International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39831585 Advancing the research on management of global airway disease: insights from a post hoc analysis 1 1 EN S. Toppila-Salmi Kuopio, Finland 3256 10.4193/Rhin25.901 Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) frequently coexist, forming a complex multimorbid condition often referred to as “global airway disease.� This concept reflects shared pathophysiological mechanisms of eosinophilic inflammation and underscores the need for integrated treatment strategies targeting both upper and lower airway manifestations (1). The burden of severe CRSwNP, asthma, and N-ERD is substantial, particularly in terms of reduced quality of life, recurrent exacerbations, revision endoscopic sinus surgeries (ESS), and healthcare utilization (2). Biologics represent a significant advancement in the treatment of global airway diseases.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 37884557 Relationship between mode of delivery and the development of allergic rhinitis: a systematic review and meta-analysis 2 12 EN M.P. Hoang Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam K. Seresirikachorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand J. Samuthpongtorn Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand W. Chitsuthipakorn Center of Excellence in Otolaryngology-Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Otolaryngology, College of Medicine, Rangsit University, Bangkok, Thailand K. Snidvongs Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand 3228 10.4193/Rhin24.262 Background: Delivery mode can influence infant microbial diversity, cause immune dysregulation, and potentially increase the risk of allergic rhinitis (AR).Methodology: A systematic review and meta-analysis were performed to assess the association between distinct modes of delivery and the development of AR in childhood and adulthood. The primary comparison was vaginal (VD) versus cesarean delivery (CD). Secondary comparisons were specified CD (elective, emergency) versus specified VD (spontaneous, abnormal) and nonmicrobiota-exposed versus microbiota-exposed deliveries. The outcomes were subsequent risks of AR presenting as odd ratios and 95% confidence intervals. Results: Thirty-seven studies were analyzed. Compared to VD, CD, and its specified modes were associated with higher subsequent risks of AR in the population under age 18. The quality of evidence supporting these effects is rated as very low to low following GRADE. Spontaneous VD was associated with lower AR risk compared to CD, but there was no significant difference between abnormal VD and CD. The distinction between non-microbiota-exposed and microbiota-exposed deliveries did not affect AR risk significantly. Conclusions: The estimated odds ratios demonstrated a positive association between cesarean section and AR up to 18 years of age. A comprehensive categorization of delivery mode is necessary to interpret the existing evidence thoroughly.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39440663 Association between cigarette smoking and nasopharyngeal cancer risk: a meta-analysis 13 21 EN I. Possenti Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy A. Martini Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy V. Bagnardi Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy C. Specchia Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy W. Garavello Department of Otorhinolaryngology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy;Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy A. Odone School of Public Health, Department of Public Health, Experimental and Forensic Medicine. University of Pavia, Pavia, Italy;Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy L.J.M. Smits Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands S. Gallus Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy A. Lugo Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy 3239 10.4193/Rhin24.265 INTRODUCTION: Nasopharyngeal cancer (NPC) is a relatively rare yet aggressive malignancy, primarily affecting regions of East and Southeast Asia. This study aims at providing an up-to-date quantification of the association between cigarette smoking and NPC risk, overall and by histological subsites. METHODS: We conducted a systematic review and meta-analysis of case-control and cohort studies on the association between cigarette smoking and NPC risk published up to May 2023. The methodology used is original and efficient and includes both a comprehensive umbrella review and a traditional review. We estimated pooled relative risks (RR) of NPC according to smoking status, intensity, duration, and time since quitting. RESULTS: Among 46 eligible articles, 40 original studies were included in this meta-analysis. Compared with never smokers, the pooled RR of NPC was 1.61 for current, 1.28 for former, and 1.62 for ever smokers. The RR for ever compared with never smokers was 2.37 for squamous cell NPC and 1.06 for undifferentiated NPC. NPC risk significantly increased linearly with smoking intensity and duration, and decreased linearly with increasing time since quitting. CONCLUSION: This meta-analysis confirms the link between tobacco smoking and NPC, highlighting the significant risk posed even by moderate cigarette consumption. Additionally, our findings underscore the differential risk between squamous cell and undifferentiated subtypes of NPC, shedding light on the distinct implications for NPC prevention strategies.