International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 Rhinology starts collaboration with Wiley 577 577 EN W.J. Fokkens AmsterdamUMC, Amsterdam, the Netherlands 3634 10.4193/Rhin26.905 Rhinology has been produced for over 60 years in-house but with the increasing complexities of publishing scientific journals we felt it was the right moment to form an external partnership and after a rigorous search, and in close collaboration with the editoril board, choose Wiley, whose expertise in the field and modus operandi are the most compatible with Rhinology.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42334381 Therapeutic outcomes of biologic switching in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis 578 587 EN H.J. Aljubran Department of Otolaryngology Head and Neck Surgery, Aljabr Eye and ENT Hospital, Alahsa Health Cluster, Alahsa, Saudi Arabia M.R. Alabdulaal Department of Otolaryngology Head and Neck Surgery, Aljabr Eye and ENT Hospital, Alahsa Health Cluster, Alahsa, Saudi Arabia L.A. Aldhaif College of Medicine, King Faisal University, Alahsa, Saudi Arabia D.M. Motabagani College of Medicine, King Faisal University, Alahsa, Saudi Arabia R.M. Alhussain College of Medicine, King Faisal University, Alahsa, Saudi Arabia Z.S. AlWusaybie College of Medicine, King Faisal University, Alahsa, Saudi Arabia F.O Aldhafeeri College of Medicine, King Faisal University, Alahsa, Saudi Arabia A. Almomen Department of Otolaryngology Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia 3482 10.4193/Rhin25.623 BACKGROUND: Biological therapy is a newer line of treatment that has been utilized in practice for patients with chronic rhinosinusitis with nasal polyps, showing excellent results. However, some patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) do not respond to this therapy. Hence, this study aims to evaluate the efficacy and safety of biological switching in these patients. METHODOLOGY: Using the Web of Science, Cochrane, MEDLINE, and Embase databases, we analyzed studies involving biological switching in CRSwNP patients published up to June 2025. The studies were extracted, and data were pooled for meta-analysis. RESULTS: Of 3,367 studies identified, eight studies (involving 470 patients) were included in the systematic review, four of which were included in the meta-analysis. The results showed that the most common reason for switching was insufficient CRS symptom control (59.7%), followed by undesirable side effects (10.8%). The findings demonstrated dramatic effects of biological switching in terms of the SNOT-22 score, with a mean improvement of 71.4%. In addition, studies that switched patients to dupilumab showed significant improvement after switching in both SNOT-22 and nasal polyp scores. Overall, the success rate of biological switching ranged from 59.6% to 100%, with an average success rate of 79.2%. CONCLUSIONS: This review demonstrated the effect of biological switching as an option for patients with refractory CRSwNP or those experiencing biological side effects. These findings highlight a new therapeutic alternative that can serve as a fundamental choice when managing CRSwNP patients.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42333495 Metropolitan air pollution and the upper and lower airway: chronic rhinosinusitis and asthma outpatient burden 588 598 EN H.H. Yang Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA E Velasquez Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA P.H. Hwang Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA 3475 10.4193/Rhin26.072 BACKGROUND: Although evidence has implicated air pollution in both upper and lower airway inflammation, regulatory efforts have primarily emphasized lower-airway outcomes. We characterize the association between ambient pollutant levels and outpatient burden of chronic rhinosinusitis (CRS) and asthma across the US. METHODOLOGY: We conducted an ecological cohort study of US metropolitan statistical areas (MSAs) between 2007 and 2020. Annual outpatient claims were obtained from the MarketScan database and linked with data from the Environmental Protection Agency (EPA) monitoring network. For each MSA, annual outpatient visits for CRS and asthma were normalized to the number of wellness check visits (CRS-OV, asthma-OV). Daily 365-day rolling averages were calculated for each EPA-monitored pollutants. Mixed-effects models estimated associations with CRS-OV and asthma-OV, and additive pollutant interactions. RESULTS: Controlling for community health indicators, higher levels of all EPA monitored pollutants predicted increased CRS-OV and asthma-OV. Adjusting for co-pollutant levels, PM2.5 (particles ≤2.5μm in diameter) and SO2 (gas from fossil fuel combustion) remained independently predictive. Each standard deviation increase in PM2.5 corresponded to 15% and 6% increases in CRS-OV and asthma-OV, while each standard deviation increase in SOâ‚‚ corresponded to 12% and 10%, respectively. Positive additive interaction between PM2.5 and SO2 was observed for both CRS-OV and asthma-OV. CONCLUSIONS: While EPA-monitored pollutants were broadly associated with outpatient burden, PM2.5 and SO2 emerged as independent and synergistic predictors after co-pollutant adjustment, with stronger associations for CRS compared to asthma. Regulatory focus should extend beyond lower-airway outcomes and include upper-airway morbidity as a critical indicator of pollutionâ€"related burden.