ISSN: 0300-0729

VOLUME 61 | SUPPLEMENT 32 | JULY

CONTENT
Official Journal of the European and International Societies
ERS 2023 abstract book

VOLUME 61 | SUPPLEMENT 32 | JULY 2023

29th congress of the European Rhinologic Society

Sofia, Bulgaria

June 18-22, 2023 ERS 2023

abstract book

2023
29th congress of the
European Rhinologic
Society

Sofia, Bulgaria

June 18-22, 2023

K

2 3
20
 POSITION PAPER ON OLFACTORY DYSFUNCTION: 2023

Official Journal of the European and International Rhinologic Societies

Editor-in-Chief Address
Prof W.J. Fokkens Journal Rhinology, c/o AMC, Mrs. J. Kosman / A2-234, PO Box 22 660,
1100 DD Amsterdam, the Netherlands.
Associate Editors Tel: +31-20-566 4534
Prof C. Hopkins Fax: +31-20-566 9662
Prof B.N. Landis E-mail: assistant@rhinology.org
Dr. S. Reitsma Website: www.rhinologyjournal.com
Prof. A.R. Sedaghat

Managing Editor
Dr. W.T.V. Germeraad

Editorial Assistant and Rhinology Secretary

Mrs. J. Kosman
Mrs. J. Keslere
assistant@rhinology.org

Webmaster
Prof D. Barać
rhinologywebmaster@gmail.com

Rhinology (ISSN 0300-0729) is the official Journal of the European and © Rhinology, 2023.
International Rhinologic Societies and appears bimonthly in February, April, All rights reserved. No part of this publication may be reproduced or transmitted
June, August, October and December. Cited in Pubmed, Current Contents, Index in any form or by any means electronic or mechanical, including photocopying,
Medicus, Exerpta Medica and Embase. recording or any information storage and retrieval system without prior permis-
sion in writing from the Publisher.
Founded in 1963 by H.A.E. van Dishoeck, Rhinology is a worldwide ­non-profit Submission of a manuscript for publication implies the transfer of the copyright
making journal. The journal publishes original papers on basic research as well as from the author(s) to the publisher and entails the author’s irrevocable and
clinical studies in the major field of rhinology, ­including physiology, diagnostics, exclusive authorization of the publisher to collect any sums or considerations for
pathology, immunology, medical ­therapy and surgery of both the nose and copying or reproduction payable by third parties.
paranasal sinuses. Review a­ rticles and short communications are also pulished,
but no Case reports. All papers are peer-reviewed. Letters-to-the-editor provide
a forum for ­comments on published papers, and are not subject to editorial revi-
sion except for c­ orrection of English ­language.
In-depth studies that are too long to be included into a ­regular issue can be
published as a supplement. Supple­ments are not subject to peer-review.
 Oral Abstracts
Best Oral for Junior Grant 1 5 – 17
CRS – pathophysiology 1 18 – 27
CRS – surgical management 1 28 – 38
Paediatric rhinology 1 39 – 49
CRS – outcome assessment 1 50 – 57
Septal and turbinate surgery 1 58 – 64
Acute Rhinosinusitis 1 65 – 70
CRS – diagnosis and investigations 1 71 – 77
Late Breaking Abstracts 1 78 – 84
Miscellaneous 1 85 – 91
CRS – medical management 1 92 – 101
Allergic Rhinitis 1 102 – 109
Rhinology – Miscellaneous 1 110 – 119
Skull base surgery 1 120 – 127
Best Poster Session 128 – 141
Best Oral for Junior Grant 2 142 – 154
Smell and Taste 1 155 – 165
CRS – surgical management 2 166 – 177
Snoring and OSA 1 178 – 185
Skull base surgery 2 / CSF leaks and management 186 – 194
Benign Nasal Tumors 1 195 – 202
CRS – diagnosis and investigations 2 203 – 210
CRS – medical management 3 211 – 219
Technological advances 1 220 – 224
Epistaxis and HHT + Facial Trauma 225 – 231
Sinonasal malignancy 1 232 – 239
CRS – medical management 2 240 – 247
Allergic Rhinitis, Non Allergic Rhinitis 248 – 257
Smell and Taste 3 258 – 267
Rhinology – miscellaneous 2 268 – 277

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 CRS – pathophysiology 2 278 – 288
Smell and Taste 2 289 – 298
Rhinoplasty 1 299 – 308
Orbital surgery/ Lacrimal Surgery 309 – 319
Pituitary Surgery 1 320 – 329
CRS – outcome assessment 2 330 – 338
Benign nasal tumours 2 339 – 346
CRS – medical management 4 347 – 355
Epistaxis and HHT 2 356 – 363
Miscellaneous 2 364 – 370
CRS – diagnosis and investigations 3 371 – 378
Sinonasal malignancy 2 379 – 387
CRS – medical management 5 388 – 397
Imaging and investigations 1 398 – 405
Late breaking Abstracts 2 406 – 415

e-Posters
Acute Rhinosinusitis 416 – 419
Allergic Rhinitis 420 – 429
Benign nasal tumours 430 – 445
CRS – diagnosis and investigations 446 – 454
CRS – medical management 455 – 464
CRS – outcome assessment 465 – 467
CRS – pathophysiology 468 – 475
CRS – surgical management 476 – 485
CSF leaks and management 486 – 492
Epistaxis and HHT 493 – 499
Facial Pain 500
Facial Plastic surgery beyond the nose 501
Granulomatous diseases of the nose 502 – 505
Imaging and investigations 506 – 507
Lacrimal Surgery 508
Miscellaneous 509 – 514

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 Nasal and facial trauma 515
Non-allergic rhinitis 516 – 517
Orbital surgery 518 – 523
Paediatric rhinology 524 – 528
Pituitary Surgery 529 – 530
Rhinology – miscellaneous 531 – 540
Rhinoplasty 541 – 545
Septal and turbinate surgery 546 – 561
Sinonasal malignancy 562 – 591
Skull base surgery 592
Smell and taste 593 – 596
Snoring and OSA 597 – 605
Technological advances 606

Author/Co-Author with abstract ID 607

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Oral Abstracts
Best Oral for Junior Grant 1

1526
Orbital complications of acute rhinosinusitis in children: A 12-year retrospective
review

Athanasios Luca Fountarlis1, Kyriaki Vallianou1, Aspasia Michoula2, Antonis Skalias3, Jiannis
Hajiioannou1, George Syrogiannopoulos2, Charalampos Skoulakis1
1
Department of Otorhinolaryngology, University General Hospital of Larissa, University of Thessaly,
Larissa, Greece, 2Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of
Thessaly, Larissa, Greece, 3Department of Otorhinolaryngology-Head and Neck Surgery, 'G.
Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessa

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday, June 19, 2023

Introduction: Orbital complications account for 80% of acute rhinosinusitis complications and
they present most commonly in children. Treatment is generally conservative in preseptal
cellulitis and surgical in orbital abscesses. On the other hand, no consensus has been reached
on the optimal treatment modality for orbital cellulitis and subperiosteal abscess.
Methods: A retrospective review of pediatric patients that were hospitalized in a tertiary
referral hospital with orbital complications of acute rhinosinusitis from January 2011 to
December 2022 was conducted.
Results: Twenty-five children with orbital complications of acute rhinosinusitis were included
in the study. 12 patients were treated conservatively and 13 patients were treated surgically.
All patients with class I Chandler disease were treated conservatively. Of those with class II
Chandler disease, 6 (75%) were treated conservatively and 2 (25%) were treated surgically. All
patients with Chandler class III and IV disease were treated surgically.
Conclusions: Preseptal and orbital cellulitis can be treated conservatively with good results in
most cases. On the other hand, subperiosteal and orbital abscesses usually require surgical
management. More prospective studies with a larger number of patients are required to
elucidate the role of surgery in orbital complications of rhinosinusitis.

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1164
Counseling/rehabilitation for patients of benign nasal tumors in resource poor nations

Pal s1, Gupta T1

1
SFCCP

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday, June 19, 2023

Background: patients of benign-nasal-tumors need counseling. Fear of cancer has to be

removed. Poor Counseling/rehabilitation facilities in asia. NGO’s play key role in
psychosocial-support, Counseling/rehabilitation. Project aimed to formulate policy to give
better & cost-effective counselling/rehab-services. Methods: NGO Team
consisted counselor & nurse trained. 4 Local traditional faith-healers involved. 11 nurses, 8
counselors trained from 2018. Aim to provide physical-comfort to patient. We Educated
patients about outcome of benign-nasal-tumors. Removed fear of
cancer. Discomfort/anxiety due to severe pain decreases overall treatment-efficacy. 63
Patients enrolled. Data collected on feedback-questionnaire. Most difficult tasks is revealing
diagnosis/its-outcome. 32 subjects of benign-nasal-tumors shifted to specialty hospital due
to intractable pain. Results: 94% responded favorably to counseling/nursing care, 80%
showed willingness to motivate fellow patients to facilitate supportive-care-program of
NGO’s. Our Holistic approach helped overcome hopelessness/fear/depression. Pain
management/supportive care emerged very serious issue affecting QOL. Conclusion: If
resources like fellowship/scholarships are available to NGO-workers, then we can learn
from senior-researchers and also show our model to ERS-2023 participants. Restricted
resource-limitations didn’t permit us to analyze this issue in large-sample-size.

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1148
Profiling the Cytokines Patterns in Sinonasal Tissues to distinguish between Chronic
Rhinosinusitis Endotypes

Liyona Kampel1, Ayala Klain1, Shaun Edalati1, narin n carmel neiderman2, Anat Wengier1,
Forsan Jahshan1, Nidal Muhanna1, Avraham ABERGEL
1
The department of otolaryngology, head and neck surgery, Tel Aviv Sourasky Medical Center, Israel,
2
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Background: Chronic rhinosinusitis (CRS) is classified into endotypes according to the

predominant T helper (Th) inflammatory response. Each pattern of inflammation has relevant
interventions, however, differentiating between CRS endotypes may be challenging due to
overlapping clinical and pathological manifestations.Objectives: To profile the cytokine
patterns in sinonasal tissues in order to distinguish between CRS endotypes and detect
distinctive inflammatory patterns that correlate with refractory disease. Methods: Nasal
polyps (NP) or uncinate process (UP) were collected from 24 patients undergoing endoscopic
sinus surgery (ESS) for CRS with nasal polyposis (CRSwNP) or CRS without NP (CRSsNP) and 6
patients with mechanical nasal obstruction (controls). Expression levels of Th1, Th2, and Th17
proinflammatory cytokines were determined in homogenates of sinonasal tissues by a
multiplex immunoassay. Results: Elevated levels of IL-13 detected in CRSwNP compared to
CRSsNP and controls (P=0.0247 and P=0.0346, respectively) demonstrates its applicability for
discriminating between CRS endotypes. An overlap between CRSsNP and non-eosinophilic NP
in terms of elevated levels of IL-6 and CXCL-8, compared to lower levels in eosinophilic NP,
was observed. Conclusion: Precise diagnosis of CRS endotypes by profiling cytokines patterns
can potentially guide treatment selection, especially with the shifting paradigms of CRS
treatment and utilization of biologic drugs.

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1146
Managing odontogenic sinusitis of endodontic origin - is dental treatment enough?

Marta Kwiatkowska1, Kornel Szczygielski1, Dariusz Jurkiewicz1

1
Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery; Military Institute of
Medicine, Warsaw, Poland

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Endodontic disease with formation of periapical lesions (PALs) is one of the most common
causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between
otolaryngologists and dentists, but the best sequence of management is still unknown. The
aim of presented study is to clarify how radiological characteristics of teeth with PALs and
previous root-canal treatment (RCT) influence clinical evolution of the disease and to define
the predictive value of its radiological and endoscopic features in necessity of further surgical
intervention. 68 symptomatic patients with ODS with PALs were included to the study. The
evaluation was performed by otolaryngologist and dentist based on medical interview, nasal
endoscopy, cold pulp testing and tomography images. Patients were prospectively followed
for at least 12 months, during which nasal steroids, saline irrigations and RCT were
administered. The criteria of disease improvement were: decrease of symptoms, healed
sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and
sinus ’inflammation. It resulted that 9 (13%) patients improved after conservative treatment,
59 (87%) required further surgical intervention. Patients who improved after medical and RCT
had a greater distance from the top of the periapical lesion to the maxillary sinus ’floor
(p=0.003). When expansion of PALs and bone destruction toward maxillary sinus was
observed on radiological imaging (p = 0.041) and when more than one tooth root was affected
(p=0.004) patients more often required surgical intervention.

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1284
Endoscopic sinus surgery vs Dupilumab: short-term outcomes in type-2 CRSwNP

Pietro Orlando1, Giandomenico Maggiore1, Giuseppe Licci1, Oreste Gallo1

1
Department of otorhinolaryngology, Careggi University Hospital of Florence, Italy

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

The advent of Dupilumab has profoundly revolutionized the clinical management of patients
affected by Chronic RhinoSinusitis with Nasal Polyps (CRSwNP), whose treatment was
historically based on intranasal steroids and Endoscopic Sinus Surgery (ESS). Dupilumab acts
by inhibiting the bond between IL4 and IL13 and their receptor, blocking two out of three
drivers of type-2 inflammation. Type-2 CRSwNP is associated with scarce response to therapy,
high recurrence rate after ESS and comorbidities (allergies, asthma, AERD) thus heavily
affecting the quality of life (QOL). In this prospective study, we compare the short-term
outcomes of ESS and Dupilumab in patients treated for type-2 CRSwNP by evaluating Nasal
Polyps Score (NPS), modified Lund-Kennedy score (mLKS), smell by sniffin’ sticks test and QOL
with the SNOT22. 21 (47.7%) patients were treated with ESS and 23 (52.3%) with Dupilumab.
Our preliminary data showed both ESS and Dupilumab were safe in reducing mean NPS (-5.4
vs -1.1), mLKS (-4.0 vs -2.6), and SNOT22 (-26.7 vs -25.6) scores three months after treatment
with no demographic differences. Dupilumab patients reported a higher improvement in SST
(+4.1 vs +2.2) and the anosmic rate fell from 91.3 to 34.8%. In the ESS arm, anosmia and
hyposmia rates decreased by 23.9% and 14.3%, respectively. Studies with larger cohorts and
longer follow-ups are needed for tailored treatments. As of today, Dupilumab appears more
suitable for patients with anesthesiological contraindications or previous ESS, whose surgical
outcomes may predispose to peri- and postoperative complications

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1592
The Surprising Impact of Priming on the SNOT-22

Ibtisam Mohammad1, Taylor Stack-Pyle1, Adam Kimple1, Abdullah Zeatoun1, Brent Senior1
1
University of North Carolina at Chapel Hill

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Introduction:Priming is a well-recognized phenomenon, impacting all facets of our lives. We

are moved to react to situations based on subconscious cues in the environment. Well known
in the world of marketing, it is less studied in medicine, and in particular, in how patients
perceive their disease, and how standardized disease-specific quality of life forms may be
impacted. Methods:87 consecutive patients with chronic rhinosinusitis (CRS) and CRS with
nasal polyps were blinded and randomized to be positively primed (44)or negative primed
(43)prior to filling out the SNOT 22. Positively primed patients were administered text
emphasizing the eminently treatable nature of CRS and how well people can do. Negatively
primed patients read a description of the marked disability CRS causes, and possible
complications of untreated disease. Results:Groups were matched in age and sex. Median
SNOT 22 score in the negatively primed group was 54 and in the positively primed group 20,
a significant difference of 34 points (p<0.001). Discussion/Conclusion:Psychological priming,
both negative and positive, has significant impact on how patient’s fill out the SNOT-22.
Studies utilizing the SNOT-22 as an outcome measure must take care to minimize this effect.

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1745
Dupilumab-Treatment In Patients With CRSwNP: Real World Data

Sven Ole Sarnoch1, Amra Hot2, Benjamin Becker1, Christian Betz1, Anna Sophie Hoffmann1

1
Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistraße 52,
20246, Hamburg, Germany, 2Institute of Medical Biometry and Epidemiology, University Medical Center
Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Since released, Dupilumab has shown great results in treating severe uncontrolled CRSwNP.
However, there is a lack of data showing real-world treatment results and it isn’t clear to what
extent blood parameters are suitable for monitoring the therapy. This study aims to analyze
parameters needed to monitor therapy and assess the effect of dupilumab. The
following parameters from 104 Patients (male 50, female 54) were analyzed retrospectively
after 13 months of observation: SNOT-22, ACS, histologic findings, NPS, olfactometry, FEV-1
and blood parameters (IgE, Eos absolute, ECP). The patients were divided into subgroups to
determine whether those with initially elevated blood marker levels showed a different
course from those with normal levels. All parameters improved after an observation period of
13 months. SNOT-22 dropped from a mean of 59.9 (SD±18,9) at baseline to 21.6 (±18.7), NPS
from 4.75 (±1,59) to 1.58 (±1,25). Olfactometry improved from 3.25(±3,66) to 8.29 (±3,17).
Patients with initially elevated IgE levels showed better progression of olfactometry and NPS
than those with normal values.Dupilumab has significantly reduced symptoms and disease
severity, making it a targeted and safe treatment option in clinical practice. IgE might be a
good marker for therapy response. Therefore, further observation is needed.

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1400
NAR: are we comparing apples and oranges?

Klementina Van der Pluijm-Avdeeva, Wytske Fokkens1, Sietze Reitsma1

1
Amsterdam UMC, Department of otorhinolaryngology, Amsterdam, the Netherlands

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Background: Several phenotypes of non-allergic rhinitis have been described, including

rhinorrhoea of the elderly, rhinitis medicamentosa, smokers’, occupational, hormonal, drug-
induced, gustatory and idiopathic rhinitis. Based on underlying pathophysiological
mechanism, NAR can be divided into two endotypes: inflammatory and neurogenic, each of
them requiring different treatment approaches. Phenotypes may serve as an indicator of an
underlying endotype. The prevalence of each phenotype is currently unknown.Methods:
Cross-sectional questionnaire-based study in the general population of the
Netherlands.Results: The prevalence of chronic rhinitis in the general population was 40%
(N=558, of those, 65% had NAR). The most common NAR phenotypes were idiopathic (39%)
and rhinitis medicamentosa (14%), followed by occupational (8%), smokers’ (6%), hormonal
(4%), gustatory (4%) and rhinorrhoea of the elderly (4%). The least prevalent phenotype was
drug-induced (1%). Nineteen percent of the NAR group could not be classified into any of the
phenotypes. Conclusions: This is the first study to describe the prevalences of NAR phenotypes
in the general population. Our data on the prevalence of phenotypes may help clinicians to
anticipate the type of patients at their clinic and help guide a tailored treatment approach.

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1438
Invasive fungal rhino sinusitis in adult patients: a single-institution 20-year experience

Giulia Monti1, Francesca De Bernardi Di Valserra, Marco Valentini, Apostolos Karligkiotis,

Paolo Battaglia, Paolo Giocondo Maria Castelnuovo, Maurizio Bignami
1
Medico Specializzando in Otorinolaringoiatria Ospedale di Circolo e Fondazione Macchi, Varese (VA)
Università degli studi dell'Insubria Varese-Como

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Invasive fungal rhinosinusitis (IFRS) is a disease characterized by evidence of fungal tissue

invasion demonstrated with histopathology. The acute and chronic forms are defined
according to the duration of the illness. A retrospective review was performed and all patients
aged> years affected by IFRS treated at our tertiary-care University Hospital of Varese from
January 2002 to December 2022 were included in the study. A total of 11 cases (9 chronic and
2 acute) were recorded; clinical presentation, surgical treatment and post-operative
outcomes were investigated and presented for each patient. All patients received systemic
anti-fungal agents and endoscopic sinus surgery was performed (100%). Among patients with
acute IFRS 1/2 died of her haematological disease while 2/9 of the chronic ones died of the
evolution of fungal disease (22%). Acute and chronic IFRS are different entities: in acute form,
the prognosis is poor, and medical and surgical treatment should be promptly performed. In
the chronic one, wide surgical excision of the disease is recommendable to obtain a complete
removal of fungal infection. In both forms, early clinical detection is essential but medical
findings are non-specific, therefore diagnosis depends on a high index of suspicion,
considering the predisposing factors.

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1457
Cranial Nerve Zero: What the Rhinologist Needs to Know

Ibtisam Mohammad1, Kazuhiro Omura1, Brent Senior1

1
University of North Carolina at Chapel

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Cranial Nerve Zero: What the Rhinologist Needs to Know BackgroundThe Roman physician,
Galen is credited with providing the first description of the human cranial nerves. Nearly 2000
years later, in 1878, Gustav Fritsch described a curious slender nerve located rostral to the
olfactory nerve (CN 1) in a shark. Fritsch termed this new cranial nerve, “Cranial nerve 0.” It
was then described in human embryos in 1905 and in adult humans in 1913. Despite, this CN
0 is frequently not described in text books and remains unknown among most
rhinologists. MethodsLiterature review and cadaver dissection ResultsAnatomically, the
nerve is different from the other cranial nerves. At the cranial base, as opposed to a single
defined fascicle, it exists as a plexus medial to the olfactory bulbs with ganglia found on the
crista galli. Branches are seen to perforate the cribriform plate along with branches of CN 1.
From there, its course in the nose and sinuses is poorly described but appears to descend over
the posterior septum and sphenoid rostrum. Based on rodent studies, severing the nerve
results in sexual dysfunction with decreased mating. However, it is distinct from the olfactory
system and the vomeronasal organ. Its function in humans is unclear. ConclusionsCranial
nerve 0 is a functionally and physically separate cranial nerve in animals and present in the
cranial base of adult humans. Its exact location and function in the nose and sinuses of humans
is unclear.

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1527
Leukocyte- and Platelet-Rich Fibrin in endoscopic endonasal skull base reconstruction:
study protocol for a multicenter prospective, parallel-group, single-blinded
randomized controlled non-inferiority trial.

Birgit Coucke1, Thomas Decramer2, Frank Dewaele3, Mark Jorissen4, Jeroen Meulemans5, Tom
Theys6, Kato Speleman7, Anaïs Van Hoylandt8, Johannes van Loon9, Thibaut Van Zele10, Vincent
Vander Poorten11, Nikolaas Vantomme12, Laura Van Gerven13

1
Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute,
Department of Neurosciences, KU Leuven, Belgium, Allergy and Clinical Immunology Research Group,
Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium, 2Allergy and
Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU
Leuven, Leuven, Belgium, Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium,
3
Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium, 4Department of
Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium, Laboratory of Experimental
Otorhinolaryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium, 5 Department of
Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Leuven, Belgium, Department of Oncology,
Section Head and Neck Oncology, KU Leuven, Leuven, Belgium, 6Research Group Experimental
Neurosurgery and Neuroanatomy and Leuven Brain Institute, Department of Neurosciences, KU Leuven,
Leuven, Belgium, Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium, 7
Department of Otorhinolaryngology, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium, 8Department of
Neurosurgery, University Hospitals Leuven, Leuven, Belgium, 9Research Group Experimental
Neurosurgery and Neuroanatomy and Leuven Brain Institute, Department of Neurosciences, KU Leuven,
Belgium, Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium, 10Department of
Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium, 11Department of Otorhinolaryngology,
Head and Neck Surgery, UZ Leuven, Leuven, Belgium, Department of Oncology, Section Head and Neck
Oncology, KU Leuven, Leuven, Belgium, 12Department of Neurosurgery, AZ Sint-Jan Brugge-Oostende,
Bruges, Belgium, 13Allergy and Clinical Immunology Research Group, Department of Microbiology,
Immunology & Transplantation, KU Leuven, Leuven, Belgium, Department of Otorhinolaryngology,
Head and Neck Surgery, UZ Leuven, Leuven, Belgium, Laboratory of Experimental Otorhinolaryngology,
Department of Neurosciences, KU Leuven, Leuven, Belgium

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Background Recent advances in endoscopic endonasal transsphenoidal approaches (EETA) for

skull base lesions resulted in significantly increased extent and complexity of skull base
defects, demanding more elaborate and novel reconstruction techniques improving healing
and preventing reconstruction failure which may result in cerebrospinal fluid (CSF) leakage.
Commercially available fibrin sealants (CAFS) are currently used to enforce sellar floor
reconstruction. However, problems have been reported regarding safety, efficacy and costs.
This trial aims to investigate autologous Leukocyte- and Platelet-Rich Fibrin (L-PRF)
membranes as an alternative to CAFS in EETA-related skull base reconstruction enforcement.
Methods/design This multicenter, prospective randomized controlled trial aims to
demonstrate non-inferiority of L-PRF membranes compared to CAFS in EETA cases (1) without
intra-operative CSF-leak as dural or sellar floor closure enforcement and (2) in EETA cases with
intra-operative CSF-leak (or very large defects) in which classic multilayer reconstruction has
been made as additional sealing. Patients in three centers in Belgium, undergoing EETA are

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randomized 1:1 comparing L-PRF with CAFS. The primary endpoint is postoperative CSF
leakage. Secondary endpoints are risk factor identification for reconstruction failure,
rhinological symptom assessment, interference with postoperative imaging and a cost-
effectiveness analysis. Discussion With this trial, we will evaluate the safety and efficacy of L-
PRF compared to CAFS.

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1363
Gustatory and olfactory function after petrous bone fracture

Sonia Macario1, Julien Wen Hsieh1, Dimitrios Daskalou1, François Voruz1, Basile Nicolas
Landis2

1
Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University
of Geneva, Geneva, Switzerland, 2Department of Otorhinolaryngology, University Hospital
Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany

Best Oral for Junior Grant 1 | Room 8 Hall 4 - Level 0 | Monday 19/06/2023

Introduction In petrous bone fractures the following impairments are described and regularly
seen: auditory dysfunction, vestibular dysfunction, facial palsy/paralysis, CSF leak, lesion of
the carotid canal, middle ear dysfunction, but there is little data about the olfactory and
gustatory function. The aim of the study is to Investigate olfactory and gustatory function after
temporal bone fracture.Methods We included consecutive patients with petrous bone
fractures. Subjective complaints (Questionnaire), gustatory (Taste Strips) and olfactory
(Sniffin’ Sticks) function were assessed in all patients.Results 131 patients were included with
a petrous bone fracture between 2007 to 2017. The type of the fractures: longitudinal 66%;
mixed 25%; transverse 9%; extra-otic 84%; trans-otic 16%. We found an ipsilateral half-sided
ageusia of the anterior two thirds of the tongue in 12% (n=16) of the patients and only 8
patients report a gustatory change. There is no correlation between the fracture type and the
presence of a gustatory impairment. Anosmia is found in 39% of the
patients. Conclusion Only 12% of the patients had an ipsilateral hemiageusia and there is no
correlation with the fracture type. A considerable amount of patients (39%) had anosmia in
the testing.

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CRS – pathophysiology 1

1134
NASAL POLYPOSIS AND SERUM ALBUMIN – SYSTEMIC EFFECTS AND LOCAL
INFLAMMATION

Andre Machado1, Francisco Rosa2, Paula Branco3, Joao Correia3, Sara Azevedo3, Ana Silva3,
Mariline Santos3, Luis Meireles3, Sam Most2, Miguel Ferreira2

1
Otolaryngology Department, CHUSA, Porto, Portugal, Faculdade de Ciências da Saúde - Universidade
da Beira Interior, Covilhã, Portugal , 2Department of Otolaryngology, HFAR, Porto, 3Otolaryngology
Department, CHUSA, Porto, Portugal

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Objective: Understand the relationship between serum albumin levels and Chronic
Rhinosinusitis with Polyposis. Methods: Retrospective analysis of 180 consecutive patients
between January 2016 and January 2020, at our center. We then divided into groups age and
gender-matched – 60 patients with chronic rhinosinusitis with nasal polyposis, 60 patients
with chronic rhinosinusitis without nasal polyposis, and a control group with 60 patients. No
patient had a history of any pathology that could alter serum albumin. We then compared the
level of serum albumin between the three groups. Results: The group of patients with
rhinosinusitis with nasal polyposis consisted of 60 patients, with serum albumin value of 4.49
± 0.29 g/dL, whilst in the control group, the serum albumin value was 4.67 ± 0.2 g/dL. We
found a significant difference between the group with nasal polyposis and the other two
groups evaluated: chronic rhinosinusitis without nasal polyposis (p<0.001) and the control
group (p<0.001). Conclusions: Lower levels of serum albumin can be seen in patients with
chronic rhinosinusitis with nasal polyposis. Further studies should aim its value since it is a
non-expensive marker, on follow-up of those patients or even to stratify them according to its
endotype.

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1145
Chloride intracellular channel 4 induces tissue remodeling via ROS signal pathway in
chronic rhinosinusitis

Heung-Man Lee1
1
Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College
of Medicine, Seoul, Korea

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Fibroblast activation plays an important role in this remodeling process. CLIC4 is known to
mediate the activation of cancer-associated fibroblasts. In this study we investigated the
effect of CLIC4 on remodeling of the sinonasal mucosa. CLIC4 expression in mRNA or protein
level was investigated in the sinonasal mucosa of chronic rhinosinusitis patients and controls.
Sinonasal fibroblasts were incubated and treated with TGF-b1. The expression of CLIC4, a-
SMA, collagen type I, and fibronectin was determined by a real-time PCR, or western blotting.
ROS expression was determined using 2’,7’-dichlorofluorescein-diacetate or Mitosox Red
fluorescence. Fibroblast migration was evaluated using the Transwell migration assay and the
contractile activity was measured by using the collagen contraction assay. CLIC4 expression
level was significantly increased in the sinonasal mucosa compared to the control. TGF-β
treatment significantly induced CICL4, myofibroblast differentiation (a-SMA) and extracellular
matrix (collagen type I, fibronectin) production in the fibroblasts. Blocking of CICL4 expression
with siRNA reduced myofibroblast differentiation and ECM production. TGF-β1 also increased
amount of ROS production, whereas pretreatment with ROS scavenger significantly decreased
the level of CICL4 expression, myofibroblast differentiation and ECM production. CLIC4 plays
an important role in TGF-β1-induced myofibroblast differentiation, extracellular matrix
production, migration, and contractile activity through the ROS signaling pathway, which
contributes to tissue remodeling in CRS.

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1186
Chronic Otitis Media in Patients with Chronic Rhinosinusitis: A Systematic Review

Andrea Lovato1, Andrea Frosolini1, Leonardo Franz1, Antonio Daloiso2, Francesco Fantin1, Cosimo De Filippis1,
Gino Marioni2, Giuseppe Brescia2

1
Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy, 2
Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35100 Padova, Italy

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Introduction: Chronic otitis media (COM) and chronic rhinosinusitis (CRS) are two of the most
common otolaryngological disorders. CRS and COM share pathophysiological mechanisms
such as bacterial infection, biofilm, and the persistence of the obstruction state of ventilation
routes. The purpose of this systematic review was to evaluate all available information on the
association between COM and CRS. Methods: The protocol of this investigation was registered
on PROSPERO in November 2022. Pubmed, Scopus, Web of Science, and Cochrane databases
were systematically searched according to the PRISMA statement. Results: After the
application of inclusion-exclusion criteria, four manuscripts with adequate relevance to this
topic were included in the review. The study population consisted of 20,867 patients with a
diagnosis of CRS, of whom 991 were also diagnosed with COM (4.75%). Conclusions: The
included studies have shown that CRS was significantly associated with COM: a global
inflammatory process involved the epithelium in both the middle ear and upper airway. The
identification of a relationship between CRS and COM may contribute to preventing chronic
inflammatory conditions through the early management of the associated disease. Further,
carefully designed studies are necessary to demonstrate the relationship between COM and
CRS.

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1189
Mouse model of neutrophilic non-Type 2 CRS: the superior effect of Staphylococcus
aureus compared with Pseudomonas aeruginosa and Streptococcus pneumoniae

Alba Sánchez Montalvo1, Aaron Ziani Zeryouh3, Marylene Lecocq3, Charles Pilette4, Valérie
Hox5
1
Pole of Pneumology, ENT and Dermatology, Institute of Experimental and Clinical Research, Université
Catholique de Louvain (UCLo, 2Department of Pneumology, ENT and Dermatology, Institute of
Experimental and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels,
Belgium, Department of Microbiology, Allergy and Clinical Immunology Research Group, Immunology
and Transplantation, Katholieke Universiteit Leuven (KULeuven), 3000 Leuven, Belgium, 3Department of
Pneumology, ENT and Dermatology, Institute of Experimental and Clinical Research (IREC), Université
Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium , 4Department of Pneumology, ENT and
Dermatology, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain
(UCLouvain), 1200 Brussels, Belgium, Department of Pulmonology, Cliniques Universitaires Saint-Luc,
1200 Brussels, Belgium , 5Department of Pneumology, ENT and Dermatology, Institute of Experimental
and Clinical Research (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium ,
Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Chronic rhinosinusitis (CRS) is an inflammatory respiratory disease with nasal symptoms of at

least 12 weeks, affecting 11% of Europeans. We find T2 eosinophilic or non-T2 neutrophilic
CRS and currently, its pathogenesis is not fully understood, especially non-T2 CRS, for which
no validated mouse models exist to study disease mechanisms.Aim: to establish a neutrophilic
mouse model of bacterial-induced CRS.Methods: nasal tampons were surgically inserted in
the nasal cavity of mice and inoculated with different bacteria: S. aureus, S.
pneumoniae and P. aeruginosa. Inflammatory features in nasal mucosa were evaluated after
4, 8 and 12 weeks on decalcified skulls by histology, antibodies and cytokines were measured
in NAL and BAL and differential cell-counts were performed.Results: post-operative mortality
was important for S. pneumoniae and P. aeruginosa. Mice with S. aureus-induced CRS showed
significant increase in epithelial thickness, fibrosis and neutrophilic infiltration at the nasal
mucosa, with increased IL-1β, TNFα, IL-17 and MIP-2. Mice with P. aeruginosa-induced CRS
showed significantly increased epithelial thickness and fibrosis. Mice with S. pneumoniae-
induced CRS did not show any changes.Conclusion: S. aureus is the most potent inducer of
neutrophilic non-T2 CRS in a mouse model of bacterial-induced CRS, allowing us to investigate
its pathogenesis.

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1257
Aspergillus fumigatus induce inflammatory cell migration and extracellular DNA traps
in chronic rhinosinusitis

Seung-Heon Shin1, Mi-Kyung Ye1, Sang-Yen Geum1, Mi-Hyun Chae1

1
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Daegu Catholic
University, Daegu 42472, Republic of Korea

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Eosinophilic extracellular trap (EET) and neutrophilic extracellular trap (NET) are commonly
found in chronic rhinosinusitis (CRS). Eosinophils and neutrophils are recruited to defense
against pathogens through damaged nasal epithelial cells. This study was conducted to
elucidate the role of fungi on EET and NET formation. Eosinophil and neutrophil migration
were determined using inverted air-liquid interface culture of primary nasal epithelial cells.
After stimulation with Alternaria, Aspergillus, and SEB, we determined migration of cells. EET
and NET were determined coculture of eosinophils and neutrophils with fungal conidia and
SEB and stained with Sytox Green and calcofluor white for confocal microscopy. To determine
the role of reactive oxygen species, cells were pretreated with glutathione or
diphenyleneiodonium.Migration study was performed after stimulation with Alternaria,
Aspergillus, and SEB for 6 h. Alternaria and Aspergillus significantly enhanced migration of
eosinophils and neutrophils. However, SEB did not influence cell migration. When the cells
were isolated from healthy volunteers, NET formation was significantly increased with
Aspergillus. However, EET formation did not influence with Aspergillus and Alternaria. When
the cells were isolated from eosinophilic CRS patients, EET and NET formation were
significantly increased with Aspergillus. Fungi enhanced eosinophil and neutrophil migration
through nasal epithelial cells and Aspergillus significantly enhanced EET and NET formation in
eosinophilic CRS.

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1309
Subjective olfactory dysfunction correlates with radiographic presentation and
inflammatory endotypes in chronic rhinosinusitis

Te-Huei Yeh1
1
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

BackgroundPrevalence of olfactory dysfunction is high in patients with chronic rhinosinusitis

(CRS), and dysfunction of olfaction impacts quality of life. Sinus opacification, olfactory cleft
infiltrations, and type 2 inflammation has been reported to be associated with olfactory
dysfunction. ObjectiveWe aimed to investigate the correlation of CRS phenotypes and
endotypes, defined by biomarkers, on one’s sense of smell.MethodsAdult patients diagnosed
with bilateral CRS and undergoing endoscopic sinus surgery were recruited. We obtained
patient demographics, blood eosinophil counts, blood-specific allergen immunoglobulin E
tests, Lund-Mackay computed tomography (CT) scores and related CT findings, 22 items Sino-
Nasal Outcome Test scores, and TIB smell identification test before endoscopic sinus surgery.
The extent of tissue eosinophilia and expression of type 2 mediators in tissue homogenates
were also recorded. ResultsIn a total of 128 subjects, 93 (72.7%) cases were identified as
having olfactory dysfunction, and 21 (16.4%) cases were asymptomatic. Patient reported
symptom score in general were correlated with TIB smell identification test (r=-0.7223,
p<0.001). The 22 items Sino-Nasal Outcome Test total score, Lund-Mackay CT score, ethmoid-
maxillary ratio, and olfactory cleft opacifications were significantly higher in the olfactory
dysfunction group. In multivariate regression analysis, Lund-Mackay score (adjusted odds
ratio 1.24, 95% confidence interval 1.02 to 1.54, p=0.039) and olfactory cleft opacifications
(adjusted odds ratio 2.54, 95% confidence interval 1.46 to 5.00, p=0.003) remained significant
predictors for symptomatic olfactory dysfunction. Elevated levels of immunoglobulin E in
middle turbinate tissue were identified in the olfactory dysfunction group, while elevated
levels of interleukin-17 and interferon-γ were observed in the asymptomatic group.
Conclusions Considering phenotypes and endotypes of CRS, olfactory cleft opacification on CT
imaging and Lund-Mackay CT scores remained the predominant indicating factors for
symptoms of olfactory dysfunction. A negative correlation of olfactory dysfunction and tissue
interleukin-17 and interferon-γ levels were additionally noted.

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1329
Oncostatin M contributes to airway epithelial cell dysfunction in chronic rhinosinusitis
with nasal polyps

Florent Carsuzaa1, Maxime Fieux2, Emilie Bequignon4, Sophie Bartier5, André Coste4, Xavier
Dufour3, Matthieu Bainaud6, Jean Claude Lecron6, Bruno Louis7, Stéphane Tringali8, Laure
Favot9
1
Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de
Poitiers, 86000 Poitiers,, 2Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL,
d’otoneurochirurgie et de chirurgie cervico-faciale, F-69310, Pierre Bénite, France; Université Claude
Bernard Lyon 1, 69003, Lyon, France, CNRS EMR 7000, F-94010 Créteil, France, Univ Paris Est Creteil,
INSERM, IMRB, F-94010 Créteil, France, 3Laboratoire Inflammation Tissus Epithéliaux et Cytokines
(LITEC), UR15560, Université de Poitiers, 86000 Poitiers, France, Service ORL, Chirurgie Cervico-Maxillo-
Faciale et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France, 4Centre
Hospitalier Intercommunal de Créteil et AP-HP, Hôpital Henri Mondor, Service d’Oto-Rhino-Laryngologie
et de Chirurgie cervico-faciale, 94010 Créteil, France, CNRS EMR 7000, F-94010 Créteil, France, Univ
Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France, 5Service d'ORL, de chirurgie cervico faciale,
hôpital Henri-Mondor, assistance Publique des hôpitaux de Paris, Créteil, France, CNRS EMR 7000, F-
94010 Créteil, France, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France;, 6Laboratoire
Inflammation Tissus Epithéliaux et Cytokines (LITEC), UR15560, Université de Poitiers, 86000 Poitiers,
France, 7CNRS EMR 7000, F-94010 Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil,
France, 8Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de
chirurgie cervico-faciale, F-69310, Pierre Bénite, France, Université Claude Bernard Lyon 1, 69003, Lyon,
France, UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie
et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, CEDEX 07, 69367
Lyon, France, 9 Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), UR15560, Université
de Poitiers, 86000 Poitiers, France, 10 Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL,
d’otoneurochirurgie et de chirurgie cervico-faciale, F-69310, Pierre Bénite, France; Université Claude
Bernard Lyon 1, 69003, Lyon, France, CNRS EMR 7000, F-94010 Créteil, France, Univ Paris Est Creteil,
INSERM, IMRB, F-94010 Créteil, France;

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

CRSwNP is a typical type-2 inflammation involving several cytokines and is associated with
epithelial cell dysfunction. Oncostatin M (OSM) (belonging to the IL-6 family) could be a key
driver of epithelial barrier dysfunction. We investigated the presence of OSM and IL-6 and the
expression pattern of tight junctions (TJs) in the nasal tissue of CRSwNP patients and controls
using RT‒qPCR and Western blotting. Then, their potential role in the epithelial barrier was
evaluated in vitro in 27 different primary cultures of human nasal epithelial cells (HNECs) by
measuring TJ expression and transepithelial electric resistance (TEER) with or without OSM or
IL-6 (1, 10, and 100 ng/ml). The effect on ciliary beating efficiency was evaluated by high-speed
videomicroscopy and on repair mechanisms with a wound healing model with or without
OSM. OSM and IL-6 were both overexpressed, and TJ (ZO-1 and occludin) expression was
decreased in nasal polyps compared to control mucosa. OSM (100 ng/ml) but not IL-6 induced
a significant decrease in TJ expression, TEER and ciliary beating efficiency in HNECs. After 24
hours, the wound repair rate was significantly higher in OSM-stimulated HNECs at 100 ng/ml.
These results suggest that OSM could become a new target for monoclonal antibodies.

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1336
Dupilumab counteracts IL-4 effects on airway epithelial cells explaining its efficacy in
CRSwNP

Maxime Fieux1, Florent Carsuzaa3, Sophie Bartier4, Jean Claude Lecron5, Bruno Louis6, Xavier
Dufour3, Laure Favot5, André Coste4, Emilie Bequignon4
1
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie
cervico-faciale, F-69310, Pierre Bénite, France, Université Claude Bernard Lyon 1, 69003, Lyon, France,
CNRS EMR 7000, F-94010 Créteil, France, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France,
2
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie
cervico-faciale, France, 3Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre
Hospitalier Universitaire de Poitiers, 86000 Poitiers, France, Laboratoire Inflammation Tissus Epithéliaux
et Cytokines (LITEC), UR15560, Université de Poitiers, 86000 Poitiers, France, 4CNRS EMR 7000, F-94010
Créteil, France, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France, AP-HP, Hôpital Henri
Mondor et Centre Hospitalier Intercommunal de Créteil, Service d’Oto-Rhino-Laryngologie et de
Chirurgie cervico-faciale, 94010 Créteil, France, 5Laboratoire Inflammation Tissus Epithéliaux et
Cytokines (LITEC), UR15560, Université de Poitiers, 86000 Poitiers, France, 6CNRS EMR 7000, F-94010
Créteil, France, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

CRSwNP is a typical type-2 inflammation involving IL-4 and IL-13. Dupilumab is a fully human
monoclonal antibody targetting IL‐4Rα, the shared receptor component for IL‐4 and IL‐13,
thereby blocking signalling by both cytokines.We investigated in 25 different primary culture
of human nasal epithelial celles (HNECs) at the air-liquid interface (ALI) in vitro the effect of
IL-4 and IL-13 (1, 10, and 100 ng/ml) on transepithelial electric resistance (TEER), tight
junctions (TJ) expression, ciliary beating efficiency and wound repair capacity, and iii) the
effect of Dupilumab on IL-4 induced epithelial dysfunctions. The effect on ciliary beating
efficiency was evaluated by high-speed videomicroscopy and on repair mechanisms with a
wound healing model with or without IL-4 and Dupilumab. IL-4 (1 ng/ml) but not IL-13 induced
a significant decrease in TEER counteracted by Dupilumab. IL-4 (1, 10 and 100ng/ml) but not
IL-13 induced a significant decrease in ciliary beating efficiency in HNECs, counteracted by
Dupilumab. After 24 hours, the wound repair rate was significantly lower in IL-4-stimulated
HNECs at 100 ng/ml, counteracted by Dupilumab. These results suggest that Dupilumab is
playing a direct role on epithelial cell functions such as ciliary beating efficiency and wound
repair capacity, explaining its efficacy.

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1372
Role of basal cells in nasal polyp epithelium in the pathophysiology of eosinophilic
chronic rhinosinusitis (eCRS).

Kawakita Kento1, Kouzaki Hideaki1, Shimizu Takeshi1

1
Department of Otorhinolaryngology, Head and Neck Surgery

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Basal cell hyperplasia is commonly observed in nasal polyp epithelium of eCRS. However, the
role of basal cells in the pathophysiology of eCRS is unknown. We found that normal human
bronchial epithelial (NHBE) cells differentiate into basal cells when the cells were cultured in
PneumaCult™-Ex Plus medium. Most of the 3rd passaged cells expressed basal cell surface
marker CD49f/CD271 and nuclear marker p63, while NHBE cells cultured in BEGM™ did not
express these basal cell markers.RNA sequencing revealed that cultured basal cells had higher
gene expression of TSLP, IL-8, TLR3 and TLR4, and lower expression of PAR-2, compared to
cultured NHBE cells. The mRNA expressions of TSLP, IL-8 and TLR3 were significantly increased
in cultured basal cells and those of PAR-2 and IL-6 were significantly increased in cultured
NHBE cells. Poly (I:C)-induced-TSLP production and LPS-induced IL-8 production were
significantly increased in cultured basal cells compared to those in cultured NHBE cells. IL-4
and IL-13 stimulated the proliferation of cultured basal cell, but they did not stimulate the
proliferation of cultured NHBE cells. These results indicate that basal cells were main source
of TSLP and IL-8 in nasal epithelium, and basal cell hyperplasia was induced by IL-4 and IL-13
in nasal polyps of eCRS.

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1386
Gene expression profiling in chronic rhinosinusitis with nasal polyps

Nelli Nepp1, Zsuzsanna Helyes2, József Kun2, Krisztina Pohóczky2, Attila Gyenesei3, Péter
Urbán3

1
University of Pécs, Clinical Center, Department of Otorhinolaryngology, 2University of Pécs, Department
of Pharmacology and Pharmacotherapy, 3University of Pécs, Szentágothai Research Center,
Bioinformatics Research Group

CRS – pathophysiology 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

The pathogenesis of chronic rhinosinusitis with nasal polyposis remains unclear. RNA
sequencing and comprehensive bioinformatics analysis allow to characterize the gene
expression profiles, determine pathways and candidate gene sets associated with
CRSwNP.We performed 3’ messenger RNA sequencing on 6 polyp and 6 paired non-
polyp lateral nasal wall mucosa tissue samples from patients with recurrent CRSwNP
and 4 nasal mucosa samples from non-CRS controls. – Another 30 samples are being
processed.We found 262 and 269 differentially expressed (DE) genes between nasal
polyp tissue versus nasal mucosa of patients with CRSwNP and between nasal polyp
tissue versus non-CRS controls, respectively. Our early results show that STATH and
XKR4 were the most downregulated, while Charcot-Leyden crystal galectin (CLC) was
one of the most upregulated genes in nasal polyp tissue in both comparisons. CLC
playes a role in eosinophil granulogenesis, STATH encodes statherin, which has a
suggested promoter effect in inflammation and nasal polyp formation. The role of
XKR4 coding for a membrane protein involved in apoptosis is still unknown in CRSwNP.

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CRS – surgical management 1

1173
The Infra-Bullar Groove, A New Landmark to Unlock the Natural Maxillary Ostium

Jameel Ghantous1, Boaz Forer1

1
Hebrew University Of Jerusalem

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

introduction:Failure to open the natural maxillary ostium (NMO) is a common surgical

mistakes during ESS, and results in recirculation and diseased maxillary sinus. To our
knowledge no landmark that aid in locating the natural maxillary ostium have been
described. We describe the infrabullar groove (IBG), a new landmark that will help the surgeon
to correctly locate the natural maxillary ostium during ESS. The IBG is a groove in the lateral
nasal wall immediately below the bulla ethmoidalis, and can be identified following uncinate
process resection. The anterior most part of the groove ends in the natural maxillary
ostium. methods:Following explanation about IBG concept and connection to NMO, clips of
Maxillary Antrostomy (MA) in mild, moderate, and severe CRS were viewed separately by two
ENT residents and the senior author. Each surgeon answered the following questions:can you
identify an IBG? When did you first identify the IBG? Does the grove end in the natural
maxillary ostium?Results:IBG was identified in all video clips by young as well as experienced
physicians. The anterior part of the IBG ended at the NMO in all cases. Conclusion:The IBG is
a new and easy to identify anatomical landmark that helps to locate the NMA. This may lower
the incidence of recirculation and MA failure. To our knowledge, this landmark was not
previously described in the literature.

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1201
Sufficient middle meatal accessing using newly designed instrument: Bofares's middle
meatal speculum (how I do it?)

Khaled Mohamed Bofares1

1
faculty of medicine-Omar ALmoukhtar university

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Abstract As it is well known that the most significant, interested and target area for surgeons
during functional endoscopic sinus surgery (FESS) is the middle meatus. The most highlighted
problem that may facing the surgeon who are approaching the endoscopic middle meatal
surgery is the inability to get a sufficient surgical access into the middle meatus. This is most
probably due to oversized middle turbinate or floppiness of middle turbinate that resulting in
the obscuring of the field and frequent fogging of the lens due to recurrent touching of coming
in route middle turbinate. Therefore, it become necessary to resolve this problem, which I am
sure that interrupt the interest of most of the surgeons. For this reason, this tool was proposed
and designed to retract the middle turbinate medially at its different three part (M1, M2, and
M3) with accommodated heights and self-retained controlled with wide range adjustor to
provide a sufficient access to this very important area. Keywords: Bofares middle meatal
speculum, Middle meatal speculum.

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1221
Comparing Medical Management to Surgical Intervention for Sinonasal Airway
Anatomy and Function in a Case of Surgical Delay in Chronic Rhinosinusitis

Amanda Balash1, Dennis Frank-Ito2

1
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, 2Department of
Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Objective: To investigate changes in sinonasal anatomy from delayed surgical intervention for
treatment of CRS in an adult male patient who waited 6 years before undergoing
FESS.Methods: CT scans of the patient were obtained at 3 time points: initial diagnosis (PRE1),
31 months after PRE1 (PRE2), and 46 months after PRE2 (POST; 6 months after FESS). Patient
had bilateral disease and was under medical management from PRE1 to PRE2. Sinonasal
airways were constructed from the CT scans and volume was quantified. Airflow simulations
were performed at 15L/min in PRE1, PRE2, and POST; resistance values were calculated and
compared with normative data (mean ± standard deviation) from 12 healthy male subjects.
Results: FESS decreased bilateral resistance (Pa.s/mL) to normative levels: PRE1=0.458,
PRE2=0.230, POST=0.024, and Normal=0.036±0.020. PRE1-PRE2 reduction was 50% and 95%
from PRE1-POST. On the less-diseased left side, PRE1-PRE2 nasal airway volume increased by
32% and PRE1-POST by 59%. The MS volume shrunk (16%) from PRE1-PRE2 and increased
(8%) from PRE1-POST. From PRE1-PRE2, FS (9%) and ES (77%) volumes increased but the SS
(14%) volume shrunk. From PRE1-POST, FS (48%), ES (715%), and SS (14%) volumes increased.
On the more diseased right side, except the FS (20%) volume that increased from PRE1-PRE2,
volume of other regions shrunk (nasal=4%, MS=7%, ES=33%, SS=20%). From PRE1-POST, the
volume of every region increased (nasal=36%, MS=59%, FS=67%, ES=296%, SS=13%).
Conclusion: FESS improved ventilation to the paranasal sinuses compared to medical
management

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1337
Isolated frontal sinus fungus ball - a rare case presentation and literature review

Elena Teodora Schipor Diaconu1, Raluca Grigore1, Anca Ionela Cirstea1, Cristian Costel
Paval1, Ruxandra Ioana Nedelcu1, Alexandru Gabriel Enea1
1
ENT Clinic, Coltea Clinical Hospital, Bucharest; Carol Davila University of Medicine and Pharmacy

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Introduction: Fungus ball is a noninvasive form of fungal rhinosinusitis represented by the

accumulation of fungal hyphae in the paranasal sinuses, mostly affecting a single maxillary
sinus. Occasionally, the hyphae accumulation may appear in the sphenoid or other sinuses.
Materials and Methods used: We performed a literature review on fungus ball in the paranasal
sinuses and presented a case of a rare localization of fungus ball in the frontal sinus in an adult
female. The frontal sinus is listed as the paranasal sinus most rarely affected by the fungus
ball comprising only 2% of the cases.Results: Fungus balls appear mostly in females with a
peak occurrence between 50 to 60 years of age. The prevalent etiological agent is Aspergillus
spp with Aspergillus fumigatus and Aspergillus flavus being the main species involved. The
maxillary sinus is the most frequent affected followed by the sphenoid, ethmoid, and, finally,
the frontal sinus. The gold standard therapeutic approach is endonasal endoscopy in any
affected paranasal sinus. Conclusion: The presence of a fungus ball in the frontal sinus despite
its low incidence, should be considered in patients with pain in the frontal region who do not
respond to the usual clinical treatments.

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1350
Objective long-term volumetric results of surgical treatment maxillary sinus
atelectasis in children

Yury Rusetsky1, Uliana Malyavina1

1
Central State Medical Academy of Department of Presidental Affairs, Moscow, Russia, 2National
Medical Research Center for Children’s Health, Moscow, Russia

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Objectives: The aim of this study was to objectively investigate volume of the maxillary sinus
in children with silent sinus syndrome using CT pre and postop. Methods: We prospectively
studied 35 children (21 girls (60%) and 14 boys (40%)), age ranging from 5 to 17 years (mean
age 10,9± 3,5 years). All children underwent endoscopic middle meatal antrostomy. The study
was carried out on the multispiral computed tomograph Discovery CT 750 HD with 0,6 mm
step. Data management and analytics was done using diagnostic software module Volume
Viewer AW VolumeShare7. MSCT was done before and 6-8 months after surgery. We
assessed the volume of the maxillary sinus pre and postop bilaterally and calculated the
coefficient of sinus volume variation in time on affected (К1) and health side (К2).Results: The
calculation was done in 31 children. Mean volume of affected sinus preop was 4,2 +/- 2,7 sm3,
during 6 months after surgery – 5,5+/-3,5 sm3, p<0,001. Mean volume of health sinus preop
was 11,0+/-6,11 sm3, postop – 12,8+/-5,8 sm3.The coefficient of variation for the affected
side (К1) was 1,3+/-0,36, and for the health side (К2) - 1,08+/-0,17, p=0,003. Conclusions: CT
measurement of the sinus volume is a valid method of evaluation of the surgery efficacy. Our
data showed that endoscopic middle meatal antrostomy allowed to stop enophtalmos
progression and enable the spontaneous increase of the sinus volume followed normal
growth of child’s facial skeleton.

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1361
Orbital complications in ESS: first ESS vs reoperation

Piotr Henryk Skarżyński1, Małgorzata Buksińska1, Anna Olszewska-Staroń1, Marta

Dzięgielewska1
1
World Hearing Center, Institute of Physiology and Pathology of Hearing, Poland

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Background Endoscopic Sinus Surgery (ESS) is an effective surgical technique. Complications

after ESS are rare. Most common are orbital complications, which can vary in severity from
minor, such as medial wall injuries, to major, such as optic nerve damage and blindness. The
aim of the study was to review orbital complications after ESS in Institute of Physiology and
Pathology of Hearing during 10-year period and comparison of the incidence and nature of
complications during the first operations and reoperations.Methods A retrospective review
was undertaken of all ESS in the last 10 years. The authors present the results of operative
treatment. Results 5287 ESS were performed in our clinic – 4315 first ESS and 972
reoperations. Orbital complications were observed in 84 patients – 56 after first operation
and 28 after reoperation. Most patients had mild complications, such as injuries to orbital
lamina. Major complications were extremely rare - one patient was blinded, two patients have
persistent vision disorder. Conclusion Orbital complications following ESS are rare but
potentially dangerous events. The risk .of complications correlates to anatomical variations,
severity of inflammation, previous operation results and surgeon’s experience. For the safety
of operations, very good knowledge of anatomy, preoperative imaging, as well as the
surgeon's experience and the ability to predict threats are necessary. During reoperation, due
to the possible lack of anatomical reference points, the use of navigation is recommended.

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1426
Surgery versus medical therapy in patients with CRSwNP – results from a multicentre
randomised controlled trial

Evelijn Lourijsen1, Sietze Reitsma1, Marleen Vleming2, Gerjon Hannink3, Maroeska Rovers4,
Wytske Fokkens5

1
Department of Otorhinolaryngology, Amsterdam UMC, location AMC, the Netherlands, 2Department
of Otorhinolaryngology, Flevohospital, Almere, Netherlands, 3 Department of Operating Rooms,
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands,
4
Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical
Center, Nijmegen, Netherlands, 5Department of otorhinolaryngology, Amsterdam UMC, location AMC,
the Netherlands

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Background: Endoscopic sinus surgery (ESS) is a common operation for patients with chronic
rhinosinusitis with nasal polyps (CRSwNP), however there is no clinical knowledge from
randomised trials about the benefit of surgery over medical therapy (MT). To overcome the
evidence gap with respect to surgical management of patients with CRSwNP we performed a
multicentre RCT to assess the efficacy of ESS+MT versus medical therapy (MT).Methods: This
was an open-label, multicentre, pragmatic RCT. Adults (aged ≥18 years) with CRSwNP and an
indication for ESS were randomly allocated to receive either ESS+MT or MT. The primary
outcome was disease-specific health-related quality of life, measured with the Sinonasal
Outcome Test 22 (SNOT-22) after 12 months follow-up.Results: Between February 2015 and
September 2019, 238 participants were randomised, of which 214 participants could be
analysed after 12 months. After 12 months follow-up the mean SNOT-22 score in the ESS+MT
group was 27.9 (SD 20.2) and in the MT group was 31.1 (SD 20.4), with a mean difference of -
4.9 points [95% CI -9.4; -0.4], favouring ESS+MT. Patients assigned to ESS+MT also scored
significantly better than patients assigned to MT on general nasal symptoms, nasal polyp size,
control of CRS and use of systemic corticosteroids. Adverse events were similar between the
groups. Conclusion: ESS+MT is more efficacious than MT in adult patients with CRSwNP and
reduces the need for systemic corticosteroids.

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1474
Outcomes of endoscopic sinus surgery in patients of Central compartment atopic
disease

Fenghong Chen1
1
Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Background: central compartment atopy disease (CCAD) is a subtype of chronic rhinosinusitis,

which is characterized by polypoid change in the posterosuperior nasal septum, middle
turbinate and superior turbinate. Endoscopic sinus surgery (ESS) outcomes in Chinese have
not been report yet. The aim of this study was to evaluate the outcomes of patients with CCAD
after ESS and compared with two following subtypes: chronic rhinosinusitis with nasal polyps
(CRSwNP) and concomitant polypoid disease in the central compartment (CRSwNP/CC) and
CRSwNP not otherwise specified (CRSwNP NOS).Methods: This prospective cohort study
consecutively enrolled patients with bilateral CRSwNP. All of these patients underwent ESS
and received regular postoperative medical treatment. The demographic data, symptom
severity scores, and surgical outcomes at 1 year after surgery were collected.Results: Our
study included 84 patients (CCAD=27, CRSwNP/CC=31, CRSwNP NOS=26). 92.31% of patients
(24/26) in the CCAD group achieved a controlled status one year after surgery, compared with
70.00% (21/30) in CRSwNP/CC group and 96.00% (24/25) CRSwNP NOS group. Conclusion:
Most of CCAD patients achieve controlled status at 1 year after surgery.

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1496
Indications for surgery in rhinosinusitis in South Africa

Christian Quitter1

1
University of Pretoria Medical School, Pretoria, South Africa

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Indications for sinus surgery are described in many publications and guidelines. These
guidelines are mostly written by physicians in high income countries and are based on
research undertaken in such countries. Africa has mostly low and lower middle income
countries which leads to unique challenges in sinus surgery. Therefore indications for surgery
need to be modified compared to affluent countries. Examples of challenges include the
ability of patients in remote areas to present themselves for regular follow ups, traditional
beliefs of patients and their families and, difficulties in obtaining certain medicines in
financially constrained circumstances.We will summarise indications for different types of
surgery from guidelines including EPOS and point out which indications need to be modified
due to the specific differences in health services between affluent countries and low and lower
middle income countries. We base this on a consensus statement to be published by the South
African Allergic Rhinitis Working Group which deals amongst others with sinus surgery. A
review of relevant literature mainly from African authors will be presented.

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1501
Introducing Functional Endoscopic Sinus Surgery assisted by navigation system at
Medical University – Pleven: learning curve and current results in the management of
chronic rhinosinusitis

Boris Duhlenski1, Aleksandar Valkov1, Tsvetan Mladenov1, Malik Yildiz1

1
Department of Otorhinolaryngology, Faculty of Medicine, Medical University – Pleven, 1 Kliment
Ohridski Str., Pleven 5800, Bulgaria, Clinic of Otorhinolaryngology, University Hospital “Dr. Georgi
Stranski” – Pleven II Clinical Base, 91 Gen. Vladimir Vazov Str., Pleven 5800, Bulgaria

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Functional Endoscopic Sinus Surgery (FESS), with opportunities for simulation and navigation,
is considered a gold standard for treating chronic rhinosinusitis with nasal polyps. Despite the
efficacy of endoscopic sinus surgery when medical therapy is insufficient, using FESS remains
a challenge for young surgeons and requires precise planning with in-depth consideration of
disorder severity, anatomical variability, co-medication and co-pathology. Optimizing team
learning curves with skill development and FESS experience is crucial for successful
outcomes.We aim to evaluate the current results from introducing FESS ± navigation (FESSn /
FESS) in the minimally invasive surgical treatment of patients with chronic rhinologic
pathology within the project BG05M2OP001-1.002-0010-C01, compare the outcomes and
follow up the development of the surgeon's learning curve.The FESS was performed in the
Operating Unit with Navigation Systems at the Center of Competence of Medical University –
Pleven. The FESS was performed in the Operating Unit with Navigation Systems at the Center
of Competence of Medical University – Pleven. We used FESSn in 54% of patients and
conventional surgery in 23%. The mean operative time was 1.17 h (SD 0.37), and the mean
blood loss was 124.10 ml (SD 37.61). During the follow-up, the local control was good and
there was no recurrence in 76 % of patients.Our study results support the importance of
precisely analyzing the indications for FESS, planning navigation assistance and improving the
surgeon's FESS experience for optimizing the clinical outcome.

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1520
The impact of follow-up adherence and medication adherence on the control rate of chronic
rhinosinusitis after endoscopic sinus surgery

Shi Jianbo1, Chen Fenghong1, Lin Haoran2, Liu Wendong1

1
The First Affiliated Hospital, Sun Yat-sen University,, 2Jinan University

CRS – surgical management 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Background：To explore the effect of follow-up or medication adherence after endoscopic

sinus surgery (ESS) on the control status of chronic rhinosinusitis (CRS).
Methods：A retrospective review of 226 patients with chronic rhinosinusitis under ESS in two
clinical centers during 2018 to 2021 was conducted. Clinical characteristics including smoking,
asthma, allergic rhinitis, sinus surgery history, endoscopic and CT scores, blood eosinophils
number and percentage and serum total IgE were collected. Follow-up of symptoms which
contained visual analogue scales, total nasal symptom score (TNSS), and sinonasal-outcome
test 22 (SNOT-22) score, and assessment of endoscopic score and control status of CRS at the
first and the 12th month after ESS were conducted.
Results：Patients with both good follow-up adherence and good medication adherence had
the highest control rate (71.2%), the second higher rate was in patients with good follow-up
adherence but poor medication adherence (42.1%) more than patients with good medication
adherence but poor follow-up adherence (22.7%) and patients with poor follow-up adherence
and poor medication adherence (5.1%).(P＜0.0001) All VAS, TNSS, SNOT-22, E-score% were
different especially at the 12th month after ESS (all P＜0.0001) in the trend in the accord with
the controlled rate above. Baseline characteristics did not influence the control
status.Conclusions: Follow-up adherence and medication adherence had a great impact on
the control status of CRS after ESS.

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Paediatric rhinology 1

1179
Choanal polyps in children and adults: 10-year experience from a tertiary care hospital

Aleksandar Peric1, Tijana Vukadinovic2, Milica Labus1, Biserka Vukomanovic Djurdjevic3

1
Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia, 2Department of
Otorhinolaryngology, Clinical Centre of Montenegro, Podgorica, Montenegro, 3Institute for Pathology,
Military Medical Academy, Belgrade, Serbia

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Purpose: Choanal polyps (CPs) are benign, solitary, soft tissue lesions extending towards the
junction between the nasal cavity and the nasopharynx through the choana. The aim of this
retrospective study was to evaluate clinical and histological characteristics of CPs in children
comparing to adult patients. Methods: Characteristics of CPs treated in our hospital
(demography, main complaints, side, localization, surgical approach, histological
characteristics, accompanying sinus disease, association with allergic rhinitis, postoperative
follow-up period, recurrence rates) were retrospectively reviewed. Results: Seventy-eight
patients with CPs were included, 22 (28%) patients in children and 56 (72%) in adults. In 27%
children and in 7% adults we found the oropharyngeal extension of CPs (p<0.01). In 18%
children and in 5.3% adults, we found the histological characteristics of an angiomatous CP
(p<0.05). The association with allergic rhinitis was more frequent in children (32%) than in
adults (18%) (p<0.05). In 32% pediatric patients and in 14% adults, we found the association
with ipsilateral chronic maxillary sinusitis (p<0.05). After the surgical treatment, we found the
recurrence in 3 (14%) pediatric and in 5 (8%) adult patients, without the significant
difference. Conclusion: Our results suggest some specificities of CPs in children comparing to
adults. Oropharyngeal extension, association with allergic rhinitis and ipsilateral maxillary
sinusitis, and the presence of angiomatous histological type of CPs are more frequent in the
pediatric population.

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1248
Sinonasal Primitive Myxoid Mesenchymal Tumor of Infancy: Immunohistochemistry
and Surgical Treatment

Gustavo Pedrosa Rocha1, Tiago Veleda2, Ana Hebe3, Ricardo Pacheco3, Pedro Montalvão3,
Miguel Magalhães3

1
Hospital Prof. Dr. Fernando da Fonseca, 2Centro Hospitalar Universitário Lisboa Central, 3Instituto
Português de Oncologia de Lisboa

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Objective: Primitive myxoid mesenchymal tumor of infancy (PMMTI) is a rare recently

described myofibroblastic tumor with intermediate aggressiveness, high recurrence, rare
metastasis and poor response to chemotherapy. We purpose to present the second reported
case of Sinonasal PMMTI, occurring in a 3-year old child, its surgical treatment and to provide
and briefly review how can the immunohistochemical phenotype can target the treatment
and the surveillance.Material and Methods: Clinical examination, medical imaging and
immunohistochemical stains and cytogenetic analysis were checked. We also briefly review
the relevant literature about PMMTI and closely associated diagnoses.Results: Identification
of BCOR immunoreactivity in the preoperative biopsy evaluation made the diagnosis of
PMMTI and help to differentiate it from closely associated diagnoses, congenital infantile
fibrosarcoma and infantile fibromatosis. Unlike those, this tumor is unresponsive to
chemotherapy, making the gold standard of treatment radical surgical excision with
establishment of negative margins. Complete excision with medial maxillectomy using Rouge
Denker approach was undertaken as definitive management.Conclusion: As
Immunocytochemistry advances, the diagnostic capabilities are becoming even more precise.
Such is the case of PMMTI, which its target treatment is the surgical excision. This reminds the
close collaboration needed between the pathologist and the surgeon, especially when dealing
with such a rare case.

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1265
Acute invasive fungal rhinosinusitis in pediatric age group

Hossam Bosraty1

1
Department of otorhinolaryngology, Cairo university

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Invasive fungal Rhinosinusitis in Pediatric Patients with Acute Leukemia Hussam Elbosraty,
MD,Prof. of ORL, Kasr Al-Aini Hospital, Cairo University.Consultant ORL, Pediatric Cancer
Hospital, Cairo, Egypt. Invasive fungal sinusitis is becoming increasingly common
immunocompromised patients. We conduct this study on 70 children with acute leukemia
treated with bone marrow transplant. Incidence, clinical presentation, diagnosis, TTT and
outcome were evaluated.70 children (46 female, 24 male), age range 2 to 19 years, 5 cases
developed acute invasive fungal sinusitis. Presenting symptoms were fever, facial pain,
headache, nasal congestion and orbital swelling.Histological examination of the debrided
tissues revealed Mucor species in 4 cases and aspergillus in one caseAlthough that IFS has
generally poor prognosis, yet, It appeared that the response to therapy in these category of
patients is excellent provided early intervention with extensive debridement & medical
therapy in the form of Liposomal amphotericin, granulocyte transfusions and special
consideration of the general health and underlying factors of immune-suppression.

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1308
Nasal Trauma in Child. Potential Consequences in Adulthood

Gabriela Kopacheva -Barsova1

1
ENT University Clinic, University Campus "St. Mother Theresa", Skopje

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Aim: To prevent and to treat nasal trauma in children properly, because it can lead to
displacement or depression of the nasal bones or septum. Second, our aim was, for the patient
to recognise and create a mature decision for eventual nose changes which will be made with
the operative intervention or they are not mature enough and the decisions were made by
their parents.
Material and Methods: Our retrospective study was made at University Clinic for Ear, Nose
and Throat, Faculty of Medicine, Ss Cyril and Methodius University of Skopje in the period of
10 years (2010-2023). Seventy-three patients were admitted with recent or previous nasal
trauma or nasal deformity. The first group of 32 were children and adolescents from 6-14
years old who were admitted to our hospital because of recent nasal trauma. The second
group of 41 children and adolescents from 6-14 years old were admitted to our hospital
because of previous nasal trauma, which was not treated on time, or it was not treated
properly. They were admitted to our clinic for surgical intervention septo/rhinoplasty. The
second group of patients fills the brief psychological questioner prepared by Clinical
psychiatrist from University Clinic of Psychiatry, in Skopje, and their psychological reactions
were taken into consideration.
Results: Eleven of the children and adolescents who had nasal fracture without dislocation,
who have no symptoms, minimal swelling, and no septal deviation or hematoma, were
observed with a specific follow-up: 3 days after nasal fracture, then every week in the first
month, after 1 month, and after 3 months period. Sixteen of children and adolescents who
had a nasal fracture with subluxation of nasal septum were operated with closed reduction
(repositio nasi) under general anaesthesia. The others with septal hematomas and
subperichondrial abscess were treated as in adults’ patients. The second group of 41 children
and adolescents from 6-14 years old consisted with with the previous nasal trauma which was
not treated on time or it was improperly treated. In 24 (58.54%) of these patients septoplasty
was performed and in 17 (41.46%) was performed rhino septoplasty.
Conclusion: Often, difficult septal deformations in children are followed with deformation of
the nasal pyramid (rhino scoliosis, rhino lordosis). In those cases, we cannot solve septal
pathology without nasal pyramid intervention in the same time and opposite. Clinical reports
have not produced solid evidence for the statement that septal surgery has no negative effect
on nasal growth or can serve for correcting abnormal growth. The functional and esthetic
problems of the patient, however, mean a continuous stimulus for further clinical and
experimental investigations.

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1381
Pediatric Nasal Polyposis : Case series from a single instituation and literature review

JULIDE KASABOGLU1, MILENA MITKOVA1, TODOR POPOV1, JULIAN RANGACHEV1

1
Department of Otorhinolaryngology , Medical University-Sofia, Sofia, Bulgaria, 2Department of ENT,
Medical University- Sofia, Sofia,Bulgaria

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Nasal polyps are benign inflammaory masses potentially arising from any portion of the
mucosa of the nose and paranasal sinuses, causing chronic nasal obstruction. Nasal polyposis
of pediatric patients can be an important signal for systemic disorders immunodeficiencies
and specific allergies. Nasal polyps are mostly represented with cystic fibrosis. In this case
series we aim to report 11 different pediatric cases which were admitted to our pediatric ENT
department and were operated with endoscopic sinus surgery in 5 years period. We will share
our treatment outcome after surgical management. We will also discuss the pathogenesis and
management of nasal polyposis in the children with different therapeutic approaches from
recent data with review of rhinologic literature.

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1403
Rhinoseptoplasty in adolescents

Aina Magomedova1, Nikolay Grachev2, Ilya Zyabkin2, Sergey Frolov2, Margarita Kalinina2

1
Federal Research and Clinical Center for Children and Adolescents of the Federal Medical Biological
Agency, 2Federal State-Funded Institution “ Federal kids and adolescents clinical research centre of
Federal Medical-Biological Agency” (FGBY (FNKC) “FCRC of kids and adolescents of Russian FMBA)

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Surgical intervention in external nasal structures under 18 years old was tabooed for a long
time, and still avoided in the pediatric patients out of concerns surrounding the potential
disruption of nasal growth centers. To date, there is still no consensus for the indications and
age limitations for septorhinoplasty under 18 years of age.The aims of the study was to assess
safety and efficacy, psychological impact, long-term outcomes and to define preferrable
surgical strategy and technique of septorhinoplasty in adolescent patients. Materials and
methods used: 31 patients (19 girls, 12 boys) with polyetiological deformities of nasal
structures, among them crooked and saddle nose deformity, associated with severe nasal
obstruction, underwent open-approach functional septorhinoplasty with simultaneous
turbinoplasty, 5 of them with autologous rib cartilage graft. Mean age of patients was 16.7
years, range from 11 to 17 years. For evaluation of nasal breathing we used Standardized
Cosmesis and Health Nasal Outcomes Survey (SCHNOS) before and after 6 month of surgery.
Results:There was a statistically significant decrease from pre-operative to post-operative
score of SCHNOS. Mean score before surgery was 58.6 ± 15.7 points, and after 6 month of
surgery it was 8.7 ± 3.8 points. There were only 2 (6.4%) cases of postoperative complications
–septal hematoma and nasal synechia. Conclusion: Open-approach septorhinoplasty can be
safely regarded as a preferrable surgical strategy in teen patients with deformities of external
nasal structures and nasal obstruction.

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1449
Septoplasty in children – when and why?

Hristo Zlatanov, Anastasiya Korkova

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Opinions of ENT surgeons differ considering the need for correction of a deviated septum in
pediatric cases. While some otolaryngologists maintain the opinion that surgery before the
completion of nasal growth may lead to facial asymmetry, others claim that the impaired nasal
breathing itself results in disruption of maxillofacial growth. Our convictions stand with the
last. We believe that septal deviation causes sleep disturbances and is frequently a reason for
recurrent sinusitis in children. In addition, constant oral breathing causes facial deformities
and dental abnormalities. Also, some etiologic factors such as septal abscess, septal
hematoma and nasal malignancies impose a septoplasty regardless of the age. Since
guidelines on pediatric septoplasty are lacking, it is a matter of the surgeon’s own assessment
and experience to manage the deviated septum in children. We are sharing our view on the
indications and timing for pediatric septoplasty.

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1470
ENT PATHOLOGY FEATURES IN CHILDREN WITH AUTOIMMUNE RHEUMATOID
DISEASES TREATED BY DMARDs

Irina Meytel1, Yuri Rusetsky3, Larisa Sotnikova4, Irina Osipova5, Zalina Sulejmanova3, Dani
Haddadin3

1
NMIC of Children's Healt of the Ministry of Health of the Russian Federation Russia, 2NMIC of Children's
Health" of the Ministry of Health of the Russian Federation Russia, 3Central State Medical Academy of
Department of Presidental Affairs, Moscow, Russia, 4National Medical Research Center for Children’s
Health, Moscow, Russia, 5Multidisciplinary Medical Center K + 31 Petrovskie Vorota

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Objectives/Hypothesis: Autoimmune rheumatic-related diseases (ARRDs) have impact on

patients, including their ENT field. DMARDs led to a breakthrough in the treatment of ARRDs
in children. But in such children, increase in upper respiratory tract and ear acute and chronic
diseases was seen.Methods: 100 children with ARRDs were examined in ENT department
before treating by DMARDs and after 3 months. The mean age - 10 ± 4 years, of which 54
(54%) were men and 46 were women (46%). Results: It was revealed that 43 (43%) children
had ENT pathology before treatment by DMARDs. 67 (67%) children had ENT pathology after
treatment by DMARDs. Adenotonsillar hypertrophy was in 15 cases before and 26 after
DMARDs, recurrent tonsillopharyngitis – 10 and 15, chronic sinusitis – 6 and 7, chronic otitis –
4 before and after, middle otitis with effusion – 8 and 15 respectively.Conclusions: DMARDs
increase risk of developing ENT pathology in children, which requires the mandatory ENT
specialist participation in observation and treatment of such children.

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1499
Choanal atresia- surgical approach without stent placement procedure, based on
anatomical particularities

Karen Dzhambazov1

1
Department of Otorhinolaryngology Medical university of Plovdiv, Bulgaria

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Introduction: Choanal atresia is a life-threatening congenital malformation. It is characterized

by impaired communication between the nasal cavity and the pharynx. The obstruction can
be unilateral or bilateral, as well as membranous, bony or combined. The diagnosis of bilateral
choanal is recognized clinically immediately after birth due to respiratory distress syndrome.
Confirmation is carried out by endoscopy of the lower nasal passage and choanae, and
computed tomography.Aim: to demonstrate the peculiarities in the anatomy of choanal
atresia and our experience in surgical treatment without stent placement.Material and
methods: Our prospective clinical study included 14 cases with choanal atresia aged 0 days to
6 years. The distribution by gender male:female is 8:6. All patients underwent endoscopy of
nasal cavity and computed tomography with measurement of the thickness of the vomer and
the width of both nasal cavities. Results: Stents were placed in three patients and revision
surgery was necessary in six of the cases due to narrowing and adhesions in the region of the
neochoana.We did endonasal endoscopic fenestration with resection of posterior part of the
nasal septum.Conclusion: In the clinical study, we found a correlation between thickening of
the posterior end of the septum and its resection, and the need for stent placement. Patients
have a significantly shorter postoperative period without the complications of а stent
placement procedure.

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1540
PEDIATRIC NASAL DERMOIDS: EXPERIENCE OF 9 CASES

Pedro Alexandre1, Inês Saldanha2, Gil Coutinho1, Tiago Órfão1, Jorge Spratley3, Carla Pinto
Moura4

1
Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, Porto, Portugal,
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal, 2Department
of Otorhinolaryngology, Hospital Distrital de Santarém, Santarém, Portugal, 3Department of
Otorhinolaryngology, Centro Hospitalar Universitário de São João, Porto, Portugal, Department of
Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal, CINTESIS, Center for Health
Technology and Services Research, Porto, Portugal, 4Department of Otorhinolaryngology, Centro
Hospitalar Universitário de São João, Porto, Portugal, Department of Genetics, Centro Hospitalar
Universitário de São João, Faculty of Medicine, University of Porto, Portugal, I3S, Institute for Research
and Innovation in Health, University of Porto, Portugal

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Nasal dermoid are uncommon midline congenital lesions in the nose that can present clinically
as a cyst, sinus or fistula. Treatment consists in surgical excision. Pre-operative imaging is
mandatory to evaluate local and intracranial extension.We present 9 children with nasal
dermoids (five females) operated at the mean age of three years (11 months – 7 years)
between 2015 and 2023. Pre-operative imaging (CT or MRI) revealed extension of the cyst to
the foramen cecum in 3 cases, none with intracranial extension. Clinical presentation was a
dermoid sinus-cyst in seven cases and a cystic lesion in two. Lesion location was on the nasal
dorsum (five cases), glabella (two cases) and between the midline and medial canthus (two
cases). A dorsal rhinotomy was used as surgical approach and the endoscope was used in
three cases to allow better in-depth visualization for a complete excision. Reconstruction of
the defect with autologous material (fascia lata, conchal cartilage, fat) was performed in three
cases, one of them with an open rhinoplasty approach. No complications or recurrence
occurred during follow-up (mean of 26 months).Careful pre-operative surgical planning is
mandatory in nasal dermoid surgery, to ensure minimal recurrence rates and the best
aesthetic results.

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1676
Predictive Factors for Severe Orbital Infections in Children: A 10-Year Hospital-based
Study

Rabia Shihada, Majd Khoury

Paediatric rhinology 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Objectives: To characterize the clinical features of hospitalized pediatric patients with pre-
and post-septal cellulitis and studying factors associated with a more advanced and
complicated disease. Patients and methods: This is a retrospective study of all children with
pre- and post-septal cellulitis who were admitted to our hospital in the last 10 years. Results:
A total of 84 cases were included with median age of 4.72 years. 30.95% patients had post-
septal cellulitis. Sinusitis (P

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CRS – outcome assessment 1

1279
Can Serum IgE or Blood Eosinophil Count Predict Postoperative Oral Corticosteroid
Response in CRSwNP?

Wang Ying-Piao1, Shen Kuang-Hsuan1

1
Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

OBJECTIVE: The primary objective was to evaluate the outcomes of postoperative oral
corticosteroid(OCS) in treating patients with CRSwNP. The secondary objective was to
determine whether preoperative serum IgE(sIgE) and/or blood eosinophil count(BEC)
correlate with postoperative patient reported outcomes after OCS use.
METHODS:Patients with bilateral CRSwNP(n=236) who underwent endoscopic sinus surgery
(ESS) were randomly assigned to receive 15 mg OCS twice daily or a placebo for 2 weeks. We
investigated the treatment effects on the basis of visual analog scale (VAS) , Sino-Nasal
Outcome Test 22 (SNOT-22) , and Lund-Kennedy Endoscopy Score (LKES) over 6 months, and
subgroups were stratified preoperatively as follows: sIgE <0 IU/mL, sIgE ≥150 IU/mL, BEC
<0.39×109cells/L,and BEC>.39×109cells/L. RESULTS:A total of 193 participants completed the
study up to 6-month follow-up; no apparent linear relationship was noted between sIgE and
BEC (r2=0.015, p=0.091). No significant differences in scores were noted upon assessment of
the VAS, SNOT-22, and LKES among the follow-up timepoints in the primary analysis. However,
in the primary or subgroup analysis with sIgE or BEC, significant differences in the longitudinal
scores of sleep dysfunction were observed between at the 1-month follow-up .
CONCLUSIONS:Postoperative OCS did not significantly affect CRSwNP outcomes. sIgE and BEC
may not be surrogate predictive biomarkers to assess the role of postoperative OCS use. OCS
may increase the risk of transient sleep disturbance.

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1328
The Long-Term Implications of Rhinitis and Chronic Rhinosinusitis In Young Adults

Shopen Yoni1, Yoni Shopen1, Nir Tzur1, Ethan Soudry1

1
Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center – Beilinson
Hospital, Petach-Tikva, Israel

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Background: The long-term impact of rhinitis and CRS on general health and medical services
utilization in young adults have been limitedly studied.
Methods: A case control study in the Israeli Defense Forces, between the years 2005-2019, of
all individuals with either rhinitis or CRS and a matched cohort of healthy individuals with at
least five years of follow-up. Results: The study groups included 617 patients with rhinitis and
296 patients with CRS and 2,739 healthy controls with an average age of 28 years. During a
mean follow up of 8 years, a significant fraction of patients in both study groups were
diagnosed with asthma compared to the control group, (26.1% and 23.3% vs 3.7%,
respectively; CI 95%: 12.1%-14.9%, p<0.0001). Significantly increased loss of productivity and
medical system utilization were noted in the study groups compared to controls (p<0.0001).
Moreover, deterioration in general health, manifested as loss of physical fitness for combative
service was observed in a third of patients during follow up.
Conclusions: Rhinitis and CRS significantly impact productivity and medical service utilization
in young adults, as well as general health associated with development of asthma and
impairment of physical fitness. A minority of rhinitis patients develop CRS overtime, further
affecting this patient group.

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1369
THE ROLE OF BODY MASS INDEX AS A PREDICTOR OF DUPILUMAB EFFICACY IN
PATIENTS WITH SEVERE UNCONTROLLED CRSwNP.

Carlotta Pipolo1, Eugenio De Corso2, Letizia Nitro3, Marco Borin4

1
Department of Otolaryngology, ASST Santi Paolo e Carlo; Department of Health Sciences, University of
Milan, 22. Otolaryngology Unit - Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, Rome,
Italy, 3Department of Otolaryngology, ASST Santi Paolo e Carlo, Milan, 4Otolaryngology Unit, ASST
Grande Ospedale Metropolitano Niguarda, Milan, Italy

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Purpose: Our study focuses on the efficacy of dupilumab for chronic rhinosinusitis with nasal
polyps. In particular, we evaluated the impact of the body mass index on therapeutic
responses and we investigated both how obesity is related to increased grades of systemic
inflammation and how a higher BMI could influence the outcomes of the treatment.Methods:
In this study, designed as a real-life observational multicentric retrospective study, we
reviewed medical charts of 106 suffering from CRSwNP treated with dupilumab. Results:
Dupilumab has shown its efficacy in all measured outcomes. According to EPOS 2020 and De
Corso et al. criteria of efficacy and response to dupilumab, three different types of response
were identified: very early responder, early responder and late responder . In our sample and
for the three different metabolic subgroups, a late response in term of NPS decrease, was
observed only in three patients, all belonging to the obese group. A statistically significant
difference was also found in SNOT-22 score decrease at V6 and V12 with higher score in
overweight/obese patients (respectively p=.018 and .020).Conclusion: Our study confirmed
the efficacy of dupilumab for treatment of CRSwNP in normal, overweight and obese patients.
However, this efficacy seems to be affected in the timing of response by the patient’s
metabolic state. Our findings suggest that patients with a compromised metabolic state have
a more impaired baseline and present a delayed response to dupilumab than normal-weight
patients.

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1387
POST ESS CARE: HOW TO MAXIMIZE OUTCOME

NADA ALSHAIKH1

1
DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, MOUWASAT HOSPITAL, DAMMAM,
SAUDI ARABIA

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Background: Postoperative care is recommended by international leaders as an important

part of the patient's medical management for Chronic RhonoSinusitis (CRS). This presentation
highlights the main steps that ENT surgeons described in the post-operative care for patients
after Endoscopic Sinus Surgery (ESS). In addition, it summarizes all recommendations in the
literature. The presenter will give a summary at the end of the presentation and speak about
own experience.
Objectives: This presentation will give a guide to the latest in the literature about post-ESS
care. Recommendations from this presentation are applicable to all ENT surgeons at all levels
who are practicing sinonasal surgeries.
RESULTS & CONCLUSION: There is a strong evidence that certain postoperative care after ESS
positively impacts the outcome of surgery. ESS success and recurrence rate is multifactorial &
postoperative care is just one aspect of CRS management dilemma. Care must start
preoperatively and continues intra- and postoperatively. There is a strong evidence to support
the use of saline nasal irrigation and some evidence to support topical & systemic steroids
post ESS. On the other hand, sinonasal debridement, nasal packing, stenting, systemic and
topical antibiotics are debatable in the postoperative care of ESS. In conclusion, optimum
post-operative care does not replace bad surgery.

