International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38829175 Outcome measures for chronic rhinosinusitis with nasal polyps 1 36 EN A.R. Sedaghat Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA R.G. Campbell Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Otorhinolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia R.G. Douglas Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands A.W. Hamizan Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Z.R. Korban Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon V.S. Lee Department of Otolaryngology, Head and Neck Surgery, University of Illinois Chicago, Chicago, IL, USA L. Macias-Valle Department of Otorlaryngology Head and Neck Surgery, Hospital Español de México, La Salle University , México City, México F.R. Romano Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand S. Alsaleh Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia 3180 10.4193/Rhin24.090 Background: With the recent proliferation of novel therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP), there is an immediate need for comprehensive means to assess CRSwNP disease status as well as to determine treatment efficacy. Outcome measures exist in different forms. Patient-reported outcome measures (PROMs) allow patients to provide direct input about their condition that is not possible to obtain in any other way. Common constructs that are measured using PROMs include quality of life or the burden of disease manifestations (e.g., symptom severity). Outcomes may also include the results of objective diagnostic testing/measurement of clinical signs or measured using psychophysical tests. Biomarkers represent an emerging class of outcome measures for CRSwNP and are chosen to directly reflect the active pathophysiologic processes of CRSwNP in the peripheral blood, sinus/polyp tissues, and sinonasal mucus. Methods: Narrative review of the literature, identifying and describing outcome measures that may be used in the evaluation of CRSwNP and for assessment of treatment responses. Results: In this review, we identify many different outcome measures for CRSwNP that fall under the categories of PROM, objective test, psychophysical test or biomarker. We describe the history of each - including seminal studies - and demonstrate the formal validation, psychometric performance, and limitations of each. Conclusions: PROMs, objective tests, psychophysical tests and biomarkers represent different classes of outcome measures that are complementary means of assessing CRSwNP disease status and treatment efficacy. The choice or interpretation of a CRSwNP outcome measure should be undertaken with full knowledge of its formal validation, psychometric performance, and limitations.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 39042861 Revision surgery, biologics, or both? 385 385 EN W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 3197 10.4193/Rhin24.904

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38446154 The effect of smell training on COVID-19 induced smell loss 386 393 EN E.J.A. Schepens Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands C.J.M. de Haas Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands E.M. Postma Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Gelderse Vallei, Ede, the Netherlands B. van Dijk Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands S. Boesveldt Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands I. Stegeman Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands D.M.A. Kamalski Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands 3165 10.4193/Rhin23.191 OBJECTIVE: while smell training appears to be effective for post viral smell loss, its effectiveness in COVID-19 induced smell loss is currently not well known. Therefore, we aim to investigate the potential effect of smell training on patients with COVID-19 induced smell loss. METHODS: we conducted a case-control study with two comparable cohorts. One of which (n=111) was instructed to perform smell training twice daily for 12 weeks, therapeutical adherence was monitored on a daily schedule, while the other cohort (n=50) did not perform smell training. The Sniffin' Sticks Test (SST) was used to objectify participants' sense of smell at baseline and after 12 weeks, reported as a Threshold, Discrimination, and Identification (TDI) score. We also determined the association between therapeutical adherence and the TDI scores. RESULTS: we found a significant difference in psychophysical smell function between patients with COVID-19 induced smell disorders who performed 12 weeks of smell training and those who did not. Median TDI difference between groups was 2.00 However, there was no association between the therapeutical adherence and olfactory function. CONCLUSION: we discovered a significant moderate difference in psychophysical smell function between patients with COVID-19-induced smell disorders who performed smell training and those who did not, implying a possible advantage of training. However, no relationship was found between therapeutical adherence of smell training and olfactory function.