International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40517302 Rhinology â€" What else? 257 257 EN B.N. Landis Department of Otolaryngology, University of Geneva Medical School and Geneva University Hospitals, Geneva, Switzerland 3302 10.4193/Rhin25.903

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40062682 Comparison of outcomes for Draf IIB vs Draf III in endoscopic frontal sinus surgery: a comprehensive systematic review and meta-analysis 258 285 EN Y. Hirayama Department of Otolaryngology, University Hospitals Birmingham, NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, United Kingdom M.S. Shahid Aga Khan University, Aga Khan University Hospital, Karachi, Sindh, Pakistan H.A. Finney Department of Otolaryngology, University Hospitals Birmingham, NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, United Kingdom J. Muzaffar Department of Otolaryngology, University Hospitals Birmingham, NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, United Kingdom M.S. Haque Department of Applied Health Science, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom R. Accorona Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy H. Iftikhar Department of Otolaryngology, University Hospitals Northamptonshire, Cliftonville, Northampton, United Kingdom 3275 10.4193/Rhin24.507 BACKGROUND: Understanding the factors associated with increased rates of restenosis following Draf procedures is crucial for developing targeted strategies to mitigate complications such as mucocele formation, reduce the need for revision surgeries, and improve long-term patient outcomes. METHODOLOGY: A systematic search was conducted using Embase, Medline, CINAHL, AMED, PubMed, and the Cochrane Database on January 17th, 2024. Research articles published in English language were included. Abstracts were independently screened by two reviewers, and data were extracted and assessed for quality in adherence to PRISMA guidelines. Meta- and sub-group analyses were conducted using the REML model and random-effects model to address high heterogeneity and I² values. RESULTS: A total of 96 studies met the inclusion criteria. For the Draf IIB subgroup (15 studies, 239 sinuses), the restenosis rate was 7%, compared to 20% in the Draf III subgroup (40 studies, 1,910 sinuses). Revision surgery rates were 5% for Draf IIB versus 12% for Draf III. Adjuvant interventions, such as steroid-impregnated stents, were associated with improved outcomes, showing an ostium patency OR of 2.20. CONCLUSION: Draf IIB had superior outcomes compared to Draf III with respect to restenosis and revision surgery. The use of steroid-impregnated stents appears effective in reducing restenosis rates.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40202087 Traditional herbal medicine in the treatment of acute and chronic rhinosinusitis: a systematic review 286 305 EN K. Choulakis Departement of Otorhinolaryngology, General Hospital of Athens “G.Gennimatas”, Athens, Greece A. Karatzanis Department of Otorhinolaryngology, University of Crete Medical School, Greece C. Skoulakis Department of Otorhinolaryngology Neurology and Sensory Organs, University of Thessaly, Greece I.M. Vlastos Departement of Otorhinolaryngology, Evangelismos General Hospital of Athens, Athens, Greece E. Prokopakis Department of Otorhinolaryngology, University of Crete Medical School, Greece 3276 10.4193/Rhin23.526 BACKGROUND: Traditional medicine and herbal medicine are relatively commonly utilized by patients for the treatment of acute (ARS) and chronic rhinosinusitis (CRS). The aim of this study is to review the literature to evaluate scientific evidence regarding the use of herbal preparations in the treatment of rhinosinusitis.METHODOLOGY: We reviewed all published studies until February 2024 in PubMed, EMBASE, and Cochrane, using the followingkeywords: herbal medicine and nasal diseases, herbs and nasal diseases, Traditional Chinese Medicine (TCM) and nasal diseases, traditional medicine and nasal diseases, phytotherapy and nasal diseases. Results: Thirty-three clinical studies met the purpose of this review and were assessed. These studies examine the effect of eleven herbal preparations for the treatment of ARS and CRS. Conclusions: Herbal preparation BNO-1016 presents significant evidence in the literature regarding its use in the treatment of ARS, while the TCM preparation Xiangju might be a useful component in the treatment of CRS. Specific traditional herbal medicinal products, therefore, show promising results for the treatment of rhinosinusitis, and their use should be examined further. Given the relatively high demand for medicinal herbs, therapeutic use of those preparations should be explored further.