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1388
Rate of Recurrence of nasal polyps after endoscopic sinus surgery & associated risk
factors.

NADA ALSHAIKH1
1
DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, MOUWASAT HOSPITAL, DAMMAM,
SAUDI ARABIA

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Background and objectives: Chronic rhinosinusitis constitutes one of the commonest

conditions encountered in medical practice. Approximately 20% of cases of chronic
rhinosinusitis are associated with nasal polyps. The aim of this study is to identify the
recurrence rate of sinonasal polyps after endoscopic sinus surgery in Saudi Arabia and to
evaluate the associated risk factors. Materials and
Methods:A retrospective study was conducted at the otolaryngology department of Dammam
Medical Complex in Saudi Arabia. The records of patients who underwent endoscopic sinus
surgery during 4-year period were reviewed. Data were entered into a standard spreadsheet
program (Microsoft Excel) and were analyzed using SPSS software version. The study was
approved by the local scientific committee.
Results: One hundred and eight adult patients (66 males and 42 females, mean age 34+/-13.78
years) were included. The most common presenting symptom was nasal obstruction (100
patients, 92.6%). Sixty-two-patients (57.4%) had coexisting allergic rhinitis, 46 (42.6%) were
asthmatics, and 43 patients (40.18%) had extensive initial disease as measured by CT scan
scores. Recurrence of nasal polyps was observed in 48 patients (44.4%) and was significantly
associated with the presence of allergic rhinitis, bronchial asthma, and with the initial extent
of disease. Conclusion: Recurrence rate of nasal polyps after endoscopic sinus surgery is high
and challenging. Coexisting allergic rhinitis and/or bronchial asthma as well as the initial extent
of disease are significant risk factors for recurrence.

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1396
Prediction of olfactory function recovery in CRSwNP treated with dupilumab

Josje Otten1, Sietze Reitsma1, Fokkens Wytske1

1
Department of otorhinolaryngology, Amsterdam UMC

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Background: There is no known predictor for olfactory function recovery with dupilumab
treatment in chronic rhinosinusitis with nasal polyps (CRSwNP). This study assessed whether
subjective recovery of olfactory function on oral corticosteroids (OCS) is a prognostic
factor.Methods: Retrospectively, 220 CRSwNP patients treated with dupilumab were divided
into two groups depending on whether they had improvement of smell during OCS treatment
before treatment with dupilumab (improved (OCS+) n = 152, not improved (OCS-) n = 68).
Olfactory function was tested with sniffin’ sticks (12 pens) at baseline, 1, 3 and 6 months of
dupilumab treatment. Results: At baseline, both groups had a mean (SD = 2) and median score
(IQR = 1.5) of 3 / 12 (anosmia). The OCS+ group showed significantly higher olfactory scores,
mean 7.2 (SD 2.9) vs 4.8 (SD 2.3) at 1 month (P < 0.001), and mean 7.6 (SD 2.7) vs 4.6 (SD 2.8)
at 3 months (P < 0.001). After 6 months, 27.6% of the OCS+ group was anosmic compared to
69.1% in the OCS- group. Conclusion: Patients who report olfactory function improvement on
OCS have a higher chance of recovery of olfactory function during the first six months of
treatment with dupilumab.

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1475
Development of a standardized assessment of patient reported outcome measures
following endoscopic sinus surgery for chronic rhinosinusitis: A qualitative study.

Justin Pyne1, Adrian Mendez1, Connor Sommerfeld1

1
Department of Surgery, Division of Otolaryngology – Head and Neck Surgery

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Background: Quality of life (QOL) outcomes following endoscopic sinus surgery (ESS) have
been reported, yet few outcome measures have been developed through direct patient
participation. Harmonizing patient reported outcome measures (PROM), observer based, and
other evaluation techniques is paramount to enable the Otolaryngologist to produce clinically
meaningful assessments. This study aimed to create a clinical instrument from PROMs to
assess patients after treatment of chronic rhinosinusitis (CRS) with ESS.
Methods: This four-phase qualitative study employed grounded theory methodology and a
modified Delphi technique. In Phase I, 15 patients were interviewed using open-ended
questioning for identification of QOL domains impacted by CRS. Domains were presented in
phase II to a focus group of new CRS patients who ranked each by order of importance. A
conceptual framework of QOL domains impacted by CRS was created based on patient
consensus and a focus group of Otolaryngologists itemized the PROM questionnaire in phase
III. The questionnaire was completed by cognitive interviewing of new CRS patients in Phase
IV.
Results: Patients identified 15 domains of QOL occupying three sub-scales: physical
symptoms, psychosocial symptoms, and activity restriction. These domains provided the basis
for the creation of a 19-item PROM questionnaire. Conclusion: Clinical application of the novel
questionnaire produced by this study yields objective assessment of patient reported
effectiveness of ESS for management of CRS. Further study will aim to validate this newly
developed technique.

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1505
Evaluation of the contributing factors associated with the clinical CRS control after
endoscopic sinus surgery.

Oh Jae Hwan1, Joo Hyun Jung1, Seon Tae Kim1, Ko yunhyuk2, Hyojun Lee3

1
Department of Otolaryngology, Gil Medical Center, Gachon University College of Medicine, Incheon,
Republic of Korea, 2Gil medical center, College of medicine, Gachon University , 3Gil medical center,
college of medicine, Gachon university , 4Department of otolaryngology , Gil Medical center, College of
medicine, Gachon University

CRS – outcome assessment 1| Room 12 Hall 40 - Level 6| Monday 19/06/2023

Background: Endoscopic sinus surgery (ESS) is a widely used surgical intervention for treating
chronic sinusitis, however, a significant number of patients continued the persistent
symptoms after adequate treatment by guidelines. This study is aimed to identify factors
related to clinically uncontrolled patients who underwent endoscopic sinus surgery. Methods:
A retrospective study was planned for patients who underwent endoscopic sinus surgery and
followed up for at least 6 months. Patients were divided into three groups (controlled, partly
controlled, and uncontrolled) according to EPOS 2020 criteria. Medical history and clinical
factors were collected and analyzed the statistical differences in each group. Results: 267
patients were enrolled in this study. The controlled group was 35.2% (n=94), the partly control
group was 52.1% (n=139), and the uncontrolled group was 12.7% (n=34). There was a
statistically significant difference in the Lund-Kennedy score between the controlled and
partially controlled groups (p=0.45) and a statistically significant difference in the Lund-
Mackay score between the controlled and uncontrolled groups (p=0.033). Bilateral disease
was a factor with statistical significance between groups (p=0.002). Gender, age, CMS
phenotype, BMI, presence of diabetes or asthma, alcohol or smoking history, and past medical
history of previous treatment did not show statistically significant differences in each
group. Conclusion: These results suggest the predicting factors in uncontrolled patients after
endoscopic sinus surgery.

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Septal and turbinate surgery 1

1241
Endonasal approach to extracorporeal septal surgery: our experience

Sevasti Konstantinidou1, Anastasia Rachmanidou2, Irfan Syed1, Ana Chioralia1, Alvi

Muhammad1, Jie Lily Huang1, Finley Davies1

1
University Hospital Lewisham, 2Lewisham and Greenwich NHS Foundation Trust

Septal and Turbinate surgery 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

ObjectivesSevere septal deviation has a negative impact on patients’ life and cannot usually
be repaired with classical septoplasty techniques, as the surgical repair is challenging. In our
practice we utilise an endonasal approach extracorporeal septal surgery technique to tackle
this problem.
MethodsRetrospective data collection was conducted for cases of endonasal extracorporeal
septal surgery in the last three years. Outcomes assessed included nasal airway, aesthetic
nasal appearance, early and late complications and revision surgery.
ResultsTwenty patients had endonasal extracorporeal septal surgery. The follow-up was on
average 5.3 weeks. The post-operative nasal airway was patent and not documented in 15
and 12 patients respectively. The aesthetic outcome was good in 12 and 7 cases respectively.
One patient was displeased with their nasal appearance. The septum had residual deformity
in one patient. Five patients had early complications, including minor epistaxis, inflammation
and rhinorrhoea. Two patients had late complications (residual septal deviation, tip nose
numbness). No-one from the patients had revision surgery.
ConclusionEndonasal approach extracorporeal septal surgery is a safe and effective
technique. It has good functional and aesthetic outcomes, irrespective of extreme nasal
deviations, with small number of complications. More robust data would be helpful for further
evaluation of this surgical approach.

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1407
Plastic closure of postoperative and recurrent nasal septal perforations using L-strut
overlay flap

Anna Elumeeva1, Yury Rusetsky2

1
Department of Otorhinolaryngology of Central State Medical Academy, 121359, ldg.. 1, 19 Marshala
Tymoshenko street, Moscow, Russ, 2Department of Otorhinolaryngology of Central State Medical
Academy, 121359, ldg.. 1, 19 Marshala Tymoshenko street, Moscow, Russia

Septal and Turbinate surgery 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Introduction. There is no conventional technique for iatrogenic and recurrent nasal septal
perforations. We present a new technique for closing postoperative defects, based on the
elevation of a vascularized flap from the L-strut area and the creation of the bed site without
dissection of the surrounding septum. Operation process. We determine the level of previous
cartilage resection and mark it. We make a lower horizontal incision along the marked line
with a scalpel, repeating L-shape in anterior sections, from the level of attachment of the
middle turbinate to the nasal cavity bottom. The second incision goes parallel to the first. Two
incisions are connected in the region of anterior nasal spine. Mucoperichondrial flap is
elevated. It receives blood supply from the branches of posterior nasal, anterior and posterior
ethmoidal arteries. We perform scarification of the septum at the site of future recipient bed
together with perforation edges de-epithelization. The fixation is performed with transseptal
sutures. Advantages. The operation is performed with minimal trauma to mucous membrane
(mucoperichondria dissection is not required); a septal flap with abundant blood supply is
used to close the defect; the flap is covered with natural respiratory nasal epithelium, which
restores nasal physiology.

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1410
Proposal for a new classification of septal areas

Octavio Garaycochea1, Maria Jesus Rojas Lechuga2, Maria Jesus Rojas-Lechuga2, Isam Alobid2

1
Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES,
Barcelona University, Barce, 2Rhinology and Skull Base Unit, Department of Otorhinolaryngology,
Hospital Clinic, IDIBAPS,CIPERES, Barcelona University, Barcelona, Spain

Septal and Turbinate surgery 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

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nasal septum plays a fundamental role in respiratory physiology and nasal aesthetics. This
osteocartilaginous structure can present different alterations along its surface such as septal
dysmorphia, perforations, tumor or vascular lesions, therefore the anatomic division of its
surface is important to describe better such pathologies or surgical treatments. The
classification system that have been mostly described and used is the Maurice Cottle
classification. However, there is a lack of consistency in the literature on this classification
and also its applicability in clinical practice is limited. We propose a new classification system
that divides the nasal septum into three areas, based on two anatomical landmarks that can
be assessed clinically and radiologically: The incisive canal (IC) and the posterior edge of the
hard palate. This classification allows the septal areas to be identified and defined without
lateral wall references and define its structures based on the embryology, vascular supply,
and surgical anatomy of the nasal septum.

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1688
Management of patients with chronic hypertrophic rhinitis 10 years retrospective
study in ENT clinic of Timisoara

Maria Chiriac1, Marioara Poenaru3, Nicolae Balica3, Delia Horhat3, Cristian Mot4, Eugen Boia4,
Andreea Kis3, Alexandru Hut5, Loredan Miksa1, Razvan Zimbru6, Bogdan Hartie6, Laurentiu
Ilinca7

1
Department of otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical
Hospital, 2Department of otorhinolaryngology head and neck surgery of Timisoara Municipal
Emergency Clinical Hospital, , 3Department of otorhinolaryngology head and neck surgery of Timisoara
Municipal Emergency Clinical Hospital,Victor Babes” University of Medicine and Pharmacy, Timisoara,,
4
Department of otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical
Hospital,Victor Babes” University of Medicine and Pharmacy, Timisoara, 5Department of
otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical Hospital, Victor
Babes” University of Medicine and Pharmacy, Timisoara, Bihor County Emergency Clinical Hospital,
6
Department of otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical
Hospital, Victor Babes” University of Medicine and Pharmacy, Timisoara,, 7Department of
otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical Hospital, Victor
Babes” University of Medicine and Pharmacy, Timisoara

Septal and Turbinate surgery 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Introduction:Nasal obstruction due to chronic hypertrophic rhinitis is increasingly common

symptom encountered in rhinology. Even if it is not life-threatening, the disease has a major
impact on the patient’s physical, social, and psychological well-being. Materials and
Methods:Our retrospective study included 2220 patient files, aged 16 to 82 years, admitted
to the ENT Clinic with chronic hypertrophic rhinitis over a 10-year
period.The following parameters were evaluated: gender, age, provenience,
associated comorbidities and particularly, the treatment method and outcome.
Results:Average age of the patients were 45 years, the male gender predominating, the
majority being from urban living environment in 69.6%. The most representative clinical signs
and symptoms according to this study are difficult nasal breathing and mouth breathingThe
results of the study prove the effectiveness of the treatment wedged between septoplasty
and electrocautery of inferior nasal turbinates. Conclusions: Chronic hypertrophic rhinitis is
most commonly noted in patients with a long-standing septal deviation. Our priority as ENT
specialists is to increase the quality of life of our patients.

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1691
Patient satisfaction with septal buttons – a UK district general hospital experience

Anna Kaleva1, Thushanth Sooriyamoorthy1, Joanna Stephens1

1
ENT Department, East and North Hertfordshire NHS Trust

Septal and Turbinate surgery 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Background Nasal septal perforations can present with symptoms such as: whistling, crusting,
epistaxis and nasal blockage and adversely affect patients’ quality of life. A septal button can
reduce these symptoms. This study aims to establish the impact of septal buttons on nasal
symptoms. Methods A retrospective search of theatre records at our district general hospital
was carried out to reveal the total number of patients who underwent an insertion of a septal
button between 2017 and 2023. These patients were contacted and asked to complete
questionnaires evaluating current nasal symptoms (Sinonasal Outcome Test – SNOT 22) and
comment on overall satisfaction. Results 40 patients had septal buttons inserted for
perforations in this period but not all completed pre-and post-operative SNOT-22
questionnaires. No intra-operative complications were encountered. 90% were performed
under general anaesthetic. Average operating time was 14.5 minutes. Patient satisfaction
overall was high and for all patients with complete data seta, there was improvement in nasal
symptoms with an average reduction of 11 points on SNOT 22 scores. Conclusion Septal
buttons represent a simple and effective option for the management of septal perforations.
In this cohort, patients were satisfied with septal buttons and had improved nasal symptoms.

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1698
Adipose stromal vascular fraction for nasal septal perforation closure: experimental
evidence

Zhanna Mokoyan1 Viktoriya Lobacheva2, Anna Zolotova1, Valery Svistushkin

1
Department of ear, nose, and throat diseases of Sechenov University, Moscow, 2Department of ear,
nose, and throat diseases of Sechenov University, Moscow, Russia

Septal and Turbinate surgery 1| Room 8 Hall 4 – Level 0| Monday 19/06/2023

One of the common problems that impairs the patient’s quality of life is the perforation of the
nasal septum. Among the population, the incidence of this pathology reaches 2.05%. Despite
significant advances in surgical closure of septal perforation, the recurrence rate remains high.
Therefore, there is an increasing interest in the regenerative medicine approaches and
materials. Adipose stromal vascular fraction (SVF) is of particular interest due to the
combination of 4 types of mesenchymal stem cells, including stromal, endothelial,
hematopoetic and pericytic lineages. To evaluate the advances and limitations of this material
for septal perforation closure, we performed an experimental study in rabbits. Under
endoscopic control, an acute perforation of the cartilaginous nasal septum was created using
cold instruments. After that, the defect was closed using collagen scaffold soaked in SVF.
During the follow-up, endoscopy was performed 1 and 3 months after the procedure to
evaluate the closure rate. In case of total perforation closure, histological examination of the
regenerated tissue performed. The microscopy revealed the restoration both cartilaginous
and mucosal layers of the septum in cases treated with SVF. Thus, SVF seems promising as a
possible alternative treatment option for nasal septal perforations, failed the surgical closure
for several times. Further studies should be performed before clinical implementation.

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1776
Intranasal trigeminal function in patients with nasal septal deviation: the effect of
surgery.

KONSTANTINOS GAREFIS1, DIMITRIOS MARKOU2, IORDANIS KONSTANTINIDIS1, ANGELOS

CHATZIAVRAMIDIS1, VASILIOS NIKOLAIDIS1, KONSTANTINOS MARKOU1

1 nd
2 Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki,
Papageorgiou Hospital, Thessaloniki, Greece, 2School of Electrical & Computer Engineering Aristotle
University of Thessaloniki, Thessaloniki, Greece

Septal and Turbinate surgery 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Background: The intranasal trigeminal system is responsible for the perception of airflow
during nasal breathing. The aim of our study was to investigate the trigeminal sensitivity in
patients with nasal septal deviation with nasal obstruction and the effect of septoplasty on
trigeminal perception. Methodology/principal: Intranasal trigeminal function assessed in 19
patients with nasal septal deviation undergoing septoplasty (before and 6 months after
surgery) and in 19 controls with similar nasal septal deviation without symptoms. Testing
included lateralisation test, trigeminal sticks test and CO₂ pain threshold. Nasal obstruction
evaluated with NOSE score. Results: CO2 pain responsiveness, lateralization test score, and
discrimination stick test score were significantly lower in patients at baseline assessment
compared to controls (p<0.05, p<0.05, p<0.001). No differences were found in trigeminal
sensitivity before and after septoplasty. However, NOSE score was significantly improved in
patients after surgery (p<0.001). Conclusion: Septoplasty had no negative effect on trigeminal
sensitivity. Patients with nasal septal deviation seeking for surgery had lower trigeminal
function than subjects with similar septal deviation but no symptoms.

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Acute Rhinosinusitis 1

1191
Has COVID-19 Changed Pediatric Acute Rhinosinusitis Epidemiology During the First
Two Pandemic Years?

Meir Warman1, Marom Tal1, Itai Hazan1, Ziv Oren1, Elchanan Zlotsower1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Acute Rhinosinusitis 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

IMPORTANCE: The coronavirus (COVID) years were associated with a decrease in all-cause
upper respiratory tract infections due to social distancing measures in different
severities.OBJECTIVE: To study national pediatric acute rhinosinusitis (ARS) burden
fluctuations before and during the first two COVID years. DESIGN: Cross-sectional, population-
based study covering the three pre-COVID years (03/2017-02/2018, 03/2018-02/2019, and
03/2019-02/2020) and the first two COVID years (03/2020-02/2021 and 03/2021-02/2022).
Records were retrieved from Clalit Health Services, the largest Healthcare Maintenance
Organization, insuring 51.6% of the pediatric population (~1.37 million children <5 years).
Urinary tract infection (UTI) was compared for time trend analysis due to its lack of airborne-
transmitted pathogenesis.
SETTING: Nationwide community clinics and hospitals.
PARTICIPANTS: Children <5 years with ARS and UTI episodes were categorized according to
age (0-1, 1-5, 5-15 years) and presentation date. Demographics, comorbidities, setting, and
antibiotic prescriptions were collected.INTERVENTION: COVID-19.MAIN OUTCOME
MEASURES: The average ARS and UTI episodes of the three pre-COVID years were used to
calculate incidence rate ratios (IRRs) of the two COVID years, analyzed separately. Seasonal
variations were explored. RESULTS: We identified 44,483 ARS and 121,263 UTI episodes. There
was a substantial reduction in ARS episodes during the COVID years (IRR 0.36, 95%CI 0.24-
0.56, p<0.001). Although UTI episode rates also decreased during COVID (IRR 0.79, 95%CI 0.72-
0.86, p<0.001), the

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1397
Orbital Complications of Acute Rhinosinusitis – Surgical management with combined
endoscopic endonasal and external approach : A case series from single institution

JULIDE KASABOGLU1, KIRIL PEEV1, ORLIN STOYANOV1, TODOR POPOV1, JULIAN

RANGACHEV1, TSVETOMIR MARINOV3

1
Department of ENT, Medical University- Sofia, Sofia,Bulgaria, 2Department of ENT , Medical University-
Sofia, Sofia,Bulgaria, 3Department of Anaesthesiology and Intensive Care , Medical University—Sofia
,Sofia, Bulgaria

Acute Rhinosinusitis 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Orbital complications of acute rhinosinusitis are often associated with the delay in diagnosis
and, or inadequate treatment. The orbital complications may range from preseptal cellulitis,
orbital cellulitis, orbital abscesses, and subperiosteal abscesses to intracranial extension. We
report a case series of 3 patients ,including a pediatric case ,managed with combination of
functional endoscopic sinus surgery and external approach - anterior orbitotomy. Post-
operatively, medical treatment continued according to the microbiological analysis. We aim
to discuss also the current strategies for the management of orbital complications of acute
rhinosinusitis for better post-treatment outcomes.

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1405
Cost and Utilization of CT Scans for Acute Rhinosinusitis Between 2016 and 2018

Neil Kondamuri1, Thomas Cyberski2, Christopher Roxbury1

1
Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
Medicine, Chicago, IL, USA., 2Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.

Acute Rhinosinusitis 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Acute rhinosinusitis (ARS) is a common problem in the United States. As most cases can be
diagnosed clinically, computed tomography (CT) imaging in ARS is not recommended.
However, the extent of continued CT scanning and associated healthcare expenditures (HCE)
is unknown. We sought to characterize CT scan cost and utilization from 2016 to 2018. Using
IBM’s MarketScan Commercial Claims Database, we conducted a retrospective cross-sectional
analysis of CT scan utilization for patients with a primary diagnosis of acute sinusitis between
January 1, 2016 and December 31, 2018. Total HCEs were stratified by year and region. One-
way ANOVA tests were used to examine both differences among mean HCEs by region and CT
scan utilization by physicians over time (alpha=0.05). Analyses were performed using Stata
version 17. Between 2016 and 2018, almost 25,000 patients received a CT scan for ARS,
though significantly fewer scans were ordered each successive year (p<0.001). HCEs totaled
$10,741,525. While otolaryngologists and radiologists (n=9,601; 84.4%) were less likely to
order CT scans over time, there was no change in CT scans ordered by primary care physicians
(n=1,334; 11.7%) (p<0.01). More CT scans were ordered in the South than in any other region
(p<0.01), though the North Central region had the highest mean HCEs per patient
($469.63). While otolaryngologists have appropriately reduced CT utilization for ARS, results
indicate a need for outreach efforts to reduce costly and unnecessary CT use by primary care
practitioners.

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1556
Rhinogenic Brain Abscesses – A Case Series from Emergency ENT department and
Literature Review

STOYAN DIMITROV1, JULIDE KASABOGLU3, ORLIN STOYANOV4

1
Department of ENT, Medical University-Sofia ,Sofia,Bulgaria, 2Department of ENT , Medical University-
Sofia ,Sofia,Bulgaria, 3Department of ENT, Medical University-Sofia, Sofia, Bulgaria, 4Department of
ENT, Medical University-Sofia, Sofia,Bulgaria

Acute Rhinosinusitis 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Brain abscess has been a known complication of head trauma, dental and rhinogenic
infections and congenital heart defects. Nose-derived intracranial complications are less
common than otogenic ones, and infections caused by nasal and sinus trauma, foreign bodies
and surgery are more common than those caused by inflammation alone. Intracranial
complications of sinusitis and AOM are best managed in a specialist centre with
multidisciplinary input of otorhinolaryngology(ORL) and neurosurgery. Concurrent ORL and
neurosurgical intervention reduces abscess recurrence and requirement for revision
neurosurgery in sinogenic complications and should represent the standard of
care. Endoscopic sinus surgery is the ORL modality of choice in experienced hands.We report
an unusual case series of two patients who were admitted to our emergency ENT department
with intracranial abscess caused by untreated acute
rhinosinusitis. We performed combined rhinological andneurosurgical approach with our
multidisciplinary team.With our experience in these cases, we aim to discuss the adequate
medical and surgical management of rhinogenic intracranial abscesses.

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1572
SEAWATER NASAL WASH EFFICACY ON NASAL SYMPTOMS AND VIRAL LOAD IN COVID-
19 AND URTIS

Ludovic de Gabory1, Sophie Vallet2, Gaelle Naelten3, Chantal Raherison-Semjen4

1
Department of Rhinology, skull base and sinus surgery, University Hospital of Bordeaux, France,
2
Virology Unit, University Hospital, Brest, France, 3Laboratoire de la Mer, Saint Malo, France,
4
Departement of pneumology, University Hospital of Guadeloupe, France

Acute Rhinosinusitis 1| Room 9 Olympic Hall – Level 0| Monday 19/06/2023

Objective: To assess efficacy of seawater nasal wash on mild-to-moderate COVID-19 and viral
URTIs. Methods: Randomized, controlled, parallel study in 355 adults with ≤48h-rhinologic
symptoms. Active group: 4-daily nasal washes with Physiomer® (undiluted isotonic seawater
spray). Assessments: 3 weeks-daily symptoms record; viral load measurement on Day0, Day5,
Day14, Day21. (*=p<0.05) Results: All subjects: In active group, smell and taste disorders
resolved earlier (-2days and -3days*), with the earliest resolution of alteration/loss of smell (-
3.9days*), post-nasal drip (-2.9days*), dyspnea (-1.3day*), face pain/heaviness (-2.6days*) in
subjects with severe nasal symptoms. COVID-19 subjects: The active group recovered 1.6 day*
earlier the ability to accomplish daily activities, with the earliest resolution of anosmia in
subjects with severe nasal congestion (-5.2days*). Evolution towards more severe COVID-19
was lower in active (Day7:9.1%, Day14:0%, Day21:0%) vs control (Day7:13.7%, Day14:12.8%,
Day21:7.9%), with earlier viral load reduction, especially in subjects with severe nasal
congestion (≥1.5log10copies/10000 cells:71.4% vs 47.4% at Day3). URTIs subjects:
Rhinorrhea, post-nasal drip and overall sickness resolved 3.5days*, 3.7days* and 4.3days*
earlier in active group, with a higher viral undetectability reached from day3 vs control (62.1%
vs 36.4%). Conclusion: This randomized controlled trial demonstrated benefit and safety of
seawater nasal wash in mild-to-moderate COVID-19 and viral URTIs.

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1610
FUNGAL RHINOSINUSITIS: A RETROSPECTIVE STUDY FROM A TERTIARY HOSPITAL IN
PORTUGAL

Rita Peça1, Cláudia Rosa1, Maria José Santos1, Mariana Caetano1, Vítor Oliveira1, Pedro
Correia Rodrigues1, Leonel Luís1

1
Serviço de Otorrinolaringologia do Centro Hospitalar Universitário de Lisboa Norte

Acute Rhinosinusitis 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background: Fungal rhinosinusitis (FRS) is a well-known entity that can be divided in non-
invasive and invasive forms. This includes a spectrum of disease processes that vary in clinical
and histological findings and treatment options.Objectives: Clinical review of presentation,
management and predictive clinical factors related to FRS.Methods: Retrospective study of
patients diagnosed with FRS and submitted to surgery between 2017 and
2022. Data collection included patient demographics and clinical features. Statistical analysis
was performed via descriptive statistics and non-parametric tests. Results: 41 patients were
diagnosed with suspected FRS based on clinical and imaging criteria. Mean age was 55 years-
old and 56.1% had comorbidities. The most prevalent symptoms were rhinorrhea and nasal
congestion, with maxillary sinus being the most affected (75.6%). Cultures or histology reports
were positive for fungal disease in 56.1%. Fungus ball was the most frequent
(36.6%), followed by allergic FRS-like (12.2%) and allergic FRS (7.3%). The dominant isolated
fungi was Aspergillus in non-invasive and Mucor in invasive forms. An association was
found between allergic FRS and surgical reintervention (p<0.001). Recurrence was associated
with both asthma and previous sinus instrumentation (p=0.009; p=0.001).Conclusions:
Our study suggests that previous sinus surgery is associated with FRS recurrence. Due to
fastidious cultures and challenges in fungal diagnosis, risk factors and clinical probability
should be considered when approaching a patient with suggestive symptoms of FRS.

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CRS – diagnosis and investigations 1

1172
Comparison of mucus and serum biomarker sampling in chronic rhinosinusitis with
nasal polyps

Sarina Müller, Olaf WENDLER1, Sarina Mueller2, Susanne Mayr2, Heinrich Iro2, Benjamin
BLEIER

1
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Otolaryngology, Head and Neck
Surgery, Germany, 2Department of Otolaryngology, Head and Neck Surgery, University of Erlangen
Nuremberg

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

Objective The objective of this study was to analyze advantages and disadvantages of mucus
and serum for biomarker analysis. Methods Prospective study of 67 CRSwNP patients. All
patients were followed over 24 months and over 9 time points after functional endoscopic
sinus surgery. At each time points, the nasal polyp score (NPS) was assessed, mucus as well as
serum was collected and selected biomarkers were measured. Mean, standard deviation and
variance, missing values, the correlation of the biomarkers to the NPS over time and to early
recurrences were calculated. Additionally, the diurnal rhythm of all biomarkers was measures
in order to assure stable biomarker values during sampling times. Results All biomarkers
showed stable values during sampling times. Serum biomarker levels displayed higher
percentages of missing values compared to mucus biomarkers. Mucus periostin(p<0.001,
r=0.89), mucus IgE(p<0.001, r=0.51), serum periostin(p<0.001, r=0.53), mucus CST1(p<0.001,
r=0.27), and serum IgE(p<0.01, r=-0.18) were the best marker and medium combinations to
track the NPS over time and to predict recurrences. Mucus serpinF2 was negatively correlated
and predicted early recurrences(p = 0.026, R2= 0.015). Conclusions Serum and mucus both
represent viable mediums for “liquid biopsies”. All markers showed stable values during the
sampling times. The most promising marker/ medium combinations over time to track
disease severity were mucus periostin, mucus IgE, serum periostin, mucus CST1, and serum
IgE. Mucus serpinF2 was the best biomarker to predict early recurrences.

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1204
Endotyping chronic rhinosinusitis by nasal secretions

Stephan Vlaminck1
1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

Background: The EPOS guidelines (2020) advocate early endotyping is for prompt
categorisation especially regarding the increasing evidence of patient-tailored therapy.
Methods: We aimed to investigate the diagnostic value and reproducibility of sinonasal
secretions sampling both by endoscopic aspiration and nasal blown secretions. First,
preoperative secretion analysis of 53 CRS patients was compared to subsequent operative
tissue analysis. Second, secretion analysis on two different time points was compared for 10
postoperative CRS patients with type 2 (T2) inflammation and 10 control participants.
Results: The sensitivity to detect T2 inflammation was higher in nasal aspiration samples (85%)
compared to nasal blow secretions (32%). A specificity of 100% for both techniques was
obtained. A 90% reproducibility for T2 eosinophil detection was found by sampling on
different time points regardless of the technique. Of the T2 patients, 60% showed no T2
inflammatory pattern more than one year after FESS surgery. Conclusions: Nasal secretions
sampling, especially aspiration of nasal secretions, is useful in the detection of T2
inflammation in CRS pathology. We proposed a structured histopathology analysis for
sinonasal secretions useful in daily clinical practice, including Congo red staining sensitive for
eosinophilic cells and free eosinophil granules. Analysis of nasal secretions enables endotyping
in an early stage, which allows more directed therapy

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1208
Analysis of expression profiling data suggests explanation for difficulties in finding
biomarkers for nasal polyps

Eun Jung Lee1, Dong Hwan Kwon1, Minheon Kim1, Hyun Su Lee1, Joo Hyung Lee1

1
Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

Background: Identification of clinically useful biomarkers for Nasal Polyposis in chronic

rhinosinusitis (CRSwNP) has proven difficult. We analyzed gene expression profiling data to
find explanations for this. Methods: We analyzed mRNA expression profiling data, GSE36830,
of six uncinate tissues from healthy controls and six NP from CRSwNP patients. We performed
Ingenuity Pathway Analysis (IPA) of differentially expressed genes to identify pathways and
predicted upstream regulators. Results: We identified 1,608 differentially expressed genes
and 177 significant pathways, and 75 upstream regulators whose activity was predicted to be
upregulated. These included regulators of known pathogenic and therapeutic relevance, like
IL-4. However, only seven of the 75 regulators were actually differentially expressed in NP.
Interestingly, these did not include IL-4, and four of the seven were receptors. This suggested
a potential explanation for the discrepancy between the predicted and observed expression
levels of the regulators, namely that the receptors, and not their ligands, were upregulated.
Indeed, we found that 10 receptors of key predicted upstream regulators were upregulated,
including IL4R. Conclusion: Our findings indicate that the difficulties in finding specific
biomarkers for CRSwNP depend on the complex underlying mechanisms, which include
multiple pathways and regulators, each of which may be subdivided into multiple components
such as ligands, soluble and membrane-bound receptors. This suggests combinations of
biomarkers may be needed for CRSwNP diagnostics.

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1216
Real-Life Efficacy of Dupilumab in Refractory Chronic Rhinosinusitis with Nasal Polyps

María Sandra Domínguez Sosa1, Cabrera Ramírez María Soledad1, Miriam del Carmen
Marrero Ramos1, Carmen Delia Dávila Quintana2, Carlos Cabrera López3, Díaz Carrillo4, Jesús
Javier Benítez del Rosario1

1
Otorhinolaryngology Department, Doctor Negrin University Hospital of Gran Canaria, 35002, Las
Palmas de Gran Canaria, Spain, 2Universidad de Las Palmas de Gran Canaria, 35001, Las Palmas de Gran
Canaria, Spain, 3Neumology Department, Doctor Negrin University Hospital of Gran Canaria, 35002, Las
Palmas de Gran Canaria, Spain, 4Allergology Department, Doctor Negrin University Hospital of Gran
Canaria, 35002, Las Palmas de Gran Canaria, Spain

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

The aim of this study was to evaluate the efficacy of Dupilumab in patients affected bychronic
rhinosinusitis with nasal polyps (CRSwNP) in real-life. A single-centerretrospective
observational study on severe CRSwNP patients, treated with dupilumab,was conducted.
Nasal Endoscopic Polyp Score (NPS), Visual Analogue Scale (VAS)symptom score, Sino-nasal
Outcome Test (SNOT-22), Asthma Control Test (ACT) score,Fractional exhaled nitric oxide
(FeNO), eosinophils blood cells and prednisone intakewere assessed at baseline and after 6
months. 37 patients were included. 29 patients(87,9%) presented with asthma; Aspirin
Exacerbated Respiratory Disease (AERD) in 14patients (42,4%). A statistically significant
decrease in the SNOT-22 score was observed(median difference -63; 95% CI: -68; -58; p<0.001)
with median t0 67 and IQR (61;90)to t6 12 (5;15). Reduction in NPS, median t0 NPS 7;
(IQR:4;6), median t6 NPS 1;(IQR:0;1) p<0,001, was greater in patients with AERD. The median
baseline VAS scorewas 6 (IQR:6;7) and the differences between t0 and t6 were statistically
significantp<0.001. Significant improvement in olfactory disfunction. Dupilumab
treatmenteffects has been demonstrated with a significantly reduced symptoms, polyp
scores,and systemic corticosteroid use, resulting in an increase health-related quality of life
inpatients with severe CRSwNP, regardless of the presence or absence of asthma orAERD

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1238
Transcriptional analysis of nasal polyps fibroblasts reveals a new source of pro-
inflammatory signaling in CRSwNP

Juan Maza-Solano1, Cristina Porras-González1, José Luis Muñoz-Bravo1, José María Palacios-
García1, Ramón Moreno-Luna1, Serafín Sánchez-Gómez1

1
Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University
Hospital/FISEVI, Seville, Spain

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

Background: Fibroblasts cells have recently been identified as critical cells triggering tissue-
specific inflammatory responses. Persistent activation of fibroblasts inflammatory program
has been suggested as an underlying cause of chronic inflammation in a wide range of tissues
and pathologies. Nevertheless, the role of fibroblasts in the emergence of chronic
inflammation in the upper airway has not been previously addressed. We aimed to elucidate
whether fibroblasts could have a role in the inflammatory response in nasal polyps
(CRSwNP).Methodology: We performed whole-transcriptome microarray in fibroblast
cultured from CRSwNP samples and confirmed our results by qRT-PCR. We selected patients
without other associated diseases in upper airway. To investigate shifts in transcriptional
profile we used fibroblasts from nasal polyps and uncinate mucosae from patient with
CRSwNP, and fibroblasts from uncinate mucosae from healthy subjects as controls.Results:
This study exposes activation of a pro-inflammatory and pro-fibrotic transcriptional program
in nasal polyps and CRSwNP fibroblasts when compared to controls. Our Gene-set Enrichment
Analysis (GSEA) pointed to common up-regulation of several pro-inflammatory pathways in
patients-derived fibroblasts, along with higher mRNA expression levels of cytokines, growth
factors and extracellular matrix components.Conclusions: Our work reveals a potential new
source of inflammatory signaling in CRSwNP, and suggest that deregulated
inflammatory signaling in tissue-resident fibroblasts could support a Type-2 inflammatory
response.

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1262
Nasal Nitric Oxide (nNO): Potential role in the diagnosis of aspirin/NSAID
hypersensitivity in patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)

Dorien Van Broeck1, Peter Hellings2, Brecht Steelant1, Lieven Dupont3, Guy Scadding4

1
Allergy and Clinical Immunology Research Group - KU Leuven, 2Department of otorhinolaryngology,
head and neck surgery, University Hospitals Leuven, 3Department Respiratory Diseases, University
Hospitals Leuven, 4Imperial College London

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

Background Although the EU guidelines recommend changes in nasal airflow

resistance/patency/geometry to assess nasal response during nasal aspirin challenge, changes
in parameters indicative of inflammation might be a good alternative. Objectives To
determine changes in the concentration of nasal and exhaled NO and type 2 inflammatory
cytokines IL-4, IL-5 and IL-13 in the nasal cavity after a nasal aspirin challenge in CRSwNP
patients with/without a positive history of aspirin/NSAID hypersensitivity. Methods 26
CRSwNP patients and 10 controls were challenged nasally with increasing doses of lysine
aspirin starting with 5 mg aspirin equivalent, then 10 mg, 20 mg, 40 mg at 45 min intervals,
until either the patient had responded with induction/aggravation of nasal and chest
symptoms plus a 20% decrease in peak nasal inspiratory flow (PNIF) or forced expiratory
volume in 1 second (FEV1) or a cumulative dose of 75 mg was reached. Nasal hyperreactivity
was excluded by applying 100 mcl isotone saline. nNO and FeNO were measured before and
after the challenge. Nasal fluid was harvested by placing Merocel° sponges in the nostril during
10 min at different timepoints. Results When nasal aspirin challenge induced/aggravated
nasal symptoms, it was associated with a decrease in nNO (av. 53%), in PNIF (av. 46%) or in
FEV1 (av. 27%). Preliminary data show a positive correlation between PNIF and nNO. FeNO
remained constant. Conclusion Nasal NO measurement might be a good objective technique
to assess aspirin/NSAID hypersensitivity in nasal aspirin challenges.

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1584
The burden of migraine on quality of life in chronic rhinosinusitis

Marlene M. Speth, Armo Derbarsegian, Sarah M. Adams, Katie M. Phillips, Ahmard R.

Sedaghat

CRS – diagnosis and investigations 1| Room 10 Peroto – Level 0 | Monday 19/06/2023

To determine the impact of comorbid migraine on quality of life (QOL) in chronic rhinosinusitis
(CRS). Methods: A total of 213 adult patients with CRS were recruited. All participants
completed a 22-item Sinonasal Outcome Test (SNOT-22), from which total and validated nasal,
ear/facial pain, sleep and emotional subdomain scores were calculated, and the 5-dimension
EuroQol general health questionnaire (EQ-5D) from which the visual analogue scale (VAS) and
health utility value (HUV) were calculated. The presence of comorbid migraine was
determined by a score of ≥4 on the 5-item Migraine Screen Questionnaire (MS-Q).Results: Of
participants, 36.2% were screened positive for having comorbid migraine. The mean SNOT-
22 score was 64.9 (SD: 18.7) in participants with migraine and 41.5 (SD: 21.1) in participants
without migraine (p<0.001). The mean EQ-5D VAS and HUV were 60.2 (SD: 21.9) and 0.69 (SD:
0.18), respectively, in participants with migraine and 71.4 (SD: 19.4) and 0.84 (SD: 0.13),
respectively in participants without migraine (p<0.001 for both). Higher ear/facial pain
(OR=1.22, 95%CI: 1.10 – 1.36, p<0.001) and sleep (OR=1.11, 95%CI: 1.04 – 1.18, p=0.002)
SNOT-22 subdomain scores were positively associated with migraine. The SNOT-22 item
scores related to dizziness, reduced concentration, and facial pain, in descending order, were
most associated with migraine. Presence of nasal polyps (OR=0.24, 95%CI: 0.07 – 0.80,
p=0.020) was negatively associated with migraine. Conclusion: Comorbid migraine may be
relatively common amongst CRS patients and its presence is associated with significantly
worse QOL. Dizziness as a symptom in CRS patients may be particularly indicative of migraine.

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Late Breaking Abstracts 1

1786
Bioequivalence of two paediatric oral suspensions of fexofenadine hydrochloride:
Data from an open-label, randomised, phase 1 study

Clemence Rauch1, Margarita Murrieta-Aguttes2, Beatrice Bois De Fer1, Michele Lheritier-

Barrand2

1
Sanofi CHC, Consumer Safety & Evidence, Gentilly, France, 2Sanofi CHC, Scientific Innovation, Gentilly,
France

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Fexofenadine (FEX) is a second-generation, non-sedating, H1-receptor antagonist used in

allergic rhinitis and chronic idiopathic urticaria. We have developed a new oral paediatric
suspension of 6 mg/mL FEX HCl (test) with potassium sorbate a widely used preservative.
Here, we report bioequivalence data of the test vs marketed suspension of 6 mg/mL FEX HCl
(reference) from a phase 1, open-label, randomised, 2-treatment, 2-sequence, 4-period
crossover study separated by a 7-day washout period, in healthy adults. Key pharmacokinetic
parameters assessed Cmax (ng/mL), tmax and AUC (ng•h/mL). Treatment-emergent adverse
events (TEAEs) were recorded. The study randomised and treated 68 adults (1st dose: 67
[test], 68 [reference]; 2nd dose: 65 [test], 64 [reference]). Mean age was 39.5 years, 57.4%
were male, mean BMI was 25.5 kg/m2. Plasma concentrations of test vs reference
formulations were similar after administration of a single dose. Bioequivalence between test
and reference formulations was demonstrated with 90% CI of the geometric LS mean ratio
within 80%–125% for each parameter. The ratio observed for Cmax, AUClast and AUC was 1.1
(1.02–1.17), 1.1 (1.03–1.14) and 1.1 (1.03–1.14), respectively. The median time to reach
maximal concentration (tmax) for test and reference formulations was approximately 1 hour
for both 1st and 2nd doses. There were no serious TEAEs or discontinuations due to TEAEs.
The test (paraben-free) vs reference FEX paediatric suspensions were bioequivalent under
fasting conditions, with consistent safety profile. Funding: Study was funded by Sanofi.

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1789
Parosmia Score : a valuable tool to quantify olfactory distortions

Sonia Macario1, Dimitrios Daskalou1, Julien Wen Hsieh1, François Voruz1, Basile Nicolas Landis1

1
Department of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and
University of Geneva, Geneva, Switzerland

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

IntroductionQualitative OD can be split into parosmia (distorted perception triggered by an

odor source) and phantosmia (distortion without odorous trigger). Parosmia and phantosmia
are mostly unpleasant and occur frequently after postinfectious OD. While testing
quantitative OD is established and valiated by many tools (Sniffin'Sticks, UPSIT, many others)
parosmia can’t yet be measured and the gold standard still is the patient’s story.Aim of the
study: Assess presence, absence and evolution of distortions by means of parosmia
score. MethodsA retrospective study was conducted on consecutive patients (n=554) with
smell and taste disorders. All patients underwent a structured patients history, ear, nose, and
throat examination, Sniffin’ Sticks testing and filled in a questionnaire with four parosmia
questions. For 71 patients a second parosmiascore could be recorded 22 months after the first
assessment. ResultsA total of 554 patients (307 females) were included with a median age of
51 years. Patients with parosmia and/or phantosmia have lower parosmia score (p<0.001)
compared to patients without qualitative disorders. In the follow-up group (n=71) , 47 patients
(66,2%) had no change in their parosmia status, 15 patients (21,1%) had no parosmia anymore
and 9 patients (12,7%) newly developed a parosmia. Analysis of the first versus second
assessment reliably indicated these changes. ConclusionThe parosmia score provides valuable
and additional clinical tool regarding the assessment and follow-up of parosmia
and complements structured patients history.

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1790
Revision Radio Frequency Ablation turbinate reduction (RFATR)

narin carmel neiderman1, Ran Bilaus1, Anat wengier1, Avraham ABERGEL1

1
Tel Aviv Sourasky medical center

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Introduction Radiofrequency ablation (RFA) reliefs nasal obstruction and improves quality of
life (QoL) in patients suffering from inferior turbinate hypertrophy (ITH). It is considered safe,
easy to perform, but not always sustain a long lasting effect. We noted that revision RFA may
Our aim was to establish the benefit from revision of RFA in patients suffering from inferior
turbinate regrowth after RFA.Study Design Prospective cohort study.Methods Prospective
Cohort study, including patients suffering from ITH undergoing RFA between 9.2017-1.2023
in Tel Aviv Medical Center. Patients were followed for 6 month post operatively. We retrieved
patients’ complaints, clinical findings and QoL questionnaires. Results 23 of 230 patients
(11.7%) underwent revision RFATR, due to lack of sufficient improvement. Mean time to
revision was 6.1±7.0 months. Only one patient failed revision RFATR and required surgery.
Conclusion Revision RFA demonstrated effectiveness and is a playable instrument in the
rhinology clinic. High satisfaction was noted not only after RFA but also after rev RFATR, and
was established in our entire cohort.

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1795
The Impact of Adhesions on Nasal Airflow: A Quantitative Analysis Using
Computational Fluid Dynamics

Narinder Singh1

1
University of Sydney/ Westmead Hospital

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Methods: CT scans of healthy adults were used to construct 3D nasal airway computational
models. A single virtual 2.5 mm diameter NA was placed at five sites within each nasal cavity
bilaterally (commonly seen following NAO surgery), resulting in 10 NA models and 1 NA-free
control for each subject. CFD analysis was performed on each NA model and compared with
the subject’s NA-free control model.
Results: 4 subjects were recruited to create 44 computational models. The NA caused the
airflow streamlines to separate, leading to a statistically significant increase in mucosal
temperature immediately downstream to the NA (wake region). Changes in the mucosal
temperature in the wake region of the NA were most prominent in anteriorly located NA with
a mean increase of 1.62°C for the anterior inferior turbinate NA (p<0.001) and 0.63°C for the
internal valve NA (p<0.001).
Conclusion: Nasal adhesions result in marked disruption to airflow patterns and reduced
mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region
mucosal cooling may be a contributing factor to the exaggerated perception of nasal
obstruction experienced by patients with nasal adhesions.

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1797
Efficacy of Vidian Neurectomy and Posterior Nasal Neurectomy in the Management of
Nonallergic Rhinitis: A Systematic Review

Narinder Singh1

1
University of Sydney/ Westmead Hospital

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Aims: Endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including
surgical (SPNN) and cryoablative (CPNN) methods, may improve symptoms in non-allergic
rhinitis (NAR). We compared the efficacy, side effect profile and complication rate between
EVN and PNN for NAR.
Methods: A systematic review of primary articles that reported original patient data for EVN/
PNN was conducted using Embase, Medline, Pubmed and Cochrane databases since 2006,
according to PRISMA guidelines. The primary outcome was improvement in NAR symptom
severity. Secondary outcomes included the incidence of post-operative side effects or
complications. Results: 58 articles met the search criteria with a total of 9 studies (including 2
RCTs) eligible for inclusion. There was a pooled sample of 229 NAR patients that underwent
EVN (n=65; 28.4%), SPNN (n=50; 21.8%) or CPNN (n=114; 49.8%). For all 3 techniques, there
was statistically significant improvement in nasal symptoms, particularly rhinorrhoea, nasal
congestion and obstruction along with QOL. Heterogeneity in outcome reporting prevented
meta-analysis and direct comparison of efficacy. The pooled incidence of post-operative
complications for EVN (n=65), SPNN (n=50) and CPNN (n=70) were 30.8% vs 0% vs 2.9% for
dry eye, 16.9% vs 0% vs 1.4% for palatal/cheek numbness and 0% vs 6% vs 4.3% for bleeding.
Conclusion: EVN, SPNN and CPNN are similarly efficacious for patients with NAR refractory to
medical management. SPNN and CPNN are associated with lower rates of complications (dry
eye and palatal/cheek numbness) compared with EVN.

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1800
Epiglottic collapse in patients with Obstructive Sleep Apnea

Tali Teitelbaum1, Itzhak BRAVERMAN, Shochat Isaac1, Isaac Shochat1

1
Hillel Yaffe Medical Center

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

OSA occurs due to the collapsibility of the upper airway structures during sleep. When the
upper airway is subjected to negative pressure during inspiration, the collapsible soft tissues
may undergo complete or partial obstruction of the upper airway, resulting in increased blood
pressure, hypoxemia, and increased oxidative stress in the body. Polysomnography (PSG) is
the gold standard for diagnosis of OSA, the frequency of obstructive events is documented in
the apnea hypopnea index (AHI); the severity of the OSA is classified based on this
information. Drug induced sleep endoscopy (DISE) demonstrates sometimes a significant
difference between PSG results. Torre C et al. systematically reviewed 14 studies regarding
epiglottis collapse (EC) prevalence in (OSA) patients and found a higher EC prevalence than
previously described. The epiglottis has been implicated in 12% of snoring cases, and sound
arising from it has a higher pitch than palatal snoring.CPAP, surgery, and positional therapy
were also considered as an option to treat EC. Lateral head position may reduce the frequency
of EC. CPAP, on the other hand, may accentuate epiglottis collapse. Surgery may help reduce
snoring in some patients with a lax epiglottis and improve OSA in patients undergoing
multilevel surgery. We evaluated various combination of EC, palatal collapse, tongue base
collapse, and oropharyngeal- tonsillar collapse using our DISE-based EC staging system (0 - no
collapse; 1 - 50% view occlusion; 2 - 75% view occlusion; 3 - 100% view occlusion). According
to this staging system we evaluated

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1806
How long is the journey from septoplasty to anterior skull base surgery? – challenges
faced by a junior ENT surgeon

Anca Cirstea1

1
Department of Othorhinolaryngology , "Carol Davila" University of Medicine and Pharmacy

Late Breaking Abstracts 1| Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

The objective of the document is to describe the first surgical steps and the first surgical
interventions made by an ENT surgeon at the beginning of the career. Furthermore, the
learning curves needed to perform a septoplasty and a complete functional endoscopic sinus
surgery and the learning curves for more complex surgical interventions like the sphenoid
sinus approach for pituitary adenoma are described.The presentation contains 24 classical or
endoscopic septal deviation surgeries, 10 antrostomies and 3 anterior ethmoidectomies
performed by the 31 year-old author during the residency period, under the observation of
an experienced surgeon, but also as a specialist. Also, using existing data from literature, a
review to establish the learning curves for each type of surgical intervention was made. All 24
patients in which septoplasty was performed had nasal obstruction prior to the intervention.
8 patients also had obstructive sleep apnea syndrome. 6 of the patients with septoplasty
procedure also had inferior turbinate radiofrequency reduction. For classical septoplasty the
complication rate is much lower after the first 30 cases. Regarding endoscopical sinus surgery,
including the frontal sinus approach, the complications decrease significantly after 90 surgical
interventions. The importance and technical difficulties of septal surgery are often
underestimated. Regarding endoscopic sinus surgery, in order to circumvent the learning
curve, a rigorous training period during residency under observation of an experienced
surgeon is mandatory.

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Miscellaneous 1

1219
The Role of Surgery in Orbitocranial Fungal Infection treatment in the Era of Azole
Antifungals

Yakirevitch Arkadi1

1
Sheba Medical Center

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

Introduction: Aggressive surgery has been justified in orbitocranial fungal infection (OCFI) as
life-saving, despite its significant morbidity. Over the past two decades, early use of azole
agents has been introduced as first-line treatment demonstrating promising outcomes. This
work aimed to provide real-life data on azole treatment outcomes and the role of surgery in
the current management of OCFI. Methods: Data was collected retrospectively from a chart
review from four participating centers and a systematic literature review. The study group
included patients with OCFI treated with azole antifungals. The control cases were treated
with other atifungal agents. The cranial and orbital involvement degree was staged based on
the imaging. The extent of the surgical resection was also classified to allow for inter-group
comparison. Results: There were 125 patients in the azole-treated group and 153 in the
control group. Among the patients with OCFI cranial extension, 23% were operated on in the
azole-treated group and 18% in the control group. However, meninges and brain resection
were performed only in the controls (11% of patients) and never in the azole antifungals group
(p-value=0.045). Orbital involvement required surgery in 26% of azole-treated cases and 39%
of controls. Despite a more aggressive cranial involvement (p-value<0.01), azole-treated
patients’ mortality was significantly lower than in controls, with a OCFI-specific mortality rate
of 21% vs. 52%. A similar trend was found for the extent of the orbital disease and the orbital
surgery.

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1243
A real-world user survey on the effectiveness of a hypertonic seawater nasal spray as
an add-on to pharmacological treatment in patients with ENT diseases

Konstantinos Alevizopoulos1, Stella Georgiou1

1
Gerolymatos International SA

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

Scarce real-world evidence exists regarding the usability and effectiveness of saline nasal
sprays. This user survey explored user satisfaction and clinical efficacy of HSS-Mini, a
hypertonic seawater nasal spray (Sinomarin® Mini, Gerolymatos International). Sixty patients
who visited pharmacies with a prescription to use nasal corticosteroids or vasoconstrictors for
an underlying ENT condition participated in the study. Patients used HSS-Mini as an add-on
treatment for up to two weeks. At the end of the evaluation period, the product’s efficacy, its
use pattern, and symptom severity before and after HSS-Mini use were scored. Users were
highly satisfied with the spray; 93.6% was satisfied with the product, 91.6% with its efficacy
and 93.3% with the overall efficacy from its combined use with medication. Reduction of
medicated product intake was reported by 93.4% of users. Users were willing to use HSS-Mini
even in the absence of medication and recommend it to other users. Patients experienced
reduced stuffy/blocked nose, runny nose, sneezing, itchy/dry nose and other nasal symptoms
(P<0.0001). Similarly, quality of life symptoms such as fatigue, reduced productivity, sleep
quality, emotional tiredness and overall feeling were also improved (P<0.0001). These results
support continuous adjunct use of HSS-Mini for optimal symptom management in sinonasal
diseases.

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1435
Hyperpneumatization of the paranasal sinuses in patient with Cushing's Syndrome

NURIA CRUZ CERÓN1, VIRGINIA GARCIA GARCIA1, Covadonga Aránguez Suárez1

1
SOCIEDAD ESPAÑOLA DE OTORRINOLARINGOLOGÍA

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

INTRODUCTION:Hyperpneumatization of the paranasal sinuses, also called Pneumosinus

dilatans, is defined as a generalized or partial enlargement of the frontal, sphenoid, or
ethmoid sinuses that contain only air. As the size increases, it can cause deformation of the
bone and tissues that cover it. It can be idiopathic, associated with other disorders such as
brain atrophy, or iatrogenic.MATERIAL AND METHODS: A 42-year-old patient with a history of
arterial hypertension, disability secondary to hydrocephalus with a shunt valve from birth and
epilepsy, and currently with Cushing's Syndrome for which he is going to undergo surgery with
a nasal approach.RESULT: For the planning of the surgery, a cranial computed tomography
(CT) was performed where post-surgical changes with ventricular shunt valve that penetrates
through the left frontal region, thickening of the diploe with hypertrophic pneumatization of
both frontal sinuses are visualized.CONCLUSION: The diversion of cerebrospinal fluid for a
prolonged period during the paranasal sinus pneumatization process can cause or aggravate
paranasal sinus hyperpneumatization, the frontal sinus being the most frequently affected.

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1514
A Rare Case of Primary Amyloidosis Presenting as a Nasopharyngeal Mass

Anna-Maria Papadopoulou1, Athanasia Marinou1, Anastasia Liapi1, Aikaterini Tsagkovits1

1
Department of Otorhinolaryngology, G.Gennimatas Athens General Hospital

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

Amyloidosis is a rare systemic depositional entity. The most common site of localized head
and neck disease is the larynx. We present a patient with primary localized nasopharyngeal
amyloidosis, which is rather uncommon, with only 41 cases described in the literature.A
healthy 45-year-old Caucasian male presented to our department due to unilateral hearing
loss since 3 months. Otoscopy and audiometry exams suggested right otitis media with
effusion and conductive hearing loss respectively. Nasendoscopy revealed a lesion obstructing
the right Eustachian tube opening. MRI showed a suspicious irregular mass with heterogenous
contrast enhancement arising from the right Rosenmuller fossa. Subsequently, a nasal
endoscopy with biopsy was performed under local anesthesia. The histopathology exam
demonstrated an amyloid plaque confirmed on Congo Red staining. Further investigations for
potential systemic disease or other conditions related to a secondary form of amyloidosis
were negative and eventually, the diagnosis of primary localized nasopharyngeal amyloidosis
was confirmed. Due to the absence of lasting follow-up protocols, no standard treatment has
been defined. In our case, a watchful waiting approach was decided, with symptomatic
treatment and regular follow-up, given the very slow progression of the disease. Surgical
debulking of the mass is also a treatment option for patients with localized amyloid deposition
of the nasopharynx and significant interference in their quality of life, according to our
literature review.

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1606
Quantifying difficulty in endoscopic endonasal surgery – a modified Deplhi method
approach

Valentin Favier1, Marc Tewfik3, Lily Nguyen3, Cécile Rumeau4, Patrice Gallet4

1
Otolaryngology Head and Neck surgery Department, Gui de Chauliac Hospital, Montpellier University
Hospital, Montpellier, France, 2Otolaryngology, head & neck surgery department, University Hopital of
Montpellier, Montpellier, France, 3Head & Neck Surgery, McGill University Health Centre, Montréal, QC,
Canada, 4Otolaryngology Head and Neck surgery Department, Brabois Hospital, Nancy Regional
University Hospital, Vandoeuvre, France

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

IntroductionSurgical difficulty quantification is a crucial step in the development of curricula

for progressive training: this need remains unmet in the field of endoscopic endonasal surgery
(EES). The objective of this work was to classify the basic skills and procedures of
EES.MethodsA three-round modified Delphi study was conducted among 59 international
experts, selected on their publications in the field of EES and medical education, or EES
surgical simulators. In round#1, basic skills competencies and EES procedures were identified
and the basic skills required for these procedures were listed. In round#2, the expert panel
ranked the difficulty of basic skills, and in round#3, the difficulty of the EES procedures. The
basic skills were grouped into 3 categories of increasing difficulty, and the subsequently
calculated difficulty of each EDC procedure was compared with the experts' score.Results23
basic skills and 26 EES procedures were identified. 15 experts from 5 countries participated in
rounds 2 and 3. Basic skills were ranked in 3 groups of increasing difficulty, from easiest
(navigation with a 0° telescope) to most difficult (suturing in the nasal cavity), with>%
agreement. The easier procedure was polypectomy; the most difficult was Vidian
neurectomy. The correlation between the expert score and the "basic skills" score reached an
R² of 0.75, reflecting the cumulative effect of required skills on procedure
difficulty.ConclusionThis study provides a basis for quantifying surgical difficulty in EES and
developing a progressive educational curriculum

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1374
Interleukin-4 receptor alpha (IL-4Rα) blockade protects from IL-4 driven loss of smell
in mice

Adam Chaker1, Yannis Hara2, Mithilesh Kumar Jha2, Hamid Mattoo3, Scott Nash4, Asif Khan5,
Jamie Orengo6, Alexandra Hicks2

1
Department of Otolaryngology and ZAUM, Technical University of Munich, 2Dupixent Research,
Immunology & Inflammation, Sanofi, 3Precision Medicine and Computational Biology, Sanofi, 4Medical
Affairs, Regeneron Pharmaceuticals Inc., 5Global Medical Affairs, Sanofi, 6Research, Allergy and
Immunity, Regeneron Pharmaceuticals Inc.

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

Introduction: Dupilumab, a human IL-4Rα monoclonal antibody that blocks IL-4 and IL-13
signaling, improves sense of smell in patients with chronic rhinosinusitis with nasal polyps
(CRSwNP) via mechanisms not well understood. We investigated the effects of IL-4 and IL-13
on the mouse olfactory system in vitro and in vivo.Methods: IL-4Rα expression was measured
using single-cell RNA sequencing data and immunofluorescence. Sense of smell was assessed
in wild-type and IL-4Rα-knockout mice by time to discover hidden food after 5 days’ intranasal
administration of IL-4/IL-13. IL-4Rα antibody was injected intraperitoneally.Results: IL-4Rα
was widely expressed in murine olfactory epithelium, including immature and mature
olfactory sensory neurons (OSN). IL-4 and IL-13 each significantly increased calcium uptake in
murine OSN in vitro. Intranasal administration of IL-4, but not IL-13, induced loss of smell in
wild-type mice. IL-4Rα inhibition/elimination protected from IL-4 driven loss of smell (mean
±SE time to discover food 149±27s with IL-4 vs 71±13s with IL-4 + IL-4Rα antibody [P<0.01] in
wild-type mice; and 59±25s with IL-4 in IL-4Rα-knockout mice [P<0.001]). Conclusions: IL-4,
via modulation of OSN activity, may play an important role in smell function. The therapeutic
effects of dupilumab on smell may be due to direct modulation of the actions of IL-4.

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1515
Preoperative medications for better outcome of awake rhinology procedures.

Sofia Anastasiadou, Hannah Finney, Mitalee Pareek1, Gloria Schiavo2, Mahesh Malhotra,
Paresh Pramod Naik

1
Kokilaben Dhirubhai Ambani Hospital.Mumbai, 2University of Padua

Miscellaneous 1| Room 12 Hall 40 - Level 6 | Monday 19/06/2023

Introduction: COVID19 resulted in suspension of routine Rhinology cases. This invariably

increased the waiting list. By the time the vaccination drive was thorough, and immunity was
developed there was an increase the surgical waiting list. Efforts have been made to decrease
the waiting list. One of the efforts have been introducing awake surgeries. Local anaesthesia
procedure, it is not dependent on anaesthetist availability. These procedures can be done
either in procedure room, theatres, or clinics. The goal is to decrease the need of mechanical
ventilation thus avoiding the use of theatre capacity. Aim:We hypothesise that giving certain
preoperative medications before the local anaesthesia procedure increases helps in better
surgical outcome. Method:40 patients underwent Awake rhinology surgeries, these patients
were given preoperative medications. Conclusion:Pre operative medications not just reduces
the intraoperative pain and bleeding but also reduces anxiety.

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CRS – medical management 1

1175
Sinonasal Stent Coated with Sustained-Release Varnish of Mometasone Furoate
Inhibited Pro-Inflammatory Cytokine Release from Macrophages: An in vitro Study

Alessandra Cataldo Russomando1, Alessandra Maria Cataldo Russomando1, Ron Eliashar2,

Menachem Gross1, Michael Friedman3, Doron Steinberg4, Vogt Sionov Ronit4

1
Department of Otolaryngology-Head and Neck Surgery, Hadassah Medical Center, Jerusalem 9112102,
Israel, 2Department of Otolaryngology-Head and Neck Surgery, Hadassah Medical Center, Jerusalem
9112102, Israel., 3Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem,
Jerusalem 9112102, Israel, 4The Institute of Biomedical and Oral Research (IBOR), The Faculty of Dental
Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

The aim of the study was to develop a sustained-release varnish (SRV) containing mometasone
furoate (MMF) for sinonasal stents (SNS), to reduce the mucosa inflammation in the sinonasal
cavity. SNS segments coated with SRV-MMF, or SRV-placebo were daily incubated in fresh
DMEM medium at 37ºC for 20 days. The immunosuppressive activity of the collected DMEM
supernatants were tested on the ability of mouse RAW 264.7 macrophages to secrete the
cytokines tumor necrosis factor α (TNFα), interleukin (IL)-10 and IL-6 in response to LPS. The
cytokine levels were determined by the respective Enzyme-Linked Immunosorbent Assays
(ELISA). We found that the daily amount of MMF released from the coated SNS was sufficient
to significantly inhibit LPS-induced IL-6 and IL-10 secretion from macrophages up to day 14
and 17, respectively. SRV-MMF had, however, only a mild inhibitory effect on LPS-induced
TNFα secretion compared to SRV-placebo-coated SNS. In conclusion, coating of SNS with SRV-
MMF maintains a sustained delivery of MMF for at least 2 weeks at a level sufficient for
inhibiting pro-inflammatory cytokine release. This technological platform is therefore
expected to provide anti-inflammatory benefits during the postoperative healing period and
may play a significant role in the future treatment of chronic rhinosinusitis.

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1235
CFTR modulators in the treatment of CF-related chronic rhinosinusitis

Saartje Uyttebroek1, Lieven Dupont3, Laura Van Gerven1

1
UZ Leuven, Department of Otorhinolaryngology, 3000 Leuven, Belgium, 2UZ Leuven, Department of
Otorhinolaryngology, 3000 Leuven, Belgium., 3UZ Leuven, Department of Pneumology, 3000 Leuven,
Belgium

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Introduction CFTR modulators are changing the disease burden in cystic fibrosis-related
chronic rhinosinusitis (CF-CRS). The aim of this study is to evaluate the impact of
tezacaftor/ivacaftor (T/I) and elexacaftor/tezacaftor/ivacaftor (ETI) on CF-CRS after 12 months
of treatment. Material & methodsA prospective study was performed, including adult CF
patients, carrying at least one F508del mutation and eligible for T/I or ETI treatment.
Subjective (SNOT-22, VAS) and objective (Lund-Kennedy, Modified Davos and Lund-Mackay)
outcome parameters were collected before and 12 months after start of modulator
treatment. ResultsTwenty-nine adult CF patients, of which twenty-three patients treated with
T/I and six with ETI, were included. No significant reduction in subjective or objective outcome
measures were observed after 12 months of treatment with T/I. Significantly lower Lund-
Mackay scores were noted after treatment with ETI with a median change of -9.80 points
(p=0.0018, 95% CI [-14.21; -5.76]. Conclusions In contrast to current literature, dual therapy
with CFTR potentiators tezacaftor/ivacaftor is less efficient in patients with at least one
F508del mutation. Highly effective triple therapy is promising in the treatment of CF-related
chronic rhinosinusitis as significantly lower CT scores were observed.

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1236
Evaluation of antibiofilm agents for the treatment of chronic rhinosinusitis in cystic
fibrosis

Saartje Uyttebroek1, Lieven Dupont3, Tom Coenye4, Laura Van Gerven4

1
UZ Leuven, Department of Otorhinolaryngology, 3000 Leuven, Belgium., 2UZ Leuven, Department of
Otorhinolaryngology, 3000 Leuven, Belgium, 3UZ Leuven, Department of Pneumology, 3000 Leuven,
Belgium, 4Ghent University, Laboratory of Pharmaceutical Microbiology, 9000 Gent, Belgium

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Introduction High-quality data on the treatment of cystic fibrosis-related chronic rhinosinusitis

(CF-CRS), targeting underlying bacterial colonization and biofilm formation, are lacking. The
ability of sodium bicarbonate (SNI) and xylitol (XNI) enriched rinsing salts, bacteriophages and
rhDNAse to degrade CF-CRS-related biofilms was investigated in vitro. Material &
methodsIsolates from the upper airways of CF patients were obtained and biofilms were
grown in pathology-specific SCFM2 medium. After treatment with SNI, XNI, rhDNAse, S.
aureus phage ISP (log7 PFU/mL) and P. aeruginosa phages PNM and 14_01 (log7 PFU/mL),
differences in colony forming units (CFU/mL) were evaluated. ResultsFourteen isolates, of
which 10 S. aureus and 4 P. aeruginosa strains, were obtained. A reduction in P. aeruginosa
counts was observed after treatment with SNI (p=0.001), XNI (p=0.0008), PNM (p=0.0479) and
14_01 (p=0.0111). Significantly lower S. aureus counts were obtained after treatment with SNI
(p=0.001), XNI (p=0.0056) and ISP when used in combination with levofloxacin (p=0.0194) and
in higher phage concentrations (log8 PFU/mL, p=0.0102). No differences between SNI and XNI
(p=0.10) were observed and combining bacteriophages with rhDNAse resulted in higher
counts (p=0.011). Conclusions Sodium bicarbonate enriched rinsing salts with/without xylitol
and bacteriophages reduce CF-CRS-related biofilms and are possible candidates for further
testing in clinical trials. Combination with rhDNAse might reduce the efficacy of
bacteriophages.

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1251
Efficacy of Xylitol Nasal Irrigation after Functional Endoscopic Sinus Surgery: A
Randomized Controlled Study

Rong-San Jiang1, Yi-Fang Chiang2, Kai-Li Liang1

1
Taichung Veterans General Hospital, 2National Yang Ming Chiao Tung University

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Objectives: Xylitol is a safe, natural, five-carbon sugar with characteristics of being a natural
antibacterial agent, promotion of innate bactericidal mechanisms, and having antiadhesive
effect. This study was to evaluate the effect of xylitol after functional endoscopic sinus surgery
(FESS).Methods: Patients with chronic rhinosinusitis who received FESS were recruited and
randomly assigned to 2 groups at one month post-surgery. Patients in the xylitol group
received 400ml of 5% xylitol nasal irrigation daily for 2 months, and those in the normal saline
(NS) group received 400ml of NS nasal irrigation daily for 2 months. Before FESS as well as
before and after nasal irrigation, sino-nasal symptoms were assessed by a 22-item Sino-Nasal
Outcome Test questionnaire and patients received endoscopic examination, acoustic
rhinometry, and smell tests. Bacterial culture was obtained from the middle meatus of all
patients.Results: Sixty-three patients completed the study. Among them, 31 received xylitol
irrigation, and 32 received NS irrigation. The olfactory threshold significantly decreased after
xylitol irrigation as compared with that before irrigation (p=0.031), but bacterial culture rates
were not different between 2 groups after irrigation. Conclusion: Our study showed that
xylitol nasal irrigation improved patients’ olfactory function more than NS irrigation in post-
FESS care.

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1263
Protocol summary: Treatment of rhinosinusitis with nasal polyposis with dupilumab
and mepolizumab: A randomized, multi-centre, head-to-head comparison in real-
world Danish patients

Christian Pedersen1, Christian Korsgaard Pedersen2, Christian von Buchwald3, Vibeke

Backer4, Kasper Aanaes4, Tonny Petersen5

1
Department of ORL, Head and Neck Surgery & Audiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark, 2Deparment of Otorhinolaryngology, Head and Neck Surgery
and Audiology Rigshospitalet Copenhagen, 3Department of Otorhinolaryngology, Head and Neck
Surgery and Audiology Rigshospitalet, University Hospital of Copenhagen, Denmark, 4Department of
Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-93053
Regensburg, Germany, 5Department of Clinical Pharmacology, Copenhagen University Hospital
Bispebjerg og Frederiksberg, Copenhagen, Denmark

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Chronic Rhino-Sinusitis with Nasal Polyps (CRSwNP) is a common disease affecting 2-4% of the
adult, Danish population. Up until recently, patients with severe CRSwNP disease has been
treated with repeated surgeries and/or courses of systemic steroids, but very recently, two
biologicals (mepolizumab and dupilumab) were approved for the treatment of severe nasal
polyposis in Denmark. It is a highly effective, and very safe treatment. However, the cost of
the drugs is high, so cost-effective use is imperative. Since biologicals have only been in use
for this indication for a few years, studies investigating the effect (and side-effects) in real-life
patient cohorts are relatively scarce, and none has so far directly compared mepolizumab and
dupilumab in a randomized, controlled trial. In this presentation, we will present the protocol
for our study which will be the world's first "head-to-head" RCT comparison of two of the most
commonly used biologicals; mepolizumab and dupilumab. We expect our study will assist
clinicians and policymakers in making cost-efficient decisions, which will ultimately benefit
our patients with CRSwNP.

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1269
Assessment of the Prevalence of the Use of Nasal Decongestants Among the General
Population in Saudi Arabia

Ahmad Alharthi, Saud Alharthi2, Abdulaziz Altowairqi3, Shrooq Alswat4, Marwan Alnofaie2

1
Otolaryngology - Head and Neck Surgery, Alhada Hospital for Armed Forces, Taif, SAU,
2
Otorhinolaryngology, King Faisal Medical Complex, Taif, SAU, 3Otarhinolaryngology - Head and Neck
Surgery, King Abdulaziz Specialist Hospital, Taif, SAU, 4General Medicine, King Faisal Medical Complex,
Taif, SAU

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

BackgroundA topical nasal decongestant (NDC) is widely prescribed in ENT practice and used
as self-medication because it is available over the counter, which makes it an easily accessible
medication. Due to its common and long-term use, it is associated with serious nasal
complications. It is commonly self-administrated in many otolaryngology diseases like the
common cold, sinusitis, and acute or chronic rhinitis. The long-term usage of nasal
decongestants is associated with significantly increased side effects.AimTo assess the
prevalence of the usage of nasal decongestants among the general population in Saudi Arabia
ad the pattern of its use.MethodologyA questionnaire-based, cross-sectional survey was
applied to level all available populations in Saudi Arabia. Participants with ages aged 10 to 60
years old in Saudi Arabia were invited to participate in the survey. Data were collected from
participants using a predesigned online questionnaire. The questionnaire included the
participant's demographic data, NDC use, and pattern of use. The questionnaire was uploaded
online by researchers and their friends using social media platforms.ResultsA total of 1456
participants completed the study questionnaire. Participants ages ranged from 10 to 60 years
with a mean age of 26.9 ± 12.4 years old. Exact 585 (40.2%) participants were males and 1270
(87.2%) were from urban regions. A total of 657 (45.1%) respondents reported using nasal
decongestants while 799 (54.9%) did not use NDC. As for the duration of use, 70.8% used NDC
for less than five days and 13.5% used it for 5-15 days. Th

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1287
Effectiveness of Dupilumab in Severe Uncontrolled CRSwNP: A “Real-Life” Single
Centre Observational Study

Giulia C. D'aleo Canova, Luca Spirito1, Valentina Sangalli1, Maurizio Bignami2, Paolo
Castelnuovo1 Stefania Gallo1

1
Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi,
Varese, Italy, 2Department of Otorhinolaryngology, Ospedale Sant’Anna, ASST Lariana, Como, Italy

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Background: Dupilumab, whose efficacy and safety have been investigated in two multicenter
phase 3 trials (LIBERTY NP SINUS-24/52), is indicated in patients with type-2 severe
uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP).Objective: to evaluate the
efficacy of dupilumab in a real-life setting, over a 12 month period. Primary endpoints were
reduction in Nasal Polyp Score (NPS) and improvement in nasal obstruction, quality of life
(SNOT-22), and olfactory function (SSIT-16). Secondary endpoints were disease control in
terms of need for surgery and/or oral corticosteroids (OCS).Methods: a retrospective
observational study including 27 patients with severe uncontrolled CRSwNP receiving
dupilumab 300mg every two weeks with a regular follow up. At each visit, patients underwent
nasal endoscopy, symptoms questionnaires and were evaluated on olfactory function and
blood eosinophilia.Results: The population had signs of type 2 inflammation and a history of
at least one previous surgery with polyps recurrence. During follow-up, we observed a
statistically significative improvement in all primary endpoints, with the greatest response
after 3 months of treatment in all objective scores and after 6 months in all symptoms scores.
All secondary endpoints improved: increased ACT score among asthmatic patients, reduced
need of OCS and surgery during the first year.Conclusions: Dupilumab was effective in
reducing NPS, disease-related symptoms and overall quality of life, achieving most of the
results in the first 3-6 months, while also reducing the need for OCS and surgery.

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1324
Effect of oral steroids on olfactory function in Chronic Rhinosinusitis with Nasal Polyps

Alexandros Ladias1, Efklidis Proimos1, Kalliopi Korakovouni1, Vaia Ntrigiou1, Panagiota

Asimakopoulou1, Chariton Papadakis1

1
ENT Department, Chania General Hospital, Chania, Greece

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Aim: The aim of this study is to investigate the effect of oral steroids on olfactory dysfunction
in patients with CRSwNP.Material and methods: 140 selected CRSwNP patients, with
hyposmia, were divided into two groups. Group A received a 7-day course of oral steroids with
a 12-weeks course of nasal steroids and douching. Group B received a 12-weeks course of
nasal steroids and douching. Assessment included Sniffin' Sticks scores, Visual Analogue Scale
score for olfaction (VASsmell), Sinonasal Outcome Test-22, Greek-version (SNOT22-Gr) and
Endoscopic Appearance Score (EAS).Objectives: The objective was to compare the olfactory
effect of different therapy between groups at 2, 12 and 24 weeks. Accessory objectives
included comparison of EAS and SNOT22-Gr between groups and evaluation of therapeutic
outcome duration.Results: The 2-weeks evaluation showed a significant statistical difference
(P<0.001) for all parameters. Olfactory outcomes (Sniffin' Sticks and VASsmell scale scores)
were found significantly better in-group A at the 24-weeks evaluation (P<0.001). Within
groups, the therapeutic result remained stable between the 12 and 24-weeks evaluation
(P>0.05). Conclusion: Our results suggest that a combination treatment of oral and nasal
steroids in well-selected patients with CRSwNP may result in early olfaction restoration with
a possible long-term effect.

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1325
Sino-Nasal microbiome transplantation as treatment for CRSsNP

Anders Mårtensson1, Anders Cervin2, Lennart Greiff1, Flavia Huygens3, Malin Lindstedt4,
Charlotte Cervin-Hoberg1, Christina Sakellariou4

1
Department of Clinicla Sciences, Lund University, Lund, Sweden, 2Department of Otorhinolaryngology
(ORL) Head & Neck Surgery, Royal Brisbane & Women's Hospital, Brisbane, Australia, 3Center for
Immunology & Infection Control, Queensland University of Technology, Brisbane, Australia,
4
Department of Immuntechnology, Lund University, Lund, Sweden

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

Twenty-two patients diagnosed with CRSsNP who had failed previous medical and surgical
treatment were recruited. The patients were treated with 13 days of antibiotics followed by
5 consecutive days of Sino-Nasal lavage transfer from healthy donors. Primary outcome
measure was the 22-item Sino-Nasal Outcome Test (SNOT-22). Other Outcome measures
included total nasal symptopm score (TNSS), 16S ribosomal RNA (rRNA) next generation
sequencing (microbiome analysis), endoscopic grading and nasal lavage fluid analysis of
inflammatory cytokines.At the end of the study , 3 months after the transplant procedure,
patients reported significantly reduced SNOT-22 scores and microbiome analysis showed
significantly increased anundance and diversity compared to at inclusion. For TNSS and
endoscopic grading no significant cahnge was observed.

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1731
Multidisciplinary management of patients with chronic rhinosinusitis with nasal
polyps (CRSwNP) from the severe asthma service to the ENT office.

Xavier Gonzalez-Compta1, Paula Cruz Toro2, Ignacio Clemente3, Alex Portillo1, Laura Pardo2,
Mireia Golet Fors1

1
Depart ENT, Universitary Hospital of Bellvitge, Barcelona. Spain, 2Depart ENT, Universitary Hospital of
Germans Trias, Badalona. Spain, 3Depart ENT, Universitary Hospital of Terrassa, Terrassa. Spain

CRS – medical management 1| Room 7 Hall 10 - Level 8| Monday 19/06/2023

The management of CRSwNP has evolved in recent years with the advent of biological
treatments. On the other hand, the creation of united airway and severe asthma units have
provided an improvement in the multidisciplinary management of patients with CRSwNP. As
a result, specialized medical consultations have been created in order to evaluate and to
follow-up patients with CRSwNP and biological treatment. The information comes from 3
hospital centers that have implemented this clinical agenda, pointing out the difficulties
encountered and the strategies used.We aim to describe our experience in the management
of CRSwNP patients from de severe asthma unit to the ENT practice.

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Allergic Rhinitis 1

1149
Exacerbation of Allergic Inflammation by Inhalation of E-Cigarette Vapor via Cytokine
Induction and MUC5AC/5B Expression in an OVA-Induced Murine Asthma Model

SANG JAE Lee1, Yong-Dae Kim1, Hyung Gyun Na1, Young-Ha Lee2

1
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam
University, Daegu, 2Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Electronic cigarettes(e-cigarettes) have quickly surpassed traditional cigarettes. Although a

few studies have shown that e-cigarette smoking is harmful in asthmatic patients, the effects
of e-cigarettes vapor on inflammation and mucin secretion remain unclear. Therefore, this
study investigated the effects of e-cigarette vapor on allergic inflammation, cytokine
production, and MUC5AC/5B expression in murine asthma models. Wild-type BALB/c mice
were randomized into the following four groups: control, e-cigarette exposure,
ovalbumin(OVA) sensitization, and e-cigarette-exposed OVA sensitization groups. The
infiltration of inflammatory cells was counted based on their microscopic morphology in BAL
fluid. Gene expression of mucin was assessed by real-time PCR. Production of inflammatory
cytokines in BAL fluid and protein production of mucin in bronchial tissues were investigated
by ELISA. Airway hyperresponsiveness was significantly higher in the e-cigarette-exposed OVA
sensitization group than in the other groups. The e-cigarette-exposed OVA sensitization group
showed significantly greater infiltration of inflammatory cells and the cytokines compared to
the other groups. MUC5AC mucin levels were significantly elevated except control group,
whereas MUC5B mucin levels were significantly elevated in the OVA sensitization and e-
cigarette-exposed OVA sensitization groups. The results may suggest that the exposure to e-
cigarette vapor in an OVA-induced murine asthma model promoted allergic inflammation and
increased mucin secretion, ultimately leading to the exacerbation of asthma.

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1182
Impact of Allergic Rhinitis and Asthma on COVID-19 Infection, Hospitalization, and
Mortality

Lan Feng1, Wendu Pang1, Jianjun Ren1, Yu Zhao1

1
Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Background: It remains unclear if patients with allergic rhinitis (AR) and/or asthma are
susceptible to corona virus disease 2019 (COVID-19) infection, severity, and
mortality.Objective: To investigate the role of AR and/or asthma in COVID-19 infection,
severity, and mortality, and assess whether long-term AR and/or asthma medications affected
the outcomes of COVID-19.Methods: Demographic and clinical data of 70,557 adult
participants completed SARS-CoV-2 testing between March 16 and December 31, 2020, in the
UK Biobank were analyzed. The rates of COVID-19 infection, hospitalization, and mortality in
relation to pre-existing AR and/or asthma were assessed based on adjusted generalized linear
models. We further analyzed the impact of long-term AR and/or asthma medications on the
risk of COVID-19 hospitalization and mortality.Results: Patients with AR of all ages had lower
positive rates of SARS-CoV-2 tests (relative risk [RR]: 0.75, 95% confidence interval [CI]: 0.69-
0.81, P < .001), with lower susceptibility in males (RR: 0.74, 95% CI: 0.65-0.85, P < .001) than
females (RR: 0.8, 95% CI: 0.72-0.9, P < .001). However, similar effects of asthma against COVID-
19 hospitalization were only major in participants aged <5 (RR: 0.93, 95% CI: 0.86-1, P = .044)
instead of elderlies. In contrast, patients with asthma tested positively had higher risk of
hospitalization (RR: 1.42, 95% CI: 1.32-1.54, P < .001). Neither AR nor asthma had an impact
on COVID-19 mortality. None of conventional medications for AR or asthma, for example,
antihistamines, corticosteroids, or β2 adrenoceptor agonists, showed association with COVID-
19 infection or severity.Conclusion: AR (all ages) and asthma (aged <5) act as protective
factors against COVID-19 infection, whereas asthma increases risk for COVID-19
hospitalization. None of the long-term medications had a significant association with
infection, severity, and mortality of COVID-19 among patients with AR and/or asthma.

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1244
Underwater posterior nasal neurectomy compared to resection of peripheral
branches of posterior nerve in severe allergic rhinitis

Seiichiro Makihara1, Mitsuhiro Okano3, Kensuke Uraguchi4, Aiko Shimizu4, Aya Murai4,
Takaya Higaki4, Aiko Oka3, Kengo Kanai3, Shin Kariya5, Mizuo Ando6

1
Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical S, 2Department of Otolaryngology-Head & Neck Surgery,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama,
Japan, Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan,
3
Department of Otorhinolaryngology, International University of Health and Welfare, School of
Medicine, Narita, Japan, 4 Department of Otolaryngology-Head & Neck Surgery, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan, 5Department of
Otolaryngology, Kawasaki Medical School, Okayama, Japan, 6Department of Otolaryngology-Head &
Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Background: Several surgical procedures for posterior nasal neurectomy have been reported,
but no conclusion has been reached about which procedure is best.Objectives: The aim is to
evaluate the improvement in symptom medication scores for resection of the posterior nasal
nerve trunk in an underwater environment, with submucous inferior turbinectomy, without
injuring the sphenopalatine artery (SPA) in severe allergic rhinitis.Material and Methods:
Improvements in symptom medication scores were retrospectively compared between 27
consecutive cases who underwent resection of the posterior nasal nerve trunk with
turbinoplasty in an underwater environment without injuring the SPA (Underwater group)
and, as a historical control, 16 consecutive cases who underwent resection of peripheral
branches of the posterior nasal nerve with turbinoplasty (Control group).Results: The
improvements in symptom medication scores in the Underwater group were significantly
better than in the Control group (3.07 vs. 1.96, p =0.02). Conclusions: By using underwater
posterior nasal neurectomy, we can easily and safely resect the posterior nasal nerve trunk
under a clear surgical view without injuring the SPA. This technique with submucous inferior
turbinectomy may, more than resection of peripheral branches of the posterior nasal nerve,
be able to reduce the medication score and symptom medication score.