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42467018 Dupilumab in chronic rhinosinusitis without nasal polyps: randomized phase 2 trial (ORION) 599 608 EN S.E. Lee Department of Otolaryngologyâ€"Head and Neck Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, United States A.T. Peters Feinberg School of Medicine, Northwestern University, Chicago, IL, United States P. Gevaert Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium J.K. Han Department of Otolaryngology and Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, United States C. Bachert Department of Otorhinolaryngologyâ€"Head and Neck Surgery, University Hospital of Münster, Münster, Germany; First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China F. Moreira da Silva Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal A. Rosenblüt Unidad de Otorrinolaringologia, Hospital Dr Sotero del Rio, Puente Alto, Santiago, Chile C.C Hu Sanofi, Morristown, NJ, United States J. Maloney Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States P. Caferra Sanofi, Amsterdam, The Netherlands; Department of Pharmacy, University of Pisa, Pisa, Italy A. Michalak Sanofi, Toronto, ON, Canada A.P. Fontenot Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States L.B. Robinson Sanofi, Cambridge, MA, United States N.A. Phadke Sanofi, Cambridge, MA, United States 3487 10.4193/Rhin25.660 BACKGROUND: Chronic rhinosinusitis (CRS) is often driven by type 2 inflammation and is characterized by nasal obstruction/ discharge, facial pain/pressure, and/or reduced smell, either with or without nasal polyps (CRSwNP or CRSsNP). OBJECTIVE: To test whether dupilumab improves radiographic features in CRSsNP. Methods: ORION (NCT04678856), a phase 2, randomized, multicenter, double blind, placebo-controlled study, assessed dupilumab efficacy and safety in adults with uncontrolled CRSsNP. Patients were randomized 1:1 to dupilumab or placebo for 24 to 52 weeks. Endpoints included changes from baseline at week 24 in Lundâ€"Mackay computed tomography (LMK-CT) score (dupilumab only [primary] and vs placebo [secondary]), sinus Total Symptom Score (sTSS), University of Pennsylvania Smell Identification Test (UPSIT) score, and 22-item Sino-Nasal Outcome Test(SNOT-22) score. Primary analysis was conducted in the intention-to-treat population with screening blood eosinophil count (sBEC) ≥300 cells/μL. Safety data were evaluated in all patients. RESULTS: Seventy-one patients were randomized (dupilumab, n = 38; placebo, n = 33). In the dupilumab group with sBEC ≥300 cells/μL (n = 16), mean (95% CI) week 24 change from baseline in LMK-CT was -6.63 (-8.71 to -4.54); week 24 mean differences vs placebo (95% CI) for LMK-CT, sTSS, UPSIT, and SNOT-22 were -5.95 (-8.38 to -3.51), -1.43 ( 3.28 to 0.41), 5.91 (-1.56 to 13.38), and -14.71 (-34.35 to 4.94). Treatment-emergent adverse events were balanced between treatment groups. CONCLUSION: Dupilumab was associated with improvement in LMK-CT score and a trend toward improvement in sinonasal symptoms at week 24 in adults with severe, uncontrolled CRSsNP with sBEC ≥300 cells/μL.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42334381 Real world efficacy of dupilumab in switchers versus biological naive CRSwNP patients 609 616 EN J. Lammens Faculty of Medicine, KU Leuven, Leuven, Belgium A. 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 G. Verstappen KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium; Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium S. Halewyck Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium; Department of Otorhinolaryngology, AZorg Aalst, Belgium B. Verhaeghe Department of Otorhinolaryngology, AZorg Aalst, Belgium C. Cox Department of Otorhinolaryngology, Jessa Ziekenhuis Hasselt V. Hox Department of Otorhinolaryngology, University Hospital Saint-Luc, Brussels, Belgium W. Lemmens Department of Otorhinolaryngology, hospital Oost-Limburg, Genk, Belgium F. Rogister Department of Otorhinolaryngology, CHU de Liège, Belgium K. Speleman Department of Otorhinolaryngology, General hospital Sint-Jan Bruges, Bruges, Belgium O.M. Vanderveken Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium; Department of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium P.W. Hellings KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, Leuven, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium; Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium 3483 10.4193/Rhin26.041 BACKGROUND: Biologicals have revolutionized care for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, real-world efficacy (RWE) data of dupilumab in patients who switch to dupilumab after having no or minimal therapeutic response to either omalizumab or mepolizumab are lacking. No comparison has been performed between patients switching from omalizumab or mepolizumab to dupilumab and those receiving dupilumab as their first biological. AIM: 55 CRSwNP patients receiving dupilumab in the RELIBIO