International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 The importance of consensus building 433 433 EN A.R. Sedaghat Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 3504 10.4193/Rhin26.904 We are currently in a period of exciting advances for understanding of pathophysiology and treatment for conditions across the entire spectrum of rhinology. These discoveries have unlocked new ways of thinking and novel approaches to patients and the treatment of their conditions. During periods of rapidly evolving knowledge, when new interesting questions are inspired faster than answers can be determined by hard data, the application of newfound knowledge to change and/or develop new paradigms may be best implemented through collaboration, discussion and ultimately consensus building.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 Linking form to function: a scoping review of the evolution of paranasal sinuses in mammals 434 443 EN L.E. Ebbert Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA N. Kumar Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA M.K. Ebbert Independent scholar T. Pace Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA P. Lanca Gomes Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA L.A. Marks Division of Education, Department of Library Services, Mayo Clinic, Scottsdale, AZ, USA D. Lal Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA 3505 10.4193/Rhin25.419 Background: The evolutionary origin and function of paranasal sinuses remain unclear. We investigated their presence, distribution, and drainage orientation across mammalian orders, to better understand their evolutionary development and roles. Methodology: A scoping review of anatomical, radiological, and descriptive literature was conducted in Ovid MEDLINE database (1946-2024). Data on sinus presence, type, and drainage pathways were extracted from representative species across mammalian orders. Phylogenetic (grouping by evolutionary ancestry) and phenetic (grouping by anatomical similarity) analyses were used to identify evolutionary patterns. Results: Final review included 24 articles. Sinus prevalence in mammalian orders was maxillary (50%), frontal (44%), sphenoid (33%) and ethmoid (20%). Frontal sinuses were more common in behaviorally complex orders (71% vs. 22%). Frontal and maxillary sinuses predominated in terrestrial and arboreal mammals, while aquatic and volant mammals largely lacked sinuses. Phenetic clustering by sinus characteristics often contradicted phylogeny, suggesting parallel evolution driven by environment over ancestry. Despite variation in morphology, drainage pathways remained conserved. Conclusions: Paranasal sinus distribution in mammals appears more ecologically than phylogenetically determined, with convergent evolution likely influencing their presence. Conserved drainage patterns suggest developmental constraints over selective advantages. Further studies incorporating underrepresented mammalian orders and sinus size quantification are needed to refine our understanding of paranasal sinus function and evolution.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41853844 Long-term dupilumab therapy reduces concomitant medication use in patients with CRSwNP 444 452 EN K. Berbalk Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria N.J. Campion Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria T.J. Bartosik Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria L. Liu Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria M. Pan Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria C. Morgenstern Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria V. Stanek Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria A. Tu Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria S. Stoshikj Clinic of Internal Medicine II-Department of Pneumology, Austria and Comprehensive Center für Chest Diseases (CCCD), Medical University of Vienna, Vienna, Austria J. Eckl-Dorna Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria S. Schneider Vienna Airway Lab, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria 3441 10.4193/Rhin25.523 BACKGROUND: Dupilumab has demonstrated efficacy in Chronic Rhinosinusitis with Nasal Polyps. While its impact on sinonasal and asthma symptoms is well established, less is known about its effects on the demand for concomitant medications in long-term routine care. METHODOLOGY: This retrospective longitudinal real-world study included 224 patients diagnosed with Chronic Rhinosinusitis with Nasal Polyps and treated with Dupilumab at a tertiary centre between 2019 and 2025, with a maximum follow-up of up to 4.5 years. At each visit, use of nasal sprays, asthma drugs, and other disease-related drugs was recorded. Linear mixed-effects models were fitted to assess longitudinal changes. RESULTS: At baseline, patients reported a mean of 1.6 concomitant medications, most commonly INCS and inhaled asthma drugs. The total number of concomitant medications, the number of nasal sprays, asthma medications, and other disease-related drugs decreased significantly over time. Parallel improvements were observed in patient-reported outcome measures (SNOT-22, TNSS, ACT, miniAQLQ). CONCLUSIONS: In this real-world cohort, Dupilumab treatment led to a sustained overall reduction in concomitant medication use, thereby lowering pharmacological burden while improving disease control.