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38507726 Objective nasal airflow measures in relation to subjective nasal obstruction, trigeminal function, and olfaction in patients with chronic rhinosinusitis 394 402 EN A.K. Hernandez Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Otorhinolaryngology â€" Head and Neck Surgery, Philippine General Hospital, University of the Philippines â€" Manila, Manila, Philippines; Department of Otorhinolaryngology â€" Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines C. Uhl Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany M. Cuevas Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 3169 10.4193/Rhin23.270 BACKGROUND: This study aimed to determine how nasal airflow measures and trigeminal function vary among patients with chronic rhinosinusitis (CRS) versus healthy controls and whether these measures are correlated with subjective nasal obstruction (SNO), olfactory function, and CRS control. METHODOLOGY: Participants included CRS patients and healthy controls. After a structured medical history, nasal airflow (peak nasal inspiratory flow [PNIF]; active anterior rhinomanometry [AAR]), trigeminal function (trigeminal lateralization test, CO2 sensitivity), and olfactory (“Sniffin’ Sticksâ€� odor identification test) tests were performed. SNO ratings were also obtained. RESULTS: Sixty-nine participants were included (37 men, 32 women, mean age 51 years). There was no significant difference for objective nasal airflow between patients and controls, but CRS patients had worse SNO, trigeminal function, and olfaction compared to controls. SNO, but not objective nasal airflow tests, was negatively correlated with CO2 sensitivity and odor identification. CONCLUSION: The perception of nasal obstruction does not only depend on nasal airflow, but may also be modulated by trigeminal function and other factors. Thus, the role of objective nasal airflow measures as a sole method of functional nasal obstruction assessment in CRS remains limited.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38775362 Steroid responsiveness predicts olfactory function recovery in dupilumab treated CRSwNP 403 409 EN J.J. Otten Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands R.J.L. van der Lans Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands L.B. Benoist Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands G.F.J.P.M. Adriaensen Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands R.D. Hoven Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands V. Verkest Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands W.J. Fokkens Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands S. Reitsma Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands 3178 10.4193/Rhin23.452 BACKGROUND: There is no known predictor for olfactory function recovery with dupilumab treatment in chronic rhinosinusitis with nasal polyps (CRSwNP). This study assessed whether patient-reported recovery of olfactory function on oral corticosteroids (OCS) is a prognostic factor. METHODS: Retrospective analysis of pre-biological OCS-responsiveness on olfactory functioning (OCS-responsive or OCS-unresponsive; OCS-r and OCR-u, respectively) as predictor for olfactory functioning after 6 months of dupilumab therapy for severe CRSwNP. RESULTS: 212 CRSwNP patients treated with dupilumab were divided between OCS-r (reported improvement of olfactory function with OCS before dupilumab treatment, n = 152), and OCS-u (OCS-unresponsive; no such improvement, n = 60). Olfactory function was tested with Sniffin’ Sticks Identification Test (12 pens; SSIT-12). At baseline, both groups had a median SSIT-12 score of 3 / 12 indicating anosmia. Hyposmia and normosmia rates were also comparable (5.9% and 3.3% in OCS-r, respectively; 5.0% and 1.7% in OCS-u, respectively). After 6 months of dupilumab treatment, OCS-r showed higher olfactory scores (median SSIT-12: 8/12; 52.6% hyposmia and 17.8% normosmia) than OCS-u (median SSIT-12: 5/12; 31.7% hyposmia and 3.3% normosmia). The positive predictive value of OCS-responsiveness on scoring ≥7 (normosmia/hyposmia) on the SSIT-12 after 6 months of dupilumab treatment was 70.4%. Conversely, the negative predictive value of OCS-unresponsiveness on scoring <7 (anosmia) on the SSIT-12 after 6 months of dupilumab treatment was 65.0%. CONCLUSION: Patients who report olfactory function improvement on OCS have a higher chance of recovery of olfactory function during the first six months of treatment with dupilumab than patients who do not.