International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 40042381 The alchemy of precision and innovation: treating chronic airway inflammatory conditions in 2025 129 129 EN M.B. Soyka Zürich, Switzerland 3271 10.4193/Rhin25.902 Chronic inflammatory processes of the upper and lower airways can represent a nightmare for both the treating physician as well as suffering patients. The advent of biologicals and use of personalized medicine has revolutionized its management in many ways, still leaving unresolved gaps that need to be closed with innovative approaches and proof of efficacy in everyday life.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39729039 Budesonide nasal irrigation for chronic rhinosinusitis: a meta-analysis of therapeutic outcomes and safety profile 130 144 EN N. Magboul Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia A.F. Alharbi Department of Otolaryngology - Head and Neck Surgery, King Saud Medical City, Riyadh, Saudi Arabia A.T. Alqutub Department of Otorhinolaryngology - Head and Neck Surgery, Makkah Health Cluster, Makkah, Saudi Arabia S. Almatrafi Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia A. Alroqi Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia S.H. Aldousary Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia S.R. Alromaih Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia A.S. Alrasheed Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia S.A. Alsaleh Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia 3249 10.4193/Rhin24.349 Background: Corticosteroids are used in managing Chronic Rhinosinusitis (CRS) through several formulations, including oral steroids and nasal sprays. More recently, incorporating concentrated budesonide respules into high-volume saline irrigations has been proposed to enhance the penetration of topical steroids into the paranasal sinuses. We aim to evaluate the safety and efficacy of budesonide nasal irrigation (BNI) in managing CRS. Methodology: A systematic review with meta-analysis was performed following PRISMA guidelines. Data were extracted independently from the eligible studies. In double-arm and single-arm meta-analyses, continuous outcomes were pooled using mean difference (MD) with a 95% confidence interval (CI). Results: Twenty-six studies were reviewed, comprising 1464 patients. BNI had better outcomes than saline nasal irrigation (SNI) regarding Sino-Nasal Outcome Test score (SNOT-22). Lund-Kennedy Endoscopy scores (LKES) changed from baseline. Regarding safety, there was no significant difference between BNI and SNI regarding Intraocular Pressure (IOP). Single-arm analysis showed a pooled mean serum cortisol level within the normal range after BNI. Conclusions: BNI demonstrated improved SNOT-22 and LKES scores, with normal post-treatment IOP and cortisol levels, indicating a beneficial impact on CRS while maintaining safety.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39733302 Management of eosinophilic otitis media in the era of biological therapy: systematic review and proportion meta-analysis 145 152 EN M. Lazzeroni Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy H. Elzinga Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands P. Merkus Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands E. van Spronsen Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands W.J. Fokkens Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands S. Reitsma Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands 3251 10.4193/Rhin24.421 Background: Eosinophilic otitis media (EOM) is a recently recognised type 2 inflammatory disease, strongly associated with asthma and chronic rhinosinusitis with nasal polyps. Known as a difficult-to-treat condition, EOM is often refractory to traditional therapies for (chronic) otitis media. This review aims to assess the success rates of the different interventions for patients with EOM including newly available biological therapy. Methodology: In March 2024 we systematically searched PubMed, Embase, Scopus and Web of Science for studies on more than 5 EOM patients undergoing any medical or surgical intervention with a reported success rate. Proportion meta-analysis on a random effect model was used to synthesize results effectively. Risk of bias was assessed through the Risk Of Bias In Non randomized Studies of Interventions tool (ROBINS-I). Results: From 1103 potential articles, 14 studies with 361 patients were included. 62% were females and 85% had bilateral presentation. Otorrhoea was present in 68% of patients, tympanic membrane perforation in 50%. The overall success rate was 61.3. However, interventions comprising biological agents targeting type 2 inflammatory cascade showed higher success rates compared to non-biological treatments. Conclusions: A shift towards biologic-based therapies could be beneficial for managing the challenging condition EOM.