International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 42117564 The future of endoscopic sinus surgery in chronic rhinosinusitis 289 289 EN B.N. Landis Geneva, Switzerland 3454 10.4193/Rhin26.903 The new issue of Rhinology reflects the wide range of topics covered by our field, spanning epistaxis, fungal sinusitis, and olfaction, as well as tissue biomarkers that characterize inflammatory processes. As always, the studies are insightful, methodologically sound, and offer new perspectives for the treatment of the diseases that occupy rhinologists. Continuous progress in our field promises considerable benefits for our patients.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41574646 Targeted biologics for chronic rhinosinusitis with nasal polyps: efficacy and safety comparison of eight monoclonal antibodies via network meta-analysis 290 300 EN X. Wang Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;Shaanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China P. Ren Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;Shaanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China H. He Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China J. Zhao Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;haanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China Y. Xin Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;haanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China H. Wang Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;haanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China X. Ren Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;haanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China K. Zhu Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;haanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China J. Chen Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi’ an, China;haanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi’ an, China 3423 10.4193/Rhin25.395 BACKGROUND: Biologics targeting key type 2 inflammatory mediators (e.g., IL-4Rα, IgE, IL-5, TSLP) represent a novel therapeutic approach for chronic rhinosinusitis with nasal polyps (CRSwNP). This network meta-analysis (NMA) aimed to compare the efficacy and safety of eight monoclonal antibodies for CRSwNP. METHODOLOGY: We systematically searched PubMed, Embase, Web of Science, CENTRAL Cochrane, and MEDLINE for randomized controlled trials (RCTs) comparing monoclonal antibodies with placebo CRSwNP. A Bayesian Network meta-analysis (NMA) was performed using the R gemtc package. RESULTS: Sixteen RCTs (n=2,034) evaluating eight monoclonal antibodies were included. All biologics significantly reduced Nasal Polyp Score (NPS); stapokibart (anti-IL-4Rα) ranked first. Both dupilumab and stapokibart improved the University of Pennsylvania Smell Identification Test (UPSIT) score, indicating a recovery of olfactory function. Dupilumab led in improving Sino-Nasal Outcome Test-22 (SNOT-22) scores, whereas stapokibart was most effective in relieving nasal congestion score (NCS). The risk of adverse events was comparable to placebo across all biologics, with GR1802 exhibiting the most favorable safety. CONCLUSIONS: All evaluated biological agents demonstrated efficacy superior to placebo, with IL-4 receptor alpha inhibitors showing the largest and most consistent benefits. All treatments exhibited favorable safety profiles, supporting their use for long-term management of CRSwNP.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41785015 Global distribution of fungal rhinosinusitis 301 311 EN S. Zhou Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Key Laboratory of Microbiology and Parasitology of Education Department of Guizhou, School of Public Health, School of Basic Medical Science, Guizhou Medical University, Guiyang, China; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Radboudumc-CWZ Center of Expertise for Mycology, Radboudumc, Nijmegen, The Netherlands R. Kwizera Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda F. Bongomin Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda;Manchester Fungal Infection Group, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom L. Okema Division of Otorhinolaryngology, Department of Surgery, Faculty of Medicine, Gulu University, Gulu, Uganda J. Okot Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda E.M. Alcanzo Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands B.E. Ekeng Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria Y. Kang Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Key Laboratory of Microbiology and Parasitology of Education Department of Guizhou, School of Public Health, School of Basic Medical Science, Guizhou Medical University, Guiyang, China D.W. Denning Manchester Fungal Infection Group, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom S. de Hoog Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education of Guizhou, Key Laboratory of Microbiology and Parasitology of Education Department of Guizhou, School of Public Health, School of Basic Medical Science, Guizhou Medical University, Guiyang, China; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Radboudumc-CWZ Center of Expertise for Mycology, Radboudumc, Nijmegen, The Netherlands; Foundation Atlas of Clinical Fungi, Hilvers S.A. Ahmed Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait 3438 10.4193/RhinBackground: Fungal rhinosinusitis (FRS) comprises BACKGROUND: Fungal rhinosinusitis (FRS) comprises subtypes with varying epidemiology and outcomes. Global comparative data remain limited. METHODS: Following PRISMA guidelines (CRD42023481670), a systematic review and meta-analysis was conducted. Cases were categorized into seven subtypes to assess variation across regions. RESULTS: 2,031 studies (40,860 cases, 77 countries) were included. Non-invasive forms accounted for 60% (n=24,582) of cases, mainly fungal ball (35%, n=14,280) and allergic FRS (25%, n=10,302). Invasive subtypes were more frequent in tropical climates, with the hyperacute rhino-orbito-cerebral mucormycosis predominating. This subtype differed from acute and subacute invasive FRS in risk factors (diabetes and COVID-19 vs. leukemia) and geography. Aspergillus species appeared in ~60% of cases: A. fumigatus dominated in temperate/continental zones, while A. flavus was frequent in dry/tropical regions. Non-invasive FRS showed high surgical cure rates (>64%), whereas invasive forms had substantial morbidity and mortality. CONCLUSIONS: FRS represents a substantial yet underrecognized global health concern. Non-invasive forms are predominating, while invasive subtypes cause major morbidity and mortality, especially in tropical regions. Notably, our findings reveal distinct geographic and climatic preferences for Aspergillus species: A. fumigatus in temperate/continental zones and A. flavus in dry/tropical regions. This ecological divergence underscores the importance of environmental surveillance and climate-informed diagnostic strategies.