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38848046 Real-life effectiveness of dupilumab in chronic rhinosinusitis with nasal polyps. Results from eight Hungarian centres with 12-month follow-up 410 420 EN A. Kiricsi Albert Szent-Györgyi Health Center, University of Szeged, Department of Otorhinolaryngology, Head Z. Bella Albert Szent-Györgyi Health Center, University of Szeged, Department of Otorhinolaryngology, Head H. Kraxner Semmelweis University, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary T. Szaloki Semmelweis University, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary Z. Fent Semmelweis University, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary B. Liktor St. John’s Hospital, Department of Otorhinolaryngology and Maxillofacial Surgery, Budapest, Hungary J. Huszka Hospital Peterfy Sandor Str, Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary, Budapest Hungary P. Laszlo Hospital Peterfy Sandor Str, Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary, Budapest Hungary D. Gobol Hospital Peterfy Sandor Str, Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary, Budapest Hungary F. Helfferich Hospital of the Hungarian Army, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary Z. Vaska Hospital of the Hungarian Army, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary Z. Piski University of Pecs, Department of Otorhinolaryngology, Head and Neck Surgery, Pecs, Hungary L. Juhasz-Loisch University of Pecs, Department of Otorhinolaryngology, Head and Neck Surgery, Pecs, Hungary B. Horvath Bajcsy-Zsilinszky Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary G. Galantai Bajcsy-Zsilinszky Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary N. Krisztin Bajcsy-Zsilinszky Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Budapest, Hungary L. Toth University of Debrecen Clinical Center Department of Otorhinolaryngology and Head-Neck Surgery Debrecen, Hungary A. Bodi University of Debrecen Clinical Center Department of Otorhinolaryngology and Head-Neck Surgery Debrecen, Hungary M. Matuz Albert Szent-Györgyi Health Center, Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary L. Lujber University of Pecs, Department of Otorhinolaryngology, Head and Neck Surgery, Pecs, Hungary A. Hirschberg St. John’s Hospital, Department of Otorhinolaryngology and Maxillofacial Surgery, Budapest, Hungary 3179 10.4193/Rhin23.278 BACKGROUND: Research on the immune mechanism behind chronic rhinosinusitis (CRS) has revealed various new endotypes, leading to targeted therapies, especially for severe uncontrolled CRS. Biologics are novel therapeutic strategies providing targeted treatment for the difficult-to-treat recalcitrant CRSwNP patients. Dupilumab is a fully human-derived monoclonal antibody that binds to IL4Rα, inhibiting the signalling of both IL-4 and IL-13. In Hungary, it is approved for the treatment of uncontrolled CRSwNP according to criteria based on the EPOS2020 and the Hungarian guidelines. METHODOLOGY: This study aimed to collect and evaluate real-world therapeutic data of CRSwNP patients treated with dupilumab. One hundred thirty-five patients from eight different referral centres have been enrolled in this study, who received dupilumab since 2020. All subjects were adult patients (over 18 years) with uncontrolled CRSwNP. Baseline data collection included demographics, medical history, previous surgeries, related comorbidities, total endoscopic nasal polyp score (NPS), SNOT22, nasal congestion parameters measured with visual analogue scale (VAS) and nasal obstruction evaluation scale (NOSE), loss of smell score (LSS) and eosinophil count. 300 mg dupilumab was administered subcutaneously every second week. Follow up visits were performed after 6 and 12 months. RESULTS: After 6 and 12 months of treatment significant improvement was detected in all clinical parameters. Safety was proved, no severe side effects occurred, and no rescue treatment was necessary. CONCLUSIONS: Our real-life findings show that continuous dupilumab treatment is effective and safe in daily clinical practice in CRSwNP and other type 2 comorbidities such as bronchial asthma and NERD.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38830185 Prevalence of chronic rhinosinusitis without/with nasal polyps according to severity in Spain 421 431 EN J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona, FRCB-IDIBAPS, CIBERES, Barcelona, Catalonia, Spain J. Sastre Department of Allergology, Fundación Jiménez Díaz, CIBER de Enfermedades Respiratorias (CIBERES), Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Community of Madrid, Spain J. Domínguez-Ortega Department of Allergology, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Community of Madrid, Spain M. Blanco- Aparicio Asthma Unit, La Coruña University Hospital, La Coruña, Galicia, Spain J.A. Castillo Vizuete Department of Respiratory Medicine, Hospital Universitari Dexeus, Barcelona, Catalonia, Spain I. Alobid Rhinology and Skull Base Unit, ENT Department, Hospital Clinic, Universitat de Barcelona, FRCB-IDIBAPS, CIBERES, Barcelona, Catalonia, Spain M. García-Vitoria Sanofi, Barcelona, Catalonia, Spain P.I. Palomo-Jiménez Sanofi, Madrid, Community of Madrid, Spain 3182 10.4193/Rhin23.341 BACKGROUND: The worldwide prevalence range of chronic rhinosinusitis (CRS) is 5-12%; from this, 20 % have nasal polyps. Due to the little epidemiological data about CRS in the Spanish population, this study analyses the prevalence and severity of CRS with (CRSwNP) or without (CRSsNP) nasal polyps, and their connection with other coexisting type 