International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 39340767 Clinical research and observations - they do matter 513 513 EN B.N. Landis Geneva, Switzerland 3221 10.4193/Rhin24.905 The new issue of Rhinology is full of articles focusing on clinical aspects and analysis of surgical and medical treatments we provide to our patients.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38913328 Gender differences in outcomes following endoscopic sinus surgery: a systematic review and meta-analysis 514 525 EN M.T. Ryan Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, ML, USA K. Patel School of Medicine, University of South Florida, Tampa, FL, USA J.L. Fischer Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, ML, USA A.M. Tolisano Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, ML, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, ML, USA E.D. McCoul Department of Otorhinolaryngology - Head and Neck Surgery, Ochsner Clinic, New Orleans, LO, USA; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LO, USA C. Lawlor Department of Otolaryngology, Children’s National Medical Center, Washington DC, USA S.M. Parsel Department of Surgery, University of South Florida, Tampa, FL, USA; Division of Otolaryngology - Head and Neck Surgery, Lehigh Valley Health Network, Allentown, PA, USA C.A. Riley Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, ML, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, ML, USA 3185 10.4193/Rhin24.009 BACKGROUND: The extent to which gender affects outcomes in chronic rhinosinusitis (CRS) is unclear. The objective of this study was to examine differential outcomes between genders following endoscopic sinus surgery (ESS) among CRS patients. METHODS: PubMed/Ovid, Embase and Cochrane databases were queried. Outcomes included disease burden on imaging and endoscopy, patient-reported outcome measures (PROMs) including the Sinonasal Outcome Test (SNOT-22), revision rates, and olfactory outcomes. Meta-analysis was performed using the Mantel-Haenszel method with random effects model. RESULTS: Of 4,656 articles screened, 32 (n=103,499) were included for qualitative analysis and four (n=2,602) for meta-analysis. On qualitative analysis, 19 of the 32 studies noted a significant gender difference in post-operative outcomes, with five studies favoring women and 14 favoring men. Nine of 18 studies with PROMs noted a difference between genders, all favoring men. Olfactory outcomes were mixed with studies divided on favoring men vs women. No studies noted significant gender differences of disease burden on imaging or endoscopy. Across four studies included in the meta-analysis, women had higher preoperative and post-operative SNOT-22 scores. CONCLUSION: Meta-analysis shows that women patients have worse pre and postoperative SNOT-22 scores. Postoperative gender differences are most apparent in studies that examined PROMs. Further research is needed to investigate the underlying causes and to mitigate disparities between genders.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38950382 COVID-19 olfactory dysfunction: associations between coping, quality of life, and mental health 526 536 EN P.T. Jacobson Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA B.J. Vilarello Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA C. Snyder Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA T-H. Choo Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA F.F. Caruana Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA L.W. Gallagher Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA J.P. Tervo Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA J.B. Gary Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA T.M. Saak Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA D.A. Gudis Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA P.V. Joseph National Institute of Alcohol Abuse and Alcoholism, Section of Sensory Science and Metabolism and National Institute of Nursing Research, Bethesda, MD, USA T.E. Goldberg Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA D.P. Devanand Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Psychiatry, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA J.B. Overdevest Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA 3189 10.4193/Rhin23.356 BACKGROUND: Persistent olfactory dysfunction (OD) is a common symptom following SARS-CoV-2 infection that can greatly impact quality of life (QoL). Because coping strategies have been shown to moderate the effect of disease symptoms on functional and affective outcomes, this study aims to determine whether specific coping strategies are associated with and moderate QoL outcomes. METHODOLOGY: Participants with prior SARS-CoV-2 infection underwent psychophysical olfactory testing with Sniffin’ Sticks and completed questionnaires to elicit subjective olfactory function, coping strategies, olfactory-specific QoL, general QoL, and mental health. RESULTS: There were 93 participants included in the study. Olfactory specific QoL scores were significantly worse among individuals