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39660730 Responders to biologics in severe uncontrolled chronic rhinosinusitis with nasal polyps: a multicentric observational real-life study 22 31 EN G. Mortuaire Otorhinolaryngology â€" Head and neck Department - Huriez Hospital, CHU Lille, Lille, France; Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France E. Béquignon Otorhinolaryngology â€" Head and neck Department, Créteil, France. CNRS EMR 7000, Créteil, France. INSERM, IMRB, Univ Paris Est Creteil, Créteil, France C. Daveau Otorhinolaryngology â€" Head and neck Department, Croix Rousse Hospital, Lyon, France J-F. Papon Otorhinolaryngology â€" Head and neck Department, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France. Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France. CNRS EMR 7000, Créteil, France. INSERM, IMRB, Univ Paris Est Creteil, Créteil, France J-P. Lecanu Otorhinolaryngology â€" Head and neck Department, Institut Arthur Vernes, Paris, France V. Favier Otorhinolaryngology â€" Head and neck Department, Gui de Chauliac Hospital, CHU Montpellier, France. Research-team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier (LIRMM), Univ. Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France L. de Gabory Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, France C. Vandersteen Head and Neck University Institute, ENT Department, CHU, Nice, France. Université Côte d'Azur, Nice, France L. Castillo Head and Neck University Institute, ENT Department, CHU, Nice, France. Université Côte d'Azur, Nice, France N. Saroul Otolaryngology Head and Neck Surgery Department, CHU Clermont-Ferrand France, Clermont-Ferrand, France. Human Nutrition Unit, INRAE, Auvergne Human Nutrition Research Center, Clermont Auvergne University, CHU de Clermont-Ferrand France, INRAE, UNH, Clermont-Ferrand, France B. Vérillaud Otorhinolaryngology and Skull Base Center, AP-HP, Lariboisière Hospital, Paris, France. Université Paris Cité, 75010 Paris, France. INSERM U1141 NeuroDiderot, Paris, France F. Carsuzaa Otorhinolarynology and audiophonology department, CHU Poitiers, Poitiers, France. Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), UR15560, Université de Poitiers, Poitiers, France C. Rumeau Otorhinolaryngology â€" Head and neck Department, université de Lorraine, CHRU Nancy, Nancy, France; Université de Lorraine, DevAH, Nancy, France R. Jankowski Otorhinolaryngology â€" Head and neck Department, université de Lorraine, CHRU Nancy, Nancy, France; Université de Lorraine, DevAH, Nancy, France J. Michel Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, Marseille, France G. de Bonnecaze Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Larrey Hospital, Toulouse, France V. Escabasse Otorhinolaryngology â€" Head and neck Department, Créteil, France. CNRS EMR 7000, Créteil, France. INSERM, IMRB, Univ Paris Est Creteil, Créteil, France A. Coste Otorhinolaryngology â€" Head and neck Department, Créteil, France. CNRS EMR 7000, Créteil, France. INSERM, IMRB, Univ Paris Est Creteil, Créteil, France G. Lefèvre Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France; Institute of Immunology, CHU Lille, Lille, France O. Malard Department of Otorhinolaryngology, CHU Hôtel Dieu, Nantes, France 3246 10.4193/Rhin24.284 BACKGROUND: Clinical trials have demonstrated the effectiveness of biologics in treating chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world evidence regarding patient outcomes and predictors of clinical response remains limited. METHODOLOGY: In this multicentric 18-month follow-up study, 326 adult patients who initiated biologic therapy for severe uncontrolled CRSwNP were included. Patient characteristics, including clinical and inflammatory markers, and comorbidities were collected at baseline and at 3, 6, 12, and 18 months of follow-up. We examined success rates based on current guidelines and identified potential factors associated to clinical response at 6 months. RESULTS: We observed a significant decrease of Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score (interquartile range) of 60.5 (47-74) at baseline to 26.0 (11-41) at 3 months. A significant decrease of nasal symptoms and endoscopic nasal polyp score was observed at 3 months. After 6 months of biologic treatment, 59% of patients were classified as excellent responders according to the EUFOREA-EPOS 2023 criteria. Multivariate analysis revealed a suggestive association between baseline eosinophil blood count, type of biologic and an excellent response at 6 months. CONCLUSIONS: This real-world study confirms the effectiveness of biologics as an add-on therapy in patients with severe uncontrolled CRSwNP. Biologics lead to rapid and sustained improvement in clinical symptoms. A significant proportion of patients exhibit an excellent response, with no need for systemic corticosteroids.