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 38971976 Work-related musculoskeletal disorders in endoscopic sinus and skull base surgeons: an international survey 312 326 EN R.G Campbell Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia;Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia;Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia J.R. Zadro Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia C.L. Chan Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia M.G. Mackey Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia A. Nettel-Aguirre School of Social Sciences, University of Wollongong, Australia;School of Social Sciences, University of Wollongong, Australia R.G. Douglas Department of Surgery, University of Auckland, Auckland, New Zealand A.R. Gamble Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia E. Pappas Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia;School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia;Shanghai University of Medicine and Health Sciences, China 3427 10.4193/Rhin25.633 BACKGROUND: Endoscopic sinus and skull base surgeons are at high risk of work-related musculoskeletal disorders (WRMD) due to the unique ergonomic risks inherent in this specialty. These musculoskeletal disorders may negatively impact surgeons and their patients. The primary aim of this international survey was to quantify this problem globally and evaluate its associated factors. METHODS: A 46-item electronic survey was distributed to endoscopic sinus and skull base surgeons at any career stage via multiple international professional societies. RESULTS: We received 1385 responses. The prevalence of WRMD in the previous week and 12 months was 44.2% and 66.5%, respectively. The neck, shoulders, lumbar spine and wrists were the most commonly involved body parts, and most surgeons had symptoms in multiple body parts. Work-related musculoskeletal disorders were reported to negatively impact work, hobbies, activities of daily living and sleep, and to shorten careers in respondents. Factors associated with higher odds of WRMD included female sex, BMI>=30kg/m2, being an attending otolaryngologist, having a high surgical and clinic caseload (performing >=100 ESSB procedures annually), and operating in standing. Regular exercise (>=7 hours weekly) and an endomorphic somatotype were associated with lower odds of WRMD. CONCLUSIONS: Endoscopic sinus and skull base surgeons have a high prevalence of WRMD. Modifiable risk factors include surgical volume, clinic time, operating position, and regular exercise. We make recommendations to assist in the reduction of WRMD in this population.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41892394 Revision endoscopic sinus surgery is rarely needed in dupilumab-treated chronic rhinosinusitis with nasal polyps 327 333 EN P. Kemp University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands J.J. Otten University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands H.B.E. Elzinga University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands R.J.L. van der Lans University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands G.F.J.P.M. Adriaensen University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands L.B.L. Benoist University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands M.E. Cornet Department of Otorhinolaryngology, Alrijne Hospital, Leiden, The Netherlands R. Hoven University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands B. Rinia Department of Otorhinolaryngology, Isala Hospital, Zwolle, The Netherlands W.J. Fokkens University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands S. Reitsma University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam, The Netherlands 3446 10.4193/Rhin24.401 BACKGROUND: This study was set out to investigate the incidence of revision endoscopic sinus surgery (ESS) in patients treated with dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP). Furthermore, clinical course and outcome of surgery of these patients was described. METHODS: A prospective observational cohort study of adult and biological-naive patients with CRSwNP treated with dupilu-mab as per EPOS2020 indication criteria (at least one previous ESS) was undertaken. Patients that had ESS due to an insufficient response to dupilumab were compared to those still on treatment. Baseline demographics and clinical characteristics (such as evidence of type 2 inflammation, SNOT-22 score, and nasal polyp score) were compared between the two groups. Furthermore, clinical measurements at indication of surgery, type of surgery and clinical outcomes are described. RESULTS: Discontinuation of dupilumab treatment occurred in 41 out of 394 (10.4%) patients, of whom 10 (2.5%) stopped because of an insufficient response. Seven of these patients (1.8% of total) underwent revision ESS. The patients that needed revision sur-gery for uncontrolled CRSwNP were significantly more often male, had lower baseline serum IgE and longer time since the last ESS compared to those still on dupilumab. Despite revision ESS, disease control postoperatively was insufficient in all but two patients. CONCLUSIONS: Revision endoscopic sinus surgery as an escape-treatment for uncontrolled CRSwNP despite dupilumab is rarely needed. The disappointing results of revision ESS for patients with uncontrolled CRSwNP who failed dupilumab calls for new treatments for this limited group.