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39907212 Is nasal closure an effective treatment for severe refractory epistaxis in HHT? A scoping review and narrative synthesis 153 162 EN R. Bickerton Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, United Kingdom R. Gera Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, United Kingdom T. Ross Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, United Kingdom; EvidENT Team, University College London, London, United Kingdom C. Rennie Department of Ear, Nose and Throat Surgery, Imperial College Healthcare Trust, London, United Kingdom 3263 10.4193/Rhin24.448 INTRODUCTION: Hereditary haemorrhagic telangiectasia (HHT) is an uncommon genetic disorder characterised by recurrent, severe epistaxis which poses significant management challenges. Nasal closure has emerged as a treatment for refractory cases, however there is limited research on its outcomes. We aim to consolidate existing evidence to assess its efficacy and safety. METHODS: We conducted a systematic search of the Cochrane library, EMBASE, PubMed and non-indexed publications from the past 30 years. Two independent reviewers extracted data and assessed bias from included studies. Findings were summarised via narrative synthesis due to heterogeneity of included studies.RESULTS: 192 patients from ten studies underwent nasal closure. Frequently used outcome measures were validated epistaxis severity scores, Glasgow Benefit Inventory and haemoglobin trends. Surgery improved quality of life and reduced epistaxis severity post-operatively. Partial dehiscence is a frequently reported complication which is usually successfully treated with revision surgery. CONCLUSIONS: Nasal closure reduces epistaxis severity, improving quality of life in patients with severe, refractory HHT-related epistaxis, providing a valuable treatment option for the most challenging cases. The strength of our conclusions is limited by the heterogeneity of outcome measures. To our knowledge, this is the largest pooled database of patients who have undergone nasal closure.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39882775 Real-world observational data on olfactory dysfunction of the Smell & Taste Clinic of UZ Leuven (Belgium) from 2021-2024 163 171 EN M. Clijsters Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium S. Bischoff Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Kantonsspital St.Gallen, Switzerland J. van Waterschoot Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium E. Hens Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium V. Nyongesa Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium P. Van Bulck Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium M. Jorissen Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium L. Van Gerven Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium;Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium 3260 10.4193/Rhin24.383 BACKGROUND: The COVID-19 pandemic led to a surge in olfactory dysfunction (OD), increasing the need for specialized care. Thi study explores the prevalence, characteristics, and clinical implications of OD in a specialized Smell & Taste Clinic established at the ENT-HNS department of the University Hospitals Leuven (UZ Leuven) in 2021. METHODOLOGY: We included consecutive patients with OD in the observational longitudinal ProspeRo’Scent registry at UZ Leuven between September 2021 and April 2024. Chemosensory assessment was done with psychophysical tests (Sniffin’ Sticks TDI and Taste sprays) and questionnaires. RESULTS: Of the 203 unique, consecutive patients, COVID-19-associated OD (C19OD) was the predominant etiology (50.2%), followed by idiopathic (25.1%), and post-traumatic (8.9%) OD. Parosmia was present in 60.2% of patients, with the highest prevalence in C19OD cases (80.9%). Sniffin’ Sticks TDI testing indicated that patients with parosmia had better olfactory thresholds and discrimination scores than patients without. During follow-up (n=116; average 7.7 months), 31% of C19OD patients exhibited clinically relevant improvement in TDI scores, compared to 13% for the other etiologies. Quality of life, as assessed by sQOD-NS, was not significantly different between etiologies but correlated with higher parosmia scores. CONCLUSIONS: C19OD patients suffered more from parosmia, correlating with worse quality of life, but had better baseline TDI scores and demonstrated a higher likelihood of clinically relevant improvement over time compared to other etiologies.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39968898 Real-world treatment of chronic rhinosinusitis with dupilumab and omalizumab: results from the Korean National Health Insurance Service database 172 179 EN S.A. Han Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi, South Korea J. Yoon Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea B.H. Kim Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyeongju, South Korea J.H. Park Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyeongju, South Korea Y-S. Lim Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyeongju, South Korea Y.B. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi, South Korea C.G. Cho Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyeongju, South Korea S-W. Park Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyeongju, South Korea J.Y. Kim Department of Otorhinolaryngologyâ€"Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Gyeonggi, South Korea; Sensory Organ Research Institute, College of Medicine, Dongguk University, Gyeongju, South Korea 3265 10.4193/Rhin24.209 BACKGROUND: Biological treatment has proven effective for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and is increasingly prescribed. However, in the real-world, strict adherence to the recommended dose may not be feasible and studies on the actual administration patterns of biologics are limited. This study aimed to evaluate the patterns of real-world use of biologics for CRS in Korea, through the National Health Insurance Service (NHIS). METHODS: We analysed data from the NHIS database from January 2010 to March 2024. Patients with CRS or nasal polyp defined by the ICD-10 codes, who had undergone computed tomography, and had a history of being prescribed dupilumab or omalizumab were identified. A total of 808 patients were analysed for their administration patterns and systemic corticosteroid use. RESULTS: Twelve weeks after initiation of therapy, 46.2% of patients received dupilumab at 2-weekly intervals and 53.9% of patients on omalizumab patients were receiving treatment at 2- or 4-week intervals. The annual expense of CRS patients treated with biologics was greater than for those receiving other treatments. The average annual usage of systemic steroids was decreased from 33.0 days to 12.7 days after using biologics. CONCLUSIONS: The results of this study which analysed real-world data in a large population, suggest a discrepancy between the recommended dose and real-world administration of biologics. Further studies are warranted on feasible administration schedules that reflect various patient factors and healthcare costs.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 40042341 The prevalence of primary chronic rhinosinusitis in young adults from a Swedish birth cohort 180 189 EN K. Åberg Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden; Medical unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden A. Asarnoj Department of Women’s and Children's Health, Karolinska Institutet, Stockholm, Sweden;Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden S.K. Georén Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden L.O. Cardell Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden;Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden I. Kull Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet A. Bergström Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;Center for Occupational and Environmental Medicine, Region Stockholm, Sweden E. Melén Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet;Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden M. Holmström Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden M. van Hage Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Stockholm, Sweden M. Westman Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden 3270 10.4193/Rhin24.048 BACKGROUND: Chronic rhinosinusitis (CRS) is common worldwide but scarcely studied among young adults. The aim was to investigate prevalence, clinical features, comorbidity, and mucosal inflammatory patterns of CRS among 24-year-olds in a populationbased study.METHOD: 3037 subjects from the birth cohort BAMSE (Barn/children Allergy Milieu Stockholm Epidemiology) had complete questionnaire answers on CRS at the 24-year-follow-up. Subjects fulfilling the European Position Paper on Rhinosinusitis (EPOS) criteria of CRS at 16 and/or 24 years (n=141), were invited to a clinical examination. We examined 81 subjects. Sixty-eight subjects were included, of whom 40 had CRSsNP, 2 CRSwNP and 26 CRS symptoms only. Twenty-three controls without CRS from BAMSE were included. Nasal endoscopy was performed, IgE against airborne allergens and cytokine gene expression in nasal lavage (NAL) were analyzed. RESULTS: The questionnaire-based CRS prevalence was 4.1%, of which 2.2% was endoscopically verified. Sensitization to airborne allergens was more often seen among CRSsNP and “CRS symptoms only�, compared to controls. Among CRS subjects overall, the proportion of asthma, AR, atopic eczema, and sensitization to airborne allergens was significantly higher compared to the rest of the cohort. The gene expression of IL-1b and IL-8 in NAL was elevated among CRSsNP and “CRS symptoms only� compared to controls, with a trend for TNF-a and MPO. CONCLUSIONS: The prevalence of primary CRS was estimated to 2-4%. There was a significant association between CRS and atopic diseases in this age group. The NAL profile showed signs of type-1 inflammation.