with subjective and psychophysically measured OD compared to those with subjective and psychophysically confirmed normosmia. Olfactory-specific QoL, general QoL, and anxiety symptom scores were positively correlated with avoidant and disengagement coping among individuals with subjective and psychophysically measured OD. Depression symptom scores were positively correlated with avoidant and disengagement coping and negatively correlated with approach and engagement coping. There were no significant moderating effects on the association between olfactory performance and QoL or mental health screening assessment. CONCLUSIONS: Approach and engagement coping mechanisms are associated with improved depression, whereas avoidant and disengagement coping tracks with worse QoL and mental health screening assessment, offering an opportunity to counsel patients accordingly.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38950422 Olfactory dysfunction in patients with type 2 diabetes mellitus 537 547 EN A. Cardella Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy A. Ferrulli Department of Biomedical Sciences for Health, University of Milan, Milan, Italy;Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multimedica, Milan, Italy S. Vujosevic Eye Clinic, IRCCS Multimedica, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy A. Preti Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy F. Ambrogi Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy I. Terruzzi Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multimedica, Milan, Italy A. Cecamore Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy;Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy A. Yakirevitch Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel;Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel A. Schindler Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy L. Luzi Department of Biomedical Sciences for Health, University of Milan, Milan, Italy;Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS Multimedica, Milan, Italy F. Mozzanica Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy;Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 3190 10.4193/Rhin23.451 BACKGROUND: diabetic complications and olfactory dysfunction (OD) in patients with type 2 diabetes mellitus (T2DM) seem related. This study aims to evaluate the prevalence of OD in T2DM patients and to analyze its relationship with diabetic complications. METHODS: 130 T2DM patients and 100 comparable controls were enrolled. Olfaction was evaluated using the Extended Smell Test (TDI) and the Italian brief Questionnaire of Olfactory Disorders â€" Brief-IT-QOD. T2DM patients were divided into: “Group 1”, patients with no complications, and “Group 2”, patients with at least one diabetic complication. Non-parametric tests were used. Machine learning algorithms were applied to explore which variables were most important in predicting the presence of OD in T2DM. RESULTS: The prevalence of OD was significantly higher in Group 2 than in controls (71.4% vs 30%) and in Group 1 (71.4% vs 43.3%). However, when comparing the TDI scores between Group 1 and 2 the only significant difference was found for the discrimination scale and not for the identification and threshold scales. Brief-IT-QOD scores were significantly higher in Group 2 than in controls. The Random Forest and variable importance algorithms highlighted the relevance of LDL, glycated hemoglobin, type of complication (macrovascular) and age in determining OD in T2DM. The last three variables were included in a nomogram for the prediction of OD risk in T2DM. CONCLUSIONS: T2DM patients with diabetic complications are more frequently affected by OD. Poor glycemic control, LDL values, age and presence of macrovascular complications are the more important factors in determining OD in T2DM patients.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 39075783 Neurofilament light chain is associated with olfactory dysfunction in US adults: findings from National Health and Nutrition Examination Survey 548 556 EN J. Zhen Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR J. Huang Department of Otorhinolaryngology Head and Neck Surgery, Huizhou Central People's Hospital, Huizhou, China Q. Cao Allergy Center, Department of Otolaryngology, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China B.M.Y. Cheung Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR;Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Hong Kong SAR C. Li Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR;State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR 3191 10.4193/Rhin24.001 BACKGROUND: Many individuals who have olfactory dysfunction are not aware of their impairment, which results in delayed detection of potentially hazardous situations. Simple and accurate methods for objectively assessing olfactory function are needed. In this study, we aim to investigate the utility of serum neurofilament light chain (NfL) levels as an indicator of olfactory dysfunction. METHODOLOGY: We analysed data on 1290 participants