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39254928 Dual blockade of IL-4 and IL-13 with dupilumab ameliorates sensorineural olfactory dysfunction in mice with eosinophilic sinonasal inflammation 32 42 EN C.F. Yeh Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan M.Y. Lan Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan C.C. Lin Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan Y.W. Hung Department of Nursing, College of Medical Technology and Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan W.H. Huang Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan Y.L. Lai School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan 3211 10.4193/Rhin24.114 Background: Dupilumab, an antibody that binds IL-4Rα and inhibits IL-4 and IL-13 signals, has demonstrated efficacy in chronic rhinosinusitis with nasal polyps (CRSwNP) primarily characterized by type 2 inflammation. Current evidence suggests that the rate of improvement in olfactory dysfunction with dupilumab exceeds that of nasal polyp reduction, yet the underlying mechanism remains undisclosed. We hypothesize that dupilumab may initially ameliorate sensorineural olfactory dysfunction. Methodology: Male BALB/c mice were intranasally administered ovalbumin and Aspergillus protease for 12 weeks to induce eosinophilic sinonasal inflammation. Dupilumab treatment was also administered. The mice underwent histological assessment, olfactory behavioural test, and gene expression profiling to identify neuroinflammatory markers within the olfactory bulb. Results: Dupilumab treatment resulted in a reduction in the number of mucosal protruding lesions, as well as decreased infiltration of eosinophils and neutrophils, along with a decrease in olfactory sensory neuron injury. Furthermore, there was a downregulation in the mRNA expression related to microglia activation and neuroinflammation in the olfactory bulb. Conclusions: Dupilumab improves the sensorineural pattern of olfactory dysfunction in mice, potentially explaining why olfaction improves more rapidly than polyp reduction in patients with CRSwNP.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39660695 Nasal secretions trace epithelial type 2 response to allergen-specific immunotherapy 43 53 EN C.A. Jakwerth Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative U.M. Zissler Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative M. Oelsner Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative L. Pechtold Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany L. zur Bonsen Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany M. Plaschke Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany J. Kau Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany M. Davidovic Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany M. Mootz Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany B. Haller Institute of Medical Informatics, Statistics and Epidemiology, Medical School, Technical University of Munich, Munich, Germany A.M. Chaker Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative; Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany C.B. Schmidt- Weber Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health, Germany, Member of the German Center for Lung Research (DZL), Munich, Germany and Member of the Helmholtz I and I Initiative 3245 10.4193/Rhin24.038 BACKGROUND: Allergen-specific immunotherapy (AIT) is a disease-modifying therapy and is effective to reduce the symptoms of grass pollen-allergy. The airway epithelium of these patients releases inflammatory mediators including type-2 cytokines, which are associated with cellular processes involved in the symptomatic response of the affected tissue. Aim of the study was to identify epithelial biomarkers indicating AIT progress. METHODS: In an exploratory, observational allergy cohort, we longitudinally phenotyped 56 grass pollen-allergic patients undergoing AIT for over three years and 18 controls using nasal secretions at critical time windows during therapy to assess peak-season responses along the course of therapy. Type-2 cytokine protein levels were analyzed using the high-sensitivity multiplex electrochemiluminescence mesoscale technique. RESULTS: The type-2 cytokines CCL26 and POSTN oscillated seasonally, in contrast to TSLP and IL-33. However, only POSTN was reduced over the three-year AIT progression. In addition to POSTN, IL-24 and IL-37 levels were continuously reduced during AIT, while IFN-g and CCL27 were increased. Compared to healthy individuals, AIT did not restore healthy secretion levels but rather induced a novel homeostasis CONCLUSION: Nasal secretions trace the epithelial response during different phases of AIT. We demonstrate that AIT only partially controls the epithelial type 2 cytokine CCL26, which also adapts to seasonal changes, while POSTN and IL-24 are potential indicators of therapy success. Therefore, nasal secretions represent a promising, non-invasive tool for monitoring seasonal progress of AIT.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39385734 Nasal endoscopy score thresholds to trigger consideration of chronic rhinosinusitis treatment escalation and implications for disease control 54 62 EN A.R. Sedaghat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA R.A. Cotter Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA I. Alobid Rhinology and Skull Base Unit, ENT Department, Hospital Clínic de Barcelona, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, CIBERES, Barcelona, Spain S. Alsaleh Department of Otolaryngology â€" Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia W.T. Anselmo-Lima Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of São Paulo, São Paulo, Brazil M. Bernal-Sprekelsen Department of ORL, Hospital Clinic, University of Barcelona, Barcelona Spain R.K. Chandra Department of Otolaryngology â€" Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA J. Constantinidis 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece W.J. Fokkens Department of Otorhinolaryngology and