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41989130 Biologics for chronic rhinosinusitis with nasal polyps: a real-world prospective cohort study 453 462 EN M. Blauwblomme Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium 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;Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium E. Bonne Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium E. Borgers Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leuven, Belgium C. Cox Department of Otorhinolaryngology, Jessa Hospital, Hasselt, Belgium G. De Vos Department of Otorhinolaryngology, Head and Neck Surgery, Sint-Lucas Hospital, Ghent, Belgium L. Derycke Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium A-S. Eeckels Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium S. Halewyck Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium V. Hox Department of Otorhinolaryngology, University Hospital Saint-Luc, Brussels, Belgium P. Janssen Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium P. Janssen Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium W. Lemmens Department of Otorhinolaryngology, Hospital Oost-Limburg, Genk, Belgium F. Rogister Department of Otorhinolaryngology, CHU de Liege, Belgium K. Speleman Department of Otorhinolaryngology, General Hospital Sint-Jan Bruges, Bruges, Belgium M. Syssauw Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, 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 E. Vandewalle Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium S. Vanhee Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium B. Verhaeghe Department of Otorhinolaryngology, AZorg Aalst, Belgium A.V. 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 T. Van Zele Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium P. Gevaert Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium;Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium P.W. Hellings Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium;KULeuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium;Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leuven, Belgium 3451 10.4193/Rhin26.004 BACKGROUND: Monoclonal antibody therapies targeting type 2 inflammation for chronic rhinosinusitis with nasal polyps (CRSwNP) have shown efficacy in randomized controlled trials (RCTs), however prospective real-world comparative data across all appro-ved biologics remain limited. We aimed to evaluate the real-world effectiveness of omalizumab, mepolizumab, and dupilumab in patients with severe CRSwNP. METHODOLOGY: A prospective, multicentre, real-world phase IV study in Belgium, enrolling 360 patients with severe CRSwNP initiating treatment with omalizumab (n=65), mepolizumab (n=242), or dupilumab (n=53) between March 2022 and April 2025. Clinical data were collected at baseline and after 6 months. The therapeutic response was evaluated based on EUFOREA criteria. RESULTS: After 6 months, nasal polyp score (NPS), olfactory function, and patient-reported outcomes improved across all biologics, with concurrent improvements in asthma control within each treatment group. A good-to-excellent multidomain therapeutic response was achieved in 51% of patients, and treatment continuation beyond 6 months was observed in 74% of omalizumab-, 81% of mepolizumab-, and 92% of dupilumab-treated patients. No severe adverse events were reported. CONCLUSION: In this real-world cohort, the three registered biologics provided significant clinical benefit in severe CRSwNP, with numerically larger improvements observed in patients treated with dupilumab.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42206465 Mepolizumab improves outcomes in patients with CRSwNP with one or more prior nasal polyp surgeries 463 471 EN J.K. Han Department of Otolaryngology Head and Neck Surgery, Old Dominion University, Norfolk, VA, USA J. Mullol Department of Otorhinolaryngology, Hospital Clinic Barcelona, FRCB-IDIBAPS, University of Barcelona, CIBERES, Barcelona, Catalonia, Spain M. Wagenmann Department of Otorhinolaryngology, Dusseldorf University Hospital, Dusseldorf, Germany L. Walrave Global Medical, Specialty Care, GSK, Wavre, Belgium L. Zhang Respiratory Biostatistics, GSK, Collegeville, PA, USA A.R. Sousa Clinical Sciences, Respiratory, GSK, London, UK P. Howarth Global Medical, Specialty Care, GSK, London, UK C. Hopkins ENT Department, Guy’s and St Thomas’s NHS Foundation, London, UK 3468 10.4193/Rhin25.599 BACKGROUND: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often undergo multiple nasal surgeries. The Phase III SYNAPSE study (GSK ID:205687; NCT0308579) demonstrated that mepolizumab reduces the need for repeat surgery. We explored whether outcomes differed based on the number of prior surgeries. METHODOLOGY: This post hoc analysis of SYNAPSE stratified patients by history of 1 or more than 1 prior surgery. Patients were randomised to receive mepolizumab or placebo every 4 weeks, alongside standard of care, for 52 weeks. Outcomes included change from baseline in endoscopic nasal polyp (NP) score, visual analogue scale (VAS) scores for nasal obstruction, loss of smell and overall symptoms, Sino-Nasal Outcome Test-22 (SNOT-22), and time to repeat surgery and/or oral corticosteroid (OCS) use. RESULTS: 189 patients had 1 prior surgery (108 mepolizumab; 81 placebo) and 218 had more than 1 prior surgery (98; 120). In both subgroups, mepolizumab significantly improved mean changes versus placebo in NP, nasal obstruction, loss of smell VAS, overall symptom VAS, and SNOT-22. Significant reductions in risk of repeat surgery and requiring OCS were observed with mepolizumab versus placebo in patients with 1 prior surgery. CONCLUSIONS: Mepolizumab improves outcomes in patients with CRSwNP with one or multiple prior surgeries; however, may offer greater benefit when initiated after a single surgery.