aged 40 years and older, who had valid data on olfaction and NfL level from the National Health and Nutrition Examination Survey 2013â€"2014. Multivariable modeling was used to investigate the relationship between olfactory dysfunction and NfL. RESULTS: Among 1290 participants, 174 participants had olfactory dysfunction based on the results of the NHANES Pocket Smell Test. In ordinal regression models, objective olfactory dysfunction was associated with NfL. After adjusting for age, sex, race/ethnicity, diabetes, smoking, olfaction-related medical history, Parkinson's disease and Alzheimer’s disease, the association remained significant. In logistic regression models, compared to participants with lower levels of NfL in the first tertile, those in the second and third tertiles had higher odds of objective olfactory dysfunction. There was no association between self-reported olfactory dysfunction and NfL tertiles. CONCLUSIONS: A strong association between objective olfactory dysfunction and serum NfL level was observed. NfL, independent of age, is a reliable marker indicating the development of olfactory dysfunction. The measurement of serum NfL level provides valuable support for assessment of olfactory dysfunction in clinical practice.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 39026455 Olfactory dysfunction management following unilateral cranial resection for olfactory neuroblastoma 557 565 EN T. Takeda Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA K. Omura Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan S. Aoki Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan R. Mori Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan Y. Ishii Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan E. Mori Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan H. Nishijima Department of Otolaryngology-Head and Neck Surgery, The University of Tokyo, Tokyo, Japan T. Ebihara Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan K. Tochigi Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan A.J. Kimple Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA B.D. Thorp Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA B.A. Senior Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA N. Otori Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan 3196 10.4193/Rhin24-186 BACKGROUND: Despite advances in techniques for olfactory neuroblastoma (ONB), such as unilateral cranial resection, preserving the patient’s sense of smell remains a challenge. This study aimed to examine the effectiveness of post-operative olfactory training in patients who underwent unilateral resection of ONB. METHODS: This retrospective cohort study assessed the effect of post-operative olfactory training on olfactory preservation in patients with ONB undergoing unilateral cranial resection. Patients were divided into training intervention (n = 5) and non-intervention (n = 6) groups. Olfactory tests were conducted pre-operatively and at multiple post-operative intervals. RESULTS: Partial olfactory function was preserved in all cases in the training intervention group, whereas only 17% of cases in the non-intervention group maintained partial olfactory function. Significant improvements in olfactory test scores were observed in the training intervention group compared with the non-intervention group. CONCLUSIONS: Our findings suggest that post-operative olfactory training could aid in olfactory preservation for patients with ONB after unilateral cranial resection. However, these results should be interpreted with caution, and further research with larger cohorts and extended follow-up periods is needed to confirm these observations.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 39066645 Assessing parosmia patients: a study on the evaluation method using a self-administered odor questionnaire for parosmia 566 575 EN M. Tei Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan E. Mori Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan N. Yonezawa Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan Y. Kishimoto Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan H. Tanaka Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan N. Yanagi Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan Y. Tsurumoto Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan M. Nagai Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan R. Sekine Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan N. Otori Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan K. Tsuzuki Department of Otolaryngology-Head and Neck Surgery, Hyogo Medical University, Hyogo, Japan 3199 10.4193/Rhin24.080 Background: Parosmia symptoms are difficult to quantify due to their heterogeneity among patients, and thus a clinical challenge. This study aimed to assess parosmia with Self-Administered Odor Questionnaire for Parosmia (SAOQ-P), a modification of the widely used SAOQ in Japan. The primary objective was to assess the effectiveness of SAOQ-P in identifying parosmia symptoms and its potential integration into the clinical