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40042569 Caudal septoplasty, a literature review 306 315 EN A. Javed Department of Otolaryngology, University Hospitals Birmingham, United Kingdom A. Alburaiki Department of Otolaryngology, University Hospitals Birmingham, United Kingdom A. Kamber Zaidi Department of Otolaryngology, University Hospitals Birmingham, United Kingdom M.U. Farooq Department of Otolaryngology, University Hospitals Birmingham, United Kingdom J. Limbrick Department of Otolaryngology, University Hospitals Birmingham, United Kingdom S. Anari Department of Otolaryngology, University Hospitals Birmingham, United Kingdom 3274 10.4193/Rhin24.415 BACKGROUND: Caudal septal deviation accounts for around five percent of patients with septal deviations that require surgery. The caudal septum provides support to the nasal tip and the deviations can narrow the nasal airway and lead to marked asymmetry in nostril shape. Over-resection of this area can compromise the structural support leading to tip collapse or saddle nose deformity. This necessitates alternative techniques to submucosal resection for surgical correction of caudal septal deviations. METHODOLOGY: This study provides a review of different surgical techniques, including open and closed septoplasty in the literature to address caudal septal deviation. Each technique is described along with a surgical illustration, its advantages, limitations, and examples of case studies with surgical outcomes. RESULTS: The submucosal resection is a commonly used method but can only be used if the septal deviation is not involving the L-strut. Other methods include scoring, swinging door, doorstop, and suturing techniques either as a stand-alone or used combined with cutting techniques. Batten graft can be used alone or in conjunction with the other methods. Extracorporeal septoplasty is used in cases of severe deformity. CONCLUSIONS: There is a variety of methods to address caudal septal deviation. Correcting the caudal septal deviation requires proper pre-operative planning and accurate execution of surgical techniques. More research on surgical outcomes is needed to improve the evidence base.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40202121 Effect of biological treatment in uncontrolled severe chronic rhinosinusitis with nasal polyps in Belgium: a multicentre real-world data study 316 324 EN A-S. Viskens KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium;Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium L. Bollens Faculty of Medicine, KU Leuven, Leuven, Belgium E. Borgers Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium S. Halewyck Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium V. Hox Department of Otorhinolaryngology, University Hospital Saint-Luc, Brussels, Belgium M. Jorissen Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium;Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium W. Lemmens Department of Otorhinolaryngology, hospital Oost-Limburg, Genk, Belgium F. Rogister Department of otorhinolaryngology, CHU de Liège, Belgium K. Speleman Department of Otorhinolaryngology, General hospital Sint-Jan Bruges, Bruges, Belgium L. Van Gerven KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium;Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium O. Vanderveken Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium;Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium B. Verhaeghe Department of Otorhinolaryngology, Onze Lieve Vrouw hospital Aalst, Belgium A. Vroegop Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium;Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium K. Martens KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium P.W. Hellings KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium;Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium 3278 10.4193/Rhin24.509 BACKGROUND: Double-blinded placebo-controlled trials have revealed the efficacy of mepolizumab and omalizumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, real-world efficacy (RWE) data, data on therapeutic response and level of disease control for both biologicals are lacking. METHODOLOGY: 167 patients with uncontrolled severe CRSwNP, meeting national reimbursement criteria, were included with follow-up over 24 weeks. Primary outcomes included changes in nasal congestion (NCS), nasal polyp score (NPS), VAS-scores, SNOT-22, ACQ-5, and AQLQ scores. Secondary outcomes were therapeutic response and disease control according to EUFOREA/EPOS criteria. RESULTS: Of the 167 CRSwNP patients, 144 received mepolizumab and 23 omalizumab. After 24 weeks, Patient reported outcomes and NPS significantly improved for both biologicals, with significant effects seen at 12 weeks, with further reduction in NPS by 24 weeks in mepolizumab patients. 