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42165784 Economic analysis of surgery and biological therapy for chronic rhinosinusitis with nasal polyps 472 481 EN 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 L. Garcia Mochon Biomedical Research Center at Ciber for Epidemiology and Public Health (CIBERESP by its Spanish acronym), Madrid, Spain;IBS Biomedical Research Institute, Granada, Spain;Department of Applied Economics, University of Granada, University Campus of Cartuja s/n, Granada, Spain J. Martin-Martin Department of Applied Economics, University of Granada, University Campus of Cartuja s/n, Granada, Spain P.W. Hellings Dept Otorhinolaryngology, University of Leuven, Belgium;Laboratory of Allergy and Clinical Immunology, University of Leuven, Belgium;Upper Airways Research Group, University of Ghent, Belgium S. Sanchez-Gomez Department of Surgery, University of Seville, Seville, Spain;Rhinology and Skull Base Unit, Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain 3466 10.4193/Rhin25.529 Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) imposes major health and economic burdens. Endoscopic sinus surgery (ESS) and biologic therapy are treatment options. This study compares their effectiveness and cost-efficiency from the Spanish National Health System (NHS) perspective. Methodology: An economic evaluation was conducted in severe CRSwNP, following Spanish-NHS guidelines. Data came from a tertiary-hospital with 10-year projections. Effectiveness was measured as reduction in the Sinonasal Outcome Test-22 (SNOT-22). Cost-utility analysis used quality-adjusted life years (QALYs). Micro-costing was applied for ESS, while annual drug costs were considered for biologics. Sensitivity analyses tested robustness. Results: 89 patients were included (63 ESS, 26 biologics). After 2-years, both strategies achieved similar SNOT-22 improvements (-31.8 ESS, -31.0 biologics). Costs were far lower for ESS (EUR 5,302.78) than biologics (EUR 27,198.23), making biologics less efficient despite comparable benefit. The 2-year incremental cost-utility ratio (ICUR) for biologics was EUR 1.2 million/QALY, above accepted thresholds. At 10-years, biologics yielded 2.75 QALYs at an incremental cost of EUR 108,917.62 (ICUR EUR 39,592/QALY). Sensitivity ana-lyses showed that biologics generally remained above commonly accepted willingness-to-pay thresholds, although substantial price reductions (up to 40%) allowed ICURs to approach the upper limit of acceptability. Conclusions: Both treatments provide meaningful improvement. ESS remained the less costly strategy and was more efficient over the short term, whereas long-term projections showed higher QALY gains with biologics at substantially greater cost. Within Spanish- NHS, biologics may approach cost-effectiveness only under favorable pricing assumptions and should be reserved for patients with contraindications or persistent disease after ESS.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41960702 Exhaled breath condensate metabolomics reveals conserved networks and bidirectional crosstalk in asthma and CRSwNP 482 493 EN Y. Yang Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China W. Zhang Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China L. Cui Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China H. Yu Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China Y. Chen Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China;The 2nd Medical College of Binzhou Medical University, Yantai, China D. Wang Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China J. Wang Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China Y. Zhang Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China X. Song Department of Otolaryngology, Head and Neck Surgery. Yantai Yuhuangding Hospital, Qingdao University, Yantai, China;Shandong Provincial Key Laboratory of Neuroimmune Interaction and Regulation, Yantai, China;Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China 3449 10.4193/Rhin25.428 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently coexist. However, the metabolic inter-play between those diseases is poorly understood. We aimed to perform metabolomic profiling of exhaled breath condensate (EBC) from CRSwNP and asthma patients and investigate possible interaction pathways. METHODOLOGY: EBC samples from the upper and lower airways of patients with CRSwNP, asthma, and control subjects were analyzed using untargeted metabolomics. Metabolite consistency and conserved modules between the upper and lower airways were quantified. WGCNA, trend cluste-ring analysis, and a pathway enrichment analysis of differential metabolite expression were performed. RESULTS: A total of 252 metabolites were identified, with a strong correlation between the upper and lower airway profiles. WGCNA analysis showed that each module of the upper or lower airway was