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39733293 Motion analysis for objective evaluation of psychomotor skills in Endoscopic Sinus Surgery 190 199 EN K. Miyaji Graduate School of Information Science and Technology, Hokkaido University, Sapporo, M. Suzuki Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan R. Watanabe Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan K. Matoba Department of Forensic Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan A. Nakazono Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan Y. Nakamaru Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan K. Ebina Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan　　　 T. Abe Department of Urology, Hokkaido University Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan D. Hinder Department of Surgery - Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia A.J. Psaltis Department of Surgery - Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia P.J. Wormald Department of Surgery - Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia A. Homma Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan A. Konno Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan 3250 10.4193/Rhin22.320 Background: This study aims to digitalize surgical maneuvers in ESS using a motion capture system under standardized conditions provided by 3D printed-sinus models. Methodology: Forty-seven otolaryngologists performed ESS on 3D printed models manufactured from computed tomography (CT) images of actual patients. Participants were classified to 3 groups according to the objective structured technical skills assessment score. All surgical maneuverers performed during ESS were captured by a motion capture system. The path length, velocity, acceleration, and jerk were calculated for each surgical instrument and compared among the groups. Principle Component Analysis (PCA) was utilized to identify which metrics reflected surgical skill level. In addition, ten registrars repeated the surgical dissection. Their motion metrics were also compared between first training and the repeated training and then subjected to the PCA. Results: Several metrics such as the angular acceleration and jerk of the cutting forceps were identified by PCA as possible indicators distinguishing the different skill levels for the ESS maneuvers. PCA analysis in the repetitive training also found the angular metrics of the upturned-cutting forceps correlating to their skill improvement. Conclusions: Combined with the validated 3D-printed sinus models, the motion capture system provided the objective evaluation of the surgical performances of ESS.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39733329 Validity and reliability of the Empty Nose Syndrome Index (ENSI) 200 208 EN J.R. Lechien 1 Research Committee of Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France; Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Division of Laryngology and Broncho-esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Department of Otorhinolaryngology and A. Maniaci Research Committee of Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France; Faculty of Medicine and Surgery, University of Enna Kore, Enna, Italy 3252 10.4193/Rhin24.394 Objective: To validate the French version of the Empty Nose Syndrome Index (Fr-ENSI). Methods: Patients with ENS, chronic rhinitis/rhinosinusitis, and asymptomatic individuals were recruited from April to August 2024. The internal consistency was evaluated with Cronbach-alpha. The test-retest reliability was assessed with the intraclass correlation coefficient (ICC). The external validity was assessed with a correlation study between the Fr-ENSI and the Sinonasal Outcome Tool-22 (Fr-SNOT-22), and Nasal Obstruction Symptom Evaluation (Fr-NOSE). The Fr-ENSI threshold for suspecting the ENS diagnosis was determined with the receiver operating characteristic (ROC) curve. Results: Ninety-three subjects completed the evaluations. There were 36 ENS patients, 23 patients with chronic rhinosinusitis/rhinitis, and 34 healthy individuals. The mean age was 44.8±14.7 years. Patients with ENS reported significantly higher Fr-ENSI scores compared to others, indicating high internal validity. The Cronbach-alpha of Fr-ENSI was 0.891, which indicates an adequate internal consistency. The test-retest reliability was high. Depression and anxiety scores were associated with sleep disturbances. The Fr-ENSI was significantly correlated with Fr-SNOT-22, which supports a high external validity. The threshold of Fr-ENSI associated with the highest sensitivity and specificity was >23/60. Conclusions: The Fr-ENSI is a valid and reliable questionnaire for documenting 12 prevalent symptoms of ENS. The consideration of sleep disorders in ENSI is important regarding its association with depression and anxiety.