2 inflammatory diseases in Spain. METHODOLOGY: This is a retrospective, large-scale, nationwide, epidemiological study based on the electronic medical records from the BIG-PAC® database. Patients diagnosed of CRSsNP and CRSwNP were identified using specific disease codes. The severe form of the disease was defined as patients who received at least a long course of antibiotics in CRSsNP or ≥2 short courses of systemic corticosteroids in CRSwNP in ≤12 months during the last 2 years, and/or had previous sinus surgery. Physician diagnosed prevalence, sociodemographic and clinical characteristics, and disease severity were assessed. RESULTS: Out of a cohort of 1,012,257 patients (≥18 years old), 42,863 and 7,550 patients with diagnosed CRSsNP and CRSwNP, respectively, were analysed. The overall prevalence of diagnosed CRS was 5.1%, being 4.3% and 0.8% for CRSsNP and CRSwNP, respectively. Patients with CRSwNP and severe forms of the disease were older and had higher levels of type 2 inflammatory biomarkers than CRSsNP patients and non-severe disease. CONCLUSIONS: Although CRSsNP was more prevalent than CRSwNP, the severe forms of CRS were more frequent in patients with CRSwNP. In addition, CRSwNP patients had a higher incidence of coexisting type 2 inflammatory diseases.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38416565 Elevated MIF identified by multiple cytokine analyses facilitates macrophage M2 polarization contributing to postoperative recurrence in chronic rhinosinusitis with nasal polyps 432 445 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 Z. Tong Department of Otolaryngology-Head and Neck Surgery, The First People's Hospital of Changde, Changde, People's Republic of China 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 C. Yang 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 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 3164 10.4193/Rhin23.412 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by tissue heterogeneity and high postoperative recurrence risk. This study aims to employ cytokine analyses to identify serum biomarkers associated with postoperative CRSwNP recurrence and elucidate underlying recurrent mechanisms. METHODS: A prospective cohort study was conducted on CRSwNP patients undergoing functional endoscopic sinus surgery. Serum and tissue samples were collected and analyzed for multiple cytokines. Participants were followed for 3 years and categorized into recurrent and non-recurrent groups. Cytokine profiles were compared, and potential markers for recurrence were further assessed. Macrophage migration inhibitory factor (MIF) expression in macrophages was modulated, and their polarization and cytokine secretion were assessed. RESULTS: In the discovery cohort (21 recurrent and 40 non-recurrent patients), circulating cytokine profiles differed significantly, with 8 cytokines showing differential expression between the two groups. Among them, serum eotaxin, MIF, RANTES, and TRAIL exhibited promise in predicting recurrence. In the validation cohort (24 recurrent and 44 non-recurrent patients), serum eotaxin, MIF, and TRAIL levels were higher in recurrent cases. Tissue MIF was elevated in recurrent cases and had a strong predictive value for recurrence. Moreover, tissue MIF was co-expressed with CD206 in recurrent cases. Mechanistically, MIF overexpression promoted macrophage M2 polarization and TGF-β1, CCL-24, and MIF secretion, and MIF recombinant protein facilitated M2 polarization, and TGF-β1 and CCL-24 production, contributing to CRSwNP recurrence. CONCLUSIONS: Serum-specific cytokine signatures were associated with postoperative recurrence risk in CRSwNP. Elevated MIF enhanced macrophage M2 polarization and cytokine secretion, contributing to the recurrent mechanisms of CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38497676 Validation and shortcomings of the most common mouse model of chronic rhinosinusitis with nasal polyps 446 456 EN A. Sánchez-Montalvo Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KULeuven, Leuven, Belgium M. Lecocq Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium E. Bouillet Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium B. Steelant Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KULeuven, Leuven, Belgium S. Gohy Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Pneumology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Cystic Fibrosis Reference Centre, Cliniques Universitaires Saint-Luc, Brussels, Belgium A. Froidure Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Pneumology, Cliniques Universitaires Saint-Luc, Brussels, Belgium D. Bullens Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KULeuven, Leuven, Belgium; Clinical Division of Paediatrics, UZ Leuven, Leuven, Belgium C. Pilette Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Pneumology, Cliniques Universitaires Saint-Luc, Brussels, Belgium V. Hox Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium 3167 10.4193/Rhin23.331 BACKGROUND: Chronic rhinosinusitis (CRS) is a highly prevalent airway disease worldwide. Whereas eosinophilic