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1275
Local allergic rhinitis induced by unilateral intranasal instillation of ragweed pollen
extract and intraperitoneal injection of FTY720 in mice

Hideaki Kouzaki1, Kwakita Kento1, Shimizu Takeshi1

1
Department of otorhinolaryngology and head and neck surgery, Shiga university of medical science

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic
responses characterized by local production of antigen-specific IgE in nasal mucosa. In the
present study, we induced local allergic responses in nasal mucosa of Balb/c mice by unilateral
intranasal instillations of ragweed pollen extract and by intraperitoneal injections of FTY720,
which suppresses lymph node function. Intranasal and intraperitoneal injections were given
for 14 days in every 2 weeks, and nose-associated lymphoid tissue (NALT), cervical lymph
nodes (cLN), and serum were collected at day 14, 42, and 72.The results showed that sneezing
frequency increased from day 14 and increased further with non-nasal antigen stimulation on
day 70, but did not change with FTY720 administration. Ragweed-specific IgE antibodies in the
serum increased on day 70 and were suppressed by FTY720, while the production of IL-5 and
IL-13 in response to ragweed antigen stimulation was also suppressed by FTY720. On day 70,
Tfh cells and Th2 cells increased in NALT and cLN, but administration of FTY720 did not change
their levels in cLN. These results indicate that the sensitization with ragweed pollen induced
local allergic responses and a sneezing symptom in LAR mouse model.

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1277
Mode of delivery and risk of allergic rhinitis: A systematic review and meta-analysis

PHUOC MINH HOANG1, JOMPOL SAMUTHPONGTORN2, KORNKIAT SNIDVONGS2

1
Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Vietnam,
2
Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

BackgroundDifferent modes of delivery can influence infant microbial diversity, cause

immune dysregulation, and potentially increase the risk of allergic rhinitis (AR). MethodsWe
systematically sought five electronic databases from interception until 03 November 2022.
Human observational studies were included. The primary comparison was vaginal (VD) versus
cesarean delivery (CD). Secondary comparisons were specified CD (elective, emergency)
versus VD, CD versus specified VD (spontaneous, abnormal), and non-microbiota-exposed
versus microbiota-exposed delivery. The outcome was risks of AR later in life presented as odd
ratios (OR) and 95% confidence interval. Subgroup analyses were performed to explore the
potential confounders, including region, study design, affluence of country, age of outcome,
definition of AR, exclusion of prematurity, available OR, and cesarean rate. ResultsThirty-four
studies were included. Compared to VD, CS and its specified subgroups were associated with
a higher risk of developing AR. Compared to CD, spontaneous VD lowered the likelihood of AR
but not abnormal VD. There was no significant difference in the likelihood of AR between the
non-microbiota-exposed and microbiota-exposed delivery populations. Potential
confounders were region and exclusion of prematurity. Conclusion Most estimated ORs were
consistent with a positive association between CD and AR. Early-life environmental exposures
that affect microbial colonization may influence allergic risks.

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1302
The Unified Airway: The Link between Allergic Rhinitis and Asthma

ABDULRHMAN ALFAYEZ1

1
KAMC

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

The Unified Airway:The Link between Allergic Rhinitis and AsthmaDr.Abdulrhman

AlfayezObjectives: -• Recognize the similar pathophysiologic features of allergy and
asthma• Understand the epidemiologic relationship of asthma and rhinitis• Describe
the concept of the “Unified Airway” “One Airway, One Disease”Asthma and allergic rhinitis
increasingly viewed as a continuum of disease involving one common airway - Allergic
rhinitis in patients with less severe disease - Asthma in patients with more severe
disease• Concept of “one airway, one disease” gaining greater acceptanceAsthma and
Rhinitis: -• Epidemiological, pathophysiological, and clinical studies, suggest a relationship
between rhinitis and asthma• Upper and lower airways may be influenced by a common
inflammatory process that is sustained and amplified by interconnected
mechanisms• “When considering a diagnosis of rhinitis or asthma, and evaluation of
both the lower and upper airways should be made” Conclusion: -• Asthma and rhinitis
often co-exist• AR associated with, and risk factor for asthma• Rhinitis and asthma
have same triggers• Rhinitis often precedes development of asthma• Patients with
AR should be evaluated for asthma and vice versa• Prevention or early treatment of AR -
May prevent occurrence of asthma - May limit severity of bronchial
symptoms Dr.Abdulrhman AlfayezENT Consultant King Abdulaziz Medical City, Riyadh, Saudi
Arabiaaialfayez@yahoo.com+966-505473183

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1375
Nutritional Role in Allergic Rhinitis.

NADA ALSHAIKH1

1
DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, MOUWASAT HOSPITAL, DAMMAM,
SAUDI ARABIA

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Objectives:This research is aimed to study the relationship between allergic rhinitis and
nutritional deficiencies in Saudi Arabia. Method:A prospective clinical observational cross-
sectional study was conducted at the Otolaryngology department of a secondary hospital in
Saudi Arabia. The study was approved by the ethics and research committee. Statistical
analysis was performed using the SPSS software. A p-value of <0.05 was considered
significant. Results:Total of 40 patients, age range between 18-65 years with a mean of 39.5
years. Bronchial asthma was found in 13 (32.5%) patients, eczema in 7 (17.5%), chronic
rhinosinusitis with nasal polyps in 15 (37.5%) patients, and allergic fungal rhinosinusitis in 3
(7.5%) patients. Out of 40 patients with allergic rhinitis, 13 (32.5%) were experiencing mild
symptoms and 27 (67.5%) were having moderate to severe symptoms.Laboratory
investigations showed that 37% of patients had elevated total IgE level, 2.5% had folate
deficiency, 12.5% had low vitamin B12, 25% of patients with low ferritin level, and 92.5% had
low vitamin D (<0ng/ml) which was significantly associated with more persistent symptoms
and sever form AR (p-value = 0.046).Conclusion:Despite the presence of many studies,
conflicting data still exists and the extent of impact on immune system is not fully elucidated.
Studies with larger sample sizes are mandatory in order to help in the understanding of
pathogenesis and subsequent management of such disease.

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1394
The Effects of Fexofenadine/Pseudoephedrine combination tablet on Nasal
Obstruction in Patients with Allergic Rhinitis using Rhinomanometry

Yosuke Nakamura1, Yuko Yokoyama1, Satoshi Koyama1, Hiromi Takeuchi2, Motoki Nakamori2,
Kazunori Fujiwara1

1
Division of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 2Division of
Otolaryngology, Tottori Red Cross Hospital

Allergic Rhinitis 1| Room 8 Hall 4 - Level 0| Monday 19/06/2023

Background: A Fexofenadine/Pseudoephedrine combination tablet (F/P) is a novel product

containing fexofenadine hydrochloride, a histamine H1-receptor antagonist for sneezing and
rhinorrhea and pseudoephedrine hydrochloride, an α adrenergic agonist for nasal
obstruction. The effect to the nasal obstruction of the F/P is confirmed empirically. In the
present study, we estimated the efficacy of the F/P on nasal obstruction for patients with
allergic rhinitis to compare with the Fexofenadine (F) objectively.Method: Twenty four
subjects (13 males and 11 females, aged 18-56 years) with perennial allergic rhinitis were
recruited for the study. A randomised study was performed testing F/P versus F. Nasal airflow
was recorded at 30 minute intervals for 8 hours after dosing as a single drug therapy.Result:
Subjects’ mean age was 31.1 years, no difference between the two groups. The onset of action
of F/P was 1.0 hour, significant improvement in nasal airflow from baseline was detected with
the mean change of 51.8 cm3/s (90% CI, 15.5-88.1; p=0.031). F/P showed significant
differences in the following changes, while F did not show throughout the study. Conclusion:
In this study, we found out that F/P is effective about an immediate effect and the
continuation to nasal obstruction of perennial allergic rhinitis.

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Rhinology – Miscellaneous 1

1608
A prospective multicentre study investigating the influence of simulation on
competence in performing flexible nasendoscopy (FNE), nasal cautery (NC) and nasal
packing (NP).

Tharsika Myuran1, Myuran Tharsika2, DeCates Catherine1, Dewhurst Sam1, Dunne Henry1,
Joshua Michaels, Bhavesh Tailor1

1
East of England ENT, 2Addenbrooke's Hospital Cambridge, Association of Otolaryngologists in Training

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background: Performing FNE, NC and NP is not well assessed in medical school. This study
uses qualitative and quantitative methodology in assessing how simulation and the workplace
may influence competence in performing FNE, NC and NP amongst junior doctors new to ENT,
and the change 1 month into clinical work. Methods:Junior doctors newly rotating to ENT from
6 hospitals in the East of England were given simulation based training on FNE, NC and
NP. Intercollegiate Surgical Curriculum Programme (ISCP) skill levels and reflections on
learning were self-assessed and trainer assessed pre- post- and 1+month after
simulation. Reflective data was analysed using NVIVO software. Results:ISCP levels
significantly increased overall (p<0.05) for all participants (n=14). Between simulation and
1+month there was further significant improvement for NC and FNE, but not NP. Themes
beyond the simulation include early references to videos and resources for learning, more
observation, supervised practice, fear of causing harm, and identifying normal v.
pathology. Conclusion:Simulation rapidly improves competence in FNE, NC and NP amongst
those with no prior ENT experience. Factors such as repeated exposure in simulation,
minimising fear of causing harm and use of picture quizzes could be considered in
augmenting future training.

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1140
Chronic rhinosinusitis with nasal polyps and its management

Syed Ahamed Peer Mohamed1

1
Fellow of the middle east academy of otolaryngology, head and neck surgery, Fellow of Royal College
of Surgeons in Ireland

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammation-

mediated disease of the nasal mucosa and paranasal sinuses with an under- recognized
clinical, humanistic, and economic burden. According to the latest EPOS guidelines, CRSwNP
should be regarded as primary or secondary with distinction between diffuse and localized
disease. Endo typing of inflammatory process is the primary aim to define prominent
inflammatory process differentiation between type 2 versus non type 2, Especially endo type
T cells which contribute innate and adoptive immune system response in type 2 inflammation.
The ENT surgeons can investigate nasal secretions for eosinophilia as a guide to likely T2
inflammation and its corticosteroid responsiveness. a high symptom burden, including nasal
congestion, loss of smell, and rhinorrhea, which has a negative impact on physical and mental
health-related quality of life, including sleep quality. Treatment is directed at enhancing
mucociliary clearance, improving sinus drainage/outflow, eradicating local infection and
inflammation, and improving access for topical medications. Because type 2 inflammation is
implicated in the pathogenesis of several coexisting diseases, patients with CRSwNP often
have comorbid asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory
disease. These patients, as well as those with high corticosteroid use and/or Sino nasal surgical
history, have more severe disease and associated symptom burden and represent a difficult-
to-treat population under the existing management paradigm. This article reviews the clinical,
humanistic, and economic burden of CRSwNP; it highlights the unmet need for effective and
safe CRSwNP therapies that effectively control symptoms and minimize recurrence by
targeting the underlying type 2 inflammatory disease pathophysiology.

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1161
Osteomalacia due to rare nasal tumor: case report and literature review

Donata Šukytė-Raubė1, Donata Šukytė Raubė1, Jurgita Jurušaitė1, Eugenijus Lesinskas1,

Justinas Ivaška1

1
Center of Ears, Nose and Throat, Vilnius university hospital Santaros klinikos

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm of soft and bone tissue producing
fibroblast growth factor 23 (FGF23), which leads to oncogenic osteomalacia. The most
common localization is the extremities and only 5% occurs in the head and neck
region. Accurate diagnosis is often delayed due to non-specific pathological changes and
symptoms. Laboratory abnormalities such as hypophosphatemia and hyperphosphaturia,
high alkaline phosphatase level together with osteomalacia-related symptoms could raise
suspicion of PMT. We present a case of a 44-year-old male who presented with progressive
symptoms of osteomalacia for almost 2 years and was found to have a nasal cavity mass. The
patient's symptoms and laboratory changes resolved upon total resection of the tumor.

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1185
Extreme weather conditions influence the frequency of rhinology-related emergency
room visits

David T. Liu1, Mateo Lucic1, Markus Haas1, Franziska Pichler1, Faris F. Brkic1, Dominik Riss1,
Christian A. Mueller1

1
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna,
Austria

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background: Global climate change increases the frequency of extreme weather events, which
directly and indirectly affects human health. This study aims to analyze the impact of extreme
weather events on rhinology emergencies. Methodology: 3091 rhinology-related
emergencies at the Vienna General Hospital between 2015 and 2018 were analyzed. A non-
linear distributed lag model was calculated to investigate the cumulative relative risk (cRR) for
rhinology emergencies after extreme weather events. The cRR is defined as the risk of a
rhinology-EV in extreme weather conditions (<5th or>th percentile) compared to the risk in
median weather conditions (50th percentile) within a given period. Results: At a mean daily
temperature of 27°C, the cRR for epistaxis-related EV doubled on day 1. At a relative humidity
of 39%, epistaxis-cRR was highest on day 3, with an increase of 59%, while extremely high
humidity (92%) led to a 30% decrease on day 1. Intense precipitation of 24mm reduced
epistaxis-cRR on day 3 by 62%. Similarly, extremely high wind speed (5.9m/s) doubled the cRR
for acute sinusitis on day 4, while extremely low atmospheric pressure (983hPa5) increased
the cRR by 14% on day 8. Conclusions: Extreme weather conditions significantly impact the
cRR for rhinology-related EVs.

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1217
Health Utility Score of Thai Patients with Chronic Rhinosinusitis: Pre and Postoperative
Analyses

Wirach Chitsuthipakorn1, Melissa Sangubol2, Saranath Lawpoolsri4, Kornkiat Snidvongs5,

Kittichai Mongkolkul1, Patlada Kowatanamongkon1

1
Center of Excellence in Otolaryngology, Head & Neck Surgery. Rajavithi Hospital, Bangkok, Thailand,
College of Medicine, Rangsit University, Bangkok, Thailand, 2Rajavithi hospital, 3Center of Excellence in
Otolaryngology, Head & Neck Surgery. Rajavithi Hospital, Bangkok, Thailand, 4Department of Tropical
Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 5Department of
Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, Endoscopic Nasal
and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background: The health utility score (HUS) is a key component of cost-effectiveness analysis.
There is no prior measurement of the HUS in patients with chronic rhinosinusitis (CRS) in
Thailand or other Asian countries. The objective was to evaluate the HUS of patients with CRS
before and after endoscopic sinus surgery (ESS).Methods: Thai patients (age ≥ 18) with CRS
who about to undergo ESS were enrolled. Patients with underlying diseases other than allergic
rhinitis and asthma were excluded. The preoperative demographics, quality of life (QoL),
endoscopic, and CT scores were recorded. This cohort of patients was interviewed with the
EuroQoL-5-Dimensions-5 levels (EQ-5D-5L), EuroQoL visual analog scale (EQ-VAS), Standard
gamble (SG), and Time trade-off (TTO) method at the preoperative and postoperative time-
points (3, 6 months).Results: A total of 60 patients were in the final analysis. The mean
preoperative HUS was 0.75, 0.65, 0.79, 0.85 by EQ-5D-5L, EQ-VAS, SG, and TTO, respectively.
At 3- and 6-months post-ESS, the score was significantly improved to 0.96, 0.91, 0.96, 0.97,
and 0.97, 0.92, 0.97, 0.98 by EQ-5D-5L, EQ-VAS, SG, and TTO, respectively. The ESS raised the
HUS by 0.12-0.27. Among 4 measurements of HUS, the EQ-VAS yielded significantly lower
scores than other methods at all time points.Conclusion: The preoperative HUS of Thai
patients with CRS ranged from about 0.65-0.85 and improved significantly to 0.92-0.98 at both
3- and 6-months post-ESS. The EQ-VAS yielded a significantly lower value than other methods
at all time points.

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1292
Trends in Level of Evidence in Rhinology Research

Alexander Brannan1, Justin Pyne1, Connor Sommerfeld1, Jin Soo Song1, Jordan Garside1, Cote
David1

1
University of Alberta

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background: Evidence-based medicine is an integral part of clinical research and practice.

Thepurpose of this study was to assess the trends in the level of evidence in leading
Rhinologyjournals in recent years.Methods: All scientific articles within the field of Rhinology
published in The Laryngoscope,Rhinology, American Journal of Rhinology and Allergy,
Otolaryngology–Head and Neck Surgery,and Journal of Otolaryngology – Head and Neck
Surgery from 2010, 2014, and 2018 were ratedfor level of evidence. The number of authors,
patient age, study type, sample size, and presenceof p-values were also noted.Results: Of 998
articles reviewed, 71.1% were clinical with 58.3% being treatment studies.Overall, there was
an increase in the average level of evidence of articles published from 2010to 2018. However,
the number of articles containing level 1 or 2 evidence remains low.Conclusions: With the
increased demand for evidence-based medicine, rhinology literature hasseen an overall
increase in the quantity of higher-level evidence research published. However,articles
representing level 1 and 2 evidence remain rare. The authors hope that this informationmay
help encourage further high-quality research in rhinology.

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1358
Polymyxin B and ethylenediaminetetraacetic acid act synergistically against
Pseudomonas aeruginosa and Staphylococcus aureus

Sam Hale1, Alan Cameron1, Christian Lux1, Kristi Biswas1, Raymond Kim1, Paul Harris1, Richard
Douglas1, Brett Wagner Mackenzie1

1
University of Auckland, Auckland, New Zealand

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background:In cystic fibrosis (CF), upper and lower airway colonisation with Staphylococcus
aureus and Pseudomonas aeruginosa biofilms is common but difficult to treat. Polymyxin B
and ethylenediaminetetraacetic acid (EDTA) have related mechanisms of action and may
exhibit synergy. This in vitro study investigated this potential synergy and their antibiofilm
efficacy in combination.Methods:Synergy was assessed against planktonic S. aureus and P.
aeruginosa type strains using checkerboard assays. Minimum biofilm eradication
concentration (MBEC) assays were performed for each agent alone and in combination. The
median combination MBEC of the type strain was tested against biofilms of ten P. aeruginosa
clinical isolates from patients with CF.Results:Synergy was confirmed against planktonic S.
aureus (FICI 0.44, FBCI 0.56) and P. aeruginosa (FICI 0.39, FBCI 0.39), and biofilms of P.
aeruginosa (FBCIb 0.38). P. aeruginosa biofilm was eradicated at 8 µg/mL polymyxin B and
16.9 mg/mL EDTA. Nine clinical P. aeruginosa isolates were comparable or more susceptible
than the type strain. S. aureus biofilms were not eradicated at clinically achievable
concentrations. Conclusion:Polymyxin B and EDTA act synergistically against both species in
planktonic form. Synergy against P. aeruginosa biofilms may be useful for enhancing
treatments for CF.

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1365
Assessment of autonomic dysfunction in the patients with nasal septal deviation (NSD)
using Composite Autonomic Symptom Scale-31 (COMPASS-31)

Sung Seok Ryu1, Doyeon Kim2, Yong Ju JANG

1
Department of Otolaryngology-Head and Neck surgery, Asan Medical Center, University of Ulsan
College of Medicine, 2Department of Otolaryngology-Head and Neck surgery, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

COMPASS-31 is a well-validated instrument by which one can evaluate autonomic

dysfunction. NSD is a remarkably prevalent condition where the severity and the deviation do
not correlate with subjective breathing difficulty. Here we hypothesized that symptomatic
NSD might have underlying autonomic dysfunction. COMPASS-31 questionnaires were
collected from 41 asymptomatic NSD (aNSD) and 279 symptomatic NSD (sNSD) patients at
Asan Medical Center from May 2022 to January 2023. Patients with empty nose syndrome,
allergic rhinitis, chronic rhinosinusitis, or history of nasal surgery were excluded. Finally, 23
aNSD and 86 sNSD patients were enrolled. NSD was diagnosed at outpatient clinic, and
patients with nasal obstruction were defined as sNSD patients. COMPASS-31 scores were
compared between aNSD and sNSD patients. The average scores of secremotor and bladder
domains of aNSD were 1.04, and 0.43, respectively. In contrast, the average scores of
secremotor and bladder domains of sNSD patients were 1.76, and 1.20, respectively; those
values all were significantly higher (p<0.05) in the sNSD group, which implies that sNSD group
patients have altered autonomic function. The mean total COMPASS-31 scores were 12.74
and 18.74 for aNSD and sNSD patients respectively, and the difference was significant
(p<0.05). Among various symptoms suggestive of autonomic dysfunction, the frequency
of urinary retention was significantly higher in sNSD group (p<0.05). In conclusion, Autonomic
dysfunction may underlie the subjective perception of breathing difficulty in sNSD patients.

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1382
The role of adenoidectomy in the surgical treatment of nasal obstruction in adults

Ivan Delchev, Sibel Redzheb2

1
UMHAT Pulmed Plovdiv, Medical University of Plovdiv, 2UMHAT Pulmed Plovdiv

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Background: Nasal obstruction is a common complaint in patients, treated in an ENT practice.

Some of the most common surgical procedures to treat nasal obstruction include septoplasty
and/or turbinate reduction. In recent years a higher incidence of abnormal adenoid
hypertrophy in adults is observed, sometimes as the only significant finding during ENT
examination. Methodology: 30 adult patients with complaints of nasal obstruction and
confirmed adenoid hypertrophy underwent cold steel adenoidectomy under endoscopic
control at ENT Department UMHAT Pulmed. Septoplasty and/or turbinate reduction were also
performed in cases where this was considered necessary. Preoperative examination included
thorough medical history and ENT examination, nasal endoscopy, CT and biopsy of the
nasopharyngeal mass to exclude a neoplasm. PNIF was measured and a self-evaluation
questionnaire was given to all patients preoperatively and on 7-day and 1-month follow up
visits to determine the outcome.Results: Significant improvement in the PNIF scores and self-
evaluation questionnaire results in most cases after adenoidectomy as only treatment or as
part of a combo procedure including turbinate reduction and/or septoplasty. Conclusions:
Adenoidectomy needs to be considered among the surgical options in cases of nasal
obstruction, where adenoid hypertrophy is confirmed.

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1393
Extracranial nasoseptal arteriovenous malformation : An unusual case report with
multidisciplinary management

JULIDE KASABOGLU1, MIROSLAVA TSEKOVA-CHERNOPOLSKA3, STANIMIR SIRAKOV4, JULIAN

RANGACHEV5

1
Department of ENT, Medical University-Sofia ,Sofia,Bulgaria, 2Department of ENT, Medical University-
Sofia, Sofia,Bulgaria, 3Department of ENT, Medical University-Sofia, Sofia, Bulgaria, 4Department of
Radiology , MU-Sofia, Sofia, , 5Department of ENT, Medical University-Sofia, Sofia,Bulgaria

Rhinology – Miscellaneous 1| Room 9 Olympic Hall - Level 0| Monday 19/06/2023

Extracranial nasoseptal arteriovenous malformations (AVMs) are high-flow congenital

vascular anomalies. They are composed of a complex system of vessels directly connecting
feeding arteries to draining veins forming a nidus. They may be potentially life-threatening
due to progressive symptoms and infiltrative disease. Extracranial AVMs most commonly
affect the head and neck area (47.4%). AVMs are best characterized as being either focal or
diffuse. The management of AVMs includes conventional surgery and endovascular
techniques. Recently, a combination of embolization and surgical resection has become the
treatment of choice. We report a rare case of a 26-year old female patient who admitted to
our head and neck surgery department with complainants of recurrent epistaxis from the right
nostril in the past two weeks from the hospitalization. We managed the embolization with
collaboration of colleagues from interventional neuroradiology department of our university.
We will discuss the management of nasoseptal AVMs from the aspect of ENT emergency care.
Furthermore we will respectively talk over the following steps of our treatment plan.

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Skull base surgery 1

1150
The Role of Tissue Sealants for Skull Base Reconstruction Following Endoscopic
Endonasal Surgery: A Systematic Review and Meta-Analysis

Edward KUAN, Jonathan Pang1, Benjamin Bitner1, Madeline Nottoli1, Anh-Tram Bui1, Cecilia
Nguyen1, Timothy Hsu1, Arash Abiri1, Theodore Nguyen1, Frank Hsu1

1
University of California, Irvine

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Background: Despite significant advances in understanding of skull base reconstruction

principles, controversy remains regarding the role of adjunctive sealants in the modification
of postoperative cerebrospinal fluid (CSF) leak outcomes. The objective of this study is to
systematically evaluate rates of postoperative CSF leak associated with the use of tissue
sealants for the repair of skull base defects during endoscopic endonasal surgery.Methods:
Systematic review and meta-analysis of risk differences (RD). A search encompassing four
databases identified original studies reporting postoperative CSF leakage after endoscopic
skull base reconstruction disaggregated based on tissue sealant use and/or type.Results: The
search yielded 2,466 unique studies, of which 27 non-randomized studies (n=2,403) were
included for qualitative and meta-analysis. Reconstruction with a single tissue sealant did not
significantly reduce risk of postoperative CSF leak compared to reconstruction without sealant
(RD[95% CI] = 0.02[-0.01, 0.06]). Sub-analyses of dural sealant (-0.02[-0.11, 0.07]) and fibrin
glue cohorts (0.01[-0.06, 0.08]) compared to no sealant cohorts, as well as analyses comparing
specific sealants/glues, similarly demonstrated no difference in outcomes.Conclusion: No
tissue sealant reduced postoperative CSF leak incidence when compared to nonuse, with also
no differences noted for outcomes based on sealant type. Prospective randomized studies are
warranted to thoroughly elucidate the clinical value of adjunct sealant use in endoscopic skull
base reconstruction

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1184
Anterior skull base schwannomas: case study and systemic review

Donata ŠUKYTĖ RAUBĖ, Donata Sukyte Raube1, Darius Rauba, Eugenijus Lesinskas, Jurgita
Jurušaitė, Jurgita Jurusaite1

1
Vilnius University Hospital Santaros Klinikos ENT department

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

We present a rare clinical case - a 20-year-old female patient who complained about left-sided
nasal congestion, severe headaches, and recurrent left-sided sinusitis. After the execution of
radiological examinations and biopsy, a rare tumor of anterior skull base that has grown into
the nasal cavity - olfactory schwannoma - was diagnosed. Expanded endoscopic endonasal
transcribriform approach for resection of anterior skull base olfactory schwannoma was
performed with a multi-layer reconstruction of the skull base. In the report, we will discuss
this clinical case, review the problems of this topic, and provide a systematic review of the
literature.

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1333
Technical Factors in Endoscopic Skull Base Surgery Associated with Reconstructive
Success: A Multicenter Observational Study

Edward Kuan1, Arash Abiri1, Theodore Nguyen1, Jonathan Pang1, Benjamin Bitner1, Kelsey
Roman1, Milind Vasudev1, Dean Chung1, Siddhant Tripathi2, Jacob Harris3, Nikitha Kosaraju3,
Ryan Shih3, Myungjun Ko3, Jessa Miller3, Jennifer Douglas4, Daniel Lee4, Jacob Eide5, Rijul
Kshirsagar6, Katie Phillips2, Ahmad Sedaghat2, Marvin Bergsneider3, Marilene Wang3, James
Palmer4, Nithin Adappa4, Frank Hsu1

1
University of California, Irvine, 2University of Cincinnati, 3UCLA Medical Center, 4University of
Pennsylvania, 5Henry Ford Health, 6Kaiser Permanente Redwood City

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Introduction: Since the advent of endoscopic skull base surgery (ESBS), advancements in
technologies and surgical techniques have enabled a broad range of strategies for
reconstructing skull base defects. In this study, we aimed to identify key technical factors that
may be independently associated with primary reconstructive success in ESBS.Methods: ESBS
cases with intraoperative cerebrospinal fluid (CSF) leaks at four tertiary academic rhinology
centers were retrospectively reviewed. Multivariate logistic regression was conducted to
identify factors associated with postoperative CSF leak by subsite (anterior cranial fossa [ACF],
suprasellar [SS], sellar, posterior cranial fossa [PCF]).Results: 706 patients (50% female) were
analyzed. 62% patients had pituitary adenomas, 73% had sellar/SS defects, and 21% had high-
flow intraoperative CSF leaks. The average defect size was 3.3 ± 2.2 cm2. The postoperative
CSF leak rate was 7.8%. On multivariate analysis, larger defect size (OR 1.00; p=0.049)
predicted ACF postoperative leaks; use of rigid reconstruction (OR 0.13; p=0.008) and
dissolvable nasal packing (OR 0.27; p=0.014) protected against SS postoperative leaks; BMI
predicted sellar postoperative leaks (OR 1.17; p=0.042); and there were no predictors of PCF
leaks. Leak flow rate, onlay type (autologous vs synthetic), vascularized flap use, and lumbar
drainage were not associated with postoperative leaks (all p>0.05). Conclusions:
Reconstructive success following ESBS may be influenced by patient and technical factors,
which appear to differ by subsite.

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1362
Olfactory function after repair of meningoceles of the olfactory cleft

Sonia Macario1, Dimitrios Daskalou1, Julien Wen Hsieh1, François Voruz1, Basile Nicolas Landis2

1
Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of
Geneva, Geneva, Switzerland, 2Department of Otorhinolaryngology, University Hospital Regensburg,
Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

INTRODUCTIONMeningoceles are one cause of CSF leakage and they occur often in the
olfactory cleft. Surgical closure is required to avoid ascending infections with potentially lethal
outcome. The aim of this study is to evaluate the olfactory function side by side in patients
before and after repair of meningoceles of the olfactory cleft. METHODSThe study was
performed in the University Hospital of Geneva. We performed Sniffin’ Sticks (threshold,
discrimination and indentification) before and 1 year after repair of meningoceles of the
olfactory cleft. The test was performed side by side. RESULTS8 Patients with confirmed
meningoceles of the olfactory cleft were included. For 7 patients the etiology of the
meningocele was idiopathic and for 1 patient an idiopathic intracranial hypertension. The
results show that the TDI score is significantly lower in the affected side (p=0.0312). After
operation, TDI score is not significantly different (before surgery mean=26.83; after surgery
mean=23.25).CONCLUSION The olfaction function of the affected side is usually lowered
before surgery and may be an additional element to find the concerned side in intractable CSF
leakage. Our data further suggest that olfactory function can be preserved after repair of
meningoceles of the olfactory cleft.

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1439
Skull base and brain radionecrosis from a series of 383 patients treated for sinonasal
and nasopharyngeal cancers: analysis of prognosticators and outcomes

Giorgio Sileo1, Marco Valentini1, Alberto Daniele Arosio1, Alessia Lambertoni1, Paolo
Battaglia1, Apostolos Karligkiotis1, Maurizio Bignami2, Paolo Castelnuovo1, Mario Turri Zanoni1

1
Department of Otolaryngology, Asst Sette Laghi (Varese) - University of Insubria - Varese, 2Department
of Otolaryngology, Asst Lariana (Como) - University of Insubria – Varese

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Radiotherapy (RT) is an essential part of the treatment of sinonasal and nasopharyngeal

malignancies. One of its most severe complications is skull base and brain radiation-induced
necrosis.A retrospective analysis was conducted on 383 patients who received RT, either in
the form of Intensity-Modulated Particle Therapy (IMPT) or Intensity-Modulated Radiation
Therapy (IMRT), for malignancies of the sinonasal tract, skull base and nasopharynx from April
2010 to April 2022 at the Otolaryngology department of the University of Insubria in Varese.
Patients who developed radiation-induced necrosis (44 cases, 11.5%) did not experience a
reduction in Overall Survival (OS). Univariate and multivariate analysis showed that patients
treated with IMPT were at significantly higher risk of developing radiation-induced necrosis
than patients treated with conventional radiations (p < 0.0005 each).In conclusion, skull base
radionecrosis is a severe complication that must be properly and timely identified and,
potentially, treated. Despite this adverse event, IMPT still remains an effective option for the
treatment of radioresistant tumors and for previously irradiated patients. Special attention
must be paid in case of internal carotid artery involvement, since this might be associated with
life-threating evolutions, such as arterial blow-out.

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1469
Wide resection of extradural skull base lesions requiring sacrifice of internal carotid
artery : Preliminary surgical outcome at a single medical center

Sung-Woo Cho1, Chae-Seo Rhee1, Tae-Bin Won1

1
Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University Bundang
Hospital

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Objectives: To evaluate our preliminary surgical outcome of extradural skull base lesions
requiring sacrifice of ICA.Methods: Retrospective review of patients was performed for those
who underwent endoscopic radical resection of extradural skull base lesion invading the ICA.
Pathologies, management of ICA, and surgical outcome including disease progression,
improvements of symptom, and survival were evaluated.Results: Eleven cases (mean age 61.7
years) were collected. Pathologies were osteoradionecrosis (ORN) (N=7), ORN combined with
malignancy (N=3), and malignancy without ORN(N=1). ICAs were managed as follows;
spontaneous ICA occlusion (N=3), occluded intentionally (pre-operative embolization or intra-
op planned ligation) (N=5), and extracranial to intracranial bypass surgery (N=3). Mean
duration of follow up was 20 months (range 3-56 months). After radical resection, severe
headache decreased from 72.7% to 17.2%. However, cranial nerve palsy was increased from
72.7% to 81.8%. There were 3 cases of disease progression and eventual death. Among them
2 had uncontrolled cancer regrowth and the other developed brain stem necrosis after
adjuvant radiotherapy. The 2-year progression free survival was 71.6%. All the patients
without disease progression (N=8) were alive and showed acceptable functional outcome with
ECOG performance below 1.Conclusion: Radical resection of the skull base lesion invading ICA
can be performed with no peri-operative mortality. Depending on the disease pathology, good
surgical outcome with acceptable social performance can be expected.

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1591
Transnasal intracranial aneurisms clipping with four hands technique - our experience.

Ksenia Klimenko1, Alan Tsarikayev2

1
Federal State Government Institution of Postgraduate Education “Central State Medical Academy”
President’s Administration of Rus, 2Federal State Government Institution “Central Clinical Hospital with
Polyclinic” President’s Administration of Russian Federatio

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Transnasal skull base surgery is widely accepted nowadays, but is it not very often performed
for cerebral arteries aneurisms clipping. The reasons include technical challenges, anatomical
issues, high intraoperative risks and need for highly experienced skull base team to perform
four-hands surgery. We present 3 cases of successful transsphenoidal clipping of arterial
aneurisms - one was located at the base on basilar artery in low clivus, one was located at the
apex of basilar artery and the last - at the paraclival segment of the internal carotid artery
(ICA). The were no intraoperative complications. One patient developed trombembolia of
pulmonary artery on the 3d postoperative day, which recovered completely. There were no
CSF-leak or any other complications of the surgeries. Postoperative postcontrast CT showed
complete occlusion of the aneurysms in all the patients.Conclusion: transnasal clipping of
intracranial aneurisms using four-hand technique is a reliable method in highly selected cases.

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1627
Multiple Various Approaches of Transoral Endoscopic Skull Base Surgery: A Literature
Review

Zhaohui Shi1

1
Department of Otorhinolaryngology, Head & Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen
University, No. 600 Tianhe Road, Tianhe District, 510000 Guangzhou, Guangdong Province, China

Skull base surgery 1| Room 10 Peroto - Level 0| Monday 19/06/2023

Objective: This compare-and-contrast study aims to illustrate four significant types of

endoscopic transoral approaches to skull base tumors by analyzing the works of literature
respectively and demonstrating the anatomical structure combined with our clinical research.
Methods: Combining basic research and clinical practice, we searched seven MEDLINE
platforms, including CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed,
ProQuest, Ovid, and Web of Science, to categorize and conclude diverse transoral approaches
retrospectively. We reviewed the anatomy, exposure area, surgical freedom, manipulation
distance, and angle of different transoral endoscopic skull base surgeries to provide a brief
literature review. Results: Four major transoral approaches to the skull base tumors, including
endoscopic-assisted transoral-transpharyngeal approach, endoscopic endonasal
infratemporal fossa (ITF) approach, transvestibular transmaxillary approach, and trans the
posterior wall of the oropharynx, are used widely according to the literature. Nevertheless,
selecting the appropriate transoral approach for skull base tumors remains an issue.
Conclusion: The endoscopic transoral approach provides better visualization and handling of
delicate tissue in a narrow space. Though the endoscopic endonasal approach (EEA) to the
skull base has been widely used to treat skull base tumors, EEA is inadequate when an
inferolateral tumoral extension is present. Furthermore, endoscopy permits a more
meticulous and precise dissection and thus allows adequate and safer transoral surgeries.

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Best Poster Session

1209
Phase I study of LP-003, a novel high-affinity, long-acting anti-IgE antibody for allergic
rhinitis

Liu Heng1, Xie Ming1, Sun Bill Nai-chau1, Sun Cecily Rou-yun1, Ma Haili1, Yang Hongzhou1, Gao
Qi1, Liu Yunhua1, Guo Ruowen1

1
Longbio Pharma, Shanghai, China

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background:Allergic rhinitis (AR) affects large population. Omalizumab was approved for the
severe AR patient can’t be adequately controlled by the current standard medication.In this
study, a new anti-IgE antibody with high affinity, stronger efficacy (FcεRI inhibition) and longer
half-life is investigated.Methods:A randomized, double-blind, single-ascending-dose Phase I
clinical study (CTR20221413) was conducted. 32 healthy subjects were randomly divided into
five groups to receive a single intravenous dose of 0.3 mg/kg, 1 mg/kg, 3 mg/kg, 6 mg/kg and
10 mg/kg respectively.Safety, pharmacokinetics, and pharmacodynamics (free IgE levels)
profile was evaluated.Results:LP-003 has affinity to IgE of 2.08 pM, which is comparable to
Ligelizumab (0.66 pM) and more than 100-fold higher than Omalizumab (1730 pM). LP-003
also shows stronger inhibition to FcεRI compared to Omalizumab and Ligelizumab using
allergic patient’s serum. In SAD of phase I study, LP-003 exhibited a non-linear PK
characteristic with T1/2 ranging from 10.6 days to 83.5 days, which is approximately 2 fold of
Omalizumab. Moreover, the free-IgE was suppressed to below detection range for more than
133 days at 1 mg/Kg group (except one with high baseline IgE level) to 10 mg/Kg group. LP-
003 demonstrated a favorable safety profile with no treatment-related SAE, and no TEAE
leading to discontinuation of the study.Conclusion:The pre-clinical and SAD of phase I study
of LP-003 suggests that this novel high affinity and long-acting anti-IgE antibody with good
safety profile renders a promising option in AR treatment.

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1261
Evaluating treatment responses of dupilumab versus omalizumab in severe chronic
rhinosinusitis with nasal polyps and comorbid asthma patients: the EVEREST trial

Martin WAGENMANN, Asif Khan1, Anju Thomas Peters2, Claus Bachert3, Enrico Heffler5, Claire
Hopkins6, Peter Hellings7, Mei Zhang8, Jun Xing8, Paul Rowe8, Judy Jacob-Nara8, Lucia De Prado
Gomez9

1
Sanofi, Chilly-Mazarin, France, 2Feinberg School of Medicine, Northwestern University, Chicago, IL,
USA, 3First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center,
Guangzhou, China, 4University of Düsseldorf, Germany, 5Department of Biomedical Sciences, Humanitas
University, Pieve Emanuele, Milan, Italy, 6Guy's Hospital & King's College London, UK, 7University
Hospitals Leuven, Leuven, Belgium, 8Sanofi, Bridgewater, NJ, USA, 9Sanofi, Reading, UK

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background: Dupilumab and Omalizumab are approved for the treatment of uncontrolled
Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) and asthma. Comparison studies can
contribute to evidence-based decision making. Methods: EVEREST (NCT04998604) is a phase-
4, multicenter, randomized (1:1), double-blind study comparing dupilumab (300mg Q2W) vs.
omalizumab (75-600mg Q2W) add-on to nasal corticosteroid therapy. Approximately 422
adult CRSwNP patients, with nasal congestion, loss of smell, NP score ≥5, coexisting asthma,
receiving low/medium/high-dose inhaled corticosteroids and a second controller, with an
Asthma Control Questionnaire (ACQ)-5 score ≥1.5, will be recruited across 15 countries.
Eligibility will no longer be based on lung function and smoking history.Results: Primary
objective is to evaluate efficacy of dupilumab vs. omalizumab in reducing NP size and
improving sense of smell (change from baseline to week 24 in NP score and University of
Pennsylvania Smell Identification Test). Secondary objectives include assessment of lung
function (pre-bronchodilator forced expiratory volume in 1 second [BD FEV1]), nasal peak
inspiratory flow, nasal congestion, quality-of-life (Sino-nasal outcome test [SNOT-22]), asthma
control (visual analogue and ACQ-7), and safety. Conclusions: EVEREST, the first head-to-head
trial comparing efficacy and safety of dupilumab vs. omalizumab will provide evidence to
optimize treatment for patients with severe CRSwNP and comorbid asthma.

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1285
Establishment of olfactory training within the framework of rehabilitation

Kengo Kanai1, Aiko Oka2, Seiichiro Makihara2, Yuji Hirata3, Maki Akamatsu4, Takahisa Koyama5,
Mitsuhiro Okano4

1
Department of Otorhinolaryngology Head and Neck Surgery, International University of Health and
Welfare Narita Hospital, Narita, Japan, 2Department of Otolaryngology-Head & Neck Surgery, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan,
3
Department of Otoralyngology Head and Neck Surgery, Kagawa Prefectual Central Hospital,
Takamatsu, Japan, 4Department of Otolaryngology Head and Neck Surgery, Hiroshima City Hiroshima
Citizens Hospital, Hiroshima, Japan, 5Department of Otolaryngology-Head and Neck Surgery, Okayama
Red Cross Hospital, Okayama, Japan

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background: Upper respiratory tract infections, sinonasal disease, trauma, inhalation of drug,
and degenerative diseases are among the frequent causes of olfactory dysfunction. Recently,
there are cases of olfactory dysfunction caused by COVID-19 infections. Objectives: Patients
with olfactory dysfunction often receives checkups with T&T olfactometer and alinamin test.
As a new treatment method for olfactory dysfunction, they have olfactory training, in which
the patients actively sniff the odors. In our hospital, speech therapists perform olfactory
training under a rehabilitation doctor. Patients diagnosed with olfactory dysfunction in our
hospital had olfactory training for more than 3 months. Olfactory training included exposure
to odorants (rose, lemon, eucalyptus, and cinnamon) for 10 seconds each, twice per day
(morning and evening). After 3 months, the 4 odorants were changed to lavender, orange,
cypress, and vanilla. The results in olfactometry before and after olfactory training were
retrospectively compared. Results: Before and after olfactory training, no significant
improvement was seen in T＆T olfactometry, but a significant improvement was seen in Self-
administered odor questionnaire, Olfactory QOL questionnaire and visual analogue scale.
Conclusions: We would like to introduce our efforts for cases of olfactory dysfunction. It is
desirable to establish a more effective and uniform protocol for Japanese.

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1315
Effect of gut microbial composition and diversity on major inhaled allergen
sensitization and onset of allergic rhinitis

Taimu Yamaguchi, Atsushi Matsubara

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background: Decreased gut microbiota diversity is associated with gut dysbiosis and causes
various diseases, including allergic diseases. We investigated the effect of gut microbial
composition and diversity on major inhaled allergen sensitization and onset of allergic
rhinitisMethods: This study included 1092 local residents who had participated in the Iwaki
Health Promotion Project in 2016. Blood samples were analyzed to ascertain specific IgE levels
against major inhaled allergens (JCP, HD1, Grass-mix, Weed-mix). Fecal samples were
analyzed for bacterial 16S rRNA using next generation sequencing. The diversity index (α-
diversity, β-diversity) and the composition of gut microbes in phylum/order levels were
compared between patients sensitized or unsensitized to allergen, and symptomatic and
asymptomatic groups.Results: Some α-diversity metrics were significantly decreased in
patients who were sensitized to allergens. β-diversity differed significantly between those
unsensitized and sensitized to allergens. The relative abundance of Bacteroidales was
significantly lower in the unsensitized group. The composition and diversity of gut microbiota
were similar between the symptomatic and asymptomatic groups. Conclusions: Our results
suggest that lack of diversity in gut microbiota has an effect on sensitization to allergens.
However, the onset of allergy symptoms was not significantly associated with bacterial
composition and diversity.

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1316
Amyloid beta and phosphorylated tau were detected in olfactory mucosa and in nasal
swab samples from patients with Alzheimer’s disease

Shino Shimizu1, Ikuo Tooyama2, Takeshi Shimizu1

1
Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science,
2
Molecular Neuroscience Research Center, Shiga University of Medical Science

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Alzheimer’s disease (AD) is pathologically characterized by senile plaques consisting of

amyloid beta (Ab) and neurofibrillary tangles formed by phosphorylated tau (p-tau) in the
cytoplasm of neurons. These changes begin 10 to 20 years before the clinical onset of AD, and
it is important to find the AD patients before having neurogenerative symptoms. Olfactory
epithelium is a unique area where the cranial nerve is exposed to the external environment,
and olfactory dysfunction is an early sign of AD. We examined the histochemical changes of
nasal mucosa in the autopsy case of juvenile AD and found the neurogenerative changes in
olfactory epithelium. P-tau was detected in neurofibrillary tangles, degenerated olfactory cells
and their axons. Ab42 was detected in the cytoplasm of supporting cells. We then developed
new methods to detect AD-related biomarkers, Ab42 and tau, in nasal swab samples. We
found that p-tau/total-tau ratio in swab samples from the middle meatus and from the
olfactory cleft were significantly high in AD patients. These results suggest that nasal mucosa
has the potential to provide AD-related biomarkers useful for the early diagnosis of AD.

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1366
Analysis of olfactory dysfunction in IgG4-related disease model mouse

Tomokazu Yoshizaki1

1
Department of Otorhinolaryngology, Kanazawa University

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Introduction: Our previous study suggested that olfactory dysfunction is prevalent in IgG4-RD
patients(Yagi-Nakanishi et al. Chem Senses. pii: bjw076, 2016). In this study, we examined the
olfactory function in IgG4-RD model mice (LAT*Y136F mice) to reveal the mechanism of
olfactory dysfunction. Method: Behavioral tests was undergone for LAT*Y136F mice and the
histology of olfactory epithelium was analyzed.Results: The olfactory epithelium in
LAT*Y136F mice was thinner than age-matched wild type mice. The expressions of Olfactory
Marker Protein (OMP) and Growth Associated Protein (GAP-43) in olfactory epithelium of the
LAT*Y136F mice were markedly less than wild type mice. Conclusion: The olfactory epithelium
impairment caused hyposmia in LAT*Y136F mice. We propose that olfactory dysfunction is a
manifestation in IgG4-RD patients.

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1370
Optimal primer selection for sinus microbiome profiling - A comparative analysis of
V1-V3 and V3-4 16S target regions

James Connell1

1
Department of Otorhinolaryngology, Queen Elizabeth Hospital, South Australia

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background: Next generation sequencing (NGS) using 16S rRNA has rapidly accelerated our
understanding of the sinus microbiome. Accurate taxonomic representation of the sampled
ecosystem is heavily dependent on primer selection. The V1-V3 and V3-V4 hypervariable
regions have become the predominant primer targets in sinus microbiome studies. Methods:
We undertook a cross-sectional paired comparative analysis of 20 middle meatus swabs from
patients undergoing endoscopic sinonasal surgery to determine whether primer selection
would significantly impact taxonomy and diversity outcomes. DNA extracted from swabs
underwent paired sequencing targeting both the V1-V3 and V3-V4 hypervariable
regions.Results: Corynebacterium, Staphylococcus, Cutibacterium, Streptococcus,
Haemophilus, Moraxella and Stenotrophomonas were the most abundant genus in both the
V1-V3 and V3-V4 primer sets. There was no statistically significant difference in relative
abundance between V1-V3 and V3-V4 for the core sinus genera. There was a trend towards
greater richness and diversity (Shannon Index) in V3-V4. Beta Diversity metrics using Weighted
Unifrac showed no significant difference in community composition between primer
sets.Conclusions: V1-V3 and V3-V4 target regions both offer reliable and comparable
biological conclusions in the sinonasal ecosystem. Variability in diversity metrics may be
influenced by the less abundant taxa in a low biomass environment.

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1371
Assessment of the expression levels of the MMP-12 in chronic rhinosinusitis with nasal
polyps

Spyridon lygeros1, Michail Athanasopoulos1,Gerasimos Danielidis1, Alkmini Gatsounia1,

Stefanos Naxakis1, Nikolaos Mastronikolis1, Vasileios Danielidis1

1
Department of otorhinolaryngology, University General Hospital of Patras, Patra, Greece

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory

condition of the nasal mucosa and paranasal sinuses associated with frustrating symptoms
and low quality of life. The aim of this study was to assess the expression of matrix
metalloproteinase-12 (MMP-12), a pivotal regulator of the pathophysiology of several
inflammatory diseases, in patients with CRSwNP. Methods: Tissue samples from 37 patients
with CRSwNP treated with functional endoscopic sinus surgery and 12 healthy mucosa
specimens (control group) were excised intraoperatively. Real-time polymerase chain reaction
and Western blotting were used to measure the mRNA and protein expression levels of MMP-
12, respectively. Results: mRNA levels of MMP-12 were found considerably increased in the
CRSwNP tissue samples compared to those determined in the control group. Aa far as the
protein levels, a non-statistical significant elevation trend was noticed. The “discrepancy” in
the expression profile among mRNA and protein levels could be attributed to post-
translational gene expression regulation. Conclusion: The raise of MMP-12 in patients with
CRSwNP could straighten its potential implication in the pathogenesis of the disease. Our
results indicate that MMP-12, in combination with other matrix metalloproteinases, may
serve as a biomarker and therapeutic target for nasal polyposis.

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1398
Dupilumab Improves Outcomes in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
Patients with a Type 2 Inflammatory Signature Across Definitions

Stella Lee1, Claus Bachert2, Asif Khan3, Anju PETERS, Scott Nash4, Harry Sacks4, Juby Jacob-
Nara3

1
Division of Otolaryngology—Head & Neck Surgery, Brigham and Women’s Hospital, Harvard Medical
School, 2Department of Otorhinolaryngology — Head and Neck Surgery, University Hospital of Münster,
Münster, Germany, 3Global Medical Affairs, Sanofi, 4Regeneron Pharmaceuticals Inc.

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Introduction CRSwNP is a predominantly type 2 (T2) inflammatory disease. This post hoc
analysis assessed dupilumab efficacy in patients with CRSwNP from the SINUS-24/-52 trials
(NCT02912468/NCT02898454) according to different T2 definitions. Methods T2 definitions
were: ≥150 eosinophils/μL or total IgE ≥100 IU/mL or any coexisting T2 condition; ≥150
eosinophils/μL or total IgE ≥100 IU/mL; ≥150 eosinophils/µL (GINA); ≥250 eosinophils/μL or
total IgE ≥100 IU/mL (EPOS); asthma or ≥300 eosinophils/μL (EUFOREA); any coexisting T2
condition. Odds ratios (ORs; dupilumab vs placebo) of achieving clinically meaningful
improvements from baseline to Week (W)24 (pooled SINUS-24/-52) and W52 (SINUS-52) were
calculated for nasal polyp score (NPS), nasal congestion/obstruction score (NC), loss of smell
score (LoS; all range 0−3; ≥1 point improvement), 110-item sinonasal outcomes test (SNOT-
22; 0−110; ≥8.9), and University of Pennsylvania smell identification test (UPSIT; 0−40;
≥8).Results OR ranges (95% confidence intervals) at W24 across the six T2 definitions were:
NPS 11.4 (7.4−17.5) to 14.9 (9.4−23.7); NC 6.5 (4.5−9.3) to 9.6 (6.0−15.3); LoS 12.2 (8.0−18.8)
to 17.8 (10.6−30.0); SNOT-22 4.3 (3.0−6.0) to 5.3 (3.6−7.9); and UPSIT 21.1 (12.0−37.3) to 34.7
(16.4−73.2) (all P < 0.0001). ORs were similar or greater at W52. Conclusion Dupilumab
showed robust efficacy across T2 inflammation definitions in patients with CRSwNP.

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1421
Endoscopic and open surgical excision of a complicated inverted nasal papilloma of
frontal sinus

Vasileios Papanikos1, Spyridon Lygeros1, Gerasimos Danielidis1, Vasileios Panagiotopoulos2,

Vasileios Danielidis1, Stefanos Naxakis1

1 2
Department of Otorhinolaryngology, University Hospital of Patras, Greece, Department of
Neurosurgery, University Hospital of Patras, Greece

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Background:Inverted papilloma is a benign sinonasal tumor that can invade surrounding

cranial structures. Early detection and prompt surgical treatment are key to ensuring
successful patient outcomes.Case Presentation:A 66-year-old male patient presented at our
ENT clinic due to a mass in his frontal sinus that was discovered incidentally on a CT scan.
He reported no symptoms other than exophthalmos of the left eye, while the laboratory
results were normal. The CT scan showed a hyperdense mass in the left frontal sinus and the
ipsilateral ethmoid air cells, and revealed lytic/sclerotic bone lesions of the posterior wall of
the left frontal sinus as well as in the inner and upper corresponding orbital wall. The patient
underwent a diagnostic biopsy through paranasal sinus endoscopy, which established the
diagnosis of an inverted papilloma of the frontal sinus. The following surgical excision of the
mass included both intranasal (Draf IIb procedure) and external approach with an osteoplastic
flap of the frontal sinus in order to manage the intraorbital and intracranial extension of the
papilloma.Conclusion: The patient had a successful postoperative recovery without
complications. This case highlights the significance of early detection and the use of a
combined surgical approach in the management of inverted papilloma.

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1497
Clinical Presentation, Diagnosis, Staging, Treatment, Complications, and Incidence of
Juvenile Nasopharyngeal Angiofibromas (JNA)in Denmark

Mohamed El Haddouchi1, Patrick Gerhard Eriksen1, Maria Kongsvad3, Giedrius Lelkaitis4, John
Jakobsen3, Christian Buchwald2, Götz Benndorf5, Christian von Buchwald6

1
Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, 2Department
of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Denmark, 3Department of
Otorhinology, Odense University Hospital, 4Department of Pathology, Rigshospitalet, Denmark,
5
Department of Diagnostic Radiology, Rigshospitalet, Denmark, 6Department of Otorhinolaryngology,
Head and Neck Surgery and Audiology Rigshospitalet, University Hospital of Copenhagen, Denmark

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Objective: To study the incidence rate of JNA in Denmark in the period 2003 to 2022, focusing
on clinical presentation, diagnosis, staging, treatment, complications, and
prognosis. Background: JNA is a rare benign mesenchymal tumor of vascular origin. It usually
emerges in the sphenopalatine foramen and exclusively affects adolescent males. Although
benign, the tumor shows aggressive growth potential and is fatal if left untreated. The tumor
has erosive and bone-remodeling features, which can result in extension into the orbital
cavity, the nasal cavity, the paranasal sinuses, and the intracranial cavity. Methods: The study
is a national retrospective cohort study. All cases of JNA diagnosed in Denmark from 2003 to
2022 were identified through the Danish Pathology Data Bank. Data were extracted from
medical records. Results: 66 cases were identified. All patients were male. The median age at
diagnosis was 16.5 years. The most common symptom was nasal stenosis (100%), followed by
epistaxis (68,2%) and nasal secretion (22,7%). The average duration of the symptoms until
diagnosis was 9 months. 91% of the patients presented with an enlarged Sphenopalatine
Foramen. 8% of the patients had intracraniel involvement upon diagnosis. 95% of the patients
underwent preoperative embolization. 88% were treated with CAS-FESS, 6% with midfacial
gloving, 1,5% with frontal craniotomy,and 4,5% with transpalatal approach in addition to CAS-
FESS. 12% had recurrences. Final data analysis and conclusions of this relative large cohort
study of JNA will be presented at the conference.

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1559
Clinical Presentation, diagnosis, staging, treatment, complications, and incidence of
Juvenile nasopharyngeal angiofibromas (JNA) in Denmark

Mohamed El Haddouchi1, Patrick Eriksen2, Maria Kongsvad3, Giedrius Lelkaitis4, John

Jakobsen5, Götz Benndorf6, Christian Buchwald2

1
Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Denmark,
2
Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, 3Department
of Otorhinology, Odense University Hospital, 4Department of Pathology, Rigshospitalet, Denmark,
5
Department of Otorhinology, Odense University Hospital, Denmark, 6Department of Diagnostic
Radiology, Rigshospitalet, Denmark

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Objective: To study the incidence rate of JNA in Denmark in the period 2003 to 2022, focusing
on clinical presentation, diagnosis, staging, treatment, complications, and
prognosis. Background: JNA is a rare benign mesenchymal tumor of vascular origin. It usually
emerges in the sphenopalatine foramen and exclusively affects adolescent males. Although
benign, the tumor shows aggressive growth potential and is fatal if left untreated. The tumor
has erosive and bone-remodeling features, which can result in extension into the orbital
cavity, the nasal cavity, the paranasal sinuses, and the intracranial cavity. Methods: The study
is a national retrospective cohort study. All cases of JNA diagnosed in Denmark from 2003 to
2022 were identified through the Danish Pathology Data Bank. Data were extracted from
medical records. Results: 66 cases were identified. All patients were male. The median age at
diagnosis was 16.5 years. The most common symptom was nasal stenosis (100%), followed by
epistaxis (68,2%) and nasal secretion (22,7%). The average duration of the symptoms until
diagnosis was 9 months. 91% of the patients presented with an enlarged Sphenopalatine
Foramen. 8% of the patients had intracraniel involvement upon diagnosis. 95% of the patients
underwent preoperative embolization. 88% were treated with CAS-FESS, 6% with midfacial
gloving, 1,5% with frontal craniotomy,and 4,5% with transpalatal approach in addition to CAS-
FESS. 12% had recurrences. Final data analysis and conclusions of this relatively large cohort
study of JNA will be presented at the conference.

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1619
INTRAOSSEOUS HEMANGIOMAS OF NASAL CAVITY: TWO CASES REPORTS

Márcia Mourão, Bárbara Rodrigues, Gonçalo Quadros, António Alves, Sérgio Raposo

1
Department of otorhinolaryngology

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Introduction: Intraosseous hemangiomas of the nasal cavity are rare. This entity can be
present in the inferior and middle turbinate, ethmoid sinus or nasal septum. The diagnosis can
be difficult, since they can remaining asymptomatic until the tumor becomes large enough.
Methods: Case reports and literature review. Pre and post-operative image documentation.
Results: We describe two cases of intraosseous hemangioma of nasal cavity. Both with no
history of epistaxis, facial trauma or nasal surgery. Case 1: 57-year-old woman presented with
complaints of left nasal obstruction. Sinonasal endoscopy revealed a firm, smooth
erythematous mass with an intact surface on the left nasal cavity, at middle turbinate
level. Sinus CT demonstrated a expansive lesion centered on left ethmoid cells. Endoscopic
sinus surgery was performed with complete resection of Intraosseous cavernous
hemangioma. Case 2. 65-year-old man presented with complaints of bilateral nasal
obstruction and pain on nasal dorsum. Sinonasal endoscopy revealed bulging in the roof of
the left nasal fossa and in the superior septal portion. Sinus CT had demonstrated a 2cm
diameter expansive lesion in the transition between the cartilaginous and osseous portion and
involving nasal bones. Lateral rhinotomy was performed with complete removal of lesion.
Both patients did well postoperatively and was free of symptoms at follow-up. Conclusions:
Intraosseous hemangioma should be considered in the differential diagnosis of a nasal cavity
mass with internal calcifications. Complete surgical excision is recommended.

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1669
Invasive Aspergillus flavus Rhino-sinusitis with Intranasal Heroin Use.

Maria Minasidou1, Eleni Gkrinia1, Athanasios-Luca Fountarlis2, Georgios Krestinidis1,

Euthymios Solomi1, Charikleia Maiou1, Charalampos Skoulakis3

1
Department of Otolaryngology - Head and Neck Surgery, University Hospital of Larissa, Greece ,
2
Department of Otolaryngology - Head and Neck Surgery, University Hospital of Larissa, Greece,
3
Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Thessaly,
Greece

Best Poster Session | Room 11 Hall 3.3 - Level 7| Monday 19/06/2023

Introduction: Although orofacial complications resulting from cocaine insufflation have been
well documented, reports of intranasal opioid abuse are rare. The aim of this study is to
present the case of a user of inhaled heroin who developed a necrotizing fungal infection of
the nasal cavity, presenting with soft tissue and bone distruction.Case Presentation: An
otherwise immunocompetent 37-year-old woman with reported 2-year history of intranasal
heroin use was referred to our clinic with a three-month history of progressive nasal pain,
epistaxis and purulent discharge with accompanying erosions of the right nasal vestibule.
Endoscopically a large septal perforation, purulent exudate and necrotic lesions of right nasal
cavity exceeding to the perinasal skin were noted. MRI and CT scans also showed necrosis of
palatine process of right maxilla and inferior turbinate. Histopathogy and cultures from the
intraoperative debridement revealed an Aspergillus flavus rhino-sinusitis. The patient
remained in hospital for treatment with intravenous isavuconazole and amphotericin B with
a satisfactory clinical response.Conclusions: Patients with a history of intranasal drug abuse,
including heroin, may be at risk of mucosal or bone necrosis leading to invasive fungal
infections. Early diagnosis and treatment, even in otherwise immunocompetent individuals,
is critical to prevent disease progression.

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Best Oral for Junior Grant 2

1227
Preoperative prediction of sinonasal papilloma by artificial intelligence using nasal
video endoscopy: A retrospective study

Ryosuke Yui1, Masahiro Takahashi2, Kosuke Miyamura2, Rinko Sakurai2, Kazuhiro Omura2,
Nobuyoshi Otori2

1
The department of Otorhinolaryngology at The Jikei University School of Medicine, 2Department of
Otorhinolaryngology, Jikei University School of Medicine

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Inverted papilloma (IP) is at risk of recurrence and malignancy, and early
diagnosis using nasal endoscopy is essential. Herein, we developed a diagnostic system using
artificial intelligence (AI) to identify nasal sinus papilloma.Methods: Fifty-three patients (21
with IP and 32 with chronic rhinosinusitis with nasal polyp) who underwent endoscopic sinus
surgery were included. The endoscopic surgery videos of the patients were edited to train and
evaluate deep neural network models, then a diagnostic system was developed. The correct
diagnosis rate by visual examination by otolaryngologists was also evaluated using the same
videos and compared with that of the AI diagnostic system.Results: The diagnostic system had
an area under the curve of 0.874, accuracy of 0.843, false positive rate of 0.124, and false
negative rate of 0.191. The average correct diagnosis rate among otolaryngologists was 69.4%,
indicating that the AI was highly accurate. Conclusions: In this study, we created an adjunctive
diagnostic system for IP among patients who underwent nasal endoscopy. Although the
number of cases was small, we were able to create a highly accurate diagnostic system. Future
studies with a larger sample size are warranted to improve the accuracy of the system.

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1652
Use of Platelet-rich Plasma in patients with COVID-19 related olfactory dysfunction.

KONSTANTINOS GAREFIS1, SOTIRIA GENETZAKI1, EVANGELIA TSAKIROPOULOU2, IORDANIS

KONSTANTINIDIS2

1
2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki,
Papageorgiou Hospital, Thessaloniki, Greece , 22nd Academic ORL, Head and Neck Surgery Department,
Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Olfactory dysfunction associates with viruses such as COVID-19. The aim of our
study was to investigate the use of Platelet-rich Plasma (PRP) injections, an autologous blood
product with supraphysiologic concentrations of growth factors, in patients with persistent
olfactory loss as a result of COVID-19 disease. Methodology/principal: 1 mL of PRP was
injected in each olfactory cleft (0.5ml at the septum, 0,5ml at the middle turbinate) in 14
patients. Duration of olfactory dysfunction was between 6 to 24 months (mean ± SD: 13.8 ±
5.8). Patients examined with Sniffin’ sticks battery test (TDI score) and reported their
subjective ratings with a visual analogue scale (VAS) at baseline and one month after PRP
injection. Results: No significant differences were found in TDI and VAS score (mean ± SD, TDI:
21 ± 3.16, VAS: 3.09 ± 1.81) before and after PRP injection (mean ± SD, TDI: 21.9 ± 4.57, VAS:
3.81 ± 2.63). Only 2 out of 14 patients (14.3%) showed an improvement of 5.5 points in TDI
score. Both of them were hyposmic with a history of the disease 6 and 10 months respectively.
None of the anosmic patients showed an improvement in olfactory function Conclusion:
Although PRP is a safe treatment it seems that has limited value in the management of
olfactory dysfunction caused by COVID-19.

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1689
The impact of the COVID-19 pandemic on FESS: A retrospective study.

Joanna Cieslik1

1
1 Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Krakow,
Poland; 2 Department of Head and Neck Otolaryngology and Oncological Surgery, 5th Military Clinical
Hospital with Polyclinic, Krakow, Poland

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

AbstractObjectives: Coronavirus disease 2019 (COVID-19) has had a significant impact on

healthcare systems around the world. The rapid spread of the virus caused several
restrictions, including a limited number of surgeries. The purpose of the study was to compare
the number of functional endoscopic sinus surgeries (FESS) and the severity of paranasal sinus
diseases performed before the pandemic, during the first wave, after 1 year and 2 years after
the COVID-19 pandemic. Methods: Volume, demographic data, and additional procedures
were analyzed. The severity of paranasal disease was assessed using the Lund-Mackey scoring
system.Results: There were 105 surgeries performed before the pandemic and, respectively,
35, 141 and 166 during the first wave, after one year and after two years of the COVID-19
pandemic. Regarding age, no significant differences were found between the groups. The
most patients were men in all time periods analyzed. The analysis did not show any significant
differences between the additional septoplasties performed and/or the turbinoplasties.
Conclusions: The COVID-19 pandemic caused a very limited number of FESS due to fear of
SARS-CoV-2 contamination. Large-scale research is needed to assess the consequences of
delayed diagnosis and treatment of chronic rhinosinusitis after the COVID-19 pandemic.

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1317
Gustatory function in patients with cerebellopontine angle masses

Dimitrios Daskalou1, Julien W. Hsieh1, Francois Voruz1, Pascal Senn1, Sonia Macario1, Basile N.
Landis1

1
Service of otorhinolaryngology- head and neck surgery, Department of clinical neurosciences, Geneva
University Hospitals, Geneva

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: The aim of this study is to investigate the impact of cerebellopontine angle
masses (CPAM) on gustatory function. Methodology: Gustatory function was assessed (Taste
Strips) retrospectively in 106 patients (55 females; mean age 55.3 ± 13.5 years). Results: The
most common CPAM was vestibular schwannoma (VS)(n=89). Overall, the taste strips score
obtained from the affected side was lower than the unaffected (p-value=0.019; 95% CI -1.77
to -0.15). When analyzed separately, only VS patients had significantly lower taste strips score
on the affected side (p-value=0.044; 95% CI -1.86 to -0.03) without any correlation between
taste and Koos stage [(F(3, 85)=1.69, p-value=0.18]. Gustatory function on the affected side
was neither correlated with facial palsy (p-value=0.22; 95% CI -3.81 to 0.89) nor pure tone
average (p-value=0.36; 95% CI -0.3 to 0.11). Conclusions: The CPAM cause a slight but
significant decrease in gustatory function on the affected side compared to the healthy side.
This is most pronounced in VS and unrelated to the Koos stage.

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1332
Systematic MRI in persistent post COVID-19 olfactory dysfunction should be
reassessed

Maxime Fieux1, Ioana Brudasca2, Quentin Lisan3, Romain Tournegros1, Moustafa Bensafi4,
Camille Ferdenzi4, Arnaud Fournel4, Luna Denoix1, Stéphane Tringali1

1
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie
cervico-faciale, France, 2Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL,
d’otoneurochirurgie et de chirurgie cervico-faciale, F-6931, 3Service d’ORL et chirurgie cervico-faciale,
Foch Hospital, Ecole de médecine, Université Versailles Saint-Quentin-en-Yvelines (P, 4Inserm U1028 -
CNRS UMR 5292, Bron, France , 5Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL,
d’otoneurochirurgie et de chirurgie cervico-faciale, F-69310, Pierre Bénite, France; Université Claude
Bernard Lyon 1, 69003, Lyon, France, CNRS EMR 7000, F-94010 Créteil, France, Univ Paris Est Creteil,
INSERM, IMRB, F-94010 Créteil, France

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Magnetic resonance imaging (MRI) is the gold standard in the etiological assessment of a
persistent smell dysfunction. MRI is recommended in all patients with persistent olfactory
disorders (OD> months). The high prevalence of persistent OD after SARS-CoV-2 infection
means evaluating this strategy is an important public health matter. The main objective of this
study was therefore to examine the impact of systematic MRI on the management of patients
with OD and to evaluate the relationship between the severity of the OD as measured by
psychophysical testing and the volume of the OB measured by MRI.This was an observational
study including all adult patients with persistant OD confirmed by an abnormal European Test
of Olfactory Capabilities (ETOC) score, after confirmed SARS-Cov-2 infection (by PCR). Among
the 67 patients with confirmed SARS-CoV-2 infection, none of the MRI exams altered the initial
diagnosis of persistent post-viral smell dysfunction. This suggests that systematic MRI may be
unnecessary in patients whose persistent olfactory impairment began soon (a few days) after
confirmed SARS-CoV-2 infection. Guidelines for the use of MRI should be based on clinical
abnormalities and the likelihood of results leading to changes in treatment.

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1342
Prognosis value of olfactory dysfunction in patients with COVID-19: the COVIDORA study

Emilie Bequignon1, Anne Laure Hammel1, Maxime Fieux2, Jean-François Papon3, Léo Delbos5,
Thomas Radulesco6, Pierre-André Natella4, Mihaela Alexandru7, Emmanuel Bartaire8, Sophie
Bartier9, Gonda Benoite11, Laurent Castillo12, Florence Canoui-Poitrine13, Florent Carsuzaa14,
Alain Corré15, André Coste16, Vincent Couloigner17, Clémentine Daveau18, Paul De Boissieu5,
Guillaume De Bonnecaze19, Ludovic de Gabory20, Christian Debry21, Simon Deraedt22, Xavier
Dufour14, Wissame El Bakkouri Madi15, Laurent Gilain23, Stephane Hans24, Charlotte
Hautefort25, Ruben Hermann26, Roger Jankowski27, Candice La Croix28, Jean-Baptiste Lecanu29,
Olivier Malard30, Michel Justin6, Yann Nguyen31, Jerome Nevoux7, Jean-Francois Papon32,
Vincent Patron33, Marine Prigent34, Virginie Pruliere-Escabasse35, Marion Renaud36, Cecile
Rumeau27, Dominique Salmon37, Nicolas Saroul23, Elie Serrano38, Christine Nhung Tran Khai7,
Stephane Tringali39, Eric Truy26, Clair Vandersteen40, Benjamin Verillaud25, Raphael Veil5

1
Centre Hospitalier Intercommunal de Créteil et AP-HP, Hôpital Henri Mondor, Service d’Oto-Rhino-
Laryngologie et de Chirurgie cer, 2Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL,
d’otoneurochirurgie et de chirurgie cervico-faciale, France, 3Assistance Publique-Hôpitaux de Paris (AP-
HP), Université Paris-Saclay, Hôpital Bicêtre, Service d’ORL, 94270 Le Kremlin-Bicêtre, 4URC, Hôpital
Henri Mondor, Assistance Publique des Hôpitaux de Paris, F-94010 Créteil, France, 5Service de Santé
Publique et d’épidémiologie, Hôpital Bicêtre, Assistance Publique des Hôpitaux de Paris, F-94270 Le
Kremlin-Bicêtre, France, 6Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-
HNS, Department, Marseille, France, 7Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-
Saclay, Hôpital Bicêtre, Service d’ORL, 94270 Le Kremlin-Bicêtre, France, 8Centre de santé SOMeD, F-
59777 Lille, Centre de santé Richerand, F-75010 Paris, Délégation à la Recherche Clinique et à
l'Innovation, GHICL, Hôpital Saint-Vincent-de-Paul, Faculté Libre de Médecine de Lille, Lille, France,
9
Service d’ORL et de chirurgie cervico faciale, Hôpital Henri Mondor, Assistance Publique des Hôpitaux
de Paris, F-94010 Créteil, France, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France; CNRS
EMR 7000, F-94010 Créteil, France, 10Service d’ORL et de chirurgie cervico faciale, Centre Hospitalier
Inter Communal de Créteil, F-94010, Créteil, France, Univ Paris Est Creteil, F-94010 Créteil, France, Univ
Paris Est Creteil, INSERM, IMRB, F-94010 Créteil, France; CNRS EMR 7000, F-94010 Créteil, France,
11
Délégation à la Recherche Clinique et à l'Innovation, GHICL, Hôpital Saint-Vincent-de-Paul, Faculté
Libre de Médecine de Lille, Lille, France, 12Institut Universitaire de la Face et du Cou, F-06100, Centre
Hospitalier Universitaire, Université Côte d'Azur, Nice, Alpes-Maritimes, France, 13Service de santé
publique, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France, 14Service
d’ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de
Poitiers, F-86000 Poitiers, France, 15Service d’ORL et de chirurgie cervico faciale, Hopital Fondation
Rothschild, F-75019 Paris, France, 16Service d’ORL et de chirurgie cervico faciale, Centre Hospitalier Inter
Communal de Créteil, F-94010, Créteil, France, Univ Paris Est Creteil, F-94010 Créteil, France , Univ Paris
Est Creteil, INSERM, IMRB, F-94010 Créteil, France; CNRS EMR 7000, F-94010 Créteil, France, 17Service
d’ORL pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université
Paris Cité, Paris, France, 18Service d’ORL et de chirurgie cervico faciale, Hôpital de la Croix Rousse,
Hospices Civils de Lyon, F-69004 Lyon, France, 19Service d’ORL et chirurgie cervico-faciale, Pôle clinique
des voies respiratoires, Hôpital Larrey, F-31059 Toulouse, France; Université Paul Sabatier Toulouse III;
Laboratoire Center for Anthropobiology and Genomics of Toulouse, F-31059 Toulouse, France, 20Service
d’ORL et chirurgie cervico-faciale, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France,
21
Service d'ORL et de Chirurgie Cervico-Faciale, Hôpitaux Universitaires de Strasbourg, Hôpital de
Hautepierre, 1, avenue Molière, 67200 Strasbourg, France; Unité Inserm 1121 Biomatériaux et
Bioingénierie, CRBS, 1, rue Eugène Boeckel, 67000 Strasbourg, France., 22Service d’ORL et de chirurgie
cervico-faciale, GHICL, Hôpital Saint-Vincent-de-Paul, Faculté Libre de Médecine de Lille, Lille, France,

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23
Service d’ORL et de chirurgie cervico-faciale, Hôpital Universitaire Gabriel Montpied, Clermont-
Ferrand, France, Unité de nutrition humaine, équipe ASMS UMR 1019, université clermont auvergne,
INRA, CNRH Auvergne, 24Service d’ORL et de chirurgie cervico-faciale, Hôpital Foch, Université Paris
Saclay, Paris, France, 25Service d’ORL et de chirurgie cervico faciale, Hôpital Lariboisière, Assistance
Publique des Hôpitaux de Paris, Inserm U1141, Université Paris Cité, Paris, France, 26Service d’ORL, de
Chirurgie cervico-faciale et d’audiophonologie, Hôpital Edouard Herriot, CHU Lyon, France; INSERM
U1028; CNRS UMR5292; Lyon Neuroscience Research Center, Equipe IMPACT, Lyon, France; Université
de Lyon, Lyon, France, 27Université de Lorraine, CHRU-Nancy, service ORL, F-54000, France; Université
de Lorraine, DevAH, F-54000 Nancy, France, 28Service d’ORL et de chirurgie cervico faciale, Hôpital
Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France, 29Service d'ORL et de Chirurgie Cervico
Faciale, Institut Arthur Vernes, 36, rue d'Assas, 75006 Paris, France, 30Service d'ORL et de chirurgie
cervico-faciale, Hôpital Universitaire de Nantes, Centre Hospitalier Universitaire de Nante, 1 Place A.
Ricordeau Hôtel-Dieu, F-44093 Nantes Cedex, France; INSERM, UMRS 1229, Regenerative Medicine and
Skeleton (RMeS), 31Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-
HP)/Sorbonne Université, 75013 Paris, France, 32Assistance Publique-Hôpitaux de Paris (AP-HP),
Université Paris-Saclay, Hôpital Bicêtre, Service d’ORL, 94270 Le Kremlin-Bicêtre, France, Univ Paris Est
Creteil, INSERM, IMRB, F-94010 Créteil, France; CNRS EMR 7000, F-94010 Créteil, France, 33Service d’ORL
et de chirurgie cervico faciale, Hôpital Universitaire de Caen, Caen, France, 34Service d’ORL et de
chirurgie cervico faciale, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, Paris, France,
35
Service d’ORL et de chirurgie cervico faciale, Centre Hospitalier Inter Communal de Créteil, F-94010,
Créteil, France, Univ Paris Est Creteil, F-94010 Créteil, France, 36Service d'ORL et de Chirurgie Cervico-
Faciale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67200
Strasbourg, France, 37Assistance Publique Hôpitaux de Paris, Direction des relations internationales,
Université Paris Cité, Paris, France, 38Service d’ORL et chirurgie cervico-faciale, Pôle clinique des voies
respiratoires, Hôpital Larrey, F-31059 Toulouse, France; Université Paul Sabatier Toulouse III, 39Hospices
Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie cervico-
faciale, F-69310 Pierre Bénite, France; Université de Lyon, Université Lyon 1, F-69003, Lyon, France; UMR
5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des
Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, CEDEX 07, F-69367 Lyon,
France., 40Institut Universitaire de la Face et du Cou, F-06100, Centre Hospitalier Universitaire, Université
Côte d'Azur, Nice, Alpes-Maritimes, France, Laboratoire CoBTeK, Université Côte d’Azur, Nice, France

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Among all studies describing COVID-19 clinical features, only a few retrospective studies have
assessed the correlation between olfactory dysfunction (OD) and the evolution of the disease
severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity
based on the patient’s medical management.A national, prospective, multicentre, cohort
study was conducted in twenty public hospitals and a public centre for COVID-19
screening.During the first wave of the pandemic, all patients tested positive for COVID-19
underwent two follow-up ENT consultations within 10 days of symptom onset. The main
outcome measures were the evolution of medical management (ambulatory care, standard
hospital admission, ICU admission) at diagnosis and along the clinical course of COVID-19
disease.Among 481 patients included, the prevalence of OD was 60.7%. Among patients
reporting OD, 12.3% required an hospitalization, all kind of units combined (standard medical
unit or ICU). Patients reporting OD were significantly less hospitalized than the ones managed
as outpatients, in either a standard medical unit (adjusted OR 0.32 [0.20-0.52] p<0.001) or an
ICU (adjusted OR 0.05 [0.01-0.23] p<0.001). As regards the clinical course of COVID-19 disease,
OD could predict a decreased risk of hospitalization.

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1479
Olfactory dysfunction and diabetic complications in type 2 diabetes mellitus

Arianna Cardella1, Andrea Preti2, Livio Luzi3, Francesco Mozzanica4

1
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy., 2Department of
Otorhinolaryngology, IRCCS Multimedica, Milan, Italy, 3Department of Biomedical Sciences for Health,
University of Milan, Milan, Italy, 4Department of Clinical Sciences and Community Health, University of
Milan, Milan, Italy

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Available literature suggests a link between type 2 diabetes mellitus (T2DM) and
olfactory dysfunction (OD). It is possible that the pathophysiological mechanisms driving
diabetic complications may also determine the onset of OD. The aims of this study are to
evaluate the prevalence of OD in a group of T2DM patients and in a comparable control group
and to analyze the relationship between OD and diabetic complications. Materials and
methods: 120 T2DM patients and 90 controls with comparable clinical and demographic
characteristics and age between 30 and 65 years were enrolled in the study. Each individual
underwent nasal endoscopy, olfactory testing with Extended Smell Test by “Sniffin’ sticks” and
subjective evaluation with the Italian version of the brief Questionnaire of Olfactory Disorders
(brief-IT-QOD). Data regarding disease condition, complications and laboratory tests were also
collected for T2DM patients. Statistical analysis was based on non-parametric tests and
regression analysis. Results: The prevalence of OD was significantly higher in T2DM patients
than in controls, specifically in T2DM patients suffering from complications. The same group
also reported significantly higher scores at Brief-IT-QOD. Regression analysis highlighted a
significant correlation between OD and age, glycaeted hemoglobin values and diabetic
complications. Conclusions: OD affects more frequently T2DM patients suffering from
complications and may be considered one of them.

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1503
Approach and Avoidant Coping is Associated with Olfactory-Specific Quality of Life
Outcomes in Individuals with Olfactory Dysfunction

Brandon Vilarello1, Patricia Jacobson2, Brandon J. Vilarello1, Clayton Snyder3, Tse-Hwei Choo3,
Jeremy P. Tervo1, Liam W. Gallagher1, Francesco F. Caruana1, Joseph B. Gary1, Tiana M. Saak1,
David A. Gudis4, Paule V. Joseph5, Terry E. Goldberg6, D.P. Devanand7, Jonathan B. Overdevest4

1
Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA, 2Department of
Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical
Center, New York, NY, USA, 3Division of Mental Health Data Science, New York State Psychiatric Institute,
New York, NY, USA, 4Department of Otolaryngology-Head and Neck Surgery, New York-
Presbyterian/Columbia University Irving Medical Center, New York, NY, USA, Columbia University
Vagelos College of Physicians and Surgeons, New York, NY, USA, 5National Institute of Alcohol Abuse
and Alcoholism, Section of Sensory Science and Metabolism & National Institute of Nursing Research,
Bethesda, MD, USA, 6Department of Psychiatry, New York-Presbyterian/Columbia University Irving
Medical Center, New York, NY, USA, 7Columbia University Vagelos College of Physicians and Surgeons,
New York, NY, USA, Department of Psychiatry, New York-Presbyterian/Columbia University Irving
Medical Center, New York, NY, USA

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Introduction: Olfactory dysfunction (OD) is a highly prevalent and persistent symptom of

COVID-19 infection. Smell loss has been shown to impair appetite, social relationships, and
ability to sense danger, which can greatly impact quality of life (QoL). Because coping
strategies have been shown to moderate the effect of disease symptoms on functional and
affective outcomes, the aim of this study was to determine whether certain coping strategies
moderate quality of life outcomes. Methods: Participants with subjective OD after COVID-19
infection underwent Sniffin’ Sticks olfaction testing and completed the Brief-COPE and
Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) to elicit coping
strategies and olfactory-specific QoL, respectively. ANOVA and spearman correlations were
used for statistical analysis. Results: Participants with both subjective and objective OD (n=52)
had a significantly higher mean QOD-NS score compared to the normosmic cohort (n=8)
(p<0.0001). Higher approach coping was significantly correlated with lower QOD-NS scores (p
= 0.0242), whereas avoidant coping mechanisms correlated with higher QOD-NS scores
(p=0.0444). Conclusion: Individuals with OD have notably poor olfactory-specific quality of
life. Among those with OD, approach coping mechanisms are associated with better QoL,
whereas avoidant coping tracks with worse QoL, offering opportunity to counsel patients
accordingly.

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1686
Postmortem bedside endoscopic endonasal surgical procedure as a new sampling
method for investigating the olfactory mucosa and bulb and adjacent tissues

Marnick Clijsters1, Wout Backaert1, Mona Khan2, Peter Mombaerts2, Laura Van Gerven3

1
Department of Neurosciences, Experimental Otorhinolaryngology, KULeuven, Belgium, 2Max Planck
Research Unit for Neurogenetics, Frankfurt, Germany, 3Department of Otorhinolaryngology, University
Hospitals Leuven, Belgium

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Harvesting high-quality tissue from the human olfactory mucosa and olfactory bulb has
proven challenging using existing methods such as biopsy or during autopsy. We therefore
developed a protocol for rapid postmortem bedside sampling of these tissues, using an
endoscopic endonasal surgical technique adapted from skull base surgery. It involves
complete resection of the inferior, middle, and superior turbinates to harvest respiratory
mucosa, followed by a sharp subperiosteal dissection of the entire mucosa lining the olfactory
cleft to procure olfactory cleft mucosa. The skeletonized anterior skull base is then removed,
followed by incision of the dura mater, to expose the olfactory bulb and adjacent brain regions
for sampling. With some experience in endoscopic sinus surgery, the sampling protocol can
be performed within 1 hour. In contrast to conventional autopsies, this endoscopic method
leaves no visible scars and facilitates a rapid response and logistic flexibility in various settings,
thereby drastically reducing postmortem intervals (median: 89 minutes, n=138). The large
tissue specimens of pristine quality benefit the representativity and spatial data, while
preserving the biomolecular integrity. This protocol provides an efficient and comprehensive
sampling method for histomolecular investigations of human olfactory tissues.

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1760
Smell, taste, and chemesthesis dysfunction 6-months after COVID-19 and factors
associated with complete recovery

Anna Lunicheva1, Marco Aurelio Fornazieri2, José Silva2, Juliana Gutschow Gameiro4, Henrique
Ochoa Scussiato2

1
Sechenov University, 2Universidade Estadual de Londrina, 3Sechenov University , 4Universidade
Estadual de Londrina

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Smell disorders persist in about half of the patients with other symptoms of
COVID-19 disease, the exact duration of the symptoms is yet unknown. Objectives: To
examine the recovery of olfactory, gustatory, oral chemesthetic deficits in a cohort of
individuals infected with SARS-CoV-2. Methods: Patients with confirmed COVID-19 were
tested at baseline (n=87) and six months later (n=76). The UPSIT, the Global Gustatory Test, a
test for chemesthesis were administered at all visits. Results: Olfactory function recovery was
unrelated to the hypertension OR 0,26 (0.03-2.49), p = 0,24, DM OR 0,71 (0.08-6.76), p = 0,77,
nasal diseases OR 0,74 (0.48-1.15), p = 0,18. Smoking was associated with poor recovery OR
2,08 (0.54-7.91), p = 0,28. There is no significant difference between parosmia (13%, p = 0,14)
and fantosmia at the onset of the disease (10%, p = 0,42) and 6 months later (12%, p = 0,19
and 13%, p = 0,13, respectively); parallel pattern was observed between sense of taste at
baseline OR 14,00 (12,00–15,00, p = 0,73), and at 6-month follow up OR 15,00 (13,00–16,00,
p = 0,19). After 6 months all patients reported normal chemesthesis and chemical sensation.
Future studies with larger cohorts are recommended.

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1680
Tubal auto-insufflator device is a predictor of sucessful eustachian tube ballon
tuboplasty

José Carneiro, Alice Vicente, Isa Eloi, Miguel Furtado, Franklin Marino-Sanchez, João Carlos
Ribeiro

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Objective: Eustachian tube balloon tuboplasty (ETBT) emerged as an alternative treatment

with promising outcomes in bothersome symptomatic patients with Eustachian tube
dysfuction (ETD). No objective predictor of success is known. This study aims to evaluate the
role of a tubal auto-insufflator (TAI) device as a success predictor of a ETBT. Methods:
prospective cohort study with 236 ears diagnosed with ETD underwent treatment with a TAI
device, followed by ETBT. ETD treatment response to the TAI and ETBT were assessed through
measurement of middle ear’s pressure (MEP) tympanometry, ETD symptoms (ETDQ-7) and
quality of life (SNOT-22). Results: There was a 20.4±5.6 decrease in the ETDQ-7 mean score
after TAI device and a 21.4±5.1 decrease after ETBT, comparing to baseline values (p<0.05).
Mean negative MEP increased by 41±33daPa after TAI device and 90±42daPa after ETBT
(p<0.05). Negative MEP, ETDQ-7 and SNOT-22 post-TAI device and ETBT were positively
correlated, as patients with greater benefits following medical treatment achieved better
surgical results, regarding symptom severity of ETD (ρ=0.798), MEP (ρ=0.320) and quality of
life (ρ=0.261), p<0.001. ETDQ-7 post-TAI device ≤14 predicts a normal ETDQ-7 after ETBT with
77,8% sensitivity and 76,7% specificity. Conclusion: Our study proves that a safe, simple, non-
invasive and non-drug related therapeutic device predicts successful surgery outcomes, which
may become extremely valuable to define patient groups who will benefit the most from
valuable to define patient groups who will benefit the most from ETBT.