74% of patients on omalizumab and 81% of patients on mepolizumab continued their therapy beyond 24 weeks, with 47% and 45% of patients on omalizumab and mepolizumab respectively showing an excellent therapeutic response, with only one out of seven having no/poor response. Disease control was reached in one third of the patients at 24 weeks. CONCLUSIONS: Both mepolizumab and omalizumab significantly improved patient-reported outcomes after 24-weeks, with major effects already observed at 12 weeks. Follow-up beyond 24-weeks might reveal additional effects on both control and remission.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40202093 Olfactory training for the treatment of COVID-19 related smell loss: a randomised double-blind controlled trial 325 333 EN T.L.I. Serrano Department of Ophthalmology and Otorhinolaryngology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil M.A. Antonio Department of Ophthalmology and Otorhinolaryngology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil L.T. Giacomin Department of Ophthalmology and Otorhinolaryngology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil A.M. Morcillo Department of Paediatrics, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil J. Dirceu Ribeiro Department of Paediatrics, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil E. Sakano Department of Ophthalmology and Otorhinolaryngology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil 3277 10.4193/Rhin24.081 BACKGROUND: Olfactory training is the most widely recommended treatment for smell loss; however, there are no randomised placebo-controlled trials evaluating its effectiveness in COVID-19. We aimed to evaluate the efficacy of isolated training and factors associated to olfactory recovery. METHODS: This is a prospective randomised double-blind controlled trial, using standard olfactory training (OT) and placebo (PB) in COVID-19 patients experiencing smell loss. They were followed up for 180 days and assessed with the Connecticut olfactory test (CCCRC) and with subjective methods on a monthly basis. RESULTS: A total of 123 participants completed follow-up: 68 in the OT group and 55 in the PB group. Overall, 84.5% achieved normosmia, with full recovery (FR) significantly higher in PB. At baseline, OT had lower olfactory scores and higher corticosteroid use. Multivariate analysis showed no significant differences in outcomes between groups. Baseline olfactory test scores were the strongest predictors of recovery. Exploratory analyses stratified participants by time to treatment initiation (early ≤ 30 days; late > 30 days), showing a 58% higher chance of FR in the early group for similar CCCRC scores, regardless of management type. CONCLUSIONS: OT is not superior to PB for treating COVID-19-related smell loss. Better results of first evaluation indicate great chance of full recovery and the use of systemic corticosteroid, in persistent olfactory loss, has not affected outcome.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40257240 Prevalence and recovery rate of persistent olfactory dysfunction in COVID-19: the COVORTS study 334 342 EN B. van Dijk Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands E.M. Postma Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands; ENT Department, Hospital Gelderse Vallei, Ede, the Netherlands W.M. Boek ENT Department, Hospital Gelderse Vallei, Ede, the Netherlands D.M.A. Kamalski Department of Otorhinolaryngology Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands S. Boesveldt Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands 3284 10.4193/Rhin24.331 BACKGROUND: Olfactory dysfunction is a well-recognized symptom of COVID-19 infection. However, prevalence and recovery rate of these persistent symptoms differ across reports. Here, we report prevalence and recovery rate of psychophysically measured quantitative olfactory dysfunction, qualitative complaints, and subjective olfactory functioning up to 15 months after infection. METHODOLOGY: The COVORTS cohort included 76 patients between 18-60 years with recent (1 month) olfactory dysfunction. The (extended) Sniffin’ Sticks test was performed at baseline (T1), and 3 months, 6 months, 9 months, and 12 months later (T13). Monthly online questionnaires were completed on self-reported overall olfactory functioning and qualitative complaints. RESULTS: Prevalence of quantitative olfactory dysfunction was 89.5% at baseline, and 69.1% at T13. Clinically relevant recovery was achieved by 29.4% of patients at T13. Prevalence of parosmia