CRS with nasal polyps (eCRSwNP) represents its most severe phenotype, pathogenic mechanisms remain poorly understood despite a wide spectrum of in vitro and in vivo experimental models. A mouse model of experimental ovalbumin (OVA)-induced airway allergy with coadministration of Staphylococcus aureus enterotoxin B (SEB) has been widely used to study eosinophilic eCRSwNP. This study revisits the features of this model and its suitability for studying eCRS. METHODOLOGY: We implemented the most used eCRSwNP mouse model based on OVA+SEB intranasal challenges. Readouts including inflammatory features by (immuno)histology of the sinonasal epithelium (NP formation, eosinophils, epithelial and basement membrane thickness, fibrosis, goblet cells, Charcot-Leyden crystals (CLC)-like, tight junctions) and IgE production by enzyme-linked immunosorbent assay (ELISA), were compared to features of the corresponding human disease. RESULTS: The OVA+SEB model induced eosinophilic inflammation of upper and lower airways, with epithelial and basement membrane thickening, goblet cell hyperplasia and subepithelial fibrosis in the sinuses, along increased IgE production. Except local IgE in nasal lavage (NL), which was only increased in OVA+SEB group, all other features did not differ between OVA and OVA+SEB groups. Macro- or microscopic NP were not detected. CONCLUSIONS: With the notable exception of local IgE production, the addition of SEB did not induce additional inflammatory or structural change in the sinuses from mice exposed to and challenged with OVA. This model might represent a model for severe upper airway allergy rather than a specific model of human eCRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38530204 Dual and triple modulator therapy for chronic rhinosinusitis in cystic fibrosis patients 457 465 EN S. Uyttebroek UZ Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, Leuven, Belgium C. Claeyssens UZ Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, Leuven, Belgium M. Jorissen UZ Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, Leuven, Belgium L. Dupont UZ Leuven, Department of Pneumology, Leuven, Belgium; KU Leuven, Department of Chronic Diseases and Metabolism, Respiratory Diseases and Thoracic Surgery, Leuven, Belgium L. Van Gerven UZ Leuven, Department of Otorhinolaryngology, Head and Neck surgery, Leuven, Belgium; KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, Leuven, Belgium; KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium 3171 10.4193/Rhin23.487 BACKGROUND: The introduction of CFTR modulators has changed the landscape in the treatment of cystic fibrosis (CF) and early case series have shown improvements in sinonasal outcomes in this patient population. METHODOLOGY: A real-word data study was performed to evaluate the impact of dual therapy with tezacaftor/ivacaftor (TEZ/IVA) and triple therapy with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on CF-related chronic rhinosinusitis (CRS), by comparing subjective and objective outcome measures at baseline, 12 months after treatment with TEZ/IVA and six months after treatment with ELX/TEZ/IVA. RESULTS: In total, 43 CF patients, with a mean age of 32 years, were included. After triple therapy, significant improvements in overall visual analogue scale, SNOT-22, Lund Kennedy, nasal polyps, and Lund-Mackay scores were observed, whereas no beneficial effect could be seen in patients treated with dual therapy. Bacterial upper airway colonization did not differ pre- and postmodulator therapy in the present study. The number of responders to dual and triple therapy is 23.8% and 63.2% of the patients, respectively. CONCLUSIONS: Triple therapy with ELX/TEZ/IVA is superior to dual therapy with TEZ/IVA in the treatment of CF-CRS, as significantly reduced sinonasal complaints, nasal endoscopy and CT scores were observed after triple therapy, whereas this was not the case for dual therapy.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38557580 Small extracellular vesicles facilitate epithelial-mesenchymal transition in chronic rhinosinusitis with nasal polyps via the miR-375-3p/QKI axis 466 479 EN X. Wang 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 R. Zheng 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 W. Liang Department of Biotherapy Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China H. Qiu 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 T. Yuan 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 W. Wang 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 H. Deng 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 W. Kong 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 J. Chen 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. Bai 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. Li Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Chen 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 Q. Wu 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 S. Wu 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 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 Z. Shi 