conserved, with at least 1 module included in the consensus network. The key enriched pathways for lower airway metabolites showed a continuous increasing or decreasing trend in the control, CRSwNP, and asthma groups, and mainly involved the impact of CRSwNP on asthma. The main enriched pathways for upper airway differential metabolites in the control, asthma, and CRSwNP groups were related to the impact of asthma on nasal polyps. N-(8Z,11Z,14Z-eicosatrienoyl) ethanolamine was significantly down-regulated in the EBC of CRSwNP and asthma patients, and was negatively correlated with the risk for CRSwNP and asthma onset. Leukotriene F4 (LTF4) was up-regulated in the EBC of CRSwNP and asthma patients, and was positively correlated with the risk for CRSwNP onset. CONCLUSION: Non-invasive EBC metabolomics revealed conserved metabolic networks and bidirectional perturbations between CRSwNP and asthma, providing new evidence for the "unified airway" hypothesis.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41989177 Chronic rhinosinusitis in a birth cohort: symptom trajectories and early-life risk factors up to young adulthood 494 501 EN K. Aberg Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stock-holm, Sweden;Medical unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden A. Asarnoj Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden;Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden A. Asarnoj Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden;Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden L.O. Cardell Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stock-holm, Sweden;Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden I. Kull Department of Clinical Science and Education Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden;Sachs'Children and Youth Hospital, Sodersjukhuset, Stockholm, Sweden A. Bergstrom Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;Center for Occupational and Environmental Medicine, Region Stockholm, Sweden E. Melen Department of Clinical Science and Education Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden;Sachs'Children and Youth Hospital, Sodersjukhuset, Stockholm, Sweden M. Holmstrom Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stock-holm, Sweden M. van Hage Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Karolinska Institutet, Stockholm, Sweden;Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden;Center for Molecular Medicine, Karolinska University Hospital Stockholm, Sweden M. Westman Department of Medicine Huddinge, Clinical Lung and Allergy Research Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden 3452 10.4193/Rhin26.079 BACKGROUND: Chronic rhinosinusitis (CRS) is common worldwide in adults, but development of CRS has rarely been studied longitudinally in birth-cohorts. The aim was to investigate development of upper airway symptoms from childhood to young adulthood and to identify early risk factors for CRS at 24 years, in a population-based birth cohort. METHOD: 3037 subjects from the BAMSE (Barn/children Allergy Milieu Stockholm Epidemiology) cohort had complete question-naire answers on CRS at the 24-year-follow-up. Subjects fulfilling European Position Paper on Rhinosinusitis (EPOS) criteria of CRS at 16 and/or 24 years (n=141) were invited to a clinical examination with nasal endoscopy and interviews. Among these, 68 had clinically verified CRS symptoms. Symptoms and clinical status were compared with questionnaire-based answers on symptoms and potential risk factors for CRS, in early childhood. RESULTS: Among subjects with CRS symptoms at 24 years, &gt; 60% reported upper airway symptoms already at 16 years. In the same group, a significant association was observed with a history of otitis media < 1 year and with heredity for atopic diseases. Moreover, the proportion of atopic features such as asthma, allergic rhinitis and eczema were significantly higher at 4, 8 and 16 years in this group. No clear association was found between CRS at 24 years and early RS infection, antibiotic use

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41989257 Relationship between olfactory function and quality of life in COVID-19 patients 502 511 EN S. Winkelmann Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany M.A. Nasr Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany A. Korth Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany B. Voss Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany N. Behrend Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany P. Pudszuhn Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wurzburg, Wurzburg, Germany C. Maetzler Neurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany A. Hermes Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany K. Franzpoetter Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany A-K. Ruß Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany D. Pape Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany S. Stork Comprehensive Heart Failure Center and Dept. Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany F.A. Montellano Institute of Clinical Epidemiology and Biometry, University of Wurzburg, Wurzburg, Germany;Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany M. Witzenrath Department of Infectious Diseases and Respiratory Medicine, Charite Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany T. Keil Institute of Clinical Epidemiology and Biometry, University of Wurzburg, Wurzburg, Germany; Institute of Social Medicine, Epidemiology and Health Economics, Charite Universitatsmedizin Berlin, Berlin, Germany; State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany M. Krawczak Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany W. Lieb Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany S. Schreiber Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany T. Bahmer Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany;German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany M. Laudien Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany NAPKON study group 3453 10.4193/Rhin24.174 Background: COVID-19 is associated with multiple long-term impairments that negatively affect patients' quality of life (QoL). Of these, olfactory dysfunction (OD), which is difficult to measure in practice, is likely to play an important role as it highly affects peoples’ QoL. Methods: In a population-based study, a total of 667 adult participants (mean age: 47 years) were examined nine months, on average, after positive PCR testing for SARS-CoV-2. Subjective olfactory function (OF) was quantified by means of a Visual Analogue Scales (OF-VAS). OF was tested by way of the Sniffin’ Sticks Test (SST). The self-reported Mini Olfactory Questionnaire (self-MOQ) was used to screen for OD. The brief (short) version of the Questionnaire of Olfactory Disorders - Negative Statements (sQOD-NS), the sinonasal outcome Test-22 (SNOT-22), the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and the EuroQoL-VAS (EQVAS) were used to assess QoL. Results: Participants with SST-tested OD or with OF-VAS-based subjective OD were characterized by significantly higher self-MOQ scores. Diagnoses of OD by self-MOQ or SST were found to be strongly correlated. Moreover, both the TDI score and the OF-VAS score were negatively correlated with the self-MOQ score. In addition to a significant reduction of QoL in participants with tested OD, the four questionnaires used in the present study also consistently highlighted a significant negative correlation between QoL and both, self-MOQ and OF-VAS score.CONCLUSION: The self-MOQ is a sufficient screening tool for OD after SARS-CoV-2 infection. Patients with persistent OD show signi-ficantly poorer QoL than those without. CLINICAL IMPLICATIONS: Olfactory function can be assessed in patients with COVID-19 using a simple 5-item questionnaire (self-MOQ). Patients with OD show reduced QoL. CAPSULE SUMMARY: In our population-based cross-sectional study of 667 patients with PCR-confirmed SARS-CoV-2 infection, par-ticipants with persistent OD had significantly poorer OF-related QoL. The self-MOQ is a simple, valid and reliable means to screen OD in patients with COVID-19.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42149672 From persistent olfactory dysfunction to permanent loss: investigating quality of life in acquired and congenital anosmia 512 520 EN W-Y. Lee Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan Y-C. Liao Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan C-H. Shu Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Otolaryngology Division, En Chu Kong Hospital, New Taipei City, Taiwan Y-T. Chao Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 3456 10.4193/Rhin25.138 BACKGROUND: Growing awareness of permanent olfactory dysfunction has raised concerns about its impact on quality of life (QoL). This study examined the effect of permanent anosmia on QoL by comparing patients with acquired anosmia of varying durations, including cases persisting for over a decade and cases of isolated congenital anosmia (ICA). METHODOLOGY: A total of 59 patients with post-viral or idiopathic anosmia who sought medical evaluation due to olfactory com-plaints completed the Questionnaire of Olfactory Disorders (QOD), which measured impairment, coping ability, and subjective disturbance. Patients were categorized into three groups: persistent acquired anosmia (PerA, duration 6 months - 2 years), prolon-ged acquired anosmia (ProA, duration >= 10 years), and ICA to reflect distinct populations. Patients with intermediate or uncertain duration were excluded to avoid recall bias. RESULTS: Perceived impairment, as reflected by QOD-NS and work domain of QOD-VAS, was higher in the PerA and ProA groups than in the ICA group. No significant differences in QOD-NS and QOD-VAS were observed between PerA and ProA groups. The ProA group exhibited better coping ability, as indicated by higher QOD-PS scores, than did the PerA group, suggesting coping over time. Coping scores in the ProA and ICA groups were comparable, indicating long-term adjustment in anosmic individuals. CONCLUSIONS: Acquired anosmia has a greater impact on QoL than does congenital anosmia. Individuals with prolonged acquired anosmia exhibited better subjective coping.