remained around 50%, while phantosmia slowly decreased from 43.4% to 23.5%. Subjective olfactory functioning slowly improved over time before levelling out at around half of pre-illness ability. At T13, 37.9% of patients reported an improvement of at least 80% of pre-COVID function. Fluctuations were observed within individuals for all three measurements. CONCLUSIONS: Irrespective of measurement method, prevalence of olfactory dysfunction remains high up to 15 months after infection, and recovery rate is low. Individual fluctuations were observed between timepoints, indicating that recovery is not stable. Acknowledgement of symptoms, knowledge of fluctuations, and longer follow-up to evaluate further recovery are crucial to improve patient management.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40249916 Mepolizumab in severe uncontrolled CRSwNP: a real-life multicentre study in Northeast Italy 343 352 EN G. Ottaviano Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy G. Roccuzzo Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy T. Saccardo Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy L.G. Locatello Department of Otorhinolaryngology, University Hospital "Santa Maria Della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy S. De Rossi ENT Unit of Legnago “Mater Salutis” Hospital, Legnago (VR), Italy A. De Massimi ENT Unit of San Vito al Tagliamento Hospital, San Vito al Tagliamento (PN), Italy E. Rigoni ENT Unit of Feltre Hospital Feltre (BL), Italy R. Marangoni ENT Department, Hospital of Rovigo, Rovigo, Italy L. Lora ENT Department, ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre-Venezia, Italy L. Calvanese ENT Unit, Department of Surgery, Ospedali Riuniti Padova Sud, 35043 Monselice (PD), Italy M. Schiappoli Allergy Unit and Asthma Center of Verona University Hospital, Verona, Italy L. Pierotello ENT Department, Hospital of Cittadella, Padua, Italy S. Munari ENT Consultant, Head and Neck Department, ULSS 2 Marca Trevigiana, Treviso, Italy M. Baldovin ENT Unit, Ospedale San Martino, Belluno, ULSS1 Dolomiti F. CorlianÃ˛ Department of Otolaryngology Head and Neck Surgery, San Bassiano Hospital, Via Dei Lotti 40, 36061 Bassano Del Grappa, Italy I. Barbarino ENT Unit of Legnago “Mater Salutis” Hospital, Legnago (VR), Italy S. Santini Department of Otorhinolaryngology, University Hospital "Santa Maria Della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy S. Zampollo Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy K. Pacaj Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy B. Scarpa Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita University of Padova, Padova Italy P. Nicolai Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy 3283 10.4193/Rhin24.420 BACKGROUND: The aim of this study was to evaluate the efficacy of mepolizumab as add-on therapy to intranasal corticosteroids for the treatment of severe, uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in a real-life setting in the Triveneto region of northeast Italy. METHODS: Patients with severe CRSwNP receiving mepolizumab were followed up at 1, 3, 6, 9 and 12 months from the first administration. At baseline and at each follow-up, patients underwent nasal endoscopy, completed the Sinonasal Outcome Test 22, Visual Analogue Scales for smell, nasal obstruction, rhinorrhoea and facial pain, the Nasal Congestion Score and the Asthma Control Test. Peak nasal inspiratory flow, Sniffin’ Sticks Identification Test and blood eosinophil count were also evaluated. RESULTS: Ninety patients from twelve different rhinological units were enrolled in the study. Both patient- and physician- derived outcome measures significantly improved within the first month after biological treatment initiation, maintaining the benefit at subsequent follow-ups. Nine percent of patients discontinued the treatment due to lack of benefit within the first year. No major adverse events were reported. CONCLUSIONS: Mepolizumab is effective in improving nasal obstruction and the sense of smell in patients with severe uncontrolled CRSwNP, based on both patient- and physician derived outcome measures.