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39831842 Advanced paranasal sinuses osteomas: a retrospective multicentric analysis on surgical management outcomes and intra- and postsurgical complications 209 220 EN V. Rampinelli Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy M. Ferrari Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences (DNS), University of Padova, Italy; Unit of Otorhinolaryngology â€" Head and Neck Surgery, “Azienda Ospedale Università di Padovaâ€�, Padova, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Canada I. Dohin Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy A. Vinciguerra Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France D. Mattavelli Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy T. Saccardo Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences (DNS), University of Padova, Italy G. Testa Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy C. Conti Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy C. Frigerio Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy B. Verillaud Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France G. Ajasllari Unit of Otorhinolaryngology, American Hospital, Tirana, Albania P. Gaudioso Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences (DNS), University of Padova, Italy D. Cazzador Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences (DNS), University of Padova, Italy A. Aga Unit of Otorhinolaryngology, American Hospital, Tirana, Albania S. Taboni Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences (DNS), University of Padova, Italy A. Daniele Arioso Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy L. Neri Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy D. Borsetto Department of ENT Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK A. Wolf Private ENT clinic, Graz, Austria C. Rodriguez-Van Strahlen Hospital Clinic Barcelona, Rhinology and Skull Base surgery unit. Otorhinolaryngology M. Turri-Zanoni Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Department of Otorhinolaryngology, Department of Surgery, ASST Lariana, University of Insubria, Como, Italy E. Emanuelli Unit of Otolaryngology, AULSS 2-Marca Trevigiana, Treviso, Italy A. Schreiber Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy P. Battaglia Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy; Department of Otorhinolaryngology, Department of Surgery, ASST Lariana, University of Insubria, Como, Italy F. Pagella Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy M. Bignami Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy C. Piazza Unit of Otorhinolaryngology â€" Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy P. Castelnuovo Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy P. Nicolai Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences (DNS), University of Padova, Italy P. Herman Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France 3257 10.4193/Rhin24.165 BACKGROUND: This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit. METHODOLOGY: A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications. RESULTS: The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra-and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone. CONCLUSIONS: This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39820838 Association between psychophysically measured olfactory dysfunction and mental health status in long COVID patients 221 229 EN P. Boscolo-Rizzo Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy R. Zandonella Callegher Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy E. Cancellieri Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy L. Pellegrini Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste;Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom G. Tirelli Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy U. Albert Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste 3255 10.4193/Rhin24.295 BACKGROUND: Long COVID frequently presents with persistent olfactory dysfunction (OD), affecting both physical and psychological well-being. This study aims to evaluate the mental health consequences of OD in long COVID patients. METHODOLOGY: A cross-sectional study involved 86 adult patients. Participants presented OD for at least three months post-COVID- 19 and were evaluated using the extended battery of Sniffin’ Sticks test (SST). Psychological assessments included the Impact of Event Scale-Revised (IES-R), Beck Hopelessness Scale (BHS), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). RESULTS: Significant differences in mental health factors were observed between patients with and without OD: in comparison to normosmic patients, hyposmic patients showed higher IES-R Total, Avoidance, and Hyperarousal scores, along with increased DASS-21 Anxiety scores and BHS total scores. CONCLUSIONS: OD in long COVID patients were significantly associated with increased post-traumatic stress symptoms, anxiety symptoms and hopelessness, and with lower quality of life. Limited sample size, inability to determine causation and exploratory nature of the study may limit the generalizability of results. Comprehensive management addressing both physical and mental health should be assessed in long COVID patients.