assessment process. The study also explored traditional olfactory test differences between patients with and without parosmia. Methods: Patients at Jikei Smell Clinic that presented between May 2022 and November 2022 were recruited and administered the SAOQ-P, which had an added question about changes in the perception of 20 daily odors compared to the original SAOQ. Traditional olfactory tests utilized T&T olfactometry and Open Essence. Results: Of 279 patients, 81 had parosmia, while 198 did not exhibit parosmic symptoms. Parosmia prevalence was influenced by the cause of olfactory dysfunction, with post-infectious and post-COVID-19 patients showing higher parosmia rates. Among parosmia patients, 87% reported changes in their perception of at least one odor assessed by SAOQ-P, with coffee, stool, and perfume most commonly affected. Traditional olfactory tests showed no significant differences between parosmia and non-parosmia groups. The number of odors causing parosmia was negatively correlated with age. Conclusion: SAOQ-P offers a promising approach to assess and quantify parosmia symptoms, seamlessly integrating into clinical assessments. SAOQ-P identified parosmia in 87% of patients and revealed insights into triggering factors. Traditional olfactory tests' limitations underscore the need for more accurate, patient-centric diagnostic approaches for parosmia.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 39058315 Mepolizumab in CRSwNP/ECRS and NP: the phase III randomised MERIT trial in Japan, China, and Russia 576 589 EN S. Fujieda Department of Otorhinolaryngology, Head and Neck Surgery, University of Fukui, Japan C. Wang Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, China M. Yoshikawa Department of Otorhinolaryngology, Toho University Ohashi Medical Centre, Japan M. Asako Department of Otolaryngology, Kansai Medical University, Japan I. Suzaki Department of Otorhinolaryngology, Head and Neck Surgery, Showa University, Japan C. Bachert ENT Department, University of Münster, Germany J.K. Han Department of Otolaryngology, Head and Neck Surgery, Eastern Virginia Medical School, USA A. Fuller Clinical Statistics, GSK, GSK House, Brentford, UK; Veramed Ltd, Twickenham, UK L. Baylis Global Medical Affairs, Specialty Care, GSK, Durham, NC, USA L. Su Clinical Development, Respiratory, GSK, Shanghai, China E. Sasaki Clinical Development (Respiratory), Respiratory Medical Affairs and Development, GSK Japan, Tokyo, Japan A.R. Sousa Clinical Sciences, Respiratory, GSK, Brentford, Middlesex, UK R. Chan Clinical Sciences, Respiratory, GSK, Brentford, Middlesex, UK L. Zhang Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, China 3198 10.4193/Rhin24.156 Background: This randomised, double-blind, placebo-controlled, parallel-group, 52-week Phase III study (MERIT; NCT04607005) assessed mepolizumab efficacy and safety in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)/eosinophilic CRS (ECRS) in Japan, Russia, and China, for which data are limited. Methodology: Eligible patients (enrolled at 60 centres) had blood eosinophil count >2%, endoscopic bilateral NP score ≥5, nasal obstruction visual analogue scale (VAS) score >5, ≥2 sinonasal symptoms, and either previous sinus surgery or systemic corticosteroid use/intolerance. Patients were randomised (1:1) to receive mepolizumab 100 mg subcutaneously or placebo every 4 weeks, plus standard of care. Co-primary endpoints: change from baseline in total endoscopic NP score (ENPS) (Week 52) and nasal obstruction VAS score (Weeks 49â€"52). Post hoc analyses conducted in a modified intent-to-treat (mITT) population excluded patients from two study sites, related to Good Clinical Practice violations by the Site Management Organisation overseeing these sites. These were considered the primary efficacy analyses. Results: In the mITT population, mepolizumab (n=80) versus placebo (n=83) significantly improved nasal obstruction VAS score from baseline to Week 49â€"52 and was associated with a trend of total ENPS improvements at Week 52. Mepolizumab/placebo on-treatment adverse events (AEs) occurred in 68/84 and 65/85 patients in the safety population (treatment-related AEs: 2/84 and 5/85, respectively), and on-treatment serious AEs in 0/84 and 4/85 patients, respectively (no fatalities reported). Conclusions: Mepolizumab was effective and well-tolerated in patients with CRSwNP/ECRS from Japan, Russia, and China.