOLOGY: Two-year outcomes for 108 patients actively treated in a prospective, multicenter, patient-blinded RCT were used to determine treatment effect durability and changes in medication/nasal dilator usage. A responder was defined as ≥20% reduction in NOSE score or ≥1 reduction in severity class. RESULTS: The mean (SD) age of patients was 48.5 (12.3) years; 66 (61.1%) women. Baseline NOSE score was 76.3. The 2-year responder rate was 90.4% and NOSE score treatment effect was âˆ'41.7; 54.7% improvement. Of 57 patients using medications/nasal dilators at baseline, 45 (78.9%) either stopped all use (33.3%) or stopped/decreased (45.6%) use in ≥1 class at 2 years. Concurrent septal deviation, septal swell body, or turbinate enlargement did not significantly affect the odds of exhibiting a NOSE score of ≤25 at 2 years. CONCLUSIONS: TCRF device treatment of NVD resulted in significant and sustained improvements in the symptoms of NAO at 2 years, accompanied by a substantial reduction in medication/nasal dilator use.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38217844 Mepolizumab improves sense of smell in severe chronic rhinosinusitis with nasal polyps: SYNAPSE 320 329 EN J. Mullol Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain V.J. Lund University College London, London, UK;Royal National Throat Nose and Ear Hospital, UCLH, London, UK M. Wagenmann Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany J.K. Han Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, VA, USA A.N. Sousa Respiratory Patient Centered Outcomes, Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK S.G. Smith Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA B. Mayer Clinical Statistics, GSK, GSK House, Brentford, Middlesex, UK R.H. Chan Respiratory Patient Centered Outcomes, Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands 3152 10.4193/Rhin22.416 BACKGROUND: Loss of smell is one of the most bothersome and difficult-to-treat symptoms in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). METHODOLOGY: SYNAPSE was a 52-week Phase III study of 4-weekly mepolizumab (100 mg subcutaneously) plus standard of care in adults with severe bilateral CRSwNP. This post hoc analysis assessed changes from baseline to study end in loss of smell visual analogue scale (VAS) symptom score, in patients stratified by several baseline clinical characteristics. SinoNasal Outcomes Test (SNOT)-22 sense of smell/taste item and University of Pennsylvania Smell Identification Test (UPSIT) scores were also assessed. RESULTS: SYNAPSE enrolled 407 patients (mepolizumab=206; placebo=201) with impaired sense of smell at baseline. Improvements from baseline to study end in loss of smell VAS score were greater with mepolizumab versus placebo (treatment difference: âˆ'0.37) and most notable in patients with fewer or more recent prior surgeries (treatment difference: 1 vs 2 vs more than 2 prior surgeries,âˆ'1.29 vs âˆ'0.23 vs âˆ'0.07; =3 years since last surgery, âˆ'0.89 vs 0.22). Approximately 25% of patients had baseline UPSIT scoresavailable; among those scoring =19 by study end. The SNOT-22 sense of smell/taste item score improved with mepolizumab versus placebo. CONCLUSIONS: Mepolizumab treatment improved patients' perceived sense of smell, as measured by loss of smell VAS score and SNOT-22 sense of smell/taste item score in patients with severe refractory CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38189480 Clinical and technical factors in endoscopic skull base surgery associated with reconstructive success 330 341 EN A. Abiri Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA B.F. Bitner Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA T.V. Nguyen Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA J.C. Pang Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA K.M. Roman Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA M. Vasudev Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA D.D. Chung Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA S.H. Tripathi Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA J.C. Harris Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA N. Kosaraju Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA R.M. Shih Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA M. Ko Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA J.E. Miller Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA J.E. Douglas Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA D.J. Lee Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA J.G. Eide Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA R.S. Kshirsagar Department of Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, CA, USA K.M. Phillips Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A.R. Sedaghat Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA M. Bergsneider Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA M.B. Wang Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA J.N. Palmer Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA N.D. Adappa Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA F.P.K. Hsu Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA E.C. Kuan Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA 3148 10.4193/Rhin23.267 BACKGROUND:In this study, we identified key discrete clinical and technical factors that may correlate with primary reconstructive success in endoscopic skull base surgery (ESBS). METHODS: ESBS cases with intraoperative cerebrospinal fluid (CSF) leaks at four tertiary academic rhinology programs were retrospectively reviewed. Logistic regression identified factors associated with surgical outcomes by defect subsite (anterior cranial fossa [ACF], suprasellar [SS], purely sellar, posterior cranial fossa [PCF]). RESULTS: Of 706 patients (50.4% female), 61.9% had pituitary adenomas, 73.4% had sellar or SS defects, and 20.5% had high-flow intraoperative CSF leaks. The postoperative CSF leak rate was 7.8%. Larger defect size predicted ACF postoperative leaks; use of rigid reconstruction and older age protected against sellar postoperative leaks; and use of dural sealants compared to fibrin glue protected against PCF postoperative leaks. SS postoperative leaks occurred less frequently with the use of dural onlay. Body-mass index, intraoperative CSF leak flow rate, and the use of lumbar drain were not significantly associated with postoperative CSF leak. Meningitis was associated with larger tumors in ACF defects, nondissolvable nasal packing in SS defects, and high-flow intraoperative leaks in PCF defects. Sinus infections were more common in sellar defects with synthetic grafts and nondissolvable nasal packing. CONCLUSIONS: Depending on defect subsite, reconstructive success following ESBS may be influenced by factors, such as age, defect size, and the use of rigid reconstruction, dural onlay, and tissue sealants.