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1466
Associations Between Olfactory Dysfunction and Cognition in Young and Middle-Aged
Adults: A Scoping Review

Jonathan Overdevest1, Patricia Jacobson2, Brandon J. Vilarello3, Nicholas A. Waring3, Jeremy

P. Tervo3, David A. Gudis2, Jonathan B. Overdevest2

1
MD, PhD, 2Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia
University Irving Medical Center, New York, NY, USA, 3Columbia University Vagelos College of Physicians
and Surgeons, New York, NY, USA

Best Oral for Junior Grant 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Introduction: Olfactory dysfunction (OD) is a precursor in neurodegenerative disease

progression and may serve as a predictor of neurocognitive decline in Alzheimer’s disease.
Research on olfaction and cognition has predominantly involved older populations who are at
highest risk for neurodegenerative disease. The aim of this scoping review was to conduct a
literature search to understand the association between cognitive outcomes and OD among
young and middle-aged adults. Methods: Comprehensive literature search of PubMed, Ovid
Embase, Web of Science and Cochrane Library identified eligible studies. The outcome of
interest was the association between OD and neurocognitive functioning in adults less than
60. Results: Of 2879 abstracts screened, 171 underwent full text review, with 73 studies
selected for data extraction. Olfactory function was measured with Sniffin’ Sticks, smell
identification tests, and smell threshold tests. Various tests of cognition measured memory,
executive function, verbal fluency, and others. A significant association between olfactory
impairment and worse cognition was found in 57 studies, while 16 studies did not find any
significant associations. Conclusion: OD may be closely associated with impaired cognition,
however, further investigation is needed to assess if these changes are age-associated with
specific neurocognitive domains and if OD etiology impacts these alterations.

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Smell and Taste 1

1135
Individualized Treatment Protocol for Long-Lasting Olfactory Dysfunction Following
COVID-19 Infection: A Prospective Study

Andre Machado1, Francisco Sousa3, Ana Silva3, Luis Meireles3

1
Department of Otolaryngology, Head and Neck Surgery, Centro Hospitalar Universitário do Porto,
Instituto de Ciências Biomédicas , 2Otolaryngology Department, CHUSA, Porto, Portugal, Faculdade de
Ciências da Saúde - Universidade da Beira Interior, Covilhã, Portugal, 3Otolaryngology Department,
CHUSA, Porto, Portugal

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Objective: The main objective of this prospective study was to evaluate the effectiveness of
non-randomized, standardized protocols for treating COVID-19 related olfactory dysfunction.
The study aimed to determine the benefit of adding adjuvant therapies to olfactory training
to treat post-COVID olfactory pathology.Methods: Patients with long-lasting post-COVID-19
olfactory dysfunction were evaluated using a non-randomized protocol based on individual
nasal endoscopy findings and patient preferences. Patients were assigned either to olfactory
training alone or olfactory training with adjuvant therapy. Results: The study enrolled 47
patients and all groups showed significant improvement in olfactory thresholds at a 3-month
follow-up, suggesting the protocol's effectiveness. Patients undergoing olfactory training with
adjuvant therapy showed better improvement in mean olfactory thresholds than those
undergoing olfactory training alone. Conclusions: This is one of the first studies to
demonstrate results in the treatment of post-COVID-19 persistent olfactory impairment. A
customized approach may be a valid option for the management of persistent post-COVID-19
olfactory disorder. Adjuvant therapy could be considered in addition to olfactory training, but
further studies are needed in order to confirm its effectiveness.

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1162
Prednisolone does not improve olfactory function after COVID-19; a randomized,
double-blind, placebo-controlled trial.

Digna Kamalski1,2, Esther Blijleven3, Emma Schepens1, Inge Stegeman1, Wilbert Boek4, Sanne
Boesveldt5, Robert Stokroos1

1
Department Otorhinolaryngology Head and Neck Surgery, University Medical Center Utrecht, The
Netherlands, 2Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center
Utrecht, Utrecht, the Netherlands, 3Esther E. Blijleven , 4Department Otorhinolaryngology, Ziekenhuis
Gelderse Vallei Ede, The Netherlands, 5Wageningen University, The Netherlands

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background Prednisolone has been suggested as a treatment for olfactory disorders after
COVID-19, but evidence is scarce. Hence, we aimed to determine the efficacy of a short high-
dose oral prednisolone treatment on patients with persistent olfactory disorders after COVID-
19. Methods We performed a randomised, double-blind, placebo-controlled, single-centered
trial. Patients were included if they were> years old and if they had persistent (>4 weeks)
olfactory disorders within 12 weeks after a confirmed COVID-19 test. The treatment group
received oral prednisolone 40mg once daily for ten days and the placebo group received
matching placebo. In addition, all patients performed olfactory training. The primary outcome
was the objective olfactory function on Sniffin’ Sticks Test (SST) 12 weeks after the start of
treatment, measured in Threshold-Discrimination-Identification (TDI) score. Results We
randomly assigned 115 patients to the treatment (n=58) or placebo group (n=57). There was
similar improvement on olfactory function in both groups after 12 weeks. Median TDI score
on SST was 26.8 (IQR 23.6-29.3) in the placebo group and 28.8 (IQR 2.0-30.9) in the
prednisolone group, with a median difference of 2.0 (95% CI 0.75 to 1.5). Conclusion This trial
shows that prednisolone does not improve olfactory function after COVID-19. Therefore, we
recommend not prescribing prednisolone for patients with persistent olfactory disorders after
COVID-19. This trial is registered on the ISRCTN registry with trial ID ISRCTN70794078.

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1163
How well do you smell?

Digna Kamalski1

1
Department Otorhinolaryngology Head and Neck Surgery, University Medical Center Utrecht, The
Netherlands

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

We often think that our smell is inferior to our other senses; as vision and hearing. But is that
really true? How do the senses compare? In this presentation you can test your own senses.
Also, you will receive background on the different working mechanisms behind them,

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1199
Evaluating Surgical Treatment for Cleft Lip Nasal Deformity on Patients’ Olfactory
Function

Dennis Frank-Ito1

1
Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center,
Durham, NC, USA

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background: Although patients with unilateral cleft lip nasal deformity (uCLND) experience
significant nasal obstruction that impact their breathing, little attention has been given to
their concomitant uCLND induced olfactory dysfunction and whether or not the standard
rhinoplasty for definitive cleft repairs is sufficient to correct patients’ airway obstruction and
restore their olfactory impairment. Methodology/Principal: This is an ongoing prospective
study. Three patients (P1, P2, P3) with uCLND who underwent rhinoplasty for definitive cleft
repairs of nasal obstruction were selected for this report. Patients’ nasal resistance (NR) was
measured before and after surgery using the NR6 Clinical/Research Rhinomanometer. Two
psychophysical olfactory tests were administered to each patient before and after surgery.
The University of Pennsylvania Smell Identification Test (SIT), and the Snap & Sniff Threshold
Test (SSTT). Results: Bilateral NR improved in all patients after surgery, but NR worsened on
the cleft-side in two patients (P1: 21.4Pa.s/ml vs 25.5Pa.s/ml; P2: 37.5Pa.s/ml vs 51.1Pa.s/ml).
Bilateral SIT improved after surgery in two patients (P2: 35 vs 36; P3: 29 vs 32) but declined in
P1 (29 vs 23). Cleft-side SSTT declined in all three patients (P1: -4.9log vol/vol vs -2.0log
vol/vol; P2: -5.9log vol/vol vs -5.8log vol/vol; P3: -5.9log vol/vol vs -5.0log vol/vol), but
noncleft-side SSTT improved in P1 and P3.Conclusion: Preliminary results suggest that current
surgical treatment may not adequately address patients’ olfactory impairment.

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1291
Anosmia in Patients with Moderate to Severe SARS-CoV-2 Infection

Konstantin Georgiev1, Yana Pacholova2, Sevda Mileva3

1
ORL Department , MBAT MMA Varna, 2Resource Center Pan, 3Department of pulmonology , MBAT
MMA Varna

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background: In a number of studies anosmia is reported as a frequent early symptom of SARS-

CoV-2 infection, associated with milder course of the disease and successful recovery.
However, there are numerous cases of hospitalized and diseased COVID patients with
anosmia. Methods: We studied 1127 patients, hospitalized in the HBAT of MMA, Varna,
Bulgaria, in the period August 2020-February 2022. The patients are divided into three groups
according to the time of the infection and probable SARS-CoV-2 variant. We compared
anosmia to the disease course, laboratory results and outcome.Results: We found
heterogeneous ratios between anosmia and the outcome of the disease in the different time
periods. In the first and second group the percentage of diseased patients with anosmia was
very low (2.5% and 4.17% respectively), while in the third group it was significantly higher
(30%), as compared to a total of 10.47% mortality rate for the whole period. Conclusions: In
patients with moderate to severe SARS-CoV-2 infection, anosmia is not a reliable prognostic
symptom for the course and outcome of the disease. The strong variability of the virus
changes the frequency of anosmia, as well as its correlation to the disease outcome.

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1300
Olfactory function in patients with parosmia and phantosmia

Rumi Sekine1, Clara Overbeck2, Eri Mori1, Antje Hähner2, Thomas Hummel2

1
Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan, 2Smell & Taste
Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Purpose: Some molecules including furfural mercaptan [FFT] and 2,6-nonadienal [Nonadienal]
are suspected to trigger parosmia. We hypothesized that altered sensitivity to these
molecules in patients with olfactory dysfunction (OD) may affect parosmia. We focused on
FFT and Nonadienal threshold of patients with parosmia (PAR), phantosmia (PHA) and
quantitative OD without either parosmia or phantosmia (ParPha-) and compared them with
healthy controls.Methods: We included 342 participants: 190 PAR, 93 PHA28, 31 ParPha- and
28 healthy controls, using structured history and investigated general otorhinolaryngologic
examination and the Sniffin’ Sticks olfactory test battery. In addition, thresholds of FFT and
Nonadienal were measured in a subset of participants.Results: Regarding Phenyl Ethyl Alcohol
(PEA) thresholds the control group scored highest followed by PAR and PHA/quantitative OD.
Interestingly, there were no significant differences in FFT and Nonadienal threshold score
between the three groups.Conclusion:PAR had better olfactory function than ParPha-.
However, sensitivity to FFT or Nonadienal did not change among the groups. As shown for two
trigger molecules for parosmia the distorted sensations are not due to an increased sensitivity
towards certain odorants, which points towards more complex mechanisms responsible for
the generation of parosmic sensations.

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1305
Trans-septal suture of the middle turbinate doesn’t impair the olfaction after
endoscopic sinus surgery in CRSwNP

Lina Piñeros, María Jesús Rojas Lechuga1, Isam Alobid1, Juan Carlos Ceballos Cantu1, Mauricio
López Chacón, Cristobal Langdon2

1
Otorhinolaryngology Department, Hospital Clínic de Barcelona, 2Otorhinolaryngology Department,
Hospital Sant Joan de Déu

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background: Many medializing techniques of the middle turbinate (MT) have been published
to prevent MT lateralization during endoscopic sinus surgery (ESS) for chronic rhinosinusitis
with nasal polyps (CRSwNP). This procedure has been questioned that it could theoretically
impair olfaction. Our study aims to measure its effect on the sense of smell. Methodology:
Quasi-experimental study measuring of the olfactory function (Barcelona Smell Test -24 /
BAST-24), sinonasal symptoms (visual analog scale / VAS), and quality of life (QoL, SNOT-22
and SF-36) was performed before and 6 months after ESS.Results: A total of 69 patients
underwent ESS (29 with and 40 without MT suture). The mean age was 49.5±1.7; 37.7% were
female. Study and control groups presented significant improvement of smell loss VAS 6
months after surgery (study group: 76.3± 5.8 to 33.4±8.3 and control group 77.7± 4.5 to
40.4±7.0), BAST-24 detection (study group: 49.0%± 8.5 to 78.9%±8.3 and control group
43.2%± 6.4 to 77.7%±7.0) and BAST-24 identification (study group: 24.4%± 5.8 to 41.8%±6.0
and control group 21.3%± 4.1 to 41.8%±4.8), with no differences between groups. Besides,
both groups experienced a significant postoperative improvement in sinonasal symptoms and
QoL. Our results determined no statistically significant differences among groups in any
area.Conclusions: Trans-septal suture of the MT does not impair the sense of smell, cause
additional sinonasal symptoms, nor affect the QoL postoperatively in patients with CRSwNP
who undergo ESS.

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1310
Does Olfactory Dysfunction Appear as a Consequence from COVID 19 Disease?
Treatment Options.

Gabriela Kopacheva -Barsova1

1
ENT University Clinic, University Campus "St. Mother Theresa", Skopje

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Aim: Hypotheses for the development of olfactory dysfunction include the loss of olfactory
sensorial neurons; damage the supporting cells in the olfactory epithelium, the neurotropic
potential of coronaviruses, and their affecting the olfactory bulbus and or olfactory – related
brain areas. Introduction: Covid 19 pandemic caused by corona come along with olfactory
loss, unlike its previous outbreaks. Loss of smell is a common complaint in adults; yet, it has
been underestimated. Anosmia, parosmia, complete loss of smell, is thought to affect at least
1% of the population, with the overall estimated prevalence of olfactory disorders now
thought to be more than 20%. Olfaction plays important roles in daily life, ranging from safety
perception, to psychosocial functions (such as recognition of emotions mediated through
body odors) and enjoyment of food and drink. Olfactory dysfunction may therefore lead to
significant morbidity in the form of nutritional disturbance, social anxiety, or depression.
Material and Methods: In our study 50 patients with PostCovid 19 olfactory dysfunction
(anosmia , parosmia, loss of smell, with and without rhinorhea) have been observed in the
period of 2020 – 2022. The patients were examined on the first examination date (nasal
endoscopy was used) The next examination dates were after 1 month, 2 months, 4 months
and 6 months after the first check. Nasal and throat smear was taken in all patients, as well as
allergy – tests, only in patients with positive anamnesis of allergic rhinitis. All of (100%)
patients were prescribed with Vitamin therapy: Omega 3 oil acids, Vit. D supplements, 40% of
patients have been treated with nasal topics steroids (Fluticasone proprionat or Budesonide),
for other 40% olfactory training was suggested, and in 20% of the patients have been
prescribed herbal nasal solutions for mucosis regeneration. Results: After 2 to 4 months we
reached the first results: the results were positive in those 45% of patients which used the
olfactory training, 30% which have been treated with nasal topics steroids, and 15% in those
who used herbal nasal solutions in combination with vitamins. In 10% of the patients there
was no improvement. Conclusion: Studies revealing the pathophysiology are important for
understanding the the postviral olfactory loss as well as developing new treatment
modalities.

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1313
SARS-CoV-2-induced inflammation and intracranial infection through the olfactory
epithelium-olfactory bulb pathway in non-human primates

Takeshi Shimizu1, Shino Shimizu1, Misako Nakayama2, Nguyen Thanh Cong2, Hirohito Ishigaki2,
Yoshinori Kitagawa2, Yasushi Itoh2

1
Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science,
2
Department of Pathology, Shiga University of Medical Science

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background: Olfactory dysfunction is a frequent symptom in patients with COVID-19.

However, the pathophysiology of SARS-CoV-2-associated olfactory dysfunction is poorly
understood. Olfactory epithelium is a unique area where the cranial nerve is exposed to the
external environment. We hypothesized that SARS-Cov-2 infection of olfactory system may
lead to intracranial infection and cause neuropsychiatric symptoms.Methods: We examined
histopathological changes of olfactory mucosa in cynomolgus and rhesus macaque model of
SARS-CoV-2 infection at day 7. Localization of N protein of SARS-CoV-2 was examined using
immunohistochemical staining and viral RNA was quantitatively measured by RT-PCR to
evaluate the intracranial infection through the olfactory epithelium-olfactory bulb
pathway.Results: SARS-CoV-2 infection induced severe inflammatory changes in olfactory
mucosa; inflammatory cell infiltration, mucus hypersecretion, edema, dilated blood vessels,
epithelial detachment and formation of nose-associated lymphoid tissues (NALT). Supporting
cells and olfactory neurons were infected and N protein of SARS-CoV-2 was detected in axons
of olfactory neurons and in olfactory bulbs. Viral RNA was detected in olfactory bulbs and
brain at day 3 and day 7. Conclusions: SARS-CoV-2 infection induces various inflammatory
responses in olfactory mucosa of cynomolgus and rhesus macaques. Olfactory epithelium-
olfactory bulb pathway may be important for the intracranial infection with SARS-CoV-2.

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1351
Olfactory and gustatory impairment and their nutritional impact in systemic cardiac
amyloidosis: a prospective study.

Emilie Bequignon1, Clémentine Hyvrard1, André Coste1, Marion Renaud2, Thibaud Damy3,
Margaux Petitjean1, Julien Lucas1, Axelle Coban1, Sophie Bartier1

1
ENT and cervico facial surgery department , Centre Hospitalier Intercommunal de Créteil, 40 Avenue de
Verdun, Créteil, 2ENT and cervico facial surgery department, Henri Mondor teaching hospital, APHP, 8
rue Gustave Eiffel, 94000 Créteil, 3Cardiology department, Henri Mondor teaching hospital, APHP, 8 rue
Gustave Eiffel, 94000 Créteil

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Introduction: Amyloidosis is a multi-systemic disease with a poor prognosis. Our objective was
to assess the prevalence of olfactory and gustatory disorders in a population with cardiac
amyloidosis (CA).Method: We enrolled prospectively patients with CA performing: nasal
endoscopy, olfaction and gustatory questionnaire, "Sniffin' Sticks" test (SST) and Taste Band
Strips test, and a nutritional evaluation (physical measurements and MNA questionnaire).
Results were compared between subtypes of CA (mutated or wild-type transthyretin and AL
(light chain)) and to standards of olfactory function in the general population.Results: Twenty-
four patients were included (mean age of 78.8 +/- 9.8 years; 58.3% of men). The mean total
score (TS) on the SST was 16.8/32 +/- 5.8: 5/24 patients (20.8%) were anosmic, 8/24 (33.3%)
hyposmic, while 4/24 (16.7%) were complaining of dysosmia. Prevalence of dysosmia was
higher than in general population. The AL group had the lowest mean TS (14.9 +/- 7.7). Taste
impairment was noted in 14/24 patients (58.3%). A high prevalence of nutritional depletion
was noted: 9/24 (37.5%) and 11/24 (45.8%) had respectively a tricipital fold below the norm
and a subnormal brachial circumference. Conclusion: This preliminary study showed that
more than 50% of CA patients have olfactory and gustatory impairments.

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1377
Efficacy of olfactory training in olfactory dysfunction associated with COVID-19: our
experience

Laura Pardo Muñoz, Paula Cruz Toro1

1
Department of Otorhinolaryngology, Hospital Germans Trias i Pujol, Barcelona, Spain

Smell and Taste 1 | Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Introduction: Olfactory dysfunction is a frequent symptom and complication associated with

SARS-CoV-2 infection. It is estimated that it occurs in 60% of patients with a complete
resolution in most cases. However, given the high global prevalence, even a small proportion
represents a high percentage of patients with olfactory sequelae. Material & Methods: A
prospective study was conducted in patients with olfactory dysfunction secondary to COVID-
19. All patients underwent anamnesis, nasal endoscopy, quality of life tests and evaluation of
orthonasal smell with “Sniffin' Sticks”. All patients with olfactory alterations were prescribed
with nasal corticosteroids and olfactory training. Evaluations with olfactometry and quality of
life tests were performed until 9 months of follow-up. Results: A total of 65 patients were
evaluated, 47 women and 18 men. The mean time between the onset of symptoms and the
first evaluation was 10 months. The main symptom was parosmia with hyposmia in 33.9%
followed by anosmia in 32.3%, hyposmia in 30.8%, and cacosmia 3.1%. After the first phase of
treatment, there was an improvement in the TDI of 5.4 points on average and an improvement
of 3.4 in the threshold subtest. Likewise, in the group who continued the olfactory training for
6 months presented an extra improvement of 4.4 points more. Conclusions: Olfactory training
is a beneficial and effective treatment and its initiation should be considered as soon as
possible in all patients who do not present spontaneous improvement.

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CRS – surgical management 2

1553
Evaluation of effect of preoperative treatment with topical steroids on bleeding during
Endoscopic Sinus Surgery. A randomized controlled pilot study.

Vera Miranda1, Tiago Santos2, Miguel Lopes1, Paulo Gonçalves1, Carlos Carvalho1

1
ENT department, Centro Hospitalar de Entre o Douro e Vouga, Aveiro, Portugal , 2ENT department,
Centro Hospitalar de Entre o Douro e Vouga, Aveiro, Portugal, Unit for Multidisciplinary Research in
Biomedicine, Institute of Biomedical Sciences Abel Salazar, Universidade do Porto

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: Functional endoscopic sinus surgery (FESS) is frequently indicated in Chronic

Rhinosinusitis. Bleeding impairs the surgery field and increases the risk and time during FESS.
Evidence suggest that oral steroids can reduce bleeding in FESS.Objective: To evaluate the
preoperative effect of topical steroids in surgical field quality and bleeding during
FESS.Methods: We prospectively enrolled 23 patients with FESS indication in a single-blind
randomized pilot study. All patients completed the SNOT-22 questionnaire and underwent
clinical evaluation and anamnestic data collection. Eosinophils and IgE serum levels and Lund-
Mackay score were also collected. The included patients were randomly assigned in two
groups. The intervention group(A) received a daily prescription of nasal steroid (fluticasone
furoate, 55µg/day) 2 weeks before surgery. The control group(B) was instructed to don't use
nasal steroids in the same period. The surgery was performed under total intravenous
anesthesia, topical and local anesthesia, through the same protocol. The surgical field quality
was assessed every 20 minutes by two surgeons. The operating room occupation and the
operating time were collected.Results: The two groups were similar in their overall
demographic and clinical characteristics. A better surgical field quality was found in group A,
although there was no statistically significant. The operating room occupation time was
significantly lower in the group A (p=0.022).Conclusion: Nasal steroids treatment can improve
the surgical field quality during FESS and reduce surgery time.

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1574
Management strategy for Chronic Rhinosinusitis with asthma

Jianbo Shi1

1
The First Affiliated Hospital of Sun Yat-sen University

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: Chronic rhinosinusitis (CRS) with asthma is considered as an unique subgroup of

CRS, with specific clinical manifestation, pathophysiologic mechanism and poor treatment
outcome. However, the long-term outcome of sinus surgery is
unknown.Methodology/Principal: Eighty CRS patients with asthma who underwent
endoscopic sinus surgery were recruited. Seventy-three were follow-up for more than 5 years
(8.22±2.75 years). Results: VAS scores of general symptoms were significant improved
(4.09±3.56 vs preoperative 8.56± 9.66, p<0.01). However, only 23% of patients (17/73)
remained controlled. 34% (25/73) of patients had revision surgery. Conclusions: Endoscopic
sinus surgery improved the symptoms of CRS in the long-term follow-up. However the long-
term outcome of endoscopic sinus surgery is unsatisfying.

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1590
Extended frontal sinus surgery: novel modifications for better outcome.

Ksenia Klimenko1

1
Federal State Government Institution of Postgraduate Education “Central State Medical Academy”
President’s Administration of Rus, 2Federal State Government Institution of Postgraduate Education
“Central State Medical Academy” President’s Administration of Russia

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Objective. Modified Lothrop procedure (MLP) has become a procedure of choice in selected
cases of severe forms of frontal sinusitis. Nevertheless, the problem of technical difficulties as
well as a high risk of postoperative scarring of frontal sinus neo-ostium represent a significant
problem nowadays. We introduced several technical tips for better intraoperative orientation
as well as grafting technique for postoperative scarring prophylaxis. Materials and
methods.MLP in our modification was performed in 43 patients. The technical innovations
included anterior boarder of drilling definition, dominant frontal sinus definition, M-sign and
grafting technique to cove a raw bone. Results of perioperative complications rate, pre- and
postoperative paranasal CT scan data (Lund-Mackay scale), SNOT 22, postoperative scarring
and need for revision procedure rate were analyzed. Average follow-up period was 22,8
(12;72) months. Results.There were no perioperative major complications in any patient.
Postoperative scarring rate with need for revision surgery occurred in two patients (4,7%).
There was statistically significant decrease in SNOT-22 and L-M-scale rates in long-term
postoperatively. Conclusions.The modified Lothrop procedure with tips introduced is highly
effective in surgical treatment of severe forms of frontal sinusitis and gives reliable long-term
results.

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1594
Where are we with total intravenous anesthesia versus inhalational anaesthetic
during endoscopic sinus surgery? - A cutting-edge review

Andre Machado1, Thomas Radulesco3, Christian Calvo-Henriquez4, Mariline Santos5, Ana

Silva5, Luis Meireles5

1
Department of Otolaryngology, Head and Neck Surgery, Centro Hospitalar Universitário do Porto;
Faculdade de Ciências da Saúde - , 2Otolaryngology Department, CHUSA, Porto, Portugal, Faculdade de
Ciências da Saúde - Universidade da Beira Interior, Covilhã, Portugal, 3Service ORL et Chirurgie Cervico-
Faciale CHU La Conception, Marseille, France, 4Complejo Hospitalario Universitario de Santiago, Spain,
5
Otolaryngology Department, CHUSA, Porto, Portugal

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Introduction: Endoscopic sinus surgery (ESS) is a surgical procedure that can be used to treat
chronic rhinosinusitis that is refractory to medical management. Intraoperative bleeding
during endoscopic sinus surgery can be challenging due to the narrow sinonasal surgical field,
single working hand, and the use of endoscopic instruments, which may affect hemostasis.
There is a role for the type of used anesthesia for intraoperative bleeding control. Total
intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are the two most used
anesthetic techniques during ESS. While both techniques have their advantages and
disadvantages, there is a need to compare their efficacy and safety to determine which
technique is more appropriate for ESS. In this review, our main focus was to summarize the
current evidence about the different types of anesthesia used in ESS. Methods: Systematic
review of the PubMed/MEDLINE database using specific terms related to TIVA and IA in ESS,
in English. Results: A total of 548 publications were considered. Among these, 329 studies did
not fulfill the criteria for inclusion in the systematic review, resulting in the inclusion of only
132 publications – 13 systematic reviews, 32 reviews, 92 randomized controlled trials, 13
meta-analysis. Conclusion: The state-of-art favors the use of TIVA in ESS due its significant
improvement in the intra-operative surgical field during ESS with less blood loss. Further
studies that aim to compare long-term nasal status with objective tools, ideally in similar
pathology with the same surgeon

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1596
Diagnosis and treatment of intracanal optic nerve cavernous hemangioma：a case
report

Liu Wendong1, Chen Fenghong1, Zhang Minjuan2, Zuo Kejun1, Shi Jianbo1

1
The First Affiliated Hospital, Sun Yat-sen University,, 2The First Affiliated Hospital, Sun Yat-sen
University

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Here we report a 42-year-old female complaining of loss of vision and visual field defect in the
left eye (BCVA 0.1), who was diagnosed with cavernous hemangioma in the left optic canal.
The size of the cavernous hemangioma lesion was 3.5 mm × 6.2 mm. We performed
transnasal endoscopic optic canal and orbital decompression and orbital cavernous
hemangioma resection without the assistance of a navigation system. After the surgery, her
left vision was enhanced to 1.0 with normal visual field, eye position and movement. Orbital
cavernous hemangioma is a venous malformation originating in the orbit, which can be
located inside the cone, outside the cone, or in the optic canal. Depending on the location of
the lesion, different surgical approaches can be selected, such as anterior orbitotomy, lateral
orbitotomy, medial orbitotomy, a combination of internal and external approaches,
transnasal endoscopy, or endoscopic-assisted orbitotomy. Surgery for cavernous
hemangioma in the orbital apex and optic canal is fairly challenging. The principle of surgery
is carefully and elaborately separating and resection of the lesion, protection of the optic
nerve, and avoiding damage to the ophthalmic artery and extraocular muscles. The operation
requires precise positioning, less bleeding, and complete lesion removal.

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1600
TREATMENT OF FRONTOETHMOIDAL OSTEOMAS

Eduardo Figueroa, Carlos Ruggeri

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: Osteomas are benign, slow-growing tumors that primarily affect the frontal and
ethmoid sinus. Most are asymptomatic and are diagnosed as imaging findings. When they
produce symptoms, treatment is surgical. The surgical approach can be external, endonasal
with endoscopes or combined. Objective: To determine the efficacy of surgery to resect
symptomatic frontoethmoidal osteomas, and to establish the factors that could facilitate an
endonasal endoscopic approach. Place of application: Otorhinolaryngology Department,
Hospital Italiano de Buenos Aires. Design: Descriptive and retrospective study. Population:
Patients older than 18 years old operated for frontoethmoidal osteomas. Methods: Patients
who were surgically treated for symptomatic frontal and ethmoidal sinus osteomas between
August 2007 and June 2022. They were evaluated by nasal endoscopy and non-contrast
computed tomography (CT) of the facial mass. In frontal osteomas, an endonasal approach
with endoscopes (Draf IIa with prebullar and Lothrop technique) and osteoplastic surgery
without obliteration was performed. In the ethmoid ones, anterior ethmoidectomy with
resection of the same. Results: Ten patients were treated surgically. Two patients had
ethmoid osteomas and one had ethmoid-sphenoid osteomas. A complete resection was
performed, and tumor reduction in the one with extension to the sphenoid. Other five
patients presented osteomas in the frontal sinus. In all of them a complete resection of the
lesion was performed. No recurrences were evidenced at 2 years of follow-up, with resolution
of the initial

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1639
Outcome After Nasal Polyposis surgery after a Minimum Observation of 10 Years

stephan Vlaminck1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Objective: In this study, we aim to estimate disease recurrence during a long-term follow-up,
together with the investigationof possible predicting and/or influencing parameters.Methods:
Out of 196 patients operated for CRSwNP between 01/2000 and 01/2006, 133 patients had a
follow-up of atleast 10 years and could be included. The inflammatory profile at surgery was
determined on nasal tissue and sinonasalsecretions, and included analysis of eosinophils,
eosinophilic-rich mucus (ERM) typically containing Charcot-Leyden crystals(CLC), and fungal
hyphae (FH). During follow-up, recurrence, received treatments and comorbidities were
collected.Results: Out of the 133 included patients, local eosinophilia was present in 81% and
ERM in 60%. Recurrence during followupwas observed in 62%, and was associated with local
eosinophilia and ERM (both p<0.001). Asthma was present in 28% atinclusion, and 17%
developed asthma after surgery during follow-up. The presence of asthma, at inclusion as well
asdeveloped during follow-up, was significantly associated with recurrence of CRSwNP
(p¼0.001 for group comparison).Conclusion: Recurrence after CRSwNP surgery is common
when a long-term follow-up is taken into account. ERMdetected in sinonasal secretions at
surgery seems to be a predictive factor for recurrence and need for revision surgery.Asthma
is a frequently found comorbid factor in CRSwNP, develops even at higher age despite surgical
treatment forCRSwNP, and is also associated with a higher recurrence rate. Sustained medical
care after surgery is mandatory.

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1656
The use of a 90-degree endoscope for the visualization of the maxillary sinus

Anastasia Lebedeva, Ksenia Klimenko1

1
Department of Otorhinolaryngology of Central State Medical Academy, 121359, bldg. 1, 19 Marshala
Tymoshenko street, Moscow, Russia

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Objectives: Middle antrostomy (MA) is the “gold standard” of surgery management of chronic
maxillary sinusitis. However, the lack of visualization of anterior-medial areas of the maxillary
sinus (MS) is one of the main factors of completing additional approaches. The use of
endoscopes with a wide field of view allows to upsize the visualization and reduce the number
of additional or alternative accesses to MS. Materials and methods: The research includes 50
MSs with a pathological process mainly in anterior-medial areas with the following nosologies:
fungal ball, retention cyst, foreign body and antrochoanal polyp. We have evaluated the
visualization of the pathological process with and without using a 90° endoscope. Results: The
90° endoscope allows to reliably improve the visualization of MS in 40 cases (80%) when it
takes place in the anterior regions. In 5 cases (20%) the visualization of the pathological
process is fully achieved using a 70° endoscope. In 1 case (2%), an additional (prelacrimal)
access was performed for the full reach of the instruments. Conclusion: the use of a 90°
endoscope allows us to visualize anterior-medial areas of the MS which reduces the formation
of additional approaches by improvement in visual control.

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1693
Long-term effectiveness of extended endonasal endoscopic approaches in chronic
rhinosinusitis with nasal polyps

Daniel Martin-Jimenez1, Ramon Moreno-Luna1, Jaime Gonzalez-Garcia1, Serafin Sanchez-

Gomez1, Juan Maza-Solano1

1
Department of Otolaryngology, Universitary Hospital Virgen Macarena, Seville, Spain

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: Endoscopic sinus surgery (ESS) constitutes one of the main aspects in treatment
of chronic rhinosinusitis with nasal polyps (CRSwNP). Different surgical approaches have been
described, but the accurate evaluation of extension and its effectiveness in terms of QoL,
healing and revision surgery rates is becoming mandatory. Methods: Moderate-to-severe
CRSwNP patients were selected for a retrospective cohorts’ study in two groups: extended
ESS versus functional ESS. Endoscopic, radiological and clinical outcomes were compared from
baseline to 2-years after ESS. Multivariate linear regression model was calculated to assess
potential confounding effect estimates, being the main outcome of interest the SNOT-22
relative change. To identify the features most strongly associated by obtaining the minimal
clinically important difference (MCID), a multivariate logistic regression algorithm was
performed. Results: 274 patients were included. NPS, Lund Mackay and SNOT-22 showed
significant differences before and after surgery in both groups, with higher improvement in
extended ESS group. A significantly increase of 14.8 units in SNOT-22 for patients undergoing
extended surgeries was observed by linear regression. In multiple logistic regression model,
an achievement of MCID was associated with extended ESS (OR=6.49) and history of previous
ESS (OR=0.17). Conclusion: Extended ESS is a more effective treatment of moderate-to-severe
CRSwNP, providing better endoscopic, radiological and QoL outcomes two-years after
surgery, irrespectively of different phenotypes.

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1710
Radiological and Intraoperative Findings in Revision Endoscopic Sinus Surgery – Do we
fail in primary surgery?

Tiago Colaco1, Tiago Branco1, Luís Castelhano1, Filipe Correia1, Pedro Escada2

1
Serviço de ORL do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal, 2 Serviço de
ORL do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

IntroductionFunctional Endoscopic Sinus Surgery (FEES) is widely accepted as an effective

surgical procedure for treatment of chronic rhinosinusitis refractory to medical therapy.
However, aggressive disease and/or anatomical variables can cause a recurrent or persistent
mucosal disease, leading to a revision surgery. ObjectiveTo describe the radiological and
intraoperative findings of patients that underwent revision endoscopic sinus
surgery. MethodsRetrospective review of patients that went under FEES surgery between
January 2017 and December 2022 in a tertiary hospital. ResultsA total of 50 nasal cavities were
revised. Two-thirds were female and mean age was 54.2 years old. Patients underwent
primary surgery 60 months before, on average (n=28). 83.3% underwent surgery due to
recurrent disease and 16.7% due to complications attributed to primary surgery (mucoceles).
The most frequent radiological and intraoperative findings were incompletely removed cells
in frontal recess (86.6%), incomplete anterior ethmoidectomy (48.0%), presence of agger nasi
(34.0%), incomplete posterior ethmoidectomy (26.0%) and neo-osteogenesis (18.0%). Three
minor complications were recorded. ConclusionsMost revision cases were performed due to
persistent or recurrent sinus disease. Nevertheless, systematic findings in those patients
suggest that incomplete dissection of some bony structures in primary surgery can be part of
the problem. Before a revision surgery, the surgeon should carefully analyze the sinus CT scan
to anticipate potential failures of the primary surgery.

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1765
Open approach and reconstruction techniques on nasosinusal tumors – impact on the
nasolacrimal system

José Pais1, Tiago Colaço2, Miguel Magalhaes3, Catarina Tinoco3, Ana Duarte3

1
CUF Tejo/IPO Lisboa, 2Hospital Egas moniz/IPO Lisboa, 3IPO Lisboa, 4Hospital Egas Moniz/IPO Lisboa

CRS – surgical management 2| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Introduction: Open approaches to sinus lesions are used for decades. Recently, reconstruction
techniques have been added to improve aesthetics, solve complications and avoid loss of
function. However, these reconstruction techniques can compromise th lacrimal drainage.
Objective: To identify factors contributing to obstructive nasolacrimal symptomatology in
patients submitted to open approach and reconstruction techniques in the treatment of
nasosinusal tumors. Methods: A retrospective study was performed identifying patients
submitted to open-approach techniques to treat nasosinusal lesions in a tertiary oncology
center. Data regarding etiology, staging, approach, the extent of the maxillectomy, orbital
floor implantation, and other reconstruction techniques were collected and analyzed in SPSS
version 28. Results: We included 48 patients in the study. Of these, 12 out of 23 (52%) patients
submitted to reconstruction techniques (including orbital floor reconstruction, temporal flaps,
scapular flaps, or septal flaps) and 3 out of 25 (12%) patients with no reconstructions
techniques, showed obstructive symptoms of the lacrimal system. Discussion/ConclusionThe
results of the group not submitted to reconstruction techniques are similar to previous
studies. A comparison between this group and the group submitted to reconstruction
techniques showed a higher percentage of the latter. This may result from inflammation,
synechia presence, or direct obliteration of the nasolacrimal duct. When opting for
reconstruction techniques, the nasolacrimal system should be reminded.

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Snoring and OSA 1

1144
Gender-specific association between obstructive sleep apnea and cognitive
impairment among adults

Minzi Mao1, Ke Qiu1, Jianjun Ren2, Yu Zhao2

1
Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan
University, Chengdu, Sichuan, China, 2 Department of Oto-Rhino-Laryngology, West China Hospital,
Sichuan University, Chengdu, Sichuan, China

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

To explore the gender-specific association between obstructive sleep apnea (OSA) and
cognitive impairment. Participants from UK biobank who have completed at least one of the
five baseline cognitive tests were included, which were initially divided into two groups based
on gender and were further categorized into three subgroups: OSA, self-reported snoring but
without OSA, and healthy controls (without OSA or snoring). Multivariable regression analysis
was performed to examine the associations among snoring, OSA and performance of each of
the five cognitive domains. A total of 267,889 participants (47% male, mean age: 57 years old)
were included in our study. In the multivariable regression analysis, female participants in the
OSA group had a higher risk of having poor prospective memory (OR: 1.24, 95% CI:1.02～1.50,
p=0.03). Meanwhile, OSA were inversely associated with the performances of fluid
intelligence (β:0.29, 95% CI: 0.46～-0.13, p<0.001) and short-numeric memory (β:0.14, 95%
CI: 0.35～0.08, p=0.02). Besides, age-related subgroup analyses showed that these
associations were largely reserved in younger (＜65 years old) female participants rather than
older female participants. In contrast, among male participants, no significant association was
observed between OSA and impairment of the five cognitive domains. OSA was significantly
associated with cognitive impairment at certain dimensions in female participants rather than
in male participants, indicating that more special attention and timely interventions should be
given to younger female OSA patients.

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1202
Self-reported snoring and risk of incident gastro-esophageal reflux disease in the UK
Biobank

LI Junhong1, Yang XU1, Yu ZHAO1, Jianjun Ren1

1
Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Introduction: The association between snoring and gastro-esophageal reflux disease (GERD)
remains unclear. Methods: UK Biobank participants recruited during 2006 and 2010 with self-
reported snoring information available were included, and individuals who were diagnosed
with GERD at recruitment were excluded. The follow-up information included data available
until 2021. Univariate and multivariate logistic regression models were used to access the
association between self-reported snoring and GERD. Subgroup analyses stratified by sex and
body mass index (BMI) categories were conducted, and the interactions between snoring and
sex/BMI were evaluated. Sensitivity analyses using more stringent definition of GERD were
conducted to test the robustness of the results. Results: A total of 429,064 participants were
included, with 29,697 developed GERD during follow-up. Snoring was associated with a higher
risk of GERD (odds ratio, OR=1.12, p<0.001), and this association was more prominent in
females than that in males (males: OR=1.06, p=0.049; females: OR=1.17, p<0.001, p-value for
interaction<0.001), while no significant effect differences were observed in participants with
different BMI categories (p-value for interaction=0.26). Consistent results were observed in
sensitivity analyses of different GERD definition. Conclusion: There was a robust higher risk of
incident GERD in participants with self-reported snoring compared with those without
snoring, with the trend more obvious in females.

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1206
DISE with PAP: A method for better compliance and individualized treatment of
patients with OSA

Michaela Mladoňová1, Petr Matoušek2, Pavel Komínek2, Martin Formánek1

1
Department of Craniofacial Surgery - Faculty of Medicine, 2Department of Otorhinolaryngology, Head
and Neck Surgery, Ostrava

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

IntroductionIn this study, we aimed to observe the effects of positive airway pressure (PAP)
on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper
airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and
to identify cases in which PAP was ineffective.MethodsThis prospective study was conducted
from June 2018 to December 2022. PAP testing was performed during DISE in patients with
moderate and severe OSA. The pressure was gradually increased in the range from 6.0 to 18.0
hPa. Our findings were evaluated using the VOTE classification.ResultsThe examination was
performed in 56 patients, with a median apnea-hypopnea index (AHI) of 26.4. Complete
obstruction of the soft palate was observed in 51/56 patients (91%), oropharyngeal
obstruction in 15/56 patients (27%), tongue base obstruction in 23/56 patients (41%), and
epiglottic collapse in 16/56 patients (29%). PAP was most effective in cases of complete
oropharyngeal obstruction, where the mean opening pressure was 11.1 hPa. PAP was least
effective in cases of epiglottic collapse, where it was ineffective in 11/16 patients.Conclusions
DISE and PAP is a simple diagnostic method, which can be helpful for identifying anatomic and
dynamic reasons for PAP intolerance. The main indication is ineffective PAP treatment.

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1567
Obstructive sleep apnea and interstitial lung disease overlap syndrome: A new
underestimated and undertreated syndrome entity.

MOHAMED ABDELGHANY1

1
Assistant professor of chest diseases Assiut university hospital ,Egypt

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

INTRODUCTIONInterstitial lung diseases (ILDs) are a group of heterogeneous disorders

characterised by varying degrees of fibrosis and inflammation of lung parenchyma.
Obstructive sleep apnoea is a type of sleep disordered breathing characterised by repeated
episodes of apnoea and hypopnoea during sleep due to narrowing or occlusion of the upper
airway. Studies conducted in the western world have found the prevalence of OSA to be
around 80% among patients with idiopathic pulmonary fibrosis (IPF). RESULTS Eighty-one
obese patients with ILD and BMI above 37 (55 females and 26 males, mean age 67.8 ± 9.2)
were studied.The mean BMI was 39.4 ± 2.4. Out of 81 obese patients diagnosed as ILD, 66
(81.5 %) were diagnosed to have OSA by overnight PSG. The mean forced expiratory volume
in first second (FEV1) /forced vital capacity (FVC) was 79.14± 3.673. Forced vital
capacity (FVC) 58.80 ±16.192 % predicted.Blood gas analysis presented a mean pH of 7.41
± 0.02, a mean PO2 of 45.14±9.250mmHg, and a mean PCO2 of 53.06±14.676
mmHg.Echocardiographic assessment of all studied group revealed ejection fraction EF
61.23±6.489and pulmonary artery systolic pressure PASP 44.58 ±18.258.All the patients
underwent overnight complete polysomnography. Diagnosis of OSA was based on (AHI)>5 on
PSG as per guidelines of the American Academy of Sleep Medicine. The mean AHI of all studied
group was 24.63± 13.776.All studied subjects underwent radiological assessment with high
resolution computed tomography HRCT Chest and severity of interstitial affection was
classified according to into: Mild 21 patient 25.9 %,Moderate 27patient 33.3%, Severe
17 patient21.0%, Honeycombing 8 patient 9.9%,Advanced honeycombing 8
patient 9.9%.Correlation between AHI and HRCT Chest revealed significant relation as
regards presence of honeycombing and advanced honeycombing in HRCT: mild HRCT pattern
mean. 18.67±9.409Pvalue.939, Moderate HRCT pattern mean 17.70±13.845Pvalue.939,
Severe HRCT pattern mean 27.82±10.187Pvalue.045, Honeycombing HRCT pattern mean
42.00±4.27Pvalue.000, Advanced honeycombing HRCT pattern mean 39.50±5.880P
value.000.Insignificant correlation was found between RDI and all parameters of functional
assessment of ILD as regards PCO2 , PO2, FEV1/FVC, FVC, EF, PASP: Pvalue 0.748,
Pvalue 0.469, Pvalue0.040, Pvalue0.020, Pvalue0.114, Pvalue 0.258, Pvalue 0.768
respectively.IPF constituted most of the patients (n=56) followed by connective tissue disease
(n=11), hypersensitivity pneumonitis ( n=14).CONCLUSION There was a high incidence rate of
OSA in obese patients with ILD. The results of the present study show that all obese patients
with ILD should be screened for OSA at the time of initial evaluation.

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1650
Is there a correlation between nasal symptoms and CPAP usage in patients with
obstructive sleep apnoea? A prospective cohort study.

Stergios Lialiaris1, Konstantinos Chaidas2, Kallirroi Lamprou3, Amberley Munnings4, Melina

Katsilidou1, John Stradling3, Annabel Nickol3

1
ENT Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece, 2ENT Department,
Oxford University Hospitals NHS Foundation Trust, Oxford, UK - ENT Department, Medical School,
Democritus University of Thrace, Alexandroupolis, Greece, 3Oxford Centre for Respiratory Medicine,
Oxford University Hospitals NHS Foundation Trust, Oxford, UK, 4ENT Department, Oxford University
Hospitals NHS Foundation Trust, Oxford, UK

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Introduction:The role of nasal symptoms in continuous positive airway pressure (CPAP)

adherence is not completely clear. The aim of this study was to investigate the correlation
between nasal symptoms and CPAP usage in patients with obstructive sleep apnoea
(OSA).Methods:Two hundred thirty patients were studied and divided into high-, low-, and
non-CPAP users. Predictive factors for CPAP usage were investigated. Nasal symptoms and
related quality of life parameters were evaluated prior to CPAP initiation and after three
months.Results:There were significantly worse baseline scores for rhinorrhoea in non-CPAP
users compared with high and low users (1.34 vs. 0.68 and 0.75, respectively, p = 0.006). There
were no other significant differences between the groups. Rhinorrhoea was an independent
predictive factor for lower CPAP usage (p = 0.036). There was a worsening in rhinorrhoea score
in high-CPAP users (p = 0.025) but not in low- and non-users at the three-month assessment.
There were no significant changes in other nasal symptoms.Conclusions:This study reveals
that runny nose was the only symptom associated with poorer CPAP adherence. Furthermore,
runny nose worsened after a three-month trial of high-CPAP usage.

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1703
Innovative and cost-efficient methods for the prediction of obstructive sleep apnoea

Viktória Molnár1, László Tamás1, László Kunos2, Zoltán Lakner3

1
Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, 2Department of
Pulmonology, Törökbálint, 3Hungarian University of Agriculture and Life Sciences

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Objective Our aim was to investigate the applicability of artificial intelligence (AI) for the
prediction of obstructive sleep apnoea (OSA), based on simple anthropometric, demographic
and questionnaire parameters. Our research objective was to develop a simple, practical and
reliable prediction system. Methods The 100 patients were divided into control-, and mild,
moderately severe-severe OSA-groups based on the results of the polysomnography
performed. The Berlin and Epworth questionnaires were completed and anthropometric
measurements were performed.Results AI OSA prediction for evaluation of BMI, age and
gender yielded an 81% accuracy of classification while the accuracy of OSA severity
categorization based on the same parameters was 64%. With the completion of the
questionnaires accuracy increased to 83%. The Berlin questionnaire alone yielded a correct
OSA prediction in 62%, while the Epworth questionnaire in 75% of all cases. The best results
for categorization by severity were obtained by combining age, gender and BMI parameters,
and responses to the questionnaires (71%). This result improves slightly supplemented with
neck circumference (73%). Conclusion The AI evaluation of demographic data and
anthropometric parameters as well as questionnaire-based results offers a cost-effective and
rapid diagnostic alternative in primary care and for postoperative risk assessment of
previously undiagnosed OSA patients.

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1717
Increased tissue necrosis and fibrosis without epithelial injury of high-intensity
focused ultrasound treated tonsil

Seung Koo Yang1, Sung Woo Cho1, Chae-Seo Rhee1

1
Seoul National University Bundang Hospital

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Introduction A non-invasive High-intensity focused ultrasound (HIFU) ablation may be a good

option for alternative treatment to reduce tonsillar hypertrophy in obstructive sleep apnea
(OSA).Method Consecutive in-vivo stimulations of HIFU to palatine tonsils of three living pig
models (Sus scrofa, weighing approximately 20 kg each and aged 1–2 months) were
performed. Stimulations were performed at baseline (pig 1,2,3) and were repeated after
2weeks (pig 2,3) and 4 weeks (pig 3). Thickness of the palatine tonsil were measured by
ultrasonography. Histological analyses were performed, with Sirius red staining,
immunohistochemistry with TFG-B1, and TUNNEL staining. Additional ex-vivo stimulation of
7 human tonsil tissue was performed right after completion of tonsillectomy. Result No
surface lesion had been identified after the stimulation. The thickness of tonsil decreased with
repeated HIFU treatment. On histological analysis, epithelial layers were all intact. Higher
amount of tissue fibrosis were noted from the HIFU stimulated tonsil tissue compared to
control tissue. In tunnel staining, the mean intensity ratio of ablated tonsils were higher
compared to control tonsil. Ex-vivo stimulation of human tonsil also revealed a significantly
higher mean intensity in HIFU ablated tissue. Conclusion HIFU stimulation of palatine tonsil
reduces tonsil size by inducing tissue necrosis followed by increased fibrosis without epithelial
injury. Therefore, HIFU may be an alternative treatment option for palatine tonsillar
hypertrophy in OSA patients. Our results warrant further human cl

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1739
The role of drug induced sleep endoscopy in the indication of surgical therapy in
obstructive sleep apnoe syndrome

Ágnes Szalenko-Tőkés1, Zsolt Bella1

1
Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Albert Szent-Gyorgyi Medical
School, University of Szeged, Szeged, Hungary

Snoring and OSA 1| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Introduction: The two cornerstones of obstructive sleep apnoe syndrome (OSAS) diagnostics
is the sleep study performed by a somnologist, which determines the severity of the
complaints, and the drug induced sleep endoscopy (DISE), which provides a
topodiagnosis.Methods: A 5 year retrospective study of patients with OSAS (N=292). The
authors introduced the basic principles of DISE, the results of topodiagnostic examinations
and the ratio of the main types of surgery indicated.Results: In childhood, OSAS is primarily
caused by adenoid and tonsillary hyperplasia, while in the case of congenital developmental
disorders, changes in the hypopharynx and larynx are the most common. In childhood (14%)
the most frequent intervention were adenotomy 82%, tonsillotomy 59% and lingual
tonsillotomy 11%. In adults (86%), the obstruction is usually multifaceted therefore, the
solution can be simultaneous or multilevel surgery. Most common interventions: septoplasty
34% with anterior inferior turbinoplasty 33-39% followed by uvulo-palato-pharyngoplasty
29% and lingual tonsillotomy 18%. Conclusion: Children with Friedman Grade II–III tonsils
exhibit "kissing tonsils" and signs of obstructive sleep apnea syndrome a few months after
adenotomy. When adult patients who underwent tonsillo-adenotomies as children present
with obstructive sleep apnea syndrome, the enlargement of the lingual tonsils is typically the
underlying cause.

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Skull base surgery 2 / CSF leaks and management

1207
Bipolar high frequency electric welding of dural defects in radical resection of frontal
sinus tumors with intracranial invasion

Olena Kvasha, Diana Zabolotna1

1
Institute of Otolaryngology named after prof. O. Kolomiychenko of the National Academy of Medical
Science of Ukraine, Kyiv, Ukraine

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

The aim of study is to develop a new method of connecting the dura mater (DM) defects in
frontal sinus tumors with intracranial spread, which would allow to avoid intra- and
postoperative complications as much as possible. Depending on the method of dura mater
defect repair, patients were divided into 2 groups (62 patients). The 1st group (N=29) (control)
included patients whose DM defects was connected according to the conventional method
(suturing with polypropylene threads), in the 2nd group (N=33) – the DM defects was
connected by high-frequency bipolar electric welding. We propose an effective method of
connecting the DM defects after the removal of frontal sinus tumors spreading intracranially.
This was possible due to the supply of current with certain wave characteristics in a certain
modulation at a temperature of 40-48°C, resulting in the connection of tissues without the
formation of a coagulation scab due to the mechanism of protein-associated electrothermal
adhesion of tissues. We studied all clinical indicators, studied the frequency of postoperative
liquefaction in both groups of patients. We`ve also studied the peculiarities of the structure
of the tissues of the junction of the DM and the DM with fascia lata, connected by high-
frequency bipolar electric welding, by morphological methods and methods of confocal
infrared spectroscopy. Presented data indicate significant advantages of using high-frequency
bipolar electric welding to restore DM, compared to the traditional suture method. This
approach has reduced intra- and postoperative complications, the time of surgery, and the
length of the postoperative period.

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1570
Unilateral nasal mass: a meningoencephalocele case report

Cláudia Santos1, Anita Paupério1, Mariana Neto1, Gonçalo Pereira2, Catarina Araújo2, Carla
André1, Luis Antunes1

1
ENT department, Hospital Garcia de Orta, Almada - Portugal, 2Internal Medicine department, Hospital
Garcia de Orta, Almada – Portugal

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Introduction:Nasal meningoencephalocele (NM) is a herniation of the cranial contents

(meninges and brain tissue) into the nose through a skull-based defect. This is an uncommon
condition, and could be congenital, traumatic or spontaneous.Case report:A 63-year-old
female, diagnosed with arterial hypertension, chronic renal dysfunction and obstructive sleep
apnea, presented at the emergency with a severe frontal headache at left side, as aggravating
factors she identified the orthostatic position and Valsalva maneuver. For the past four years
she had a left unilateral nasal discharge and hyposmia that she related to a car accident years
before. At the nasal endoscopy, in the left nostril, was seen a whitish, vascularised, pulsatile
mass with apparent origin at the ethmoidal roof, medial to the middle turbinate, and a clear
fluid at the anterior side of the mass. The beta-trace protein test performed on nasal
secretions was compatible with cerebrospinal fluid (CSF). The paranasal sinuses computed
tomography scan showed, on the left, a cribriform plate fracture apparently related to the
nasal mass. The magnetic resonance imaging scan suggested a left NM. A endoscopic
nasosinusal surgery (ENS) was performed with closure of the CSF fistula.Conclusion: The
patient's history, physical examination findings and imaging are essential for the differential
diagnosis of a unilateral nasal mass, allowing the diagnosis of a rare entity such as
meningoencephalocele. ENS is effective and safe for meningoencephalocele approach and for
CSF fistula repair.

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1573
Ecchordosis physaliphora: Five case reports and brief review of the literature.

GIOLINA PAPARGYRIOU1, PANAGIOTIS PYRGAKIS2, VASILEIOS CHATZINAKIS1, ARGYRO

LEVENTI1, IOANNIS GERAMAS1, CHRISTOS GEORGALAS1
1
Endoscopic Skull Base Centre of Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23
Marousi, Athens, Greece, 2Athens General Hospital Evangelismos, Ipsilantou 45-47, Athina , 106 76

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Ecchordosis physaliphora (EP) is a rare, benign hamartomatous remnant of the vestigial

notochord that can be found across the craniospinal axis, most commonly posterior to the
superior clivus. In the vast majority of cases it represents an incidental radiological finding.
However, EP may occasionally become symptomatic and be associated with mass effect due
to compression of brainstem or cranial nerves or with cerebrospinal fluid leak with recurrent
meningitis due to clival defect. In such cases surgical treatment is necessary.In this study we
report the radiological signs and clinical symptoms of five patients with symptomatic
retroclival ecchordosis physaliphora (four male, age range : 34 to 82) : Four of these patients
presented with CSF rhinorrhoea while three were admitted with acute bacterial meningitis.
All of them were treated with endoscopic endonasal transsphenoidal transclival approach and
reconstruction of the clival defect.The aim of this study is to underline the importance of a
timely diagnosis of this rare entity as it can easily be missed due to its small size and rarity.An
endoscopic endonasal transsphenoidal / transclival approach facilitates the complete excision
of these lesions, as well as the 3-layer reconstruction of the skull base defects, with minimal
morbidity.

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1634
Salvage endoscopic endonasal surgery of Skull base osteoradionecrosis

Zhaohui Shi, Tianfeng Zhao

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Objectives: Skull base osteoradionecrosis was a potential lethal post-radiation complication

with low incidence. We aimed to report a single-center salvage endonasal endoscopic surgery
results, evaluate its clinical efficacy and share our surgical experience. Methods: We
conducted a retrospective, observational study of 9 skull base ORN patients with ICA involved
from the year 2017 to 2019. We identified the involved segment of carotid artery by
computerized tomogram and surgical confirmation. During the surgery, we achieved
anatomical exposure of different parts of ICA. We collected clinical data including
demographic information, pathology results, reconstruction method and calculated the
surviving time, mortality rates of this surgery, and complication rates. the endpoint was an
overall survival (OS) rate of 2 years.To verify the efficacy of this aggressive surgery, we
compared verbal rating score (VRS) of headache by utilizing Wilcoxon rank-sum test.Results:
A total of 11 patients were diagnosed, 9 of whom were enrolled in the study; the mean age
was 53.3 years. Among them ,7(77.7%) were nasopharyngeal carcinoma (NPC), 1(11.1%)
squamous cell carcinoma (SCC) of the sphenoid sinus, and 1(11.1%) adenoid cystic carcinoma
(ACC).1 death resulted from severe parapharyngeal space infection within 2 months after the
surgery. The median follow-up time was 39.33 months. The OS rate was 88.9% during the 2-
year study. Wilcoxon rank-sum test showed the mean rank decreased after the surgery. (Z=-
2.719, P=0.007)Conclusion: Skull base salvage debridement surgery will be beneficial

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1657
Endoscopic endonasal approach for trigeminal schwannomas: our experience of 39
patients in 10 years

Dehui Wang1, Lu Yang1, Weidong Zhao2, Huankang Zhang1, Quan Liu1

1
Department of Otolaryngology-Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Shanghai
Medical College, Fudan University, 2Department of Skull Base Surgery, Eye Ear Nose and Throat Hospital,
Fudan University

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Background:The anatomical locations involved in trigeminal schwannomas (TSs) are quite

complex. Given the nerve function recovery and postoperative neurological deterioration
varied in different reports, the author demonstrates his surgery tips and the functional
outcomes under endoscopic surgery. Methods: A retrospective review of patients with TSs
was undertaken to assess the outcome of endoscopic surgery from 2006 to 2016. Clinical
features, imaging findings, preoperative/postoperative neurological deficits, surgical
approaches and followed up data were collected. Results: Thirty-nine patients with TSs were
included. Surgical approaches include endoscopic medial maxillectomy approach (n=8),
endoscopic endonasal-assisted sublabial transmaxillary approach (n=27) and endoscopic
endonasal-assisted sublabial transmaxillary combined with septectomy (n=4). Gross total
resection and sub-total resection were achieved in 27 and 10 patients, respectively. The most
common chief complaint was facial numbness, accounting for 41%, with a resolved rate of
62.5% after treatment. Fifteen patients developed new neurologic symptoms, including facial
numbness/pain (n=9 and 2, respectively), dry eye (n=3) and mastication weakness (n=1). Eight
of these patients had partial improvement except for patients with dry eye. Conclusion:
Endoscopic endonasal approach represents a safe and effective surgical procedure for TSs in
pterygopalatine fossa, infratemporal fossa and even Meckel cave. Tumor resection can be
achieved by endoscope with few neurologic deficits and complications.

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1660
Endoscopic endonasal resection and radiotherapy as treatment for skull base
chordomas

Dehui Wang1, Hongbing Li1, Huankang Zhang1, Li Hu1, Huan Wang1

1
Department of Otolaryngology-Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Shanghai
Medical College, Fudan University

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Objective: We investigated the effect of endonasal endoscopic surgery and radiotherapy as

treatment for skull base chordomas. Method: We investigated 46 patients (2006–2018)
treated at the Affiliated Eye Ear Nose and Throat Hospital, Fudan University. We documented
demographics, clinical presentation, operative resection, complications, postoperative
radiotherapy, follow-up time, and survival. Result: Complete tumor resection was performed
in 18 (39.1%), subtotal tumor resection in 16 (34.8%), and partial tumor resection in 12 (26.1%)
patients. The most common clinical manifestation was nasal obstruction (41%). The median
duration of progression-free survival (PFS) and overall survival (OS) was 21.5 and 33.5 months,
respectively. Primary vs. recurrent disease, partial resection (PR) vs. subtotal resection (STR),
STR vs. gross total resection (GTR), GTR vs. PR, and complicated vs. uncomplicated status were
significantly associated with PFS. Primary vs. recurrent disease, PR vs. STR, GTR vs. PR, surgery
alone vs. surgery concomitant with radiotherapy, and complicated vs. uncomplicated status
were significantly associated with OS. Conclusion: Surgery is the primary treatment for
chordoma; higher tumor resection rates are associated with higher OS and PFS. Surgeons
should aim to resect as much tumor as is safely possible. Postoperative radiotherapy is useful
adjuvant treatment to improve OS, and IMRT serves as an effective alternative to PBRT. The
optimal radiotherapeutic technique is determined by cost, accessibility, availability of the
modality, and tumor volume.

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1684
Contralateral Transorbital Endoscopic Approach to Petrous Apex: A Feasibility Cadaver
Study

Hazan Basak1, Cem Meco1, Ayhan Comert2, Suha Beton1

1
Ankara University Medical School Department of ORL, 2Ankara University Medical School Department
of Anatomy

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Objective: Petrous apex(PA) of the temporal bone is an anatomically challenging area to

access. Nowadays in suitable cases minimal invasive ventral approaches is the preferred
approach. The aim of this anatomic study is to compare and combine contralateral
transorbital endoscopic approach with EEA to get full access to the petrous apex and to
describe technical notes. And defining an improved approach and direct visualization of the
surgical field, with limited morbidity. Methods: 3 human cadaver heads (6 sides) were
dissected. Endoscopic dissection through purely endonasal endoscopic route and a combined
with contralateral transorbital route were done. Results: The two minimally invasive
approach (endonasal endoscopic and contralateral transorbital) to petrous apex let us have
different degree of visualization to the PA. Contralateral transorbital approach to PA makes
it possible to visualize ICA better and widely. A combined approach makes it possible
to remove bone and to reach PA fully without a need for a curved instruments and drills.
In suitable cases with reduced Palluzzi angle, this apprach may help to overcome the
difficulty of to reach PA. Conclusion: Surgical approach to PA is challenging. Combined
approach with endonasal and contralateral transorbital route provides a good access to
control to petrous apex and internal carotid artery even without curved instruments. This
combined approach may be especially useful if there is no access to curved endoscopic
instruments and drills. Possibly pioneer clinical applications are necessary

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 1706
Infratemporal Fossa and Pterygomaxillary Tumours: Experience from a Tertiary
Medical Center

Mariana Correia1, Vitor Oliveira1, César Silva1, Mariana Calha1, Rita Peça1, Paulo Rocha
Pereira1, Leonel Luís1

1
Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Introduction: Tumours involving the infratemporal fossa (ITF) are rare and the majority result
from extension from adjacent spaces. They have distinctive presentations and the diagnosis
is crucial in planning a treatment strategy.Objectives: Consecutive case series report regarding
ITF and pterygomaxillary space (PMS) lesions.Methods: Descriptive retrospective study of
patients presenting with ITF/ PMS lesions in a tertiary medical center, between January 2017
and January 2023.Results: A total of 19 patients were included, with a mean age of 61,3 years
(13-81 years) and 57,9% were male. The most common presentation was nasal obstruction
(42,1%), headache (36,8%), rhinorrhea and visual symptoms (21.1% each). Plasmacytomas
(21,1%) and juvenile nasopharyngeal angiofibroma (15,8%) were the most common tumours.
63,2% patients (n=12) performed surgical resection, 8 of them (66,7%) were selected to pure
endoscopic endonasal approach (EEA) and 4 needed cranio-endoscopic approach (33.3%). A
total of 3 (27,3%) underwent preoperative embolization. Total resection was achieved in 10
patients (83,3%) and near-total in 2 with a rate of 1,3 surgeries per patient. 4 patients (33,3%)
had adjuvant chemo/ radiotherapy and the mean follow-up time for surgical patients was 38,7
months (1-118 months). 5 patients (26,3%) were selected to receive medical treatment
upfront and 2 are awaiting surgery.Conclusions: In this study, the EEA proved to have the
advantage of being minimally disruptive with excellent endoscopic control and contributed
extensively to achieve total or near-total resection.

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1773
PosESS-Study (Positioning in Endoscopic Skull Base Surgery): Semi-Sitting Versus
Supine: Interim Analysis of a Randomized Controlled Trial

Yves Brand1, Jonathan Rychen2, Tim Hallenberger2, Christoph Oetliker3, Luigi Mariani2, Michel
Roethlisberger2

1
Department of Otorhinolaryngology, Kantonspital Graubünden, Chur, Switzerland, 2Department of
Neurosurgery, University Hospital of Basel, Basel, Switzerland, 3Department of Anesthesiology,
University Hospital of Basel, Basel, Switzerland

Skull base surgery 2/ CSF leaks and management| Room 12 Hall 40 - Level 6| Tuesday
20/06/2023

Endoscopic endonasal pituitary surgery is standardly performed with the patient in supine
position. In semi-sitting position, the intracranial pressure is lower than in supine position due
to decreased venous congestion. Aim of the study is to compare the supine and the semi-
sitting position in endoscopic endonasal pituitary surgery. Methods: This study is a
prospective randomized clinical trial. Inclusion criteria are as follow: adult patients with a
presumed pituitary adenoma, who are suitable for endoscopic endonasal surgical resection.
The primary outcome is intraoperative bleeding, assessed by the blood loss and the frequency
of hemostatic maneuvers. Secondary outcomes include surgical ergonomics and the incidence
of air embolism. Results: 36 patients (60% of the expected 60 patients) have been
randomized so far. The mean blood loss was 201ml (±132) in the semi-sitting vs. 291ml (±159)
in the supine group (reduction of 31%) (p=0.06). The mean frequency of hemostatic
maneuvers was 86 (±27) in the semi-sitting vs. 121 (±44) in the supine group (reduction of
30%) (p=0.01). There were no significant differences in the incidence of air embolism (3
(21.4%) in the semi-sitting vs. 0 (0%) in the supine group (p=0.23)) and no difference in the
surgical ergonomic score (29/32 (±4) in the semi-sitting vs. 30/32 (±2) in the supine group
(p=0.61). Discussion: The hypothesized decrease in intraoperative bleeding may enhance the
surgical workflow.

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Benign Nasal Tumors 1

1197
PREOPERATIVE PREPARATION OF PATIENTS WITH JUVENILE ANGIOFIBROMA

Aziz Uzakov1, Nilufar Usmanova3

1
Tashkent Medical Academy, 2Tashkent Medical Academy, Profmedservice Medical Clinic, 3Tashkent
State Dental Institute

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Abstract. Today, the prevalence of juvenile angiofibroma is about 0.05% of all

head and neck tumors. Juvenile angiofibroma occurs in the nasal cavity and nasopharynx only
in men aged 9 to 19 years. It was believed that hormonal
and genetic factors contribute to the occurrence of juvenile angiofibroma in young men, but
recent studies have shown conflicting data on hormonal effects. There
were no direct links between the proliferative index, hormonal level, age at the time
of diagnosis and the stage of the tumor or bleeding. Thus, the significance of puberty
induced testosterone levels in tumor development remains unclear.
Histological diagnosis of juvenile angiofibroma is usually not difficult. The main
purpose of the study is to determine the most correct tactics of preoperative
preparation of the patient.Research methods. We analyzed the clinical data of 11 patients wi
th juvenile angiofibroma who received surgical treatment in our department from 2019 to
2023.Results and conclusion. Juvenile angiofibroma usually occurs in the posterior
nasal cavity, near the basissphenoid and the upper edges of the wedgepalatine
opening. The tumor demonstrates an expansive and destructive nature of growth. Healthy
tissues are displaced and exposed to pressure. Preoperative assessment of the size
and location of the tumor includes: endoscopic examination of the nasal cavity, CT,
MRI and angiography of the vessels of the head and neck.

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1205
Quality-of-Life Outcomes Following Surgical Treatment of Sinonasal Inverted
Papilloma: A Multicenter Analysis

Edward Kuan1, Arash Abiri1, Benjamin Bitner1, Mandy Salmon2, Elysia Grose3, Siddhant
Tripathi4, Sanjena Venkatesh2, Yohan Kim2, Daniel Lee2, Jennifer Douglas2, Jacob Eide5, Rijul
Kshirsagar6, Katie Phillips4, Ahmad Sedaghat4, John Lee3, Charles Tong7, Nithin Adappa2, James
Palmer2

1
University of California, Irvine, 2University of Pennsylvania, 3University of Toronto, 4University of
Cincinnati, 5Henry Ford Health, 6Kaiser Permanente Redwood City, 7Lenox Hill Hospital

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Introduction: There is growing interest in assessing patient quality-of-life (QOL) following

treatment of sinonasal tumors, including inverted papilloma (IP). In this study, we aimed to
elucidate the natural history of postoperative QOL outcomes in IP patients treated with
surgery.Methods: Cases of sinonasal IP treated surgically at 4 tertiary academic rhinology
centers were retrospectively reviewed. SNOT-22 scores were used to evaluate QOL
preoperatively and postoperatively (1, 3, 6, 12 months). Repeated measures ANOVA assessed
for differences in mean scores over time. Linear regression identified factors associated with
QOL longitudinally.Results: 373 patients were analyzed. Mean preoperative SNOT-22 score
was 20.6 ± 20.4, which decreased to 16.3 ± 18.8 (p=0.041) and 11.8 ± 15.0 (p<0.001) at 1 and
3 months postoperatively, respectively. No further changes in SNOT-22 scores occurred
beyond 3 months postoperatively (p>0.05). When analyzed by subdomain, nasal, sleep, and
otologic/facial symptoms (all p<0.05) demonstrated improvement at 12-month follow up
compared to preoperative scores; this was not observed for emotional symptoms (p=0.80).
Recurrent cases were associated with higher long-term SNOT-22 scores (β=7.08; p=0.017).
Age, sex, degree of dysplasia, prior surgery, primary site, and smoking history did not correlate
with symptoms (all p>0.05).Conclusions: QOL outcomes related to IP resection are largely
driven by nasal, sleep, and otologic/facial subdomains, though patients appear to experience
enduring improvement as early as 3 months postoperatively.

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1264
Endoscopic management of Advanced JNA: Tips & Tricks

Hussam Elbosraty1

1
Department of otorhinolaryngology, Cairo university

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

ENDOSCOPIC MANAGEMENT OF ADVANCED JNA: tips & tricksBy:Hussam Elbosraty, MD, Prof.
Kasr El-Ini Cairo University. Institution: Kasr El-Aini Hospital, Cairo University.
Abstract:Juvenile nasopharyngeal angiofibroma (JNA) is a combined vascular and fibrous
neoplasm which arises from the posterior-lateral wall of the nose. The tumor exhibits a strong
tendency to bleed and, despite being microscopically benign, frequently exhibits destructive
and aggressive behavior. Various treatment modalities are currently available for JNA, but
surgical resection remains the best option. Recently, and after the advent of preoperative
embolization many endoscopic trials were used to treat small JNA with great success. Still,
however, the large Tumors remain a challenge.We describe our experience in 153 cases of
endoscopic resection of advanced JNA including cases with intracranial intradural extension.
Materials and methods: We describe our experience in 145 cases of endoscopic resection of
advanced JNA including cases with intracranial extension. All the patients were adolescent
males, the age ranges from 6 to 48 years. Tumor staging was 71 cases were stage III, 39 cases
were stage IV and 43 cases were stage I and II. all cases were embolized 2 days pre-op.Results:
complete tumor removal is achieved in 143 cases. incomplete removal in 10 cases. one case
has been irradiated, the other 9 cases a 2nd session of endoscopic resection was done. 3 of
these cases required a 3rd. session with no recurrence on the next 5 years. morbidity in the
form of permanent loss of Eustachian tube dysfunction in

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1306
The difference between HPV papilloma, Schneiderian papilloma and the other tumors
in sinonasal cavity

Gabriela Kopacheva -Barsova1

1
ENT University Clinic, University Campus "St. Mother Theresa", Skopje

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Schneiderian papilloma is typically found on the lateral nasal wall, but, in rare cases, can be
located at the mucosa of the nasal septum. Respiratory epithelial tumors (REAH) in sinonasal
cavity, characterized by an abnormal proliferation of glandular part of the respiratory nasal
mucosa. The possible involvement of HPV in the aetiology of both benign respiratory
papillomas and squamous cell carcinomas, a substantial number of studies have explored this
issue. Typical clinical signs for this tumors usually are: nasal obstruction, rhinorrhea, epistaxis,
and hyposmia. To date, 33.3% of sinonasal papillomas and 21.7% of sinonasal carcinomas
analysed have been shown to be positive for HPV. Many elements of the data parallel the
observations made in HPV lesions at other mucosal sites, such as malignant transformation
and frequent recurrence after radical treatment; the fact that low risk HPV types 6 and 11 are
usually confined to benign lesions, whereas the reverse is true for the oncogenic HPV types
16 and 18; and the presence of squamo–columnar junctions and squamous cell metaplasia in
the sinonasal system. The discrepancies reported by several studies might result in part from
technical reasons, but it is also possible that sinonasal lesions have a heterogeneous aetiology
(HPV related and non-related) and/or that some novel (yet unidentified) HPV types exist in
these lesions, which are detected by some studies but not by others.

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1411
Transorbital approach for lateral frontal sinus lesions: Outcomes of 2 cases and
anatomical considerations.

Camilo Rodriguez Van Strahlen1, Octavio Garaycochea1, Maria Jesus Rojas Lechuga2, Jessica
Matas1, Isam Alobid1

1
Rhinology and Skull Base Group, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CIPERES,
Universitat de Barcelona. , 2Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital
Clinic, IDIBAPS,CIPERES, Barcelona University, Barcelona, Spain

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

The frontal sinus (FS) has been the most challenging sinus to approach with Endoscopic Sinus
Surgery (ESS). The use of Draf III procedure has allowed surgeons to treat infectious,
inflammatory, and neoplastic diseases affecting the FS. However, when lesions are located in
the furthermost lateral portion of the FS, external approaches are needed. The Transorbital
Endoscopic Surgery (TOES) approach for the FS has become a strong tool in the armory of
external FS surgery to successfully treat lateral lesions of the FS. Anatomic considerations
must be taken in account to perform TOES of the FSMaterials: We described anatomic
considerations to perform TOES of the FS and present two cases where lesions were treated
with transorbital approach with adequate resection and successful outcome. One case is a
lateral mucocele after a complex cranial trauma with TOES only approach. The second case is
a large osteoma recurrence in the posterior wall of the left frontal sinus treated with a
combined ESS and TOES approach.Conclusion: Transorbital endoscopic surgery of the frontal
sinus is a useful and efficient approach to treat lateral lesions of the frontal sinus that are not
able to be successfully treated by EES only approach.

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1493
Sinonasal inverted papilloma: Epidemiology, diagnostic features and treatment
through a case series of a tertiary hospital.

Aikaterini Tsoumaridou1, Dimitrios Terzakis1, Stylianos Triantos1, Dimitrios Lefantzis1

1
Otorhinolaryngology/ Head & Neck Surgery Department, “Korgialenio- Benakio” General Hospital of
Athens (Greek Red Cross Hospital

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Background: Inverted papilloma (IP) is a benign epithelial tumor, with characteristic clinical
and imaging findings1, well known for recurrence and malignant transformation.2-4 Incidence
varies between 0,2-1,5 new cases per 100.000 per year3, with a male:female ratio 2-5:12-4
and age of onset between 5th-6th decade of life2,3.Methodology: We present our case series
of IP patients during the last 5 years.Results: 22 cases of IPs (15:7 male:female, mean age 54,7
years) were diagnosed after clinical examination, imaging with CT or CT/MRI scan. A biopsy
under local anesthesia was performed in 19 primary cases. The origin of IP was as follows: 11
maxillary sinus (50%), 3 lateral nasal wall (13,6%), 3 nasal septum (13,6%), 2 lamina papyracea
(9,1%), 2 sphenoid sinus (9,1%) and 1 frontoethmoidal region IP (4,6%). All patients were
treated with endoscopic sinus surgery with drilling of hyperostosis and followed up. 21/22
patients are disease free till today (2-60 months postoperatively).Conclusions: When
unilateral, a nasal tumor should be promptly investigated with imaging studies, a biopsy and
when diagnosis of IP is confirmed, a wide resection. Follow-up is demanded for at least 3
years.Chawla A, Shenoy J, Chokkappan K, Chung R. Imaging Features of Sinonasal Inverted
Papilloma: A Pictorial Review. Curr Probl Diagn Radiol. 2016 Sep-Oct;45(5):347-53. doi:
10.1067/j.cpradiol.2015.10.004. Epub 2015 Nov 11. PMID: 26632214.Lund V, Stammberger H,
Nicolai P. European position paper on endoscopic management of tumours of the nose and
paranasal sinuses and skull base. Rhinology. 2010. 22(22). 30-31Lisan Q, Laccourreye O,
Bonfils P. Sinonasal inverted papilloma: From diagnosis to treatment. Eur Ann
Otorhinolaryngol Head Neck Dis. 2016 Nov;133(5):337-341Goudakos JK, Blioskas S, Nikolaou
A, Vlachtsis K, Karkos P, Markou KD. Endoscopic Resection of Sinonasal Inverted Papilloma:
Systematic Review and Meta-Analysis. Am J Rhinol Allergy. 2018 May;32(3):167-174

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1512
A Rare Case of Sinonasal Glomangiopericytoma Treated with Endoscopic Sinus Surgery

Anna-Maria Papadopoulou1, Anastasia Liapi1, Athanasia Marinou1, Aikaterini Tsagkovits2

1
Department of Otorhinolaryngology, G.Gennimatas Athens General Hospital, 2ENT Department,
General Hospital of Athens G. Gennimatas, Athens, Greece

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Sinonasal glomangiopericytoma (SNGPC) is a rare, borderline and low malignant potential soft
tissue tumour, originating from the pericytes of the vessels of the nasal cavity. It accounts for
0.5 to 1.0% of all sinonasal tumors and it is a less aggressive and invasive variant of
haemangiopericytoma.We report a case of a 76-year-old Caucasian female who presented to
the ENT emergency department with recurrent episodes of unilateral epistaxis of the right
side since one week. Nasendoscopy of the right nasal cavity revealed a pink, smooth, round
mass, medial to the middle turbinate. A CT scan showed a 1.8 cm, hypodense, homogeneous
circumscribed lesion attached to the cribriform plate, with no evidence of bony erosion. An
endoscopic biopsy was taken and histopathology along with immunohistochemical staining
demonstrated SNGPC. The patient underwent endoscopic intranasal excision of the tumor.
Minimal intraoperative CSF leak from the lamina cribosa was repaired with an overlay mucosal
free flap, DuraSeal and Spongostan. The patient had an uneventful recovery and was
discharged on the 5th postoperative day.SNGPC must be differentiated from more aggressive
lesions, such as glomus tumour, haemangiopericytoma or leiomyosarcoma or malignant
melanoma. The mainstay of treatment is total surgical resection, which is considered sufficient
for local disease control. Limited evidence supports the use of adjuvant therapies. Although
the prognosis is favorable with a 90% 5-year survival rate, this tumor has a propensity for
delayed recurrence. Hence, long-term follow-up is advocated.

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1575
Surgical strategy for Juvenile nasopharyngeal angiofibroma in Onerci stage Ш

Fenghong Chen1

1
The First Affiliated Hospital of Sun Yat-sen University

Benign Nasal Tumors 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Objective: to develop a surgical strategy for Juvenile nasopharyngeal angiofibroma (JNA) in

Onerci stage Ш.Methods: Patients diagnosed as JNA Onerci stage Ш and undergoing
endoscopic surgery from 2011 to 2016 was prospective enrolled.Results: Fifteen patients
were enrolled. All were male and the average age was 16.4 years (10-31 years). Nine patients
received angiography before surgery and eight of them received embolism. The mean follow-
up time was 3.5 years (15-80 months). Recurrence was found in three cases, and endoscopic
endonasal approach was performed in two cases, and one was received endoscopic endonasal
approach combined with Caldwell Luc approach. The surgical strategy was: 1. The inferior
turbinate and the lower part of the middle turbinate were resected to expose the upper and
lateral surgical field. 2. Maxillostomy was performed and enlarged till the posterior wall of the
maxillary sinus was fully exposed. 3. The posterior wall of the maxillary sinus was removed to
expose the tumor in the pterygopalatine fossa and intratemporal fossa. 4. The anterior wall
of the sphenoid sinus was resected to fully expose the tumor in the sphenoid sinus. 5. The
tumor mobilized from the attached bone and nasopharynx. 6. The major feeding artery was
identified and cauterized. 7. Removal of the tumor from the nose. 8. The vidian tube and
basisphenoid were drilled. Conclusion: endoscopic endonasal approach is alternative for
Onerci stage Ш JNA. The principle of the surgery is fully exposure and mobilization of the
tumor before removal it.

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CRS – diagnosis and investigations 2

1276
The presentations of eosinophilia in type 2 and non-type 2 CRwNP in Taiwan

Chih-Jaan TAI

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) are classified to type 1, type
2 and type 3 according to their inflammatory endophenotype. Type 2 inflammation accounts
for the majority in Western countries’ studies. Most of the etiologies are nonspecific, but
some are related to genetic, metabolic and immune diseases, such as aspirin-exacerbated
respiratory disease (AERD), allergic fungal sinusitis (AFRS), central compartment allergic
disease (CCAD), etc. The purpose of this study was to compare the difference of clinical
manifestations between patients in type II and non-type II CRSwNP, based on different
diagnostic criteria, tissue or blood eosinophilia. Method: From February 2021 to July 2022, a
total of 182 patients diagnosed with chronic rhinosinusitis and received FESS were included.
Among which, 55 (30.22%) were CRSwNP, 127 (69.78%) were CRSsNP. According to the
pathological tissue and blood eosinophil count, they were divided into type 2 and non-type 2
groups. Patient characteristics, allergic comorbidities, nasal polyps score (NPS), CCAD, CT L-M
score, preoperative and postoperative olfactory and SNOT-22, and intraoperative blood loss
surgical bleeding amount were analyzed.Results: The average age of 55 patients with CRSwNP
was 45.7 years (24 to 66 years), and 37 (62.27%) were male. When based on histological
diagnostic criteria, 43 cases (78.2%) are type 2 CRSwNP. However, when based on blood
diagnostic criteria, 31 cases (56.4%) are type 2 CRSwNP. When based no histological diagnostic
criteria, NPS, CCAD, CT L-M score, and intraoperative blood loss were higher in type 2 group
than those in non-type 2 group. When based on blood diagnostic criteria, there was limited
difference in NPS, CT L-M score, and intraoperative blood loss between the two groups.
Conclusion: The patients with CRSwNP are mainly middle-aged male and their age is lower
than that of the patients with CRSsNP. Whether based on histological diagnostic criteria or
blood diagnostic criteria, more than half of the CRwNP were type 2 inflammation, which is
different from the traditionally believe that the prevalence of type 2 CRSwNP is not high in
Asian patients. The histological diagnostic criteria showed more differences between type 2
and non-type 2 CRSwNP in clinical manifestations, than the blood diagnostic criteria.

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1293
TAS2R38 bitter taste receptors in CRS - new data on polish population

Joanna Jeruzal-Świątecka1, Wioletta Pietruszewska1

1
Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Studies have shown differences in TAS2R38 receptor expression in patients with chronic
rhinosinusitis (CRS) compared to healthy controls. Known agonists of TAS2R38 stimulate
epithelial cells, leading to robust intracellular nitric oxide (NO) production, which damages
bacterial membranes, enzymes, and DNA, but also increases ciliary beat frequency. We
examined, using qRT-PCR, the expression of TAS2R38 receptor in nasal polyps (NP) of patients
with CRS (N = 107) and in inferior turbinate mucosa (ITM) of patients with CRS and controls
(N = 39), and confronted it with clinical features. The expression was shown in 43 (50.00%)
samples of ITM in the study group (N = 107), in 28 (71.79%) in the control group (N = 39) (p =
0.037), and in 43 (46.24%) of NP. There were no differences in levels of the expression in all
analyzed tissues. Patients who rated their symptoms at 0–3 showed
higher TAS2R38expression in ITM in comparison to the patients with 8–10 points on the VAS
scale (p = 0.020). A noticeable, however not significant, correlation between
the TAS2R38 expression in ITM and the Lund–Mackay CT score was shown (p = 0.068; R =
−0.28). Patients with coexisting asthma had significantly higher receptor expression in the NP
(p = 0.012). Our study is the first to confirm the presence of the TAS2R38 receptor in NP.
Expression of the TAS2R38 receptor is reduced in the sinonasal mucosa in patients with more
advanced CRS with NP.