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41521892 Upper and lower airways response to tezepelumab in asthma patients with / without comorbid nasal polyposis: a 6-months reallife perspective 334 341 EN M. Caminati Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy;Department of Medicine, University of Verona, Italy A. Mastrototaro Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy M. Maule Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy;Department of Medicine, University of Verona, Italy M. Schiappoli Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy;Department of Medicine, University of Verona, Italy R. Vaia Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy;Department of Medicine, University of Verona, Italy M. Zurlo Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy;Department of Medicine, University of Verona, Italy F. Bini Pulmonology Unit ASST Rhodense Garbagnate Milanese Hospital, Milan, Italy L. Brussino Department of Medical Sciences, University of Turin, Immunology and Allergy Unit, Mauriziano Hospital, Turin, Italy M. D’Amato Respiratory Department, Monaldi Hospital AO Dei Colli, Federico II University, Naples, Italy A.M. Marra Pulmonology Unit ASST Rhodense Garbagnate Milanese Hospital, Milan, Italy S. Nicola Department of Medical Sciences, University of Turin, Immunology and Allergy Unit, Mauriziano Hospital, Turin, Italy J.W.V. Schroeder Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy G. Senna Asthma Center and Allergy Unit, Verona Integrated University Hospital, Verona, Italy;Department of Medicine, University of Verona, Italy R. Benoni Department of Diagnostics and Public Health, University of Verona, , Verona, Italy;National Center for Global Health, Italian National Institute of Health (Istituto Superiore Di Sanita), Rome, Italy 3419 10.4193/Rhin25.474 BACKGROUD: The efficacy of tezepelumab in chronic rhinosinusitis with nasal polyps (CRSwNP) has been demonstrated in clinical trials, but real-world evidence remains limited. Our study investigated the trend of CRSwNP outcomes in patients prescribed with tezepelumab for severe asthma and the impact of upper airways comorbidity on asthma outcomes over a 6 months follow-up. METHODS: Data from 5 referral centres for severe asthma and CRSwNP were retrospectively analysed. Patient reported outcomes and objective measures related to nasal (SNOT-22, VAS, nasal polyp score) and bronchial (asthma control test, lung function) evaluation were assessed at baseline, 3 and 6 months after tezepelumab initiation. RESULTS: Tezepelumab significantly and rapidly improved all the nasal outcomes and asthma-related parameters, irrespective of sex, body mass index, prior biologic use, or disease duration. Furthermore, significant reduction of oral corticosteroid use, hospitalizations and exacerbations were also observed. When comparing patients with and without CRSwNP, no differences were observed in term of treatment response. CONCLUSIONS:In patients with severe asthma and CRSwNP, tezepelumab demonstrated to induce in the real-life setting an overall rapid and sustained improvement of nasal outcomes, as well as of lung function and clinical parameters in asthma patients regardless of upper airway involvement. Although larger studies are needed, these findings contribute to the positioning of tezepelumab in the real-world clinical practice according to a precision medicine approach.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41487101 Comparative study between different methods for treatment of recurrent anterior idiopathic epistaxis in children: a prospective randomized clinical study 342 348 EN A.M. Abdelghany Otorhinolaryngology Department, Benha University, Benha, Egypt A.A.A. Hendy Kafr Shokr Specialized Hospital, Egypt A.F. Allam Otorhinolaryngology Department, Benha Faculty of Medicine, Egypt 3414 10.4193/Rhin25.530 INTRODUCTION: Recurrent anterior idiopathic epistaxis is common in children, yet optimal management remains debated. This study compared the efficacy of antiseptic cream, antiseptic plus corticosteroid cream, and silver nitrate cautery in reducing epistaxis severity in paediatric patients. METHODOLOGY: In a prospective randomised dual-centre clinical trial, 136 children with recurrent idiopathic anterior epistaxis were evenly allocated to antiseptic cream, antiseptic plus corticosteroid cream, or silver nitrate cautery. Epistaxis Severity Score was assessed at baseline, 2 weeks, and 1, 3, and 6 months. RESULTS: All groups showed significant reductions in ESS over time. At 2 weeks, silver nitrate cautery produced the most rapid early improvement, compared with antiseptic cream and the combination cream. By 1 month, the antiseptic plus corticosteroid group showed the greatest improvement, with further reductions at 3 months and 6 months. At 6 months, improvement rates were highest with the combination therapy, followed by antiseptic cream and cautery. CONCLUSIONS: Cautery achieves rapid short-term control, but antiseptic plus corticosteroid cream provides the most durable improvement following a short, two-week course. It should be considered a first-line therapy for recurrent idiopathic anterior epistaxis in children.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41521868 Assessment of the extent of previous endoscopic sinus surgery using the ACCESS score in patients with chronic rhinosinusitis referred to tertiary care rhinologic clinics 349 356 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 R. Hoven Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands E. de Corso Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy C. Montuori Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy A.R. Sedaghat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A. Sarafidou Department of Otorhinolaryngology, Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece J. Constantinidis Department of Otorhinolaryngology, Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece C. Hopkins Department of Otolaryngology-Head and Neck Surgery, Guy’s and St. Thomas’ Hospitals, London, United Kingdom B.R. Castro Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA, USA Z. Patel Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA, USA P. Capaccio Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy 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 3418 10.4193/Rhin25.236 BACKGROUND: Despite optimal medical and surgical therapy, many patients suffering from chronic rhinosinusitis (CRS) experience continuous inflammation for which revision surgery can be indicated. The present work was set out to investigate the extent of prior endoscopic sinus surgery (ESS) performed in CRS patients referred to tertiary rhinologic centers for revision surgery in Western countries. METHODS: A retrospective multicenter study was conducted including patients with any (pheno)type of diffuse CRS, who had undergone at least one prior ESS. All patients had a sinus computed tomography (CT) scan performed before their revision surgery which was used to retrieve the Amsterdam classification of completeness of ESS (ACCESS) scores, which range from 0 (sinuses functionally opened) to 24 (no sinus opening). RESULTS: 114 patients from 6 different centers were included. The median ACCESS score was 12 (7-17). Most patients had only one previous ESS (70/114, 61%), while 24 (21%) had 2 previous surgeries, 13 (11.4%) patients had three, and 7 (6%) patients had four or more. Median ACCESS scores by number of previous ESS were: 13 (6-16) for one prior surgery, 12 (7-18) for two, 10 (8-13) for three, and 6 (3-13) for four or more surgeries. Multivariate linear regression analysis showed small changes in the patient’s ACCESS score in relation to their number of previous surgeries. CONCLUSIONS: Our study underscores a large heterogeneity in extent of prior ESS among patients referred to tertiary rhinologic centers for diffuse CRS, regardless of the number of previous surgeries

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41487116 From postoperative cerebrospinal fluid leak to meningitis: unveiling the risk factors for meningitis after endoscopic skull base surgery 357 366 EN C. Lee Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School 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 G. Ryu Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea W-J. Lee Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea D-S. Kong Department of Neurosurgery, 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 3415 10.4193/Rhin25.357 BACKGROUND: Postoperative cerebrospinal fluid (CSF) leak is a significant complication of endoscopic skull base surgery (ESBS) that increases meningitis risk, a serious and potentially life-threatening infection. This study aimed to delineate the risk factors associated with the development of meningitis in patients who experienced postoperative CSF leakage. METHODOLOGY: We reviewed 1,303 ESBS cases for skull base lesion between January 2020 and July 2024 at a single tertiary center. Patient demographics, pathology, intraoperative CSF leak grade, reconstruction techniques, and postoperative CSF leak management strategiesâ€"including the use of nasoseptal flaps, fat grafts, and lumbar drainsâ€"were collected. Clinical and surgical factors were analyzed among patients with postoperative CSF leak to identify associations with the development of meningitis. RESULTS: Postoperative CSF leak was suspected in 49 patients (3.8%). Among them, 36 (2.8%) underwent repair surgery, while 13 (1.0%) were treated conservatively without surgical confirmation. Meningitis occurred in 21 of these patients. Multivariate analysis revealed that intraoperative CSF leak grade, use of fat grafts, lumbar drain insertion, and delayed CSF leak recognition were significantly associated with meningitis development. Patients with grade 3 intraoperative leaks had 3.21-fold increased odds of developing meningitis compared to grade 0. Tumor pathology, nasoseptal flap viability, and hydroxyapatite use were not significantly associated. CONCLUSIONS: The transition from postoperative CSF leak to meningitis is influenced by the severity of intraoperative leakage, reconstructive choices, and the timing of leak detection. Restricting fat grafts and lumbar drains to selected cases and ensuring close postoperative rhinologic surveillance are critical in mitigating infectious complications following ESBS.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41574552 Digital intervention for smell training: a real-world study on engagement, adherence, and behavioural dynamics 367 376 EN C. Besevli Department of Computer Science, University College London (UCL), London, United Kingdom G. Brianza Department of Computer Science, University College London (UCL), London, United Kingdom C. Dawes Hynt Labs Limited, London, United Kingdom S. Mathur Norwich Medical School, University of East Anglia, Norwich, United Kingdom S. Beganovic Department of Computer Science, University College London (UCL), London, United Kingdom D. Boak SmellTaste, Bicester, United Kingdom A. Fatah gen. Schieck Bartlett School of Architecture, UCL, London, United Kingdom M. Lechner Division of Surgery and Interventional Science and UCL Cancer Institute, UCL, London, United Kingdom E. Maggioni Hynt Labs Limited, London, United Kingdom C. Philpott Norwich Medical School, University of East Anglia, Norwich, United Kingdom;SmellTaste, Bicester, United Kingdom;The Norfolk Smell M. Obrist Department of Computer Science, University College London (UCL), London, United Kingdom 3421 10.4193/Rhin25.290 BACKGROUND: Despite advances in digital health, many interventions fail, not due to technical shortcomings, but because they are not meaningfully adopted or sustained in everyday life. Understanding real-world engagement remains a critical gap, especially in under-explored domains such as olfactory health. This study aimed to evaluate the real-world feasibility of a home-based Digital Smell Training (DST) system, focusing on how - participants - engage with it and sustain its use over time. METHODOLOGY: A six-month real-world feasibility study of a DST system, combining a scent-delivery device and mobile app, was tested in 18 UK households with and without olfactory disorders. A mixed methods approach captured adherence and user experiences over time. RESULTS: Participants completed 74% of 5,600 potential sessions, showing high adherence to twice-daily training. Qualitative data revealed dynamic behavioural patterns: users’ motivations fluctuated over time, shaped by perceived progress, novelty effects, and evolving relationships with the intervention. CONCLUSIONS: This study offers rare insight into how people engage with unfamiliar digital health tools outside controlled settings. Beyond the specific use case of smell, our findings highlight design and engagement strategies essential for achieving real-world impact, showing that sustained adoption hinges not just on innovation, but on behavioural understanding.