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42157707 Nasal septal perforation has a negative impact on olfactory and trigeminal function 521 530 EN K. Yuen-Ato Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Spain;Department of Otorhinolaryngology, Hospital Universitario Joan XXIII, Tarragona, Spain;Universitat de Barcelona, Barcelona, Spain M.J. Rojas-Lechuga Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Spain;Universitat de Barcelona, Barcelona, Spain A. Izquierdo-Dominguez Department of Allergology, Hospital Universitario de Terrassa, Barcelona, Spain;Unidad Alergo Rino, Centro Medico Teknon, Barcelona, Spain J. Mullol Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Spain I. Alobid Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Spain;Universitat de Barcelona, Barcelona, Spain;Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain 3459 10.4193/Rhin25.285 BACKGROUND: Nasal septal perforation (NSP) is commonly associated with nasal obstruction, crusting and epistaxis. Research on its impact on olfactory function remains limited. This study aims to evaluate the sense of smell in patients with NSP and identify factors associated with the olfactory dysfunction. METHODOLOGY: Cross-sectional study of patients with symptomatic NSP and a control group was conducted at Clinic and Teknon hospitals in Barcelona from 2017 to 2024. Data collected included sex, age, comorbidities, body mass index (BMI), NSP aetiology, SNOT-22 and NOSE-Perf questionnaires. Olfactory function was assessed using visual analogue scale (VAS) and the Barcelona Smell Test 24 (BAST-24). NSP size and position were determined through nasal endoscopy and sinus computed tomography scan. RESULTS: 123 patients with symptomatic NSP and 74 healthy controls were included. Intranasal cocaine use was the most common aetiology. Olfactory dysfunction was observed in 26 patients (21.1%) for detection, 26 (21.1%) for memory, and 85 (69.1%) for identification, significantly different from control group. Patients with olfactory dysfunction presented trigeminal detection and identification impairment in 34% and 51%, respectively. In multivariate analysis, significant differences were found in olfactory identification based on NSP area and BMI, corrected by aetiology. A moderate correlation was found between olfactory identifica-tion with VAS, SNOT-22 item 21 and NOSE-Perf item 10. Olfactory identification was significantly correlated with trigeminal scores. CONCLUSIONS: NSP significantly affects olfactory and trigeminal function. Lower identification outcomes were associated with larger NSP area and higher BMI, independently of aetiology.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42206496 The elongated ciliated cells derived from nasal polyps are distinctly different from ciliated cells in different parts of the nasal mucosa 531 540 EN H. Deng Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China M. Pang Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Q. Yang Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China H. Qiu Department of Otorhinolaryngology-Head and Neck Surgery, Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China 3469 10.4193/Rhin25.225 BACKGROUND: Ciliary abnormalities are implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), but whether these changes are site-specific traits or confined to specific cell populations remains unknown. Here, we systematically examined ciliated cells throughout the sinonasal tract to characterize disease-specific ciliary alterations and identify a distinct population of elongated ciliated cells in nasal polyps (NPs). METHODS: Nasal biopsy specimens were obtained from patients with CRSwNP (n=32) and non-CRSwNP (n=22). hNECs were differentiated at the air-liquid interface (ALI). Tissue sections, cytospin preparations, and ALI cultures were immunostained for α-tubulin. Cilia length, length of horizontal axis, and length of vertical axis of ciliated cells were recorded. RESULTS: Cilia length was significantly greater in CRSwNP patients than in non-CRSwNP controls (8.17 ± 3.35 μm vs. 5.67 ± 1.64 μm). Within NPs tissues, we identified a distinct population of elongated ciliated cells (ECCs) exhibiting marked inner/outer cilia length disparity, with outer cilia reaching up to 20.0 μm. These ECCs accounted for 8.10% ± 3.56% of total ciliated cells in NPs. Notably, ECCs-like cells were also detected in polypoid-transformed mucosa adjacent to NPs and persisted after ALI culture. In contrast, ciliated cell dimensions did not differ between groups or across the nasal anatomical sites examined. CONCLUSION: A population of ciliated cells characterized by abnormally elongated cilia and concomitant impairment of ciliary function can be found in NPs, which may represent a key pathogenic factor in the development and progression of CRSwNP

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42153360 CTSS as a novel biomarker for tissue remodeling in CRSwNP: insights from multi-omics research 541 552 EN C. Li Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China Y. Huang Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China J. Yan Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China Y. Yan Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China; Department of Otolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China Y. Guo Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China K. Li Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China Y. Wen Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China J. Li Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China Y. Wei Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China W. Wen Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China; Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen Z. Xu Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Department of