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1294
Sinonasal symptoms in COPD; burden and associations with clinical markers of diease

Marte Øie1, Marte Rystad Øie2, Anne-S Helvik3, Malcolm Sue-Chu4, Wenche Moe Thorstensen1

1
Department of Otolaryngology, head and neck surgery, St. Olavs hospital, Trondheim University
Hospital, 2Department of Otolaryngology, head and neck surgery, St. Olavs hospital, 3Department of
Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU),
4
Department of Thoracic Medicine, St. Olavs hospital, Trondheim University Hospital

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Sinonasal symptoms are frequently reported in COPD and the prevalence of rhinosinusitis
without nasal polyps (RSsNP) was 3-fold greater than in controls in a recent study. Knowledge
of the relationship between sinonasal symptoms and clinical markers of COPD is limited. This
study explores the associations between the burden of sinonasal symptoms and clinical
markers.Methodology: Sinonasal symptoms were quantified with the rhinological subscale of
the Sino-Nasal-Outcome-Test (SNOT-22) in 90 COPD patients characterized by the EPOS2012
criteria for RSsNP. Associations between a high burden, defined as a SNOT22_rhinological
score of ≥ 11, and the following markers were assessed by adjusted multivariable linear
regressions; severity of dyspnea [modified Medical Research Council (mMRC)] and cough
[Visual Analogue Scale], physical activity [6-minute-walking distance (6MWD)], mortality risk
(BODE index), and HRQoL [disease-specific (CAT and SGRQ) and generic (PCS-SF36)].Results: A
high burden was associated with greater severity of dyspnea and cough, lower 6MWD, higher
BODE index and poorer HRQoL.Conclusion: A high burden of sinonasal symptoms is positively
associated with the clinical markers of symptom severity and mortality risk and is inversely
associated with physical activity and HRQoL in COPD. This has clinical relevance, and enquiry
about sinonasal symptoms should be incorporated into the clinical routine.

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1295
Association between Helicobacter pylori and nasal polyps

Dimche Markovski1, Dimce MARKOVSKI

1
Department of Otorhinolaryngology at Clinical Hospital Bitola, North Macedonia

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Helicobacter pylori is the most common etiological factor of chronic infection
worldwide. It has also been found in human dental plaques, mouth, saliva, tonsils and adenoid
tissue, medial ear or nasal polyps and sinuses mucosa, as well in several benign and malignant
lesions of the larynx and pharynx.Nasal polyposis is an inflammatory condition of unknown
etiology. The etiological factors for nasal polyps include infection, inflammation or an
imbalance of a metabolic pathway. Few years back, and these days GERD or
Helicobacter pylori as a possible pathologic cause of nasal polyps is still increasing and often
presented in cases that we are operating. Materials and Methods: With collaboration of
department of Gastroenterology in our hospital, at period of 3 years (2017-2020) 24 patients
with chronic rhinosinusitis from 34-68 years old with nasal polyps who had undergone nasal
endoscopic sinus surgery were evaluated and detected association with helicobacter pylori.
The investigation showed the presence of serum specific Helicobacter pylori antibodies (IgG
and IgA) from the blood samples and feces controlled by ELISA and rapid urease tests of the
biopsy specimens of the nasal polyps.Helicobacter pylori status was regarded as positive, if
2 (both) tests were positive.Results: 13 patients (7 women and 6 male) were positive of
h.pylori (54,16%)Conclusion: Our recommendation is, that at diagnostic algorithm for CRSwP
patients should be included helicobacter pylori tests, and treatment management therapy for
it.

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1523
Deep Learning Model for Endoscopic Chronic Rhinosinusitis Endotypic Classification
Using Preoperative Diagnostic Nasal Endoscopy Images

Tamar Tobi Porat1, Ahmed Safadi2

1
972-52-7214573, 2Department of Otolaryngology -Head and neck surgery, Tzafon Medical center,
affiliated with Azrieli Faculty of Medicine, Bar Ila

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Chronic rhinosinusitis (CRS) is a complex heterogeneous disease with different phenotypes

and endotypes. The advances in our understanding of the pathogenetic mechanisms of CRS
endotypes have resulted in broader insight into the disease mechanisms and allowed for
better orientation of therapy. The EPOS 2020 reflects these changes with updated CRS
classifications and new integrated care pathways. The current approach proposes the
differentiation between type 2 and non-type 2 inflammatory responses. Histopathological
CRS subtyping by tissue eosinophilia has prognostic and therapeutic implications. Data derived
preoperatively regarding the endotypic nature of the disease can significantly influence
treatment selection and course of disease. Considering the strong feature extraction and
screening ability of artificial intelligence, applying this technology to diagnostic nasal
endoscopy may allow preoperative differentiation between eosinophilic CRS (ECRS) and non-
eosinophilic (NECRS). Objective: This study aims to determine if a convolutional neural
network could be trained on preoperative transnasal endoscopic images to classify and
differentiate between ECRS and NECRS. Methods: A series of nasal endoscopic images will be
obtained from healthy individuals and patients undergoing functional endoscopic surgery for
CRS confirmed by histopathology. A deep neural network model will be applied for feature
selection and classification of images. Performance will be evaluated for accuracy and
precision. Clinical significance: Non-invasive diagnosic tool for preoperative CRS subtyping

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1524
BLOOD AND NASAL EOSINOPHILIA IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS:
MAY THEY PREDICT SEVERITY OF DISEASE?

Camilla Spanu1, Eugenio DE CORSO, Marco Corbò1, Daniela Furno1, Rodolfo Mastrapasqua2,
Veronica SECCIA, Silvia Baroni3, Giuseppe D'Agostino1, Daniele Penazzi1, Maria Elisabetta
Onori3, Jacopo Galli1, Francesca Sarlo3

1
Otorhinolaryngology, Catholic University of The Sacred Heart, Rome, Italy, 2ENT Department, Rivoli
Hospital, ASL Torino 3, 10098 Torino, Italy, 3Department of Basic Biotechnological Sciences, Intensive
Care and Perioperative Clinics; Catholic University of Sacred Heart, Rome, Italy

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

The objective of this study is to evaluate the role of blood and local eosinophilia (at nasal
citology) to define in practice type-2 inflammation and severity of disease in CRSwNP.This is a
cross-sectional multicentric observational study including 425 CRSwNP patients. For each
patient, we collected data on blood eosinophilia, nasal cytology, asthma and severity of
disease assessed by VAS- symptoms and SNOT-22.In our series 274/425(64%) patients had
local eosinophilia at nasal cytology and 303/425(71%) had blood
eosinophilia(>250units/microliter). The 35%(43/122) of patients with no blood eosinophilia
had a local eosinophilic infiltrate detected by nasal cytology. Regarding severity of disease,
patients who have a local eosinophil count>hpf have a significant mean SNOT-22 score
compared to the ones with <5hpf(51vs37). Moreover, patients with eosinophil count>5hpf
had a significant higher median specific VAS for nasal obstruction, rhinorrhea, smell
impairment and watery eyes. Patients with comorbidities(asthma,allergic rhinitis,N-ERD) had
a higher mean local eosinophilic count than patients without it. We did not observe a
correlation between peripheral and local eosinophilia; furthermore, blood eosinophilia was
not correlated with severity of symptoms. Our data suggest that local eosinophil count is
clinical important both to define type-2 CRSwNP and to focus on more severe patients.

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1551
The patient journey in patients with CRSwNP in the United States and Europe

Peter Howarth1, Jeremiah Hwee2, Steve G Smith3, Mark Small4, Lauren Lee4, Shibing Yang5

1
Global Medical Affairs, GSK, Brentford, Middlesex, UK, 2Epidemiology, GSK, Mississauga, Canada,
3
Specialty Therapeutic Area, GSK, Durham, NC, USA, 4Adelphi Real World, Bollington, Cheshire, UK,
5
Value Evidence and Outcomes, GSK, Collegeville, PA, USA

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Although timely diagnosis may prevent further chronic rhinosinusitis with nasal
polyps (CRSwNP) disease development, delayed diagnosis or misdiagnosis is common. This
analysis quantified the CRSwNP patient journey from onset to diagnosis. Methods: This cross-
sectional point-in-time study of adults with moderate-to-severe CRSwNP in the USA and
Europe (EU5: France, Germany, Italy, Spain, UK) used patient- and physician-reported survey
data collected from 2018–2019 from the Adelphi CRSwNP Disease-Specific
Programme (DSP™). Association between self-rated health (measured by European quality of
life 5-dimension visual analog scores [EQ-5D VAS]) and time since diagnosis was assessed using
regression analysis. Results: 1071 patients were included (USA=251, EU5=820); 378 (USA=56,
EU5=322) responded to all patient-reported journey questions. Many patients received an
alternative diagnosis before a CRSwNP diagnosis (USA: 41%[23/56], EU5: 36%[117/322]).
Patient-reported journey from first symptoms to CRSwNP diagnosis was 1.5 and 2.1 years in
the USA and EU5, respectively. Longer periods since diagnosis (>1 year) were associated with
lower EQ-5D VAS (P=0.017). Conclusions: Patients had substantial delays between symptom
onset and CRSwNP diagnosis. Longer time since diagnosis was associated with worse self-
rated health, highlighting a gap in timely CRSwNP
diagnosis. Funding: GSK(ID:208086/213369) Abstract previously presented at ATS 2022: Am J
Respir Crit Care Med 2022;205:A3992.

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1614
Clinicopathological features of invasive type of fungal infection in sinonasal cavity and
the influence of patient’s innate and adaptive immunity system

Hideyuki Kawauchi

1
Shimane University, Microbiology Department

CRS – diagnosis and investigations 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Invasive aspergillosis in paranasal sinuses is not a common disease, in comparison with non-
invasive type aspergillosis in paranasal sinuses. This disease entity usually coincides with the
immunocompromised hosts such as immunodeficiency patients, the aged patients, and
patients with diabetes mellitus. Clinical outcome of these patients is not satisfactory. The
prognosis varies in each case, depending on effects of multidisciplinary treatments such as
medication of anti-fungal agents and/or surgical intervention. We have experienced more
than 10 different cases of paranasal sinus Aspergillus or Mucor invading to the orbit and skull
base. Based on our clinical experience, the following conclusion can be addressed. In order
to improve its prognosis, an earliest diagnosis should be confirmed by CT scan and MRI, and a
multidisciplinary treatment should be planned and performed with a systemic administration
of anti-fungal agents. Serum level of beta-D-glucan seemed to be very useful indicator for a
diagnosis of invasive type of Aspergillus infection and monitoring the disease activity in clinical
courses. In our presentation, clinicopathological feature of this disease entity and clinical
course are introduced in detail, based on host innate and adaptive immunity system against
fungal infection.

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CRS – medical management 3

1359
Maxitrol® as an antibiofilm agent against Staphylococcus aureus and Pseudomonas
aeruginosa

Sam Hale1, Raymond Kim1, Mark O'Carroll2, Kristi Biswas1, Brett Wagner Mackenzie1, Richard
Douglas1

1
University of Auckland, Auckland, New Zealand, 2Respiratory Services, Te Toka Tumai, Te Whatu Ora,
Auckland, New Zealand

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background:Maxitrol® (Novartis) contains antimicrobials and a corticosteroid. If it possesses

antibiofilm activity, it may be useful for treating chronic rhinosinusitis (CRS). We investigated
the in vitro efficacy of Maxitrol against Staphylococcus aureus and Pseudomonas aeruginosa
biofilms.Methods:Minimum biofilm eradication concentration assays were performed for P.
aeruginosa ATCC 27853 and S. aureus ATCC 6538 type strains at 30 minutes, 1 hour or 6 hours.
Isolates of both species were collected from the middle meati of patients with cystic fibrosis.
Biofilms of clinical isolates were grown and treated in vitro for 6 hours with Maxitrol, both
undiluted and at MBEC, then cultured to identify bacterial survival. Results:Neither type strain
was eradicated at 30 min, nor S. aureus at 1 hour at any tested concentration. P. aeruginosa
was eradicated by a median of 90% and 5.6% Maxitrol at 1 hour and 6 hours, respectively, and
S. aureus with 90% Maxitrol at 6 hours. Undiluted Maxitrol reliably eradicated all clinical
isolates of P. aeruginosa but only one of five S. aureus isolates.Conclusions:Maxitrol reliably
eradicates P. aeruginosa biofilm but not S. aureus biofilm in vitro. It may have a therapeutic
role against biofilms in which P. aeruginosa is the dominant pathogen.

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1437
DUPILUMAB INDUCED BLOOD EOSINOPHILIA IN SEVERE UNCONTROLLED CRSwNP
PATIENTS: A REAL-LIFE STUDY.

Claudio Montuori1, Eugenio De Corso2, Stefano Settimi1, Alessandro Cantiani1, Marco Corbò3,
Daniela Furno3, Tiziana Di Cesare1, Rodolfo Mastrapasqua4, Leandro Maria D'Auria1, Dario
Mele1, Jacopo Galli3

1
Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168
Rome, Italy., 2Unit of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation
IRCCS, 00168 Rome, Italy., 3Otorhinolaryngology, Catholic University of The Sacred Heart, Rome, Italy,
4
ENT Department, Rivoli Hospital, ASL Torino 3, 10098 Torino, Italy

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Dupilumab induced blood eosinophilia may be observed during the first year of treatment,
but few information about it is available in literature. In this real-life study we analyzed blood
eosinophilia levels in 74patients with severe uncontrolled CRSwNP in treatment with
dupilumab, evaluating its characteristics, trend, correlation with outcomes of response, and
dupilumab safety in relation with blood eosinophilia. We identified: patients with hematic
eosinophilia increase of at least 50%of baseline values in one of the time controls(GroupA) or
not(GroupB). Then we estimated its trend over time: early onset(within 6months)
with/without subsequent reduction, late onset(after 6months). The increase was observed
from the first month, with a peak at 3months. The difference was still significant at 6 and
9months, decreasing at 1year with values comparable to baseline. We compared all
outcomes between two groups and found no statistically significant differences. Furthermore,
we focused on patients that developed absolute blood eosinophilia>1500cells/mm3 and on
how we managed it. Finally, no difference was observed between patients with or without
blood eosinophils>1500cells/mm3. In conclusions, a subgroup of CRSwNP patients may
experience blood eosinophilia increase during the first year of dupilumab treatment not
influencing the outcomes of response to treatment, correlated with low risk of adverse
events.

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1451
Analysis of antibody levels after SARS-CoV-2 vaccination in patients with chronic
rhinosinusitis with nasal polyps and concomitant use of biologics therapy.

Inga Nierkamp1, Claudia Rudack2, Achim Georg Beule1

1
Department of Otorhinolaryngology, University hospital Münster, KArdinal-Von-Galen-Ring 10, D-
48149 Münster, Germany, 2Departement of Otorhinolaryngology, University Hospital Münster

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background: Complete basic immunization with an mRNA vaccine (Comirnaty®;

BioNTech/Pfizer or Spikevax®; Moderna) protects against severe courses of SARS-CoV-2
infection. The effect of mRNA vaccination under biologic therapy in patients with severe
chronic rhinosinusitis with polyps (CRSwNP) is largely unclear. Method: We examined blood
samples from n=74 patients with type 2 CRSwNP under biologic therapy and from n=15
healthy patients (control group). Blood samples were collected at scheduled appointments.
To characterize vaccination response, antibodies to the receptor binding domain (RBD) of the
SARS-CoV-2 spike protein were quantified using a chemiluminescence microparticle
immunoassay (SARS-CoV-2 IgG II Quant, Abbott Diagnostics). A questionnaire was used for
retrospective questioning regarding the applied vaccine and influence on CRSwNP. The
statistical analysis was performed with SPSS Statistic 29. Results: Serological analysis showed
lower antibody titers of SARS-CoV-2-anti-S-IgG in the group of CRSwNP under ongoing biologic
therapy than in the control group. The results of the functional analysis of the SARS-CoV-2-
anti-RBD IgG by neutralization assay are pending at this time. Conclusion: Based on results of
single studies, recommendations regarding Covid-19 vaccination in patients with CRSwNP
using biologic therapy have been available since 2021. No clinically relevant adverse effect or
interaction of biologics with the mRNA vaccines could be demonstrated in our cohort. Despite
chronic disease, depending on the risk of exposure, SARS-CoV-2 vaccination is recommended.

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1452
Hypereosinophilia during Dupilumab therapy for nasal polyposis: a review after two
years of experience

Andrea Rampi1, Umberto Tanzini2, Mona-Rita Yacoub3, Luca Moroni3, Giulia Dané2, Matteo
Trimarchi2

1
Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific
Institute, Milan, Italy; School of, 2Otorhinolaryngology unit, Division of Head and Neck department,
IRCCS San Raffaele Scientific Institute, Milan, Italy, School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy, 3Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San
Raffaele Scientific Institute, Milan, Italy

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Rationale: the introduction of biologics for nasal polyposis (CRSwNP) has been a turning point
for its management. Dupilumab has proven outstanding results in efficacy and safety; thus,
an increase in the absolute eosinophil count is common, and in extreme cases it determines
organ damage.Materials and methods: we present the HE-focused 2-year update of a
prospective study on Dupilumab prescribed for CRSwNP, and a multidisciplinary evaluation of
the literature on the topic.Results: in the present cohort, asymptomatic HE was confirmed in
a significant proportion of cases (~21%>1.5), and persistence of HE in the second year was
frequent (~16%). This represents an original finding, as HE was considered transient in
different studies (also for other indications), and only in a few cases it persisted over 1 year;
an early increase in eosinophils may predict long-lasting HE. Three possible managements for
HE in the literature were analyzed and compared.Conclusions: in a subset of patients, a long-
lasting HE, although silent, may impact on the therapy continuation. Accurate selection of
patients is crucial to reduce the risk of HE. A target for future studies is the identification of
markers to differentiate a rare, potentially symptomatic HE from its most common, indolent
variant.

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1458
Effective reduction of type-2 inflammatory biomarkers through biologic therapy is
not mirrored by outperforming clinical outcome in patients with Aspirin-exacerbated
respiratory disease

Jan Hagemann1, Franziska Spahn1, Rebekka Staufenberg1, Ulrike Förster-Ruhrmann2, Ludger

Klimek3 Christoph Matthias1

1
Universitatsmedizin Mainz, Dept. of Otolaryngology, 2Charité Berlin, Dept. of Otolaryngology, 3Center
of Rhinology and Allergology Wiesbaden

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background:Biologics used in Asthma and CRS patients with or without Aspirin-Exacerbated

Respiratory Disease (AERD) offer new treatment options, yet there is insufficient knowledge
about treatment outcome in AERD cases and possible influence
factors.Methods:Retrospective cohort study of CRSwNP, Asthma and AERD patients that
underwent screening for biologics at University Medical Center Mainz/Charité Berlin. Analyses
included subjective and objective criteria and diagnostics with regards to previous therapy,
nasal symptoms, quality-of-life, olfactory function, serum biomarkers, endoscopy, lung
function at different time points.Results:A total of 124 patients were included in this study.
AERD was plausible in 31.7% of cases. Baseline burden of symptoms and clinical presentation
showed insignificant differences between non-AERD and AERD cohorts before treatment with
Dupilumab, Omalizumab or Mepolizumab. Cohorts showed comparable improvements in
SNOT questionnaires and visual analogue scales upon biologics therapy after 4m; however,
improvement of nasal polyp score and Sniffin’Sticks identification testing were significantly
diminished in AERD. In contrast, blood eosinophils could be reduced significantly better in
AERD to 312/µl (95CI 161-463; p<0.02), compared to non-AERD patients.Conclusions:Anti-
Type-2 biologics therapy successfully improved disease control in non-AERD and AERD
patients. Suppression of key biomarkers was more successful in AERD. Tailoring future biologic
therapy approaches for specific subgroups of patients needs better understanding of
underlying endotypes

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1461
Our experience in `One Airway clinic’ and novel multi-modality treatments for patients
with complex upper airway inflammatory conditions

Mitanshi Luhana, Nirmal Kumar1

1
Wrightington, Wigan and Leigh NHS Foundation Trust, UK

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Patients with inflammatory conditions of upper airway like Allergic Rhinitis and Chronic
Rhinosinusitis with Nasal Polyps (CRSwNP) are often associated with lower airway disease
(asthma) and Aspirin Exacerbated Respiratory Disease. A concept of ‘One airway’ is now
recognized due to similar aetiology, risk factors and pathophysiological processes underlying
these conditions. Hence, it is only appropriate to consider these presentations as a continuum
rather than as individual problems. This also emphasizes the need for a comprehensive,
integrated approach to airway management. Our unit is leading by example in providing a
unified approach to these patients by involvement of ENT, Respiratory physicians, and multi-
disciplinary team to tackle these complex patients and their often-long-standing intractable
issues.Leading on from that, we are also now researching the use of biologic medications in
patients with CRSwNP and the up-to-date clinical management using appropriate biomarkers
to determine the most appropriate biologics (monoclonal antibodies) targeting IL-4, 5 and
13. We will discuss, with examples of these patients who benefited from both the concepts
of ‘one airway, one disease’ and the outcomes when using combined modality novel
treatment options.

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1483
Peak nasal inspiratory flow and the impact of dupilumab treatment in patients with
severe CRSwNP from the SINUS-24 and SINUS-52 studies

Martin Desrosiers1, Scott Nash2, Andrew Lane3, Stella Lee4, Eugenio De Corso5, Changming
Xia2, Asif Khan6, Juby Jacob-Nara6, Harry Sacks2, Paul Rowe6, Yamo Deniz2

1
Division of Otolaryngology-Head and Neck Surgery, University of Montreal, 2Medical Affairs, Regeneron
Pharmaceuticals Inc., 3Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School
of Medicine, 4Division of Otolaryngology—Head & Neck Surgery, Brigham and Women’s Hospital,
Harvard Medical School, 5Otorhinolaryngology-Head and Neck Surgery, A. Gemelli Hospital Foundation
IRCCS, 6Global Medical Affairs, Sanofi

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Background: Lack of nasal airflow is recognized as a high burden of disease for patients with
chronic rhinosinusitis with nasal polyps (CRSwNP). This post hoc analysis evaluated the effect
of dupilumab on peak nasal inspiratory flow (PNIF) and other outcome measures in patients
with CRSwNP and limited baseline PNIF (

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1536
Sustained clinical benefits in patients with chronic rhinosinusitis with nasal polyps 24
weeks post-mepolizumab treatment

Martin Desrosiers1, Zuzana Diamant2, Paolo Castelnuovo3, Peter W Hellings2, Joseph K Han4,
Jared Silver5, Philippe Gevaert6, Anju T Peters7

1
Faculté de Médecine, Université de Montréal, 2Department of Microbiology Immunology &
Transplantation, KU Leuven, Catholic University of Leuven, 3Department of Otolaryngology Head & Neck
Surgery, Ospedale di Circolo ASST Settelaghi Varese, 4Division of Rhinology and Endoscopic Sinus-Skull
Base Surgery & Division of Allergy, Eastern Virginia Medical School, 5US Medical Affairs Respiratory,
GSK, Research Triangle Park, 6Upper Airways Research Laboratory, Department of Otorhinolaryngology,
Ghent University, 7Division of Allergy-Immunology, Northwestern University

CRS – medical management 3| Room 9 Olympic Hall - Level 0| Tuesday 20/06/2023

Introduction: SYNAPSE, a Phase III study in patients with severe chronic rhinosinusitis with
nasal polyps (CRSwNP), demonstrated significantly reduced disease severity with 52 weeks of
4-weekly mepolizumab 100 mg versus placebo. Here, post-treatment durability of
mepolizumab clinical improvements were assessed.Methods: Exploratory endpoints
evaluated for 24 weeks post-treatment were mean (SD) change from baseline in: total
endoscopic NP score (NPS; Week 76) and patient-reported outcomes (PROs: nasal obstruction
visual analogue scale [VAS] score [Weeks 73–76], post hoc in patients without surgery during
SYNAPSE; 22-item sinonasal outcome test [SNOT-22] total score [Week 76] in the overall
follow-up population).Results: 134 patients (mepolizumab n=69; placebo n=65) entered
follow-up; 26 patients with surgery during the study were excluded. Larger NPS reductions
from baseline to Week 52 with mepolizumab versus placebo persisted throughout follow-up
(Week 76: -1.4[-1.7]/-0.5 [1.7]). Larger PRO improvements from baseline with mepolizumab
versus placebo were maintained throughout follow-up (nasal obstruction VAS Weeks 73–76:
-4.4 [3.2]/-3.9 [3.3]; SNOT-22 Week 76: -28.5 [26.8]/-16.7 [25.8]).Conclusions: Post-treatment,
patients with severe CRSwNP maintained mepolizumab-induced NP size and symptom
improvements, suggesting that targeted IL-5 inhibition offers durable clinical response in
CRSwNP.Funding: GSK[ID:205687/NCT03085797]Abstract previously presented at ACAAI
2022: Ann Allergy Asthma Immunol 2022;129(5):S71-2.

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Technological advances 1

1220
Reduced intra-subject variability of an automated skin prick test device compared to
a manual test

Senne Gorris1, Saartje Uyttebroek2, Wout Backaert2, Mark Jorissen2, Rik Schrijvers3, Mark
Thompson4, Dirk Loeckx1, Sven Seys1, Laura Van Gerven2, Peter Hellings2

1
Hippo Dx, Aarschot, Belgium, 2Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven,
Leuven, Belgium, 3Department of General Internal Medicine, UZ Leuven, Leuven, Belgium, 4Zurich
University of Applied Sciences, Switzerland

Technological advances 1| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: The skin prick test (SPT) is the gold standard for identifying allergic sensitization
in individuals suspected of having an aeroallergy. Previous research has shown considerable
variability due to the sequence of steps inherent to a manual SPT.Objective: This study aimed
at comparing the reproducibility, tolerability, and safety of a newly developed skin prick
automated test (SPAT) device compared to the manual SPT (SPMT).Methods: The 118
volunteers enrolled in the study underwent both SPAT and SPMT with histamine and glycerol
control solutions. Wheal size readouts were performed manually by an experienced clinician
and automated by the SPAT device. Discomfort for the participants was assessed using a visual
analogue scale.Results: Coefficient of variation was significantly lower in the SPAT (median
(interquartile range): 13.6% (10.4-17.7%)) compared to the SPMT (17.6% (13.6-22.9%)) group
(p<0.0001). Discomfort was scored significantly lower in the SPAT (median (IQR): 2cm (1-2cm))
compared to the SPMT (2cm (1-4cm)) group (p=0.0009). Prick failures were significantly less
frequent in the SPAT (N=6) compared to the SPMT group (N=179) (p<0.0001).Conclusion: SPAT
showed increased reproducibility and tolerability compared to SPMT. SPAT can limit the
number of prick failures due to human errors during SPMT.

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1303
communication skill in Otolaryngology

ABDULRHMAN ALFAYEZ1

1
KAMC

Technological advances 1| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Communication skills in patient safety Dr. ABDULRHMAN ALFAYEZENT CONSULTANTKing

Saud Bin Abdulaziz University for Health SciencesKing Abdulaziz Medical City — Define
communication and discuss the standards of effective communication— Describe the
importance of communication— Recognize the connection between communication and
medical error— Describe strategies for information exchange Magnitude of the
Problem— Identify barriers, tools, strategies, and outcomes to communication— 1 person
get problem every 5-10 minutes due to harmful events in hospitals— 70% of these events is
the result of breakdown in communication— Where breakdowns occur:— Between patients
and health-care providers— Between health-care providers Components of Successful
Teamwork— Open communication— Nonpunitive environment— Clear direction— Clear
and known roles and tasks for team members— Respectful atmosphere— Shared
responsibility for team success— Appropriate balance of member participation for the task
at hand— Acknowledgment and processing of conflict— Clear specifications regarding
authority and accountability— Clear and known decision making procedures— Regular and
routine communication and information sharing— Enabling environment, including access to
needed resources— Mechanism to evaluate outcomes and adjust
accordingly— understanding where communication can break down and the tools that can
be used to establish effective communication Communication Challenges: - Common Barriers:
- Communication Styles: -— Aggressive— Passive— Assertive How to improve
communication skills, by (I – S – B – A – R –
D)• Identify• Situation• Background• Assessment• Recommendation• D
ecision Dr. ABDULRHMAN ALFAYEZaialfayez@yahoo.com00966-505473183

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1609
Mixed-method analysis of FESS skill acquisition by training grade using simulation on
PHACON models.

Myuran Tharsika1, Devakumar Haran2, Tailor Bhavesh2, Ioannidis Dimitrios2

1
Addenbrooke's Hospital Cambridge, Association of Otolaryngologists in Training, 2East of England ENT

Technological advances 1| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: PHACON models are 3D printed hand assembled models made using DICOM data
from CT sinus scans. They are emerging as an alternative to cadaveric models and becoming
popularised in view of the option to practice on simulated pathology. Methods:ENT trainees
in the East of England were provided with a 1-day FESS simulation training session using
PHACON models. Intercollegiate Surgical Curriculum Programme (ISCP) levels were self-
assessed before and after the simulation, and compared using Wilcoxon signed ranks
tests. Thematic analysis was conducted on reflective data on
learning goals before, during, and after simulation using NVIVO software. Results:Before the
simulation themes included: practicing surgical techniques, confidence with anatomy,
familiarity of instruments and experience. ISCP levels significantly improved for core trainees
(p=0.03) and ST3-5 trainees (0.008) but not ST6+ trainees (0.083). Themes for more junior
CT1-5 trainees included visibility, access and technique. Senior trainees ST6+ themes included
variable anatomy, real cases, and use of angled instruments. Conclusions:Simulation using
PHACON for FESS procedures is an effective method of improving self-assessed FESS skills,
particularly for CT1-ST5 level trainees. Learning themes post-simulation may inform further
training. Future studies may benefit from stratifying trainee groups using variable anatomy
and increasing complexity of techniques.

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1618
Use of a of a Novel Interactive Video Tool in Assessing UK Junior Doctors’ Knowledge
of Nasendoscopic Anatomy

Vishani Loyala1, Robert Maweni1, Mridul Rana1, Haleema Siddique1, Roland Hettige2

1
Department of ENT, John Radcliffe Hospital, Oxford , 2Department of ENT, Wexham Park Hospital,
Slough, United Kingdom

Technological advances 1| Room 10 Peroto - Level 0| Tuesday 20/06/2023

BackgroundJunior doctors in ENT are expected to use flexible nasal endoscopy (FNE) routinely,
even independently, during out-of-hours cover. However, their knowledge of nasendoscopic
anatomy is not well understood. This study aimed to evaluate the efficacy of a novel
interactive video tool in assessing their knowledge. MethodsJunior doctors in four UK
hospitals were sent an interactive FNE video with 25 anatomy identification and 3 procedural
questions, tailor made using H5P software. A questionnaire was also administered to collect
trainee demographics, previous ENT exposure, and confidence in identifying FNE
anatomy. ResultsThe study received 22 responses from doctors at various levels of training.
The average score for the FNE video was 58.6%. CSTs scored significantly higher (91.5%) than
GP trainees (33.9%), FY2s (59.1%), and non-training post-FY2 doctors (53.3%) (one-way
ANOVA p=0.004). Confidence was moderately correlated with performance (Person’s
Coefficient 0.49), but the number of FNEs performed was not significantly correlated with
score (Spearman’s rank correlation test rho = 0.479, p = 0.083). ConclusionsAs well as
highlighting a knowledge, and potentially insight, gap in junior doctors' FNE anatomy, the
interactive video tool provides a promising approach to identify knowledge gaps and tailor
training to individual needs. Further studies using this tool are needed to determine its
effectiveness in improving trainees' performance in clinical practice as well as broader
application to endoscopic sinus surgery.

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1171
Identifying chronic rhinosinusitis without nasal polyps by analyzing aspirated nasal air
with an electronic nose based on differential mobility spectrometry

Jussi Virtanen1, Kontunen Anton2, Numminen Jura1, Oksala Niku3, Rautiainen Markus1, Roine
Antti1, Kivekäs Ilkka1

1
Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital, Finland, 2
Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital,
Finland, 3Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital,
Finland

Technological advances 1| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background
The diagnosis of chronic rhinosinusitis (CRS) is a complicated procedure. An electronic nose is
a novel method that detects disease from gas-phase mixtures, such as human breath.
Aims/Objectives
To determine whether an electronic nose based on differential mobility spectrometry (DMS)
can detect chronic rhinosinusitis without nasal polyps (CRSsNP) by analyzing aspirated nasal
air.
Materials and Methods
Adult patients with CRSsNP were examined. The control group consisted of patients with
septal deviation. Nasal air was aspirated into a collection bag and analyzed with DMS. The
DMS data were classified using regularized linear discriminant analysis models with 10-fold
cross-validation.
Results
The accuracy of the DMS to distinguish CRSsNP from patients with septal deviation was 69%.
Sensitivity and specificity were 67% and 70%, respectively. Bonferroni-corrected statistical
differences were clearly noted. When a subgroup with more severe inflammatory disease was
compared to controls, the classification accuracy increased to 82%.
Conclusion
The results of this feasibility study demonstrate that CRSsNP can potentially be differentiated
distinguished from patients with similar nasal symptoms by analyzing the aspirated nasal air
using DMS. Further research is warranted to evaluate the ability of this novel method in the
differential diagnostics of CRS.

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1214
Objective assessment of significant effects of endonasal inflammation on the nasal
cycle

Achim BEULE, Mona Wrzodeck2, Claudia Rudack2, Inga Nierkamp2

1
Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald,
2
Dapartment of ENT, Univsity Hospital Münster

Technological advances 1| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Longterm rhinofolowmetry gives a prolongated insight into endonasal pathophysiology, but

up to date lacks a clear rhinologic indication. Our hypothesis was affacetion of the nasal cycle
caused by endonasal chronic inflammation such as chronic rhinosinusitis or allergic
rhinitis.Methods: 113 subjects (72 ♀ , 41 ♂; 81 patients and 34 healthy controls mean 34,8
years of age) were evaluated using a standardised rhinologic assessment inlcuding
nasendoscopy, olfactory testing, rhinomanometry/rhinoresistometry, acoustic rhinometry
and long-term rhinoflowmetry in a prospective manner. Long-term rhinologic measurements
were objectively assessed for technical issues and artefacts. Suitable measurements were
assessed by three different, blinded investigators and in several technical settings to
determine optimal visualisation and calculation employing intra-class correlation coefficient
of 6 different items. Results: Technical visualisation of the optimal calculation mode was
determined with a mean ICC of 0.88 suggesting very high reliability. 12 subjects had to be
excluded for technical reasons (8,4%). Nasal breathing volume varied between 0,75 to 19,7
l/min. Endonasal inflammation resulted in significantly smaller MCA2 (p<0.001) and
significantly lower nasal respiratory volume if measured during night time (p<0.0001) among
more significant group differences. Discussion: Long-term rhinoflowmetry is able to explain
sleep disturbances in patients with chronic endonasal inflammation and can be used for
objective quantification of nasal cycle pathophysiology.

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Epistaxis and HHT + Facial Trauma

1472
NASAL SEPTUM PERFORATION CONSERVATIVE TREATMENT IN SYSTEMIC JUVENILE
IDIOPATHIC ARTHRITIS PATIENTS

Irina Meytel1, Yuri Rusetsky2, Larisa Sotnikova1, Irina Osipova3, Zalina Sulejmanova2, Dani
Haddadin2

1
National Medical Research Center for Children’s Health, Moscow, Russia, 2Central State Medical
Academy of Department of Presidental Affairs, Moscow, Russia, 3Multidisciplinary Medical Center K +
31 Petrovskie Vorota

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

Objectives/Hypothesis: Most of perforation symptoms and clinical manifestations can be

reduced with conservative treatments, thus improving the patient’s quality of
life.Methods: 10 adult patients and 18 children received treatment by nasal septum silicone
prothesis. The mean age - 23 ± 17 years, of which 15 (54%) were men and 13 were women
(46%). We assessed patient tolerance of this method using a modified Russian version of the
above-mentioned questionnaire (Nasal Button Outcome Questionnaire)Results: The total
score in patients before splinting was 6.5 ± 2.3 points out of the maximum possible 36 points,
after 3 months of splinting, the total score was 2.4 ± 2.5 (p=0.232). Conclusions: The method
allows to reduce the frequency of nosebleeds, difficulty in nasal breathing, the crusts
formation, whistling during breathing. Increase in the epithelialization of the edges of the
perforation contributes to a slower increase in its size and a better prognosis with subsequent
plastic closure.

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1589
Surgical management of patients with refractory epistaxis: A single-center experience

Cláudia Rosa1, Rita Peça2, Mariana Caetano2, Pedro Correia-Rodrigues2, Tiago Eça2, Leonel
Luís2

1
Serviço de Otorrinolaringologia do Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa
Norte, 2Serviço de Otorrinolaringologia do Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte | Lisboa, Portugal

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

Objective: Our aim was to present our center’s experience in treating patients with severe
relapsing epistaxis who had previously undergone conservative procedures and evaluate their
outcomes.Methods: Single-center retrospective review of the medical records of patients
hospitalized due to epistaxis and submitted to surgery and/or embolization from January 2017
to December 2022. Results: A total of 36 patients were identified. Mean age was 62,7±17,1
years and 66,7% (n=24) were male. 69,4% (n=25) were hypertense, 33,3% (n=12) anti-
aggregated, and 16,6% (n=6) had platelet dysfunction. 25 patients (70%) were submitted to
endoscopic ligation and/or electrocauterization of the sphenopalatine artery (SPA) and 3 to
arterial embolization. Revision surgery or nasal packing was necessary in 16%. Hypertension
was associated with revision (p=0,04). There was no relationship between revision and age>
years (p=0,66), antiaggregant use (p=0,61), atrial fibrillation (p=0,45) or diabetes (p=0,16).
Hospital stay was significantly lower in patients who underwent surgery within the first 24
hours of admission compared to those submitted more than 24 hours after hospitalization
(4,5±2,7 vs 8,1±4,4 days, p<0,01). No complications of SPA ligation were registered. 1 patient
had venous thrombosis after the embolization procedure.Conclusion: As demonstrated in our
study, SPA ligation is an effective and safe management strategy for surgical control of
refractory epistaxis. Early timing of surgery may lead to a reduction in length of stay.

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1728
Septal splints for recurrent epistaxis in Hereditary hemorrhagic telangiectasia patients

Eugenia Maiorano1, Elina Matti1, Nacu Bogdan1, Andrea Luceri1, Fabio Sovardi1, Vera
Siragusa1, Giuseppe Spinozzi1, Carla Olivieri2, Marco Benazzo1, Fabio Pagella1

1
Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, 2Molecular
Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Pavia, Italy

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

Objective: To report our experience in the use of silicone septal splint for recurrent severe
epistaxis in Hereditary haemorrhagic telangiectasia patients (HHT).Methods: This is a
descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS
Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT.
We retrospectively evaluated HHT patients who underwent silicone septal splint positioning
after the endoscopic surgical treatment of epistaxis from 2000 to 2022.Results: Of the 506
patients surgically treated in the period of analysis, 74 patients underwent silicone septal
splint positioning and 37 were postoperatively interviewed. With a mean of 2.4 previous
surgical treatment and a mean epistaxis severity of 7.38, the majority of patients presented
with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5
months, with a good tolerability and a significant reduction in epistaxis severity, need for
blood transfusion and improvement of haemoglobin levels.Conclusions: In HHT patients with
recurrent severe epistaxis and with septal perforation, the placement of septal splints offers
a useful additional strategy in the management of nosebleeds.

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1740
Investigating the effects of Midvault Repair Techniques on the likelihood of epistaxis
from intranasal sprays

Dennis Frank-Ito1

1
Duke University Medical Center

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

Background: The use of topical intranasal steroid sprays is known to cause epistaxis when an
increasing amount of drug medications deposit at the nasal septal wall, even in cases when
patients follow manufacture's’ recommendations to aim spray laterally towards the nasal
lateral wall. This study uses computational modeling to compare the drug quantity depositing
at the septum before and after midvault reconstruction with spreader graft (SG) or spreader
flap (SF).Methodology/Principal: SG and SF were performed sequentially on two cadaveric
head specimens. Computational fluid dynamics modeling was used to simulate airflow and
intranasal spray drug delivery in each specimen’s nasal airway reconstructed models (Pre, SF
and SG) at resting inspiratory airflow rate of 15 L/min. Drug delivery was simulated to mimic
instructions for use of most topical intranasal sprays from manufacturers’ package inserts.
Anterior (AS) and posterior (PS) septal wall drug depositions were quantified for Pre, SF, and
SG.Results: Depositions in Specimen 1 were: Pre - left AS=72%; left PS=10%. SF - left AS=47%;
left PS=23%. SG - left AS=37%; left PS=29%. Specimen 2 depositions were: Pre - left AS=80%;
left PS=3%. SF - left AS=53%; left PS=29%. SG - left AS=85%; left PS<1%. Approximately zero
deposition was recorded on the right septum for Pre, SF and SG in both
specimens. Conclusion: In general, preliminary results suggest that SF reduces septal wall drug
deposition anteriorly but not posteriorly, which was also true for SG in specimen 1 but not
specimen 2.

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1772
3-D matrix Purabond® use to achieve haemostasis in Awake surgery.

Paresh Pramod Naik1, Hemang Brahmbhatt1, Hannah Finney2, Nikhil Sundaraj3

1
University Of Northamptonshire, 2University of Northamptonshire, 3University of Northamptonshire UK

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

IntroductionHaemostasis is one of the ultimate goals of surgery. Recently there has been a
rising trend of awake surgery. Awake surgeries also known as office-based surgeries are
procedures done under local anaesthesia. Bleeding especially during local anaesthesia
procedures can be stressful. In many cases the sight of blood can cause anxiety to the patients
which in turn can lead to physiological changes like tachycardia, increase in blood pressure
and which can increase bleeding.Post operative nasal packing can cause discomfort and
increase recovery time. Purabond® has a synthetic peptide which forms crosslink 3D matrix
when in contact with blood. Method:We used Purabond® in patients who underwent awake
Rhinology surgery in NHS trust. Results:100% patients had a good haemostasis control. None
of the patients had any post operative bleed. Conclusion:Purabond® 3Dmatrix achieves good
haemostasis without causing any discomfort to the patient.

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1151
Forehead flap as reliable method for functional and aesthetic nasal reconstruction

Dmytro Slosser, Oleksandr Lompas

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

Rising incidence of nasal & fascial trauma is an increasing concern in Ukraine. Paramedian
forehead flap is reliable workhorse for reconstruction of nasal defects. However, incessant
processes of surgical improvement require the use of new approaches, which allow patients
to receive more effective result.The purpose of this study is to demonstrate the
implementation of the forehead flap for nasal reconstruction to address a partial or complete
rhinectomy after traumatic cases, burns and oncological treatment. This work demonstrate
process of preoperative assessment and planning, further intraoperative procedure and
postoperative patients follow up.Through precise analysis of the defect, planning and correct
execution of surgery, large nasal defects can be restored, with excellent functional and
aesthetic results. With careful attention to the reconstruction of all nasal subunits, skin
matching, paramedian forehead flap can restore virtually any large nasal defect. Our cases
will demonstrate the range of techniques that can be used for variety of nasal defects

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1631
Video Clinics for Nasal bone Injuries in COVID times – Is it a valid tool for Routine
Practice

Ved Narang1, Megan McGlone2

1
Delhi ENT Hospital & Research Centre, New Delhi, India, 2University of Glasgow, Scotland, UK

Epistaxis and HHT + Facial Trauma| Room 11 Hall 3.3 - Level 7| Tuesday 20/06/2023

Aims of the studyTo compile and compare the results of virtual clinics for nasal bone injuries
conducted during peak covid times, and face-to-face clinic appointments. Methodology The
pre-existing three-month data for video clinics was available & we collected similar data for
face-to-face clinics lasting six months. The data was collected for the total number of patients
by age group, the sex, failure to attend and, the numbers requiring nasal manipulations. The
data were analysed using the Chi-Square test in Scify Python 3.0. Results No difference was
observed when comparing patients under & over 18 age groups (p-value – 0.961), DNA at
follow-up clinic (p-value – 0.0734) and the numbers requiring fracture reduction (p-value –
0.0734 with 2 degrees of freedom). Conclusions The Video clinics are seen equally effective in
managing patients with suspected fracture nasal bones. Their use can build into routine
clinical practice & they may not be limited to emergency times as contemplated before. The
authors recommend a balanced approach to the use of video clinics as it costs an additional
appointment.

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Sinonasal malignancy 1

1143
Adenoid cystic carcinoma of maxillar sinus: A report case

Ángeles Mercedes Oviedo Santana1, María Soledad Cabrera Ramírez1, María Sandra
Domínguez Sosa1, Sara Soria Medina, Rocío Andreu Abeledo1
1
Hospital Universitario de Gran Canaria de Doctor Negrín

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Introduction: Adenoid cystic carcinoma is a malignant neoplasm that usually settles in the
exocrine glands, especially the salivary glands. Other less frequent locations (5%) are the
oropharynx and nasopharynx. More frequent between the 5th and 6th decade of life and in
women. They are usually asymptomatic or present with non-specific inflammatory symptoms
such as unilateral nasal respiratory failure, rhinorrhea...Material and methods: We present
the case of a 63-years male patient with diabetes and benign prostatic hypertrophy, under
follow-up by otolaryngology due to left nasal respiratory failure that did not improve despite
medical treatment. Subsequently, she developed a stony consistency tumor in the left malar
region that had been increasing and nasofibroscopy revealed septal dysmorphia in the left
nostril and mass effect of the maxillary sinus tumor. CT of paranasal sinuses and echo-trucut
of the lesion are requested.Results: The CT shows a large tumor with aggressive radiological
behavior, located in the region of the left maxillary sinus that invaded the nostril and
infiltrated the base of the skull, chewing space, orbits and cheek. The biopsy revealed the
result of adenoid cystic carcinoma of the left maxillary sinus.the patient was taken to a Tumor
Committee where the treatment with concurrent radiotherapy and chemotherapy was
completed.Conclusion: The adenoid cystic carcinoma of the maxillary sinus is an aggressive
tumor with a tendency to invade and infiltrate neighboristructures. Diagnosis and treatment
are often delayed because it presents asymptomatically.

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1267
Primary Extracranial Meningiomas of the Sinonasal tract

Xin Lei Goh1, Justin Chee Rui Tzen1, Chengyao Alex Tham2
1
Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, 2Tan Tock Seng Hospital

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Primary extracranial meningiomas of the sinonasal tract (PEMS) with no intracranial extension
are rare tumors of the head and neck. Our study presents the largest systematic review to
date, along with an emblematic case report. We aim to provide a comprehensive overview of
the clinical characteristics and prognosis of PEMS.A systematic review was conducted
according to PRISMA guidelines on PubMed, Embase, and Google Scholar up to 1st November,
2022. A total of 70 documented cases from 64 articles were included. Majority of patients
were symptomatic (97%) with nasal symptoms (72%); though eye symptoms (41%) and facial
swellings (41%) were not uncommon. The maxillary sinus was the most commonly affected
anatomical site. PEMS have a predilection for invasion, nearly half of the cases reported
erosion of sinonasal walls and orbital involvement. Most tumors are WHO Grade 1 of
meningothelial type, EMA and vimentin positive. PEMS have a favourable prognosis, with a
high survival rate and a low rate of recurrence, despite the predilection for invasion. There are
no clear defining clinical features of PEMS, hence it is imperative for clinicians to have a high
level of suspicion and prioritise histological diagnosis with immunohistochemical testing to
guide further management. Surgical resection remains the mainstay of treatment

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1271
Facial skull reconstruction with patient-specific 3-D printed titanium implants

Laszlo Lujber1, Lajos Bozsanyi2, Zsolt Pasztor3, Janos Kónya4, Arpad Szabo5, Gyula Marada5,
Zsanett Kover5

1
Pécs University Clinical Center Otolaryngology, Head and Neck Surgery. Hungary, 2Dent Art Technik Kft,
3
Premet Kft, 4Dent-Art Technik Kft, 5Pecs University clinical Center Dental and Maxillofacial Surgery

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

The anatomy of the craniofacial region is complex, with critical functional and aesthetic
importance. The consequences of facial bone damage caused by sino-nasal malignancies,
various maxillo-facial surgeries, traumas, inflammations and congenital anomalies
dramatically impact the quality of life. However, current surgical options to reconstruct
advanced facial bone defects have limitations in achieving good facial cosmetics and restoring
impaired chewing, swallowing, speaking and breathing, highlighting the importance of
developing new surgical solutions. The author presents a series of six cases in which the
extensively missing facial bones were reconstructed entirely with a patient-specific 3D-printed
titanium implant. Computer tomographic images of the head processed with computer-
assisted design (CAD) software aided the medical team in designing the ideal implant with
reverse engineering to replace specific bony defects. The operating surgeon carefully planned
and performed the facial implantation on the model head with the prototype printed in 3D
from cheap resin. The ready-designed implant was printed from grade 23 titanium powder
with laser metal fusion technology.In most cases, the surgeon used the mid-facial degloving
approach for positioning and fixing the implant. As a result, the surgeries were complication-
free, and the complex 3D-printed custom-fit titanium implant successfully improved the
previous structural, aesthetic and functional deficits. In addition, oral health-related
questionnaires, pre-and postoperative photographs and clinical tests documented the surgical
details and the cosmetic and functional results.

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1283
A plan to reduce morbidity and mortality in a high incidence area of sinonasal
adenocarcinoma

Francisco Teixeira Marques1, Francisco T. Marques, Lara Pinheiro Guedes2, Inês Pacheco3,
Roberto Estêvão4, Clara Pedro Mota4, Adriana Cunha4, Nuno Lousan4

1
Tâmega e Sousa Hospital Center, 2Baixo Tâmega Public Health Unit, Marco de Canaveses,
Portugal, 3Vale Sousa Sul Public Health Unit, Penafiel, Portugal, 4Tâmega e Sousa Hospital
Center, Penafiel, Portugal

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Background: Sinonasal intestinal type adenocarcinoma (ITAC) is rare and accounts for a
minority of all sinonasal carcinomas. Among woodworkers, however, the incidence of
sinonasal ITAC is believed to be around 1000 times higher. The purpose of this study is to
create a protocol of intervention in an area of 550.000 habitants with a high number of
occupationally exposed professionals to wood dust. Methods: Retrospective cohort study of
all the patients diagnosed with sinonasal ITAC in the otorhinolaryngology department of a
Portuguese tertiary level hospital between January 2018 and December 2022. Results: We
diagnosed 28 cases of sinonasal ITAC in the last 5 years, 12 of which (43%) presented in an
advanced stage (T3 or T4). History of occupational exposure to wood dust was established in
26 patients (93%). Conclusion: According to the literature, sinonasal ITAC has a global annual
incidence of around 0.13/100.000. Thus, our hospital would be expected to diagnose less than
1 case per year. With that in mind, a collaborative work is taking place between the
otorhinolaryngology and public health departments to create a plan of primary intervention
in wood companies and rapid referral to otorhinolaryngology in case of suspected signs and
symptoms of sinonasal malignancy.

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1298
Maxillectomy – Otorhinolaryngology Department Expertise and Review of Surgical
Nomenclature

Gustavo Pedrosa Rocha1, António Trigueiros2, Joana Nascimento3, Patrícia Lopes4, Lígia
Ferreira5, Pedro Montalvão5, Miguel Magalhães5

1
Hospital Prof. Dr. Fernando da Fonseca, 2Hospital Beatriz Ângelo, 3Centro Hospitalar Universitário
Lisboa Central, 4Centro Hospitalar do Funchal, 5Instituto Português de Oncologia de Lisboa

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Introduction and Objectives: Open maxillectomy is still the treatment of choice in malignant
and recurrence benigns tumors. The complex anatomy and the lack of consensus in
classification systems reflects the variety of adjectives to the extent of the operation. Accurate
description is necessary to appropriate rehabilitation, reconstruction and comparison. We
propose to present the experience of the department and to analyze and uniform the
different maxillectomies. Material and Methods: We have reviewed 43 maxillectomies
between 2017-2022, its extent, approach and adjacent structures removal. Spiro classification
and relevant literature about the topic was reviewed. Results: Histologic diagnosis was
squamous carcinoma in 28%, followed by salivary gland carcinoma (25%) and sarcoma (12%).
The maxillectomy performed in 30% was a limited maxillectomy - which primarily removed
one wall of the antrum. Medial wall was removed in 61% and vestibular approach used in 54%.
Sub-total maxillectomy was performed (28%) when was removed at least two walls, including
the palate, but not the posterior wall. Access was provided by Weber-Ferguson (WF) incision
in 92%. Total maxillectomy was performed in 18, 12 with WF incision and subciliar extension
and 5 with orbital exenteration. Conclusion: As well as histopathologic specificity in sinonasal
tumors grows, so does the complexity of the surgical and reconstructive procedures. Despite
Spiro classification is not guided for the reconstruction of the defect, it is quite informative
and easy to uniform the surgical procedure nature.

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1327
Unilateral Nasal Polyp: Predictors for Malignancy

Shahaf Shilo1, Tommy Jacob1

1
Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky
Medical Center, Tel Aviv, Israel

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

Objective: To identify factors suggestive of malignancy in patients presenting with a unilateral

nasal polyp (UNP). Methods: The medical records of 235 patients (>18y) who underwent
endoscopic-guided biopsy for UNPs between 2007-2020 were reviewed. Patients were
divided into “benign” and “malignancy” groups based upon the histopathology results.
Statistical analyses identified factors predictive for malignancy.Results: Twenty-seven patients
(11%) were included in the “malignancy” group and 208 (89%) in the “benign” group (60%
with inflammatory disease and 29% with benign neoplasm). Factors associated with
malignancy included clinical presentation of epistaxis (32% vs 11%, p=0.01) and extranasal
manifestations (24% vs 4%, p<0.001), suspicious appearance (e.g., friable, irregular mass)
(42% vs 4%, p<0.001) and non-middle meatus location on endoscopy (82% vs 36%, p<0.001),
and suspicious radiological findings (e.g., bone erosion, invasion to adjacent structures) (65%
vs 5%, p<0.001). Conclusion: Clinicians should have a high index of suspicion to rule out
malignancy in patients with UNPs, especially in patients who present with epistaxis or
extranasal symptoms, when the polyp has suspicious endoscopic or radiologic appearance,
and is located outside of the middle meatus.

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1353
Inverted Sinonasal and Middle Ear Papilloma with evidence of Squamous Cell
Carcinoma. A case reports

Alicia María Pérez Orribo1, Alicia Maria Pérez Orribo1, Beatriz Sacramento Garcia1, Silvia
Martín Martín1, Maria Gabriela Muñoz Cordero, Francisco Arias Marzán1, Luis Antonio
González2, Alba Aparicio- Parrado León1, Daniel López Campos1, Mario Bonis Redondo2

1
Departament of Otorhinolaryngology, University Hospital of Canarias, Ofra s/n, San Cristóbal de La
Laguna, Tenerife, Spain., 2Department of Otorhinolaryngology, University Hospital Regensburg, Franz-
Josef-Strauss-Allee 11, D-93053 Regensburg, Germany

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

AbstractSinonasal schneiderian papilloma is a benign neoplastic proliferation that originates

from epithelial cells that typically affects the nasal cavity. These tumors have been reported
to be locally aggressive with a high tendency of malignant transformation and recurrence
particularly if incompletely resected. The occurrence of IP in the middle ear or mastoid process
is a rare entity. Case Presentation. A 52-year-old female patient, operated on nasal inverted
papilloma in 2007and 2008. In 2020 presents history of nasal obstruction on the left
side undergoing inverted papilloma with dysplasia in the lateral wall of the left maxillary
sinus.In May 2022 recurrence of inverted papilloma in the tail of the left middle turbinate and
occupation of the left middle ear. Pathological anatomy reports of carcinoma in inverted Sino
nasal Papilloma and middle ear. The patient underwent subtotal petrosectomy October2022
and is now undergoing radiotherapy treatment. Conclusions. This abstract describes a rare
case of inverted papilloma of the Sino nasal cavity with middle ear involvement. Investigations
revealed malignant transformation and positive HPV association. Reported cases of middle
ear papilloma reveal higher recurrence rates and malignancy potential compared to those
confined to the Sino nasal cavity. Accordingly, an aggressive approach to the management of
similar lesions is recommended along with strict close follow[1]up using nasal endoscopy,

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1455
Multiphenotypic sinonasal carcinoma: an interesting new entity

Gianluca Dalfino1, Mario Turri Zanoni2, Paolo Battaglia2, Alessia Lambertoni2, Maurizio
Bignami3, Paolo Castelnuovo1

1
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria,
Varese, Italy., 2Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences,
University of Insubria, Varese, Italy, 3Department of Otorhinolaryngology, Department of Surgery, ASST
Lariana, University of Insubria, Como, Italy.

Sinonasal malignancy 1| Room 7 Hall 10 - Level 8| Tuesday 20/06/2023

HPV-related multiphenotypic sinonasal carcinoma (HMSC) is a recently described sinonasal

neoplasm morphologically like adenoid cystic carcinoma (ACC), characterized by a salivary
gland tumor-like appearance with myoepithelial and ductal cells, surface squamous dysplasia,
and indolent behavior. Differential diagnosis of HMSC includes basal cell adenocarcinoma and
ACC, both aggressive high-grade salivary gland carcinomas. These tumors are defined by HPV
infection in the absence of MYB, MYBL1, or NFIB fusion genes. High-risk HPV genotypes
infection such as type 33, the most common, but also types 35, 52, and 56, strongly support
the diagnosis. Immunohistochemical analysis, ibridation in situ (ISH) and polymerase chain
reaction (PCR) are fundamental and essential for an accurate differential diagnosis; therefore,
the full morphologic and immunophenotypic profile of HMSC continues to be unrevealed.
Expressions of p16, SOX10 and LEF-1 are typical in these tumors; conversely, MYB protein
presents a variable expression. Currently, ISH and PCR are the best ways to diagnose HMSC,
but further studies will be needed to standardize the diagnostic modalities of this sinonasal
tumor and to use innovative biological treatments.

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CRS – medical management 2

1356
Nasodine is an effective antibiofilm agent with the potential for treating chronic
rhinosinusitis

Sam Hale1, Christian Lux1, Brett Wagner Mackenzie1, Kristi Biswas1, Raymond Kim1, Peter
Molloy2, Simon Tucker2, Stephen Goodall2, Peter Friedland2, Richard Douglas1

1
University of Auckland, Auckland, New Zealand, 2Firebrick Pharma, Melbourne, VIC, Australia

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background:Staphylococcus aureus biofilms in the paranasal sinuses are associated with more
severe and recalcitrant chronic rhinosinusitis (CRS). Few suitable antibiofilm agents are
available to treat this problem. Nasodine® Nasal Spray (Nasodine) is a 0.5% povidone-iodine
based formulation, developed specifically for sinonasal application. We investigated the
antibiofilm efficacy of Nasodine to determine whether it may have potential as a treatment
for CRS-associated biofilms. Methods:Biofilms of S. aureus ATCC 6538 were grown in vitro
using the Centers for Disease Control biofilm reactor. Intact biofilms were treated by
immersion in 0.9% saline (control), half concentration Nasodine, or full concentration
Nasodine for between 5 minutes and 6 hours. Further biofilm cells were dispersed into
suspension then treated for between 30 seconds and 5 minutes. Surviving bacteria were
enumerated by culture and counting colonies. Results:Nasodine demonstrated time and
concentration dependent bacterial killing against intact biofilm. Statistically significant
reductions in viable bacteria from intact biofilms were seen with exposures as brief as 5
minutes. Nasodine consistently eradicated dispersed biofilm within 1
minute. Conclusion:Nasodine is highly active against biofilms of S. aureus ATCC 6538 in
vitro. The intact biofilm structure led to increased kill time despite bacteria remaining
susceptible to Nasodine.

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1357
A modified formulation of Zoono® has enhanced efficacy against bacterial biofilms

Sam Hale1, Christian Lux1, Raymond Kim1, Kristi Biswas1, Brett Wagner Mackenzie1, Richard
Douglas1

1
University of Auckland, Auckland, New Zealand

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background:Sinonasal bacterial biofilms are associated with greater severity and recalcitrance
of chronic rhinosinusitis (CRS). Few effective topical products are available for their
management. Zoono® is a quaternary ammonium compound-based hand sanitiser. Zoono
B22-1402A is a modified formulation of this product. If effective against biofilms, they may
hold promise for managing biofilms in CRS. Methods:Biofilms of Staphylococcus aureus and
Pseudomonas aeruginosa were grown using the Centers for Disease Control (CDC) biofilm
reactor and the Calgary Biofilm Device (CBD) then immersed in Zoono®, Zoono® B22-1402A,
or 0.9% saline control for up to 24 hours. Viable bacteria remaining after treatment were
cultured and enumerated by colony counting. Results:Time and concentration dependent
killing was observed with both formulations against both species. For biofilms grown in the
CDC biofilm reactor, Zoono® B22-1402A eradicated biofilms of both species at 6 hours, though
complete eradication was not achieved with the original Zoono® formulation. In the CBD,
biofilm killing occurred more rapidly leading to eradication within 6 hours with both
formulations against both species. Conclusions:Both Zoono® formulations exhibited
antibiofilm activity, with Zoono® B22-1402A demonstrating greater potency. In vitro toxicity
studies progressing to human trials are warranted.

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1384
Investigating Best Drug Delivery Characteristics After Functional Endoscopic Sinus
Surgery

Amanda Balash1, Dennis Frank-Ito2

1
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, 2Department of
Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Introduction: Topical medications are typically prescribed after functional endoscopic sinus
surgery (FESS) for patients with chronic rhinosinusitis (CRS) to improve healing and reduce
recurrence rate. This study compares sinus drug depositions between manufacturer’s current-
use instruction (CUI) and best-case scenario (BCS) in a post-FESS sinonasal airway using
computation fluid dynamics modeling. Methods: Post-FESS computed tomography images of
an adult male patient with bilateral CRS were used to create a patient-specific sinonasal
airway model. Drug particles (1-100µm) transport simulations were performed at resting
inspiration (15 L/min) from 5 release locations (Bottom, Center, Top, Lateral, and Medial) and
in 5 head positions (Mygind, Supine, Tilted-Back, Tilted-Forward, and Upright) to compare CUI
(head Tilted-Forward and Lateral release location) versus BCS. Depositions were calculated for
all sinuses– frontal (FS), maxillary (MS), ethmoid (ES), sphenoid (SS), and the ostiomeatal
complex (OMC). Results: CUI depositions– Left: ES=0.16%, MS=0.42%, OMC=0.06%,
FS=SS=0%; Right: MS=0.01%, ES=FS=SS=OMC=0%. BCS depositions– Left: ES=0.51%,
FS=0.04%, MS=0.42%, SS=0.01%, OMC=2.64%; Right: ES=0.28%, FS=0%, MS=2.13%, SS=0.22%,
OMC=4.48%. The Mygind head position and Top release location demonstrated superior
performance for depositions under BCS.Conclusion: Preliminary findings suggest that
intranasal spray administration to target delivery of drugs into the paranasal sinuses and OMC
may not provide maximum benefit under manufacturer’s current recommended instructions.

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1389
Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
Initiating Dupilumab in Real-world Clinical Practice in the US

Joshua Levy1, Zachary Soler2, Asif Khan3, Nehal Kamal4, Chelsea Vigna5, Veena Hoffman5, Scott
Nash6, Lucia De Prado Gomez4, Paul Rowe3, Harry Sacks6, Juby Jacob-Nara3

1
Emory University School of Medicine, 2Medical University of South Carolina, 3Global Medical Affairs,
Sanofi, 4Sanofi, 5OM1, Inc., 6Regeneron Pharmaceuticals Inc

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

.

Background: This real-world evidence study describes characteristics of patients with CRSwNP
treated with dupilumab in the US.Methods: A retrospective observational cohort of adults
with CRSwNP initiating dupilumab 300 mg was identified from June 2019 to June 2021 using
claims and electronic medical records data from the OM1 Real World Data Cloud (OM1, Inc,
Boston, MA, US) and Reg-ENTSM registry (AAO-HNS/F, Alexandria, VA, US). Demographics and
comorbidities, medications, sinus procedures, and sinus-related imaging during the 12
months prior to dupilumab initiation were summarized descriptively.Results: A total of 1,016
dupilumab initiators were identified. Patients had a mean (SD) age of 53.8 (14.1) years (60%
were 40−64 years), 54% were male, 79% Caucasian, 14% African American, 3% Asian, and 90%
non-Hispanic/non-Latino. The most common type 2 inflammatory comorbidities were allergic
rhinitis (71%) and asthma (57%). Other comorbidities included diabetes (9%) and chronic
obstructive pulmonary disease (8%). Prior to initiating dupilumab, 74% of patients received
systemic corticosteroids, 65% antibiotics, 71% nasal endoscopy, 22% CT scan, 16% endoscopy
and CT scan, and no patient received an MRI scan. Conclusions: This real-world population of
adult CRSwNP patients initiating dupilumab had a high therapeutic burden including systemic
treatments and diagnostic procedures, and a high burden of comorbidities.

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1390
Can we repurpose Simvastatin to treat recalcitrant S. aureus-mediated chronic
rhinosinusitis?

Simon Goldie1, Huw Jones2, Philip Harries3, Andrew Walls1, Rami Salib1

1
Clinical and Experimental Sciences, University of Southampton, Southampton, 2otorhinolaryngology
Department, University Hospital Southampton, Southampton, United Kingdom, 3Otorhinolaryngology
Department, University Hospital Southampton, Southampton, United Kingdom

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Epithelial S. aureus colonisation with intracellular localisation is associated with

chronic rhinosinusitis (CRS) disease resistance and an increased number of revision sinus
surgeries. Our data shows Simvastatin is effective in reducing intracellular S. aureus burden in
mast cells and reduces the associated inflammatory response. We tested the effects of
Simvastatin treatment on both infected and Staphylococcal enterotoxin B (SEB)-exposed nasal
epithelial cells. Methodology: Air-Liquid Interface (ALI) cultured primary nasal epithelial cells
were harvested from CRS patients. The apical surface was exposed to S. aureus and SEB
treatment in the presence and absence of Simvastatin. Trans-epithelial electrical resistance
(TEER) and pro-inflammatory cytokine release were measured. Results: Simvastatin treatment
reduced the TEER when ALI apical surface was exposed to SEB, but appeared to have no
significant effect on live S. aureus. Simvastatin treatment appeared to reduce pro-
inflammatory cytokine expression from baseline significantly reducing IL6 production (0.56-
fold, P<0.05) and reducing TSLP (0.46-fold), TNFa (0.46-fold), CXCL8 (0.53-fold) and IL33 (0.64-
fold) which was tending towards significance. Light microscopy demonstrated a reduction in S.
aureus burden on simvastatin-treated ALI cells.Conclusions: Simvastatin has the potential to
be repurposed to target intracellular S .aureus in resistant CRS disease and may reduce the
associated pro-inflammatory response.

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1391
Two-year results of tapered dupilumab for CRSwNP demonstrates enduring efficacy
established within half year

Rik Van der Lans1, Wytske J Fokkens2

1
Amsterdam UMC, University of Amsterdam, Department of Otorhinolaryngology & Head and Neck
Surgery, Meibergdreef 9, Amsterdam, Th, 2Department of Otorhinolaryngology, Academic Medical
Center, Amsterdam, the Netherlands

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: dupilumab is an anti-T2-inflammatory biological registered for CRSwNP,

indicated by integrated CRS-care pathways when optimal medico-surgical treatment yields
insufficient CRS-control. This study aims to evaluate long-term results with focus on
therapeutic efficacy established while tapering.Methods: real-life, prospective observational
cohort study in single tertiary referral center with add-on dupilumab as primary biological
treatment in adult (≥18y) biological-naïve CRSwNP-patients per EPOS2020-indication with a
2-year follow-up. Tapering (increasing interdose-interval) applied every 24 weeks, conditional
to sufficient treatment response and CRS-control.Results: mean scores (s.d.) of all co-primary
outcomes improved significantly from baseline (N=228) to the 48- (N=214) and 96-weeks
(N=99) timepoints: NPS improved from 5,3 (1,9) to 1,4 (1,8) and 1,3 (1,7); SNOT-22 improved
from 53,6 (19,6) to 20,2 (15,4) and 21,2 (15,6); Sniffin’Sticks-12 improved from 3,7 (2,4) to 7,7
(2,9) and 7,3 (3,04); ACT improved from 18,5 (4,8) to 21,8 (3,8) and 21,4 (3,9). One-way
repeated-measures ANOVA demonstrated no significant alterations of individual co-primary
outcome mean-scores from 24-weeks onward.Conclusion: this first long-term real-life
prospective observational cohort study shows high therapeutic efficacy of dupilumab for
severe CRswNP in the first two years. Therapeutic efficacy is principally established within 24
weeks, and endures while tapering dupilumab conditional to treatment response and CRS-
control.

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1416
Optimizing the local delivery of corticosteroids for chronic rhinosinusitis

Brent Senior1, Robert Kern2

1
Department of Otolaryngology - Head & Neck Surgery, University of North Carolina, Chapel Hill, NC,
USA, 2Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago,
IL, USA

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Intranasal corticosteroid sprays (INCS) are a mainstay treatment for patients with CRS,
however, their efficacy is suboptimal due to inconsistent drug delivery and limited penetration
deep into the sinonasal passages. The rapid mucosal clearance rates from the nasal cavity and
daily dosing regimens of INCS are augmented by poor patient adherence. Approximately half
of patients with CRS inadequately respond to medical treatments including INCS, making them
potential candidates for sinus surgery. Recent advances to optimize local corticosteroid
treatment, such as EDS-FLU and sinonasal implants, aim to address the limitations of INCS and
have been shown to reduce nasal polyp burden, post-operative outcomes, and/or CRS
cardinal symptoms. However, these therapies are only indicated for certain subsets of
patients with CRS. In the development pipeline for CRS are LYR-210 and LYR-220,
bioresorbable drug matrices designed to conform to the middle meatus or operated ethmoid
cavity, respectively, and release mometasone furoate for up to 24 weeks in a single
administration. LYR-210 demonstrated clinically meaningful symptom improvement and
decreased ethmoid opacification and the need for rescue treatment after 24 weeks of
treatment in the randomized, controlled LANTERN study. If these results are confirmed in
ongoing clinical trials, LYR-210 and LYR-220 may be a promising therapeutic option for
patients with CRS.

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1519
Reimbursement criteria drive the choice for a specific biologic in severe uncontrolled
CRSwNP patients in Belgium

An-Sofie Viskens1, Laura Bollens2, Elien Borgers3, Kato Speleman4, Laura Van Gerven5, Mark
Jorissen6, Stijn Halewyck7, Olivier Vanderveken8, Valérie Hox9, Winde Lemmens10, Peter W.
Hellings11

1
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, 2Faculty of Medicine, KU Leuven, Leuven, Belgium, 3Department of
Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium, 4Department of
Otorhinolaryngology, General hospital Sint-Jan Bruges, Bruges, Belgium, 5KU Leuven Department of
Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit,
Leuven, Belgium, Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven,
Belgium, Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven,
Leuven, Belgium, 6 Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven,
Belgium, Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven,
Leuven, Belgium, 7Department of Otorhinolaryngology, University Hospital Brussels, Jette, Belgium,
8
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, 9Department of
Otorhinolaryngology, University Hospital Saint-Luc, Brussels, Belgium, 10Department of
Otorhinolaryngology, hospital Oost-Limburg, Genk, Belgium, 11KU 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, Department
of Ear-Nose-Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium,
Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam,
The Netherlands

CRS – medical management 2| Room 8 Hall 4 - Level 0| Tuesday 20/06/2023

Background: Since 2022, mepolizumab and omalizumab are reimbursed for severe
uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) in Belgium. The
reimbursement criteria for omalizumab are stricter than for mepolizumab, as the presence of
asthma and a nasal polyp (NP)-score of minimum 4 out of 8 are required. Aim and
objective: Investigate the impact of reimbursement criteria on patients with CRSwNP
prescribed a biologic in Belgium in 2022. Methods: Patients from 6 medical centers in
Belgium, prescribed a biologic for CRSwNP, were studied. The baseline characteristics
(demographics, medical history, NP-score and SNOT-22 score) were analyzed in relation to
their eligibility for either biologic. Results: Fifty patients were included in the trial, with a
mean SNOT-22 score of 45 ± 20.77 and mean NP-score of 5 ±1.78. Respectively, 100 % and
57% of these patients met the reimbursement criteria for mepolizumab and omalizumab. In
reality, 89% of patients were started on mepolizumab, and only 11% on omalizumab.
Interestingly, 51% of the patients prescribed mepolizumab did also fulfil the criteria for
omalizumab. The median NP-score of patients on omalizumab tended to be higher with a
mean score of 6 ±1.22 instead of 4 ± 1.8 with mepolizumab. The mean SNOT-22 score was
similar in both groups with 43 ± 28.8 and 45 ± 19.7 for omalizumab and mepolizumab,
respectively. Conclusion: Since the reimbursement of biologics for CRSwNP, reimbursement
criteria seem to have a considerable influence on the prescribed biologic, with 89% of
patients prescribed Mepolizumab.

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Allergic Rhinitis, Non Allergic Rhinitis

1399
Unified Airways: is hyperreactivity ‘unified’ as well?

Klemenitna Van der Pluijm-Avdeeva1, Zuzana Diamant2, Karin Lammering3, Wytske Fokkens4,
Sietze Reitsma4, Klementina VAN DER PLUIJM-AVDEEVA

1
Amsterdam UMC, 2• Dept of Microbiology Immunology & Transplantation, KU Leuven, Catholic
University of Leuven,Belgium, 3Pulmonary function center O2CO2, 4Amsterdam UMC, Department of
otorhinolaryngology, Amsterdam, the Netherlands

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

Introduction: The upper and lower airways are linked at several levels as a unified airways
system. Nasal hyperreactivity (NHR) is a common feature of chronic rhinitis, whereas
bronchial hyperresponsiveness (BHR) is a key feature of asthma. Previously, we showed
superior nasal reactivity to cold-dry air versus histamine (Braat, AJRCCM 1998). However, little
is known of a possible association between NHR and BHR in chronic rhinitis. In the current
study we explored the association between NHR and BHR in subjects with chronic
rhinitis.Methods: Non-smoking subjects (M/F; 18-70 y) with non-allergic rhinitis (NAR),
allergic rhinitis (AR) and healthy controls (HC) underwent a cold-dry air challenge to assess
NHR and a histamine bronchoprovocation to test BHR on two separate days. Results: 34
subjects completed the study (12 NAR, 11 AR, 11 HC); 16 (5 AR, 6 NAR, 5 HC) presented with
a positive response to cold-dry air (decline in PNIF ≥20%) and 9 (7 AR, 2 NAR) reached a
PC20histamine

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1534
A calendar of pollen and fungi over a three-year period in Northeast Greece.

Georgios Fotiadis1, Petros Katsimpris1, Christos Nikolaidis1, Ipek Chatzisouleiman1, Georgios

Fyrmpas1, Konstantinos Chaidas1, Maria Lampropoulou2, Michael Katotomichelakis1

1
Department of Otorhinolaryngology, Medical School, Democritus University of Thrace,
Alexandroupolis, Greece, 2Laboratory of Histology-Embryology, Medical School, Democritus University
of Thrace, Alexandroupolis, Greece

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

Introduction: Differences in airborne allergens exist between different countries, but also
between regions of the same country. Pollen calendars have been proved important in allergic
management. This study provides new data concerning the atmospheric pollen and fungi
content of Western Thrace in North-East Greece and presents their seasonal differences over
the years, and association with climate parameters. Material and methods: A volumetric trap
was used to collect and count circulating pollen grains and fungi spores. The primary allergenic
pollen season was identified, and their 10-day averages were measured over time.
Correlations with temperature, rain, and humidity were assessed. Results: Pollen grain
families (five arboreal, two nonarboreal taxa, and spores from two fungi species) were
identified. The three most prevalent taxa were Oleaceae, Poaceae, Pinaceae,
and Cladosporium in the fungi. Peak pollen concentrations were detected during April and
May and Poaceae presented the longest pollen season. Cladosporium was the fungus with the
highest spore concentration and variable associations with meteorological parameters
(rainfall and relative humidity) were noted. Conclusion: Our study presents the pollenic and
fungal spectrum of a Mediterranean region, and information, that can be proved significant
for the appropriate diagnostic and therapeutic approach of allergic patients.

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1616
Future-coming antigen-specific immunotherapy (IT) for patients with allergic rhinitis:
mucosal route of IT (sublingual or per os) or regional intralymphatic IT(ILIT), using high
dose of allergenic epitopes delivery system

Hideyuki Kawauchi1

1
Shimane University, Microbiology Department

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

Introduction and summary Allergen-specific subcutaneous immunotherapy(SCIT) with house

dust mite(HDM) and Japanese cedar pollen extract has long been employed to desensitize
patients with perennial allergic rhinitis and cedar pollinosis in Japan. SLIT with HDM and cedar
pollen extract is most recently developed and permitted in Japan to be utilized in clinical
routine as a more safe and effective method. For the last decade, we have been investigating
the therapeutic effect of mucosal route of administration and its mechanism, employing with
ovalbumin (OVA) or transgenic rice (Tg-rice) seeds, which contain T-cell epitopes of Cryj1 and
Cryj2, on murine allergic rhinitis models at the induction and eliciting phase and reported its
clinical efficacy to actually attenuate nasal symptom1,2,3. In this presentation, we would like
to summarize our experimental data in mice and discuss the mechanism of it, based on
immunological tolerance with high dose antigen loading, in comparison with SLIT and
ILIT. References 1. Hidenori Takagi et al：A rice-based edible vaccine expressing multiple
T cell epitopes induces oral tolerance for inhibition of Th2-mediated IgE responses. PRONAS
2005:102(48);17525-17530.2. Takaya Yamada et al. Sublingual immunotherapy induces
regulatory function of IL-10 expressingCD4+CD25+Foxp3+ T cells of cervical lymph nodes in
murine allergic rhinitis model. J Allergy 2012:
ArticleID 490905,11pagedoi:10.1155/2012/4909053. Yinfei Qu et al. Sublingual
immunotherapy attenuates nasal symptoms upon allergen exposure in murine allergic rhinitis
model via an induction of IL-10 producing T cells in submandibular lymph node. Ann Otol
Rhinol Laryngol 2019 Jun;128(6_suppl):26S-35S. doi: 10.1177/0003489419835848.
4. Hideyuki Kawauchi: Mucosal Regulatory System for the Balanced Immunity in the Middle
Ear and Nasopharynx. Chapter 18, Mucosal Vaccines edited by H Kiyono, D Pascal, chapter 18,
2020 Elsevier Inc.

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1648
The role of NLK on the pathogenesis of Chronic rhinosinusitis with nasal polyps

Bing Guan1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

Chronic rhinosinusitis is an inflammatory reaction disease with its pathogenesis still unclear.
In this experiment, The Nemo-like kinase and part of inflammatory mediators content of sixty
patients of chronic rhinosinusitis with nasal polyps were compared with thirty patients with
nasal septum deviation. The content of Nemo-like kinase in polyp and turbinate tissue was
detected by immunohistochemistry. Moreover, the levels of IL-5, IL-6 and GSK-3β in the
peripheral blood were compared between the two groups by ELISA. The data obtained were
statistically analyzed using SPSS software. Correlation among these parameters was
performed by Pearson correlation analysis. Each data analysis was repeated three times. The
immunohistochemistry exposed that The percentage of positive areas of Nemo-like kinase in
the polyp tissue in the experimental group was extremely significantly higher than control;
The ELISA detection indicated that The serum levels of IL-5, IL-6 and GSK-3β in the
experimental group were significantly higher than control; Correlation analysis exhibited that
The concentration of IL-6 was positively correlated with the percentage of positive areas of
Nemo-like kinase (r=0.377, P=0.013<0.05). There may be a certain synergy between IL-6 and
Nemo-like kinase, and the regulation mechanism is under further investigation.

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1653
Late phase IL-13 production corresponds to the clinical late allergic response following
birch pollen nasal allergen challenge

Nicholas Campion1, Sergio Villazala-Merino2, Helen Killick3, Eleftheria Pertsinidou4,

Mohammed Zghaebi2, Josef Toth2, Renate Fröschl5, Victoria Stanek1, Ryan Thwaites6, Thomas
Perkmann5, Katarina Gangl1, Sven Schneider1, Robin Ristl9, Ian Scott8, Suzanne Cohen8,
Magnus Molin4, Margit Focke-Tejkl10, Trevor Hansel7, Rudolf Valenta10, Julia Eckl-Dorna1,
Verena Niederberger-Leppin1

1
Medical University of Vienna, Department of Otorhinolaryngology, Austria, 2Medical University of
Vienna, Department of Otorhinolaryngology, 3Translational Science and Experimental Medicine,
Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca,
Cambridge, 4Thermo Fisher Scientific, Uppsala, Sweden, 5Department of Laboratory Medicine, Medical
University of Vienna, Austria, 6National Heart and Lung Institute, Imperial College London, UK, 7National
Heart and Lung Institute, Imperial College London, United Kingdom, 8Translational Science and
Experimental Medicine, Research and Early Development, Respiratory & Immunology,
BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom, 9Center for Medical Statistics,
Informatics and Intelligent Systems, Medical University of Vienna, Austria, 10Divison of
Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna,
Austria

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

Background: Nasal allergen provocation studies have shown biphasic nasal responses to
provocation termed early (EAR) and late allergic responses (LAR). To date no clear methods
have been discovered to identify those at risk of developing LAR. Objective: In this study we
set out to thoroughly characterise immunological events and clinical nasal responses in the
EAR and LAR. Methods: 30 eligible birch-allergic patients were challenged intranasally with
either birch extract (n=20) or placebo (n=10) on 3 consecutive days, 24h sampling time courses
took place on provocation days 1 and 3. Clinical responses were assessed and a panel of 33
inflammatory mediators were measured in nasal secretions.Results: Patients provoked with
birch all showed significant drops in nasal airflow and rises in symptom scores. Birch-
challenged patients saw significant increases in tryptase and sST2 in the EAR. 8/20 birch
provoked patients displayed significant IL-13 responses in the LAR. These patients were also
the only ones that showed a significant drop in nasal airflow and significant rises of Th2
cytokines as well as IL-6, sST2, EDN and TSLP in the LAR. Conclusion: Patients with significant
IL-13 responses in the LAR were the only patients to display significant clinical and cytokine
responses in this phase.Funded by the Austrian Science Fund FWF: DK W 1248-B30, SFB F4605,
SFB F4613, Medical Scientific Fund of the Mayor of the City of Vienna AP18092BGM and the
Medical University of Vienna

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1659
ALLERGY PROFILE IN A MULTI ETHNIC POPULATION AND ITS CORELATION TO
SINONASAL OUTCOME TEST (SNOT-22) SCORES- A CROSS SECTIONAL STUDY.

VISHWANATH NATESH1, VISHWANATH ASTER DM HEALTHCARE DUBAI UAE2

1
DEPARTMENT OF ENT ASTER AL KHAIL, 2DEPARTMENT OF ENT, ASTER CLINIC AL KHAIL, DUBAI, UAE,
3
DEPARTMENT OF ENT ASTER AL KHAIL, DUBAI. UAE

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

PURPOSE OF THE STUDY: Epidemiological studies with reference to allergy profile in mixed
populations are very few, more so regarding its relationship to nasal symptom severity. This
study intended to evaluate the allergy profile of a multi ethnic population and also to find a
correlation between variations of allergy profile and SNOT score of patients. SNOT-22 domains
have not been validated specifically for nasal allergic condition. MATERIALS AND METHODS:
Analysis of patient data collected in a prescribed paper and google link format with regard to
their allergy profile which included Eosinophil count, nasal smear for eosinophil, total serum
Immunoglobulin E, Respiratory allergy test for presence of IgE antibodies to specific
aeroallergens and food allergy test for presence of IgE antibodies to specific food allergens.
The 22-item Sinonasal Outcome Test (SNOT-22) is a validated chronic rhino-sinusitis health-
related quality-of-life outcome (HRQoL) measure and was measured for all patients on the
first visit.RESULTS: Airway allergy is a common finding in an admixed and multi-
ethnic population living in an urban environment. A total of 50 cases with high total serum
Immunoglobulin E and positive respiratory and/ or food allergy were evaluated in this cross
sectional study. Total IgE levels correlated well with both SNOT-22 score and nasal smear.
Respiratory allergy test correlated more with total Ig E levels compared to food allergy test.
The most common aeroallergens in the respiratory allergy test were Dermatophagoides
pteronyssinus(DP) and Dermatophagoides farinae(

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1762
Global Distribution, Discontinuation, and Non-publication, and Characteristics of
Clinical trials on Chronic Rhinitis; Analysis of Registered Studies on clinicaltrials.gov

Shirin Cadri1, Ahmed Negida2

1
Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania, 2Harvard Medical School, MA

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

IntroductionChronic rhinitis is long-lasting inflammation of the nasal passages that affects

about 15-30% of the population worldwide at some point in their lives. This study examined
the global distribution, non-publication, discontinuation, and characteristics of registered
clinical trials of chronic rhinitis. MethodsWe searched clinicaltrials.gov for all registered
clinical trials using the keywords “Chronic Rhinitis”. Search results were exported from the
database. Data about the publications were obtained by manually searching PubMed and
Google Scholar using the clinical trial identifiers. Statistical analysis was done using Jamovi for
macOS. ResultsA total of 306 studies registered on clinicaltrials.gov were included in the
analysis. Of them, 247 were clinical trials (80%), while 59 were observational (19.3%).
Biological agents were investigated in 32 studies (10.5%). Most studies (n=232, 88%) were
conducted in high-income countries, and none were registered in low-income countries. Most
studies were conducted in the US (54.9%) and Canada (11.7%). Results were available for only
69 studies (22.5%). 30% of registered studies were either suspended, terminated, withdrawn,
or with unknown status, and 224 were never published (73.2%). ConclusionMost registered
studies in chronic rhinitis are conducted in high-income western countries, reflecting the need
for local research in low- and middle-income countries. Owing to the high discontinuation and
non-publication rates, more robust data-sharing and collaboration methods are needed to
support rhinology clinical trials.

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1299
Cases with non-allergic rhinitis with IgG4-tissue accmulation in elderly

Maki Akamatsu, Takayuki Shiomi2, Sei-ichiro Makihara3, Mitsuhiro Okano4, Aiko Oka4, Kengo
Kanai5

1
Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima City Hiroshima Citizens
Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, International University of
Health and Welfare Narita Hospital, 2Department of Pathology, International University of Health and
Welfare Narita Hospital, 3Department of Otolaryngology-Head and Neck Surgery, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 4Department of
Otorhinolaryngology, Head and Neck Surgery, International University of Health and Welfare Narita
Hospital, 5Department of Otorhinolaryngology Head and Neck Surgery, International University of
Health and Welfare Narita Hospital, Narita, Japan

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

Rhinitis in elderly shows non-typical and varied nasal signs due to heterogenous changes of
nasal function due to aging. These include volume reduction of nasal glands, thinness of
ciliated epithelial cells and fibrosis of lamina propria, leading to atrophy of nasal mucosa. On
the other hand, some elderly show hypertrophy of nasal mucosa, which promotes severe
nasal congestion. Here, we reported the cases aged over 60 showing substantial infiltration of
IgG4-positive cells into nasal mucosa. All cases were male, and had a hypertrophy in anterior
part of inferior turbinate, leading to nasal congestion as a chief complaint. None of the
patients complained hypresthetic paroxysmal nasal symptoms such as sneezing or itching.
One patitent exhibited a high level of serum IgG4. Another patient had a cormobid
rhinosinusitis. All the patients received endoscopic mucosal resection of bilateral anterior part
of inferior turbinate. After surgery, symptoms and objective nasal passage were improved
with the use of intranasal corticosteroid. In case of hypertrophic rhinitis with severe swelling
especially in the anterior part of the inferior turbinate in elderly, non-allergic rhinitis with
IgG4-tissue accumulation (NARITA) should be suspected.