Head and Neck Surgery, University of Amsterdam, Amsterdam, the Netherlands C. Franzese Department of Otolaryngology, University of Missouri, Columbia, MO, USA S.T. Gray Department of Otolaryngology â€" Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA A.A. Halderman Department of Otolaryngology â€" Head and Neck Surgery University of Texas Southwestern Medical Center, Dallas, TX, USA E.H. Holbrook Department of Otolaryngology â€" Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA C. Hopkins Department of Otolaryngology and Head Neck Surgery, Guys and St Thomas’ Hospital, London, UK P.H. Hwang Department of Otolaryngology â€" Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA E.C. Kuan Department of Otolaryngology â€" Head and Neck Surgery, University of California, Irvine, Orange, CA, USA B.N. Landis Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland V.J. Lund Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK E.D. McCoul Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, LA, USA V. Niederberger-Leppin Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria E.K. O’Brien Department of Otolaryngology â€" Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA C.M. Philpott Rhinology and Olfactology Research Group, Norwich Medical School, University of East Anglia, Norwich, UK; Norfolk and Waveney ENT Service, James Paget University Hospital, Great Yarmouth and Norfolk S.D. Pletcher Department of Otolaryngology â€" Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA M.A. Pynnonen Department of Otolaryngology â€" Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA S. Reitsma Department of Otorhinolaryngology and Head and Neck Surgery, University of Amsterdam, Amsterdam, the Netherlands J. Rimmer Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia; Department of Otolaryngology Head and Neck Surgery, St Vincent’s Hospital Melbourne, Melbourne, Australia S. Toppila-Salmi Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland E.W. Wang Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA M.B. Wang Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA S.K. Wise Department of Otolaryngology â€" Head and Neck Surgery, Emory University, Atlanta, GA, USA B.A. Woodworth Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA W.C. Yao Department of Otorhinolaryngology â€" Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA K.M. Phillips Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 3233 10.4193/Rhin24.291 BACKGROUND: In the absence of direct evidence supporting how to use nasal endoscopy findings to judge chronic rhinosinusitis (CRS) disease control, experts' practice patterns could provide guidance. METHODOLOGY: Participants consisted of a diverse group of twenty-nine rhinologists. Participants were presented with every possible combination of bilateral nasal endoscopy findings represented by the modified Lund-Kennedy (MLK; range: 0â€"12) endoscopic scoring system and Nasal Polyp Score (NPS; range: 0â€"8). Reflecting the practical consequence of CRS disease control assessment, participants were asked whether they would consider CRS treatment escalation based on each scenario in the absence of any CRS symptoms, and how strongly they considered escalating therapy. The same scenarios were then presented in the context of 1 burdensome CRS symptom and participants again were asked whether they would consider treatment escalation. RESULTS: The median threshold total MLK score for considering treatment escalation was ≥4 and 75.9% of participants’ MLK thresholds were within 1 point of 4. The median threshold total NPS for considering treatment escalation was ≥3 and 62.5% of participants’ NPS thresholds were within 1 point of 3. Endoscopy score thresholds decreased in the presence of 1 burdensome symptom and generally increased when requiring stronger affirmation for considering CRS treatment escalation. CONCLUSION: Reflecting the practice patterns of a diverse group of rhinologists, MLK score ≥4 or NPS ≥3 may serve as thresholds for considering CRS treatment escalation. Alternatively, MLK score under 4 or NPS under 3 may serve as endoscopic goals of CRS treatment. These results provide guidance for using nasal endoscopy findings as a criterion of CRS disease control.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39387820 Influence of septal deviation side on preoperative eustachian tube dysfunction and the effectiveness of septoplasty in alleviating eustachian tube dysfunction 63 69 EN C. Lee Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea E. Lee Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea M. Park Department of Otorhinolaryngology-Head and Neck Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea D. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Y.G. Jung Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea H.Y. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea G. Ryu Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea S.D. Hong Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 3235 10.4193/Rhin24.267 BACKGROUND: The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) serves as a valuable tool for assessing eustachian tube dysfunction (ETD). We investigated the impact of septal deviation side on ETD using preoperative ETDQ-7 scores and evaluated the effectiveness of septoplasty based on postoperative ETDQ-7 scores. METHODOLOGY: We conducted a retrospective analysis of patients with septal deviation who were scheduled for septoplasty. ETDQ-7 surveys were conducted preoperative and 1 and 3 months postoperative. RESULTS: 120 patients were included, with 72 completing the ETDQ-7 at all three time points. The average prevalence of ETD was 29.2%. Preoperative ETDQ-7 scores showed no significant difference between convex and concave nasal sides. However, the prevalence of ETD was significantly higher on the convex side (28.3% vs. 15.8%), especially in unilateral ETD cases. Preoperatively, the positive ETD group had significantly higher ETDQ-7 scores on the convex side while no significant difference was found between concave and convex sides in the negative ETD group. Postoperatively, the positive ETD group showed significant improvement in ETDQ-7 scores with significantly higher on the convex side (66.7% vs. 33.3%). ETDQ-7 scores improved after septoplasty, with more improvement in the positive ETD group. CONCLUSIONS: Septoplasty significantly improves ETD, particularly in the preoperative positive ETD group, by reducing ETDQ-7 scores. The prevalence of ETD was higher on the convex side preoperatively, and the positive ETD group exhibited significant postoperative improvements, especially on the convex side. This suggests that the direction of septal deviation influences ETD prevalence and surgery outcomes, although septoplasty alleviates ETD on both sides.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39660677 The relationship between intravenous olfactory test and taste disorder in patients with olfactory disorder 70 76 EN R. Sakurai Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan E. Mori 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; Depertment of Otorhinolaryngology, Tokyo Dental College Ichikawa General Hospital, Chiba, 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 Daisan Hospital, Tokyo, Japan M. Tei Department of Otorhinolaryngology, Jikei University Katsushika Medical Centre, Tokyo, Japan N. Otori Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan 3244 10.4193/Rhin24.005 Background: The intravenous olfactory test (alinamin test [AT]) is a retronasal olfactory assessment and may evaluate the flavour disorder; however, studies assessing whether AT accurately determines the severity of taste disorders are lacking. Our study aims to evaluate the relationship between AT and subjective taste disorders in the patiensts with olfactory disorder. Methods: Between April 2019 and March 2020, 228 patients visited our smell clinic reporting olfactory disorders. Of these, 193 patients who underwent AT were included in this study. We evaluated the differences in AT response, latency time, and duration time between patients with and without subjective taste disorder. We also assessed the degree of subjective taste disorder experienced by patients using the visual analogue scale (VAS) and the correlation between latency and duration time of AT. To assess taste perception more broadly, we inquired about the presence of disorder using the term “taste� rather than “flavour,� without focusing on any specific type of taste disorder. Results: Of the included 193 patients, 62 reported awareness of a taste disorder. The duration time of AT was significantly shorter in patients with subjective taste disorder. A weak correlation was found between the VAS scores for subjective taste disorders and the duration time of AT. Conclusions: Our results showed that among the patients with olfactory disorders, the duration time of AT was reduced for those with subjective taste disorders.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39404183 Clinical efficacy of olfactory training using aromatic traditional Chinese medicine in managing olfactory dysfunction induced by SARS-CoV-2 77 84 EN X-F. Qiao Department of Otorhinolaryngology, Shanxi Provincial People’s Hospital Affiliated to Shanxi Medical University, Taiyuan, China L-Y. Han Graduate School, Shanxi Medical University, Taiyuan, China Y-F. Li Graduate School, Shanxi Medical University, Taiyuan, China H. Li Graduate School, Shanxi Medical University, Taiyuan, China H-M. Zhen Graduate School, Shanxi University of Traditional Chinese Medicine, Taiyuan, China H-R. Dang Graduate School, Shanxi University of Traditional Chinese Medicine, Taiyuan, China Y. Chen Department of Otorhinolaryngology, Shanxi Provincial People’s Hospital Affiliated to Shanxi Medical University, Taiyuan, China X. Li Department of Surgery, Children's Hospital of Shanxi Province, Taiyuan, China 3236 10.4193/Rhin24.035 OBJECTIVE: The aim of this study is to assess the clinical efficacy of olfactory training using aromatic traditional Chinese medicine (TCM) for addressing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-induced olfactory dysfunction, while also exploring the factors that influence the observed efficacy. METHODS: 172 outpatients with SARS-CoV-2-related olfactory dysfunction were randomized into two groups. The experimental group received olfactory training with TCM aromatics (ginger, Pericarpium Citri Reticulatae, Santali Albi Lignum, Styrax), while the control group used non-TCM aromatics (phenyl ethanol-rose, menthol-mint, citronellal-lemon, eugenol-clove) for 24 weeks. Olfactory function was assessed using the Sniffin' Sticks test and TDI (threshold-discrimination-identification) scores at baseline, 1, 3, and 6 months post-treatment. RESULTS: Response rates at 1, 3, and 6 months post-treatment were 3.66%, 25.61%, and 43.90% in the experimental group, and 4.94%, 23.46%, and 