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38078376 Strategies for patients with recurrent nasopharyngeal carcinoma involved internal carotid artery who are intolerant to embolization 342 352 EN W-B. Wu Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China X-B. Zhang Department of Neurosurgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China Z-K. Feng Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China H-F. Li Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China Y-P. Liu Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China J-L. Liang Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China Y-L. Xie Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China Y-J. Hua Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China R. Sun Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China S-L. Wang The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Department of Otolaryngology, Guangzhou, China J-H. Chen Department of Neurosurgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China M-Y. Chen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China 3143 10.4193/RhinRhin23.130 BACKGROUND: The surgical treatment of recurrent nasopharyngeal carcinoma (rNPC) involving the internal carotid artery (ICA) is challenging, as the massive bleeding caused by intraoperative rupture of the ICA is life-threatening. We reported that ICA embolization is an effective pretreatment to avoid fatal bleeding, but some patients cannot tolerate the procedure. We used endovascular vascular protection (ICA stents), vascular sacrifice (bypass grafting) and extravascular vascular protection (transcervical external stent placement) of the ICA to provide alternative options for these patients. METHODOLOGYy: This study enrolled patients with rNPC adjacent to or invading the ICA who were unsuitable for ICA embolization from January 2015 to June 2020. ICA pretreatment combined with endoscopic nasopharyngectomy (ENPG) was performed for the 30 patients. We report the survival outcome and incidence of complications after ICA pretreatment. RESULTS: ICA pretreatment was performed for the 30 enrolled patients, among whom 8 underwent endoscopic-assisted transcervical protection of the parapharyngeal ICA combined with ENPG, 6 underwent bypass grafting, and 16 underwent ICA stent implantation followed by ENPG. After pretreatment, at a median follow-up of 43 months (range, 2-80 months), the 3-year locoregional overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) were 62.9%, 61.3%, 70.2%, and 71.4%, respectively. CONCLUSIONS: ICA pretreatment combined with salvage ENPG enables the feasible and effective resection of rNPC lesions involving the ICA in patients who cannot tolerate ICA embolization. Therefore, this treatment may be an effective method for improving outcomes. Multidisciplinary therapy is needed to reduce operation-related complications.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38189590 Diagnostic value of serum squamous cell carcinoma antigen and cytokeratin fragment antigen 21-1 for sinonasal inverted papilloma: an exploratory study 353 361 EN Z. Zhang Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China; Department of Medicine, Qingdao University, Qingdao, China B. Xu Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China; Department of Medicine, Qingdao University, Qingdao, China L. Wang Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China X. Yan Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China S. Li Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China; Department of Medicine, Qingdao University, Qingdao, China Y. Jiang Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China L. Yu Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China 3149 10.4193/RhinRhin23.325 BACKGROUND: Serum tumor markers have not yet been developed for the clinical diagnosis and treatment of sinonasal inverted papilloma (SNIP), one of the most significant sinonasal tumors. Therefore, this study aimed to determine the diagnostic value of serum squamous cell carcinoma antigen (SCCA) and cytokeratin fragment antigen 21-1 (CYFRA 21-1) for SNIP. METHODS: Clinical data were obtained from 101, 56, and 116 patients with SNIP, sinonasal squamous cell carcinoma (SNSCC), and unilateral chronic rhinosinusitis (CRS), respectively. Preoperative serum SCCA and CYFRA 21-1 levels were compared, and logistic regression analyses were performed to screen serum tumor markers, which may be used to diagnose SNIP. Diagnostic cut-off values were determined using receiver operating characteristic (ROC) curves, and their diagnostic power was verified. RESULTS: Serum SCCA and CYFRA 21-1 differentiated SNIP from CRS with the cut-off values of 1.97 ng/mL and 2.64 ng/mL and the areas under the ROC curves (AUC) of 0.895 and 0.766, respectively, and the AUC of the combination of the two markers was 0.909. CYFRA 21-1 differentiated SNIP with malignant transformation from that without malignant transformation with a cut-off value of 3.51 ng/mL and an AUC of 0.938. CYFRA 21-1 distinguished SNIP with malignant transformation from SNSCC with a cut-off value of 3.55 ng/mL and an AUC of 0.767. CONCLUSIONS: This study provides novel potential diagnostic tools for SNIP by demonstrating the use of serum SCCA and CYFRA 21-1 in the diagnosis of SNIP.