trial were divided into those who were biological naive (n = 30) and those who showed no to poor therapeutic response to 6 months therapy with either omalizumab or mepolizumab (n = 25), with evaluation of the following parameters at baseline and 6 months: SNOT-22 scores, nasal congestion scores (NCS), VAS scores for nasal obstruction, smell loss and postnasal drip, ACQ-5, AQLQ and total nasal polyp scores (TNPS). We determined disease control and therapeutic response evaluation (TRE) at 6 months for both groups using the EUFOREA/EPOS criteria. RESULTS: Dupilumab showed significant improvements on all patient-reported outcome measures (PROMs) and TNPS in both groups. When comparing the efficacy between switchers and naive patients, dupilumab showed equal efficacy in both groups on SNOT-22, TNPS, NCS, VAS scores for smell loss, nasal blockage and postnasal drip, ACQ-5 and AQLQ. A good to excellent therapeutic response at 6 months was observed in 67% of switchers compared to 97% of the biological naive patients. Regarding disease control at 6 months, we observed 44% being controlled in the switchers and 67% in the biological naive group, with smell loss being the main reason for not being controlled. CONCLUSIONS: This prospective RWE study shows that dupilumab significantly reduced symptom severity and nasal polyp scores in CRSwNP patients at 6 months of therapy, also in those showing a minimal therapeutic response to mepolizumab or omalizumab. Patients in the biologic naive group showed a higher likelihood of achieving disease control.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42578497 Baseline EPOS 2020 eligibility and real-world outcomes of dupilumab in CRSwNP: a longitudinal cohort study 617 626 EN N.J. Campion Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria D.P. Petsiou Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria F. Fally Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria K. Berbalk Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria N. Melamed Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria A. Tu Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria C. Morgenstern Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria M. Zghaebi Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria F.A. Kidane Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria L. Liu Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria M. Pan Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria T.J. Bartosik Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria V. Stanek Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria K. Gangl Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria J. Eckl-Dorna Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria S. Schneider Vienna Airway Lab, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria 3493 10.4193/Rhin25.687 Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is often a type 2â€"driven inflammatory disease that markedly impairs quality of life. Dupilumab offers major therapeutic benefit but at high cost, underscoring the need for accurate patient selection. EPOS2020 introduced indication criteria for biologic therapy, yet their real-world predictive validity remains underexplored. Methods: This study screened 224 CRSwNP patients treated with dupilumab between November 2019 and May 2025. Outcomes included Total Polyp Score (TPS), 22-item Sinonasal Outcome Test (SNOT-22), olfactory performance, and serum biomarkers. Patients were stratified into EPOS-eligible and ineligible groups based on EPOS2020 criteria, and responses were evaluated using minimal clinically important difference (MCID) thresholds and EPOS/EUFOREA response criteria. Predictors of adequate response were analyzed with logistic regression, and treatment trajectories with linear mixed-effects models. Results: EPOS2020 criteria could be assessed in 177 patients, of whom 76 met them at baseline. EPOS-eligible patients achieved greater improvements in TPS, SNOT-22, and olfaction, and were more likely to reach MCID for TPS. EPOS-eligible patients also had higher composite EPOS response scores, although “adequate EUFOREA responseâ€� rates did not differ. Non-steroidal anti-inflammatory drug exacerbated respiratory disease independently predicted adequate response, while higher baseline serum IgE was associated with faster improvement trajectories. Conclusions: EPOS2020 criteria provide an effective framework for dupilumab allocation, although markers of active type 2 inflammation may better predict response than categorical eligibility alone.