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39982171 Analysis of clinical characteristics of fungus ball based on the number of involved sinuses 230 236 EN T. Yang Department of Otolaryngologyâ€"Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, Beijing Institute of Otolaryngology, Beijing, China C. Liu Department of Otolaryngologyâ€"Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, Beijing Institute of Otolaryngology, Beijing, China Y. Wang Department of Otolaryngologyâ€"Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, Beijing Institute of Otolaryngology, Beijing, China J. Zhou Department of Otolaryngologyâ€"Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, Beijing Institute of Otolaryngology, Beijing, China Y. Li Department of Otolaryngologyâ€"Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, Beijing Institute of Otolaryngology, Beijing, China H. Wei Department of Otolaryngologyâ€"Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China, Beijing Institute of Otolaryngology, Beijing, China 3266 10.4193/Rhin23.501 BACKGROUND: Fungus ball (FB) typically presents unilaterally, with the maxillary sinus being the most commonly affected site.Multi-sinus FB cases are seldom discussed. METHODOLOGY: A retrospective study involving 1709 FB patients categorized them into single sinus fungus ball (SSFB), double sinus fungus balls (DSFB), and multiple sinus fungus balls (MSFB) groups for clinical analysis. RESULTS: The SSFB group comprised 1596 patients (93.39%), the DSFB group 111 patients (6.50%), and the MSFB group two patients (0.12%). The prevalence of diabetes mellitus in the DSFB group was higher than that in the SSFB group. A female prevalence was noticed and there was no difference in the sex ratio by age group. On computed tomography (CT), maxillary sinus FB group had higher intralesional hyperdensity than sphenoid sinus FB group. Oppositely, sphenoid sinus FB group had higher lateral sinus wall sclerosis than maxillary sinus FB group. CONCLUSIONS: DSFB occurs in a minority of cases but needs to be investigated especially in diabetics given the link between diabetes mellitus and increased DSFB risk. A female predominance is seen in both pre- and postmenopausal women. On CT, the presence of intralesional hyperdensity and lateral sinus wall sclerosis correlates with the location of the FB.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39676711 Hydration alters viscosity of nasal secretions in postnasal drip 237 238 EN S. Bucher Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland T.M.L. Friederici Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland Y. Stanossek Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland M.B. Soyka Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland 3248 10.4193/Rhin24.459 In our recent study, increased viscosity, delayed mucociliary clearance as well as hyposensitivity/dysesthesia of the nasopharynx seemed to play a relevant role in the pathophysiology of postnasal drip (PND). Earlier concepts of PND, regarding an increased volume of secretions and atopy, do not seem to hold true since our latest analyses showed no significant difference between cases and controls. However, to this day its therapy is debated and the evidence for an effective treatment of PND is lacking so far. The fundamental rheological properties of nasal mucus constitute of the viscosity and elasticity.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39982222 Remission in chronic rhinosinusitis with nasal polyps (CRSwNP) 239 241 EN P.W. Hellings Allergy and Clinical Immunology Research Unit, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium;Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Belgium E. De Corso UOC Otorinolaringoiatria, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italia V. Backer Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark M. Bernal-Sprekelsen Clinic Barcelona, University of Barcelona, Spain Y. Chan Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada D.M. Conti Allergy and Clinical Immunology Research Unit, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium; Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid. Calle Francisco Tomás y Valiente, nº 2. Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain M.E. Cornet Department of Otorhinolaryngology, Alrijne Hospital, the Netherlands W.J. Fokkens Department of Otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherlands P. Gevaert Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Belgium J. Han Department of Otolaryngology and Head and Neck Surgery, Eastern Virginia Medical School, Virginia, USA C. Hopkins Department of Rhinology and Skull Base Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK B.N. Landis Rhinology-Olfactology Unit, Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Geneva, Geneva, Switzerland S. Lau Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany S. Lee Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA V.J. Lund Royal National Ear, Nose and Eastman Dental Hospital, London, UK;Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals, UK J. Mullol Rhinology Unit; Smell Clinic, ENT Department, Hospital Clinic Barcelona; FRCB-IDIBAPS; Universitat de Barcelona; CIBERES. Barcelona, Catalonia, Spain A. Peters Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA S. Schneider Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria B. Senior Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA 3267 10.4193/Rhin24.457 Remission has recently been proposed as the new goal of care in CRSwNP or Nasal Polyp Syndrome by the European Forum for Research and Education in Allergy and Airway Diseases / European Position Paper on Rhinosinusitis and Nasal Polyps (EUFOREA/EPOS) as well as by global leaders in Rhinology. In CRSwNP, remission is defined as a prolonged state of control, without bothersome symptoms reported by the patient for at least 12 months, without the need for either oral corticosteroids or endoscopic sinus surgery (ESS), and without endoscopic signs of active disease. This new goal of care is to be encouraged by the ENT community and CRSwNP patients as persistent symptoms unalleviated by historical approaches can be reduced by new therapies including biologics. The goal of therapy for CRSwNP has long been to achieve control, with Visual Analogue Scale (VAS) and Sino-Nasal Outcome Test (SNOT-22) scores guiding physicians towards a step-up treatment aiming for control.