43.21% in the control group. The TDI scores of the experimental group and the control group were statistically different before and after treatment. At 3 and 6 months post-treatment, TDI scores increased significantly, with enhanced odor discrimination and identification capabilities in both groups compared to pre-treatment, while the odor detection threshold was not improved compared with that before treatment. At the 3- and 6-month follow-ups, experimental group showed significantly higher self-rated sleep and anxiety scores than controls, indicating notable improvement in both after treatment. CONCLUSION: Olfactory training with aromatic TCM offers an effective treatment for SARS-CoV-2-induced olfactory dysfunction, improving odor discrimination, identification without significant differences compared to conventional aromatics, besides, it may also improve anxiety and sleep quality.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 Topical intranasal anesthesia impairs trigeminal function and airflow perception 85 91 EN C. Migneault-Bouchard Department of Anatomy, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada F.J.M. Boselie Department of Otorhinolaryngology, Centre Hospitalier de Luxembourg, Luxemburg J. Frasnelli Department of Anatomy, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada; Research Center, Sacré-Coeur Hospital, Montréal, QC, Canada 3224 10.4193/Rhin BACKGROUND: Impairment of airflow perception by the intranasal trigeminal system may explain chronic nasal obstruction (CNO),especially in cases where no major deformity or mucosal inflammation can explain reduced airflow. We aim to characterize the effect of topical intranasal anesthesia on intranasal trigeminal sensitivity and consequently the sensation of nasal obstruction. METHODOLOGY: We performed a crossover study of 16 healthy subjects, randomised for either treatment (topical intranasal anesthesia with 10% Xylocaine) or placebo (saline solution). We used the Trigeminal Lateralization Task (TLT) with eucalyptol to assess trigeminal sensitivity. We measured nasal patency objectively with Peak Nasal Inspiratory Flow (PNIF), and subjectively with a Visual Analog Scale (VAS), the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire.RESULTS: Topical intranasal anesthesia significantly reduced intranasal trigeminal sensitivity. Further, after topical intranasal anesthesia,reduced trigeminal sensitivity was associated with the subjectively reduced nasal patency, as highlighted by ENS6Q and NOSE scores. CONCLUSIONS: Topical intranasal anesthesia reduces intranasal trigeminal function resulting in subjectively reduced nasal patency. In future studies, the relation of reduced intranasal trigeminal function and subjective nasal obstruction needs to be addressed to open an avenue for potential interventions for an important portion of ENT patients.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39382022 Normative data for the lateralization task in the assessment of intranasal trigeminal function 92 102 EN Y. Mai Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Germany A.K. Hernandez Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Germany; Department of Otolaryngology, Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines I. Konstantinidis Smell and Taste Clinic, 2nd Department of Otorhinolaryngology, Aristotle University of Thessaloniki, Greece A. Haehner Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Germany 3230 10.4193/Rhin24.063 Aim: To provide normative data for the lateralization task in the assessment of intranasal trigeminal function, as well as to investigate potential effects of age, sex and olfactory function. Methods: The lateralization task using eucalyptus as target stimulus was performed to assess intranasal trigeminal function. Data were collected from: 360 healthy adult participants (mean age 37.5±17.4) for the 40-trial version; 284 participants (mean age 32.6±14.1) for the 20-trial version; and 418 participants (mean age 42.6±15.6) for the 10-trial version. The “Sniffin’ Sticks� test was used to measure olfactory function. Results: The mean scores were 35.46±4.50 for the 40-trial version, 15.64±3.65 for the 20-trial version, and 8.14±2.16 for the 10-trial version. In the reference group aged 18-25 years, the 10th percentiles were 33 for the 40-trial version, 11 for the 20-trial version, and 6 for the 10-trial version. Significant effects of age and odor discrimination score were observed on lateralization performance. Conclusions: We provide reference scores for the lateralization task, in large sample of healthy participants. Among the three examined tasks (40, 20 and 10), the 40-trial task yielded the most reliable information. For the 40-trial version, scores equal or higher to 33 points indicate a normal lateralization ability, whereas scores between 27 and 32 may warrant further assessment. Scores below 27 possibly point towards a decreased trigeminal function. The lateralization task serves as surrogate marker of intranasal trigeminal functions and further studies with pathological cases are needed to explore its clinical usefulness.