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38088419 Continuous investigation of the nasal cycle over 48 hours 362 369 EN J. Lindemann Department of Otorhinolaryngology, University Hospital Ulm, Germany M.O. Scheithauer Department of Otorhinolaryngology, University Hospital Ulm, Germany F. Sommer Department of Otorhinolaryngology, University Hospital Ulm, Germany T.K. Hoffmann Department of Otorhinolaryngology, University Hospital Ulm, Germany J. Hahn Department of Otorhinolaryngology, University Hospital Ulm, Germany J. Foerg Department of Otorhinolaryngology, University Hospital Ulm, Germany 3145 10.4193/RhinRhin23.284 BACKGROUND: Previous results on the nasal cycle refer to measurements over up to 24h. The long-term rhinoflowmetry (LRFM) allows continuous observations over a longer period. The aim of the study was to observe the nasal cycle for the first time over 48h under everyday conditions. METHODOLOGY: The LRFM was continuously applied to 30 rhinologically healthy subjects (20 female, 10 male) over 48h. The different types of nasal cycle were classified as follows: "classic", in concert", "one-sided";, "no-cycle" and "mixed". The focus of this study was on the results over the entire 48 hours. The comparison of the two consecutive days was also made. RESULTS: A nasal cycle could be detected in 100% of the subjects over 48h. With 97%, the mixed type most commonly occurred as a combination of classical and in concert components. In all subjects, classical cycle components could be detected at least once. The no-cycle type was not observed. In the awake state, the mixed type dominated (80%), as a combination of classical and in concert parts. In the sleep state, the classical type was the most common type (97%). The average phase duration was 206 ± 83 minutes. CONCLUSIONS: In the very first continuous 48-hour study on the nasal cycle, 100% of the subjects presented a nasal cycle. The LRFM method is the only one that offers the possibility to perform continuous measurements over a longer period during daily routine. The results of previous single-stage examination methods should thus be questioned.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38416065 Body mass index’s effect on CRSwNP extends to pathological endotype and recurrence 370 382 EN W. Chen Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Bai Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China P. Fang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China J. Chen Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China X. Wang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Li Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China X. Luo Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Z. Xiao Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China R. Iyer Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA F. Shan Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China T. Yuan Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China M. Wu Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China X. Huang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China D. Fang Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Q. Yang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Zhang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou Key Laboratory of Mechanistic and Translational Obesity Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China 3161 10.4193/Rhin23.402 BACKGROUND: Elevated body mass index (BMI) has been recognized as an important contributor to corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to delineate the effects of elevated BMI on immunological endotype and recurrence in CRSwNP individuals. METHODOLOGY: A total of 325 patients with CRSwNP undergoing FESS were recruited and stratified by BMI. H&E staining was employed for histological evaluation. Characteristics of inflammatory patterns were identified by immunohistochemical staining. The predictive factors for recurrence were determined and evaluated by multivariable logistic regression analysis and the receiver operating characteristic (ROC) curves across all subjects and by weight group. RESULTS: In all patients with CRSwNP, 26.15% subjects were classified as overweight/obese group across BMI categories and exhibited a higher symptom burden. The upregulated eosinophil/neutrophil-dominant cellular endotype and amplified type 2/ type 3 coexisting inflammation was present in overweight/obese compared to underweight/normal weight controls. Additionally, a higher recurrent proportion was shown in overweight/obese patients than that in underweight/normal weight cohorts. Multivariable logistic regression analysis identified BMI as an independent predictor for recurrence. The predictive capacity of each conventional parameter (tissue eosinophil and CLCs count, and blood eosinophil percentage) alone or in combination was poor in overweight/obese subjects. CONCLUSIONS: Overweight/obese CRSwNP stands for a unique phenotype and endotype. Conventional parameters predicting recurrence are compromised in overweight/obese CRSwNP, and there is an urgent need for novel biomarkers that predict recurrence for these patients.

International Rhinologic Society Rhinology 0300-0729 62 3 2024 6 1 38478151 Eosinophils are the dominant type2 marker for the current indication of biological treatment in severe uncontrolled chronic rhinosinusitis with nasal polyps 383 384 EN R. van der Lans Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands J.J. Otten Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands G.F.J.P.M. Adriaensen Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands L.B.L. Benoist Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands M.E. Cornet Department of otorhinolaryngology, Alrijne Hospital, Leiden, The Netherlands D.R. Hoven Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands A.B. Rinia Department of otorhinolaryngology, Isala Hospital, Zwolle, The Netherlands W.J. Fokkens Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands S. Reitsma Amsterdam Rhinology Team (ART), department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands 3166 10.4193/Rhin23.081 The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) defines markers for type2 inflammation in the context of indicating biological therapy in severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) as either a total serum immunoglobulin E (total-IgE)