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38984431 Differential healthcare direct costs of asthma and chronic rhinosinusitis with nasal polyps in Catalonia (Spain) 590 596 EN T. Mora Research Institute for Evaluation and Public Policies, Universitat Internacional de Catalunya (UIC), Barcelona, Catalonia, Spain R. Muñoz-Cano Allergy Department, Hospital Clinic Barcelona, Catalonia, Spain; Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; REI-RICORS - Instituto de Salud Carlos III, Madrid, Spain;Universitat de Barcelona, Catalonia, Spain P. RibÃł Allergy Department, Hospital Clinic Barcelona, Catalonia, Spain; Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Spain; Universitat de Barcelona, Catalonia, Spain J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain; Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Spain;Universitat de Barcelona, Catalonia, Spain A. Valero Allergy Department, Hospital Clinic Barcelona, Catalonia, Spain; Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Spain; Universitat de Barcelona, Catalonia, Spain 3193 10.4193/Rhin24.147 INTRODUCTION: This study compares the direct healthcare costs associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from 2013 to 2017 in Catalonia (Spain) with a population control group without these conditions.METHODS: A population administrative database containing healthcare information was used. The database contained information on primary care, hospitalisations, and emergency care from 2013 to 2017 in Catalonia. The unit cost of each healthcare procedure was imputed using a complete list of public prices for primary care services, hospital, and speciality services. Differential costs were estimated using a finite mixture model.RESULTS: Individuals diagnosed with asthma or CRSwNP showed a higher incidence of comorbidities than the control group. Mean annual direct costs per patient were €1,102 for asthma, €1,612 for CRSwNP and €2,197 for those with both conditions. According to our estimations, differential costs were €162 - €274 for patients with asthma and €481 - €1,257 for patients with CRSwNP compared to the reference population. These costs were significantly higher when asthma and CRSwNP coexist and especially in their severe condition. CONCLUSION: This population-based study revealed that asthma and CRSwN are associated with great economic burdens for healthcare systems. These costs were significantly higher when comorbidity was present (asthma and CRSwNP) and especially in their severe condition (€4,441).

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38497762 Clinical outcomes of functional endoscopic sinus surgery in cystic fibrosis patients - a single centre experience 597 602 EN Y. Devabalan Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK R. Towning Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK J. Magill Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; The Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK H. Saleh Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; The Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK C. Rennie Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; The Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK 3168 10.4193/Rhin23.057 BACKGROUND: Endoscopic sinus surgery (ESS) is an established surgical option for cystic fibrosis (CF) patients with chronic rhinosinusitis that is refractory to conventional medical management. Objective and subjective evidence of benefit of ESS in this cohort of patients is currently conflicting in the literature. METHODOLOGY: A single center retrospective study was undertaken of all CF patients (transplanted and non-transplanted) over the age of 16 who underwent an ESS over a six-year period from 2015 to 2021. Patients on triple-therapy CFTR modulators were excluded. Data was collected on demographics, clinical management, and outcome measures. The objective outcome measures were lung function (%predicted FEV1), pulmonary exacerbations (total number of days of IV antibiotics- both ambulatory and in hospital). The subjective outcome measure was SNOT-22 scores pre and 6 months post-operatively. A minimally clinical important difference (MCID) in SNOT-22 scores of 9 points was used. RESULTS: 55 patients were included in our study, with a median age of 31 and 53% females. Median Lund-Mackay scores for the cohort was 13 (3-24). There was a significant improvement in lung function at 1-year post-surgery, and a significant MCID reduction in SNOT-22 scores at 6 months post-surgery across the cohort. Sub-group analysis revealed a sustained MCID reduction in SNOT-22 scores in both lung-transplanted and native lung groups, and in patients with primary ESS or previous ESS. However, there was no post-operative pulmonary function improvement in lung transplanted patients and patients with previous ESS. There was no impact on the rate of pulmonary exacerbations across the cohort. 2 patients in the cohort died secondary to pulmonary disease. CONCLUSIONS: There was a demonstrated clinical and symptomatic benefit of ESS in CF patients in this study. Stricter guidelines for indications for ESS need to be established with regards to CF patients who will undergo ESS in the future.