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1343
Correlation between nasal provocation tests and rhinologic clinical evaluation in a
cohort of 67 patients with occupational rhinitis

Emilie Bequignon1, Lise Le Corguillé1, André Coste1, Sophie Bartier1, Françoise Zerah-
Lancner1, Pascal Andujar2, Sarah Basses3, Marie Thérèse Lecam3

1
Centre Hospitalier Intercommunal de Créteil et AP-HP, Hôpital Henri Mondor, Service d’Oto-Rhino-
Laryngologie et de Chirurgie cer, 2Université Paris-Est, Faculté de Médecine, Créteil, F-94010, France,
3
Centre Hospitalier Intercommunal de Créteil, service de pathologies professionnelles, Créteil, 94010,
France

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

The objective of this study was to investigate the relationship between clinical symptoms of
patients suffering from occupational rhinitis (OR) and nasal provocation test (NPT) positivity
and secondly between NPT results and rhinoscopic status and quality-of-life score based on
the 22-item Sinonasal Outcome Test (SNOT22). We conducted an observational study
including subjects consecutively referred to our center for suspected OR performing clinical
and occupational examination, nasal endoscopy, immunological tests and pulmonary function
tests. Nasal provocation tests (NPT) were performed using posterior active rhinomanometry
with 5 different agents (didecyldimethylammonium chloride (DDAC), benzalkonium,
persulfates, wood and flour). We compared patients with positive NPT versus negative
NPT. During a study-period of 3 years, 67 patients were included. Forty- one NPT were
performed with quaternary ammoniums, 20 with persulfates, 4 with wood and 2 with flour.
There was no correlation between NPT positivity and age, type of agent tested, basal binasal
resistances, pre-test symptoms score, rhinologic evaluation and SNOT22 results. A positive
NPT was significantly more frequent in atopic patients. It confirms the difficulty to assume
patients suffering from OR before performing the NPT and that NPT is the gold standard test
in OR diagnosis, thus leading to occupational rehabilitation or preventive workplace
measures.

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1280
Cytological and biological markers for the diagnosis of local allergic rhinitis: A meta-
analysis and adjusted indirect comparison of diagnostic test accuracy

PHUOC MINH HOANG1, WIRACH CHITSUTHIPAKORN2, KACHORN SERESIRIKACHORN3,

KORNKIAT SNIDVONGS3

1
Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Hue,
Vietnam, 2Endoscopic Nasal and Sinus Surgery Excellent Center, King Chulalongkorn Memorial Hospital,
Bangkok, Thailand, 3Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand

Allergic Rhinitis, Non Allergic Rhinitis| Room 9 - Olympic Hall - Level 0| Tuesday 20/06/2023

BackgroundThere is insufficient direct or indirect evidence of all current techniques for

diagnosing local allergic rhinitis (LAR). Nasal provocation test (NPT) is a key diagnostic tool for
LAR. Cytological and biological markers are investigated to provide convenient approaches
without a misdiagnosis of LAR. MethodsSystematic searches on five electronic databases were
performed for human studies comparing the accuracy between NPT and index tests
(cytological and biological markers) for diagnosing LAR. Pooled outcomes, including
sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and
diagnostic odds ratio (DOR), were calculated. Relative diagnostic outcomes between index
tests were computed using the indirect comparison of modalities. ResultsEighteen studies
met the inclusion criteria. Compared to NPT, nasal eosinophilia on nasal cytology had the
highest sensitivity but the lowest specificity. Nasal-specific IgE (nsIgE) had the lowest
sensitivity and the highest specificity. The basophil activation test (BAT) had good sensitivity
and specificity. Comparisons among three index tests showed that nsIgE ranked among the
highest for PLR and DOR while BAT ranked among the lowest for NLR.Conclusion Our study
indicated that BAT had greater diagnostic values for LAR than nsIgE and nasal eosinophilia.
Measurement of nsIgE is still challenging due to the low positivity rate.

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Smell and Taste 3

1507
Prevalence and Persistence of Parosmia After COVID-19

Brandon Vilarello1, Patricia Jacobson2, Jeremy Tervo1, Liam Gallagher1, Francesco Caruana1,
Joseph Gary1, Tiana Saak1, David Gudis3, Paule Joseph4, Terry Goldberg5, D. P. Devanand6,
Jonathan Overdevest3

1
Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA, 2Department of
Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical
Center, New York, NY, USA, 3Columbia University Vagelos College of Physicians and Surgeons, New York,
NY, USA, Department of Otorhinolaryngology-Head and Neck Surgery, New York-Prebyterian/Columbia
University Irving Medical Center, New York, NY, USA, 4National Institute of Alcohol Abuse and
Alcoholism, Section of Sensory Science and Metabolism & National Institute of Nursing Research,
Bethesda, MD, USA, 5Department of Psychiatry, New York-Presbyterian/Columbia University Irving
Medical Center, New York, NY, USA, 6Columbia University Vagelos College of Physicians and Surgeons,
New York, NY, USA, Department of Psychiatry, New York-Prebyterian/Columbia University Irving
Medical Center, New York, NY, USA

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Introduction: Persistence of COVID-19-associated chemosensory disturbances has been

reported widely throughout the literature. Qualitative disturbances can have profound effects
on olfactory-related quality of life. This study seeks to assess the prevalence and persistence
of parosmia in COVID-19 patients and to correlate these findings with the Sniffin’ Sticks
Parosmia Test (SSParoT). Methods: Participants with self-reported olfactory changes
completed questionnaires to evaluate for the presence of olfactory distortions (n=91) and to
identify and characterize parosmia-triggering odors (n=37). Participants also underwent
quantitative psychophysical testing with Sniffin’ Sticks (TDI, SSParoT) across two distinct time
points. Statistical analysis utilized paired-samples t-tests. Results: 73% (66/91) of participants
endorsed parosmia at baseline assessment and 54% (19/35) of participants endorsed
parosmia after one year. SSParoT evaluation demonstrated statistically significant increases
in group averages (n=34) of both hedonic range (p=0.003) and hedonic direction (p<0.001)
across one year. The most common parosmia-triggering scent was onion, and participant’s
familiarity with a scent was the most important factor in determining parosmia triggers.
Conclusions: Parosmia affects many individuals after acute COVID-19 and may persist for
longer than previously recognized. Given these persistent alterations in odor perception,
further evaluation and validation of the SSParoT would allow for improved characterization.

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1562
Relationship between cognitive complaints and olfactory measures in post-COVID-19
condition individuals

María José Peñalver1, Adriana Izquierdo-Domínguez2, Mar Ariza3, Neus Cano4, Maite
Garolera5, Barbara Segura6, Carme Junqué6, Marta Viñas1

1
Allergy Department and Smell Unit, Consorci Sanitari de Terrassa, Barcelona. Spain., 2Allergy
Department and Smell Unit, Consorci Sanitari de Terrassa, Barcelona. Spain. Alergo-Rino Unit, Teknon
Hospital, Barcelona, 3Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de
Terrassa, Terrassa, Spain, 4Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari
de Terrassa, Terrassa, Spain. Departament de Ciènci, 5Clinical Research Group for Brain, Cognition and
Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain. Neuropsychology Unit,, 6Medical Psychology
Unit, Department of Medicine, University of Barcelona, Barcelona, Spain.

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Introduction:Olfactory dysfunction (OD) is prevalent among COVID-19 patients, accompanied

by fatigue, cognitive impairment and mood disorders resulting in the post-COVID-19 condition
(PCC). Our objective was to investigate the relationship between OD and cognitive complaints
(CC). Methods:Olfactometry was performed using Barcelona Olfactory Test. Participants
assessed smell loss by visual analogue scale (VAS), Quality of Life (QoL) and completed the
Spanish version of the Memory Failures of Everyday (MFE) Questionnaire, assessing memory
forgetfulness and complaints. A linear regression was adjusting (alpha level was set at
p=0.05).Results:75 COVID-19 patients (mean age=51.21SD=6.40; mean years of
education=13.80SD=3.50; mean days from acute disease=362.80SD=194.10). The MFE scores
correlate positively with depressive symptoms (R2=.46;ꞵ=.502p=.0001), women
(R2=46;ꞵ=.299p=.0001) and negatively with odor detection (R2=.46;ꞵ=-.182p=.04). These
three factors accounted for 54% of the variance in CC. 62.7% affectation in QoL was observed
with a higher VAS and older age. Subjective memory complaint is positively correlated with
irritants (C=.23p=0.04) and negatively with pleasant odors (C=-.31p=0.007).Conclusion:CC are
associated with depressive symptoms, women and poor odor detection, regardless of COVID-
19 severity, age or educational level. With more CC, patients smell more irritating odors and
less pleasant odors. If a post-COVID OD, the healthcare professional should refer the patient
for a cognitive evaluation.

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1581
The impact of olfactory disorders on personal safety and wellbeing: a cross-sectional
observational study

Liam Lee1, Louis Luke2, Carl Philpott2, Duncan Boak3

1
University of East Anglia, 2James Paget University Hospital, 3Fifth Sense

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Introduction: Olfactory dysfunction can expose individuals to day-to-day safety hazards. We

sought to investigate the perceptions of safety, quantify the incidence of hazardous events,
and how safety scares/incidents manifest through patient stories. Methods: Data was
collected through an online survey between 25th February 2022 to 28th September 2022. The
survey was distributed through Fifth Sense media channels and open to anyone who claimed
to suffer from olfactory dysfunction. Results: Our survey collected responses from 432
individuals. The majority were female (79.6%), ages 41-70. Around a fifth (20.6%) were non-
UK residents, encompassing 21 different countries. Covid-19 was the commonest cause of
olfactory dysfunction (22%). Majority (85.9%) were worried about any form of safety due to
their smell dysfunction. Specifically, 32.2%, 14.8%, 34.5%, 18.5% of participants have
experienced at least one food incident, gas incident, gas scare, and work scare, respectively.
Affected individuals have taken active measures to prevent adverse events at home (60.2%),
but fewer measures are taken by either employers or the individual in question in the
workplace. Conclusion:There is an unmet need in mitigating hazardous events for individuals
with olfactory dysfunction. We suggest educating the public sector and high-risk sectors such
as gas companies, and introduction of safety ‘scratch and sniff’ cards as a screening
method. Regular assessment of an individual’s olfactory ability similar to sight and
hearing would allow proactive identification of vulnerable people

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1640
The effect of Smell Training on COVID-19 induced Smell Disorders

Emma Schepens1, D.M.A. Kamalski2, Sanne Boesveldt3, Birgit van Dijk3, Charlotte de Haas1,
Inge Stegeman1, Elbrich Postma3, Robert stokroos1, WIlbert Boek4

1
Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht,
Utrecht, the Netherlands, 2Department of Otorhinolaryngology, University Hospital Regensburg, Franz-
Josef-Strauss-Allee 11, D-93053 Regensburg, Germany, 3Division of Human Nutrition and Health,
Wageningen University, Wageningen, the Netherlands , 43. Department of Otorhinolaryngology- Head
and Neck Surgery, Hospital Gelderse Vallei, Ede, the Netherlands

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

While smell training appears to be effective for post viral and posttraumatic smell disorders,
its effectiveness in COVID-19 induced smell disorders is currently unknown. Therefore, we aim
to investigate the potential effect of smell training on patients with COVID-19 induced smell
disorders. We conducted a prospective case-control study for which we included two
comparable cohorts. One of which (n=111) was instructed to perform smell training twice
daily for 12 weeks, and therapy compliance was monitored on a daily schedule, while the
other cohort (n=47) did not perform smell training. The Sniffin' Sticks Test (SST) was used to
objectify the participants' sense of smell over the course of 12 weeks, reported as a Threshold,
Discrimination, and Identification (TDI) score. Prior to and following the training period, these
measurements were taken. Results showed a significantly better sense of smell after 12 weeks
in patients who performed smell training compared to those who did not. Median difference
was 3.00 (95%CI 1.00-5.00; p =0.004). This study suggest a potential beneficial effect of smell
training for patients with COVID-19, to corroborate our findings this should ideally be
demonstrated in a randomized controlled trial.

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1670
High-dose IgG regenerates injured olfactory system by suppressing local inflammation

Masayoshi Kobayashi1, Kohei Nishida1, Eisuke Ishigami1, Kazuhiko Takeuchi1

1
Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of
Medicine

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Objective: Head trauma can be a cause of refractory olfactory dysfunction due to olfactory
nervous system injury. Anti-inflammatory treatment using steroids or anti-cytokine agents is
known to contribute to functional recovery of the central and peripheral nervous systems in
injury models, while there is a concern that they can induce adverse reactions. The present
study examines if high-dose immunoglobulin G (IgG) can facilitate olfactory functional
recovery following injury. Methods: Olfactory nerve transection (NTx) was performed in OMP-
tau-lacZ mice to establish injury models. High-dose IgG was intraperitoneally injected
immediately after the NTx and histological assessment of recovery within the olfactory bulb
was performed at 5, 14, 42 and 100 days after the drug injection. X-gal staining labeled
degenerating and regenerating olfactory nerve fibers and immunohistochemical staining
detected the presence of reactive astrocytes and macrophages/microglia. Olfactory function
was assessed using an olfactory avoidance behavioral test. Results: High-dose IgG-injected
mice showed significantly smaller areas of injury-associated tissue, fewer astrocytes and
macrophages/microglia, and an increase in regenerating nerve fibers. An olfactory avoidance
behavioral test showed improved functional recovery in the IgG-injected mice. Conclusion:
These findings suggest that high-dose IgG could provide a new therapeutic strategy for the
treatment of olfactory dysfunction following head injuries.

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1671
High-sulfur and nitrogen foods are the main triggers of parosmia

Marcel Miyake1, Eduardo Hirata1, Leonardo Volpi1, Juliana Pascutti1, Luiza Medina1, Bruno
Siqueira2

1
Santa Casa de São Paulo School of Medical Science, 2Firmenich Foundation – Brazil

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: Parosmia is a condition associated with a significant impact on quality of life, and
although its pathophysiology is still not well understood, some aromas and fragrances are
commonly reported as triggers. The aim of our study is to determine the main parosmia
triggers and analyze molecular similarities between them. Methods: This was a cross-sectional
study that evaluated subjects with current complaints of parosmia. Data were collected
prospectively using an online survey that assessed the main triggers and the perceptions
associated with them. A perfumer analyzed the molecular characteristics of these substances.
Results: In total, 97 parosmic subjects were included. The main triggers described were onion
(68%), garlic (62.9%), coffee (49.5%), and beef (48.5%). These substances share sulfurous,
nitrogenous, and thioester components that have high aromatic potency and sensorial notes
of "rotten", "sulfurous", and "toasted/burned". The most common perceptions associated
with them were sewage (71%) and burned (37.6%). Discussion: The main parosmia triggers
apparently have important molecular similarities. This knowledge can contribute to a better
understanding of parosmia pathophysiology and represent a first step in the development of
new treatments for this disorder.

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1724
Changes in pediatric patients with olfactory disorders before and after COVID-19
pandemic

Yuji Kishimoto1, Eri Mori1, Masayoshi Tei1, Rumi Sekine1, Monami Nagai1, Hirotaka Tanaka1,
Yuika Turumoto1, Hajime Shinmura1, Norihiro Yanagi1, Rinko Sakurai1, Otori Nobuyoshi1

1
Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

PurposePediatric patients consist of approximately 1.6-2.3% of all olfactory disorder patients.

However, this number was studied before the COVID-19 pandemic and there are no reports
after the pandemic. We investigated the proportion of pediatric patients and compared
before and after the COVID-19 pandemic.MethodPatients who visited our smell clinic from
January 2009 to December 2022 were included in the study. The patients were divided into
two groups, one from January 2009 to March 2020 (before pandemic), and the other from
January 2021 to December 2022 (after pandemic). Patients from April 2020 to December 2020
were excluded because of frequent emergency declarations and hospital lockdowns in Japan.
The percentage of pediatric patients and the causes of the olfactory disorder were
investigated. ResultsBefore pandemic, the percentage of pediatric patients was 1.3%
(31/2342) and the most common causes were olfactory cleft stenosis (26%, 9/35) and
congenital olfactory disorder (17%, 6/35). After pandemic, the percentage was 5.4% (22/409)
and COVID-19-related olfactory disorder (45%, 10/22) was the most common cause, while
olfactory cleft stenosis and congenital olfactory disorder were both 9.1% (2/22).Conclusion
The percentage of pediatric patients before pandemic was similar to that previously reported,
but after pandemic the percentage of pediatric patients quadrupled. The causes of the
olfactory disorder were also found to have changed, with COVID-19-related olfactory
disorders accounting for the majority of cases.

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1737
Does Trigeminal Neuralgia Have an Effect on Olfactory Functions and Sinonasal QoL?

Hazan Basak1, Deniz Uluc1, Ozlem Ergin Beton2, Cem Meco1, Suha Beton1

1
Ankara University Medical School Department of ORL, 2Ankara Bilkent City Hospital Department of
Neurology

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Objective: Olfactory and trigeminal system has close relationship. Most odor stimulate
trigeminal system in addition to olfactory system. Studies showed olfactory loss may affect
trigeminal system. However, effect of trigeminal system on olfaction is still a dilemma. The
aim of the study is to evaluate olfactory functions, sinonasal QoL of the patients with
trigeminal neuralgia and to compare them with normal population. Material Methods: A total
of 52 participants (26 with TGN and 26 normal control) were included in this study. Anterior
rhinoscopy, Modified Sniffin Stick Test (MSST)and SNOT 22 were done. Results: There was no
statistically significant difference between TGN, and control group detected. Compared to
control group SNOT-22 score averages found to be higher in TGN group (p 0,005). There was
no statistically significant difference in SNOT 22 and MSST scores between medically
treatment and combined (medical and invasive) treatment of TGN. The mean identification
and discrimination scores were higher in TGN treated only medically(p0,005). Mean SNOT-22
scores was higher in group with TGN getting combined therapy(p0,005). Conclusion: Recent
studies showed dynamic relationships between olfactory and trigeminal system. Our study
showed there is no detectable clinical effect of trigeminal neuralgia on olfaction. However as
expected QoL affected in cases with TGN significantly. There is a need for further studies
including electrophysiological examination results to have a complete assessment of the
relationship between trigeminal and olfactory systems.

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1775
Development of a new olfactory test for clinical practice: Santa Casa de São Paulo
Olfactory Test (SCOT)

Marcel Miyake1, Renato Trinta1, Luiza Medina1, Axel Voelker2, Bruno Siqueira2, Eliane Bonani2,
Joyce Pereira2, Mônica Machuca2, Luis Roschel2

1
Santa Casa de São Paulo School of Medical Sciences, 2Firmenich Foundation - Brazil, 3MD, PhD

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Background: Despite being widely used in research, psychometric tests are rarely used to
assess olfactory function in clinical practice, due to the high cost, time and complexity of
application. The objective of this study is to develop the prototype of a new psychophysical
test, that evaluates both the olfactory threshold and identification capacity, and is feasible to
be applied in clinical routine. Methods: The SCOT consists of 12 bottles containing essences
developed and standardized by a perfume and flavor industry, that are presented to patients
through scent strips, disposable, and widely used in perfumery. The olfactory threshold is
determined by the lowest concentration of n-butanol (1.35%, 0.45%, 0.15%, 0.05% or 0.015%)
that the patient is able to differentiate from an identical scent strip soaked in water. The
identification test is evaluated by the number of essences that the patient is able to recognize
among coffee, onion, cinnamon, orange and chocolate, in addition to menthol (trigeminal
test). 20 patients without olfactory complaints underwent SCOT on two occasions separated
by at least 30 days. The average application time was 6:12 minutes. All patients and examiners
reported easy understanding in answering and applying the test and high agreement between
visits. Discussion: SCOT may allow the universalization of the psychophysical smell test in
clinical practice, as it presents aromas that are common in different cultures, is complete (both
threshold and identification tests), has a low cost, and is quick and easy to apply. Further
validation is needed.

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1784
Quantitative assessment of olfactory quality in patients with parosmia after COVID-19
infection, and the role of therapeutic adherence in olfactory improvement

Helga KRAXNER1, Kristof LUDANYI1

1
Semmelweis University Budapest, Dept. of Otorhinolaryngology and Head and Neck Surgery

Smell and Taste 3| Room 10 Peroto - Level 0| Tuesday 20/06/2023

Introduction: SARS-CoV-2 infection may be associated with long-term complicationsaffecting

quality of life, such as quantitative and qualitative changes in olfaction. While asuitable tool
has long been available to assess olfactory impairment, a modified version ofthe Sniffin' sticks
test (SSParoT) has been described to assess qualitative changes in olfactoryfunction during
the pandemic, with which little experience is available.Aim: To assess and quantify the
olfactory function of patients with parosmia in a prospectivestudy and to investigate the
changes in different parameters during the control and the roleof therapeutic
adherence.Methods: 38 patients with parosmia (26 women, 12 men, mean age 41.27 and
42.91 years,respectively) were tested with Sniffin' stick and SSParo test at baseline and 3-
month follow-up. Between the two studies, patients were advised to perform olfactory
training. Anolfactory diary was used to assess treatment adherence. Measured values (TDI
threshold,discrimination, identification, HR-Hedonic range, HD-Hedonic direction) were
compared andanalysed according to therapeutic adherence.Results. 15 patients completed at
least 50% of the training (group 1), 23 patients trained less(group 2). At baseline, the mean
TDI was 25.75 (24.91 and 26.64, respectively), the mean HRwas 1.52 (0.68 and 2.29,
respectively), and the mean HD was 0.44 (0.23 and 0.63,respectively). Group 1 TDI mean
during control was 26.73 (p=0.226 vs. baseline), while thatof group 2 was 31.1 (p=0.006 vs.
baseline). The HR and HD control values for group 1 were 2(p=0.001) and 1.045

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Rhinology – miscellaneous 2

1420
Impact of LYR-210 corticosteroid matrices on SNOT-22 subdomains in patients with
chronic rhinosinusitis from the Phase 2 LANTERN study

Brent Senior1, Anders Cervin2, Joanne Rimmer3, Agnieszka Wrobel4, Allison Gartung5, Lindsay
Brayton5, James Shao5, Vineeta Belanger5, Robert Kern6

1
Department of Otolaryngology - Head & Neck Surgery, University of North Carolina, Chapel Hill, NC,
USA, 2University of Queensland Centre for Clinical Research, Royal Brisbane & Women’s Hospital
Campus, Herston, QLD, Australia, 3Monash Health, St. Vincent’s Hospital Melbourne, and Department
of Surgery, Monash University, Melbourne, Australia, 4Centrum Medyczne ALL-MED, Kraków, Poland,
5
Lyra Therapeutics, Inc., Watertown, MA, USA, 6Department of Otolaryngology, Northwestern
University Feinberg School of Medicine, Chicago, IL, USA

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Background: LYR-210 is an implantable corticosteroid matrix being developed as a 24-week

treatment for chronic rhinosinusitis (CRS). LYR-210 demonstrated dose-dependent and
significant improvement in the SNOT-22 total score vs. control, with all LYR-210 (7500µg)
subjects achieving the 8.9-point minimal clinically important difference (MCID) at week 24 in
the LANTERN study. This report evaluates the change from baseline (CFBL) and proportion of
responders for the SNOT-22 subdomains. Methods: Adults with CRS who failed previous
medical management enrolled in the patient-blinded, randomized, controlled LANTERN study
and received sham-procedure control (N=23), LYR-210 (7500µg) (N=21), or LYR-210 (2500µg)
(N=23). MCID thresholds for the rhinologic, extranasal rhinologic, ear/facial, psychological
dysfunction, and sleep dysfunction domains are 3.8, 2.4, 3.2, 3.9, and 2.9, respectively. CFBL
and MCID response were analyzed using ANCOVA and logistic regression.Results: LYR-210
demonstrated dose-dependent improvement with LYR-210 (7500µg) achieving statistical
significance in each SNOT-22 subdomain vs. control at week 24. Mean rhinologic, ear/facial,
extra-nasal rhinologic, psychological, and sleep domain scores decreased by 10.0, 8.0, 5.2,
15.2, and 10.3 points from baseline at week 24 in the LYR-210 (7500μg) arm, respectively. LYR-
210 (7500µg) subjects achieved more than 2x the MCID in each SNOT-22 subdomain at week
24. Conclusions: LYR-210 (7500µg) demonstrated clinically meaningful global symptom
improvement in the LANTERN study and may be a promising treatment for CRS.

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1423
Significant correlation between the SNOT-22 and 3-cardinal symptom composite score
at 24 weeks in patients with chronic rhinosinusitis from the Phase 2 LANTERN study

Brent Senior1, Joanne Rimmer2, Anders Cervin3, Agnieszka Wrobel4, Allison Gartung5, Lindsay
Brayton5, James Shao5, Vineeta Belanger5, Robert Kern6

1
Department of Otolaryngology - Head & Neck Surgery, University of North Carolina, Chapel Hill, NC,
USA, 2Monash Health, St. Vincent’s Hospital Melbourne, and Department of Surgery, Monash University,
Melbourne, Australia, 3University of Queensland Centre for Clinical Research, Royal Brisbane &
Women’s Hospital Campus, Herston, QLD, Australia, 4Centrum Medyczne ALL-MED, Kraków, Poland,
5
Lyra Therapeutics, Inc., Watertown, MA, USA, 6Department of Otolaryngology, Northwestern
University Feinberg School of Medicine, Chicago, IL, USA

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Background: LYR-210 is an implantable matrix being developed for chronic rhinosinusitis (CRS)
that gradually releases mometasone furoate to the sinonasal mucosa for 24 weeks. LYR-210
(7500µg) significantly improved the SNOT-22 and 3 cardinal symptom composite (3CS) scores
at week 24 in the LANTERN study. 3CS (range 0-9) includes 0-3 scores for nasal blockage, nasal
discharge and facial pain. This report evaluates the correlation between SNOT-22 and 3CS at
week 24. Methods: Adults with CRS who failed prior medical management enrolled in the
patient-blinded, randomized, controlled LANTERN study, and received LYR-210 (7500µg)
(N=21), LYR-210 (2500µg) (N=23) or sham-procedure control (N=23). Correlation between
change in SNOT-22 and 3CS at week 24 was evaluated using Pearson and Spearman methods
and linear regression. Proportion of subjects with a ≥1 or ≥2-point improvement in 3CS at
week 24 was assessed with Fisher’s exact test. Results: Changes in SNOT-22 and 3CS at week
24 were strongly (r=0.76) and significantly (p<0.0001) correlated. At week 24, subjects with a
1-point improvement in 3CS were expected to have an 8.2-point improvement in SNOT-
22. Significantly higher proportions of LYR-210 (7500µg) vs control subjects improved by ≥1
point (100% vs 65%) or ≥2 points (90% vs 43%) in 3CS at week 24. The 3CS response was dose
dependent. Conclusions: 3CS strongly correlates with SNOT-22 at week 24 in LANTERN and
may provide a clinically relevant measure of the impact of treatment for CRS. 3CS is being
assessed in ongoing Phase 3 studies of LYR-210.

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1132
PYRIFORM TURBINOPLASTY AND LATERAL NASAL WALL LATERALIZATION: HOW WE
DO IT – PRACTICAL HINTS

Andre Machado1, André Machado2, Hans Rudolf Briner3, Francisco Alvarez4, Daniel Simmen3

1
Faculdade de Ciências da Saúde - Universidade da Beira Interior, 2Otolaryngology Department, CHUSA,
Porto, Portugal, Faculdade de Ciências da Saúde - Universidade da Beira Interior, Covilhã, Portugal,
3
ORL-Zentrum, Hirslanden Klinik, Zurich, Switzerland, 4Faculdade de Ciências da Saúde - Universidade
da Beira Interior, Covilhã, Portugal

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Pyriform Turbinoplasty (PT) is as an option for the management of turbinate hypertrophy. The
philosophy and goal of the procedure are to improve the symptoms of a restricted airway
while preserving function. We report a case of surgical management of inferior turbinate
hypertrophy with PT and Lateral Nasal Wall Lateralization (LNWL). PT and LNWL improve nasal
airflow of the nose providing a wider nasal cavity by acting directly into the bone of the inferior
turbinate (IT). Sustained symptomatic improvement has been documented and is less
susceptible to the influence of turbinate hypertrophy with other techniques.Further studies
are needed in order to evaluate its morbidity and long-term impact in nasal airflow.

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1413
Mucosal Leishmaniasis of the nasal vestibule after a 5 year latency period

Muhammad Alvi, Irfan Syed1, Anastasia Rachmanidou1

1
Lewisham and Greenwich NHS Foundation Trust

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

BackgroundLieshmaniasis is a parasitic disease spread by sandflies and is found in the tropics,

subtropics and southern Europe. After initial cutaneous infection mucosal leishmaniasis can
occur, sometimes after a considerable latency period.Case presentationA 60 year old male
patient presented to ENT outpatients with right nasal vestibular swelling and a background of
nasal obstruction being treated with mometasone nasal spray. On examination an inflamed
right nasal aperture was seen and oral and topical antibiotics prescribed. No improvement
was seen and at review significant fullness extending from nasal columella into the upper lip
with erosion of the anterior septum was seen. Urgent CT, MRI and excision biopsy of the area
was arranged. MRI demonstrated circumferential soft tissue thickening of the right nasal
vestibule. Excision biopsy revealed widespread intracytoplasmic microorganisms. PCR
confirmed Leishmania Donovani.DiscussionDifferential diagnosis for nasal vestibule lesions
include malignancy and infection. A travel history and of previous tropical disease infections
is relevant. This patient later revealed a history of a non healing leg-ulcer secondary to
cutaneous leishmaniasis following a trip to Greece in 2017. Local immunosuppression with
mometasone may have led to recurrence of leishmaniasis in the nasal mucosa. The patient
was referred to the leishmaniasis MDT and successfully treated.

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1487
Implementation of Personalized Medicine in the predictive assessment of
effectiveness and risk of treatment in patients with rhinologic disorders

Boris Duhlenski1, Aleksandar Valkov1, Tsvetan Mladenov1, Malik Yildiz1

1
Department of Otorhinolaryngology, Faculty of Medicine, Medical University – Pleven, 1 Kliment
Ohridski Str., Pleven 5800, Bulgaria, Clinic of Otorhinolaryngology, University Hospital “Dr. Georgi
Stranski” – Pleven II Clinical Base, 91 Gen. Vladimir Vazov Str., Pleven 5800, Bulgaria

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Rhinologic pathology is complex and multifactorial in origin. The personalized approach to

patients with rhinologic disorders is crucial for optimizing disease control and considering
appropriate medical or surgical intervention to improve the effectiveness and clinical
prognosis. The introduction of new biologic therapies in the targeted treatment of chronic
airway diseases challenges physicians with the growing need for developing competencies
regarding the pathophysiology of the inflammatory cascade, spectrum of rhinologic disorder
endophenotypes and reliable immune-cell and mediator biomarkers involved in disease
development, treatment and prognosis.Our study aims to analyze the current status of
translational knowledge in rhinology, outline the perspectives for implementing personalized
medicine (PM) in the clinical assessment of rhinologic disorders, and make evidence-based
decisions about the most appropriate individual treatment.We conducted an online search in
Pubmed and Scopus using keywords to identify relevant information about the application of
PM in rhinology for the endotype-phenotype association, immunotherapy, predictive
biomarkers, clinical guidelines and personalized treatment recommendations.Most of the
publications focused on applying PM to rhinologic oncology and managing chronic
rhinosinusitis by predicting phenotypes. We found insufficient evidence on the
implementation of biomarker strategy to predict outcomes.This study outlines the current
status of implementing PM in rhinology and barriers to its application in precision decision
making.

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1490
Identifying essential technical elements of endoscopic sinus surgery using a Delphi-
methodology

Mads Guldager1, Jacob Melchiors3, Christian von Buchwald3

1
ERS Junior member, 2Department of Otorhinolaryngology, Head and Neck Surgery and Audiology
Rigshospitalet, University Hospital of Copenhagen, Denmark, 3Department of Otorhinolaryngology,
Head and Neck Surgery and Audiology Rigshospitalet, University Hospital of Copenhagen, Denmark

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

IntroductionEndoscopic sinus surgery is a common procedure performed by

otorhinolaryngologis. It is performed for chronic inflammation and benign or malignant
lesions. To the best of our knowledge, no study has identified essential elements of
endoscopic sinus surgery based on a broad international consensus. In this study, we aimed
to identify essential elements in endoscopic sinus surgery based on an international consensus
among content experts invited by the European Rhinologic Society. The study is ongoing, but
we will present the end product at ERS 2023 in Sofia. Method In close collaboration with the
European Rhinologic Society content experts were invited to participate in this study. An
international panel was established. Through three rounds of Delphi, items were identified,
and important items were voted through and included in the final assessment tool. Content
experts will finally deem whether the tool contains essential technical elements and if they
find it useful in future training and assessment of junior doctors. Results37 content experts
were enrolled through an invitation forwarded by the European Rhinologic Society. Through
a 3-round Delphi process approximately 27 items were identified. We are now in the process
of the 3rd round where the final consensus is established. Discussion The use of international
content experts in a Delphi panel contributes to the tool being of international relevance in
future training and assessment of junior doctors. In a forthcoming study, we will validate the
assessment tool.

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1509
Anxiety Screening in Awake Rhinology Procedures

Paresh Pramod Naik, Varsha Karanth2, Mitalee Pareek3

1
University of Northamptonshire, 2Sri Madgusudan Sai Institute of Medical Sciences and Research,
Chikkaballapur, India, 3Consultant Das Hospital , Mumbai , India

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Surgical procedures can evoke anxiety. COVID19 had resulted in an increased waiting list in
the UK. In one of the efforts of decreasing the waiting list, adoption of awake surgical practice
is on growing trend. Awake surgeries also known as office-based surgeries are procedures
done under local anaesthesia. Most of the patients who are healthy and without co-
morbidities do not undergo preoperative assessment. Anxiety is an emotion characterized by
feelings of tension, worried thoughts, and physical changes like increase in blood pressure,
heart rate and muscle tension. These physiological effects preoperatively and intraoperatively
can impact surgical time and clearance and in worst case surgery may have to be
abandoned. In this prospective study, 30 patients had State Trait anxiety scoring. The
patients with higher scores suggesting anxiety were given propranolol. This showed
improvement in the surgical outcomes and patient satisfaction. We suggest use of the State
Trait anxiety scoring system for screening of anxiety which allows us to understand the state
of mind, preoperatively for smooth procedure.

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1539
Comparison between Prelacrimal Approach and Endoscopic Partial Maxillectomy:
Quality of Life Outcomes

Vasileios Chatzinakis1, Andreas Karelis3, Argyro Leventi, Giolina Papargyriou2, Ioannis

Geramas2, Christos Georgalas2

1
Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str.; Kifisias Av., 151 23
Marousi, 2Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av.,
151 23 Marousi, 3Department of Otorhinolaryngology - Head and Neck Surgery, Hellenic Red Cross
Hospital 'Korgialeneio-Benakeio', Athens, Greece, 4Endoscopic Skull Base Centre Athens, Hygeia
Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23 Marousi, Greece

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Prelacrimal approach (PLA) has been gaining popularity in treating benign pathologies of the
maxillary sinus, since it is thought to be well-tolerated, with minor post-operative morbidity.
To the best of our knowledge, patient-reported outcomes comparing PLA to conventional
endoscopic partial maxillectomy do not exist in the literature. In this study we used Sino Nasal
Outcome Test-22 (SNOT-22) to assess the preoperative and postoperative quality of life in
patients undergoing different types of medial maxillectomies. The study included 59 patients
(37 male and 22 female, age range 16 to 91) affected by benign (38 cases) and malignant (20
cases) pathologies. 11 were treated via PLA and 48 with endoscopic partial maxillectomy -
either as a standalone procedure or as part of another operation. The mean SNOT-22 score
was 12 (SD 9,9) points for patients undergoing PLA and 20 (SD 18,6) for patients undergoing
other types of endoscopic partial maxillectomy (p=0.02). Patients undergoing the latest,
usually have a greater burden of disease, including both nasal and emotional/general
symptoms compared to PLA patients; surgery results in improvement in both groups. Patients
with benign pathologies had an average SNOT 22 of 15 versus 28 for those with malignancies,
with p=0.02. However, after multiple regression analysis for all potential variables affecting
SNOT 22 only type of pathology and gender, fit the model and were highly predictive of SNOT
22 postoperatively (F=38, p<0.001). Individual analysis of symptoms was also performed and
is described.

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1580
The musculoskeletal consequences of mouth breathing

Raewyn Campbell1

1
Macquarie University Hospital

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Nasal airflow is vital for craniofacial development and for upper airway muscle tone. However,
more than 20% of adults and up to 60% of children are chronic mouth breathers and the most
common cause of this is nasal obstruction. There is a well known strong correlation between
chronic mouth breathing and bruxism. However, chronic mouth breathing is also associated
with adaptive postural changes that impact the function of many other systems such as the
stomatognathic system, the autonomic nervous system, the respiratory musculature, the
Eustachian tube, temporomandibular joint and the cervical spine. The impact of nasal
obstruction on general quality of life is well known. However, improving nasal airflow has
other significant positive outcomes on body systems that have not yet been fully explored.This
talk will explore the musculoskeletal consequences of chronic mouth breathing and will
discuss the impact of nasal surgery in this context.

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1354
Giant frontal sinus mucocele as a complication of craniofacial resection – case report

Kaamil Gani1, Pedro Branco1, Filipe Correia1, Luís Reis1, Pedro Escada1

1
Centro Hospitalar de Lisboa Ocidental

Rhinology – Miscellaneous 2| Room 11 Hall 3.3 - Level 7 | Tuesday 20/06/2023

Introduction: Giant frontal mucoceles are rare entities, resulting from sinus ostium
obstruction, caused by inflammation, trauma, previous surgery or tumour. The aim of this
work is to report a case of giant frontal mucocele after craniofacial resection and to
demonstrate its marsupialization through endoscopic endonasal approach. Material &
Methods: 62-year-old male patient, with a history of sinonasal carcinoma submitted to
craniofacial resection with left orbital exenteration. Surgical defect was reconstructed
through a transverse rectus abdominus myocutaneous flap. No signs of locoregional relapse
were observed during the follow-up. Five years after the surgery, the patient referred a
progressively enlarging tumefaction close to the left medial cantus, in the upper and medial
side of the flap. Radiological imaging confirmed the diagnosis of a giant frontal mucocele. The
patient was submitted to a modified Draf III procedure with marsupialization of the giant
mucocele.Results: Six months after surgery there are no clinical/radiological signs of relapse.
Conclusions: Giant frontal mucoceles can occur as rare complications of previous surgeries,
when the reconstruction method leads to an entrapment of normal mucosa. It is important to
recognize this entity and the management, through an endoscopic endonasal approach to
create a large pathway for frontal drainage, is safe and effective.

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CRS – pathophysiology 2

1392
Is there a role for Staphylococcus pseudintermedius in resistant chronic rhinosinusitis?

Simon Goldie1, Huw Jones2, Philip Harries2, Andrew Walls1, Rami Salib1

1
Clinical and Experimental Sciences, University of Southampton, Southampton, 2Otorhinolaryngology
department, University Hospital Southampton, Southampton, United Kingdom

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background: Staphylococcus pseudintermedius is an emerging zoonotic pathogen closely

related to S. aureus and has been found in the nares of immunosuppressed patients, including
13% of granulomatosis with polyangiitis patients. There is limited information regarding its
prevalence and virulence in chronic rhinosinusitis. In our cohort of 40 CRS patients, we
identified 2 cases. Methodology: Nasal swabs and demographics were obtained from patients
with CRSsNP and CRSwNP. Swabs were tested for the presence of Staphylococcus species and
sequenced using Illumina paired read whole genome sequencing and interrogated using the
Bactopia pipeline. Results: In our cohort 5% of patients with CRS cultured S.
pseudintermedius, both had evidence of underlying immunosuppression. Genomic
sequencing surprisingly demonstrated fewer antimicrobial resistance genes than S. aureus.
Beta-lactam resistance genes (blaPC1, blaR1, blaI, blaZ) seemed conserved throughout
staphylococcal species however the virulent multidrug resistance qacG/J genes were
identified which was not observed in any S. aureus cultured (n=13). Conclusions: S.
pseudintermedius affects a limited number of patients with CRS but has been shown to be
highly multidrug resistant. This may be due to the qacG/J gene, however it is likely the
organism demonstrates a higher number of drug resistance mechanisms which are as yet
unrecognised.

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1414
Predictive significance of immunohistochemistry for inflammatory mediators in
CRSwNP

Aleksandra Aleksic1

1
ENT Department. University Clinical Centre of Banja Luka. Faculty of Medicine, University of Banja Luka,
Bosnia and Herzegovina

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Introduction: the phenotype of chronic rhinosinusitis with nasal polyposis (CRSwNP) in most
cases is characterized by Th2 inflammation, the dominant role of cytokines that promote IgE
production and eosinophilic inflammation.Objective: the aim of the study was to determine
the role of the Th2 inflammatory profile in the pathophysiology of CRSwNP, and its association
with clinical parameters of the disease.Method: the study included 120 patients with CRSwNP
and 70 patients of the control group. Basic demographic data, subjective and objective clinical
parameters, immunological tests were registered for all subjects. Pathohistological analysis
included the morphological structure and degree of inflammation. Immunohistochemical
analysis was used to detect the expression of IL-5, IL-13 and IgE in the tissue.Results: We
demonstrated a significant predominance of Th2 inflammation markers (IL-5 and IgE) in polyp
tissue. A significant degree of inflammation was found in polyp tissue with positive expression
of IL-5, IL-13 and IgE. Conclusion: The dominant model of CRSwNP endotype, Th2
inflammation mediated by significant expression of IL-5 and IgE, conditions eosinophilic
predominance in polyp tissue, clinically and radiologically more severe forms of the disease.

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1465
Oxidant/antioxidant imbalance induces imflammation in chronic rhinosinusitis with
nasal polyps

Jing Zhou1, Jintao Du1, Qiao Wen1

1
Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, China

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background: Oxidative stress is involved in the pathophysiological process of chronic

rhinosinusitis with nasal polyps (CRSwNP), but the specific mechanism is still unclear. Whether
antioxidant therapy can treat CRSwNP needs further
investigation.Methods: Immunohistochemistry, western blotting and quantitative
polymerase chain reaction analyses (qPCR) were performed to assess the oxidative status and
antioxidative defense in nasal polyps tissue. Correlation was examined by qPCR between
oxidase, antioxidase and inflammatory cytokines in CRSwNP patients. HNEpC and primary
macrophages were cultured to track the cellular origin of oxidative stress in nasal polyps and
estimate whether antioxidants can reduce cellular inflammation by enhancing antioxidant
capacity.Results:The expression of NOS2, 3-NT, NOX1, HO-1 and SOD2 was increased and was
enriched in nasal epithelial cells and macrophages of nasal polyps. Inflammatory cytokines
were positively correlated with oxidase and negatively correlated with antioxidant enzymes.
Crocin, an antioxidant, enhanced antioxidant ability to reduce inflammation via the
KEAP1/NRF2/HO-1 pathway in HNEpC. Moreover, crocin could inhibit the polarization of M1
and M2 and improve antioxidant enzymes expression in M2 polarization.
Conclusion:Oxidative stress plays an important role in the development of CRSwNP by
promoting various types of inflammation. Inhibition of oxidative reaction by crocin could
reduce inflammation via the KEAP1/NRF2/HO-1 pathway. Therefore, antioxidant therapy may
be a promising strategy for CRSwNP.

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1485
Recurrence of severe chronic rhinosinusitis with nasal polyps after multiple surgeries:
could the inflammatory pattern predict a “recalcitrant” disease?

Giuseppe Alberto Di Bella, Eugenio De Corso, Silvia Baroni, Laura Tricarico, Stefano Settimi,
Davide Paolo Porru, Tiziana Di Cesare, Rodolfo Francesco Mastrapasqua, Maria Elisabetta
Onori, Jacopo Galli

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background. Functional Endoscopic Sinus Surgery (FESS) still represents the upfront therapy
for chronic rhinosinusitis with nasal polyposis (CRSwNP). Nevertheless, polyps’ recurrence can
occur also after an adequate surgical approach, thus defining a cohort of “Recalcitrant”
CRSwNP patients. Methods. We enrolled 173 patients affected by severe diffuse CRSwNP.
Patients were subdivided in a case group (A; n= 40) including patients who underwent more
than 1 FESS and in a control group (B; n=133), including patients never treated or who
underwent 1 FESS. We analysed in nasal secretions the levels of IL-5 and calprotectin,
respectively markers of eosinophilic and neutrophilic inflammation.Results. Some clinical
features were associated to higher risk of recalcitrant CRSwNP: intolerance to ASA (p <0.0001),
asthma (p<0.05), high blood eosinophil count(p<0.0001). Group A showed higher levels of
calprotectin (p<0.01) and IL-5 (p<0.05) in nasal secretions. The nasal cytology revealed that
neutrophil count was much higher in patients of Group A compared to those of group B
(p<0.01). The levels of both IL-5 and calprotectin exponentially increase proportionally with
the number of surgical interventions.Conclusions. Our research demonstrated a predictive
role of type 2 biomarkers in stratifying patients on the base of the inflammatory load, with a
non-invasive diagnostic procedure.

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1494
Tissue IL-13+ percentage of inflammatory cells, tissue eosinophils per field of view and
relationship with clinical and imaging findings in patients with chronic rhinosinusitis
with nasal polyps (CRSwNP): A pilot study in greek population

Aikaterini Tsoumaridou1, Nataly Polatoglou1, Eleni Dimitriou2, Maria Alexandri2, Vasileios

Samaras2, Eirini Modestou3, Nikolaos Kokkos3, Stylianos Triantos1

1
Otorhinolaryngology/ Head & Neck Surgery Department, “Korgialenio- Benakio” General Hospital of
Athens (Greek Red Cross Hospital, 2Pathologoanatomy Laboratory, “Korgialenio- Benakio” General
Hospital of Athens (Greek Red Cross Hospital), Athens, Greece, 3Allergology Department, “Laikon”
Hospital of Athens, Athens, Greece

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background: Current focus on understanding the pathophysiology of chronic rhinosinusitis is

toward understanding the molecular pathways that have been activated.1 IL-13 is a cytokine
with an important role in type 2 inflammation initiation2 as well as eosinophil activation and
recruitment1,3,4. SNOT-22 score, endoscopic appearance score and CT Lund-Mackay scoring
system are well established and widely used methods for evaluating patients with
CRSwNP.Methodology: We prospectively collected data by measuring tissue IL-13+
percentage of inflammatory cells by immunohistochemistry (IHC), tissue eosinophils per field
of view (f.o.v.) (40x) and correlated them to SNOT-22 score, endoscopic appearance score and
CT Lund-Mackay scoring system in patients with CRSwNP that were treated by endoscopic
sinus surgery in our hospital.Results: Preliminary results of 46 patients (male-to-female ratio
1,6:1, mean age 47,3 y.o., range 22- 72), showed that 35% had> eos/f.o.v. Patients with>
eos/p.o.f. had the highest percentage of IL13+ inflammatory cells and scored higher to SNOT-
22 score, endoscopic appearance score and CT Lund-Mackay scoring system compared to
patients with <0 eos/f.o.v.Conclusions:The correlation of biomarkers with clinical and imaging
findings may guide more rationally the treatment of CRSwNP.Fokkens WJ, Lund VJ, Hopkins C,
Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J. Executive
summary of EPOS 2020 including integrated care pathways. Rhinology. 2020 Apr 1;58(2):82-
111. doi: 10.4193/Rhin20.601. PMID: 32226949.Güllüev M, Yücel A, Kahraman ME, Bor MA.
Measurement of some serum cytokines in nasal polyp and evaluation of its correlation with
disease severity. Eur Arch Otorhinolaryngol. 2021 Sep;278(9):3345-3349. doi:
10.1007/s00405-020-06600-9. Epub 2021 Jan 15. PMID: 33452622.Laidlaw TM, Mullol J,
Woessner KM, Amin N, Mannent LP. Chronic Rhinosinusitis with Nasal Polyps and Asthma. J
Allergy Clin Immunol Pract. 2021 Mar;9(3):1133-1141. doi: 10.1016/j.jaip.2020.09.063. Epub
2020 Oct 13. PMID: 33065369.Schleimer RP. Immunopathogenesis of Chronic Rhinosinusitis
and Nasal Polyposis. Annu Rev Pathol. 2017 Jan 24;12:331-357. doi: 10.1146/annurev-pathol-
052016-100401. Epub 2016 Dec 5. PMID: 27959637; PMCID: PMC5514544.

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1550
Beta-Adrenergic Sweat Secretion in Chronic Rhinosinusitis

Fernanda Rodrigues da Cunha1, Fernando Augusto de Lima Marson2, Silvana Dalge Severino1,
Maria de Fatima Servidoni1, Jose Dirceu Ribeiro1, Eulalia Sakano1, Carla Cristina SOUZA
GOMES3

1
State University of Campinas, 2University of São Francisco, 3UNICAMP: Universidade Estadual de
Campinas (University of Campinas)

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Introduction: Chronic rhinosinusitis (CRS) has an undefined etiology and may be associated
with multiple factors and is probably caused by interactions between genetic, environmental
factors and inflammation of the respiratory mucosa. The high prevalence of CRS among
patients with Cystic Fibrosis (CF) suggests that the CFTR (Cystic Fibrosis Transmembrane
Regulator) protein may contribute to the pathogenesis of CRS.Objective: Evaluate CFTR
protein function using the evaporimetry technique, sweat test, presence of CFTR variant
F508del and verify whether there is a correlation with the presence or absence of nasal
polyposis.Methods: Adults with CRS, from the Rhinology outpatient clinic of the University
Hospital of UNICAMP, who underwent nasofibroscopy, measurement of electrolytes in sweat,
measurement of beta adrenergic sweat rate using evaporimeter and genetic study for the
F508del variant were evaluated.Results: 72 patients with CRS were evaluated, 14 without
polyposis. Of the 58 with polyposis, 5% (11) presented, in response to the evaporimetry test,
valuesthat suggest CFTR-related disease, although without the F508del variant and normal
sweat test.All those without polyposis had normal exams.Conclusion: Patients with CRS
should be investigated for CFTR protein function and genetic variant .

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1576
Type 2 endotype Staphylococcus aureus biofilm Secreted Factors cause mucosal
damage, mast cell infiltration and goblet cell hyperplasia in vivo

Ghais Houtak1, Roshan Nepal1, George Bouras1, Gohar Shaghayegh1, Catherine Bennett1, John
Finnie2, Kevin Fenix1, Alkis James Psaltis1, Peter-John Wormald1, Sarah Vreugde1

1
Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide,
Australia., The Department of Surgery - Otolaryngology-Head and Neck Surgery, the University of
Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health
Network, South Australia, Australia., 2Adelaide Medical School, Faculty of Health and Medical Sciences,
The University of Adelaide, Adelaide, Australia.

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Chronic Rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses mucosa.

Despite being a common health issue, the exact cause of CRS is yet to be understood.
However, research suggests that Staphylococcus aureus, particularly in the biofilm form, plays
a role in driving the disease. This study aimed to investigate the impact of long-term exposure
to secreted factors of Staphylococcus aureus biofilm (SASF), harvested from non-CRS carriers
and CRS patients, on the nasal mucosa in a rodent model.Wistar rats were randomised
(n=5/group) to receive daily intranasal instillations of 40 μL (200 μg/μl) SASF for 28 days or
vehicle control with S. aureus isolated from the sinuses of a non-CRS carrier, a type 2 endotype
CRS with nasal polyps (CRSwNP) patient, and a non-type 2 endotype CRS without nasal polyps
(CRSsNP) patient. The sinonasal samples were then analysed through histopathology and
transcriptome profiling.The results showed that all three intervention groups displayed
significant lymphocytic infiltration (p<0.05). However, only the SASF collected from the
CRSwNP patient caused significant mucosal damage, mast cell infiltration, and goblet cell
hyperplasia compared to the control. The transcriptomics results indicated that the SASF
significantly enriched multiple inflammatory pathways and showed distinct expression
differences between the control group and the SASF collected from CRS patients (p<0.05).
Additionally, the SASF challenges induced the expression of IgA and IgG, but no IgE was
detected. In conclusion, this study indicates that long-term exp

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1598
Microvessels quantification by fully convolutional neural networks and its association
analysis with endotyping in chronic rhinosinusitis

Wendong Liu1, Xing Liu2, Nan Zhang1, Jian Li1, Yihui Wen1, Yi Wei1, Zhengqi Li1, Tong Lu1,
Weiping Wen1

1
The First Affiliated Hospital, Sun Yat-sen University,, 2Computer, Electrical, and Mathematical Sciences
and Engineering Division, King Abdullah University of Science and Technology

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background: The pathogenesis of highly heterogeneous chronic rhinosinusitis (CRS) is still

unclear, and the angiogenesis of tissue remodeling has rarely been studied. Objective: We
aimed to explore the tissue quantification of microvessels and their potential association with
immune inflammation in CRS by using fully convolutional network (FCN), to exploit CRS more
deeply and widely. Methods: For endotyping of CRS, tissue homogenates of 79 patients with
CRS who had undergone FESS and 17 control subjects were analyzed for IFN-γ, TGF-β, IL-1β,
IL-5, IL-6, IL-8, IL-10, IL-17, TNF-α, ECP, IgE, SE-IgE. 552 HE stained images of 27 CRS tissue
samples were used to develop a FCN, going through training, validation, and evaluation
process. An optimized FCN was applied for quantifying the microvessels of tissue samples of
all subjects. Correlation analysis between microvessels quantification with phenotype,
endotype, clinical characteristics, and cytokines expression of CRS were carried out. Results:
We found that tissue quantification of microvessels between type 2- and non-type 2 CRS had
significant difference, with great higher expression in type 2 CRS than that of non-type 2 CRS.
There existed a strongly negative correlation between the area ratio of microvessels with
tissue TNF-α or TGF-β level, and a mildly positive correlation with tissue IL-5 or ECP
concentration. Conclusions: This study demonstrated that angiogenesis may play an crusial
role in CRS, and elucidated the close association of angiogenesis with endotyping and
cytokines, may assisting to the therapy for CRS.

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1613
INFLUENCE OF IL-33 GENE POLYMORPHISM ON FORMATION OF CLINICAL
PHENOTYPES OF CHRONIC RINOSINUSITIS WITH NASAL POLYPS

Yuliya Moiseeva1

1
Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical
Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) has various pathogenic
mechanisms. Comparison of the clinical phenotypes of the disease with genetic mutations can
expand the understanding of which immunological mechanism will be triggered in a particular
patient.Purpose: to predict the development of certain clinical phenotypes in patients
suffering from CRSwNP using genotyping.Methods: the study involved 103 patients with
CRSwNP and a control group of 50 relatively healthy individuals who were examined for the
presence of mutations in the single-nucleotide polymorphisms (SNP) rs3939286 and
rs1342326 of the IL-33 gene.Results: Statistical analysis of the obtained data revealed that the
A-allele of SNP rs3939286 is a genetic predictor of the development of CRSwNP OR=2.484
(95% CI, 1.184-5.212, p-value = 0.0235), and the heterozygous variant (GA) of rs3939286 is
associated with the formation of chronic purulent inflammation of the mucous membrane of
the nasal cavity and paranasal sinuses OR= 2.788 (95% CI, 1.068-7.276, p-value = 0.04848);
the homozygous variant (AA) rs3939286 aggravates the course of CRSwNP and 4 times (p-
value=0.0492) increases the risk of developing predominantly non-atopic asthma. The G allele
rs1342326 also showed a statistically significant association with the development of asthma
in patients with nasal polyps OR=3.048 (95% CI, 1.136-8.179, p-value=0.04574).Conclusion:
SNP of rs3939286 and rs1342326 of the IL-33 gene have a prognostic role in the formation of
certain phenotypes of CRSwNP.

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1644
Association between smoking and chronic rhinosinusitis: a systematic review and
meta-analysis

Bryan Leow1, Charn Tze Choong1, Claire Tan1, Benjamin Tan1, Neville Teo1
1
Singhealth, Republic of Singapore

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Chronic rhinosinusitis (CRS) is a debilitating inflammatory disease of the paranasal sinuses.

While cigarette smoking has known associations with lower respiratory tract diseases, the
impact of smoking on CRS has not been clearly established. Objective: To clarify the
association between first-hand cigarette smoking and the prevalence and prognosis of CRS,
including quality of life (QOL), olfactory dysfunction, computed tomography (CT) and
endoscopy scores, as well as outcomes following functional endoscopic sinus surgery
(FESS). Data Sources: PubMed, Embase, SCOPUS, and Cochrane Library; from inception until
15 May 2022. Study Selection: Three blinded reviewers selected observational studies
reporting the prevalence and prognosis of CRS in smokers, as compared to non-smokers.Data
Extraction and Synthesis: Three reviewers extracted data, evaluated study bias using the
Newcastle-Ottawa scale and Cochrane Risk of Bias tool, following PRISMA guidelines and a
PROSPERO-registered protocol (CRD42022345585). We used random-effects meta-analyses
to pool the prevalence of smoking in CRS and CRS in smoking, the association between active
versus past smoking and CRS, and the association of smoking with QOL in CRS before and after
FESS. We also performed descriptive analysis of olfactory function, CT scores and endoscopy
scores in smokers versus non-smokers before and after FESS. Main Outcomes and Measures:
Pooled prevalence, odds ratios (OR) and standardized mean differences. Results: Attachment

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1679
FXa augments IL-8 and GM-CSF expression in nasal epithelial cells through PAR2

Ping-Ping Cao, Bai-Yang Wang, Ying-Ying Wang, Shi-Chang Li, Yun-Yun Zhang, Bao-Feng Wang

CRS – pathophysiology 2| Room 7 Hall 10 - Level 8| Wednesday 21/06/2023

Background: Fibrin deposition resulting from local activation and dysregulation of the
coagulation cascade plays a vital role in the pathogenesis of chronic rhinosinusitis with nasal
polyps (CRSwNP). The interaction between coagulation activation and local inflammation may
promote each other, forming a vicious circle.Objective: To explore the effect of activated
coagulation factor X (FXa) on nasal epithelial cells through protease activated receptor 2
(PAR2). Methods: FXa levels were determined by ELISA in nasal polyps (NP) and control tissue
homogenates. The expression and localization of PAR2 in CRSwNP were evaluated through
WB and immunohistochemistry. The effect of FXa on BEAS-2B and primary nasal epithelial
cells from patients with CRSwNP was investigated. Results: The levels of FXa were significantly
increased in NP from patients with CRSwNP compared with control tissue. The expression of
PAR2 was significantly higher in NP vs. control tissue. Moreover, PAR2 was mainly localized in
epithelial, glandular, and scattered tissue or inflammatory cells. FXa significantly increased the
expression of IL-8, GM-CSF, and VEGFa in BEAS-2B cells, and IL-8, GM-CSF, but not VEGFa in
primary nasal epithelial cells from patients with CRSwNP. PAR2 antagonist can inhibit the
effect of FXa on BEAS-2B cells and primary nasal epithelial cells.Conclusion: FXa increases the
expression of IL-8 and GM-CSF in nasal epithelial cells from patients with CRSwNP through
PAR2. The coagulation activation and local inflammation promote each other in CRSwNP.

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Smell and Taste 2

1322
Correlation of olfactory bulb volumes and COVID-19 associated olfactory dysfunction

Christian Betz, Benjamin Becker2, Marvin Petersen3, Carola Mayer3, Elina Petersen4, Raphael
Twerenbold4, Bastian Cheng3, Anna-Sophie HOFFMANN

1
Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, 2Department of
Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
3
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
4
Population Health Research Department, University Heart and Vascular Center, Hamburg, Germany

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Introduction: One common symptom of COVID-19 infections is olfactory dysfunction. The

presented study aimed at a verification of the hypothesis that COVID-19 associated olfactory
dysfunction correlates to structural changes in the olfactory bulbs (OB). Methods: Data of 233
COVID-19 convalescents from the Hamburg City Health Study were analyzed. After
recruitment, patients underwent MR imaging with an automated volumetry of the OB
(“baseline” examination, 253.51 ± 84.46 days after COVID-19), as well as neuropsychological
testing and an assessment of smell via Sniffin’ Sticks (screening test) and standardized
questionnaire in a “follow-up” examination (663.51 ± 109.74 days after COVID-19). OB
volumes and clinical measures were statistically compared between participants with and
without persistent smelling impairment. Results: COVID-19 convalescents with post-acute
smelling impairment showed significantly lower OB volumes than those with perceived
normal smelling (mean at baseline: 40.76 mm3 vs. 46.74 mm3, p=0.046; mean at follow-up:
40.45 mm3 vs. 46.55 mm3, p=0.036). OB volume successfully predicted olfactometric scores
at follow-up (p=0.018). Performance in neuropsychological testing was not significantly
associated with OB volumes. Conclusion: Our data shows a correlation between persistent
olfactory dysfunction after COVID-19 and OB volumes. OB volumetry might be a surrogate
marker for an objective evaluation of post-COVID olfactory function.

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1378
Does Uvulopalatopharyngoplasty

ALSHAIKH NADA1, NADA ALSHAIKH1

1
DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, MOUWASAT HOSPITAL, DAMMAM,
SAUDI ARABIA

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Background: UPPP is a surgical procedure that is aimed to reduce snoring and obstruction
through elimination of redundant pharyngeal mucosal folds, obstructing tonsils, and excess
soft palate. Alternation of taste has been documented as a potential complication since UPPP
involves reduction of redundant palatal tissue which contains taste buds. However, potential
effect of UPPP on olfaction has yet to be determined. The aim of this study is to investigate
the effects of UPPP on olfaction and taste sensations.Method: A prospective clinical study
was conducted in a tertiary Otolaryngology referral hospital in Singapore. Patients who
underwent UPPP for OSA in the absence of any sinonasal diseases were invited to participate.
Assessment of olfaction and taste was conducted pre-operatively and 1- and 12-weeks post-
operatively using 10-point Visual Analogue Scale (VAS), Sniffin' Sticks extended test battery,
and four basic tastes sprays.Results: 15 patients enrolled in the study (1 woman, 14 men;
mean age 62 years). Nine patients (60%) had abnormally low smell scores pre-operatively
while the rest have normal scores. Six patients (40%) showed improvement in olfaction at
one- and 12-weeks after surgery, 4 (26.7%) had decreased smell score at both visits after
surgery, and 5 (33.3%) defaulted from last follow up visit although 3 of them (60%) showed
improved smell scores.Conclusion: This pilot study showed no significant effect of UPPP no
olfaction. However, changes in smell scores have been detected in some patients. Further
studies are recommended.

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1383
Olfactory loss associated with SARS-CoV-2 and other respiratory viruses: A multicenter
prospective cohort

Marcel Miyake1, Fabiana Valera2, Edwin Tamashiro3, Eurico Arruda Neto3, Ronaldo Martins
Junior3, Marina Fantucci3, Wilma Anselmo Lima3

1
Santa Casa de São Paulo School of Medical Science, 2Ribeirão Preto Medical School, São Paulo
University, 3Ribeirão Preto Medical School, University of São Paulo

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Background: Although the COVID-19 pandemic has increased the prevalence of cases with
olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare
the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with
sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on
olfactory symptoms. Methods: Patients with sudden smell loss were recruited in a multicenter
prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut
Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to
perform a PCR-based respiratory viral panel were collected at first visit (day 0) and after 30
and 60 days. Results: 188 of 213 patients presented positive test result for SARS-CoV-2, among
which 65 were co-infected with other respiratory viruses (e.g. rhinovirus, enterovirus, and
parainfluenza). Patients with SARS-CoV-2 and non-SARS-CoV-2 had a mean corresponding to
anosmia (<2 points) at day 0 in the psychophysical olfactory test CCCRC, with no significant
difference between them (-0.55; -1.18 to 0.07; p=0.08). Both groups had significant smell
scores improvement after 30 and 60 days, with no difference between them. Co-infection with
other respiratory viruses and SARS-CoV-2 viral load did not impact olfactory scores.

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1433
Regrowth of olfactory sensory neurons in acquired anosmia (REGROLF)

Julien Wen Hsieh, Rebecca Sipione1, Nicolas Liaudet2, Rousset Francis1, Landis Basile1, Pascal
Senn1

1
The Inner Ear and Olfaction Lab, Department of Pathology and Immunology, Faculty of Medicine,
University of Geneva, Geneva, Switzerland, 2Bioimaging core facility, Faculty of medicine, University of
Geneva, Geneva, Switzerland

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Anosmia is a frequent condition that can be caused by traumatic brain injury and subsequent
shearing of olfactory axons traversing the skull base. There is currently no primary cure for
this debilitating and often permanent condition. We intend to create a biodegradable scaffold
to be implanted in the cribriform plate to promote olfactory axonal regrowth. The aim of this
study, is to analyze the microenvironment (growth factors, extracellular matrices) that
enhances axonal regrowth in mice. We harvested olfactory epithelium of C57BL/6 mice and
cultured them during 15 days on coverslips coated with various proteins (Fibronectine,
Collagen IV, Laminin, none) and different growth factors (FGF2, BDNF, GDNF, NGF, Retinoic
Acid, TGF-β). We measured the attachment rate on the coverslips, presence of axonal
outgrowth, and finally the total axonal length with a newly developed automated high-
throughput quantification tool. Our results showed that this quantification tool took only 3
minutes to effectively quantify axonal length instead of 22 minutes in average, when a manual
tracing using standard application (Neuron J) was used. Neuronal outgrowth and total axonal
length was better enhanced with Fibronectin and Collagen IV (p= 0.001) and growth factors
with the following sequence: FGF2 from 0 to 7 days, and FGF2 with NGF from 8 to 15 days of
culture (p< 0.0001). In conclusion, this method allowed for a rapid screen of conditions that
enhances regrowth of olfactory sensory neurons. These data will be used to further the
development of a biodegradable olfactory implant.

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1441
Does repeated surgery have an influence on intranasal trigeminal function ?

Basile Landis1, Soina Macario, Dimitrios Daskalou, Francois Voruz, Julien Hsieh

1
University of Geneva Hospital

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Introduction Treatment-refractory, chronic nasal obstruction is frequent. It is characterized

by failure of standard medical treatment. Endoscopic examination shows either a clear
anatomic deformity which is mostly solved by surgery or is ambiguous with no major anatomic
explanation for the complaint. The latter group of patients are a clinical challenge since
surgery not necessarily leads to successful outcome. It has been hypothesized that such
paradoxical nasal obstruction may be due to low intranasal trigeminal function and thus
airflow perception. Methods We included 314 patients complaining of chronic nasal
obstruction. The common feature they shared was that the endoscopic examination did not
clearly showed an anatomical deformity that would explain the complaint. One hundred
eleven patient did never had any nasal surgery whereas the remaining ones had one, two or
more previous nasal surgeries. All patients underwent intranasal trigeminal function testing,
rhinomanometry and PINF testing. Results Compared to normal values established for the
trigeminal intranasal function according to the literature, all included patients showed lower
mean intranasal trigeminal function. There was no difference in intranasal trigeminal function
between patients without, after one, or after 2 and more intranasal surgical procedures.
Conclusion The results suggest that the number of intranasal surgeries does not have a major
effect on intranasal trigeminal function.

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1443
Can MRI predict olfactory loss and improvement in post-traumatic olfactory
dysfunction?

Julien Wen Hsieh1, Vincent Lenoir3, Rebecca Sipione4, Marianne Hugentobler2, Dimitrios
Daskalou2, Johan Lundström5, Pascal Senn6, Basile Landis2

1
Rhinology-Olfactology Unit, Department of Otorhinolaryngology- Head and Neck Surgery, Geneva
University Hospitals, Geneva, Switz, 2Rhinology-Olfactology Unit, Department of Otorhinolaryngology-
Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland, 3Division of Radiology,
Department of diagnostics, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, CH-1211 Geneva,
Switzerland, 4The Inner Ear and Olfaction Lab, Department of Pathology and Immunology, Faculty of
Medicine, University of Geneva, Geneva, Switzerland, 5Department of Clinical Neuroscience, Karolinska
Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden, 62The Inner Ear and Olfaction Lab,
Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva,
Switzerland

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Objective markers of smell function and prognostic factors are lacking for post-traumatic smell
loss. The aims of our study were to carefully classify the extent of post-traumatic
neurodegeneration, to determine its relationship with chemosensory dysfunction and to
establish whether MRI evaluation can predict olfactory improvement. We conducted a
retrospective study based on a consecutive series of 56 patients with post-traumatic olfactory
dysfunction. All patients underwent tests of their smell, taste, and trigeminal functions, ENT
evaluation, and MRI. A radiologist blinded to patient data evaluated 40 chemosensory-
relevant brain regions according to a four-point scale (0=no lesion to 3=large lesion). Data on
follow-up visits were available in 46 patients (mean follow-up = 47 months). The results
showed four brain lesion clusters associated with the olfactory dysfunction categories:
anosmia, hyposmia and normosmia (χ2(6, n=56) =15.5, p=0.015). Two clusters with the largest
lesions were highly specific for anosmia (100% specificity) and could accurately predict this
condition (100% positive predictive value). Regarding improvement, 72.7% of patients in the
cluster with mild lesions experienced subjective and measurable olfactory improvement. This
was only the case in 21.7-37.5% of patients with larger lesion clusters. The odds of subjective
smell improvement were 5.9 times higher in patients within the milder cluster compared to
larger ones. In conclusion, clusters of brain lesion patterns predicts anosmia and measurable
smell improvement.

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1445
Follow up results of the Covid-19 anosmia clinic - our experiences with smell retraining

Mitanshi Luhana, Catrin Evans1, Yasin Valli2, Nirmal Kumar1

1
WWL NHS Trust UK, 2WWL NHS Trust UK , 3WWL NHS Trust

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

The aims were to characterise demographics of patients presenting with persistent loss or
alteration of smell and taste following Covid-19 infection. The primary aim was to assess
change in formal smell test scores (UPSIT) and quality of life questionnaires following
interventions such as smell training & advice given in a specialist Smell clinic. The smell clinic
was set up based on ENT UK & BRS guidelines. Patients were asked to complete an ‘UPSIT’
test and eODQ questionnaire. Patients were then advised to undertake smell retraining for 4
to 6 months.We completed a retrospective analysis of patients who had attended for Smell
clinic follow up. This allowed analysis of patients’ presentations to identify patterns in patients
who are more likely to suffer long term olfactory dysfunction following Covid-19 infection.
Our primary aims were assessed via repeat UPSIT scores and eODQ scores to assess for any
improvement. Initial data showed patient's presenting with anosmia in 35%, 40% with
parosmia and 25% had taste disturbances. The UPSIT score ranged between 22-34 and the
eODQ score ranged between 42-151.Post smell retraining results suggest an improvement in
their UPSIT scores and eODQ scores.83 % of patients followed up were female. 94% completed
smell training for a minimum of 2 months.55% of patients showed an improvement in their
UPSIT scores on retesting of 1-3 points.All patients were keen to continue smell training. Our
data analysis shows promising results from use of smell training for treatment of COVID-19
related smell disorders.

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1463
SMELL-RS: a universal and digital olfactory test

Julien Wen Hsieh1, Basile Landis2, Leslie Vosshall3, Andreas Keller3, Melisa Dougherty3

1
Rhinology-Olfactology Unit, Department of Otorhinolaryngology- Head and Neck Surgery, Geneva
University Hospitals, Geneva, Switz, 2Rhinology-Olfactology Unit, Department of Otorhinolaryngology-
Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland, 3Laboratory of
Neurogenetics and Behavior, The Rockefeller University, New York, NY 10065

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Available smell tests can be time consuming and require trained healthcare providers to
administer them. Their scores are often affected by patient's cultural and genetic background.
Because of these issues, many clinical settings (e.g. private practice) and many countries do
not have access to a validated smell test. To overcome these issues, we developed a smell
sensitivity (SMELL-S) and resolution test (SMELL-R) that are non-semantic and made of
unfamiliar odor-mixtures. They overcome the cultural and genetic biases as previously shown.
We recently adapted SMELL-RS into a practical, self-administered and digital format. The aim
of this study was to analyze it's reliability, accuracy and administration time. We recruited 100
subjects of various cultural background and smell disorders at a tertiary smell and taste clinic.
The outcome measures was SMELL-RS test scores, Sniffin' Sticks battery test scores,
administration time, smell loss etiologies, and demographics. They came for a test and retest
visit scheduled one week apart. We found that SMELL-RS scores had high test-retest
reliability, accurately discriminated patients with different degrees of olfactory function, and
correlated with Sniffin' Sticks TDI test scores. The time needed to complete SMELL-RS was on
average 16 minutes (16 SD) compared to the standard test, which took 30 minutes (10 SD)
(p<0.001). In conclusion, SMELL-RS is reliable, accurate, and was less time consuming
compared to the Sniffin' Sticks. We hope to create a practical and accessible smell test that is
applicable worldwide.

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1464
Analysis of smell status after COVID-19 infection in patients classified according to
World Health Organization guidelines.

Elio Bittar Barbosa1, Fernanda Cunha1, Thiago Serrano1, Fernando Marson2, Patricia Conti1,
Aline Souza1, Jose Dirceu Ribeiro1, Eulalia Sakano1

1
State University of Campinas, 2São Fransciso University

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Introduction: Olfactory loss is a frequent symptom of COVID-19. Clinical evolution varies

between patients, being classified by the World Health Organization (WHO). The relationship
between loss and recovery of olfaction according to the severity of the case is not yet well
established.Objective: to evaluate relationships between olfactory loss and severity of COVID-
19.Methods: SARS-CoV-2 infected patients for more than 3 months were invited to
participate. General data, questionnaires, olfactory assessment (Connecticut test) and taste
test (solutions by Vaira et al) were collected. Data were analyzed by dividing patients
according to the criteria recommended by WHO.Results: 187 patients were analyzed; mean
age of 49.4 ±11.8 years. 94 patients (50.3%) reported olfactory loss during the acute condition.
57 (60.6%) had a non-severe condition, 24 (25.5%) had a severe condition, and 13 (13.8%) had
a critical condition (p

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1471
Chronic Post-viral Olfactory Dysfunction Diagnosis and Management

Retno Wardani1, Yessy Mardhatillah3, Niken Lestari4, Febriyani Endiyarti5, Trijuda Airlangga6

1
Otorhinolaryngology Head and Neck Surgery Department Faculty of Medicine Universisty of Indonesia
Dr. Cipto Mangunkusumo Nationa, 2ORL-HNS Department, Faculty of Medicine University of Indonesia
_ Dr. Cipto Mangunkusumo National Hospital , 3ORL-HNS Department Faculty of Medicine University of
Indonesia - Dr. Cipto Mangunkusumo National Hospital Jakarta Indonesia, 4ORL HNS Department
Faculty of Medicine University of Indonesia - Dr. Cipto Mangunkusumo National Hospital Jakarta,
Indonesia, 5ORL-HNS Department Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo
National Hospital , Jakarta Indonesia, 6ORL-HNS Department Faculty of Medicine University of
Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta Indonesia

Smell and Taste 2| Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Background: Chronic post-viral olfactory dysfunction became viral during the Covid-19
pandemic.Objective: To objectively assess chronic post-viral olfactory dysfunction and the
effectiveness of combined orthonasal olfactory training and nasal protocol
treatment.Method: A quasi-experimental of 12 subjects with chronic post-viral olfactory
dysfunction was included and assessed for olfactory function using the alcohol sniff test (AST),
the intravenous olfactory test (IOT), and the Sniffin Stick Test (SST), and underwent a
combined treatment of orthonasal olfactory training and a nasal therapy protocol for 6
weeks. Results: There were 8 subjects with hyposmia and 4 subjects with anosmia. In the
hyposmic group, there were 2 phantosmia and 2 parosmia subjects, while 1 subject of
phantosmia occurred in the anosmic group. The types of post-viral olfactory disorders in this
study were 9 sensorineural subjects and 3 conductive subjects. At the initial measurement,
the AST measurement value was 7.1 (1.5-19.5), with delayed onset of IOT 22 (14-55), and
decreased duration of IOT 45 (11-150). The results of SST consist of a threshold was 6.4 (1.5-
12,5), discrimination 7.5 (3-13), identification 9.5 (5-14), and TDI 23.8 (12.6-29.6). Statistical
calculations of olfactory function after therapy were found to be significant based on AST, the
onset of IOT, duration of IOT, discrimination, identification, and TDI (p<0.05).Conclusion: The
combination of orthonasal olfactory training and nasal therapy protocol for 6 weeks has been
shown to be effective in improving olfactory function

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Rhinoplasty 1

1133
VALIDATION OF THE EUROPEAN PORTUGUESE LANGUAGE VERSION OF THE STANDARDIZED
COSMESIS AND HEALTH NASAL OUTCOMES SURVEY

André Machado1, Ana Silva2, Santos Mariline2, Luis Meireles2, Sam Most3, Miguel Ferreira2

1
Otolaryngology Department, CHUSA, Porto, Portugal, Faculdade de Ciências da Saúde - Universidade
da Beira Interior, Covilhã, Portugal , 2Otolaryngology Department, CHUSA, Porto, Portugal ,
3
Department of Facial Plastic Surgery - Otolaryngology, Stanford University, USA

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Introduction: The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS)
questionnaire is a tool developed to evaluate functional and aesthetic components of
rhinoplasty. It is a reliable patient-reported outcome measure, not available in the European
Portuguese language. Objective: our goal was to translate and culturally adapt the SCHNOS
questionnaire to the European Portuguese language.Methods: The questionnaire was
forward and backward translated and culturally adapted to the European Portuguese
language following international guidelines. The authors evaluated internal consistency,
correlation, and reproducibility to determine the validity of the questionnaire.Results: The
final European Portuguese version of the SCHNOS was administered to 58 native European
Portuguese speakers. Both the SCHNOS-O (obstructive) and SCHNOS-C (cosmetic) showed
high internal consistency with Cronbach’s alpha of 0.93 and 0.95, respectively. Also, for the
entire SCHNOS, Cronbach’s alpha was 0.96. All the items demonstrated good item-test and
item-rest correlations with the differences between pre-and post-estimates being non-
significant. Conclusions: The translation, adaption, and validation of the SCHNOS into
European Portuguese was successfully performed. This provides another tool to help evaluate
the functional and aesthetic outcomes of rhinoplasty patients.

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1168
Navigated osteotomies in rhinoplasty, a cadaver study

Soyka Michael1, Joel Vavrina1, ThüringChristian1, Colacicco Giovanni2, Moe Kris3, Gander
Thomas4
1
Department of Otorhinolaryngology, Head and Neck Surgery, University and University Hospital Zurich,
Zurich, Switzerland, 2Institute of Anatomy, University of Zurich, Zurich, Switzerland, 3Department of
Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, USA,
4
Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Background: To perform osteotomies during rhinoplasties requires a lot of skills and long term
experience. Chisels and osteotomes are often used in a semi-blind way due to the thick
envelope of the nasal soft tissue and skin. In selected cases, i.e. in post-traumatic nasal
deformities, concise refracturing of old fracture lines would be desirable. It was the aim of this
study to investigate the accuracy of CT-navigation guided osteotomies.
Methods: Ten cadaveric heads were used to perform electromagnetic Cone-Beam-CT (CB-CT)
navigated transnasal and transcutaneous osteotomies, where the naso-maxillary suture line
was tried to be followed. Postinterventional CB-CTs were compared to preinterventional
imaging and the distance between the true naso-maxillary suture and the osteotomies were
measured. Heads were then dissected to expose the bony pyramid of the nose and to measure
the mean distance between the two lines.
Results: The mean distance between the osteotomy and the suture line was 1.4mm on both
sides, varying between 0.3mm and 3.7mm. There was a relevant intra- and interindividual
variance.
Conclusion: CB-CT navigated transnasal and transcutaneous osteotomies achieved a fair
accuracy in this cadaveric model. The suture lines could not be followed perfectly. Therefore,
it is questionable if this technique could re-fracture old fracture-lines with adequate accuracy
without additional landmarks. Real-life evaluation, however, is yet to be accomplished.

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1190
The « scroll swing flap », a novel technique for mid-nose derangements.

Armela Gorica1, Chiara Zeroli1, Pietro Palma1

1
Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese,
Italy.

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

BACKGROUNDPinching of the caudal cartilaginous vault or regional depressions of the lateral

alar/supra-alar wall are rather common deformities observed in patients seeking
rhinoplasty.The aim of this study is to present the « scroll swing flap », i.e. a soft-
tissues/cartilage composite flap sculpted via a transcartilaginous approach(via
intracartilaginous incision), rotated cranially(medial pivot point) or supero-laterally(lateral
pivot point) to correct, the caudal pinching of the midnose or regional depressions of the
alar/supra-alar wall.METHODSDuring the past 3 years, the composite scroll swing flap was
used in 27 patients undergoing rhinoplasty to correct monolateral (16cases) or bilateral (5)
caudal pinching of the midnose. In 6 patients the technique to correct monolateral (5cases)
or bilateral (1case) regional depressions of the “empty triangle”. Further cosmetic
improvement was achieved by using small onlay cartilaginous graft in targeted areas around
the flap. In revision cases, mature scar tissue was used as onlay graft when available.RESULTST
Results were evaluated by pre- and post-op standard photos. In all the cases presenting with
the classical “hour-glass” configuration, the deformity was improved and more aesthetically
“brow-dome llines” resulted as a conjoined result of the concomitant reduction of the tip
volume. In the long term controls, no evident resorption of the transferred tissues was
observed. CONCLUSIONSThe scroll wing flap technique can be considered a useful and reliable
technique to correct midnose pinching and deformity of the empty triangle

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1212
Nasal reconstruction using both cranial bone and ear cartilage

Muzaffer Çelik

1
Cranioplast Clinic

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Since 1996, more than 100 patients have been operated on for dorsal nasal augmentation. In
this study , an anatomic reconstruction is described using cranial bone graft for the bony part
of the nose while reconstructing the cartilaginous part with ear cartilage. This modification
provides protection of the nose from the traumatic forces creating a flexible nasal tip. A
modification is described and compared with the nasal reconstruction by calvarial bone itself.
The cranial bone and ear cartilage have been used for dorsal nasal augmentation on the nasal
reconstruction cases with high rates of satisfaction.According to the 26 years follow-up, the
technique is durable and usefull for nasal augmentation.In this study, the technique and long
term results will be presented.

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1352
Changing Practices in Septorhinoplasty: the Irish Experience

Rory O'Neill1, Shawkat Abdulrahman1

1
Tallaght University Hospital

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

BackgroundSeptorhinoplasty(SR) is one of the most complex surgical procedures of the head

and neck. As an elective procedure aiming to enhance patient quality of life, it can be difficult
to perform in single-payer healthcare systems due to capacity pressures from
acute/oncological surgical demand. We aimed to review national trends in the practice of SR
to inform future healthcare planning. MethodsThis was a cross-sectional, population-based,
longitudinal study of SR cases in Ireland’s single-payer(public) healthcare system from 2005-
2021. Time-series analysis using a linear regression model was performed to analyse trends
by operation type, revision rates and length of stay. The impact of the Covid-19 pandemic and
national surgical guidelines were analysed and compared. Results1952 SR were performed.
Annual mean cases declined in both real(R=0.76,p<0.01) and relative(R=0.87,p<0.01) terms by
31% and 43% respectively. Daycase rhinoplasty, while initially rarely performed, increased to
account for 55% of cases performed. The mean hospital length of stay declined
significantly(R=0.85,p<0.01) by 44%. Conclusions SR increasingly struggles to find its’ place in
Ireland’s public healthcare system. New changes in SR practices including the rapid growth of
daycase surgery and shorter lengths of hospital stay are positive developments in response to
increased healthcare system pressures.

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1633
Revision rhinoplasty: do we get the right perspective?

marko velimir grgić1, mislav knežević2, Mateo Čukman2, andro tarle2, Marija Pastorčić Grgić3

1
Department of ENT and Head & Neck Surgery, Univ Med Center "Sestre milordnice", Zagreb, Croatia,
2
Univ Med Center "Sestre milordnice", 3Department of ENT and Head & Neck Surgery, Univ Med Center
Zagreb

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Introduction: Every patient undergoing rhinoplasty should be informed about possibility of

need for revision. According to literature, revision rate varies between 5 and 15%. Planned
two-stage rhinoplasties are rare, so secondary rhinoplasty usually indicates the failure of the
primary one.Patients and methods: We analyzed the data of operated rhinoplasty patients in
last 2 years, and the recent literature related to frequency and causes for revision
rhinoplasty.Results: There is increasing number of revisions among total number of
rhinoplasties. The reasons for revisions are functional and esthetic, which is according to the
literature. Conclusions: Regardless of the causes for revision, the increasing rate of secondary
rhinoplasty is a negative trend. We believe that there is a need for improvement in indicating
surgery, as well as in informing the patients regarding their expectations, which could
altogether decrease the need for revisions.

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1741
The Importance of the Nasal Tip in Correction of the Deviated Nose

Mohsen NARAGHI
1
Rhinology Research Society

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Background: Establishing stable and long-term results in the correction of the deviated nose
has been a nightmare even for experienced surgeons. Most patients have problems both in
form and function. Analyzing the underlying anatomy in each case is important to establish
the plan of treatment that differs in every case. Methods: Six hundred seventy selected
deviated nose patients underwent different surgical procedures for correction of the deviated
nose. More than three fourth of patients had a combination of more than four procedures to
correct various aspects of deviation from radix to the tip. All types of deviated noses were
operated in one stage with the correction of the pyramid and septum. Proper cuts and
resections of cartilage and insertion of resected materials as different types of grafts were the
basis of most techniques for correction. Results: Correction of form and function included
restoration of the straight dorsum, reducing asymmetries and providing a functionally patent
nasal valve. There was an improvement in breathing and appearance of the nose with varying
degrees in our cases. Improvement was more noticeable in patients with multiple procedures
to correct the entire framework from the radix to the tip. Conclusions: The deviated nose is a
complex deformity extending from the radix to the tip. Successful surgery is not possible
without the correction of tip deformities and asymmetries as an important part of the
procedure.