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39405420 In vitro selection of human cerebrospinal fluid-specific aptamers using clinical samples 103 112 EN A. Abiri Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA;Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine (UCI), CA, USA X. Chen Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA B. Latifi Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA F.P.K. Hsu Department of Neurological Surgery, University of California, Irvine, CA, USA A. Lupták Department of Pharmaceutical Sciences, University of California, Irvine, CA, USA M. Khine Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA E.C. Kuan Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine (UCI), CA, USA; Department of Neurological Surgery, University of California, Irvine, CA, USA 3237 10.4193/Rhin24.341 BACKGROUND: Cerebrospinal fluid (CSF) leaks may occur due to numerous etiologies and are associated with severe morbidity. Currently in the U.S., confirming the presence of a CSF leak requires protein electrophoresis testing, oftentimes involving specialized processing, and there exists no point-of-care (POC) device for CSF detection. We aimed to discover a single-stranded deoxyribonucleic acid (ssDNA) aptamer capable of selectively binding to CSF-specific biomarkers, with the future goal of developing an aptamer-based POC CSF detection device. METHODS: To identify a candidate aptamer, we performed Systematic Evolution of Ligands by EXponential enrichment (SELEX) using a DNA library containing a randomized 63-nucleotide (nt) stretch flanked by 2 primer-binding sites. Quantitative polymerase chain reaction (qPCR) and fluorescence anisotropy (FA) assessed aptamer binding affinity and kinetics. RESULTS: Following 14 SELEX cycles, 2 dominant and functionally viable 98-nt ssDNA sequences (C2 and C3) were found. C2 and C3 demonstrated ~586x and ~82x higher affinity for CSF compared to serum, respectively. Increases in FA upon aptamer exposure to higher CSF concentrations demonstrated a K1�2 of 5.0% and 14.1% for C2 and C3, respectively. CONCLUSIONS: In vitro selection of a diverse pool of ssDNA sequences yielded 2 aptamers with high selectivity for CSF-specific biomarkers, with potential for integration into a rapid POC electrochemical diagnostic system.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39660637 Global airway disease: mepolizumab simultaneously improves outcomes in severe CRSwNP and asthma 113 115 EN J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain V. Backer Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark J. Constantinidis Department of ORL, AHEPA University Hospital, Thessaloniki, Greece I. Eguíluz-Gracia Allergy Unit, Hospital Regional Universitario de Málaga. Allergy group, IBIMA-Plataforma BIONAND. RICORS Inflammatory Diseases. Málaga, Spain A.L. Moure Specialty Care Unit, Medical Affairs, GSK, Madrid, Spain R. Cuervo-Pinto Specialty Care Unit, Medical Affairs, GSK, Madrid, Spain L. Zhang Respiratory Biostatistics, GSK, Warren, NJ, USA P. Shah Data Analysis Statistics, GSK, UK W. Kerr Global Specialty Care, GSK, UK P. Hellings Otorhinolaryngology, Catholic University of Leuven, and Upper Airways Research Laboratory, University of Ghent, Belgium 3243 10.4193/Rhin24.337 Chronic rhinosinusitis with nasal polyps (CRSwNP) often co-exists with asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), creating a more severe phenotype and an additional burden compared with CRSwNP disease alone. The relationship between these diseases in terms of shared immunological disbalance has been coined in the literature as ‘global airway disease’ or ‘unified airway disease’ and requires integrated treatment strategies. Our post hoc analysis of the Phase III randomised, double-blind, placebo-controlled, multicentre SYNAPSE study (GSK ID: 205687; NCT03085797) assessed the efficacy of mepolizumab, an anti-interleukin-5 monoclonal antibody, in simultaneously improving both CRSwNP and asthma outcomes versus placebo. By utilising a combined measure that accounts for quality of life, sinonasal symptoms and asthma control, we aimed to validate the potential of mepolizumab as an effective therapeutic option for global airway disease.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39323186 Omalizumab reduces allergic rhinitis symptoms due to Japanese cedar pollen by improving eosinophilic inflammation 116 117 EN K. Hirano Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan I. Suzaki Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan N. Okuzawa Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan A. Oki Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan Y. Otani Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan M. Takeuchi Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan A. Minoura Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan K. Murakami Department of Radiology, Division of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan Y. Ihara Division of Oral Functional Rehabilitation Medicine, Department of Oral Health Management, School of Dentistry, Showa University, Tokyo, Japan H. Kato Division of Oral Functional Rehabilitation Medicine, Department of Oral Health Management, School of Dentistry, Showa University, Tokyo, Japan Y. Watanabe Department of Internal Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan T. Shimane Department of Otorhinolaryngology, Head and Neck Surgery, Showa University School of Medicine, Tokyo, Japan 3219 10.4193/Rhin24.105 Seasonal allergic rhinitis caused by Japanese cedar pollen (SAR-JCP) is a serious social problem in Japan, affecting 38.8% of the population. Omalizumab, a recombinant humanised monoclonal anti-immunoglobulin (Ig)E antibody, reduces serum-free IgE levels by 84â€"99%. The reduction of serum-free IgE levels induced by omalizumab ultimately downregulates FcÎ#181;RI expression in basophils and mast cells. Omalizumab significantly reduces nasal symptoms and improves the quality of life in patients with allergic rhinitis ; however, other than a decrease in free IgE, its biomarker activity is unclear. Allergic rhinitis reactions are more pronounced in nasal secretions and mucosa than in serum; however, no studies have examined the changes in proteins in nasal secretions after omalizumab administration. In this study, we aimed to elucidate the pathophysiology of the effect of omalizumab. This may serve as a basis for the identification of new biomarkers through the examination of proinflammatory proteins in nasal secretions, which may reflect the pathophysiology more accurately than peripheral blood.