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 Real-world dupilumab treatment reduced healthcare resource utilization and medication use in patients with CRSwNP 627 635 EN J.K. Han Department of Otolaryngology and Head and Neck Surgery, Old Dominion University, Norfolk, VA, United States S.E Lee Division of Otolaryngologyâ€"Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States A.T. Peters Division of Allergy and Immunology and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States Z. Soler Department of Otolaryngologyâ€"Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States N. Kamal Global Medical Affairs, Sanofi, Dubai, United Arab Emirates S. Nash Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States M. Corbett Global Medical Affairs, Sanofi, Morristown, NJ, United States A. Radwan Regeneron Pharmaceuticals Inc., Uxbridge, United Kingdom J. Levy Department of Otolaryngologyâ€"Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States 3509 10.4193/Rhin25.714 BACKGROUND: Evidence of dupilumab’s real-world effectiveness in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) in US clinical practice is limited. OBJECTIVE: To investigate healthcare resource utilization (HCRU) and medication use in patients with CRSwNP before and after dupilumab initiation in real-world US clinical practice. METHODS: This retrospective observational study included adults with CRSwNP who initiated dupilumab 300 mg every 2 weeks between June 2019 and June 2022. Data including claims and electronic health records were extracted from the OM1 Real-World Data Cloud and Reg-ENT Registry. Medication use, healthcare visits, sinus procedures, and imaging were assessed during the 12 months before (baseline) and after (follow-up) dupilumab initiation. RESULTS: The study comprised 1,016 patients (mean age 53.8 years, 46.1% female). Annual mean [standard deviation] number of visits per patient was lower during follow-up vs baseline for outpatient (5.0 [5.2] vs 7.1 [6.0]), otolaryngologist (3.7 [6.7] vs 4.0 [6.1]) and emergency department visits (0.1 [0.6] vs 0.2 [0.6]). The proportion of patients prescribed oral corticosteroids for any reason was lower during follow-up (28.7% vs 68.1%, respectively. Fewer patients were prescribed antibiotics (31.8% vs 64.6%) and CRSwNP related oral corticosteroids (17.7% vs 59.1%), and fewer patients underwent nasal endoscopy (47.5% vs 71.2%) and CT scan (4.5% vs 22.1%) during follow-up than at baseline. CONCLUSIONS: These findings suggest an association between dupilumab treatment and reductions in HCRU and medication use in patients with CRSwNP, and provide supportive evidence of dupilumab’s real-world effectiveness.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42333497 Association between chronic obstructive pulmonary disease and chronic rhinosinusitis: a longitudinal follow-up study using a national health insurance database 636 646 EN M.W. Park Department of Otorhinolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea H.J. Jung Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea H.G. Choi Department of Otorhinolaryngology-Head and Neck Surgery, Mdanalytics, Suseoseoulent Clinic, Seoul, Republic of Korea J.H. Wee Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea 3479 10.4193/Rhin26.130 BACKGROUND: This study aimed to examine whether chronic obstructive pulmonary disease (COPD) is associated with the subsequentdevelopment of chronic rhinosinusitis (CRS) among Korean adults. METHODOLOGY: Using the 2002â€"2019 Korean National Health Insurance database, we conducted a retrospective cohort study. Individuals with COPD, definted by relevant ICD-10 codes recorded on at least two occasions together with at least two prescriptions for COPD-related medicines (n=615,706), were matched with control participants (n=2,184,000) by age, sex, income, and region of residence. The incidence of CRS with and without nasal polyps was evaluated in both COPD and control groups. Hazard ratios (HRs) were estimated using stratified Cox proportional hazards models, and prespecified subgroup analyses were conducted. RESULTS: The incidence rate of CRS was higher in patients with COPD than in control participants. After adjustment, the HR for CRS was significantly higher in the COPD group compared with the control group. Likewise, the HRs for CRS with nasal polyps and CRS without nasal polyps were also significantly higher in the COPD group than in the control group. Statistical significance was observed in all subgroups according to age, sex, income, and region of residence. Kaplanâ€"Meier analyses showed a higher cumulative incidence in participants with COPD. CONCLUSIONS: In this nationwide Korean cohort, COPD was associated with a higher incidence of CRS, both with and without nasal polyps.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 The qualitative exploration of work productivity among chronic rhinitis patients 647 657 EN S.N. Sharudin Department Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia F.D. Zahedi Department Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Department Otorhinolaryngology Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia H.M. Yusoff Department of Community health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia S. Husain Department Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Department Otorhinolaryngology Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia A.K.W. Hamizan Department Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Department Otorhinolaryngology Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia R. Hod Department of Community health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia 3494 10.4193/Rhin25.032 Background: Chronic rhinitis is a global public health concern affecting sleep, cognitive function, mood, quality of life, and work performance. It