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41686484 Olfactory vulnerability in older adults undergoing endoscopic skull base surgery: insights from olfactory strip elevation 377 385 EN J. Kim Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea;Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea C-S. Rhee Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea I.K. Choi Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea J-A. Park Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea J. Oh Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea S.A. Ko Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea K. Hwang Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea J-W. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea T-B. Won Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea H-W. Shin Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea;Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea;Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea;Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Na S-W. Cho Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea 3428 10.4193/Rhin25.450 INTRODUCTION: Postoperative olfactory outcomes after endoscopic endonasal approaches (EEA) vary, and the influence of age remains uncertain. This study evaluated whether age affects postoperative olfaction in patients undergoing EEA with a uniformly performed nasal phase including olfactory strip elevation. Age-related histologic features of the olfactory mucosa were also exa-mined. METHODS: We retrospectively reviewed patients who underwent EEA with olfactory strip elevation for sellar or parasellar tumors. Olfactory function was assessed preoperatively and at 6 months postoperatively using the Cross-Cultural Smell Identifica-tion Test (CCSIT) and the Korean Olfactory Questionnaire (OQ). In a subgroup, olfactory mucosa was immunostained for markers of horizontal basal cells (HBCs), olfactory sensory neurons (OSNs), and olfactory ensheathing cells (OECs) to evaluate age-related histologic patterns and associations with postoperative olfaction. RESULTS: Forty-three patients (mean age 53.7 years) were analy-zed. CCSIT decreased from 8.0 to 7.3 and OQ from 39.9 to 33.1. Age >=50 years was associated with lower postoperative CCSIT and OQ. Olfactory mucosa available for analysis showed negative correlations between age and OSN counts, HBC counts, and S100 expression intensity. S100 expression correlated positively with postoperative olfactory outcomes. CONCLUSIONS: Patients aged >=50 years showed greater postoperative olfactory decline after EEA with olfactory strip elevation. Increasing age was associated with reduced levels of key olfactory cells. Higher S100 expression was associated with better postoperative olfactory outcomes.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41719101 Comparative analyses of COVID-19-related olfactory dysfunction and classical post-viral olfactory dysfunction: a multicenter retrospective study 386 394 EN T. Miwa Department of Otorhinolaryngology, Kanazawa Medical University, Kahoku, Ishikawa, Japan K. Tsuzuki Department of Otorhinolaryngology - Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan I. Suzaki Department of Otorhinolaryngology Head and Neck Surgery, Showa Medical University, Tokyo, Japan K. Kondo Department of Otorhinolaryngology Head and Neck Surgery, The University of Tokyo, Tokyo, Japan E. Mori Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan M. Kobayashi Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan M. Suzuki Department of Otorhinolaryngology-Head and Neck Surgery, Nagoya City University, Nagoya, Aichi, Japan K. Fushimi Department of Otorhinolaryngology, Kobe Century Memorial Hospital, Kobe, Hyogo, Japan T. Saito Department of Otorhinolaryngology - Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan T. Hirose Department of Otorhinolaryngology - Head and Neck Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan H. Shiga Department of Otorhinolaryngology, Kanazawa Medical University, Kahoku, Ishikawa, Japan M. Takeuchi Department of Otorhinolaryngology Head and Neck Surgery, Showa Medical University, Tokyo, Japan N. Okuzawa Department of Otorhinolaryngology Head and Neck Surgery, Showa Medical University, Tokyo, Japan K. Ogawa Department of Otorhinolaryngology Head and Neck Surgery, The University of Tokyo, Tokyo, Japan R. Sekine Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan M. Nagai Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan M. Tei Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan H. Tanaka Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan Y. Kishimoto Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan H. Morishita Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan E. Ishigami Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan H. Nakanishi Department of Otorhinolaryngology-Head and Neck Surgery, Nagoya City University, Nagoya, Aichi, Japan R. Ueha Department of Otorhinolaryngology Head and Neck Surgery, The University of Tokyo, Tokyo, Japan;Swallowing Center, the University of Tokyo Hospital, Tokyo, Japan Y. Iinuma Department of Infectious Diseases, Kanazawa Medical University, Kahoku, Ishikawa, Japan Y. Iida Department of Mathematics, Kanazawa Medical University, Kahoku, Ishikawa, Japan 3434 10.4193/Rhin25.396 INTRODUCTION: Olfactory dysfunction (OD) is a common symptom of COVID-19. However, prevalence and clinical characteristics of OD due to COVID-19 (COVID-19-OD) differ from those of conventional post-viral OD (PVOD). Even among COVID-19-OD cases, they vary depending on the virus subtype. We aimed to compare the differences between COVID-19-OD and PVOD, as well as the differences across viral variants within COVID-19-OD. METHODS: This is a multicenter retrospective study. The subjects were PVOD patients from 2017 to 2019 and COVID-19-OD patients from 2020 to 2022. Patient backgrounds, olfactory cleft condition, and olfactory function were obtained from medical records and compared. RESULTS: Of the 649 patients, 269 had COVID-19-OD (pre-Omicron: 191; Omicron: 78) and 380 had PVOD. Compared to the PVOD group, the COVID-19-OD group was younger and exhibited a higher rate of olfactory cleft obstruction and a greater prevalence of parosmia or phantosmia. The severity of OD was milder in the COVID-19-OD group. Even after controlling for age, the severity of OD remained milder in the COVID-19-OD group. Compared to the Omicron group, the pre-Omicron group was younger and had a higher incidence of parosmia or phantosmia. CONCLUSION: COVID-19-OD and PVOD differ significantly in clinical features and in the pathophysiology of OD. Moreover, even within COVID-19-OD, there are differences between the variants, which are thought to reflect biological differences in the virus.