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 40042485 Pocket guide: biologics in upper and lower airways in adults 242 244 EN W.J. Fokkens Amsterdam UMC, University of Amsterdam, Department of Otorhinolarynogology, Amsterdam, the Netherlands V. Backer Department of Otorhinolaryngology, Head and Neck surgery and Audiology, Rigshospitalet, Copenhagen University Hospitalet, Copenhagen, Denmark V.J. Lund University College London, London, United Kingdom; Royal National Throat Nose and Ear Hospital, UCLH, London, United Kingdom P.J. Barnes Royal National Heart and Lung Institute, Imperial College London, London, United Kingdom M. Bernal-Sprekelsen Hospital Clinic, Barcelona, University of Barcelona, Spain L. Bjermer Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden E. de Corso UOC Otorinolaringoiatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy D.M. Conti The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members M.E. Cornet Department of Otorhinolaryngology, Alrijne Hospital, Leiden, the Netherlands Z. Diamant Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, the Netherlands R. Djukanovic School of Clinical and Experimental Sciences, Medical Faculty, University of Southampton and NIHR Southampton Biomedical Research Centre, Southampton, United Kingdom M. Gaga 1st Respiratory Medicine Department, Hygeia Hospital, Marousi, Greece P. Gevaert Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium J.K. Han Department of Otolaryngology and Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA C. Hopkins King's College London, London, United Kingdom G. Joos Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences at Ghent University, Belgium B.N. Landis Unité de Rhinologie-Olfactologie, Service d'Oto-Rhino-Laryngologie et de Chirurgie cervico-faciale, Hôpitaux Universitaires de Genève, Geneve, Switzerland S. Lau Charité Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany S.E. Lee Division of Otolaryngology â€" Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain A.T. Peters Department of Medicine, Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA G.K. Scadding Department of Allergy and Rhinology, Royal National ENT Hospital,London, United Kingdom, Division of Immunity and Infection, University College, London, United Kingdom S. Schneider Department of Otorhinolaryngology â€" Head and Neck Surgery, Medical University of Vienna, Austria B. Senior Harold C Pillsbury, III Distinguished Professor of Otolaryngology, Chief, Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA I.D. Pavord Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom S. Quirce Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain D. Ryan AUKCAR, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom M.E. Wechsler Department of Medicine, National Jewish Health, Denver, CO, USA P.W. Hellings The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members; Department of Otorhinolaryngology - Head and Neck Surgery, University Hospitals, Leuven, Belgium; Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium 3272 10.4193/Rhin24.510 The introduction of biologics for the treatment of severe upper and lower (type 2) airway inflammation has been a game changer in the management of these diseases. Biologics are injectable medications targeting different molecules relevant in (type 2) inflammation in patients with severe (type 2) airway diseases, like asthma, eosinophilic chronic obstructive pulmonary disease (COPD), chronic rhinosinusitis (CRS) and those who remain uncontrolled despite regular treatment. After the phase 3 trials, showing significant impact on symptoms, quality of life and interventions like surgery (for the upper airways) and exacerbations needing hospitalisation (for the lower airways), biologics are now used in daily practice in many parts of the world. This pocket guide is aimed at all specialists treating adult patients with severe airway disease.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39806809 Patient preferences for treatment of chronic rhinosinusitis with nasal polyps 245 247 EN J. Sutphin Duke Clinical Research Institute, Duke University, Durham, NC, USA S. Okafor Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA S.D. Reed Duke Clinical Research Institute, Duke University, Durham, NC, USA A. Deb Value Evidence and Outcomes, GSK, Upper Providence, PA, USA J. Silver Medical Affairs, GSK, Durham, NC, USA M.J. Wallace Duke Clinical Research Institute, Duke University, Durham, NC, USA J.