contributes to socioeconomic costs through decreased productivity, including absenteeism and presenteeism. This study explores the impact of chronic rhinitis on work productivity and employee performance to inform better management strategies. Method: A literature review and semi-structured interviews were conducted with 19 chronic rhinitis patients from Hospital Canselor Tuanku Muhriz and Hospital Ampang. Data saturation was reached, and thematic analysis was performed using Atlas.ti. Result: Eight themes were identified: absence during working hours, work limitations, disruption of social interactions, reduced work efficiency, emotional disturbances, weaknesses in compliance with work procedures, sleepiness at work, and negative perceptions from colleagues. Conclusion: Chronic rhinitis significantly affects work productivity, leading to absenteeism, reduced efficiency, and workplace stigma. These findings highlight the need for targeted management strategies to improve work performance and reduce the negative impact of chronic rhinitis on affected individuals.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42206541 Factors influencing timing of cerebrospinal fluid leak after endoscopic skull base surgery: a multicenter study 658 668 EN A.A. Halderman Department of Otolaryngology-Head and Neck Surgery, Westchester Medical Center Health Network, Valhalla, NY, USA M.Z. Cheng Department of Otolaryngologyâ€"Head and Neck Surgery, University of California, Irvine, Orange, CA, USA A. Abiri Department of Otolaryngologyâ€"Head and Neck Surgery, University of California, Irvine, Orange, CA, USA K.E. Daniels Department of Otolaryngologyâ€"Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA V. Pandrangi Department of Otolaryngologyâ€"Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA A.D. Workman Department of Otolaryngologyâ€"Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA S. Chung Department of Otolaryngologyâ€"Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA S.L. Barnett Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA N.D. Adappa Department of Otorhinolaryngologyâ€"Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Pittsburgh, PA, USA G. Choby Department of Otolaryngologyâ€"Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, US; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA P.A. Gardner Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA M. Geltzeiler Department of Otolaryngologyâ€"Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA J.N. Palmer Department of Otorhinolaryngologyâ€"Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Pittsburgh, PA, USA C.H. Snyderman Department of Otolaryngologyâ€"Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, US; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA E.W. Wang Department of Otolaryngologyâ€"Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, US; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA G.A. Zenonos Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA E.C. Kuan Department of Otolaryngologyâ€"Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA 3471 10.4193/Rhin25.695 INTRODUCTION: Considerable work has been done to delineate risk factors for cerebrospinal fluid (CSF) leak after endoscopic skull base surgery (ESBS). Little work has been done to evaluate factors that influence the timing of CSF leaks after ESBS. The timing of when CSF leaks occur may have important implications on postoperative precautions and managing the underlying etiology. The aim of this multi-institutional study was to evaluate postoperative CSF leaks after ESBS to determine timing of occurrence and factors that influence when leaks occur. METHODS: Data were collected retrospectively on patients diagnosed with CSF leak after ESBS at 5 institutions from 2010 to 2024. Variables including patient demographics, tumour and defect dimensions, defect location, reconstruction, timing of CSF leak, management of leak, and rates of meningitis were collected. Results: A total of 184 patients were analysed. The median postoperative day (POD) when CSF leak occurred was 7. Prior radiation, BMI less then 25, recurrent tumours, large defect size, defects located in the clivus, and CSF diversion were all associated with delays in presentation of postoperative CSF leak (all p less then 0.05). On multivariate analysis, BMI and history of radiation retained significance in association with delayed CSF leak. Timing of leak also appeared to be impacted by the number of, and specific layers used in reconstruction. CONCLUSIONS: Several factors were found to impact the timing of CSF leak after ESBS including patient, intraoperative, and postoperative factors. Understanding timing of postoperative CSF leaks may provide insights for prevention and secondary management.