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41717895 Olfactory bulb volume changes following olfactory training in normosmic individuals 395 404 EN I. Torvik Heian Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway ;Department of Otolaryngology, Head and Neck Surgery, Nordmore and Romsdal Hospital, Hjelset, More and Romsdal Hospital Trust, Norway;Department of Research and Innovation, Helse More and Romsdal, Norway A-S. Helvik Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tonsberg, Norway T.A. Myklebust Department of Research and Innovation, Helse More and Romsdal, Norway E.M. Berntsen Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway;Department of Circulation and Medical imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway T. Hummel Smell and Taste Clinic, Department of Otolaryngology, Universitatsklinikum, Technische Universitat Dresden, Germany. S. Nordgard Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway M. Bratt Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway W. Moe Thorstensen Institute of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Department of Otolaryngology, Head and Neck Surgery, St. Olavs University Hospital, Trondheim, Norway 3433 10.4193/Rhin25.424 BACKGROUND: Olfactory training (OT) has been linked to changes in olfactory function and structural modifications in the olfactory bulb (OB); however, the neuroplastic potential in the OB remains unclear. In this pilot study, we investigate how OT with different exposure lengths influences olfactory bulb volume (OBV) and olfactory function in individuals with normosmia. METHODOLOGY: Seventy-seven normosmic individuals were assigned to either standard OT, extended OT, or a control group. The intervention groups performed OT for three months, sniffing four odours - eucalyptus, lavender, mint and lemon â€" for 10 seconds per bottle, twice daily, totalling either 40 seconds (standard OT) or 4 minutes (extended OT), while the control group did not perform any OT. OBV (manual segmentation of 3-Tesla magnetic resonance images) and olfactory function (Sniffin' Sticks test) were assessed at baseline, post-intervention and at one-year follow-up. RESULTS: OBV increased significantly in both the standard and extended OT groups after the intervention and at follow-up, compared to controls. There were no differences between the training methods and no significant changes in olfactory function. CONCLUSIONS: In normosmic individuals, OBV increased after both standard and extended OT, with no differences between training methods. The volume increase was evident at three-month assessment and persisted at one-year follow-up, indicating that neuroplastic changes induced by OT occur rapidly and may extend beyond the duration of the training itself, an effect not previously reported. However, the OBV changes were not accompanied by improve-ments in olfactory function.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41834781 Juvenile nasopharyngeal angiofibroma: nationwide study on incidence, diagnosis, treatment, and recurrence 405 414 EN M. El Haddouchi Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark P.R.G. Eriksen Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark R.H. Dahl Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copengagen, Denmark M. Kongsvad Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark W. Krone Department of Radiology, Odense University Hospital, Odense, Denmark G. Gal Department of Radiology, Odense University Hospital, Odense, Denmark M. Holtmannspoetter Department of Neuroradiology, Nuremberg Hospital, Paracelsus Medical University, Nuremberg, Germany G. Benndorf Department of Radiology, Baylor College of Medicine, Houston, TX, USA G. Lelkaitis Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark C. von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark 3440 10.4193/Rhin24.550 BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumour affecting adolescent males, originating near the sphenopalatine foramen and often expanding aggressively. This nationwide study examines the clinical presentation, treat-ment, and prognosis of patients diagnosed from 2003 until mid-2022. METHODS: Patients were identified in the national patho-logy database. The Kaplan-Meier estimator calculated event-free survival, and t-test and Fisher's exact test compared variables. The incidence rates were determined using the 2000 World Health Organization World Standard Population. RESULTS: Sixty-one male patients were included (median age: 16.5 years). The national incidence was 0.12 per 100,000 male person-years (0.43 per 100,000 men at risk (10-24 years)). Common symptoms included nasal obstruction (90%) and epistaxis (59%). Predominant tu-mour stages were Radkowski IIB (31.3%) and Chandler III (65%). Most patients (97%) underwent preoperative embolization, with image-guided endoscopic sinus surgery (ESS) as the primary treatment (86%). Median intraoperative blood loss (IBL) was 500 mL. Radkowski staging correlated with IBL, tumour devascularization, and internal carotid artery (ICA) blood supply. No major compli-cations occurred. Recurrence (25%) was associated with Chandler stage III-IV, with a two-year recurrence-free survival rate of 77%. CONCLUSIONS: Tumour stage correlated with IBL, tumour devascularization, and ICA supply. Recurrence mainly occurred within two years post-surgery, exclusively in advanced-stage cases. With close collaboration between interventionists and rhinologists, preoperative embolization followed by image-guided ESS is recommended as a safe approach with minimal risks.