Allergy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China;Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, Guangdong, P.R. China 3458 10.4193/Rhin25.504 BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a refractory, relapsing upper airway inflammatory disorder cha-racterized by prominent tissue remodeling. Current therapeutic options remain suboptimal. We aimed to identify novel potential targets and biomarkers using integrative multi-omics. METHODOLOGY: We performed Mendelian randomization (MR) analyses integrating blood expression quantitative trait loci (eQTL) from eQTLGen and plasma protein quantitative trait loci (pQTL) from deCODE with nasal polyps (NP) genome-wide association study data from 8,496 NP patients and 371,520 controls. Significant targets underwent validation via bulk/single-cell RNA sequen-cing, immunohistochemistry, and immunofluorescence. RESULTS: MR analyses identified 6 targets causally linked to NP risk in both eQTL and pQTL analyses. Therein, cathepsin S (CTSS) increased the risk of NP, exclusively demonstrating colocalization with NP and exhibiting significant upregulation in NP tissue. Single-cell data showed CTSS mainly express in monocyte/macrophages, and CTSS-high subsets enriched in CRSwNP vs. Control. Immunohistochemistry and immunofluorescence further confirmed high CTSS expression in NP. Moreover, CTSS expression cor-related with tissue remodeling pathways and associated with CRSwNP clinical severity. CONCLUSIONS: CTSS may contribute to the pathogenesis of CRSwNP by modulating tissue remodeling. CTSS is a noval biomarker for CRSwNP.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42206533 Combining EBV DNA dynamics with RECIST-based radiographic response to improve prognostic stratification of recurrent/metastatic nasopharyngeal carcinoma in the era of immunotherapy 553 563 EN H.X. Long Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China S.C. Li Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China C.R. Lai School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China C.L. Huang School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China X.S. Sun Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China B.W. Shen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China; Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Guan J.Y. Shen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China; Department of Anaesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Guan H.J. Wang Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China Y.F. Li Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China J. Chen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China H. Cheng Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China L.T. Liu Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China Q.Y. Chen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China H.Q. Chen Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China L.Q. Tang Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, Guangdong, China; School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China 3470 10.4193/Rhin25.511 BACKGROUND: This study assessed the prognostic value of early Epsteinâ€"Barr virus (EBV) DNA dynamics combined with Response Evaluation Criteria in Solid Tumours (RECIST)-based radiographic response in patients with recurrent/metastatic nasopharyngeal carcinoma (R/M NPC) receiving immunotherapy, to refine risk stratification. METHODOLOGY: A real-world cohort of 306 patients with R/M NPC and detectable EBV DNA at baseline received PD-1 monoclonal antibodies (PD-1 mAbs), alone or with chemotherapy. EBV DNA and radiological assessments were performed at baseline and after two therapy cycles. Biological responses based on EBV DNA were compared with RECIST evaluations. Survival outcomes were analysed using inverse probability treatment weighting, and a Cox regression model was developed incorporating baseline features and early responses. RESULTS: Among 306 patients, 174 achieved complete biological response (cBR), and 203 achieved complete or partial radiological response (CR/PR). Patients achieving both cBR and CR/PR had the most favourable progression-free survival. Early cBR was the dominant prognostic factor for overall survival, whereas radiological response did not affect overall survival within biological response strata. A prediction model integrating baseline features, radiological, and biological responses achieved an optimismcorrected C-index, surpassing models with baseline features alone, baseline plus radiological response, and baseline with biological response. CONCLUSIONS: Early biological response by EBV DNA was a stronger prognosticator than radiological response in PD-1 mAbs-treated R/M NPC. Combining baseline clinical features with biological and radiological responses improved survival prediction.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41553197 Expanding the olfactory implant paradigm through recent advances in brain-computer interface technology 564 565 EN E.K. Bhargava Department of ENT, Sheffield Children’s Hospital, Sheffield, United Kingdom;Faculty of Health, University of Sheffield, Sheffield, United Kingdom M. Arvaneh School of Electrical and Electronic Engineering, University of Sheffield, Sheffield, United Kingdom 3420 10.4193/Rhin25.554 The international opinion paper by Whitcroft et al. provides invaluable guidance for the emerging field of olfactory implants. While the authors thoroughly address clinical considerations and current technological approaches, we would like to expand upon Statements 9.1 and 9.3 regarding electrode technology limitations and highlight recent advances in brain-computer interface (BCI) technology that could address key technological challenges around electrode longevity and biocompatibility.