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42478532 Nasal endoscopic indocyanine green fluorescence imaging guided surgery for recurrent nasopharyngeal carcinoma 669 677 EN T. Liang Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China J. Li Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China X. Hu Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China Y. He Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China X. Li Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China Z. Zhu Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China K. He CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China H. Zhang Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China C. Yu Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China 3489 10.4193/Rhin25.558 INTRODUCTION: To evaluate the feasibility and diagnostic value of indocyanine green (ICG) fluorescence imaging in the surgical treatment of recurrent nasopharyngeal carcinoma (rNPC). METHODOLOGY: A retrospective analysis was conducted on clinical data of patients who presented to our department between January 2024 and January 2026, and underwent endoscopic surgery guided by ICG fluorescence imaging system intraoperatively. These patients had previously received radiotherapy for NPC and were found to have suspected recurrence during follow-up examinations. ICG fluorescent agent was administered preoperatively or intraoperatively, and tumours were resected under real-time fluorescence endoscopic monitoring. The fluorescence imaging effects of the tumours and the pathological results of fluorescence-positive lesions were recorded and analysed. RESULTS: This study included 82 patients with suspected recurrence on preoperative evaluation who underwent ICG fluorescence imaging. Patients were stratified based on pathological findings into tumour group (n=46) and non-tumour group (n=36). Statistical analysis demonstrated a significant correlation between ICG fluorescence localization and pathological diagnosis. The sensitivity of ICG for tumour detection was 89.1%, specificity was 72.2%, positive predictive value was 80.4%, negative predictive value was 83.9%, and overall accuracy was 81.7%. ROC curve analysis yielded an area under the curve (AUC) of 0.88 for ICG fluorescence in distinguishing tumours. CONCLUSIONS: This study is the first to systematically validate the feasibility and diagnostic value of ICG fluorescence imaging in the complex clinical scenario of rNPC surgery, providing a new tool to improve the radicality and safety of surgery for rNPC.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42411335 Pharmacological silencing of nasal TRPV1+ nociceptors ameliorates eosinophilic infiltration but exacerbates neutrophilic infiltration in murine models of allergic rhinitis 678 690 EN F. Ye Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China Y. Tao Department of Otolaryngology-Head and Neck Surgery, Shenzhen Third People's Hospital, Shenzhen, China J. Chen Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China R. Wang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China Y. Li Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China Z. Shi Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China Q. Yang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China 3484 10.4193/Rhin25.667 BACKGROUND: The pathogenesis of allergic rhinitis (AR) involves hyperreactivity of both the immune and neural systems. While sensory nerves detect allergens and release neuropeptides that directly participate in immune regulation, their precise role within the AR inflammatory network remains incompletely elucidated. METHODOLOGY: Using house dust mite (HDM) and ovalbumin (OVA)-induced murine AR models, we selectively silenced nasal TRPV1-expressing sensory nerves pharmacologically with QX-314 (co-administered with capsaicin) and Resiniferatoxin (RTX). The effects of neuronal silencing on animal behavior, allergen-specific IgE levels, inflammatory cell nfiltration, and immune cell populations were systematically evaluated via immunofluorescence, histological staining, ELISA, and flow cytometry. RESULTS: Both QX-314 and RTX effectively silenced TRPV1+ sensory neurons in the trigeminal ganglia and significantly downregulated the expression of neuropeptides CGRP and SP. Silencing nasal TRPV1+ sensory nerves markedly reduced eosinophilic infiltration and levels of the associated marker ECP in the nasal mucosa of AR model mice. Unexpectedly, it also led to a significant increase in neutrophilic infiltration and MPO-positive cells. RTX-mediated ablation further compromised epithelial barrier integrity and aggravated the local inflammatory burden. Flow cytometric analysis further confirmed that RTX-mediated ablation of TRPV1+ neurons significantly decreased the proportions of infiltrating eosinophils and B cells, but increased the proportion of neutrophils in the OVA model. CONCLUSIONS: Silencing nasal TRPV1+ sensory nerves exerts a dual immunomodulatory effect in AR, attenuating eosinophilic inflammation while promoting neutrophilic infiltration. This reveals a critical neuro-immune balance in the nasal mucosa and suggests that precisely targeted neuromodulation strategies are required to suppress allergic inflammation.