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41487053 Endoscopic sinus surgery versus biologic therapy for chronic rhinosinusitis with nasal polyposis: a systematic review with meta-analysis 415 417 EN H. Majeethia Department of Otolaryngology â€" Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA Z. Mehdi Department of Otolaryngology â€" Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA O.G. Ahmed Department of Otolaryngology â€" Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA M. Takashima Department of Otolaryngology â€" Head and Neck Surgery, Houston Methodist Hospital, Houston, TX, USA G.A. Kelley School of Public and Population Health and Department of Kinesiology, Boise State University, Boise, ID, USA J. Lee Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA H.H. Ramadan Department of Otolaryngology â€" Head and Neck Surgery, West Virginia University, Morgantown, WV, USA C.A. Makary Department of Otolaryngology â€" Head and Neck Surgery, West Virginia University, Morgantown, WV, USA 3412 10.4193/Rhin25.345 Biologic therapies targeting type 2 inflammation, such as dupilumab, omalizumab, and mepolizumab, have been developed to manage chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in patients with comorbid asthma or aspirin-exacerbated respiratory disease (AERD). Functional endoscopic sinus surgery (FESS) remains the mainstay of treatment in patients who are refractory to medical therapy. However, direct comparisons between biologic therapy and FESS are limited. This systematic review and meta-analysis aimed to compare sinonasal outcomes between FESS and biologic therapy in real-world settings.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41111462 Otolaryngologist's role in European CRSwNP care: clinical needs versus economic considerations 418 419 EN P. Petrone Directorate General, ASL BA, Bari, Italy 3372 10.4193/Rhin25.483 In recent years, the role of the medical specialist has undergone a substantial evolution, increasingly intersecting with the fields of healthcare management and economics. Many clinicians are now gaining skills in areas such as cost-effectiveness analysis, health policy, and service organization. While such competencies can enhance awareness of the broader healthcare context, it is critical to reaffirm that the primary duty of a specialist â€" particularly in the field of otorhinolaryngology â€" is to ensure clinical appropriateness based on current evidence and guidelines, not to account for economic variables.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41701542 Real-world effectiveness of omalizumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP): findings from CHRINOSOR 420 422 EN T. Bartosik Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria S.F. Seys Galenus Health (part of Cascador Health Group), Tielrode, Belgium J. de Kinderen Galenus Health (part of Cascador Health Group), Tielrode, Belgium M. Wagenmann Department of Otorhinolaryngology, Universitatsklinikum Dusseldorf (UKD), Dusseldorf, Germany M. Bruch Otorhinolaryngology Department, Ordens Klinikum Linz, Linz, Austria A. Andrianakis Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria X. Gonzalez-Compta Rhinology Unit, Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, Barcelona, Catalonia, Spain V. Hox Service d'Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium L. Pardo Muñoz Allergology Department, Hospital Universitario de Terrasa, Barcelona, Spain S. Schneider Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria G. Bettio Galenus Health (part of Cascador Health Group), Tielrode, Belgium M. Burian Otorhinolaryngology Department, Ordens Klinikum Linz, Linz, Austria J. Eckl-Dorna Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria M. Golet Fors Rhinology Unit, Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, Barcelona, Catalonia, Spain G. Marien Galenus Health (part of Cascador Health Group), Tielrode, Belgium C. Morgenstern Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria K. Scheckenbach Department of Otorhinolaryngology, Universitatsklinikum Dusseldorf (UKD), Dusseldorf, Germany P-V. Tomazic Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria A. Tu Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria S. Allu Novartis Healthcare Private Limited, Hyderabad, India Z. Diamant Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium;Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic;University Groningen, University Medical Center Groningen, Department Clinical Pharmacy and Pharmacology, Groningen, the Netherlands C. Bachert Clinic for ENT diseases and Head and Neck Surgery, University Clinic Munster, Munster, Germany;Department of Otorhinolaryngology, First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China CHRINOSOR Consortium*: Isam Alobid, Carlo Cavaliere, Wytske Fokkens, Peter W. Hellings, Claire Hopkins, Adriana Izquierdo-Dominguez, Xavier Jaumont, Anette Kjeldsen, Anu Laulajainen-Hongisto, Valerie Lund, Geoffrey Mortuaire, Petter Olsson, Laura Van Gerven, Sietze Reitsma 3429 10.4193/Rhin25.514 Omalizumab is a recombinant DNA-derived humanized monoclonal antibody targeting free immunoglobulin E. In the omalizumab phase III studies for chronic rhinosinusitis with nasal polyp (CRSwNP), a clinically relevant reduction of the nasal polyp score (NPS) was observed leading to improved SinoNasal Outcome Test-22 (SNOT-22). In the extension study, sustained or further improvement of symptoms and NPS reduction were observed up to 52 weeks. Real-world data is needed to establish effectiveness in uncontrolled severe CRSwNP, but so far, data on long-term omalizumab treatment is sparse .

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 42170825 The effect of large air pollution exposure on chronic rhinitis 423 424 EN C. Abi Zeid Daou Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon I. Carapiperis Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon J. Ghadieh Department of Medicine, American University of Beirut, Beirut, Lebanon O. Abou Hosn Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon C.A. Makary Department of Otolaryngology and Head and Neck Surgery, West Virginia University, United States of America Z. Korban Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon 3467 10.4193/Rhin25.293 On August 4th, 2020, Beirut witnessed the largest non-nuclear explosion in modern history. The explosion resulted in the release of large amounts of gases and particulate matters (PM) including ammonia and nitrogen oxides (NOx), as well as pure oxygen (O2). NO2 conversion into nitric and nitrous acids has been shown to damage the alveolar structure in distal airways. The goal of this study is to investigate the early and late, subjec-tive and objective, effects of the explosion and particulate mat-ter exposure on the upper airway, specifically chronic rhinitis.