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1747
The Autologous Nasal Fibro-fat in Rhinoplasty: A New Graft Option

Mohsen Naraghi1

1
Rhinology Research Society

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Background: Various grafting materials have been described for augmentation in rhinoplasty.
These materials have potential problems such as visibilities and irregularities, unwanted
reactions and inflammations and considerable resorption. The increased operation time for
harvesting and donor site morbidities were other reasons which persuaded us to use intrinsic
nasal fat as a graft material for different steps of rhinoplasty. Methods: Forty nine patients
underwent open and closed approaches for primary rhinoplasty. After elevating the skin flap
in a supraperichondrial plane, the lower lateral cartilages and cartilaginous dorsum were
exposed. The fibro-fatty tissue over the lateral crura and between the medial crura was
harvested with sharp scissors. Spreading that fibrofat tissue and use it like a fascia
camouflages dorsal irregularities. Fibro-fat grafts are fixed in the radix area with suture. The
size is adjusted to compensate for slight absorption over time. In all techniques, the fibrofat
tissue is inserted in direct contact with the overlying skin. Results: The patients were followed
up to four years after surgery. No complications have been noted with this type of graft. Minor
resorption was observed in two cases. Conclusions: The nasal fibro-fat graft is a suitable and
easy harvested graft material with no morbidity for augmentation of the nasal profile. It could
fit the place with no visibility problem. It camouflages the irregularities, contour deformities,
or asymmetries of the nose as an alternative to more common grafting techniques.

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1749
Functional and Aesthetic Correction of the Primary Alar Concavity

Mohsen Naraghi1

1
Rhinology Research Society

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Introduction: Extreme concavities of the lower lateral crura can cause severe aesthetic and
functional problems. Lateral crural reversing can contour the shape, reconstruct lateral crus
completely and correct concavity and valve collapse by a simple technique. It could be done
with or without reinforcing grafts. Methods: This retrospective study was directed on thirty-
three primary rhinoplasty patients. After transcolumellar and marginal incisions, the skin flap
was elevated in a supraperichondrial plane, exposing the lower lateral cartilages and
cartilaginous dorsum. Then the mucosa was detached from the posterior surface of the lower
lateral crura. The cartilages were released, excised, reversed and fixed in place. Different
lateral crural grafts were used in some of the patients. Results: All patients were improved in
form and function. There was no difference in the patient with the use of grafts or without
them. Postoperative swelling was slightly longer in our patients. However, there were no
complications and all patients were satisfied with the long-term aesthetic and functional
results. Conclusion: With the lower lateral crural reverse plasty, severe concavities of the
lower lateral crura can be corrected. This technique is a useful and reproducible procedure,
performed without additional tissue to achieve functionally and aesthetically satisfying and
enduring results.

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1753
Postoperative malodorous smell in open septorhinoplasty: the effect of intradomal
suturing with mucosal release

Abdullah Arafat1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Rhinoplasty 1| Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Purpose: The aim of this study was to test a mucosal release method for decreasing the
occurrence of malodourous smells after septorhinoplasty by preventing formation of debris
pockets after surgery.Methods: This study included 50 adult patients from 18 to 45 years of
age who underwent open septorhinoplasty from January to May 2019. Patients were divided
into two groups. The first group had intradomal (transdomal) sutures without submucosal
release, while the second group had mucosal release. All patients had scheduled post-op visits
at 1, 2, 4, and 8 weeks and 6 months.Results: The overall postoperative rate of malodorous
smell in both mucosal release and non-mucosal release patients at 2 weeks, 8 weeks and 6
months was 43.1%, 31.4% and 5.9%, respectively. Patients 36-45 years of age had a higher
rate of postoperative malodorous smell with 55.6% at 2 weeks, decreasing to 33.3% at 8
weeks, and to less than 1% at 6 months. At 2 weeks after surgery, only 20% of the mucosal
release group reported a malodorous smell compared to 65.4% in the non-mucosal release
group. The rate was 8% at 8 weeks, and less than 1% at 6 months in the mucosal release group
compared to 53.8% at 8 weeks and 11.5% at 6 months in the non-mucosal release
group.Conclusions: Utilizing absorbable polydioxanone sutures and releasing the vestibular
mucosa of the LLC significantly reduced the rate of postoperative malodorous smell for
septorhinoplasty patients with intradomal (transdomal) single-dome suturing.

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Orbital surgery/ Lacrimal Surgery

1323
Endoscopic Dacryocystorhinostomy without Mucosal flap preservation. A seven years
retrospective results from Chania General Hospital, ENT Dept.

Alexandros Ladias1, Efklidis Proimos1, Vaia Ntrigiou1, Konstantina Tzima1, Kalliopi

Korakovouni1, Chariton Papadakis1

1
ENT Department, Chania General Hospital, Chania, Greece

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Objective: Assessment of seven years anatomical and functional outcomes of primary

powered endoscopic dacryocystorhinostomy (DCR) without mucosal flap
preservation.Remains the debate on whether to use or not mucosal flap, after endoscopic
powered DCR.Methods:The purpose of the present study is a retrospective review of patients
with epiphora secondary to acquired nasolacrimal duct obstruction who underwent primary
powered endoscopic DCR performed over a 7-years period from 2010 to 2022 without
mucosal flaps preservation.Assessmentof the long-term anatomical and functional outcomes
was performed.Main outcome measures were subjective improvement in epiphora and
assessment of anatomic patency based on lacrimal irrigation and endoscopic
evaluation.Results:Forty-two patients all primary cases totaling 49 procedures, 35 unilateral
and seven bilateral underwent analysis. All patients presented with epiphora. The mean
follow up was 12.8 months (range: 6–36 months).The mean age at surgery was 67.8 years
(range 54–81 years).Intraoperative complications were not recorded. At the final follow up 43
of 49, 87.8% had absolute resolution of epiphora and 4, 7.1% had partial resolution with mild
epiphora? Anatomicsuccess was achieved in (47 of 49) 95.9%. Conclusion:Powered
Endoscopic DCR ensures excellent resultscomparable to those in recent literature. According
to our study mucosal flap preservation does not present as a necessary condition for achieving
and maintaining this result.

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1355
Endoscopic and external dacryocystorhinostomy: long term results from a tertiary
center in Portugal

Kaamil Gani1, Luís Castelhano1, Filipe Correia1, Luís Reis1, Pedro Escada1

1
Centro Hospitalar de Lisboa Ocidental

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Introduction: Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This

study aims to report the demography, clinical presentation, influence of agger nasi opening,
uncinectomy and septoplasty, complications and success of endoscopic and external
dacryocystorhinostomy over a period of 11 years.Methods: Retrospective review of clinical
records, from January 2012 to December 2022, at a tertiary center in Portugal.Results: A total
of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision
cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years.
Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success
(p=0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7, 6.0 and
15.3%, respectively, but although associated with higher success rates, no statistically
significant result was found. Minor complication rate for both external and endoscopic
approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100%
and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%,
respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a
worse anatomical success (p=0.05). Conclusions: Endoscopic dacryocystorhinostomy is an
effective and safe alternative to external approach. Minor procedures can increase the
success rate, but multicentre studies need to be performed for a statistically significant result.

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1454
Current developments in the diagnostic and therapeutic process of tear duct
obstruction with a view to the future

Federico Barberi1, Marco Valentini1, Paolo Battaglia1, Luca Volpi3, Apostolos Karligkiotis4,
Maurizio Bignami5, Paolo Castelnuovo1

1
Department of Otorhinolaryngology, University of Insubria, Varese, Italy, 2Department of
Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-93053
Regensburg, Germany, 3Department of Otorhinolaryngology, ASST-Lariana, Ospedale Sant'Anna, San
Fermo della Battaglia, Italy, 4Department of Otorhinolaryngology, ASST-Sette laghi, Ospedale di Circolo
e Fondazione Macchi, Varese, Italy, 5Department of Otorhinolaryngology, University of Insubria, San
Fermo della Battaglia, Italy

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Background: Dacryostenosis is the most common pathology of the tear ducts and typically
manifests with epiphora. To date, dacryocystorhinostomy (DCR) is the most widely used
method for the treatment of nasolacrimal duct obstruction (NLDO), with a success rate of
about 90%. If the narrowing depends on an obstruction at the level of the Hasner valve, an
alternative surgical strategy is endoscopic Hasner valvulotomy.Methods: Monocentric
retrospective study on 281 cases of DCR (2004-2022) and 10 cases on endoscopic valvulotomy
(2018-2022). A statistical analysis was carried out to identify any factors that could influence
the short and long-term outcome of treatment.Results: After a median follow-up of 21
months following DCR, the anatomical result was achieved in 87.2% of cases and the
functional result in 82.7%. Surgical failure requiring revision surgery was observed in 12.8% of
cases. The only factors statistically linked to a reduction in failure rates were the use of
peristomal mucosal flaps and the use of lacrimal stents. After a median follow-up of 12 months
following valvulotomy, anatomical success was 75% and functional success was 67%. In 25%
of cases, surgical failure required DCR.Conclusions: The validity of the treatment of distal
dacryostenosis by endonasal endoscopic surgical approach has been confirmed. The
application of an appropriate diagnostic-therapeutic approach and regular follow-up is
essential to reduce the failure rate. In the case of very distal NLDO, endoscopic valvulotomy is
showing promising results for the future.

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1709
Lacrimal System Complex Congenital Anomaly: Conjunctivodacryorhinostomy with
Stoploss Lester Jones Tube

Tiago Colaco1, Kaamil Gani1, Pedro Branco1, Luís Castelhano1, Filipe Correia1, Pedro Escada1

1
Serviço de ORL do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

IntroductionOne of the main indications for performing a conjuctivodacryocystorhinostomy

(CDCR) is chronic epiphora caused by an obstruction of the upper lacrimal tract due to specific
anatomical anomalies that contraindicate a conventional dacryocystorhinostomy (DCR).
Creating a new pathway between the conjunctiva and the nasal cavity and placing a
permanent tube is highly effective allows the epiphora to resolve. ObjectiveTo describe a rare
case of a complex congenital anomaly and its treatment with a CDCR. Case ReportA 26-year-
old male presented to an ENT clinic with right congenital epiphora. There were neither other
ophtalmological symptoms neither history of acute dacryocististis or ocular diseases. The
complete ophthalmologic evaluation was unremarkable, besides absence of superior lacrimal
puncto. Dacryoscystography showed a complete obstruction of the inferior lacrimal
canaliculus. On CT scan, lacrimal fossa and nasolacrimal canal were empty. The patient was
submitted to a CDCR with the insertion of a stoploss Lester Jones tube. Intraoperatively, the
absence of lacrimal sac was confirmed. Six months after surgery, the tube was completely
obstructed by conjunctival proliferation. The patient went under a CDCR revision, where the
conjunctiva was resected, mitomycin C was applied and a longer tube was
placed. ConclusionMultiple congenital anomalies of lacrimal apparatus can coexist to cause
epiphora by multilevel congenital anomalies. The first-line treatment should consist in a CDCR
with insertion of a Lester Jones tube that is a simple and effective procedure.

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1759
OUTCOMES OF ENDONASAL DACRYOCYSTORHINOSTOMY: RETROSPECTIVE ANALYSIS

Márcia Mourão1, Bárbara Rodrigues1, Gonçalo Quadros1, Filipe Rodrigues1, Marta Guerra2,
António Alves1, Joaquim Estrada2, Sérgio Raposo1

1
Department of otorhinolaryngology, 2Department of oftalmology

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Aims:Endonasal dacryocystorhinostomy (EN-DCR) has been widely used to treat nasolacrimal

duct obstruction in patients with epiphora. The purpose of this study is to evaluate long term
outcomes of the EN-DCR (primary and revision).Methods: Retrospective review of the clinical
records of patients who underwent EN-DCR at our center, performed by a single surgical team
(one Otolaryngologist and one Oculoplastic Surgeon), between May 2020 and May 2022. Only
patients with minimum follow-up of 6 months were included. Nasal endoscopic evaluation
was performed during follow-up and anatomical and functional success evaluated. Results: A
total of 92 patients (124 EN-DCR) was included: 102 primary and 22 revision EN-DCR were
performed. An overall success rate of 91.1% was obtained. In the primary group success rate
was 94,1% % compared to 77,3% in the revision group (p-value = 0,011). Septoplasty was
performed in 91,9% of cases and Mitomycin C was applied in 38,7% (revision surgery or
purulent discharge), both with no statistical significance in the success rate. The rate of
unexpected admissions to the emergency room in the first 30 days was 9,7%. Conclusions:
Our data suggests that EN-DCR and concomitant septoplasty is a safe and effective procedure.
Septoplasty and intraoperative mitomycin C did not improve patient outcome and revision
EN-DCR was associated with a worse outcome in our study.

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1222
Management of the orbit during endoscopic sinonasal tumor surgery – an update with
survival data for a consecutive series of 32 patients

Todor Popov1, Nezi Nizamova1, Stoyan Dimitrov1, Teodora Yordanova1, Liuben Dimitrov1,
Lubomir Rangachev1, Tzvetomir Marinov2

1
Department of ENT, Medical University - Sofia, 2Department of Anesthesiology and Intensive Care,
Medical University – Sofia

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Background: The aim of our study is to report intraoperative management of the orbit during
endoscopic resection of benign and malignant sinonasal pathologies and subsequent
postoperative results.Methodology: A total of thirty-two patients met the main inclusion
criteria –endoscopic resection should incorporate at least one subsite of the orbital interface.
All patients underwent surgery at University Hospital "Queen Jovanna-ISUL", Medical
University - Sofia, Bulgaria during the period 2018-2022 - single surgeon consecutive
series.Results: Malignancies (43.75%%) and inverted papilloma (40.63%) comprise the
majority of the cases. Most commonly surgical resection included lamina papyracea (90.6%),
the inferomedial orbital strut (46.8%) and floor of the orbit (21.8%). Diplopia (37.5%) and
exophthalmos (40.6%) were the most common preoperative ophthalmologic symptoms,
which significantly improved after the surgical resection (χ (1) = 0.846, p=0.000). 59.3% of the
patients underwent larger resections of the orbital bony interface (two or more anatomical
subsites). We report a recurrence free survival rate of 72.7% for the malignancy cases in the
group with an average follow-up period of 23 months. Conclusions: Overall our data suggests
that even larger resections of the orbital bony framework could be managed by a purely
endoscopic approach with low complication and recurrence rates.

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1266
Endoscopic Optic Nerve Decompression

Hussam ElBosraty1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Endoscopic optic nerve decompression (EOND) is currently the treatment of choice for
traumatic optic neuropa[1]thy (TON). Familiarity with anatomical landmarks and optic nerve
decompression are important determinants of safe and effective surgeries. Having a firm
understanding of the anatomical structures of the optic nerve region and obtaining an
anatomical image of the patient prior to the surgery could critically facilitate optic nerve
decompression and reduce surgical risk. Other indica[1]tions include skull base tumors e.g.,
meningiomas growing into the optic canal. or fibro-osseous lesions of the skull base.
Endoscopic optic nerve decompression is most suited to pathology located medial to the optic
nerve. In this study we demonstrate our experience about Endoscopic optic nerve
decompression in 7 cases with variable etiologies and showing the value of the powered
instrumentation to achieve the best outcome.

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1599
Quality of life assessment after endoscopic orbital decompression for Graves
orbitopathy

Miguel Saro-Buendía1, Nabil Attrache Al- Attrache2, Noelia Muñoz Fernández2, Claudio
Krstulovic2, Raúl Mellídez Acosta2, Lucas Fito Martorell2, Nezly Mosquera2, Enrique España
Gregori3, Miguel Armengot Carceller1, Alfonso García Piñero2

1
Department of Otorhinolaryngology- Head and Neck Surgery, La Fe University and Polytechnic Hospital,
University of Valencia, Spain., 2Department of Otorhinolaryngology- Head and Neck Surgery, La Fe
University and Polytechnic Hospital, Spain., 3Department of Ophthalmology, La Fe University and
Polytechnic Hospital, Spain.

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

INTRODUCTION: Graves orbitopathy (GO) is a sight- threatening autoimmune process. In

severe cases, an orbital decompression may be indicated. Our aims were: (1) to determine if
purely endoscopic orbital decompression (EOD) improves health- related quality of life (QoL),
(2) to determine the proptosis reduction (PR) after EOD and (3) to determine if QoL
improvement is related with PR.MATERIAL & METHODS: A 3- year prospective study was
conducted. Patients with severe GO and indication for EOD were included. We evaluated QoL
(GO-QoL questionnaire) and proptosis (Hertel exophthalmometer) preoperatively and 12
months after surgery.RESULTS: Twenty patients were included. 12 months after surgery the
GO-QoL showed a mean improvement of visual performance (2.87 points, 11.2%) and physical
appearance (5.75 points, 22.57%). The exophthalmometer showed an average 3.7-millimetre
PR. In cases with>-millimetre PR, there was a corelation with QoL improvement (physical
appearance parameters).DISCUSSION AND CONCLUSIONS: To measure EOD outcomes,
objective clinical parameters are assessed. Nonetheless, to improve QoL is the primary aim.
Then, the subjective perception of health- related QoL is key to understand surgical outcomes.
We observed an overall improvement of objective and subjective parameters. Additionally,
both seem corelated when PR exceeds 5 millimetres.

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1612
Endoscopic Endonasal Intraorbital Surgery: 360°anatomy and illustrative cases

Jianfeng Liu1, JIANHUI ZHAO1, YU ZHAO1, YIBEI WANG1, JUN HAN1, DAZHANG YANG1

1
China Japan Friendship Hospital

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Objectives To identify the anatomic landmarks of endoscopic endonasal intraorbital approach,

and to present six illustrative cases. Methods In anatomy research section, four silicon-
injected adult cadaveric heads (8 sides) were dissected, using the endosopic surgical
instruments to perform the endoscopic endonasal intraorbital approach and the Karl Storz
Image 1S system to record the entire process. In clinical application section, we report five
cases with intraorbital diseases underwent an endoscopic endonasal intraorbital approach.
Results With the optic nerve as the center, establishing the horizontal and vertical coordinate
axes, the intraorbital anatomy was divided into four quadrants, namely, superior medial,
inferior medial, superior lateral and inferior lateral quadrants. In the sagittal plane, dissection
was performed from the orbital apex, orbital nerve, to the globe; in the coronal plane,
dissection was performed from the medial wall to the central optic nerve, superior, lateral
and inferior walls of the orbit. Taking the optic nerve as the center and dissection was
performed layer by layer, including adipose tissue, vascular nerves and muscles. Surgical
dissection was able to access not only the medial superior and medial inferior quadrants, but
also the lateral superior and lateral inferior quadrants. Important landmarks, such as the
medial orbital wall, part of the inferior orbital floor, periorbita in the deep layer, and
intraorbital fat in the superficial layer could be identified using this approach. Furthermore,
medial rectus muscle, superior oblique muscle and inferior rectus muscle could also be
recognized. Following dissecting the space between the medial rectus muscle and the inferior
rectus muscle, the intraconal space could be accessed. After removing the intraconal fat,
important vessels and nerves were identified, including the ophthalmic artery and its inferior
medial muscular trunk, the optic nerve, and the branches of oculomotor nerve. Five cases
were presented including 2 cavernous hemangioma, 1 metallic intraorbital intraconal foreign
body, 1 invasive mucormycosis, 1 lymphoma. Endoscopic endonasal transorbital approaches
were successfully performed, and the aims of the operation were all achieved. Patients
recovered well, and no major postoperative complications occurred. Conclusions An
understanding of the landmarks of the intraorbital structures is paramount for surgically
dealing with diseases located within or adjacent to this region. The endoscopic endonasal
intraorbital approach is safe, effective and minimally invasive for appropriately selected cases.

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1617
Surgery of sight-threatening Graves’ orbitopathy

Tibor Szalóki1

1
Department of Otorhinolaryngology Head and Neck Surgery, Semmelweis University, Budapest,
Hungary

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Background: The orbit is a multidisciplinary surgical field. Due to this fact, we have an orbital-
team in our university since 2018.Methodology/Principal: We would like to present our
surgical cases, operated with sight-threatening Graves’ orbitopathy (GO) between 2018-2023.
The two main indications for surgery were disthyroid optic neuropathy (DON) and corneal
breakdown. All DON patients received high-dose methylprednisolon therapy first, in our
center according to the European Group on Graves’ orbitopathy (EUGOGO) clinical practice
guidelines. Patients with corneal breakdown underwent urgent surgery.Results: We have
operated 30 balanced orbital decompressions in 19 patients. The postoperative improvement
in visual acuity was significant compared to the preoperative one and stayed stable in most
patient. The medial orbital decompressions were done by the transnasal endoscopic way,
the lateral wall decompressions via lateral orbitotomy.Conclusions: However the orbit is a
relatively small anatomical space, we think, multidisciplinarity is the only way to treat it’s
pathologies.

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1649
Orbital implantation surgery for correction of delayed enophthalmos

Jae Hwan Kwon1

1
Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan,
Korea1, 2Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-
Allee 11, D-93053 Regensburg, Germany, 3Department of Otolaryngology-Head and Neck Surgery,
Kosin University College of Medicine, Busan, Korea

Orbital surgery/ Lacrimal Surgery| Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Purpose: Enophthalmos is posterior displacement of the globe within the orbit caused by
several etiologies. The correction of enophthalmos involves not only reducing the bony orbital
expansion, but also increasing the orbital tissue volume. For delayed correction of
enophthalmos, orbital volume measurement and the visual axis should be considered a major
part of enophthalmos treatment. Various surgical options and implant materials for orbital
volume augmentation have been reported, but no consensus has yet been reached regarding
appropriate surgical treatment. In this article, we introduce orbital implantation surgery using
cartilage and bone chips for the correction of delayed enophthalmos.Methods: Fifteen
patients who had undergone orbital implantation surgery for correction of sustained
enophthalmos were enrolled. Medical records were reviewed for past history, and
preoperative and postoperative facial photographs and CT scans were taken to evaluate the
improvement in enophthalmos.Results: The causes of enophthalmos were inappropriate
surgical correction of orbital wall fracture (n=9), ignored blowout fracture (n=5), and
fibrodysplasia (n=1). Preoperative eye ball protrusion difference of both orbit was 1.42 mm
(SD=0.98), and it was reduced to 0.94 mm (SD=0.77) postoperatively. Three patients
presented with diplopia preoperatively, and two of them showed improvement after surgery.
Eight patients underwent reduction of old fractured orbital wall via endonasal and balloon
support, six patients underwent open reduction surgery, and one patient underwent both
procedure.

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Pituitary Surgery 1

1141
Endoscopic Approaches for Resection of Pituitary Macroadenomas with different
Suprasellar Extensions

Mostafa Ismail1
1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

In pituitary macroadenomas with suprasellar extension (SSE), the possibilities for extra-
capsular tumor resection through transsphenoidal approach provide a feasible alternative to
craniotomy. Suprasellar region can be approached by extending exposure either anteriorly by
endoscopic transtuberculum transplanum approach (ETTA) or posteriorly from inside sellar
cavity by endoscopic transsellar transdiaphragmatic approach (ETSDA). We report the surgical
outcome of all endoscopic approaches used for surgical resection of pituitary macroadenomas
with SSE.

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1156
Long Term Quality of Life among Patients Undergoing Endoscopic Pituitary Gland
Resection with and without Middle Turbinectomy

Orr Raved1, shay Kaufman1, anat wengier1, Avraham abergel1, narin carmel neiderman1

1
Tel Aviv Sourasky medical center

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Introduction: Pituitary adenoma resection is associated with significant morbidity andcan

potentially damage patients' quality of life. The endoscopic approach to skullbase lesions is
considered less aggressive, and associated to improved tumor relatedand nasal related quality
of life. However, there is an ongoing literature debateregarding the necessity to preserve the
middle turbine during the procedure.Objective: The aim of the study was to compare tumor
and nasal related quality of lifein patients undergoing endoscopic endonasal resection of
pituitary tumors with orwithout middle turbine preservation.Materials and Methods
Prospective cohort study of all patients with pituitaryadenomas who underwent trans-
sphenoidal surgery at Tel Aviv Sourasky MedicalCenter between 2014 and 2021. Recruited
patients completed the Anterior Skull BaseDisease-Specific QOL (ASBS-Q) questionnaire and
the Sinonasal Outcome Test 22(SNOT-22) questionnaire prior to surgery and 3-6 months post-
operatively.Demographic and clinical data were collected.Results: Our study included 56
patients, 46 patients underwent middle turbinectomyand 10 did not. The overall score
difference of pre and post ASBS-Q score did notalter significantly between both groups
(0.15±0.64 among those who underwentmiddle turbinectomy vs 0.19±0.74 among those who
did not; p=0.87). SNOT-22score difference also did not alter significantly (1.54±15.29 vs
3.92±16.84, p=0.32)post operatively.Conclusion: We found that middle turbinectomy did not
cause significantdeterioration in nasal and tumor related QOL in the post-operative co

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1157
Long Term Quality of Life among Patients Undergoing Endoscopic Pituitary Gland
Surgery

narin carmel neiderman1, Shay Kaufman1, Anat Wengier1, Avraham abergel1

1
Tel Aviv Sourasky medical center

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Introduction: The endoscopic approach to skull base lesions is considered less aggressive then
the microscopic and open approaches. Yet to date it was not evaluated for long term nasal
and tumor related quality of life.Objective: To evaluate long-term quality of life in patients
after endoscopic endonasal resection of pituitary tumors and detect predictors for poor
quality of life.Materials & Methods: Prospective cohort study of patients with pituitary
adenomas who underwent trans-nasal surgery at TASMC between 2014 - 2021. Recruited
patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and
the Sinonasal Outcome Test 22(SNOT-22) questionnaire prior to surgery, and 1,2 & 3 to 5 years
after surgery. Demographic and clinical data was collected.Results: Our study included 43
patients. Overall ASBS-Q and SNOT-22 scores did not decrease throughout the duration of the
study. SNOT-22 Score difference between baseline and the year 1,3,5 did not
alter significantly .ASBS-Q score difference also did not alter significantly as well. Factors such
as secreting and non-secreting tumors, tumor size, intraoperative cerebrospinal fluid leak,
gross tumor resection, endocrine remission, and the use of nasoseptal flap reconstruction did
not have asignificant effect on QOL.Conclusion: Patients undergoing extended endoscopic
approach for pituitary lesionsmaintained high nasal and tumor related QOL in the 5 post-
operative years. Thissuggests that the endoscopic approach to skull base is as safe as effective
approachand should be considered treatment of choice whe

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1211
Is endoscopic diving technique effective in the surgical treatment of functioning
pituitary adenomas? A prospective randomized study

Donata Sukyte Raube1, Vaiva Mickeviciene1, Eugenijus Lesinskas1

1
Center of Ears, Nose and Throat, Vilnius university hospital Santaros klinikos

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Objective/hypothesis: Endoscopic diving technique (EDT) is an effective, cheap, and easy to

perform surgical tool to ameliorate remission rates in functional pituitary adenomas (PA) after
the endoscopic endonasal transsphenoidal surgery. Methods: This prospective randomized
study was performed in Vilnius University hospital Santaros clinics in 2021-2023. This study
enrolled 68 patients (19 – 77 years) with functioning pituitary adenomas. Patients were
randomly attributed to either EDT (patients who underwent EDT at the end of the endoscopic
endonasal transsphenoidal tumor removal) or non-EDT (EDT was not performed) groups.
Patients were followed up to 2 years after the surgery and the endocrine and radiologic
remission was evaluated 3 and 6 months postsurgery and 1-2 years later.Results: 68 patients
with functioning PA were enrolled in this prospective study: 41 of them were attributed to the
EDT group and remaining 27 – to the non-EDT group. Data analysis demonstrated that the
endocrine remission was more frequent in the EDT group; however, the difference was not
significant. On the other hand, 3, 6 months and 1-2 years after the surgery significantly less
radiologic relapses were observed in the EDT group. Complication rates were statistically
similar between the study groups and EDT did not carry any additional complication risk to
patients.Conclusions: The use of the endoscopic diving technique after the endoscopic
transsphenoidal surgery was associated with better endocrine and radiologic remission rates
in functional PA patients.

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1442
Mononostril, transnasal, paraseptal approach for pituitary adenomas

Nelli Nepp1, Zalán Piski1, Levente Juhász1, Dominik Iván2, Péter Tóth2, Tamás Dóczi2, András
Büki3

1
University of Pécs, Clinical Center, Department of Otorhinolaryngology, 2University of Pécs, Clinical
Center, Department of Neurosurgery, 3University Hospital Örebro, Department of Neurosurgery

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Transnasal endoscopic pituitary surgery has more than hundred-year history. In the beginning
wide approaches were used to achieve optimal exposure with the resection of nasal
turbinates and septum. Nowadays we are increasingly trying to preserve the anatomical
structures, thereby reducing approach-related morbidities. Our team uses mononostril
paraseptal approach without ethmoidectomy to achieve the sellar region, which ensures a
less traumatic procedure. One hundred and fourty-five patients with pituitary gland
pathologies underwent primary surgery (reoperations excluded). The most common
pathology was pituitary macroadenoma (n=130, 90%), which showed suprasellar expansion in
94 (65%) cases and parasellar expansion in 50 (34%) cases. The most frequently observed
complication was intraoperative liquorrhea, which was noticed in 14 (10%) patients, in 13 (9%)
cases it was resolved during the same surgery. Late-onset liquorrhea was found in 2 (1,4%)
patients. Transient diabetes insipidus occurred in 22 (15%) patients, while in one (0,7%) case
diabetes insipidus was irreversible. The 3-month postoperative MRI scans showed residual
tumors in 29 (20%) patients, further intervention (reoperation or radiotherapy) was required
in 15 (10%) cases. Mononostril, transnasal, paraseptal approach without ethmoidectomy
provides maximal exposure for the skull base despite its unilateral design while preserves the
sinonasal mucosa the most and minimizes approach-related nasal morbidity.

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1473
Impact of transsphenoidal pituitary surgery on orthonasal and retronasal olfactory
function

Serge Le Bon1, Sonia Macario1, Julien Hsieh1, Shahan Momjian2, Basile Landis1

1
Rhinology – Olfactology Unit. Department of ENT and Head and Neck Surgery, HUG, Geneva,
2
Department of Neurosurgery, HUG, Geneva

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Introduction Various studies have investigated the impact of transsphenoidal pituitary surgery
(TPS) on olfactory function and have found contradicting results. These studies rarely
comprised more than 50 patients and none investigated retronasal olfactory function. Our
study aims to assess orthonasal and retronasal olfactory function following TPS in a larger
cohort. Material and methodsTwo hundred patients were enrolled in this monocentric
retrospective study and were submitted to orthonasal and retronasal psychophysical olfactory
tests before and 3 months after TPS. ResultsFollowing TPS, no patient reported total loss of
smell and 8% reported partial loss of smell. At 3 months post-surgery, no significant difference
in olfactory function was observed compared to pre-operative function, whether orthonasally
or retronasally. Conclusion The impact of TPS on olfactory function remains controversial in
the literature and none investigated retronasal olfactory function. This present study on 200
patients suggests that TPS is at minimal risk of injuring orthonasal and retronasal olfactory
function.

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1506
Transsphenoidal nasal endoscopic approach to pituitary adenomas: early reports of a
single center

Tiago Caneira1, Subtil João1, Amets Sagarribay2, José Saraiva1, Caneira Tiago1

1
Department of Otorhinolaringology, Hospital CUF Descobertas, Lisboa Portugal, 2Department of
Neurosurgery, Hospital CUF Descobertas, Lisboa Portugal

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Introduction The most prevalent lesion in the pituitary region are benign tumors called
pituitary adenomas.The direct and minimally invasive transsphenoidal nasal endoscopic
approach is the most popular method for accessing the sellar area.We aim to present our data
and technical details of the surgery with videos. Material and Methods At the CUF
Descobertas hospital in Lisbon, Portugal, a retrospective analysis of the cases operated in the
previous six years was completed. We frequently close the sellar area with a multilayer closure
made of bone, Duragen ® and nasoseptal flap. Results A total of 32 patients were included in
this study. Male to female ratio was 50%. 56, 25% presented with macroadenoma and 43,75%
were non-function pituitary adenomas. Most patients presented with symptons from mass
efect, either visual impairment and/or hypopituitarism. The main surgery complications were
nasal synechias (28,1%), CSF leak (6,25%) and epistaxis (3,1%). Due to a few aneurisms
present inside the tumor, we experienced one incidence of internal carotid artery damage. It
was resolved with embolization. The risk of complications was not associated with tumour
size (p>0,05). Visual function improved in 87,5% and recovery of pituitary function in
62,5%. Maximum tumour diameter was associated with unfavorable surgical
outcome. Conclusion This approach for pituitary adenomas seems to be safe and leading to
satisfactory results. Our results are comparable to other studies.

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1532
Correlation between nasal obstruction and quality of life in endoscopic vs. microscopic
transsphenoidal pituitary surgery: a study in a low/middle-income country

Daniel Peñaranda1, Augusto Peñaranda2, Enrique Jimenez-Hakim3, Lucia C. Perez-Herrera4,

Sergio Moreno-Lopez5, Fernando Hakim3, Juan Garzon5, Martín Pinzón Navarro1
1
Otolaryngology Section, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia,
2
Otolaryngology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia, 3Neurosurgery
Deparment, Fundación Santa Fe de Bogotá, Bogotá, Colombia, 4Otolaryngology Research Group,
UNIMEQ-ORL, Bogotá, Colombia, 5School of Medicine, Universidad de Los Andes, Bogotá, Colombia

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Few studies compare the post-operative nasal symptoms and quality of life in the microscopic
vs. endoscopic transsphenoidal approaches for pituitary adenomas, particularly in
low/middle-income Latin American populations. This ambispective study assessed the
correlation between the perception of nasal obstruction and quality of life of endoscopic vs.
microscopic transsphenoidal pituitary surgery at the Fundación Santa Fe de Bogotá, Colombia
(January 2018- December 2019). A total of 46 patients (mean age: 50.57 years) who
underwent pituitary resection for adenomas either by microscopic or endoscopic approach
were included. Postoperative perception of nasal obstruction was assessed through the Nasal
Obstruction Symptom Evaluation (NOSE) and a visual analog scale (VAS). Quality of life was
assessed with the Glasgow Benefit Inventory (GBI). A median difference of 45 points favoring
the microscopic approach was found in the global scores of the NOSE scale. A median
difference of 4 points was found in the VAS score (p<0.001 in both interventions). The GBI
median scores were 27.78 points (IQR: 55.56), and 25.00 (IQR: 25) for the microscopic and
endoscopic approaches, respectively. A negative correlation between the GBI and NOSE was
found (ρ =̂ -0.44; 95% CI: -0.684 to -0.095), implying that the less postoperative nasal
obstruction, the better quality of life. Nasal obstruction and quality of life were correlated,
highlighting the impact of sinonasal outcomes in patients’ quality of life.

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1641
Endoscopic Endonasal Transsphenoidal Surgery for pituitary adenomas: A 7-year
experience from a tertiary centre

Mariana Caetano1, Vítor Oliveira1, César Silva1, Mariana Calha1, Tomás Carvalho1, Rodrigo
Franco1, Diogo Tomé1, Leonel Luís1, Cláudia Faria2, Diogo Simão2

1
Department of Otorhinolaryngology, North Lisbon University Hospital Center, Lisbon, Portugal,
2
Department of Neurosurgery, North Lisbon University Hospital Center, Lisbon, Portugal

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Background: Pituitary adenomas account for the third most common intracranial neoplasm.
Endoscopic endonasal transsphenoidal surgery (EETS) has gained increasing acceptance for
the treatment of pituitary adenomas.Methods: Retrospective study of patients who
underwent EETS for pituitary adenomas between September 2017 and January 2023.
Results: There were 49 (62.8%) non-functioning adenomas and 29 (37.2%) hormone-
secreting adenomas. Gross-total resection of the pituitary adenoma was achieved in 47
patients (60.3%). Preoperative cavernous sinus invasion was associated with lower resection
rates (gross-total resection rate 44.0% vs. 71.7%, p < 0.05). Of the 45 patients who
experienced preoperative vision deterioration, 41 (91.1%) achieved visual remission. Chemical
remission in functional adenomas was achieved in 75.9%. The most common complications
were new pituitary deficit (26.9%), diabetes insipidus (7.7%; permanently in one [1.3%]) and
cerebrospinal fluid (CSF) leak (6.4%). There was no significant difference in postoperative CSF
leak rate between patients undergoing free mucosal graft (7.7%) and nasoseptal flap (6%)
sellar reconstruction. Surgery-related mortality was 0%. Conclusion: EETS represents a safe
and effective treatment for pituitary adenomas. Cavernous sinus involvement is associated
with lower rates of complete surgical removal. Although nasoseptal pedicled flap constitutes
the primary option for sellar reconstruction, free mucosal graft showed similar CSF leak rates.

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1766
Prediction of sphenoid sinus septation using MRI compared to CT in transsphenoidal
pituitary surgery

Yves Brand1, Adrian Faber2, Jonathan Rychen2, Lukas Horvath4, Prepageran Narayanan5, Luigi
Mariani2, Vicknes Waran6, Michel Roethlisberger2

1
Department of Oto-Rhino-Laryngology, Kantonsspital Graubünden, Loëstrasse 170, 7000 Chur,
Switzerland, 2Department of Neurosurgery, University Hospital Basel, University of Basel, Spitalstrasse
21, 4031 Basel, Switzerland, 32Department of Oto-Rhino-Laryngology, Kantonsspital Graubünden,
Loëstrasse 170, 7000 Chur, Switzerland, 4Department of Oto-Rhino-Laryngology, Kantonsspital Aarau,
Tellstrasse 25, 5001 Aarau, Switzerland, 5Department of Ear-Nose-Throat, University Malaya Medical
Centre, University of Malaya, Jalan Universiti, 59100, Kuala Lumpur, Malaysia, 6Department of
Neurosurgery, University Malaya Medical Centre, University of Malaya, Jalan Universiti, 59100, Kuala
Lumpur, Malaysia

Pituitary Surgery 1| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Objectives: MRI and computed tomography CT are the most common imaging modalities used
for presurgical assessment prior transsphenoidal pituitary surgery (TSS). It remains unclear
whether both modalities are necessary as a standard approach. The study aims to evaluate
whether MRI alone is sufficient to identify relevant intra-sphenoidal anatomical variations
when compared to CT. Methods: Retrospective cohort study of 109 patients that underwent
TSS at the University Hospital Basel between 2009-2016. Preoperative MRI (T1 and T2) were
compared to CT. A “correctly” identified posterior termination at the skull base was defined
as: true presence or absence of a bony septum contact to the 1. sella; 2. internal carotid artery;
3. evident asymmetry. Sensitivity and specificity analysis and intrareader variability testing
using Cohens Kappa coefficient were performed. Results: 71/109 patients were eligible for
analysis. MRI (T1/T2) was able to identify the correct number of intra-sphenoidal septa in 65
(92%) patients. Hence, MRI was able to reliably identify the existence of an intra-sphenoidal
septum with a sensitivity of 99%. A correct posterior termination at the sella turcica was
identified in 66 (97%), a posterior termination along the carotid artery in 63 (93%), and an
evident asymmetry in 63 (93%) of cases. Hence, MRI had a sensitivity of 94%, 97% and 92%,
respectively. Conclusions: MRI alone is feasible to reliably detect the posterior termination
of a single intra-sphenoidal septum in cases without tumor infilration of the posterior
shenoidal sinus wall.

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CRS – outcome assessment 2

1542
Cohort description from the CHronic RhINOSinusitis Outcome Registry (CHRINOSOR)
– A Real-World data study

Sven Seys1, Peter W. Hellings2, Isam Alobid3, Vibeke Backer4, Emilie Beguignon5, Giulia
Bettio1, Christian von Buchwald6, Carlo Cavaliere7, Andrea Ciofalo7, André Coste5, Zuzana
Diamant8, Julia Eckl-Dorna9, Wytske J. Fokkens10, Simon Gane11, Philippe Gevaert12,
Christiane Holbaek-Haase4, Clemens Holzmeister13, Valérie Hox14, Caroline Huart14, Roger
Jankowski15, Mark Jorissen16, Anette Kjeldsen17, Lisa Knipps18, Bibi Lange17, Rik van der
Lans10, Anu Laulajainen-Hongisto19, Kenneth Larsen17, David Liu9, Edgar Mauricio Lopez3,
Valerie Lund20, Gert Mariën1, Simonetta Masieri21, Geoffrey Mortuaire22, Mathilde
Moyaert23, Joaquim Mullol24, Sietze Reitsma25, Maria Jesus Rojas Lechuga3, Philippe
Rombaux14, Sven Schneider9, Peter Valentin Tomazic13, Sanna K. Toppila-Salmi26, Aldine Tu9,
Laura Van Gerven27, Thibault Van Zele12, Paula Virkkula19, Martin Wagenmann18, Claus
Bachert28

1
Galenus Health, Hasselt, Belgium, 2Allergy and Clinical Immunology Research Group, Department of
Microbiology, Immunology & Transplantation, KU Leuven, Belgium, Department of
Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium, Department of Otorhinolaryngology,
Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands, 3Rhinology and
Skull Base Surgery Unit, Otorhinolaryngology Department, Hospital Clinic, IDIBAPS, Ciberes, Barcelona,
Spain, 4Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet,
Copenhagen, Denmark., 5Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal
de Créteil, 94000 Créteil, France, 6Department of Otorhinolaryngology, Head & Neck Surgery and
Audiology, Rigshospitalet, Copenhagen, Denmark., 7Department of Sense Organs, Sapienza University,
Rome, Italy, 8Allergy and Clinical Immunology Research Group, Department of Microbiology,
Immunology & Transplantation, KU Leuven, Belgium, Department of Respiratory Medicine &
Allergology, Institute for Clinical Science, Skane 30 University Hospital, Lund University, Lund, Sweden,
Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer
Hospital, Prague, Czech Republic Department of Clin Pharm & Pharmacol, University Groningen, Univ
Med Ctr Groningen, Groningen, Netherlands, 9Department of Otorhinolaryngology, Head and Neck
Surgery, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria, 10Department of
Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The
Netherlands, 11Department of Rhinology, Royal National Ear, Nose, Throat and Eastman Dental
Hospital, University College London Hospital, UK, 12Upper Airways Research Laboratory, Department of
Otorhinolaryngology, Ghent University, Belgium, 13Department of General ORL, Head and Neck Surgery,
Medical University of Graz, Graz, Austria, 14Service d'Otorhinolaryngologie, Cliniques Universitaires
Saint-Luc, Brussels, Belgium, 15ENT Department, Hospital of Nancy, Brabois-ILM, University Lorraine,
Nancy, France., 16Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium,
Laboratory of Experimental Otorhinolaryngology, Department of Neurosciences, KU Leuven, Belgium,
17
Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark, 18Department of
Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany, 19Department of
Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki,
Finland, 20Department of Rhinology, Royal National Ear, Nose, Throat and Eastman Dental Hospital,
University College London Hospital, UK, Institute of Otology, University College London, UK,
21
Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy,
22
Otorhinolaryngology-Head and Neck Department, Huriez Hospital, Centre Hospitalier Universitaire
(CHU) Lille, Lille, France, 23Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven,
Belgium, 24Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Universitat de Barcelona,

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IDIBAPS, CIBERES, Barcelona, Catalonia, Spain., 25Department of Otorhinolaryngology, Amsterdam
University Medical Centres, location AMC, Amsterdam, The Netherlands, 26Skin and Allergy Hospital,
Helsinki University Hospital and University of Helsinki, Helsinki, Finland, 27Department of
Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium, Laboratory of Experimental
Otorhinolaryngology, Department of Neurosciences, KU Leuven, Belgium, Department of
Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium,
28
Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Belgium,
Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska
Institutet, Stockholm, Sweden, Department of Otorhinolaryngology - Head and Neck Surgery, University
Hospital of Münster, Münster, Germany

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Background: CHRINOSOR is a collaborative effort of 17 University ear-nose-throat (ENT)

Departments in Europe that aims at improving our understanding of chronic rhinosinusitis
(CRS), its comorbidities, and the effectiveness of its treatments in the Real-World
setting1. Methodology: Real-world data from adult patients (n=142) with a diagnosis of CRS
by the ENT surgeon have been collected prospectively through the Galenus Health app. Data
from 7 EU clinics on patient’s profile, disease history, patient outcomes and relevant clinical
outcomes were analysed. Also, CRS patients treated with biologic therapy (n=535) were
included for retrospective analysis.Results: 75.4% of patients reported a previously diagnosed
CRS with nasal polyps (CRSwNP) in the prospective cohort whereas all patients had CRSwNP
in the biologic-treated cohort. Both self-reported allergy (58.5% and 58.8%) as well as asthma
(64.4 and 63.3%) diagnosis were equally high in both cohorts, respectively. N-ERD was higher
in the biologic-treated cohort (30.4%) compared to the prospective cohort (19.7%).
Differences were observed in history of sinus surgery (range: 62.3-96.8%) and use of systemic
corticosteroids (range: 63.5-100%) across countries in the biologic-treated cohort possibly
impacted by varying eligibility criteria.Conclusions: Valuable scientific insights have been
generated by the standardised collection of real-world data from different EU countries.

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1545
Chronic Rhinosinusitis and quality of life.

Alicia Perez Orribo,1Beatriz Sacramento García1, Gabriela Muñoz Cordero1, Ayoze Lemes
Robayna1, Cecilia Salom Lucena1

1 2
Department of Otorhinolaryngologist of Hospital Universitario de Canarias, Deartment of
Otorhinolaryngologist of Hospital Universitario de Canarias

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Background: Chronic Rhinosinusitis (CRS) has a great impact on patients' quality of life.The
aim of our work is to describe the characteristics of patients with CRS in our series. In addition,
we aim to study the impact of the disease on the patients' quality of life and relate it to the
endoscopic and radiological evaluation. Methods: The study included 75 patients with CRS
from the Department of Rhinology who completed the SNOT-22 quality of life questionnaire
over a 19-month period. Results: 91% of patients had CRSwNP. According to SNOT-22, 96% of
patients have relevant changes in quality of life, 44% have moderate involvement, 36% have
severe involvement, and 20% have mild involvement. The nasal area is most commonly
affected (57%).On endoscopic examination, 81.5% of patients have bilateral polyp
involvement.The Lund-Mackay Score is realized in 52% of patients. The most frequent results
areGrade 2 (51.3%).56 % of patients receive intranasal corticosteroid treatment only. Surgical
treatment is indicated in 16% of patients and biologic treatment in 14.7%. Conclusion:
Currently, the impact on quality of life of CRS is considered the main criterion for evaluating
disease severity and response to treatment.

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1565
Comparative real-world outcomes of endoscopic sinus surgery versus Dupilumab for
treatment of chronic rhinosinusitis with nasal polyps.

Davide Paolo Porru1, Eugenio De Corso1, Rodolfo Mastrapasqua1, Gabriele De Maio1, Claudio
Montuori1, Simone Lo Verde1, Alessandro Cantiani1, Giulio Cesare Passali1, Jacopo Galli1

1
Otorhinolaryngology, Catholic University of The Sacred Heart, Rome, Italy.

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Background: Biologic therapy and surgery are the main options of treatment for severe
chronic rhinosinusitis with nasal polyps. The objective was to compare outcomes over 1 year
of follow up in two groups of patients treated with Dupilumab or endoscopic sinus surgery
(ESS).Methods: We enrolled 44 patients treated with ESS and 49 treated with Dupilumab. In
each follow-up visit we measured: nasal polyp score (NPS); SNOT-22 score; VAS for specific
nasal symptoms and olfaction assessed by Sniffin Sticks identification test. Finally, we
evaluated the need for oral corticosteroid and presence of local inflammation by nasal
cytology. Results: Patients undergoing surgery had a faster improvement in NPS at 6 months
(p<0.05) but needed more brief cycles of systemic corticosteroids. Patients treated with
Dupilumab had a greater improvement in SNOT-22 and olfaction at 12 months (p<0.05). After
1 year of treatment with dupilumab only 6.1% of patients had local eosinophilia at nasal
cytology while it occurred in 57% of patients treated by surgery. Conclusion: both treatments
are effective at reducing symptoms of patients with CRSwNP. Patients undergoing surgery
have less control of local inflammation. Patients treated with dupilumab reported greater
improvement in nasal symptoms, especially in sense of smell.

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1568
The postoperative quality of life in endoscopic frontal sinus surgery: a retrospective
study

Argyro Leventi1, Vasileios Chatzinakis1, Ioannis Geramas1, Christos Georgalas1, Andreas

Liodakis2, Giolina Papargyriou1

1
Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. & Kifisias Av., 151 23
Marousi, Greece, 2Head and Neck Surgery Consultant, Hygeia Hospitals, 4 Erythrou Stavrou Str. &
Kifisias Av., 151 23 Marousi, Greece

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

During the last decades significant experience has been gained in functional endoscopic sinus
surgery procedures. However, the patient-reported outcomes of frontal endoscopic sinus
surgery procedures are still poorly understood. In this study we try to assess the preoperative
and postoperative quality of life in patients undergoing extended endoscopic frontal sinus
surgery (Draf type 2 and Draf type 3 procedures) using the 22-item sino-nasal outcome test
(SNOT-22). Out of 670 patients undergoing endoscopic sinus surgery and a total of 186
patients having undergone endoscopic frontal sinus surgery (Draf 2 or Draf 3), for a variety of
diagnoses from 2015 to 2020, we selected 99 patients with chronic rhinosinusitis, who
underwent frontal sinus surgery in isolation. The mean preoperative SNOT-22 was 45.6 points
for patients undergoing Draf 2 and 59 for patients undergoing Draf 3. Mean SNOT 22
improvement was 22.9 points for Draf 2 and 37 points for Draf 3 respectively and remained
significant in all time intervals. All symptoms improved by a far bigger extent in Draf 3 group,
despite the considerably worse starting point, with only exception of loss of smell/taste. Effect
size of Draf 3 was greatest in symptoms of being frustrated/restless/irritable, nasal blockage,
reduced concentration, fatigue, runny nose and need to blow nose. Both groups achieve
similar postoperative quality of life, despite the different starting points. Further investigation
with SNOT-22 is essential for a more definite answer to “who” and “when” a patient benefits
from endoscopic frontal sinus surgery.

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1571
Measuring Nasal Patency and the Sense of Smell in CRSwNP Patients Treated with
Dupilumab

Giancarlo Ottaviano1, Eugenio De Corso2, Elena Cantone3, Andrea Ciofalo4, Tommaso

Saccardo1, Piero Nicolai1

1
Otolaryngology Section, Department of Neurosciences DNS, University of Padova, 35128 Padova, Italy,
2
ENT Department of A. Gemelli Unversitary Hospital IRCCS, 00168 Rome, Italy, 3Reproductive and
Odontostomatological Sciences-ENT Section, Department of Neuroscience, University of Naples
Federico II, 80131 , 4Rhinology Unit, Department of Sensory Organs, Sapienza University of Rome, 00161
Rome, Italy

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Chronic rhinosinusitis with nasal polyps (CRSwNP) in the most severe forms is associated with
a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe
CRSwNP. Severe CRSwNP patients treated with Dupilumab in different rhinological units were
followed up at 1, 3, 6 and 12 months from the first administration and were considered for
this study. At baseline (T0) and at each follow-up, patients underwent nasal endoscopy and
completed the sinonasal outcome test (SNOT)-22, a visual analogue scale (VAS) for smell/nasal
obstruction, peak nasal inspiratory flow (PNIF) and the Sniffin’ Sticks identification test (SSIT).
The aim of the present study was to evaluate the effects of Dupilumab on recovering nasal
obstruction and smell impairment. Moreover we assessed which method between PNIF and
SSIT had the highest correlation with patients’ response. 147 patients were included. All
parameters improved during treatment (p < 0.001). At T0, no correlations were found
between PNIF and nasal symptoms. Nevertheless, during the following evaluations significant
correlations between PNIF changes and both nasal symptoms and NPS were observed (p <
0.05). At T0, SSIT did not correlate with SNOT-22. Similarly to PNIF, during the follow-up SSIT
changes significantly correlated with nasal symptom and NPS (p < 0.05). Comparing PNIF and
SSIT correlations with SNOT-22 and NPS, PNIF showed a higher correlation with both.
Dupilumab improves nasal obstruction and the sense of smell. PNIF and SSIT are effective
tools in monitoring patients’ response to Dupilumab.

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1597
Follow-up adherence and medication adherence after endoscopic sinus surgery
effectively control the recurrence of chronic rhinosinusitis

Wendong Liu1, Fenghong Chen1, Haoran Lin2, Jianbo Shi1

1
The First Affiliated Hospital, Sun Yat-sen University, 2Jinan University

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Backgroud：To explore the effect of follow-up or medication adherence

after endoscopic sinus surgery (ESS) on the control status of chronic rhinosinusitis
(CRS).Methods：A retrospective review of 226 patients with chronic rhinosinusitis under ESS
in two clinical centers during 2018 to 2021 was conducted. Clinical characteristics including
smoking, asthma, allergic rhinitis, sinus surgery history, endoscopic and CT scores, blood
eosinophils number and percentage and serum total IgE were collected. Follow-up
of symptoms which contained visual analogue scales, total nasal symptom score (TNSS), and
sinonasal-outcome test 22 (SNOT-22) score, and assessment of endoscopic score and control
status of CRS at the first and the twelveth month after ESS were conducted.Results：
Patients with both follow-up adherence and medication adherence
had the highest control rate(71.2%), the second higher rate was in patients with follow-up
adherence but medication non-adherence (42.1%) more than patients with medication
adherence but follow-up non-adherence (22.7%) and patients with follow-up non-adherence
and medication non-adherence (5.1%).(P＜0.0001) All VAS, TNSS, SNOT-22, E-score% were
different especially in the twelveth month after ESS (all P＜0.0001) in the trend in the accord
with the controlled rate above. Baseline characteristiscs did not influence the control
status.Conclusions: Follow-up adherence and medication adherence after ESS effectively
control the recurrence of chronic rhinosinusitis especially in a long term.

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1625
Development of a standardized assessment of patient reported outcome measures
following endoscopic sinus surgery for chronic rhinosinusitis: A qualitative study.

Justin Pyne1, Connor Sommerfeld1, Adrian Mendez1, David Cote1

1
Department of Surgery, Division of Otolaryngology - Head and Neck Surgery

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Background: Quality of life (QOL) outcomes following endoscopic sinus surgery (ESS) have
been reported, yet few outcome measures have been developed through direct patient
participation. Harmonizing patient reported outcome measures (PROM), observer based, and
other evaluation techniques is paramount to enable the Otolaryngologist to produce clinically
meaningful assessments. This study aimed to create a clinical instrument from PROMs to
assess patients after treatment of chronic rhinosinusitis (CRS) with ESS. Methods: This four-
phase qualitative study employed grounded theory methodology and a modified Delphi
technique. In Phase I, 15 patients were interviewed using open-ended questioning for
identification of QOL domains impacted by CRS. Domains were presented in phase II to a focus
group of new CRS patients who ranked each by order of importance. A conceptual framework
of QOL domains impacted by CRS was created based on patient consensus and a focus group
of Otolaryngologists itemized the PROM questionnaire in phase III. The questionnaire was
completed by cognitive interviewing of new CRS patients in Phase IV. Results: Patients
identified 15 domains of QOL occupying three sub-scales: physical symptoms, psychosocial
symptoms, and activity restriction. These domains provided the basis for the creation of a 19-
item PROM questionnaire. Conclusions: Clinical application of the novel questionnaire
produced by this study yields objective assessment of patient reported effectiveness of ESS
for management of CRS. Further study will aim to validate this newly developed technique.

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1692
The Role of Blood and Tissue Eosinophilia on Prognosis of Chronic Rhinosinusitis with
Nasal polyposis

Mohammed Alwashahi1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-
Allee 11, D-93053 Regensburg, Germany

CRS – outcome assessment 2| Room 12 Hall 40 - Level 6 | Wednesday 21/06/2023

Abstract:,Objectives :This study aimed to investigate the role of the blood eosinophil count
(BEC) in categorizing Chronic Rhinosinusitis with Nasal polyposis (CRSwNP) and its role in
predicting the need for revision functional endoscopic sinus surgery (FESS). Patients and
methods:This study included 121 CRSwNP patients who underwent endoscopic sinus surgery.
The preoperative BEC, Lund-MacKay scores and the endoscopic scores of the patients were
collected from the medical record. Using haematoxylin and eosin staining (H&E) the cut-off
value of tissue eosinophil count (15/HPF) was used to divide the patients into groups of
eosinophilic and non-eosinophilic CRSwNP. Results:We recruited 40 patients in the
eosinophilic CRSwNP group and 81 patients in the non-eosinophilic CRSwNP group. The level
of BEC in the eosinophilic CRSwNP group was significantly higher than that of non-eosinophilic
CRSwNP group (0.79 ± 0.27 × 109/L vs 0.30 ± 0.22 × 109/L; p < 0.001). We observed a statistical
significance in CRSwNP phenotypes (eosinophilic/non-eosinophilic, 28/3 vs 2/32; p < 0.001)
when the cut-off value of BEC was set at 0.4 × 10^9/L. Preoperative BEC and Lund-Mackay
score were associated significantly with the need for FESS (p< 0.032 and P=0.01 respectively),
whereas endoscopic NP score and SNOTT22 score were not (p> 0.05). With the cut-off values
of ( BEC ≥.7 × 10^9/L) and the cut-off value of (LM score ≥ 17) , the sensitivity and specificity
were optimal for predicting the group needing revision FESS (p = 0.006 and p =
0.041, respectively).conclusion :The results suggest that BEC m..

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Benign nasal tumours 2

1585
CAN WE PREDICT WHO WILL BENEFIT FROM NASAL STEROID TREATMENT IN PATIENTS
WITH NASAL POLYP DIAGNOSIS BY CLINICAL AND PATHOLOGY?

Murat Can Bektaş1, Turkan Memmedli1, Emre İpek1, Abdulkadir İmre1, Erdem Eren1

1
Department of Otorhinolaryngology, University Hospital of Katip Çelebi, Hasan Tahsin street, N:1,
Karabağlar, İzmir, Turkey

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

OBJECTIVE In patients with a diagnosis of nasal polyps, the predictability of treatment success
is investigated by clinical and pathologic evidences.MATERIAL AND METHODSPretreatment
and posttreatment(3 months of 100 µg/day nasal steroid),Meltzer scores,SNOT-22
questionnaire scores and Butanol Threshold Test results of 54 patients were recorded and
compared.Meltzer 1-2 classified as mild, 3-4 severe.Eosinophil and mast cell counted in
pathology preparations taken before treatment.Correlation analysis were made with Snot-22
score difference.RESULTSIn mild nasal polyps, the difference between BTT scores
before(mean:4.11)and after(mean:5.52) and Snot-22 scores before(mean:29.58)and after
treatment(23.64) was significant(p<0.05).The difference between BTT before(mean:2.35) and
after(3.59) was significant in severe nasal polyps.(p<0.05) There was no significant difference
between Snot-22 scores before(mean:38.1)and after(mean:37.97)treatment in patients with
severe nasal polyps.(p>0.05).Moderately significant correlation was found between the
number of mast cells and the change in SNOT-22 scores.(CC:0.47)CONCLUSION It was
observed mast cell count can be used in terms of treatment benefit and nasal steroid
treatment was beneficial in patients with Meltzer grade 1-2 but there was no improvement in
the patients' Snot-22 scores when 3-4 polyps were detected.Consequently, early surgery may
be recommended for patients with grade 3-4 nasal polyps.

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1603
Clinical analysis of sinonasal hemangiopericytoma

Qingjia Gu1

1
artment of Otorhinolaryngology，Afffliated Hospital of University of Electronic Science and
Technology of China, Sichann Provincial People S Hospital ，Chengdu 610072，China

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Objective:To investigate the clinical features therapeutic methods and therapeuticeffects of

sinonasal hemangiopericytoma． Methods:Clinical data of 6 patients with sinonasal
hemangiopericyt0ma， diagnosed by pathology and immmunohistochemistry between
January 1990 and December 201 2 were analyzed retrospectively． There were 4 males and
2 females，with a median age of 58 years． Clinical manifestation included epistaxis and
nasla obstruction．These patients were operated on by nasal endoscopic surgery or
endoscope—assisted surgery，of which 2 cases of tumor located in the nasal cavity
underwent nasal endoscopic surgery and 4 cases of tumor located in the nasal cavity and
sinuses underw ent endoscope—assisted surgery．Results All the patients were followed up
for a period of 6 months to 7 years after operation．Two cases recurred and 4 cases didn t
recurre． One case recurred 6 months after operation and underw ent second operation，
with no recurrence by further one year follow—up． Another case recurred 17 months fater
operation and underw ent second operation，with recurrence by further 9 months follow—
up． This patient lived with tumor over two years． Conclusions: Heman opericytomas are
rarely found in the sinonasal cavity． Nasal endoscopic or endoscope—assisted surgery
provides satisfactory effect．

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1620
Successful Management of a Rare and Aggressive Extranasopharyngeal Angiofibroma
Arising from the Nasal Septum in a 59-Year-Old Female

Robert Maweni1, Haleema Siddique2, Roland Hettige1

1
Department of ENT, Wexham Park Hospital, Slough, United Kingdom, 2Department of ENT, John
Radcliffe Hospital, Oxford

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

BackgroundExtranasopharyngeal angiofibromas are rare benign tumours which can present

with significant epistaxis, and usually arise from the posterolateral wall of the nasal cavity.
They can, therefore, present a diagnostic and management challenge when they occur, and
do so in unusual locations. We describe a rare case of an angiofibroma originating from the
anterior nasal septum and its successful management. Case:A 59-year-old female presented
with left-sided epistaxis and nasal obstruction. Examination revealed a small, pedunculated,
vascular lesion on the anterior nasal septum which grew rapidly over a period of weeks to
deform the nares and extrude externally. The patient underwent semi-elective excision biopsy
with a left supra-perichondral flap raised via a Killian’s incision to remove the tumor, with the
aid of coblation for debulking. Histological examination confirmed that it was an
angiofibroma, and no residual or recurrent disease was observed during follow-
up. Conclusions: This case underscores the need for clinicians to consider the possibility of
extranasopharyngeal angiofibroma in the differential diagnosis of head and neck tumors,
particularly in cases of significant epistaxis. Clinicians should be aware that angiofibromas can
occur in unusual locations and that prompt and accurate diagnosis is critical for optimal
patient management. This report also highlights the successful use of a left supra-perichondral
flap and coblation in the surgical management of this rare and aggressive presentation.

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1626
A CLINICAL STUDY OF 5 CASES WITH BLOOD BOILS OF THE MAXILLARY SINUS

Koji Otsuka, Masanori Yatomi2, Yohei Okayoshi3, Atsuo Takeda, Kazuhiro Hattori, Ryo
Maruyama, Kiyoaki Tsukahara

1
Department of Otolaryngology, Tokyo Medical University Ibaraki Medical Center, 2Department of
Otolaryngology/Head and Neck Surgery, Tokyo Medical University, 3Tokyo Medical University

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Introduction: Blood boils is a benign and non-neoplastic lesion that may cause bleeding or
bone destruction. Material and methods: We retrospectively analyzed 5 patients with blood
boils of the maxillary sinus treated from June 2015 to December 2017. Subjects were 3 men
and 2 women, aged 14 to 90 years (mean: 51 years). In all, we conducted endoscopic sinus
surgery (ESS) under general anesthesia without prior arterial embolism. 70-degree
endoscope, microdebrider and curved blade were used for resection blood boils of the
maxillary sinus. Results: The diameters of blood boils were 30-55 mm (mean: 41 mm). The
operation times for ESS in ethmoid and maxillary sinuses were 45-108 minutes (mean: 79
minutes). Amounts of bleeding were from small amount to 225ml. Though the amounts of
bleeding significant correlated between operating times (coefficient-of-determination
R2=0.83), those did not correlate between the diameter. Discussion: The correlation amounts
of bleeding between operating times was due to persistence bleeding by more veinous than
arterial. It is important to shorten operating times for minimum blood loss. The appearance
of microdebrider and curved blade made possible to resect the maxillary sinus blood boils by
ESS without prior arterial embolism.introduction: Blood boils is a benign and non-neoplastic
lesion that may cause bleeding or bone destruction. Material and methods: We
retrospectively analyzed 5 patients with blood boils of the maxillary sinus treated from June
2015 to December 2017. Subjects were 3 men and 2 women, aged 14 to 90 years (mean: 51
years). In

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1629
ENDOSCOPIC RESECTION OF JEUVENILE NASOPHARYNGEAL ANGIOFIBROMA

Hossam ELSHERIF1

1
Department of Otorhinolaryngology, Faculty of Medicine, Tanta University, Egypt

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Abstract:Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor in young males, with a

non-negligible potential for recurrence. Preoperative embolization is a safe procedure that
diminishes the preoperative blood loss and the need for blood transfusion. Objectives: To
evaluate the endoscopic technique in management of JNA. The four hands technique and the
endoscopic assisted techniques are also described. Patients and methods: We report a series
of 10 consecutive cases operated by exclusive endoscopic approach from January 2012 to
November 2015. All were male. The mean age was 14.5 years old. The endoscopic approach
was used with good results in JNA stages Radkowski I to IIIa. Results and conclusion: All
patients underwent surgery, and the endoscopic approach was used in all cases. The
embolization procedure proved to be safe and decreased the intraoperative blood loss. In
conclusion, endoscopic resection of JNA is a difficult but effective operation in experienced
hands. Based upon the recent international literature, endonasal surgery combined with a
preoperative embolization of the arterial supply is indicated for small and middle size JNAs
but also for large tumors extended to the pterygopalatine fossa and medial aspect of the
infratemporal fossa.

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1705
Burkitt's lymphoma in the pterygopalatine fossa

Houda Ben Abdellah1, Covadonga Suárez1, Nuria Cruz Cerón1

1
Hospital Reina Sofía de Córdoba- Spain

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Introduction: Burkitt's lymphoma is a high-grade B lymphoma. It can present in an endemic,

typical in children between 5 and 7 years of age and with greater involvement of the facial
bones; or sporadic form, more frequent in 12-year-old children and as an abdominal mass. It’s
presentation in nasal sinus and in adults is rare. Materials and methods: A 79-year-old patient
with no history of interest, starts with a trigeminal neuralgia resistant to medical treatment.
In the MRI a 6x4cm tumor was identified in the left chewing space with aggressive behavior.
It extends to the nasopharynx, pterygoid musculature, infiltrates the lower and middle
turbinates, reaches the left buccal and parapharyngeal spaces, and infiltrates the hard palate,
floor of the left maxillary sinus and left infraorbital fissure. Cranially it extends to the temporal
lobe, cavernous sinus, sella turcica, sphenoid sinus, sphenoid wing, clivus, and the pontine
cistern. An intraoperative biopsy was taken by endonasal endoscopic surgery (Denker
edoscopic) after embolization of the internal maxillary artery. Result: The result of the biopsy
was high-grade B lymphoma compatible with Burkitt's lymphoma with a high proliferative
index (80%). Treatment with curative chemotherapy was started, but the patient passed out
3 weeks after diagnosis. Discussion: Burkitt's lymphoma is rapidly progressive and can be
highly invasive with minimal symptoms. The worst prognostic factors are adult onset, central
nervous system involvement at diagnosis, and bone marrow infiltration. In our case, the
patient had these three factors.

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1708
Conservative Surgical Management of a Maxillary Odontogenic Myxoma: a Case
Report

Colaço Tiago1, Branco Pedro1, Castelhano Luís1, Correia Filipe1, Escada Pedro1

1
Serviço de ORL do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

IntroductionOdontogenic myxomas are rare slowly growing but locally aggressive benign
tumors. They have an ectomesenchymal origin and histologically they present stellate or
spindle-shaped cells within a myxomatous tissue stroma. The most common location is the
mandible, followed by the maxilla. Surgery remains the gold-standard treatment, but a
complete resection with negative margins implies an excessively aggressive surgery for an
otherwise benign tumor. ObjectiveTo describe a rare case of a maxillary odontogenic myxoma
with emphasis on the conservative surgical procedure. Case ReportA 26-year-old female
presented to an ENT clinic with a left midfacial swelling. CT scan showed a destructive lesion
of left maxilla with partial erosion of the anterior and the medial walls of maxillary sinus, hard
palate and left superior alveolar ridge. Endoscopic nasal biopsy revealed an odontogenic
myxoma. Surgical alternatives were discussed with the patient. A total tumor removal was
performed by a combined approach: endoscopic medial maxillectomy (to remove nasal fossa,
maxillary and pterygopalatine fossa components) and sublabial Roughe Denker approach (to
remove anterolateral and alveolar roots components). No complications were recorded.
Patient is rigorously controlled with regular nasal endoscopy and MRI. ConclusionWhenever
possible, conservative approach should remain the first-line treatment of an odontogenic
myxoma particularly in young patients. They should be advised of surgical alternatives and
their recurrence rates.

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1730
Identification and 3D reconstruction of sinonasal inverted papilloma pedicle

Eugenia Maiorano1, Sveva Introini1, Fabio Sovardi1, Elina Matti1, Vera Siragusa1, Salvatore
Catalano1, Andrea Luceri1, Bogdan Nacu1, Roberto Sannasardo1, Michele Demaria1, Paolo
Carena1, Fabio Pagella1

1
Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Benign nasal tumours 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Our study aimed at finding an instrumental method of evaluation of volume and surface of IP,
analyzing CT imaging using 3D reconstruction . The clinical documentation of patients treated
between 2002 and 2021 at Policlinico San Matteo IRCCS for IP with endoscopic surgery were
reviewed. CT imaging were analyzed for morphological information and 3D reconstruction.
The parameters evaluated were Volume, Surface and Base Area of the IP. Furtherly analyzing
CTs, three grades of distinction of the pedicle, its shape and site of origin were defined. CT-
acquired information was compared with the intraoperative findings. The study confirmed the
crucial role of CT imaging in the localization, morphological evaluation and, through the 3D
resolution, reconstruction of the pedicle. This study represents an important starting point in
the improvement of the 3D reconstruction of sinonasal district, especially focusing on the
pedicle of the IP, resulting in a more personalized of the surgical planning.

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CRS – medical management 4

1486
Dupilumab improved objective and patient-reported outcomes in patients with
chronic rhinosinusitis with nasal polyps (CRSwNP) and complete bilateral nasal
obstruction in the SINUS-24 and SINUS-52 trials

Martin Wagenmann1, Asif Khan2, Claus Bachert3, Claire Hopkins4, Jérôme Msihid5, Scott
Nash6, Yamo Deniz6, Paul Rowe2, Harry Sacks6, Juby Jacob-Nara2

1
Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), 2Global Medical Affairs,
Sanofi, 3Department of Otorhinolaryngology — Head and Neck Surgery, University Hospital of Münster,
4
Department of Otorhinolaryngology, King's College London, 5Global Health Economics and Value
Assessment, Sanofi, 6Medical Affairs, Regeneron Pharmaceuticals Inc.

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Background: In CRSwNP, nasal polyp score (NPS) of 8/8 signifies complete nasal obstruction.
Dupilumab is efficacious in severe CRSwNP; here we report outcomes in patients with NPS=8.
Methodology: Post-hoc analysis of patients with NPS=8 at randomization in SINUS-24/SINUS-
52 (NCT02912468/NCT02898454), receiving dupilumab 300 mg/placebo q2w. Assessments:
NPS (0−8), peak nasal inspiratory flow (PNIF), Lund‒Mackay computed tomography (LMK-CT;
0−24), nasal congestion, loss of smell (NC, LoS; 0−3), 22-item Sino-Nasal Outcome Test (SNOT-
22; 0−110).Results: 98/724 (13.5%) patients had baseline NPS=8 (placebo/dupilumab, 30/68).
Mean (SD) baseline PNIF (L/min), LMK-CT, NC, LoS, SNOT-22 were 33.8 (45.1), 18.9 (3.9), 2.7
(0.4), 2.9 (0.3), 56.9 (21.6), respectively. All assessments improved with dupilumab versus
placebo at Week (W)24 (least squares mean difference [95% CI]): NPS −2.04 [−2.67, −1.40],
PNIF 65.9 [39.4, 92.4], LMK-CT −4.97 [−6.50, −3.44], NC −1.30 [−1.72, −0.89], LoS −0.96 [−1.39,
−0.54], SNOT-22 −25.3 [−34.1, −16.4], with similar results at W52. At W24, 69.1%/10.0%
patients (dupilumab/placebo) achieved NPS improvement ≥1; 51.5%/0% LMK improvement
≥5; 73.5%/16.7% NC improvement ≥1; 60.3%/20.0% LoS improvement ≥1; all p< 0.0001;
73.5%/40.0% SNOT-22 improvement ≥8.9 (p=0.0010). Conclusions: In CRSwNP patients with
complete bilateral nasal obstruction, dupilumab treatment demonstrated significant, clinically
relevant reduction in NPS, and improved nasal inspiratory flow, symptoms, and health-related
quality of life.

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1531
Oral Corticosteroid (OCS) Burden and Healthcare Resource Utilization (HCRU) in
Patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) Undergoing
Functional Endoscopic Sinonasal Surgery (FESS) in US Real-World Practice

Stella Lee,4Danielle Isaman,2, Sietze Reitsma1, Asif Khan3, Anju Peters5, Peter Hwang6, Natalia
Petruski-Ivleva2, Scott Nash8, Juby Jacob-Nara9

1
Department of Otorhinolaryngology and Head & Neck Surgery, Amsterdam University Medical Centers,
location AMC, University of Ams, 2Real World Evidence, Sanofi, Cambridge, MA, USA, 3Global Medical
Affairs, Sanofi, Chilly-Mazarin, France, 4Division of Otolaryngology—Head & Neck Surgery, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA, 5Division of Allergy and Immunology and
the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,
6
Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford,
CA, USA, 7Department of Otorhinolaryngology and Head & Neck Surgery, Amsterdam University Medical
Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands, 8Medical Affairs,
Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA, 9Global Medical Affairs, Sanofi, Bridgewater, NJ,
USA

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Rationale: The impact of FESS on OCS burden and HCRU in CRSwNP is unclear.Methods:
Claims-based study (Optum; 2011−2021). CRSwNP patients undergoing FESS were
propensity-score matched with patients not undergoing FESS. Intervention/follow-up periods
were Day 0−44/45−365. OCS burden (cumulative dose in mg prednisone
equivalents)/HCRU/costs were compared among FESS vs non-FESS patients in the 1-year
post-surgery period and change in OCS dosing from the 1-year baseline period to follow-up
(pre/post-index).Results: Each group included 8,909 patients. During follow-up, OCS use was
lower among FESS vs non-FESS patients (mean difference in cumulative dose: −40 mg [95% CI
−64, −16] per patient); in patients who filled an OCS prescription (34.6% vs 36.0%), OCS burden
remained high (mean [SD] cumulative dose 521 [786] mg vs 612 [906] mg). Proportion of
baseline OCS users (FESS n=5,636; non-FESS n=5,728) with decrease/increase/no change in
dosing was similar in both groups (80.5%/19.3%/0.2% vs 77.3%/22.5%/0.2%). Mean total
healthcare costs during intervention period were $28,832/$2,537 (FESS/non-FESS), but similar
during follow-up ($15,659 and $15,926, respectively). HCRU was similar during follow-up,
except more FESS patients visited an otolaryngologist (57.5% vs 32.0%, p<0.01). Conclusions:
CRSwNP patients undergoing FESS have similar OCS burden compared to those not
undergoing FESS, with similar costs during follow-up.

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1533
Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)
Who Did or Did Not Undergo Functional Endoscopic Sinus Surgery (FESS) in US Real-
World Practice

Sietze Reitsma1, Asif Khan2, Danielle Isaman3, Stella Lee4, Anju Peters5, Peter Hwang6, Natalia
Petruski-Ivleva3, Scott Nash7, Judy Jacob-Nara8

1
Department of Otorhinolaryngology and Head & Neck Surgery, Amsterdam University Medical Centers,
location AMC, University of Ams, 2Global Medical Affairs, Sanofi, Chilly-Mazarin, France, 3Real World
Evidence, Sanofi, Cambridge, MA, USA, 4Division of Otolaryngology — Head & Neck Surgery, Brigham
and Women’s Hospital, Harvard Medical School, Boston, MA, USA, 5Division of Allergy and Immunology
and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University, Chicago, IL,
USA, 6Department of Otolaryngology — Head & Neck Surgery, Stanford University School of Medicine,
Stanford, CA, USA, 7Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA, 8Global
Medical Affairs, Sanofi, Bridgewater, NJ, USA

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Rationale: Data regarding the characteristics of patients with CRSwNP who undergo FESS vs
those who do not are limited.Methods: Retrospective cohort study of patients with CRSwNP
with/without FESS in US real-world practice (Optum claims data 2011−2021). Demographics
were assessed on the index date, and comorbidities/OCS use over the 12 months pre-
index.Results: This analysis included 9,305 FESS and 34,446 risk-set matched non-FESS
patients. FESS patients were younger vs non-FESS (mean 52 vs 57 years, p<0.01) and more
likely commercially insured (69% vs 59%, p<0.01). High proportions of patients in both groups
had a diagnosis of acute sinusitis (47.2% [FESS] vs 33.5% [non-FESS], p<0.01), allergic rhinitis
(51.9% vs 53.1%, p=0.05), asthma (25.7% vs 29.8%, p<0.01), sleep disorders (21.1% vs 20.0%,
p=0.02), depression (12.9% vs 12.1%, p=0.03), and anxiety (13.9% vs 13.8%, p=0.86). Use of
oral corticosteroids (OCS) was high in both groups (64.6% vs 52.2%, p<0.01) and higher in FESS
vs non-FESS patients 30 days (28.5% vs 10.3%, p<0.01) and 60 days (40.7% vs 18.2%, p<0.01)
pre-index. Conclusion: In US clinical practice, although patients with CRSwNP undergoing FESS
appear to have more acute sinusitis and greater OCS use, both FESS and non-FESS patients
share significant comorbidity and systemic treatment burden.

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1537
The impact of mepolizumab therapy on sleep in patients with chronic rhinosinusitis
with nasal polyps: data from the SYNAPSE study

Peter Howarth1, Joaquim Mullol2, Claus Bachert3, Wytske J Fokkens4, Steven G Smith5, Tom
Keeley6, Bhabita Mayer7, Robert Chan6, Steve W Yancey5

1
Global Medical Affairs, GSK, Brentford, Middlesex, UK, 2Department of Otorhinolaryngology, Hospital
Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain, 3Upper Airways
Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University
Hospital, Ghent, 4Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the
Netherlands, 5Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA, 6Respiratory Patient
Centered Outcomes, Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK, 7Clinical
Statistics, GSK, GSK House, Brentford, Middlesex, UK

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Background: Sleep disturbance is one of the most bothersome patient-reported symptoms of

chronic rhinosinusitis with nasal polyps (CRSwNP). In the Phase III SYNAPSE study, 4-weekly
mepolizumab 100 mg treatment for 52 weeks reduced NP size and symptoms versus placebo
in patients with severe CRSwNP; here, we compare impact on sleep-related outcomes.
Method: Change from baseline in sleep-related sinonasal outcome test (SNOT-22) item scores
from the Sleep Domain and Fatigue Domain at Week 52 were assessed post hoc. Patients
rated severity and frequency of each item from 0 (no problem) to 5 (as bad as can
be). Results: Of 407 patients enrolled in SYNAPSE, 403 (mepolizumab=205, placebo=198) had
baseline SNOT-22 data available. At Week 52, mean improvements from baseline in all 4 sleep-
related SNOT-22 item scores were significantly larger in mepolizumab- versus placebo-treated
patients (treatment difference (95% confidence interval): difficulty falling asleep -0.9 [-1.2,-
0.5]; wake up at night -1.0 [-1.3,-0.6]; lack of good night’s sleep -0.8 [-1.2,-0.5]; wake up tired
-0.9 [-1.2,-0.5]; all p<0.001). Conclusions: Sleep improvements were observed in patients with
CRSwNP following treatment with mepolizumab, suggesting that mepolizumab can improve
sleep disturbances in this population. Funding: GSK [GSK ID:205687/NCT03085797] Abstract
previously presented at the EAACI 2022 Congress.

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1541
Assessment of patient eligibility for biologic therapy: Real-World data from the
CHronic RhINOSinusitis Outcome Registry (CHRINOSOR)

Sven Seys1, Sven F. Seys2, Peter W. Hellings3, Isam Alobid4, Vibeke Backer5, Bequignon Emilie6,
Bettio Giulia7, Christian von Buchwald8, Carlo Cavaliere9, Andrea Ciofalo9, André Coste6,
Zuzana Diamant10, Julia Eckl-Dorna11, Wytske J. Fokkens12, Simon Gane13, Philippe Gevaert14,
Christiane Holbaek-Haase5, Clemens Holzmeister15, Claire Hopkins16, Valérie Hox17, Caroline
Huart17, Roger Jankowski18, Mark Jorissen19, Anette Kjeldsen20, Lisa Knipps21, Bibi Lange20, Rik
van der Lans22, Anu Laulajainen-Hongisto23, Kenneth Larsen20, David Liu11, Valerie Lund24, Gert
Mariën7, Simonetta Masieri25, Geoffrey Mortuaire26, Mathilde Moyaert27, Joaquim Mullol28,
Lina Piñeros4, Sietze Reitsma22, Camilo Rodriguez Van Strahlen4, Philippe Rombaux17, Sven
Schneider11, Peter Valentin Tomazic15, Sanna K. Toppila-Salmi29, Aldine Tu11, Laura Van
Gerven30, Thibault Van Zele14, Paula Virkkula23, Martin Wagenmann21, Claus Bachert31

1
Galenus Health, Hasselt, Belgium, 2Galenus Health, Belgium, Allergy and Clinical Immunology Research
Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Belgium, 3Allergy and
Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU
Leuven, Belgium, Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium,
Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC,
Amsterdam, The Netherlands, 4Rhinology and Skull Base Surgery Unit, Otorhinolaryngology
Department, Hospital Clinic, IDIBAPS, Ciberes, Barcelona, Spain, 5Department of Otorhinolaryngology,
Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark, 6Service d'ORL et de
chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, 26 94000 Créteil, France,
7
Galenus Health, Belgium, 8Department of Otorhinolaryngology, Head & Neck Surgery and Audiology,
Rigshospitalet, Copenhagen, Denmark., 9Department of Sense Organs, Sapienza University, Rome, Italy,
10
Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology &
Transplantation, KU Leuven, Belgium, Department of Respiratory Medicine & Allergology, Institute for
Clinical Science, Skane University Hospital, Lund University, Lund, Sweden, Department of Respiratory
Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic,
Department of Clin Pharm & Pharmacol, University Groningen, Univ Med Ctr Groningen, Groningen,
Netherlands, 11Department of Otorhinolaryngology, Head and Neck Surgery, Vienna General Hospital
(AKH), Medical University of Vienna, Vienna, Austria, 12Department of Otorhinolaryngology, Amsterdam
University Medical Centres, location AMC, Amsterdam, The Netherlands, 13Department of Rhinology,
Royal National Ear, Nose, Throat and Eastman Dental Hospital, University College London Hospital, UK,
14
Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Belgium,
15
Department of General ORL, Head and Neck Surgery, Medical University of Graz, Graz, Austria, 16ENT
Department, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, 17Service
d'Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium, 18ENT Department,
Hospital of Nancy, Brabois-ILM, University Lorraine, Nancy, France, 19Department of
Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium, Laboratory of Experimental
Otorhinolaryngology, Department of Neurosciences, KU Leuven, Belgium, 20Department of
Otorhinolaryngology, Odense University Hospital, Odense, Denmark, 21Department of
Otorhinolaryngology, Universitätsklinikum Düsseldorf, Dusseldorf, Germany, 22Department of
Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The
Netherlands, 23Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital
and University of Helsinki, Finland, 24Department of Rhinology, Royal National Ear, Nose, Throat and
Eastman Dental Hospital, University College London Hospital, UK, Institute of Otology, University
College London, UK, 25Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy,
26
Otorhinolaryngology-Head and Neck Department, Huriez Hospital, Centre Hospitalier Universitaire
(CHU) Lille, Lille, France, 27Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven,

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Belgium, 28Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Universitat de Barcelona,
IDIBAPS, CIBERES, Barcelona, Catalonia, Spain, 29Skin and Allergy Hospital, Helsinki University Hospital
and University of Helsinki, Helsinki, Finland, 30Department of Otorhinolaryngology-Head and Neck
Surgery, UZ Leuven, Belgium, Laboratory of Experimental Otorhinolaryngology, Department of
Neurosciences, KU Leuven, Belgium, Department of Neurosciences, Experimental Otorhinolaryngology,
Rhinology Research, KU Leuven, Leuven, Belgium, 31Upper Airways Research Laboratory, Department of
Otorhinolaryngology, Ghent University, Belgium, Division of ENT Diseases, Department of Clinical
Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Department of
Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Background: Biologics are a therapeutic option for uncontrolled, severe chronic rhinosinusitis
with nasal polyp (CRSwNP) patients. Applying a mobile application, we investigated eligibility
criteria for biologics, published earlier by Bachert et al1, in a Real-World
setting.Methodology: Adult patients (n=142) from 7 EU university clinics, diagnosed with CRS
by the ENT surgeon and using the Galenus Health mobile application have been included.
Complete data on required outcome parameters of 100 patients were available for this
interim analysis. Results: 75.4% of analysed patients reported a previously diagnosed
CRSwNP. 81.6% of CRSwNP patients reported either a history of endoscopic sinus surgery
(ESS) (only ESS: 71.6%) or ≥1 systemic corticosteroid (OCS or injected) course in the past year
(only steroids: 55.6%). Within these patients, a NPS 4 or 5 was observed in respectively 49.0%
and 31.3% of patients. Of patients with NPS 4, 64% showed a SNOT-22 score 35 points or a
VAS total sinus symptoms 5 pointing towards severe symptoms. Taken together, we identified
23.9% of CRSwNP patients meeting definitions of uncontrolled, severe
CRSwNP.Conclusions: This first Real-World analysis from patients recruited at academic
hospitals showed that almost a quarter of CRSwNP patients could meet the EUFOREA
eligibility criteria for biologic therapy.

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1547
The Effectiveness of Budesonide Nebulizer After Endoscopic Sinus Surgery in Chronic
Rhinosinusitis in Non-Asthmatic Patients

Khalid Hakami1

1
Department of Otolaryngology, Head and Neck Surgery, Rhinology Unit, Alhada Armed Forces
Hospital, Saudi Arabia

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Context: nasal irrigation had a better effect than normal saline nasal irrigation. Nebulized
budesonide is an effective and safe treatment for patients with allergic fungal rhinosinusitis
(AFRS) or chronic rhinosinusitis with nasal polyps (CRSwNP), following endoscopic sinus
surgery. Aims: to evaluate the efficacy of postoperative use of nebulized budesonide in
patients with chronic rhinosinusitis. Subjects and Methods: A retrospective examination of
the patients who underwent endoscopic sinus surgery to measure the effectiveness of
budesonide nebulizer on post-operative and recurrence symptoms was conducted using the
questionnaires between 2016 and 2020 at Al-Hada Armed Forces Hospital in the Western
region of Saudi Arabia. Statistical analysis: descriptive statistics included mean, standard
deviation, frequencies, and percentages, and inferential statistics such as independent t-tests
and Chi-square were carried out using the Statistical Package for the Social Sciences software
(Version 26.0 IBM SPSS Corp., Armonk, NY, USA). Results: The study included 111 patients who
underwent endoscopic sinus surgery; 27.9% had a history of bronchial asthma. Budesonide
nebulizer usage was reported to be 55.9%. At 2nd, 3rd, and 8th weeks postoperatively,
patients who were not utilizing a Budesonide nebulizer had significantly greater signs of
crustation, nasal blockage, headache, malodor, anosmia, and secretions than those who were.
Conclusions: Although further research is needed, utilizing a nebulizer to deliver budesonide
to the sinonasal mucosa is more effective and affordable than employing nasal irrigation.