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 Q. Fu Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, 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 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 3172 10.4193/Rhin23.520 BACKGROUND: Epithelial-mesenchymal transition (EMT) plays a crucial role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, the involvement of small extracellular vesicles (sEVs) in EMT and their contributions to CRSwNP has not been extensively investigated. METHODS: SEVs were isolated from nasal mucosa through ultracentrifugation. MicroRNA sequencing and reverse-transcription quantitative polymerase chain reaction were employed to analyze the differential expression of microRNAs carried by sEVs. Human nasal epithelial cells (hNECs) were used to assess the EMT-inducing effect of sEVs/microRNAs. EMT-associated markers were detected by western blotting and immunofluorescence. Dual-luciferase reporter assay was performed to determine the target gene of miR-375-3p. MicroRNA mimic, lentiviral, and plasmid transduction were used for functional experiments. RESULTS: In line with the greater EMT status in eosinophilic CRSwNP (ENP), sEVs derived from ENP (ENP-sEVs) could induce EMT in hNECs. MiR-375-3p was elevated in ENP-sEVs compared to that in control and nonENP. MiR-375-3p carried by ENP-sEVs facilitated EMT by directly targeting KH domain containing RNA binding (QKI) at seed sequences of 913-919, 1025-1033, and 2438-2444 in 3’-untranslated region. Inhibition of QKI by miR-375-3p overexpression promoted EMT, which could be reversed by restoration of QKI. Furthermore, the abundance of miR-375-3p in sEVs was closely correlated with the clinical symptom score and disease severity. CONCLUSIONS:MiR-375-3p-enriched sEVs facilitated EMT by suppressing QKI in hNECs. The association of miR-375-3p with disease severity underscores its potential as both a diagnostic marker and a therapeutic target for the innovative management of CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38598348 Development and validation of the Sinonasal Endoscopic Score (SiNES) for chronic rhinosinusitis 480 487 EN J.C. Hernaiz-Leonardo Division of Otolaryngology â€" Head and Neck Surgery, University of British Columbia, Canada B.M. Alim Division of Otolaryngology â€" Head and Neck Surgery, University of British Columbia, Canada; Prince Mohammed Bin Abdul Aziz Hospital, National Guard Health Affairs, Madina, Saudi Arabia A. Pascual Division of Otolaryngology â€" Head and Neck Surgery, University of British Columbia, Canada K. Aldossari College of Medicine, King Saud University, Riyadh, Saudi Arabia J. Fan Division of Otolaryngology â€" Head and Neck Surgery, University of British Columbia, Canada S. Alsaleh Otolaryngology â€" Head and Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia A.R. Javer Division of Otolaryngology â€" Head and Neck Surgery, University of British Columbia, Canada 3173 10.4193/Rhin23.434 BACKGROUND: Although there are several endoscopic grading systems for chronic rhinosinusitis (CRS), they are limited in their range and applicability. We developed a SiNonasal Endoscopic Score (SiNES) that builds upon the strengths of previous systems while addressing their limitations. METHODS: The SiNES system was developed by consensus after multiple rounds of guided discussions. Face, content, and convergent validity were investigated. It was validated using an independent sample of 79 CRS individuals from two referral centres from September 2021 to February 2022. Each patient underwent a sinonasal endoscopy and filled PROM questionnaires. Three independent rhinologists graded endoscopic videos using the SiNES and modified Lund-Kennedy (MLK) scores. Inter-rater and test-retest reliability were assessed via the intraclass correlation coefficient (ICC). SiNES and MLK scores were correlated with PROMs using a Spearman correlation and canonical correlation analysis (CCA). RESULTS: The SiNES system evaluates five anatomical spaces regarding edema, discharge, and scarring. Face, content, and convergent validity were deemed satisfactory by the study authors and an independent panel of Otolaryngologists. Inter-rater reliability was excellent for the SiNES and good for the MLK score. Test-retest reliability was excellent for both systems. Total SiNES was correlated with self-reported smell loss. CONCLUSIONS: The SiNES system is an accurate and reliable grading framework applicable to all CRS subtypes. It can be utilized in clinical and research settings and improves upon previously published systems.