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42467066 Subepithelial ALOX15+ macrophage niches orchestrate eosinophil recruitment in chronic rhinosinusitis with nasal polyps via the ALOX15-ERK-CCL13 axis 691 703 EN Y. Cui Department of Otolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China; Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China C. Liu Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China K. Wang Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China W. Liu Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China W. Wen Department of Otolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China; Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China J. Shi Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Y. Sun Department of Otolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China; Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, Guangzhou, China 3488 10.4193/Rhin26.124 BACKGROUND: Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is characterized by intense type 2 inflammation and high recurrence rate. The precise spatial determinants and cellular mechanisms sustaining tissue eosinophilia within the polyp microenvironment remain unkown. This study aimed to identify the spatially cellular niches driving eosinophil recruitment and evaluate the therapeutic efficacy of targeting specific macrophage-driven pathogenic loops in eCRSwNP. METHODOLOGY: Transcriptomic profiles were analyzed using bulk RNA-sequencing of nasal polyp tissues from CRSwNP patients (n = 30, stratified by eosinophilic severity) and healthy controls (HC, n = 10). Spatial transcriptomics (GeoMx DSP) and single-cell RNA sequencing analyses were utilized to map macrophage niches. Mechanistic findings were validated ex vivo and in vitro using human sinonasal explant models and migration assays, incorporating an independent cohort of healthy controls (n = 12). RESULTS: Bulk transcriptomics of nasal polyps stratified across a gradient of tissue eosinophil density identified ALOX15 and CCL13 as top candidates positively correlating with tissue eosinophilia. Spatial transcriptomics revealed that subepithelial ALOX15+ macrophages served as the primary source of CCL13, and the localized CCL13 expression significantly correlated with eosinophil density in epithelial areas. Mechanistically, IL-4/IL-13 induces ALOX15-ERK-CCL13 axis in macrophages. Functional explant assays confirmed that ALOX15+ macrophages drive eosinophil recruitment via CCR3. IL-4Ra blockade with Dupilumab or Stapokibart abrogated the pathogenic ALOX15-CCL13 loop and attenuated eosinophil chemotaxis. CONCLUSIONS: Our findings identify the subepithelial ALOX15+ macrophage niche as a pivotal spatial determinant of eosinophilia in eCRSwNP. Targeting this specialized immune hub with emerging biologics offers a promising precision therapeutic strategy.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 41965112 Anterior superior alveolar nerve dysfunction after lateral nasal wall surgery: a prospective observation 704 706 EN A. Machado Department of Otolaryngology, ULSTMAD, Vila Real, Portugal;Faculdade de Ciências da Saúde â€" Universidade da Beira Interior, Covilhã, Portugal M. Castelo-Branco Sousa Faculdade de Ciências da Saúde â€" Universidade da Beira Interior, Covilhã, Portugal H.R. Briner ORL-Zentrum, Hirslanden Klinik, Zurich, Switzerland D. Simmen ORL-Zentrum, Hirslanden Klinik, Zurich, Switzerland 3450 10.4193/Rhin26.046 The anterior superior alveolar nerve (ASAN), a branch of the infraorbital nerve, provides sensory innervation to the anterior maxilla, lateral nasal wall, and maxillary dentition. Owing to its anatomical proximity to the anterior maxillary wall and piri-form aperture, the ASAN is vulnerable during lateral nasal wall surgery. Although postoperative sensory disturbances such as gingival hypoesthesia or dental numbness are frequently re-ported, prospective data combining subjective symptoms with objective sensory testing across different surgical techniques remain limited .

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42233219 Impact of real-world confounders on the accuracy of an AI model to support read out of skin prick automated test results 707 709 EN K. Roux Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium S.F. Seys Hippo Dx, Aarschot, Belgium; Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria V. Hox Service d'Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium A.M. Chaker Department of Otorhinolaryngology and Center of Allergy and Environment (ZAUM), TUM School of Medicine and Health, TUM University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany P.W. Hellings Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium; Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium G. de Greve Department of Otorhinolaryngology-Head and Neck Surgery, ZAS Sint-Augustinus, Antwerp, Belgium W. Lemmens Department of Otorhinolaryngology-Head and Neck Surgery, ZOL, Genk, Belgium A.L. Poirrier ENT Department, CHU Liège, Liège, Belgium R. Daems Affiliation1; Hippo Dx, Aarschot, Belgium. Affiliation2; IDLab, Ghent University-imec, Ghent, Belgium D. Loeckx Hippo Dx, Aarschot, Belgium S. Gorris Hippo Dx, Aarschot, Belgium; Department of Otorhinolaryngology, AZ Herentals, Herentals, Belgium L. van Gerven Department of Otorhinolaryngology, Headlogy, and Neck Surgery, UZ Leuven, Leuven, Belgium; Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium 3474 10.4193/Rhin25.634 Skin prick testing (SPT) is the gold standard for diagnosing allergic sensitization in individuals with a suspected airborne allergy (1). Skin tests are used as first option in 90% of individuals suffering from respiratory allergies and almost two-third of all types of allergies (2).