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41487079 Sinonasal outcomes on nasal acoustics and resonance (SONAR) 425 426 EN N. Berick Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel F. Jahshan Department of Otolaryngology, Head and Neck Surgery, Sourasky Medical Center, Tel Aviv, Israel M. Darawshe Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel I. Braverman Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel I. Shochat Department of Otolaryngology, Head and Neck Surgery, Hillel Yaffe Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel 3413 10.4193/Rhin25.486 The nasal and paranasal cavities constitute integral components of the vocal tract resonator system, yet their precise contribution to voice quality remains a subject of debate. While early anatomical and acoustic models (1-3) suggested that sinus coupling through open ostia may introduce anti-resonances and spectral alterations, subsequent investigations employing cadaveric dissections, physical simulations, and three-dimensional replicas (4, 5) have confirmed notable effects on frequency response and formant balance. Clinical studies, including those examining patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery (FESS), have shown that surgical management can improve both sinonasal and vocal quality of life without adverse effects on voice characteristics (6,7). However, conventional acoustic measures such as jitter and shimmer frequently fail to detect such changes (8). In contrast, Mel-frequency cepstral coefficients (MFCCs), which transform the speech spectrum into a perceptually weighted domain, have shown superior sensitivity to resonance-related shifts and hypernasality (9). Based on this evidence, we investigated whether MFCCs and spectral flatness can more accurately identify post-operative alterations in resonance that are not captured by traditional acoustic parameters.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41800528 Type 2 inflammation promotes distinct metabolic profiles in chronic rhinosinusitis with nasal polyps 427 429 EN T. Yonaga Department of Otolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medical Science,University of Yamanashi, Chuo, Japan H. Ishii Department of Otolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medical Science,University of Yamanashi, Chuo, Japan K. Yoshimura Division of Molecular Biology, Center for Medical Education and Sciences, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Japan A. Shimamura Department of Otolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medical Science, University of Yamanashi, Chuo, Japan K. Sakamoto Department of Otolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medical Science, University of Yamanashi, Chuo, Japan T. Matsuoka Department of Otolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medical Science, University of Yamanashi, Chuo, Japan D. Sakurai Department of Otolaryngology, Head and Neck Surgery, Interdisciplinary Graduate School of Medical Science, University of Yamanashi, Chuo, Japan 3439 10.4193/Rhin25.540 Chronic rhinosinusitis (CRS) is an inflammatory disorder of the sinonasal mucosa that occurs with or without nasal polyps (NPs). Compared with CRS without NPs, CRS with NPs (CRSwNP) is associated with more severe and uncontrolled sinonasal symptoms. Type 2 inflammation, driven by TH2 cytokines (interleukins 4, 5, and 13), promotes eosinophilic infiltration into NPs and contributes to disease progression and recurrence. Although recent studies have emphasized biological phenotyping and identified genetic/epigenetic endotypes to optimize treatment strategies for CRSwNP, clinical translation remains limited. Because cellular phenotypes are strongly influenced by metabolic alterations, profiling of the metabolic landscape may provide insight into CRSwNP pathogenesis and identify bio-markers of type 2 inflammationâ€"related symptom exacerbation, treatment resistance, and recurrence. However, metabolomic characterization of CRSwNP remains underexplored.

International Rhinologic Society Rhinology 0300-0729 64 3 2026 6 1 41891950 Reconsidering biologic treatment recommendations for CRSwNP without asthma in EUFOREA guidelines 430 432 EN J. Oppenheimer Department of Internal Medicine, University of Medicine and Dentistry of New Jersey/Rutgers New Jersey Medical School, Newark, NJ, USA G.W. Canonica Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy;Department of Biomedical Sciences, Humanitas University, Milan, Italy P. Chanez Department of Respiratory Diseases, Aix-Marseille University, Marseille, France J. Maza-Solano Rhinology and Skull Base Unit, Department of Otolaryngology, University Hospital Virgen del Rocio, Seville, Spain;Department of Surgery, University of Seville, Seville, Spain C. Tacon Global Medical Affairs, GSK, London, UK K. Kallinikou Respiratory Biologics, GSK, Athens, Greece P. Howarth Global Medical Affairs, GSK, London, UK M. Bonini Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy;National Heart and Lung Institute (NHLI), Imperial College London, London, UK I. Eguiluz-Gracia Allergy Unit. Hospital Regional Universitario de Malaga and IBIMA-Plataforma BIONAND. RICROS Inflammatory Diseases. Malaga, Spain A. Bourdin Department of Respiratory Diseases, PhyMedExp, University of Montpellier, INSERM CNRS, Montpellier, France 3445 10.4193/Rhin25.359 The recently published EUFOREA pocket guide "Biologics in Upper and Lower Airway Diseases" summarises recommendations on the use of biologics in chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma and offers advice on biologic choice for practicing clinicians. The creation of this pocket guide, in the absence of any head-to-head studies at that time, drew on expert opinions and published indirect treatment comparison (ITC) approaches. It makes a single recommendation for a preferred biologic, in patients affected by CRSwNP, without concomitant asthma (apart from specific cases such as pregnancy), whilst offering different options in asthma endotypes and phenotypes. We wish to draw the attention of the readership to some additional considerations relating to biologic choice for these diseases and how they are classified.