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38762784 The differences between sinonasal respiratory epithelial adenomatoid hamartoma and nasal polyps: insights into immunopathology 488 495 EN X. Du Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China M. Zhang Department of Otorhinolaryngology and Clinical Allergy Center, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China S. Zhang Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China X. Yan Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China L. Wang Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China Z. Zhang Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China N. Li Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China L. Yu Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China Y. Jiang Department of Otolaryngology, Head and Neck Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China 3175 10.4193/Rhin23.405 BACKGROUND: Respiratory epithelial adenomatoid hamartoma (REAH) is a benign lesion commonly occurring in the nasal cavity and sinuses. It is often accompanied by nasal polyps (NP). While the histological features of these two conditions have been studied, there is limited knowledge about their differences in the underlying immunopathology. METHODS: Nasal tissue specimens were collected from 8 patients with concurrent REAH and NP and 10 controls. The expression levels of inflammatory cytokines, tight junctions (TJ), and epithelial-mesenchymal transition (EMT)-related factors in the tissues were analyzed. The mRNA expression of the aforementioned factors was measured using qRT-PCR, while the expression of TJ and EMT-related proteins was analyzed through Western blotting and immunohistochemistry. RESULTS: Compared to the control group, levels of inflammatory cytokines (IFN-γ, IL-5, IL-17A, IL-31, IL-33, and TNF-α) and EMT-related factors (α-SMA, COL1A1, MMP9, TGF-β1, and Vimentin) were significantly increased in both REAH and NP tissues. Conversely, E-Cadherin and TJ-related factors (Claudin-4 and Occludin) significantly decreased. When comparing REAH with NP, it was observed that the expression of IL-4, IL-5, and IL-33 was lower in REAH, while TNF-α was higher. Regarding TJ-related factors, the expression of Occludin was lower in REAH. Furthermore, in terms of EMT-related factors, except for E-Cadherin, the expressions of α-SMA, COL1A1, CTGF, MMP9, TGF-β1, and Vimentin were higher in REAH. CONCLUSION: REAH and NP exhibit different immunopathological mechanisms. NP demonstrates a more severe inflammatory response, whereas REAH is characterized by a more pronounced TJ and EMT breakdown than NP.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38949841 Screening olfaction under dupilumab in chronic rhinosinusitis with nasal polyps 496 505 EN T. Mauthe Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 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; Faculty of Medicine, University of Zurich, Zurich, Switzerland F.S. Ryser Department of Rheumatology and Immunology, University Hospital Bern, University of Bern, Bern, Switzerland;Graduate School for Health Sciences, University of Bern, Switzerland C. Brühlmann Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland A. Yalamanoglu Department of Immunology, University Hospital Zurich, University of Zurich, Zurich, Switzerland U.C. Steiner Department of Rheumatology and Immunology, University Hospital Bern, University of Bern, Bern, Switzerland; Institute of Clinical Chemistry, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland M.B. Soyka Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland 3186 10.4193/Rhin23.476 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently leads to olfactory dysfunction. This study aimed to assess the impact of dupilumab on CRSwNP patients, focusing on olfactory outcomes and potential correlations with other clinical factors. METHODS: CRSwNP patients eligible for dupilumab therapy received subcutaneous Dupixent® injections every two weeks (300mg/2ml dupilumab). The 12-item Sniffin' Sticks Test (SST-12), fractional exhaled nitric oxide (FeNO) and Nasal Polyp Score (NPS) were assessed at baseline and after one, three, and six months. Patients also completed the Sino-Nasal Outcome Test (SNOT-22) weekly. RESULTS: 26 CRSwNP patients were included. After one month, dupilumab led to substantial reductions in FeNO, SNOT scores, andNPS, whereas SST-12 scores improved significantly only after three months. A shift toward normosmia occurred, with 81% achieving normosmia after six months, and a drop in anosmia prevalence to 9.5%. Significant negative correlations between olfaction (SST-12) and polyp severity (NPS) at baseline and after six months were found, while no significant correlations were observed between SST-12 and FeNO or SNOT scores. Age did not correlate with olfaction. CONCLUSIONS: Dupilumab demonstrated efficacy in restoring olfaction in CRSwNP patients. Reaching normosmia in over 80% ofpatients after six months of treatment underscores the drug's effectiveness in managing this challenging symptom.