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40215396 Mouse model of Staphylococcus aureus- and Pseudomonas aeruginosa-induced neutrophilic chronic rhinosinusitis 353 362 EN A. SÃˇnchez-Montalvo Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Microbiology, Allergy and Clinical Immunology Research Group, Immunology and Transplantation, KU Leuven, Leuven, Belgium A. Ziani-Zeryouh Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium M. Lecocq Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium B. Steelant Department of Microbiology, Allergy and Clinical Immunology Research Group, Immunology and Transplantation, KU Leuven, Leuven, Belgium S. Gohy Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium;Department of Pneumology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;Cystic Fibrosis Reference Centre, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium P. Hellings Department of Microbiology, Allergy and Clinical Immunology Research Group, Immunology and Transplantation, KU Leuven, Leuven, Belgium;Clinical Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium D. Bullens Department of Microbiology, Allergy and Clinical Immunology Research Group, Immunology and Transplantation, KU Leuven, Leuven, Belgium;Clinical Division of Paediatrics, UZ Leuven, Leuven, Belgium C. Pilette Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium;Department of Pulmonology, Cliniques Universitaires Saint-Luc, Brussels, Belgium V. Hox Pole of Pneumology, ORL (airways) and Dermatology (skin) (LUNS), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium;Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium 3279 10.4193/Rhin24.545 Background: Chronic rhinosinusitis (CRS) is a highly prevalent upper airway disease. Its pathogenesis remains poorly understood, especially non-eosinophilic CRS. Currently, no validated mouse model exists to study disease mechanisms, indicating an important research gap. We aimed at establishing a reproducible mouse model of non-eosinophilic CRS to allow further research on its pathophysiology. Methodology: Mice were infected with relevant bacteria for sinus disease via surgical insertion of a nasal tampon in their nasal cavity. Inflammatory features in sinus mucosa were evaluated after 4, 8 and 12 weeks on decalcified skulls by histology and immunohistochemistry and by cytospins and enzyme-linked immunoassay on nasal lavage. Results: S. aureus-inoculated mice showed better survival than S. pneumoniae- and P. aeruginosa- inoculated mice. S. aureus and, to lesser extent, P. aeruginosa were still detectable in the nasal lavage up to 12 weeks. Mice with S. aureus and P. aeruginosa-induced CRS showed significant hypertrophia of the epithelium, neutrophilic infiltration and fibrosis in the sinus mucosa, with increased non-Type 2 cytokines in the nasal lavage. Conclusions: S. aureus and P. aeruginosa are more potent inducers of neutrophilic inflammation than S. pneumoniae in mice. This model allows us to further study non-eosinophilic chronic rhinosinusitis pathophysiology in vivo.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40226901 Integrating pretreatment 18F-FDG PET-CT parameters, peripheral blood indicators and clinical characteristics in predicting chemotherapy plus immunotherapy outcomes for de novo metastatic nasopharyngeal carcinoma 363 372 EN L-w. Gu Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China Y-c. Li Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China S-y. Xue Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China B-b. Xiao Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China D-x. Wen Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China L-p. Wu Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China X. Zhang Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China L-q. Tang Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China L. Guo Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China L-t. Liu Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China 3280 10.4193/Rhin24.547 BACKGROUND: To develop a prognostic nomogram based on pretreatment 18F-FDG PET-CT radiomics parameters, peripheral blood indicators and clinical characteristics for risk stratification in patients with de novo metastatic nasopharyngeal carcinoma (dmNPC) receiving immunochemotherapy. METHODOLOGY: The eligible patients were randomly divided into training (n=183) and validation (n=79) cohorts. Least absolute shrinkage and selection operator regression was used for variable selection. Multivariate Cox regression analysis was performed to identify independent prognostic factors for progression-free survival (PFS). The predictive accuracy and discriminative ability of the nomogram were determined with a concordance index (C-index) and calibration curve. RESULTS: Multivariate Cox analysis suggested that total lesion glycolysis, number of metastases, Epsteinâ€"Barr virus DNA, N-stage, lactate dehydrogenase, and total bilirubin were independent predictors of PFS and were used to develop a nomogram that could classify patients into low- and high-risk groups. The C-index of the nomogram for predicting disease progression was 0.75, which was significantly higher than the C-indices of the TNM stage and EBV DNA. The patients were then stratified into low- and high-risk groups based on the calculated scores. The median PFS was significantly higher in the low-risk group than in the high-risk group. CONCLUSIONS: The proposed nomogram with PET-CT parameters, peripheral blood indicators and clinical characteristics resulted in accurate prognostic prediction for patients with dmNPC receiving chemotherapy plus PD-1 inhibitors and could provide risk stratification for these patients.