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38950374 Overall symptom severity as a patient-reported outcome measure for chronic rhinosinusitis: what it reflects and how to measure it 603 611 EN J.T. Garcia Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA R.A. Cotter Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA R.S. Boparai University of Nevada, Reno School of Medicine, Reno, NV, USA A. Alsayed Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia S. Schneider Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria D.T. Liu Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria J. Eckl-Dorna Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria N.A. Parail Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA F.A. Houssein Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA M.M. Chu Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA J.C. Meier University of Nevada, Reno School of Medicine, Reno, NV, USA; Nevada ENT and Hearing Associates, Reno, NV, USA S. Alsaleh Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia 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 3188 10.4193/Rhin24.145 BACKGROUND: The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and whether it can be measured using alternatives to the standard visual analog scale (VAS). METHODS: CRS patients from four sites across three continents rated their OSS scores, severities of nasal obstruction, nasal drainage, decreased sense of smell, facial pain/pressure and sleep disturbance using a standard VAS, VAS with labeled tick marks at every 1 centimeter, and by writing down their OSS on a scale of 0 - 100 (which was divided by 10), all of which lead to severity scores ranging from 0 - 10 in 0.1 intervals. Quality of life was measured using the SNOT-22 and EQ-5D VAS. RESULTS: In 311 CRS patients, OSS score was significantly correlated with SNOT-22 and EQ-5D VAS. OSS score was most greatly associated with the mean of all individual symptom severity scores. From individual CRS symptoms, OSS was most greatly associated with nasal obstruction followed by nasal drainage and facial pain/pressure severities. These results held true for participants with and without nasal polyps. Measurement of OSS and individual symptom severity scores using a standard VAS, tick-marked VAS, and write-in option had near-perfect consistency. CONCLUSIONS: We demonstrate for the first time that OSS largely reflects the mean of individual CRS symptom severities, although OSS is=== most weighted by nasal obstruction severity. OSS and individual symptom severity scores can be measured using a standard VAS, tick-marked VAS or write-in prompt with near-perfect consistency.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38752541 Clinical characteristics and management of orbital apex syndrome: a 10-year multicentre experience 612 622 EN Y.H. Im Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital,College of Medicine, The Catholic University of Korea, Incheon, Korea Y.J. Kang Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea C-S. Park Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea D.M. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Y.C. Kim Department of Ophthalmology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea J-S. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea H. Ra Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea S.H. Park Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea D-W. Bae Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea H.R. Yum Department of Ophthalmology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Y.W. Chung Department of Ophthalmology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea S.H. Hwang Department of Ophthalmology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea 3174 10.4193/Rhin23.454 BACKGROUND: Orbital apex syndrome (OAS) is a condition characterised by lesions within the orbital apex, leading to various ophthalmologic symptoms. This study aimed to analyse the clinical characteristics and treatment strategies of OAS with respect to aetiology. METHODS: This retrospective analysis utilised data from 5 medical institutions between 2013 and 2022. Patients who were diagnosed with OAS were initially enrolled, but patients who failed to follow up at least 1 month were excluded. The prevalence of initial ophthalmologic symptoms and visual improvement after treatment was compared according to aetiology. Factors related to visual improvement were analysed. RESULTS: Among 73 enrolled patients, the leading aetiology was tumours, followed by fungal infections and inflammation. Visual impairment and proptosis were prevalent in tumour-related OAS cases. Inflammation-related OAS exhibited a higher likelihood of painful eye movements and ophthalmoplegia. Ptosis was most frequently observed in fungal infection-related OAS. Notably, fungal infections emerged as the sole significant factor negatively impacting vision progression. In inflammation-related OAS, the time interval between symptom onset and the administration of steroids was longer in patients without visual improvement, even though there was no statistically significant difference. CONCLUSIONS: Tumours were the predominant cause of OAS. Visual impairment was a common manifestation in tumour-related OAS, while fungal infections were strongly associated with a poor visual prognosis. The timely administration of steroids might be helpful for improving vision in patients with inflammation-related OAS. However, further studies are needed to enhance understanding and management of OAS.