-C. Yang Duke Clinical Research Institute, Duke University, Durham, NC, USA R. Abi Hachem Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA D.W. Jang Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, USA 3253 10.4193/Rhin24.475 Choosing between revision endoscopic sinus surgery (ESS) versus biologic therapy for recurrent chronic rhinosinusitis with nasal polyposis (CRSwNP) is a complex, multifaceted decision that involves not only clinical and financial factors but also patient preferences. Currently, there are no quantitative studies investigating patient preferences for CRSwNP treatment options. Increased awareness of patient-centered approaches to treatment warrant further investigation.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39862127 Validation of the Sino-Nasal Outcome Test-25 (SNOT-25) measure for patients with nasal septal perforation 248 249 EN S.P. Williams Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom S.C. Leong Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom 3259 10.4193/Rhin24.443 Nasal septal perforations (NSPs) are a common referral to specialist rhinology practice. A wide range of management options have been described but to be able to offer the most effective treatment modalities to our patients we must be able to capture quantitative data on patient symptom burden accurately and robustly.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39968850 Radial intralesional linear calcifications and focal hyperostosis: key points for diagnosis, extension and point of origin identification of sinonasal inverted papilloma 250 252 EN E. Granell Department of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain A. Cardesin Department of Otolaryngology/Head and Neck Surgery, Hospital Parc Taulí de Sabadell, Spain D. Pallarés Department of Radiology, Hospital Parc Taulí de Sabadell, Spain R. Sánchez Department of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain J.R. Gras Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Spain 3264 10.4193/Rhin24.379 Sinonasal inverted papilloma (IP) often appears as a unilateral sinonasal soft-tissue mass with varying enhancement, often accompanied by bone remodelling, intralesional calcifications, focal hyperostosis, and cone-shaped bone thickening (observed in 60 to 80% of cases). A non-contrast sinonasal CT scan may reveal a soft tissue polypoid mass that closely resembles inflammatory polyps. While hyperostosis is recognized as a marker of the tumor's point of origin, intralesional calcifications are less frequently described but may offer valuable insights. Early studies, such as those by Lund and Lloyd, highlighted the presence of intralesional calcifications as a distinct feature of inverted papilloma, a finding later supported by studies emphasizing the role of bone morphogenic proteins in calcification development.

International Rhinologic Society Rhinology 0300-0729 63 2 2025 4 1 39365314 Ligation of anterior ethmoidal artery nasal branch: anatomical-based management of recalcitrant epistaxis 253 255 EN A. Vinciguerra Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France A. Daloiso Unit of Otorhinolaryngology and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy I. Dohin Unit of Otorhinolaryngology and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy F. Boaria Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France M. Marc Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France M. Ferrari Unit of Otorhinolaryngology and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy B. Verillaud Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France F. Chatelet Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France P. Herman Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France 3223 10.4193/Rhin24.317 Recurrent epistaxis, despite conservative therapies (i.e. nasal packing or direct vessel coagulation), is generally treated with ligation of the sphenopalatine artery (SPA). Indeed, the rationale behind SPA ligation lies in its ability to disrupt arterial blood supply to the nasal mucosa, thereby reducing the likelihood of recurrent bleeding episodes (1). Nevertheless, in some cases, nosebleeds persist despite appropriate SPA ligation, opening discussion of the anterior ethmoidal artery (AEA) contribution in recalcitrant epistaxis that, for some authors, is up to 28.8% (2). From an anatomical point of view, the AEA leaves the orbital cavity and passes the ethmoidal roof through the ethmoidal canal, before entering inside the anterior cranial fossa via the lateral lamella (3). Endocranially, the AEA gives posterior branches which vascularize the anterior cribriform plate, whereas its many trunk continues anteriorly and divides into two branches: the anterior meningeal branch, and a second vessel that enters inside the nasal fossa through the cribroethmoidal foramen located 2.86 ± 1.93 mm (range, 1-7 mm) (4) anteriorly to the first olfactory phylum, giving rise to the so-called nasal branch (NbAEA) (5).