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40226907 High-HDAC7 expression related to poor prognosis in sinonasal mucosal melanoma 373 382 EN D. Zheng Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China C. Liu Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China;Department of Otolaryngology, Head and Neck Surgery, The First People's Hospital of Xiangtan City, Xiangtan, China X. Pu Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China X. Deng Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China Y. Chen Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China S. Li Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China 3281 10.4193/Rhin24.463 BACKGROUND: Sinonasal mucosal melanoma (SNMM) is a rare malignant melanoma. Histone deacetylase 7 (HDAC7) is involved in the development of various tumours, but its function in SNMM remains underexplored. METHODOLOGY: We retrospectively studied 30 patients with SNMM treated between 2013 and 2023. Immunohistochemistry was used to assess HDAC7, β-catenin, c-Myc, and Ki-67 expression. Relationships among HDAC7 expression, clinical characteristics, prognosis, β catenin, c-Myc, and Ki-67 were analysed. RESULTS: HDAC7 was overexpressed in SNMM tissues compared to normal tissues. Expression was higher in stage IV compared to stage III and in T4 grade compared to T3 grade. The median overall survival (OS) was 29 months, with 8 patients alive. High-HDAC7 expression (in 13 patients) correlated with poorer OS and disease-free survival (DFS). HDAC7’s carcinogenic role in SNMM may be mediated by β-catenin/c-Myc. Univariate analysis for OS revealed high-HDAC7, high c-Myc, positive surgical margins, T4 grade, and stage IV were significant factors leading to SNMM's poor prognosis. However, HDAC7 expression was the only independent prognostic factor. Additionally, a nomogram model showed promising results but was not validated in another cohort. CONCLUSIONS: High-HDAC7 expression is associated with advanced T grade, clinical stage, and poor prognosis in SNMM. HDAC7 may influence cell proliferation, invasion and migration by activating the Wnt/β-catenin/c-Myc signalling pathway.

International Rhinologic Society Rhinology 0300-0729 63 3 2025 6 1 40042513 Safety and feasibility of the endoscopic endonasal approach to anterior skull base tumour resections in young children 383 384 EN M. Castellanos Department of Otolaryngology â€" Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA D.K. Lerner Department of Otolaryngology â€" Head and Neck Surgery, University of Miami, Miami, FL, USA S.A. Hamimi Department of Otolaryngology â€" Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA A.D. Workman Department of Otolaryngology â€" Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA J.E. Douglas Department of Otolaryngology â€" Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA M.A. Kohanski Department of Otolaryngology â€" Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA P.B. Storm Department of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA J.N. Palmer Department of Otolaryngology â€" Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA N.D. Adappa Department of Otolaryngology â€" Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA 3273 10.4193/Rhin24.494 Tumours of the anterior skull base present unique surgical challenges due to critical neurovascular proximity and developing cranial anatomy. While open transcranial approaches (TCAs) have traditionally been used for these tumors, the endoscopic endonasal approach (EEA) is preferred due to reduced morbidity and higher gross total resection (GTR) rates. Studies report excellent GTR rates and reconstructive outcomes with EEA in the under-18 paediatric population, with complications including cerebrospinal fluid (CSF) leak, meningitis, and stroke being relatively rare. However, limitations in anatomy, including restricted sphenoid pneumatization, narrower nasal apertures, and smaller nasoseptal flaps (NSFs), contribute to hesitancy in adopting EEA for younger patients. Minimal evidence focuses on outcomes in young pediatric patients in particular. This study evaluates outcomes of EEAs for anterior skull base pathologies in young paediatric patients.