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 38958021 Endoscopic dacryocystorhinostomy with and without bicanalicular silicone tube in patients with a small lacrimal sac: a comparative study 623 630 EN B. Yu Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China B. Mao Department of Ophthalmology, Central hospital of Lishui, Lishui, Zhejiang, China Y. Tu Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China M. Wang Department of Ophthalmology, Baoan Central Hospital of Shenzhen, Shenzhen, Guangdong, China W. Wu Department of Orbital and Oculoplastic Surgery, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China 3192 10.4193/Rhin22.151 BACKGROUND: To establish whether bicanalicular silicone tube intubation is required during endoscopic dacryocystorhinostomy (En-DCR) for treating chronic dacryocystitis with a small lacrimal sac. METHODS: In total, this study enrolled 264 patients diagnosed with unilateral chronic dacryocystitis with small lacrimal sacs via computed tomography-dacryocystography that underwent En-DCR from March 2016-September 2020. Patients were randomized into two treatment groups, with those in group A undergoing tubes intubation and those in group B not undergoing this procedure. The tubes were removed 3 months post-operation in group A. Surgical outcomes and related complication rates were then compared. RESULTS: This study included 242 patients, including124 and 118 in groups A and B, respectively. At the three-month follow-up time point, 12.90% of patients in group A exhibited ostial granulation tissue, with this frequency with no differences observed in group B (11.86%). At 6 months post-surgery, 80.65% of patients in group A and 72.88% of patients in group B exhibited successful surgical outcomes, with no significant differences between groups. At 9 months postoperatively, the overall effective success rate was 60.74%, and the success rate was significantlyhigher in group A relative to group B (group A: 75.81%; group B: 44.92%). There were no failed patient outcomes observed as of the 12-month follow-up time point. CONCLUSIONS: While En-DCR-based treatment of chronic dacryocystitis in those with smalllacrimal sacs did not yield satisfactory outcomes with respect to the overall effective success rate, these results suggest that intraoperative intubation may improve success rates in long-term follow-up.

International Rhinologic Society Rhinology 0300-0729 62 5 2024 10 1 39066656 The neural regulation and impact of posterior nasal neurectomy on nasal ciliary motion in vivo in a murine allergic rhinitis model 631 640 EN C. Pang Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China C. Liu Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Childrens Hospital, Capital Medical University, National Center for Childrens Health, Beijing, China N. Yu Senior Department of Otolaryngology-Head and Neck Surgery, the Sixth Medical Center of PLA General Hospital, Beijing, China; State Key Laboratory of Hearing and Balance Science, Beijing, China; National Clinical Research Center for Otolaryngologic Diseases, Beijing, China W. Yi Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China M. Xu Senior Department of Otolaryngology-Head and Neck Surgery, the Sixth Medical Center of PLA General Hospital, Beijing, China P. Liang Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China L. Chen Senior Department of Otolaryngology-Head and Neck Surgery, the Sixth Medical Center of PLA General Hospital, Beijing, China 3201 10.4193/Rhin23.337 Background: Posterior nasal neurectomy (PNN) is a commonly employed surgical approach for the treatment of allergic rhinitis (AR). Due to its denervation effect on the nasal mucosa, PNN may potentially alter the motion and defensive capability of cilia. Previous research on the effects of neural regulation and denervation on cilia has been limited by the absence of a feasible in vivo evaluation method for assessing ciliary function. Methodology: Utilizing a new system developed by our team for visualizing and analyzing ciliary motion in vivo, we analysed ciliary beat frequency and distance in vivo and histomorphological changes in a murine PNN and AR model. Ovalbumin, histamine and neurotransmitters (acetylcholine chloride, α receptor agonist and β receptor agonist) were applied to investigate the responsiveness and neural regulation of the nasal mucosa. Results: Denervation resulting from PNN led to a reduction in nasal ciliary beat frequency (CBF) to 78% of the control, as well as diminished response towards allergens and histamine. Among neurotransmitters examined, α receptor agonists exhibited inhibitory effects on in vivo ciliary motion while acetylcholine and β receptor agonists demonstrated stimulatory effects. PNN did not affect the reactivity of in vivo cilia towards these neurotransmitters. Conclusions: PNN-induced denervation can reduce ciliary motion, potentially compromising the defensive capability of nasal mucosa. Neural regulation and the neurotransmitters involved have significant effect on ciliary motion.