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38299637 Low levels of miR-143-3p are associated with severe chronic rhinosinusitis with nasal polyps 506 508 EN V. Tubita INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Universitat de Barcelona. Barcelona, Catalonia, Spain M. Fuentes INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain;Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Catalonia, Spain B. Callejas INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain;CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain M. Bantulà INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain C. Marin INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain I. Alobid INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain; Universitat de Barcelona. Barcelona, Catalonia, Spain;CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain;Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelo J. Bartra INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain;Universitat de Barcelona. Barcelona, Catalonia, Spain;Allergy Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain A. Valero INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain;Allergy Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain J. Roca-Ferrer INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain J. Mullol INGENIO, Clinical and Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain; Universitat de Barcelona. Barcelona, Catalonia, Spain;CIBER of Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain;Rhinology Unit and Smell Clinic, ENT Department, Hospital Cli­nic Barcelona, Universitat de Barcelona, Barcel 3157 10.4193/Rhin23.332 microRNAs (miRNAs) are small, single-stranded, non-coding RNA molecules that regulate post-transcriptional gene expression. Accumulating evidence suggests their involvement in regulating various biological and pathological processes, including inflammation. Studies have revealed distinct expression patterns of miRNAs in Chronic Rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps (1). Specifically, miR-155 and miR-21 have been observed to be upregulated in CRSwNP, increasing and attenuating the expression of pro-inflammatory cytokines, respectively (2,3). Conversely, the downregulation of miR-34, miR-449, and members of the miR-200 family has been associated with impaired ciliogenesis and the regulation of epithelial-mesenchymal transition, respectively (4,5). Nonetheless, the direct role of miRNAs in CRSwNP is still being investigated.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38416120 On the outcome of septoplasty 509 510 EN O. Sunnergren Department of Otorhinolaryngology, Region Jönköping County, Jönköping, Sweden; Centre for Oral Health, Department of Odontology and Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden C. Alexandersson Department of Otorhinolaryngology, Hallands Hospital, Kungsbacka, Sweden F. Eliasson Department of Otorhinolaryngology, Region Norbotten, Sunderbyn, Sweden M. Jangard Department of Otorhinolaryngology, Sophiahemmet Hospital, Stockholm, Sweden Y. Lilja Department of Otorhinolaryngology, Capio Lundby Hospital, Gothenburg, Sweden K. Sandelin Department of Otorhinolaryngology, Kalmar County Hospital, Kalmar, Sweden C. Ahlström Emanuelsson Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden 3162 10.4193/Rhin23.472 In 2019 and 2023, two randomised controlled trials (RCTs) on the effectiveness of septoplasty were published (1,2). Part of the rationale for both studies was that the value of septoplasty had been questioned by policymakers, health insurance carriers and health care providers. The results of both studies showed that patients undergoing septoplasty had a better outcome than patients in the control group. Without questioning these results or the general perception in the rhinology community that septoplasty is of great value to the right patient, we still see the need for caution when interpreting the outcome of the RCTs and when rhinologists try to transfer the results to routine clinical practice. Van Egmond et al. draw the conclusion that the results from their RCT should be applicable to all patients with nasal obstruction due to a deviated septum.

International Rhinologic Society Rhinology 0300-0729 62 4 2024 8 1 38530198 Taste loss in COVID-19 â€" psychophysical evidence supporting a low prevalence 511 512 EN C.A. Hintschich Department of Otorhinolaryngology, Regensburg University Hospital, Regensburg, Germany S. Le Bon Rhinology-Olfactory Unit, Department of Otorhinolaryngology, University Hospital of Geneva, Geneva, Switzerland; Department of Otorhinolaryngology, CHU Saint-Pierre, Brussels, Belgium E. Trecca Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy; Department of Otorhinolaryngology and Maxillofacial surgery, IRCCS Research Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy S. Saussez Department of Otorhinolaryngology, epiCURA, Mons, Belgium T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany 3170 10.4193/Rhin24.040 Much â€" possibly even too much â€" has been published about chemosensory dysfunction as a consequence of COVID-19. Studies have reported prevalence of taste loss in up to 89.9%, which is in a similar range as COVID-19 related smell loss. However, most of these publications rely solely on patients’ self-reports. Only few studies used validated psychophysical tests to specifically address olfaction and gustation. Especially for gustation, it is evident that subjective reporting does not correlate well with more objective psychophysical findings, often leading to an overestimation of subjectively impaired taste.