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39484735 The evaluation of therapeutic outcomes of biologics in allergic fungal rhinosinusitis: a systematic review and meta-analysis 118 120 EN H.J. Aljubran College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia O.A. Bamalan College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia;Department of Surgery, Security Forces Hospital, Dammam, Saudi Arabia A.A. Alfayez College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia R.M. Abdulhameed College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia T.M. Almuhaimid Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia M. Al Bar Department of Otolaryngology Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia A.A. Almomen Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia M.S. Alahmari Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia 3242 10.4193/Rhin24.397 Allergic fungal rhinosinusitis (AFRS) is a localized inflammatory, hypersensitivity reaction affecting the nasal cavity and its sinuses secondary to fungal colonization. The burden of surgical revisions and recurrence rates in this disease led to a recent hypothesized advancement in the medical management being experimented, which is the use of biologics. Therefore, this systematic review analyzed nine articles to highlight the significance of biologics in the management of AFRS through a comprehensive strategy, as seen in Supplementary Methods Section.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39323186 Analysis of nasal fracture management and subsequent surgical outcomes across demographics 121 124 EN D. Karasik Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA S. Politano Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA T.J. O’Neil Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA T. Baglam Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA C.C. Rabbani Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA J. Thuener Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA 3218 10.4193/Rhin24.334 Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and even mental health issues as serious as post-traumatic stress disorder as persistent complications. Optimal management remains controversial and subjective based on the clinician’s judgment, with many factors playing a role in the provider’s decision, including the timing of treatment, the choice between foregoing treatment or choosing to undergo a closed or open reduction, and how to manage subsequent revision surgeries if necessary.

International Rhinologic Society Rhinology 0300-0729 63 1 2025 February 1 39440768 The Lamella Ostium Extent Mucosa (LOEM) system: a new classification for endoscopic sinus surgery 125 128 EN S. Sanchez-Gomez Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain R. Moreno-Luna Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain D. Martin-Jimenez Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain; Department of Otolaryngology, Head and Neck Surgery, Alava University Hospital, Alava, Spain J. Maza-Solano Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain A. del Cuvillo Rhinology and Asthma Unit, Department of Otolaryngology, Jerez University Hospital, Jerez, Spain J-M. Villacampa-Auba ENT and Cervicofacial Surgery Department, Fundacion Jimenez Diaz University Hospital, Madrid, Spain J. Gonzalez-Garcia Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain R. Fernandez-Liesa Rhinology and Anterior Skull Base Unit, ENT Department, Hospital Universitario Miguel Servet, Zaragoza, Spain I. Alobid Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain M. Bernal-Sprekelsen Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain 3240 10.4193/Rhin24.370 In the last decades, various types of endoscopic sinus surgery (ESS) have emerged as treatments for chronic rhinosinusitis (CRS), particularly with the development of personalized, endotype-driven approaches targeting mucosal inflammation and remodeling. Despite these advancements, the literature reports heterogeneous and often divergent outcomes, leaving the actual benefit of more extensive surgical approaches in CRS control a matter of ongoing debate. This discrepancy stems from inconsistent definitions of surgical techniques, leading to variations in osseous and mucosal resections depending on patient phenotype, disease severity and surgeon preference. To address this inconsistency, the Japanese Rhinology Society introduced a classification based on procedure extent, but it lacks details on anatomical structures and mucosal treatment. Similarly, the ACCESS system measures ESS extent with postoperative CT-scans but overlooks mucosal interventions.