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42170825 The effect of large air pollution exposure on chronic rhinitis 566 567 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 3491 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) (1). NO2 conversion into nitric and nitrous acids has been shown to damage the alveolar structure in distal airways (2). The goal of this study is to investigate the early and late, subjective and objective, effects of the explosion and particulate matter exposure on the upper airway, specifically chronic rhinitis.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42165754 Reply to: The potential confounding role of nutritional support 568 569 EN R-L. Xie Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China 3465 10.4193/Rhin26.345 On behalf of all co-authors, I sincerely thank Dr. Hong for his insightful comments regarding our article and discuss the potential role of nutritional support as a confounder in our study. First, we recognized the prognostic importance of nutritional and inflammatory status in our cohort, as evidenced by our inclusion of baseline albumin (ALB) and the C-reactive protein/albumin (CRP/ALB) ratio as covariates in our propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. Both were identified as independent adverse prognostic factors in multivariate models. These markers were adjusted for in our models to account for baseline nutritional and inflammatory status. Moreover, our PSM and IPTW analyses successfully balanced the groups for key baseline nutritional markers, suggesting that the groups were comparable in terms of underlying nutritional risk at treatment initiation.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41498195 Neuromodulators do not appear effective for post-viral parosmia 570 572 EN K. Resler Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland;Department of Otolaryngology â€" Head and Neck Surgery, Stanford School of Medicine, Stanford, CA, USA B.R. Castro Department of Otolaryngology, University of São Paulo, São Paulo, Brazil Z.M. Patel Department of Otolaryngology â€" Head and Neck Surgery, Stanford School of Medicine, Stanford, CA, USA 3416 10.4193/Rhin25.162 The COVID-19 pandemic brought attention to post-viral smell distortion, or parosmia, which is defined as a qualitative dysfunction resulting from distorted odor perception in the presence of an odorous medium. Very often, qualitative and quantitative alterations occur simultaneously. Patients severely affected by qualitative odor disorders find that their quality of life has deteriorated. For quantitative loss from viruses, the role of olfactory training has been emphasized, along with high volume steroid nasal irrigations, and even injections with platelet-rich plasma. However, there has been no high-level evidence demonstrating an effective treatment for qualitative olfactory disorders.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 41853893 Comment on "Endoscopic endonasal versus transcranial approaches for trigeminal schwannomas" - the emerging role of the endoscopic transorbital approach 573 574 EN I. Dallan Skull base and rhino-orbital Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy S. Serioli Skull base and rhino-orbital Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;Department of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy;Department of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy D-S. Kong Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 3442 10.4193/Rhin26.039 We read with great interest the article by Pan et al.: "Endosco-pic endonasal versus transcranial approaches for trigeminal schwannomas: choosing the optimal surgical corridor based on tumour traits",recently published in Rhinology. The authors provide a valuable trait-based framework comparing endosco-pic endonasal (EEA) (trans-meckel's cave, transclival, trans-lamina papyracea, and trans-prelacrimal recess approaches) and transcranial approaches (TCA) (intra/extradural subtemporal with or without anterior petrosectomy, Kawase, and zygoma-tic middle fossa approach) in the management of trigeminal schwannomas (TS), according to the Samii's classification.

International Rhinologic Society Rhinology 0300-0729 64 4 2026 8 1 42165736 When sleep improves but AHI does not: comments on mepolizumab +- FESS in severe CRSwNP 575 576 EN W-Z. Hong Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong, China 3463 10.4193/Rhin26.159 We read with great interest the randomized trial by Homoe et al. evaluating mepolizumab with or without functional endo-scopic sinus surgery (FESS) for severe uncontrolled CRSwNP (1), integrating patient-reported sleep outcomes (ESS, FOSQ-10, SNOT-22 sleep items) with WatchPAT-derived indices of sleep-disordered breathing (AHI/ODI). The study addresses a clinically frequent scenario in which patients report prominent fatigue and "poor sleep", while OSA may coexist and require indepen-dent management.