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42446525 Upper airway disease in Jeju Haenyeo: the aging and resilience cohort (JH-ARC) study 710 712 EN S.W. Chang Department of Otolaryngology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea M. Kang Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea J. Lee Biomedical Research Institute, Jeju National University Hospital, Jeju, Republic of Korea M.J. Suh Department of Otolaryngology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea J.H. Kim Department of Otolaryngology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea E. Park Department of Pathology, Jeju National University College of Medicine, Jeju, Republic of Korea S. Ji Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea E. Lee Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea C. Yang Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea A. Ha Department of Ophthalmology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea J.K. Rhim Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea J. Cho Department of Clinical Research Design J.D Joo Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea 3485 10.4193/Rhin26.196 Jeju Haenyeo are traditional female breath-hold divers from Jeju Island, the southernmost and largest island of the Republic of Korea, who harvest marine products without modern diving equipment. During diving, they are repeatedly exposed to cold seawater, breath-holding, and pressure changes. The upper airway may be particularly vulnerable, as it is the first anatomical region directly exposed to seawater and pressure-related stimuli.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42578487 Effectiveness of mepolizumab in eosinophilic asthma and chronic rhinosinusitis with nasal polyps 713 715 EN E. Chiner Pulmonology Department, San Juan de Alicante University Hospital, Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Elche, Alicante, Spain I. Boira Pulmonology Department, San Juan de Alicante University Hospital, Alicante, Spain J.L. Lafuente Otorhinolaryngology Department, San Juan de Alicante University Hospital, Alicante, Spain M. Antón Allergy Department, San Juan de Alicante University Hospital, Alicante, Spain M.A. Bernabeu Pharmacy Department, San Juan de Alicante University Hospital, Alicante, Spain P. Fernández Pulmonology Department, San Juan de Alicante University Hospital, Alicante, Spain V. Esteban Pulmonology Department, San Juan de Alicante University Hospital, Alicante, Spain M. Llombart Pulmonology Department, San Juan de Alicante University Hospital, Alicante, Spain 3492 10.4193/Rhin26.207 Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease affecting 2â€"4% of the population which has a significant impact on quality of life. Approximately 40% to 60% of people with CRSwNP also have eosinophilic asthma, reflecting the unified airway concept characterised by type 2 inflammation driven by interleukin (IL)-4, IL-5 and IL-13.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42446510 Nasal biopsy in ANCA-associated vasculitis: a game changer or a false friend? 716 717 EN L. Gazzini Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy I. Girolami Department of Pathology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy S. Niederbacher Department of Reumathology, Hospital of Brunico (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Brunico, Italy L. Calabrese Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy M. Bond Department of Reumathology, Hospital of Brunico (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Brunico, Italy 3486 10.4193/Rhin26.217 Earâ€"noseâ€"throat (ENT) involvement is common in ANCA associated vasculitis, particularly in granulomatosis with polyangiitis (GPA) and EGPA eosinophilic granulomatosis with polyangiitis (EGPA), with sinonasal manifestations frequently representing the earliest clinical features of disease.

International Rhinologic Society Rhinology 0300-0729 64 5 2026 10 1 42578479 Mucus transport in the olfactory cleft is significantly slower than in the nasal respiratory mucosa 718 720 EN A.K. Hernandez Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany AND Department of Otolaryngology - Head and Neck Surgery, College of Medicine and Philippine General Hospital, University of the Philippines - Manila, Manila, Philippines AND Department of Otolaryngology â€" Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines S. Biguerdi Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany K. Schindowski Institute for Applied Biotechnology, Biberach University of Applied Science, Biberach an der Riss, Germany T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 3495 10.4193/Rhin26.082 Intranasal mucociliary transport has been conventionally described as moving, essentially, in an anterior-to-posterior direction along the ciliated respiratory mucosa (RM). This mechanism is essential for clearing inhaled particles and pathogens and may be impaired in individuals with certain genetic conditions or infections.