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1621
Assessment of the Prevalence of Use of Nasal Decongestants Among General
Population in Saudi Arabia

ahmad alharthi1, saud alharthi3, Altowairqi Abdulaziz F4, Shrooq alswat5, alnofaie marwan5

1
ORL , HEAD AND ENCK SURGERY , ALHADA HOSPITAL FOR ARMED FORCES , TAIF , SAUDI ARABIA ,
2
ALHADA HOSPITAL FOR ARMED FORCES, 3king faisal medical complex , taif . saudi arabia ,
4
Otorhinolaryngology - Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, SAU.,
5
Otorhinolaryngology, King Faisal Medical Complex, Taif, SAU, 6Otolaryngology - Head and Neck
Surgery, Alhada Hospital for Armed Forces, Taif, SAU

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

BackgroundA topical nasal decongestant (NDC) is widely prescribed in ENT practice and used
as self-medication because it is available over the counter, which makes it an easily accessible
medication. Due to its common and long-term use, it is associated with serious nasal
complications. It is commonly self-administrated in many otolaryngology diseases like the
common cold, sinusitis, and acute or chronic rhinitis. The long-term usage of nasal
decongestants is associated with significantly increased side effects.AimTo assess the
prevalence of the usage of nasal decongestants among the general population in Saudi Arabia
ad the pattern of its use.MethodologyA questionnaire-based, cross-sectional survey was
applied to level all available populations in Saudi Arabia. Participants with ages aged 10 to 60
years old in Saudi Arabia were invited to participate in the survey. Data were collected from
participants using a predesigned online questionnaire. The questionnaire included the
participant's demographic data, NDC use, and pattern of use. The questionnaire was uploaded
online by researchers and their friends using social media platforms.ResultsA total of 1456
participants completed the study questionnaire. Participants ages ranged from 10 to 60 years
with a mean age of 26.9 ± 12.4 years old. Exact 585 (40.2%) participants were males and 1270
(87.2%) were from urban regions. A total of 657 (45.1%) respondents reported using nasal
decongestants while 799 (54.9%) did not use NDC. As for the duration of use, 70.8% used NDC
for less than five days and 13.5% used it for 5-15 days. Th

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1636
Exploration and safety evaluation of hormone nebulized administration in promoting
recovery after endoscopic sinus surgery

Yong Li1, Zhiqi Ma1

1
Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine

CRS – medical management 4 | Room 8 Hall 4 - Level 0| Wednesday 21/06/2023

Objective: To investigate the efficacy and safety of using nasal pulse nebulized budesonide in
patients after functional nasal endoscopy (FESS). Methods: A total of 40 patients with chronic
sinusitis who underwent functional nasal endoscopic surgery (FESS) in our hospital were
randomly divided into nebulized inhalation group (n=20) and oral hormone group (n=20) using
a random number, all patients received the same postoperative routine treatment, both
groups of patients were followed up in our hospital outpatient clinic after 2 weeks, after
cleaning up the nasal tamponade material on the 14th postoperative day, the nebulization
group began to nebulize inhalation budesonide suspension, and the other group took
methylprednisolone tablets orally, both for 2 weeks. Visual analogue scores (VAS) and Lund-
Kennedy endoscopic scores for nasal symptoms (nasal congestion, runny nose, smell,
headache) were performed before and after treatment to assess safety by adverse events and
morning serum glucocorticoid levels. Results: After 12 weeks of follow-up treatment, 2 cases
were dropped in the oral hormone group, and the VAS visual analogue score of the 2 groups
was significantly reduced, and the Lund-Kennedy endoscopic score of the nebulized group and
the oral group was also significantly reduced, the morning serum glucocorticoid concentration
in the nebulized group decreased after treatment, but there was no significant statistical
difference, while the morning serum glucocorticoid concentration in the oral group was
significantly reduced after treatment, and obvious periadrenal corticosteroid suppression was
visible. Conclusion: The application of glucocorticoid pulse atomization after FESS can fully
diffuse the drug to the sinus oronasal tract complex, and its area of action is more extensive,
which can significantly reduce the edema reaction of the mucosa in the operative cavity and
promote the benign outcome of the mucosa. It has no significant inhibitory effect on the
hypothalamic-pituitary-adrenal axis, which is safer than traditional oral hormone therapy.
May be used as a postoperative treatment option for chronic sinusitis.

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Epistaxis and HHT 2

1127
“TIMolol nasal spray as a treatment for epistaxis in Hereditary Hemorrhagic
Telangiectasia (TIM-HHT) – A prospective, randomized, double-blind, controlled cross-
over trial”

Kornelia Andorfer1, Florian Zeman1, Michael Koller1, René Fischer1, Caroline Seebauer1,
Christopher Bohr1, Thomas Kühnel1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Question Can the effectiveness of the standard treatment for epistaxis in hereditary
hemorrhagic telangiectasia (HHT) patients with a pulsed diode laser be increased by
additionally use of timolol nasal spray?Findings This randomized, placebo-controlled, cross-
over trial included 18 HHT patients and showed a reduction of the severity of epistaxis and an
improvement of subjective satisfaction in the timolol group compared to the placebo group.
These effects were statistically reliable at the 1-month assessment point, but just fell short of
the conventional significance level after three months. Meaning Timolol nasal spray has a
measurable positive effect on epistaxis and satisfaction in HHT patients when used additively
to standard laser therapy.

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1224
Refractory epistaxis with hereditary hemorrhagic telangiectasia

Jing Zhou1, Jintao Du2, Jiao Zhou3

1
Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan
University,China, 2Department of Otolaryngology-Head and Neck Surgery, West China Hospital,
Sichuan University, China, 3Department of Geriatrics, West China Hospital, Sichuan University, China

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease

characterized by systemic telangiectases and larger vascular malformations. Herein, we report
a case of a 64-year-old woman who complained right refractory epistaxis for 16 years. Physical
examination showed a paving stone-like characteristic in mucocutaneous junction on right
nasal septum, telangiectasia on left nasal septum mucosa, oral labial mucosa , tongue and
fingers. Radiography and angiography confirmed pulmonary arteriovenous malformation in
the bilateral hemithorax and occluded middle cerebral artery with increased small blood
vessels in left brain. Lab examination showed serious anemia by low hemoglobin of 59 g/L.
Nasal packing, blood transfusion and long-term oral ferrous lactate supplement were the main
treatment methods before. In addition, recurrent mild epistaxis happened in her son and
granddaughter. Collectively, she was diagnosed as hereditary hemorrhagic telangiectasia
according to the Curaçao Criteria for the first time. The patient was urgently given
electrocoagulation and then nasal packing with NasoPore to stop bleeding, as well as blood
transfusion. Then a continued treatment of thalidomide for 3 months was prescribed, with
symptom of epistaxis significantly alleviated after 3-month follow-up. The results of genetic
testing were positive for endoglin with heterozygous frameshift mutation in
NM_001114753.2: c.210_214dupCAAGG in the patient, her son and her granddaughter.

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1245
Treatments of Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review
and Network Meta-Analysis

Wirach Chitsuthipakorn, Minh Hoang2, Dichapong Kanjanawasee3, Kachorn Seresirikachorn4,

Kornkiat SNIDVONGS

1
Center of Excellence in Otolaryngology, Head & Neck Surgery. Rajavithi Hospital, Bangkok, Thailand,
College of Medicine, Rangsit University, Bangkok, Thailand, 2Department of Otolaryngology, Hue
University of Medicine and Pharmacy, Hue University, Hue, Vietnam, 3Department of Parasitology,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, Center of Research
Excellence in Allergy & Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand, 4Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital,
Bangkok, Thailand

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

BackgroundEpistaxis is the most common presenting symptom of Hereditary Hemorrhagic

Telangiectasia (HHT). This study aimed to analyze the effects of various kinds of epistaxis
treatment for HHT patients.MethodsPubMed and EMBASE were searched until October 30th,
2022. Randomized controlled trials (RCTs) studying the effects of any treatments in adults with
HHT were included. Network meta-analysis was conducted assessing epistaxis severity score
(ESS), frequency and duration of epistaxis, quality of life, visual analog scale (VAS), hemoglobin
level, and adverse event. ResultsOf total of 18 RCTs, the data from 14 RCTs (634 patients, 7
treatments: timolol, bevacizumab, doxycycline, tacrolimus, propranolol, estriol, and
tranexamine) could be pooled in the meta-analyses while the others (4 treatments:
electrosurgical coagulation, LASER, tamoxifen, and estradiol) were reviewed qualitatively.
When compared to placebo, propranolol offered the most improved ESS -1.68 [95%
confidence interval, CI, -2.80, -0.56] followed by timolol -0.40 [95%CI -0.79, -0.02]. Moreover,
tranexamine significantly reduced the epistaxis frequency -1.93 [95%CI -3.58, -0.28]. The
other treatments had indifferent effects to placebo. The adverse events from tranexamine,
tacrolimus, propranolol, and estriol were significantly reported. ConclusionsPropranolol,
timolol, and tranexamine were the only treatments which offered benefits to HHT patients in
epistaxis management with some concerns of adverse events in propanolol, tranexamine,
tacrolimus, and estriol.

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1318
Long-term control of Epistaxis in in Hereditary Hemorrhagic Telangiectasia with Blue
Light Laser Treatment

Kornelia Andorfer1, Caroline Seebauer1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Hereditary hemorrhagic telangiectasia (HHT) is a hereditary condition that is associated with

arteriovenous malformations. Core symptom of the disease is epistaxis. According to the
latest guidelines ablative therapies, including laser treatment with ND: YAG laser or KTP laser
are an established therapy for endonasal manifestations. Since recently, the blue light laser
has expanded the spectrum of laser treatment of nasal Osler's disease. To date, the
effectiveness of this laser has hardly been investigated.In the retrospective study presented
here, we present the long-term effect of this therapy in a collective of over 100 patients over
a duration of up to 4 years. Treatment efficacy is assessed using the established ESS
questionnaire.

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1340
Management of severe spontaneous epistaxis in a tertiary ENT center: our experience
over the last decade

Coloma Grau, Blanca Mateos1, Carolina Alfonso1, Javier Gavilan1

1
Department of Otorhinolaringology, University Hospital La Paz, Madrid, Spain

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Purpose. To describe and compare the different treatments used to control severe
spontaneous epistaxis in patients requiring hospitalization.Methods. A retrospective
descriptive study of a case series of patients hospitalized for spontaneous epistaxis in La Paz
University Hospital in Madrid between 2012 and 2022.Results. 191 patients were included,
with a total of 207 episodes. 65% were male. The mean age was 67 years. The mean length of
hospitalization was 5 days similar in patients managed conservatively and surgically. Initially,
conservative management was performed in all cases with anterior nasal packing. 60% of
cases required surgery to control the epistaxis. The most performed surgery was endoscopic
sphenopalatine artery ligation, in 55% of cases. Ligation of the internal maxillary artery or
ethmoidal artery was not required in any case. Arterial embolization was performed in only
one case. The mean length of hospitalization prior to surgery was less than two days. No post-
surgical complications were observed.Conclusions. Endoscopic nasal surgery is a safe and
effective alternative for the control of severe epistaxis. There is a tendency in our center to
perform early surgery on patients with epistaxis refractory to nasal packing. Arterial
embolization can be avoided with adequate nasal endoscopic surgery.

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1428
Management of epistaxis in hereditary haemorrhagic telangiectasia (HHT) patients
using pulsed dye laser and the effect of withholding treatment during the COVID
pandemic

Yuchen Jiang1, Simon Dennis1, Brewin Mark2

1
Department of Otolaryngology, Salisbury District Hospital, Salisbury, United Kingdom, 2Salisbury Laser
Clinic, Salisbury District Hospital, Salisbury, United Kingdom

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Using a patient survey, pulsed dye laser (PDL) treatment of epistaxis for hereditary
haemorrhagic telangiectasia (HHT) patients was evaluated. Due to the COVID pandemic, a
natural experimental set-up allowed assessment of an enforced withdrawal of treatment.
Thirty-four subjects identified as undergoing PDL for HHT- related epistaxis were surveyed to
look at the effectiveness of PDL after initial referral and the effect of delay to treatment during
COVID on epistaxis and the associated quality of life (QoL). The survey also examined the
comparison to other available treatments. Retrospective pre-COVID Epistaxis Severity Scores
(ESS) were compared to post-COVID data to assess the effect of treatment withdrawal. The
patients were then followed up after resumption of their treatment to assess the ensuing
change in ESS. After initial referral, frequency and severity of epistaxis decreased. Fifty-six
percent of patients experienced several bleeds per day before treatment, compared to 12%
after. 88% of patients had episodes of epistaxis longer than 5 min, which halved to 44% after
treatment. Average ESS pre-COVID was 4.42 compared to 5.43 post-COVID (p = 0.02). On
resumption of treatment, average ESS reduced to below pre-COVID levels at 4.39 after only 2
sessions. Seventy-six percent of patients found that withdrawal of PDL during COVID
diminished their quality of life. PDL treatment of nasal mucosal telangiectasia reduces the
frequency and duration of epistaxis. The ESS is reduced following treatment and QoL
subjectively improved.

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1477
Young's procedure for severe epistaxis in hereditary haemorrhagic telangiectasia

Robert Bickerton, Nikita Mehtani1, Lizzie Bullock1, Vikas Acharya1, Catherine Rennie1

1
Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

IntroductionHereditary haemorrhagic telangiectasia (HHT) is a rare genetic

disorder characterised by the formation of widespread arterio-venous malformations.
Involvement of the nasal mucosa results in recurrent severe epistaxis, significantly impacting
on quality of life. Nasal closure is occasionally used to treat severe refractory epistaxis in HHT,
but there is limited research on its outcomes. We aim to evaluate the efficacy and patient
satisfaction of nasal closure in this context.MethodsA case series of 5 patients with HHT and
severe transfusion dependent epistaxis refractory to conventional management were treated
with nasal closure between 2020 and 2022. Post-operative outcomes were measured using
the Glasgow Benefit Inventory (GBI), epistaxis severity scale (ESS), haemoglobin
concentrations and transfusion frequency.ResultsAll patients had an improvement in ESS.
Haemoglobin concentrations increased in all patients, with none requiring transfusion for
epistaxis after the procedure. Four patients experienced a complete cessation in
epistaxis. Four patients had significantly positive GBI scores following nasal closure. The one
patient with limited improvement had the closure to prevent worsening of severe pulmonary
hypertension by anaemia.Conclusions Nasal closure appears to be a safe and effective option
for the management of epistaxis in patients with HHT. Treatment improved quality of life,
reduced severity of epistaxis and increased haemoglobin concentrations. Larger
controlled studies are required to confirm these findings and evaluate long-term outcomes.

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1586
Epistaxis and Pregnancy in Women with HHT – A Retrospective Survey and
Recommendations for Management from an Otorhinolaryngology Perspective

Kornelia Andorfer1, Caroline Seebauer1, Thomas Kühnel1, René Fischer1, Christopher Bohr1,
Steven Marcrum1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Epistaxis and HHT 1 | Room 9 Olympic Hall - Level 0| Wednesday 21/06/2023

Background: Heredity hemorrhagic telangiectasia (HHT) is a rare inherited condition leading

to telangiectasia of the mucosa and skin as well as visceral arteriovenous malformations
(AVMs). Via hormonal changes, modifications of the vascular bed and circulation promote
complications during pregnancy and delivery. The aim of this study was to assess patients`
awareness about the disease and its complications during pregnancy in order to develop
management recommendations from an ENT point of view. Methods: Included in our survey
were 46 female HHT patients. A 17- item questionnaire was used to analyze their knowledge
of the disease and its pregnancy associated complications, the severity of epistaxis during
their pregnancy and delivery and the need for better education. Results: 85% of the
participating women didn’t know about their disease during first pregnancy and none was
aware about potential adverse events. 28 of the 46 respondents suffered from epistaxis
during pregnancy. One-third of patients even reported increased nosebleeds during
pregnancy. One-third (33%) of women with HHT would have found counseling helpful.
Conclusion: Our study showed that the awareness on the disease and its adverse events
before and during pregnancy during the last decades has been poor. Epistaxis during
pregnancy is an issue for women with HHT that needs to be addressed. In the light of these
facts, improving HHT diagnosis and information by treating physicians is an objective and
women with HHT should be counseled professionally prior onset of pregnancy.

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Miscellaneous 2

1158
Nasal Valve dysfunction : Classification and management

JI YUN CHOI1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany, 2Department of otorhinolaryngology, Chosun University Hospital,
Gwangju, Korea

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

Objectives: A key aspect of rhinoplasty is integrity of nasal valves area because of its
fundamental role in patent nasal airway. furthermore, nasal obstruction is a dominant feature
in patient with nasal valves dysfunction (NVD) which can be devastating outcome after
rhinoplasty. Methods: Nonetheless, NVD has been widely investigated regarding their
etiologies and management. However, it has been assumed that the anatomical complexity
and interplay between its structures causing a confusion for a beginner surgeon to diagnose
and treat NVD. This study was approved by the institutional review board of Chosun University
Hospital, Gwangju, Korea (2022-11-005). Results: To date, the lack of consensus on nasal valve
pathologies and corrective procedures has led to its underestimations during analysis and
management. As result, we proposed a classification system based on its affected anatomical
part, location, and their management. Thus, implementing a classification system for NVD will
help guide the practice of rhinoplasty and introduce a more structured approach. Conclusion:
This approach will prove useful in expanding our understanding of how important to locate
the pathology of NVD and apply the most relevant management options, particularly for a
beginner surgeons

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1159
Usefulness of structural rhinoplasty using 3D Printed Polycaprolactone Plate in Asian

JI YUN CHOI1

1
Department of otolaryngology, Chosun University Hospital, Gwangju, Korea

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

Background: Tip plasty using a septal extension graft (SEG) is useful in the Asian population.
However, complications such as decreased tip projection, infection, or deviation are noted
post-surgery, and additional support using an SEG is often necessary. We aimed to transplant
an additional 3D printed polycaprolactone (PCL) graft to the tip plasty using the SEG to
reinforce the SEG. Methods: The study included 43 patients (20 males and 23 females; mean
age, 28.7 years; range, 17–58 years) who received rhinoplasties using the SEG method
combined with a 3D printed PCL graft from November 2016 to August 2017. The mean
observation period was 14.8 months (range, 12–20 months). Results: Twenty-six patients
rated their satisfaction level as excellent, 13 rated good, 3 rated fair, and 1 rated poor. In total,
28 patients did not exhibit tip drooping at the 1-year follow-up; 13 patients demonstrated
mild to moderate tip drooping, and 2 patients demonstrated severe tip drooping. Thirty-one
patients demonstrated “stiffness” of the nasal tip, of which 11 patients reported discomfort,
and 20 patients reported none; two patients demonstrated deviation of the tip. Conclusion:
Although the 3D-printed PCL graft provided support, biocompatibility, and manipulability,
care is required to prevent complications.

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1213
Splitting advancement genioplasty, a long term follow-up and outcome

Muzaffer Çelik1
1
Cranioplast Clinic

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

A new genioplasty technique has been described and performed on more than 200 patients
since 1996. The technique has been developed to avoid some undesired results of the current
osseous genioplasty techniques and to achieve a more natural appearance in advancement
genioplasty. According to the authors' technique, a rectangular part of the outer table of the
mentum is split away from the mandible, and is advanced and fixated to the mandible. This
technique can be used for advancement cases but not for reduction genioplasty. This
technique was performed on more than200 patients with only minor complications, including
one case of wound dehiscence, one hematoma, and one case of osteomyelitis, which was
managed with systemic antibiotic therapy. Aesthetic results were found to be satisfactory
according to an evaluation by the authors. When the results were evaluated using pre- and
postoperative photos, lip position and projection of the mentum were found to be natural in
shape appearance. During the late postoperative period, the new bone formation between
the advanced segment and the mandible was demonstrated radiographically. The new bone
formation is also stable according to long term fpollow-up. Avantages of the technique include
having more contact surfaces for bony healing, a natural position of the lower lip, more natural
projection of the mentum, tridimensional movement of the mentum, and improvement in the
soft tissue of the neck. The disadvantages of the technique are, manipulation problems during
surgery, and possible mental nerve injury. Splitting advancement geniop

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1628
Personalized Digital Technologies for Improved Late Zygomatic-Orbital-Skull-Base
Reconstruction

Zhaohui Shi1, Min Xu2, Jian Wang2, Yubin Lai2, Xiaodong Chen2, Yi Sun3

1
Department of Otorhinolaryngology, Head & Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen
University, No. 600 Tianhe Road, Tianhe District, 510000 Guangzhou, Guangdong Province, China,
2
Department of Otorhinolaryngology, Head & Neck Surgery, The First Affiliated Hospital of of Airforce
Medical University, Xi’an, Shanxi, China, 3Oral Pathology and Maxillofacial Surgery, Faculty of Medicine,
Katholieke Universiteit Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

Introduction: We present a case with zygomatic-orbital-skull-base reconstruction using virtual

planning (multi-spiral computed tomography and 3D modeling), computer-aided surgical
simulation, and a patient-specific implant. It is the first complex case in the literature to get
improved using various customized digital technologies.Methods: A 37-year-old man with a
complex late zygomatic-orbital-maxillary deformity on the left side and cerebrospinal fluid
rhinorrhea (CSF) was referred to our department and treated in two stages after examination
and discussion. We performed CSF rhinorrhea repair and zygomatic-orbital-maxillary
reconstruction with preoperative virtual surgical planning and patient-specific implant
designing. Two months after the primary stage, we replaced the patient-specific implant with
a customized, three-dimensional, and preformed titanium mesh during the second orbital-
skull-base reconstruction and simultaneous right-sided facial nerve decompression.Results:
The postoperative outcome was satisfactory, permitting functional and esthetic rehabilitation
of the patient. Facial symmetry in patients was observed and improved after the final
reconstruction. The patient could finely tune his fixational eye movements and retain normal
visual acuity. No particular complications occurred.Conclusion: Personalized digital
technologies to treat late zygomatic-orbital-skull-base deformities benefit avoiding the
problematic issues of implant positioning and the development of complications during total
orbital reconstruction, ensuring a markedly satisfactory outcome.

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1460
Look Who’s Back: Re-emergence of cocaine associated vasculitis in an Irish population

Nadia Van Den Berg1, Michael Walsh1, Alanna Quinn1, Mona Thornton1

1
Department of Otolaryngology Head & Neck surgery, St Vincent’s University Hospital, Ireland

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

Introduction: Ireland has seen a significant increase in cocaine use and its nasal
complicationsin recent years, with cocaine prevalence increasing from 8.6% in 2008 to 30.2%
in 2021. Therehas been a re-emergence of cocaine induced vasculitis, not seen clinically since
the early 2000’swhen the addition of levasimole was recognised as a contributory factor. We
wish to highlightthis recent increase in cocaine induced vasculitis.Methods & Results: Four
cases were evaluated where patients presented to our outpatient service complaining of
sinusitis and rhinitis symptoms, however examination showed evidence of significant
destruction and necrosis of internal nasal architecture. All patients had positive ANCA and
anti-PT3 antibodies. Biopsies excluded a malignant process. One patient had an associated
skin rash, night sweats and lymphadenopathy, and subsequently underwent a lymph node
biopsy to exclude lymphoma. Conclusion:Increasing societal cocaine use has been reflected in
our outpatient units, with associated vasculitis increasing. This patient cohort are often not
forthcoming regarding recreational drug use, which proves challenging. Induced vasculitis is
not exclusive to cocaine usage and includes a number of differentials including lymphoma;
therefore, tissue diagnosis and rheumatology consultation are essential in the work up. 200
words (excluding titles)

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1155
Adaptation and validation of the Hebrew version of the nasal obstruction symptom
evaluation (NOSE) scale

narin carmel neiderman1, Nir Halevy1, Tal Kas1, Anat Wengier1, Ahmad Safadi1, Avraham
abergel1, narin n carmel neiderman2

1
Tel Aviv Sourasky medical center, 2Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

Purpose To adapt the Nasal Obstruction Scale Evaluation (NOSE) questionnaire to the Hebrew
language (H-NOSE), and to assess its sensitivity and specificity. Methods: Prospective
instrument validation study. The English NOSE questionnaire was translated into Hebrew and
re-translated for translation validity. Surgical candidates completed the H-NOSE questionnaire
before and after surgery for nasal obstruction. The same questionnaire was completed by
healthy controls. Test-retest reliability was performed within a two-week interval.
Psychometric properties (reliability, reproducibility, validity and responsiveness) were
assessed by a test-retest procedure, internal consistency and correlation to the Hebrew Sino-
Nasal Outcome Tool 22 (He-SNOT-22) and response sensitivity.Results 179 patients with nasal
obstruction and 74 controls completed the questionnaire. The Alpha Cronbach score was 0.93
for internal consistency. The ROC-curve demonstrated high sensitivity and specificity (<0%)
and AUV=0.97. There was no significant difference was found in test re-test reliability. The
difference between the pre- and postoperative questionnaire scores was highly significant
(13.9±4.0 vs 3.2±4.1, respectively, p < 0.001), demonstrating the anticipated postoperative
improvement in nasal obstruction symptoms. Conclusion The H-NOSE questionnaire
demonstrated reliable internal consistency, sensitivity, specificity

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1754
Psammomatoid Juvenile Ossifying Fibroma: An Endoscopic Endonasal, Transorbital
and Transcaranucular Approach

Mustafa Thamer1, Ramkishan Balakumar1, Richard Edwards1, Rebecca Ford1, Kumar Abhinav2,
Warren Bennett1

1
University Hospitals Bristol and Weston NHS Foundation Trust, 2North Bristol NHS Trust

Miscellaneous 2| Room 10 Peroto - Level 0| Wednesday 21/06/2023

BackgroundPsammomatoid juvenile ossifying fibroma (PJOF) is a benign pathology which has

aggressive local growth leading to invasion of surrounding tissue and recurrence after surgical
excision. It has also unique features in terms of age of onset, location and
presentation. Method14 year old girl presented with left sided facial pain and proptosis for a
few days. A CT scan showed a large nasal mass and an MRI scan revealed an enhancing solid
mass occupying the left nasal cavity and involvement of cribriform plate with dural
enhancement. The mass extended to medial margin of left optic foramen as well as her
frontal, maxillary and sphenoid sinus. She had biopsies and histology suggested PJOF.
Therefore, the ENT, Neurosurgery and Ophthalmology team undertook a joint endonasal
craniofacial resection with additional transorbital and trancaruncular approaches. Repair was
with a Facia Lata overlay graft. Post-operatively, her vision function was intact and only had a
little residual telecanthus and she is currently under surveillance. ConculsionThe risk of
recurrence and aggressive nature of these benign lesions require early detection and
complete resection. We present this case to emphasise the importance of a multidisciplinary
approach in-order to achieve good resection with excellent functional and cosmetic
outcomes.

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CRS – diagnosis and investigations 3

1373
The Microbiological Profile of Allergic Fungal Rhinosinusitis

James Connell1

1
Department of Otorhinolaryngology, Queen Elizabeth Hospital, South Australia

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Background: Allergic Fungal Rhinosinusitis(AFS) is a severe phenotype of chronic rhinosinusitis

(CRS). While fungal allergy and type 2 inflammation are considered central mechanisms, the
direct and synergistic role of bacteria and fungus remains a key theory. Defining the AFS micro-
environment can improve our understanding of this debilitating pathology.Methods: We
undertook a cross-sectional study analysing the microbiome profile of 61 patients. Swabs
were obtained from the middle meatus at the time of surgery. Fungal and bacterial DNA were
extracted and underwent fungal ITS, 16S short read (V3-V4) and 16S long read sequencing.
Utilising a QIME2 bioinformatics pipeline, abundance and diversity metrics were established.
Results: 61 participants represented the clinical subgroups: AFS(12); Fungal CRS(19); allergic
mucin CRS(18); and CRS(12). Staphylococcus was the most abundant genus(40.78%) across
the cohort and was highest in the fungal CRS group(53.1%). Streptococcus was significantly
more abundant in AFS(35.5%) and Fungal CRS(25.8%) compared to the non-fungal groups
(16.9% allergic mucin CRS; 4.17% CRS). There was a trend towards lower phylogenetic
diversity in the fungal groups. Aspergillus was the dominant fungal genus on culture and ITS.
Conclusion: A low diversity environment dominated by staphylococcus and streptococcus
suggests a central role for these genera in AFS and fungal CRS. While the former is established
in bacterial-fungal cross-kingdom super antigen theorem, the latter is a novel finding in this
context and one that warrants further investigation.

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1554
Does The Endotype Influence the Quality of Life in Chronic Rhinosinusitis Patients?
Prospective Study

Vera Miranda1, Tiago Santos2, Paulo Gonçalves3, Miguel Lopes3, Carlos Carvalho3

1
ENT department, Centro Hospitalar de Entre o Douro e Vouga, Aveiro, Portugal , 2ENT department,
Centro Hospitalar de Entre o Douro e Vouga, Aveiro, Portugal, Unit for Multidisciplinary Research in
Biomedicine, Institute of Biomedical Sciences Abel Salazar, Universidade do Porto, 3ENT department,
Centro Hospitalar de Entre o Douro e Vouga, Aveiro, Portugal

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Background: Based on the inflammation type, Chronic Rhinosinusitis (CRS) can be classified in
type 2 and non-type 2 inflammation. Although type 2 inflammation is associated with a higher
recurrence rate, it remains unclear the relationship between the endotype and quality of life
in CRS patients. The Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire is used to assess
quality of life (QOL) in CRS patients. Objective: Evaluate if the inflammation type influences
the QOL in CRS patients.Materials and Methods: A prospective study was conducted between
January 2021 to December 2022. The included patients didn’t receive any medical therapy
(antibiotics, corticosteroids) two months prior to the medical appointment. The SNOT-22
questionnaire, IgE and blood eosinophils count was collected before medical therapy. Type 2
inflammation was defined by blood eosinophils count ≥ 250/μL and/or IgE level ≥ 100
/μL.Results: 141 CRS patients were included. Type 2 inflammation was presented in 64.5% of
the sample. We found a positive correlation between SNOT-22 score and IgE level (r=0.023,
p=0.783) and negative correlation between SNOT-22 score and blood eosinophils count (r=-
0.023, p=0.789) none of them statistically significant. No association was found between the
type of inflammation and the SNOT-22 score (p=0.788).Conclusion: Recent literature suggests
that type 2 inflammation may induce a higher rate of recurrence when compared to non-type
2 inflammation. However, our results demonstrated that the inflammation type does not
significantly influence the QOL in CRS patients.

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1564
Aspirin provocation and desensitization in Samter’s triad: a 25-patient series

Malgorzata Leszczynska1, Maciej Krawczyk1, Joanna Witkiewicz1, Dorota Jenerowicz2

1
Departament of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences,
Poland, 2Departament of Dermatology, Poznan University of Medical Sciences, Poland

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Introduction The trinity of recurring nasal polyps, bronchial asthma and aspirin intolerance
characterize the Samter’s triad (ST). ST is an underdiagnosed non-allergic hypersensitivity
reaction associated with abnormal metabolism of arachidonic acid, which decreases
prostaglandins and increases leukotriene synthesis. Patients present with symptoms of
sinusitis and are frequently recipients of ESS. Aim We aim to trial aspirin desensitization
therapy group of 25 patients. ST diagnosis was confirmed by positive aspirin provocation.
Materials and methods 25 patients with suspected ST underwent immunophenotyping and
diagnostic provocative aspirin challenge. All patients were administered a placebo and
increasing doses of Aspirin from 30 to 600mg. Patient condition and resultant symptoms were
monitored. Patients exhibiting severe hypersensitivity symptoms were assigned
desensitization therapy with Aspirin 600mg daily. Results 25 patients were diagnosed with ST.
5 of these 25 patients exhibited severe symptoms. 16 patients were assigned desensitization
therapy. After 12 months all patients reported better quality of life. Endoscopic examination
confirmed no recurrence of nasal polyps. Conclusion Aspirin desensitization therapy improves
quality of life but remains uncommon. Desensitization is a ready alternative to biological
treatment. Desensitization doses are controversial and maintenance doses are also not
standardized. A larger ST cohort should be studied to determine the effectiveness of threshold
desensitization doses.

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1672
Potential anti-inflammatory role of miR-143-3p in upper airway inflammation

Valeria Tubita1, Mireya Fuentes2, Borja Callejas3, Marina Bantulà3, Concepcio Marin2, Isam
Alobid4, Joan Bartra5, Antonio Valero5, Jordi Rocca-Ferrer2, Joaquim Mullol4

1
Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona,
Catalonia, Spain., 2Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Barcelona,
Catalonia, Spain, 3Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Catalonia,
Spain, 4Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Rhinology Unit & Smell Clinic, ENT
Department, Hospital Clínic, CIBERES, Barcelona., 5Clinical & Experimental Respiratory Immunoallergy,
IDIBAPS, Allergy Department, Hospital Clínic, CIBERES, Barcelona, Catalonia, Spain.

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

BACKGROUND:microRNAs (miRNAs) are described to be involved in the inflammatory

response. However, their direct role in Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is
still under investigation. This study aimed to study the expression and role of miR-143-3p in
upper airway samples from CRSwNP patients and controls in regulating
inflammation.METHODS: The localization of miR-143-3p in NP and NM samples was analyzed
by miRNAscope. miR-143-3p expression was detected in nasal polyps (NP, n=49) and control
nasal mucosa (NM, n=25) by using RT-qPCR and a ROC curve was calculated. Cytokines protein
expression in tissue lysate from NP and NM was analyzed by ELISA assays. RESULTS:miR-143-
3p expression was localized in the sub-epithelial area in both NM and NP tissues. In NP
compared with NM, a significant downregulation (p<0.0001) of miR-143-3p was observed. The
ROC curve confirmed a high accuracy in discriminating NP from NM tissues (AUC: 0.94; 95%
confidence interval 0.89 to 0.99). In NP compared with NM, IL-8 and Eotaxin were upregulated
(p<0.001 and p<0,0001 respectively) while RANTES and GM-CSF were downregulated
(p<0.001 and p<0,0001, respectively).CONCLUSIONS: miR-143-3p may play an anti-
inflammatory effect in the regulation of upper airway inflammation.

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1673
Expression of PAF receptors and Lyso-PAF isoforms in healthy and inflamed upper
airway mucosa

Valeria Tubita1, Jordi Roca-Ferrer2, María Pérez-González2, Isam Alobid3, Mireya Fuentes2,
Rosa Muñoz-Cano4, Antonio Valero4, Iñaki Izquierdo5, Joaquim Mullol3

1
Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona,
Catalonia, Spain., 2Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Barcelona,
Catalonia, Spain, 3Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Rhinology Unit & Smell
Clinic, ENT Department, Hospital Clínic, CIBERES, Barcelona., 4Clinical & Experimental Respiratory
Immunoallergy, IDIBAPS, Allergy Department, Hospital Clínic, CIBERES, Barcelona, Catalonia, Spain.,
5
Clinical Development & Medical Advise, R&D, NOUCOR / Uriach Group. Barcelona, Catalonia, Spain

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Background. The Platelet-Activating-Factor (PAF) and its receptor (PAF-r) are involved in
anaphylaxis, asthma, and allergic rhinitis. However, no studies have investigated the
expression of PAF-r and the Lyso-PAF isoforms in sinonasal tissue from chronic rhinosinusitis
with nasal polyp (CRSwNP) patients. Methods. Tissues were obtained from controls (nasal
mucosa, NM, n=6) and CRSwNP (NP, n=6), with asthma (NP-ATA, n=6) or with NSAID-
exacerbated respiratory disease (NP-N-ERD, n=6). mRNA was analysed by RT-PCR, PAF-r
proteins by western blot and immunofluorescence, and Lyso-PAF isoform concentration by
mass-spectrometry. Results. 1) The PAF-r mRNA was up-regulated in NP (P<0.05), ATA-NP
(P<0.05), and N-ERD-NP (P<0.05) vs NM while PAF-r proteins were detected in both NM and
NP. 2) Lyso-PAF C16 was higher in NP (P<0.05), ATA-NP (P<0.05), and N-ERD-NP (P<0.05) vs
NM. Lyso-PAF C16 was higher in asthmatic (both ATA and N-ERD) than in non-asthmatic NP
(P<0.05). 3) Lyso-PAF C18:1 and C18 were higher in N-ERD-NP (P<0.05) and ATA-NP (P<0.05)
vs NM. Lyso-PAF C18 was higher in ATA-NP and N-ERD-NP than in NP (P<0.05). Conclusions.
PAF-r mRNA and protein expression was found in both NM and NP tissues. NP showed an
over-expression of PAF-r mRNA and Lyso-PAF isoforms, suggesting that PAF/PAF-r system
could play a pathophysiological role in CRSwNP.

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1697
Anatomical variations of the internal carotid artery involved in endoscopic sinus
surgery

Mihail Dan Cobzeanu1, Bogdan Mihail Cobzeanu1, Liliana Gheorghe2, Maria Luiza Cobzeanu2,
Dragos Octavian Palade1, Vasilica Baldea3, Victor Vlad Costan4, Florentina Severin1, Andrei
Rosu1, Marius Cristian Martu1, Geanina Bandol5

1
Surgery Department, Faculty of Medicine, University of Medicine and Pharmacy "Gr.T.Popa" Iasi,
2
Radiology Department, Faculty of Medicine, UMF "Gr.T.Popa" Iasi, 3ENT Ambulatory Service
"N.Titulescu" Buzau, 4Surgery Department, Faculty of Medicine, University of Medicine and Pharmacy
Iasi, 5Regional Oncology Institute Iasi, 6Department of Surgery, Faculty of Medicine, UMF "Gr.T.Popa"
Iasi, Romania

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

FESS has become a well-established standard treatment for recurrent chronic sinusitis. In the
assessment of lesions, modern imaging techniques, such as CT scan play a vital role in
facilitating an adequate therapeutic plan. Moreover, these techniques offer guidance for
endoscopic interventions in risky regions, thereby decreasing surgical risks and enhancing the
efficacy of the intervention. Material and Method. The present study describes a retrospective
analysis of 50 cases that were surgically treated at the ENT department of "Sf. Spiridon"
Clinical Emergency Hospital Iasi, between 2020 and 2022. The paraclinical investigation
involved acquiring measurements and interpreting a range of CT images regarding the
anatomical variations of the internal carotid artery and its relationships with other structures,
which serve as landmarks in FESS. Results and Discussions. The study placed particular
emphasis on the pneumatization types of the sphenoid sinus, with special attention paid to
hyperpneumatization, since these variations can alter the conventional relations among the
diverse anatomical structures, including the anatomical variations of the optic nerve and
internal carotid artery. The imaging study revealed various topographic aspects, which were
extensively presented. Conclusions. This study examines the anatomical variations of the
sphenoid sinus with a focus on the key anatomical landmarks, namely the internal carotid
artery and optic canal. This preoperative plan helps in reducing complications and allows a
safe and effective surgical intervention.

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1712
Contemporary review of the Bent and Kuhn Criteria

James Connell1

1
Department of Otorhinolaryngology, Queen Elizabeth Hospital, South Australia

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Background: Allergic Fungal Sinus Rhinosinusitis(AFS) is a distinct clinical entity with severe
clinical manifestations. The Bent and Kuhn Criteria for AFS have served as a diagnostic
mainstay since their first description. As we enter an era of defined CRS phenotypes, we
review the ongoing applicability of the major and minor criteria. Methods: We performed a
cross sectional series of 149 patients suspected to have AFS based on the presence of
eosinophilic mucin, nasal polyposis and characteristic CT findings. We collated extensive
patient data including demographics, clinical, microbiological and tissue analysis. Results: Out
of 149 patients, only 19(12.8%) met all criteria required for AFS. 62 patients better fit the
distinct clinical entity, eosinophilic mucin CRS. The remaining 68 patients had highly
comparable disease severity, minor criteria, radiological changes and microbiological results
to the AFS but failed to meet all five diagnostic criteria. Negative fungal stains (despite positive
fungal cultures) and incomplete or negative fungal allergy testing (despite positive fungal
stains) were the primary reasons for incomplete diagnosis. Conclusion: A number of patients
that clinically and microbiologically behave similarly to AFS fail to meet all diagnostic criteria,
which may represent a distinct pathological group or limitations of the criteria. As we progress
into an era where diagnosis may dictate treatment, further insights to optimise diagnostics
become critical. In depth bio-informatics may enhance our understanding of the AFS disease
phenotype.

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1720
Infectious and rheumatic diseases manifesting as orbital sinusitis complications – case
reports.

Malgorzata Leszczynska1, Dorota Jenerowicz2, Maciej Krawczyk1, Joanna Witkiewicz1

1
Clinic of Otolaryngology, Poznan University of Medical Sciences, 2Clinic of Dermatology, Poznan
University of Medical Sciences

CRS – diagnosis and investigations 3| Room 11 Hall 3.3 - Level 7| Wednesday 21/06/2023

Introduction Sjögren’s syndrome (SS) is a chronic autoimmune disease of unknown etiology.

It predominantly affects middle-aged females and manifests itself mainly as
keratoconjunctivitis sicca, and xerostomia. On the other hand erysipelas is a skin disease
caused by bacterial infection, usually by Streptococcae. Both of these conditions can lead to
swelling, tissue redness and pain. The presence of these symptoms in specific locations can
mislead a clinician and suggest incorrect diagnosis. We present 2 cases of patients admitted
with symptoms suggestive of orbital sinusitis complications that turned out to be
manifestations of SS and erysipelas. Material and methods We present 2 cases of patients
both primarily treated as complicated chronic rhinosinusitis (CRS). During the diagnostics it
came out out that in the first case we were dealing with SS and in the second case with the
bacterial infection - erysipelas. Symptoms of orbital complications were masking infectious
and autoimmune disorders. Conclusion Autoimmune and infectious disorders can present
themselves in a form suggesting various diseases. A clinician should always implement
differential diagnosis in questionable situations, especially after unsuccessful surgical
intervention it preformed to rule out any underlying reasons of persistent CRS symptoms.

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Sinonasal malignancy 2

1491
Pterygopalatine Fossa And Orbital Apex May Be Predictors Of Distant Metastatic
Disease: A Retrospective Cohort Study of Sinonasal Intestinal-type Adenocarcinoma

António Andrade1, Pedro Alexandre1, Carla Pinto Moura2, Manuel Mendes Leal1, Gil
Coutinho1, José Maria Sousa3

1
Department of Otorhinolaryngology, Centro Hospitalar Universitário São João, Oporto, Portugal &
Department of Surgery and Physiology, Faculty of Medicine of University of Oporto, Oporto, Portugal,
2
Department of Otorhinolaryngology, Centro Hospitalar Universitário São João, Oporto, Portugal.&
Department of Genetics, Centro Hospitalar Universitário São João, Faculty of Medicine of University of
Oporto, Portugal & I3S, Instituto de Investigação e Inovação em Saúde, Institute Research and
Innovation Health, University of Oporto, Portugal, 3Neurorradiology Department, Centro Hospitalar
Universitário de São João, E.P.E., Oporto, Portugal. & CINTESIS, Centre for Health Technology and
Services Research, Faculty of Medicine of University of Oporto, Oporto, Portugal

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

IntroductionIntestinal-type adenocarcinoma (ITAC) is an aggressive subtype of sinonasal

neoplasms. The objective is to characterize the population of patients with ITAC and identify
relevant structures regarding distant metastasis.MethodsA retrospective cohort of patients
diagnosed with ITAC from January 2010 to December 2022 was performed in a tertiary
center. ResultsTwenty-five patients, all male, and the average duration of follow-up was 37.6
(± 27.4) months. Twenty (80%) patients were exposed to wood dust. T3/T4 cancer accounts
for 20 (80%) of cases.Endoscopic sinus surgery was performed in 13 (56.5%) cases and 10
(43.5%) patients underwent a combined approach of endoscopic and craniofacial resection.
Negative margins were achieved in 14 (60.9%) cases.During the postoperative follow-up, 10
recurrences (43.5%) were detected after a mean interval of 24.5 months. All 4 patients with
distant metastatic disease had involvement of the orbital apex and pterygopalatine fossa.
None of the patients recurred with nodal metastasis.The median overall survival was 78
months, and the 5-year survival rate was 51.4%.Conclusion Occupational exposure to wood
dust may act as a important risk factor, commonly seen in the northern region of Portugal.
Without nodal involvement, M+ disease implies non-lymphoid route spread, maybe via the
orbital apex and pterygopalatine fossa.

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1538
Poorly-differentiated sinonasal carcinomas: study of the genetic and epigenetic
fingerprints.

ALBERTO DANIELE AROSIO1, ALESSIA LAMBERTONI1, LAURA LIBERA2, NORA SAHNANE2,

FABIANA PETTENON2, DANIELA FURLAN2, CARLA FACCO2, GIORGIO SILEO1, FEDERICO
LEONE1, MARIO TURRI-ZANONI1, PAOLO BATTAGLIA1, FAUSTO SESSA2, PAOLO
CASTELNUOVO1

1
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, ASST Sette-Laghi,
University of Insubria, 21100 , 2Unit of Pathology, Department of Medicine and Surgery, ASST Sette-
Laghi, University of Insubria, 21100 Varese, Italy

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Introduction. Poorly differentiated sinonasal cancers (PDSNCs) are high grade aggressive
neoplasms; they include: poorly differentiated SCC, sinonasal undifferentiated and
neuroendocrine carcinoma. PDSNCs have undergone a significant refinement of their
subtyping from a genetic point of view, with the identification of new novel molecular
subgroups: NUT carcinoma, IDH2-mutated carcinoma, and SWI/SNF complex deficient
malignancies. PDSNCs are treated with a multimodal treatment protocol.Materials and
methods. A retrospective review of patients affected by PDSNCs treated in a single Italian
tertiary care referral centre (2008-2018) was performed. Patients were investigated from a
histological, genetic/epigenetic and survival point of view.Results. 53 patients were enrolled
(33 SCC G3, 6 SNUCS and 14 SNEC). 9 cases showed loss of INI1 expression (7 cases
homozygous deletion); 5 cases showed IDH2 hotspot mutation in codon p.Arg172 (mutually
exclusive with INI1 deficiency); 13 cases had hypermethylated LINE-1 sequences. 5-years DSS
was 55.9%. Histotype, INI1-loss, IDH2 mutation, LINE-1 hypermethylation, and occupational
exposure were significant prognostic factors.Conclusions. INI1-deficient and IDH2-mutated
tumors are aggressive diseases. IDH2 mutation and INI1 loss were associated with
hypermethylated LINE-1. The combined analysis of LINE-1, INI-1 and IDH2 alterations define a
distinct molecular subset of PDSNCs characterized by an aggressive biologic behavior and
potentially targets for innovative biological therapies.

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1667
Acinic cell carcinoma of the Nasal Cavity: A systematic review of the literature

Eleni Gkrinia1, Maria Alexiou1, Charikleia Maiou1, Athanasios Saratziotis1, Jiannis

Hajiioannou2, Charalampos Skoulakis2

1
Department of Otolaryngology - Head and Neck Surgery, University Hospital of Larissa, Greece ,
2
Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Thessaly,
Greece

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Introduction: Acinic cell carcinoma (ACC) is a rare malignant tumour, constituting 1% of

salivary gland neoplasms. It appears predominately in the parotid gland, whereas its
occurrence in different locations is unusual. The aim of this study is to review the available
evidence regarding the prevalence, diagnosis and management of ACC of the nasal
cavity.Methods and Material: This was a systematic review of the current literature
concerning ACC of the nasal cavity, which was conducted according to the PRISMA Protocol.
An electronic search of the English-language literature was performed through
Pubmed/Medline, Scopus and Embase databases. Case reports, case series and cohort
studies were considered eligible. Results: Eighteen studies, with 39 patients (mean age:32.0
years) were included in the review. No predominance between sexes was observed. ACC
mainly arose at the lateral and inferior wall of the nasal cavity (29.7%), the ethmoid sinuses
(21.6%) and the maxillary sinus (21.6%). Surgical treatment was chosen for all the patients,
followed by radiotherapy in 60% of them. A recurrence was noticed in 3 cases and the
overall survival approached 96.2%. Conclusion: Sinonasal acinic cell carcinoma is a rare
entity that otolaryngologists should be aware of, in order for the adequate management to
be accomplished.

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1700
The role of inverted papilloma as a prognostic factor in sinonasal squamous cell
carcinoma

Liliana Carvalho1, Luís Oliveira2, Pedro Montalvão1, Miguel Magalhães1

1
Hospital Professor Doutor Fernando Fonseca, 2Instituto Português de Oncologia de Lisboa Francisco
Gentil

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Introduction: Inverted papilloma (IP) is a benign tumor that has high recurrence rates and the
potential for malignant transformation into squamous cell carcinomas (SCC). IP has been
described in as a prognostic factor for sinonasal squamous cell carcinoma (SCC), and some
authors report that its presence is associated with better prognosis. The aim of this study is
to compare the response to therapy, recurrence, and survival rates between patients with
sinonasal SCC with history of IP with those without IP. Methods: Retrospective study with
review of records of patients with a diagnosis of sinonasal SCC between 2007 to 2019 in a
reference oncology center. Results: A total of 78 patients were selected for the study. IP was
present in 11 patients (14,1%), either at the time of SCC diagnosis or prior to this. Most
patients were in stage III or higher. Age, recurrence or persistent disease after initial treatment
were not statistically different between IP an non-IP groups. Overall survival was statistically
higher in the IP group. Discussion/conclusion: Sinonasal SCC often present in an advanced
stage and this is one of the factors for poor prognosis. Our findings support IP as another
potential marker for prognosis in sinonasal SCC.

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1707
Metastatic tumours to the Nasal Cavities, Paranasal Sinuses, and Orbit: a single-
institution 20-year experience

Giulia Monti1, Alberto Daniele Arosio2, Alessia Lambertoni2, giorgio sileo2, Gianluca Dalfino2,
Elisa Maria Lazzari3, Paolo Battaglia2, Mario Turri Zanoni2, Paolo Castelnuovo2, Maurizio
Bignami4

1
Division of Otorhinolaryngology, University of Insubria, Department of Biotechnology and Life
Sciences,Varese-Como, Italy , 2Division of Otorhinolaryngology, University of Insubria, Department of
Biotechnology and Life Sciences, Varese, Italy,, 3Division of Otorhinolaryngology, University of Insubria,
Department of Biotechnology and Life Sciences, Varese, Italy, 4Division of Otorhinolaryngology,
University of Insubria, Department of Biotechnology and Life Sciences, Varese- Como, Italy

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Rationale: Extra nasal cancers that metastasize to the paranasal sinuses are utmost rare. Due
to their uncommon occurrence, literature is scant regarding their prognosis and management.
The purpose of this study is to analyze clinical, therapeutical and survival data of such rare
pathology.Material and Methods: A retrospective review of all the patients affected by
metastatic cancers to the sinonasal and orbital region from 2000 to 2020 in a tertiary-care
referral University Hospital was performed. Demographic information, clinical presentation,
treatment modalities and survival outcomes were investigated and collected for each
patient. Results: A total of 20 patients (14 males, 6 females), aged between 32 and 79 years,
were included. The most common primary tumor site spreading to sinonasal and orbital
region was renal cell carcinoma (6 cases) followed by lung cancer (3 cases), breast and colon
carcinoma (2 cases), and hepatocarcinoma, thyroid carcinoma, oropharyngeal carcinoma, skin
melanoma, prostate cancer, parotid adenoid cystic carcinoma, bone sarcoma (one case, each).
Four patients underwent biopsy for histological diagnosis, while in 16/20 cases surgical
resection was perfrmed. The 2-year survival rate was 63±2%. Conclusions: Even if rare events,
paranasal sinus and orbital localization of distant cancers might occur, and it should be
suspected in patients with previous history of malignancy. Although the overall survival
remains poor in the setting of a metastatic disease, early diagnosis and prompt treatment can
improve patients’ quality of life and, occasionally

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1715
ADULT SINONASAL ALVEOLAR RHABDOMYOSARCOMA: CASE REPORT AND
LITERATURE REVIEW

Rafael Pires1, Dentinho Jorge1, Proença Vitor1, Cunha e Sá Manuel1

1
Otorhinolaryngology-Head and Neck Surgery, Hospital Garcia de Orta, Almada, Portugal

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Introduction: Alveolar rhabdomyosarcoma (ARMS) is a rare soft-tissue malignancy that mainly

affects children and adolescents, frequently misdiagnosed in the head and neck
region.Objectives: To report a case and to review the literature on sinonasal ARMS.Case
Report: A 34-year-old female presented with two seizures and bilateral proptosis. Imaging
studies reported a mass int the right nasal cavity extended to the left nasal cavity, paranasal
sinuses, orbits and anterior skull base. The patient underwent combined nasal endoscopic
and subfrontal craniotomy for lesion ressection. The immunohistochemical diagnosis of
alveolar rabdomyossarcoma was made. Molecular analysis was positive for PAX/FOXO1 fusion
gene. Three weeks after surgery, the patient presented with left arm paresthesia and dorsal
backpain. Imaging studies revealed tumor recurrence with spinal metastases. Palliative
radiotherapy for spinal cord compression was started, followed by ongoing
chemotherapy.Discussion: Sinonasal ARMS has a wide spectrum of presentation, from
localized nasal to ophtalmic and neurologic symptoms. The diagnosis is based on
histopathology and molecular analysis. Poor prognosis factors include age, intracranial
extension, alveolar subtype and metastasis. ARMS warrants a multidisciplinary treatment
approach with chemotherapy, radiation and surgery if permitted by anatomical
site.Conclusion: Early diagnosis and prompt treatment for sinonasal ARMS are crucial for
outcome.

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1729
Pediatric Sino-orbital Rhabdomyosarcoma: A Case Report and Literature Review

Alex-Iulian Milea1, Andreea Elena Bejenariu1, Codrut Sarafoleanu2

1
”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 2Carol Davila” University of
Medicine and Pharmacy, Bucharest, Romania

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Rhabdomyosarcomas are aggressive and rare soft tissue malignancies, that frequently affect
the nose, paranasal sinuses and nasopharynx. Notwithstanding their rarity,
rhabdomyosarcomas are the most common pediatric soft tissue malignancies of the head and
neck .We describe a 15-year-old girl who presented with sudden right-sided gaze diplopia,
right-sided exoftalmia, right-sided nasal obstruction and right-sided temporoparietal
headache, from 9 days before presentation. Magnetic resonance imaging described a large
right sinonasal mass, with right intraorbital extension. Histopathologic examination revealed
a diagnosis of embryonal-type rhabdomyosarcoma. The sinonasal and orbital mass was
resected through an endoscopic endonasal approach, with the restoration of visual function.
The patient received adjuvant chemotherapy and radiotherapy after surgery. Endoscopic
examination and magnetic resonance imaging showed complete regression of the tumor 1
year after her first hospital presentation. We provide a literature review of pediatric sinonasal
rhabdomyosarcomas with multiple manifestations. Despite the poor prognosis of large
parameningeal rhabdomyosarcomas in children, patients with embryonal histology have a
more favorable prognosis than those with alveolar histology. Aggressive and early treatment,
including surgery, radiotherapy and chemotherapy, may increase local remission rates and
lead to a better prognosis.

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1752
Biphenotypic Sinonasal Sarcoma – A Case Report

Mustafa Thamer1, Ramkishan Balakumar1, Kumar Abhinav2, Warren Bennett1

1
University Hospitals Bristol and Weston NHS Foundation Trust, 2North Bristol NHS Trust

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Background:Biphenotypic sinonasal sarcoma (BSNS) is a rare, low-grade malignant, soft-tissue

sarcoma of the sinonasal cavity. It has only been recognised in the WHO of head and neck
tumours in 2012. BSNS display both myogenic and neural differentiation making them unique
to other mesenchymal lesions and only 4 case series have been reported in the
literature. Clinical Case: A 35 years old male was referred urgently to the ENT clinic with a 6
month history of left-sided nasal blockage despite oral or topical steroids treatment. There
was no other concerning symptoms. Examination revealed a pedunculated mass filling most
of the left nasal cavity. MRI scan showed a 45mm left sided nasal cavity mass abutting the left
cribriform plate. Endoscopic biopsy confirmed the diagnosis of BSNS. Immunohistochemistry
was positive for SMA, Bcl2 and vimentin. PAX3-MAML3 fusion was detected. The patient
underwent a unilateral endonasal craniofacial resection. The 3-month post-operative MRI
scan showed no residual disease or recurrence. Conclusions:The paucity of cases in the
literature highlights the rarity of this new entity and therefore we publish this case to consider
BSNS as an important differential in sinonasal tumours and highlight the importance of
immunohistochemistry markers for its diagnosis.

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1764
Neck node metastasis in sinonasal malignant tumor

Gianluca Dalfino1, Mario Turri Zanoni1, Paolo Battaglia1, Maurizio Bignami2, Paolo
Castelnuovo3

1
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of
Insubria, Varese, Italy, 2Department of Otorhinolaryngology, Department of Surgery, ASST Lariana,
University of Insubria, Como, Italy., 3Division of Otorhinolaryngology, Department of Biotechnology
and Life Sciences, University of Insubria, Varese, Italy.

Sinonasal malignancy 2| Room 7 Hall 10 - Level 8 | Wednesday 21/06/2023

Sinonasal tumors are rare and heterogeneous diseases with a low incidence of neck node
metastasis. This study aims to analyze the risk of neck nodes recurrences, the corresponding
clinical results and to study any biological markers that could predict the regional spread of
sinonasal malignant tumor.A total of 718 patients affected by a sinonasal malignant tumor
were included. Twenty-one patients presented regional disease at presentation (3%); 35
patients experienced lymph node relapse during follow-up (4.6%). Histotypes involved were
squamous cell carcinoma (14/137,10.2%), mucosal melanoma (7/58,12%), intestinal type
adenocarcinoma (6/207,2.9%), adenoid cystic carcinoma (6/53,11.3%), olfactory
neuroblastoma (5/74, 6.75%), neuroendocrine carcinoma (5/23,21.7%), sinonasal
undifferentiated carcinoma (3/13,23%), mucoepidermoid carcinoma (1/3,33.3%), salivary
duct carcinoma (3/12,25%), high grade adenocarcinoma (1/17,5.9%), INI1-deficient sinonasal
carcinoma (1/2,50%), HPV-related multiphenotypic sinonasal carcinoma (1/4,25%). Neck
nodes metastases are rare but possible, so it is important to identify them during follow-
up.Poorly differentiated epithelial tumors have an early and high risk of neck node recurrence;
olfactory neuroblastoma, otherwise, has a low risk of recurrence but regional spread can
occur even after several years and therefore an adequate and long follow-up is essential.

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CRS – medical management 5

1167
Predictors of outcome in type 2 CRS patients treated with dupilumab

Michael Soyka1, Fabio Ryser2, Catrin Brühlmann3, Danielle Fehr4, Jacqueline Dülgeroglu2,
Peter Schmid-Grendelmeier4, Marie-Charlotte Brüggen4, Urs Steiner2

1
Department of Otorhinolaryngology, Head and Neck Surgery, University and University Hospital
Zurich, Zurich, Switzerland, 2Department of Immunology, University Hospital Zurich, University of
Zurich, Zurich, Switzerland, 3Department of Otorhinolaryngology, Head and Neck Surgery, University
Hospital Zurich, University of Zurich, Zurich, Switzerland, 4Allergy Unit, Department of Dermatology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Background: Type 2 chronic rhinosinusitis (T2CRS) may present with and without nasal polyps.
Some cases might be difficult to treat despite receiving multiple operations and topical as well
as systemic steroids. In these patients biological treatment is a promising option. However, so
far there are no predictive markers to identify responders before such an expensive
treatment.Methods: T2CRS patients starting dupilumab treatement were enrolled in a
retrospective study. The aim was to assess ultra short term and short term follow-up using
clinical scores and markers. Blood samples were drawn at given intervals and proteomic
analysis was performed using Olink®. The aim of the study was to identify clinical and serologic
predictive markers of dupilumab response.Results: We included 30 patients with 80% being
treatment responders. Ultra rapid response was observed already on day 7 after treatment
initiation. For those showing rapid improvement of symptoms (SNOT-20 score) and polyp
scores a sustainable improvement was demonstrated. This factor was highly predictive with a
sensitivity of 86%. Proteomic analysis identified two dysregulated proteins before treatment,
that could predict positive outcome. To confirm this finding a new prospective cohort was
formed and the test reperformed. Osteoprotegrin (OPG) was confirmed as a serologic
predictor of positive outcome.Conclusion: One week of treatment is sufficient to predict
outcome of dupilumab treated T2CRS patients. Olink proteomics identified OPG as a
predictive serologic marker in dupilumab treatment.

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1569
Dupilumab increases aspirin tolerance in NSAID-exacerbated respiratory disease (N-
ERD)

Sven Schneider1, Christina Morgenstern2, Katharina Poglitsch1, Tamara Quint3, Katharina

Gangl1, Tina Bartosik1, Nicholas Campion1, David Liu1, Lukas Landegger1, Aldine Tu4, Victoria
Stanek1, Marianne Rocha-Hasler1, Christoph Sinz3, Christine Bangert3, Julia Eckl-Dorna1

1
Department of Otorhinolaryngology, General Hospital and Medical University of Vienna, Vienna,
Austria., 2Science Impuls, Seeboden, Austria., 3Department of Dermatology, General Hospital and
Medical University of Vienna, Vienna, Austria , 4Department of Otorhinolaryngology, University
Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD)

comprises the triad of chronic rhinosinusitis with nasal polyps, asthma, and intolerance to
NSAIDs. Dupilumab treatment significantly reduces polyp burden and asthma symptoms. Here
we aimed to investigate the effect of dupilumab on aspirin intolerance, burden of disease, as
well as on nasal cytokine profiles in patients suffering from N-ERD. Patients with confirmed N-
ERD were treated with dupilumab for six months. Clinical parameters, oral aspirin provocation
testing, blood, nasal and urine sampling were monitored up to six months after starting
dupilumab therapy at regular intervals. After six months of treatment, 23.3% (n=7/30) of
patients developed complete aspirin tolerance and an additional 33.3% of patients (n=10/30)
tolerated higher doses. Polyp burden was significantly reduced (total polyp score: -2.68±1.84,
p<0.001) and pulmonary symptoms (asthma control test: +2.34±3.67, p<0.001), as well as
olfactory performance improved (UPSIT: +11.16±9.54, p<0.001) in all patients after therapy.
Patients with increased aspirin tolerance showed a significant decrease in urine leukotriene
E4 levels and their improvement in clinical parameters was associated with the reduction of
eotaxin-1, CCL17, IL-5, IL-17A and IL-6. 57% of N-ERD patients tolerated higher doses of aspirin
under dupilumab therapy.

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1638
Evaluation of the efficacy and safety of nasal pulse nebulization of hormones in
promoting mucosal recovery after nasal endoscopic sinus surgery

Yong Li1, Zhiqi Ma1

1
Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

To investigate the efficacy and safety of using nasal pulse nebulized budesonide in patients
after functional nasal endoscopy (FESS). A total of 40 patients with chronic sinusitis who
underwent FESS in our hospital were randomly divided into nebulized inhalation group (n=20)
and oral hormone group (n=20) using a random number, all patients received the same
postoperative routine treatment, both groups of patients were followed up in our hospital
outpatient clinic after 2 weeks, after cleaning up the nasal tamponade material on the 14th
postoperative day, the nebulization group began to nebulize inhalation budesonide
suspension, and the other group took methylprednisolone tablets orally, both for 2 weeks.
Visual analogue scores (VAS) and Lund-Kennedy endoscopic scores for nasal symptoms (nasal
congestion, runny nose, smell, headache) were performed before and after treatment to
assess safety by adverse events and morning serum glucocorticoid levels. Results: After 12
weeks of follow-up treatment, 2 cases were dropped in the oral hormone group, and the VAS
visual analogue score of the 2 groups was significantly reduced, and the Lund-Kennedy
endoscopic score of the nebulized group and the oral group was also significantly reduced,
the morning serum glucocorticoid concentration in the nebulized group decreased after
treatment, but there was no significant statistical difference, while the morning serum
glucocorticoid concentration in the oral group was significantly reduced after treatment, and
obvious corticosteroid suppression was visible.

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1651
The Role Of Vitamin D3 Supplementation In The Treatment Of Chronic Rhinosinusitis
With Nasal Polyposis

Osama Salem1, Mohamed Masoud1, Mohammad Mahmoud1, Amr Shafik1, Mohamed

ElSharnouby1, Manal Salman2, Hany Mohamed1
1
Department of Otolaryngology, Faculty of Medicine Ain shams University, Cairo, Egypt, 2Department
of Pathology, Faculty of Medicine Ain shams University, Cairo, Egypt

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Background: Recent evidence suggested the anti-inflammatory and immune modulator effect
of Vitamin D3 (VD3) and the relation between vitamin D deficiency and chronic rhinosinusitis
with nasal polyposis.Aim: Our study aims to determine the anti-inflammatory effect of VD3
supplementation clinically and histologically. Furthermore, investigate its relation to
immunohistochemical tissue expression of basic Fibroblast Growth Factor
(bFGF).Methodology: A prospective study based on seventy patients divided into two groups:
Group I (50 patients with CRSwNP) and group II (20 control). Group I was subdivided into (Ia),
which received vitamin D (VD) 50000 IU/Week and group (Ib), which received local and oral
steroids. Before and after treatment, Group Ia & Ib were assessed clinically using SNOT-22 and
Lund & Kennedy’s scores. Also, Nasal biopsies were taken for histological examination and
immunohistochemical detection of bFGF (basic fibroblast Growth Factor) expression.Results:
There was mild clinical improvement with VD supplementation. However, After VD
supplementation the changes in bFGF expression in stromal cells were statistical
insignificant.Conclusion: Clinical improvement was noted by history and examination after VD
supplementation; however, group Ib (steroids supplemented) demonstrated a better
response. Histopathological results revealed improvement in the total inflammation score,
while immunohistochemical expression of basic fibroblast growth factor decreased more in
response to VD3 than to steroids. More research is required to prove the therapeutic rule of
VD.

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1655
Sustained co-release of ciprofloxacin and dexamethasone in rabbit maxillary sinus
using polyvinyl alcohol-based hydrogel microparticle

Maryam Jalessi1, Yasaman Tavakoli1, Mehdi Khanmohammadi1, Sajad Hassanzadeh2, Elham

Badali3, Zahra Azad1

1
Skull Base Research Center, The Five Senses Institute, School of Medicine, Iran University of Medical
Sciences (IUMS), Tehran, Iran, 2Eye Research Center, Five Senses Health Research Institute, School of
Medicine, Iran University of Medical Sciences, Tehran, Iran, 3Department of Chemistry, Kharazmi
University, Tehran, Iran

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Background: Topical drug delivery to paranasal sinuses through sustained release stents is a
new horizon in the treatment of chronic rhinosinusitis (CRS). This animal study aims to
introduce a new sustained release hydrogel and evaluate its efficacy and safety.Material and
Method: Both DEX and CIP were encapsulated in tyramine-substituted polyvinyl alcohol
(PVATyr) microparticles. The controlled release of DEX/CIP from microparticles was evaluated
in the maxillary sinus mucosa and the blood samples of 12 rabbits. Nasal endoscopy, imaging,
and respiratory and olfactory epithelium histological exams were conducted to track the
changes.Results: A sustained release of DEX/CIP up to 28 days was observed in vivo. The DEX
and CIP tissue concentrations remained within the therapeutic window on days 7, 14, and 28.
At 28 days, tissue and blood concentrations were>.4µg/kg and 0.22µg/L for DEX, and>µg/kg
and 2.3µg/L for CIP, respectively. No prominent pathologic mucosal changes were detected in
endoscopy, imaging, or histological examinations.Conclusion: The DEX/CIP loaded PVATyr
MPs provided effective, safe, and controlled sustained release drug delivery in the in vivo
analyses, at quite suitable concentrations compared to the systemic route, introducing a
unique therapeutic strategy for CRS.

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1668
USE OF NEW BIOLOGICAL THERAPIES IN PATIENTS WITH UNCONTROLLED CHRONIC
RHINOSINUSITIS

Nuria López González1, Juan Manuel Maza Solano1, Julissa Aida Vizcarra Melgar1, Daniel Iván
Martín Jiménez1, Ramón Moreno Luna1, Jaime González García1, Serafín Sánchez Gómez1

1
Department of Otorhinolaryngology, University Hospital Virgen Macarena, Av. Dr. Fedriani, 3, 41009,
Seville, Spain

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

López González Nuria, Maza Solano Juan Manuel, Vizcarra Melgar Julissa Aida, Martín Jiménez
Daniel Iván, Moreno Luna Ramón, González García Jaime, Sánchez Gómez
Serafín .Background: Therapeutic protocols and multidisciplinary teams for Chronic
Rhinosinusitis (CRS) and comorbid asthma have been enriched by the appearance of new
monoclonal antibodies (mAbs) used in non-responding patients to conventional treatment.
Our study aimed to analyze the results of implementing mAbs in patients with CRS with Nasal
Polyps (CRSwNP) in our institution.Methods: An observational retrospective study of patients
with CRSwNP and asthma treated with mAbs (Omalizumab, Mepolizumab, Benralizumab, and
Dupilumab) was carried out in the Rhinology Unit of a tertiary referral hospital. Demographic,
laboratory, clinical, and quality of life variables were analyzed.Results: Eighty patients treated
with mAbs were included, with a mean age of 57,2. Sixty-three were treated with anti-IL5,
eleven with anti-IgE, and six with anti-IL4/IL13. Statistically significant improvements in quality
of life evaluated by SNOT-22 questionnaire (p<0.001), in VAS score and in asthma
control (Asthma Control Test) were found after the use of mAbs. The majority (69%) of
patients obtained an improvement of the minimum clinically significant difference (MCID) in
the SNOT-22 after one year of treatment.Conclusions: The use of mAbs has allowed patients
with poorly controlled CRS and comorbid moderate-severe asthma to obtain a significant
improvement in their nasal symptoms and quality of life.

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1682
Management of patients with chronic rhinosinusitis and nasal polyps a 10 years
retrospective study in ENT clinic of Timisoara

Alexandru Hut1, Nicolae Balica2, Marioara Poenaru2, Alin Marin2, Felicia Manole3, Eugen
Boia2, Delia Horhat2, Cristian Mot2, Diana Para2, Simina Boia4, Loredan Miksa5, Ana
Stefanovici5, Maria Chiriac6

1
Department of otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical
Hospital, Victor Babes” University of Medicine and Pharmacy, Timisoara, Department of
otorhinolaryngology head and neck surgery of Bihor County Emergency Clin, 2Department of
otorhinolaryngology head and neck surgery of Timisoara Municipal Emergency Clinical Hospital, Victor
Babes” University of Medicine and Pharmacy, Timisoara,, 3Department of otorhinolaryngology head
and neck surgery of Bihor County Emergency Clinic, Oradea Faculty of Medicine and Pharmacy,
4
Department of Periodontology, Faculty of Dentistry, "Victor Babeș" University of Medicine and
Pharmacy, Timișoara, Romania, 5Department of otorhinolaryngology head and neck surgery of
Timisoara Municipal Emergency Clinical Hospital, 6Department of otorhinolaryngology head and neck
surgery of Timisoara Municipal Emergency Clinical Hospital

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Introduction:Chronic rhinosinusitis is prevalent in general population and lowers quality of life

and increases the use of medical services. Chronic rhinosinusitis may be accompanied by an
infection or blockage of the sinus outflow. Nasal polyps are frequently present along with
chronic rhinosinusitis, which has a complicated etiology.Materials and Methods:We analyzed
the patient files of 1172 patients admitted to the ENT Clinic with chronic rhinosinusitis and
nasal polyps over a 10-year period.The following parameters were evaluated: age,
gender, provenience, associated comorbidities and particularly, the treatment method
and outcome.Results:Of the total patients evaluated, 60% cases were men and 40% women,
The main Treatment methods include endoscopic polypectomy and sinus antrostomy.The
outcome was and is debatable because is a chronic pathology and many of them came back
for another intervention.One of most frequent pathology associated was bronsic
asthmaConclusions:In addition to the increased prevalence of this pathology, managing
patients with chronic rhinosinusitis and nasal polyps continues to be a top concern for ENT
doctors due to their complexity and, in particular, their associated comorbidities.

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1696
The role of sustained blood eosinophil count elevations in patients treated with
dupilumab for CRSwNP

Robert Böscke1, Mathias Heidemann2

1
Department of Otorhinolaryngology, Head and Neck Surgery, Carl-von-Ossietzky University of
Oldenburg, Oldenburg, Germany, 2Department of Otorhinolaryngology, Head and Neck Surgery,
University of Lübeck, Lübeck, Germany

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

BACKGROUND: Dupilumab, an IL4-/IL-13-inhibitor, leads to mostly transient blood eosinophil

count (BEC) elevations. OBJECTIVE: To assess the impact of sustained BEC elevations after 12
months of dupilumab treatment for CRSwNP. METHODS: We retrospectively studied 41
subjects treated with dupilumab for CRSwNP. For our statistical analysis, we used ANOVA-
type tests, Wilcoxon test and penalized logistic regression analysis. RESULTS: Median BECs
increased from 0.44 (IQR 0.30) giga/L at baseline to 0.73 (IQR 0.91; p=0.004) at month 3 and
were 0.50 (IQR 0.68; p=0.56) at month 12. The proportion of patients with elevated BECs ≥0.6
giga/L at month 12 was higher than at baseline (42.1 vs. 19.5%; p<0.05). Comparing
effectiveness and safety in patients with BECs <0.6 and ≥0.6 giga/L at month 12, we found that
patients with BECs ≥0.6 had higher NPS (p<0.05) and lower SSIT-12 scores (p<0.05), while
SNOT-22 total scores and treatment-emergent events were not significantly different.
Penalized logistic regression analysis showed that BECs at baseline (OR= 89.89) and the
presence of NERD (OR=7.01) predict 12-month BECs ≥0.6 giga/L. CONCLUSIONS: Sustained
BECs elevations may negatively affect NPS and SSIT-12 outcomes in patients receiving
dupilumab for CRSwNP. Baseline BECs and presence of NERD could predict sustained BEC
elevations.

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1714
Exploration of the Efficacy and Safety of Intranasal Pulse Steroid Inhalation After
Nasal Endoscopic Surgery

Yong Li1, Zhiqi Ma1

1
Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Objective: To evaluate the safety and efficacy of intranasal pulse steroid inhalation in patients
undergoing functional endoscopic sinus surgery (FESS).Methods: 40 patients with chronic
sinusitis undergoing FESS at our center were randomly divided into an intranasal budesonide
inhalation group (n=20) and an oral steroid group (n=20) using a random number generator.
All patients received the same postoperative routine treatment and were followed up in the
outpatient clinic 2 weeks after surgery. After removing nasal packing materials on
postoperative day 14, the intranasal group began inhaling budesonide suspension through a
nebulizer, while the other group took oral prednisone tablets for 2 weeks. The visual analog
scale (VAS) was used to evaluate nasal symptoms (nasal obstruction, rhinorrhea, anosmia, and
headache), and the Lund-Kennedy endoscopic score was used to evaluate efficacy. Adverse
events and morning serum cortisol levels were used to assess safety.Results: Both groups
showed significant improvements in VAS scores and Lund-Kennedy endoscopic scores
compared to baseline. After treatment, the intranasal group had a decrease in morning serum
cortisol concentration, but there was no statistically significant difference. However, the oral
steroid group had a significant decrease in morning serum cortisol concentration, indicating a
significant inhibitory effect on the hypothalamic-pituitary-adrenal axis.Conclusion: Compared
to traditional oral steroid therapy, intranasal pulse steroid inhalation can better promote
benign mucosal transformation and is safer.

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1746
Comparison of intranasal medication delivery devices before and after functional
endoscopic sinus surgery (FESS) using Phacon© sinus surgery models
.
Christoforos Constantinou1, Arbaaz Pervaiz1, Fabrizio Bandino1, Devesa Pablo-Martinez1,
Sanjeeva Jeyaretna1, Ali Qureishi1, Darren Yap1, Pablo Martinez-Devesa1

1
Oxford University Hospitals NHS Foundation trust

CRS – medical management 5| Room 8 Hall 4 - Level 0 | Wednesday 21/06/2023

Introduction:Functional endoscopic sinus surgery (FESS) in the context of chronic

rhinosinusitis (CRS) aims to improve both sinus drainage and medication delivery in the nasal
cavity. Our study, aims to compare medication distribution between different delivery
methods used in clinical practice in normal and altered anatomy (post-FESS) using sinus
surgery models (PHACONÓ).Methods: To simulate medication, dye was delivered using nasal
drops nasal spray and an irrigation device (NeilmedÓSinus rinseÔ).The dye was initially
delivered in a normal (non-operated) model and subsequently in an operated (post-FESS)
model that has undergone slightly different operations on either side Endoscopic pictures
were taken at various sites and the percentage of the total area covered in dye was calculated
using computer software. Results and Discussion:NeilmedÓ Sinus rinseÔ generally provided
the best distribution for most sites in both the normal and operated models, followed by nasal
spray. Also, altering head position (lying down) improved delivery of the drops in the sphenoid
sinus (p= 0.33) The nasal spray did not appear to reach the sphenoid cavity if sphenoidotomy
is performed without connecting to the posterior ethmoid cells. Finally, following DRAF 3
surgery, all 3 methods appear to deliver dye in the frontal sinus.

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Imaging and investigations 1

1281
The importance of preoperativ CT in endoscopic sinus surgery - key points for young
surgeos

Shirley Tarabichi1, Codrut Sarafoleanu2

1
ENT&HNS Clinical Department, „Sfanta Maria” Clinical Hospital, Bucharest, Romania, 2ENT&HNS
Department, “Sf. Maria” Clinical Hospital, Bucharest, Romania, ”Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

INTRODUCTIONThe preoperative high-resolution sinus computed tomography (CT) scan is

considered the roadmap of the surgeon, as it not only serves as a diagnostic imaging technique
but also provides valuable information about the origin, nature, and extent of the pathology
and its relationship to surrounding structures. It plays a crucial role in endoscopic sinus surgery
as it provides important information such as the type that can help guide the surgical plan and
improve surgical outcomes.OBJECTIVE Analyzing and identifying different structures on
the sinus CT scan, such as sinus anatomy, abnormalities, relationships to surrounding
structures, anatomic variations, blood supply in the sinus area, and density of the sinus
tissue. In addition to knowledge and experience, the identification of potentially dangerous
anatomical features, such as the depth of the frontal skull base or the course and bony
coverage of the optic nerve and internal carotid artery, is crucial and mandatory in order to
minimize the risks associated with the surgery. CONCLUSION Young surgeons
must be familiar with this tool and not rely only on the interpretation given by the radiologist
in order to avoid intraoperative complications and achieve successful surgical outcomes.

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1334
OBJECTIVE DIAGNOSIS OF INTERNAL NASAL VALVE COLLAPSE BY 4-PHASE
RHINOMANOMETRY

Maxime Fieux1, Pierre Gagnieur2, Bruno Louis3, Emilie Bequignon4, Sophie Bartier5, Delphine
Vertu-Ciolino6

1
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d’ORL, d’otoneurochirurgie et de chirurgie
cervico-faciale, France, 2Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de chirurgie
maxillo-faciale et plastique de la face, Pierre Bénite cedex F-69495, France, 3Université Paris Est Créteil,
INSERM, IMRB, F-94010 Créteil, France, CNRS EMR 7000, F-94010 Créteil, France, 4Université Paris Est
Créteil, INSERM, IMRB, F-94010 Créteil, France, CNRS EMR 7000, F-94010 Créteil, France, Service d’ORL
et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, F-94000 Créteil, France, ,
5
Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France, CNRS EMR 7000, F-94010 Créteil,
France, Service d’ORL et de chirurgie cervico-faciale, AP-HP, Centre Hospitalier Universitaire Henri
Mondor, F-94000 Créteil, France, 6Université de Lyon, Université Lyon 1, F-69003, Lyon, France, Service
d’ORL et de chirurgie cervico-faciale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, F-94000
Créteil, France, Hospices Civils de Lyon, hôpital Edouard Herriot, Service d’ORL et de chirurgie cervico-
faciale, Lyon F-69003, France

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

Internal valve collapse (IVC) is a frequent cause of nasal obstruction but remains poorly
understood and is sometimes treated inappropriately. The reference diagnostic technique is
physical examination. The objective of this study was to evaluate the potential of 4-phase
rhinomanometry (4P-RNM) as a diagnostic test for IVC. In a case–control diagnostic accuracy
study, the nostrils of adult patients consulting for chronic nasal obstruction were classified as
“collapsed” or “non-collapsed” based on clinical findings. 4P-RNM was performed in all
patients. The area defined by the path of the flow/pressure curve in the two phases of
inspiration (the “inspiratory loop area” or “hysteresis loop area") was calculated for both nasal
cavities and the threshold value with the highest Youden index was identified.66 patients (132
nostrils) were included with 72 nostrils classified as collapsed and 60 as non-collapsed. Before
nasal decongestion, the inspiratory loop area with the highest Youden index was 17.3 Pa∙L∙s−1
and the corresponding sensitivity and specificity were 88.3% [95% confidence interval, 80.0–
95.0%] and 89.9% [82.6-95.7%] respectively. In these patients, a cutoff inspiratory loop area
in 4-phase rhinomanometry data reproduced clinical diagnoses of internal valve collapse with
high sensitivity and specificity.

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1385
Preoperative Computed-Tomography for Endoscopic Sinus Surgery: A Simplified
Checklist

NADA ALSHAIKH1

1
DEPARTMENT OF OTOLARYNGOLOGY HEAD & NECK SURGERY, MOUWASAT HOSPITAL, DAMMAM,
SAUDI ARABIA

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

Introduction: Endoscopic sinus surgery gained growing popularity with indications expanding
beyond rhinosinusitis. Preoperative high-resolution computed tomography scan is essential
in providing surgical map for surgeons. In addition, it gives valuable information about origin,
nature and extension of the pathology to adjacent structures. Therefore, CT scan is crucial in
order to perform successful and complete surgery with avoidance of complications. The main
objective of this research is to propose a new comprehensive, simplified, practical, and
applicable pre-endoscopic sinus surgery CT scan checklist.Methods & Results: Extensive
literature review in database engines was conducted. 4 Published checklists were identified
and reviewed carefully. The strength as well as the deficiencies in the previous lists were
identified. Accordingly, a new checklist was constructed. It incorporates significant
pathological data in addition to the previously included items. It also considered surgeon’s
most common pattern in looking and analyzing the CT scans. The new checklist was
validated. Conclusion: Preoperative CT checklist for endoscopic sinus surgery improves
surgeon understanding of the anatomy, nature of the disease and helps planning the surgery.
Utilizing the checklist aid to organize the process of interpretation the CT scans and avoids
missing significant findings. Careful reviewing of preoperative images with radiologist can help
to address critical anatomical areas and to avoid complications.

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1422
Ultra-low-dose CBCT: new cornerstone of paranasal sinus imaging

Pekka Tamminen1, Jorma Järnstedt2, Antti Lehtinen2, Jura Numminen2, Lauri Lehtimäki1,
Markus Rautiainen1, Ilkka Kivekäs1

1
Tampere University; Tampere University Hospital, 2Tampere University Hospital

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

We present two studies of clinical image quality (IQ) and usability of a sinonasal ultra-low-
dose (ULD) cone-beam computed tomography (CBCT) scan. The results are compared to those
of a high resolution (HR) CBCT scan to identify strengths and weaknesses of a ULD CBCT
protocol. Sixty-six anatomical sites in 33 subjects were imaged twice using two imaging
modalities: HR CBCT (Scanora 3Dx scanner; Soredex, Tuusula, Finland) and ULD CBCT (Promax
3D Mid scanner; Plandent, Helsinki, Finland). The IQ of paranasal sinuses (in-focus) and ear
(off-focus) were evaluated. IQ of paranasal ULD CBCT is sufficient for clinical diagnostics, and
may be considered for surgical planning. We recommend it as the primary imaging protocol
for all patients meeting imaging criteria due to recurrent or chronic nasal symptoms.
Additional or conventional imaging might be needed for patients with extensive chronic
rhinosinusitis and/or indications of frontal sinus involvement. Information at image margins
are underutilized. HR CBCT can produce excellent structural resolution with conventional
imaging parameters, even with off-focus images, while ULD CBCT provides good
comprehension of significant structures regarding ear surgery. It is mandatory to develop
imaging protocols towards lesser radiation exposure as well as to prove that new methods are
clinically valid and applicable.

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1427
Analysing the feasibility of an automated AI-based classifier for detecting paranasal
anomalies in the maxillary sinus

Panna Sophie Hoffmann1, Debayan Bhattacharya1, Benjamin Becker2, Christian Betz2,

Alexander Schläfer1, Marvin Petersen3, Dirk Beyersdorff4, Elina Petersen5

1
Insititute of Medical Technologies and Intelligent Systems, Hamburg University of Technology,
Hamburg, Germany, 2University Hospital Hamburg-Eppendorf 3Clinic and Polyclinic for Neurology
University Medical Center Hamburg-Eppendorf, Hamburg, Germany 4Clinic and Polyclinic for
Diagnostic and Interventional Radiology and Nuclear Medicine 5Population Health Research
Department, University Heart and Vascular Center

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

Introduction: Large scale population studies have been performed to analyse the rate of
finding sinus opacities in cranial MRIs. It is of interest whether there are findings requiring
clarification. Using AI-based methods can automate the detection of the sinus opacities and
reduce the workload of clinicians. In this work, a method for AI-based classification was
developed in order to automatically recognise paranasal sinus opacities. Methods: As part of
the Hamburg City Health Study (HCHS), cMRIs of participants (45-74 years) were recorded for
neuroradiological assessment. The following questions were addressed: 1. Is there an opacity
of the maxillary sinus: yes/no? 2.Differentiation of opacity: mucosal thickening, polyp(s) or
cyst(s). All MRIs (199) were annotated by specialists and the results of the AI were compared
with this as a "gold standard". 106 participants showed inconspicuous and 93 participants
maxillary sinuses with opacities. The AI-based classification system was carried out by a neural
network (3D ResNet18), the data analysis was performed using a 5-fold cross-
validation.Results: Considering “opacity" as the positive class, our AI classification system
showed high classification accuracy (F1 score of 0.70±0.06 and an Area under Receiver
Operating Characteristic (AuROC) of 0.85±0.03). In the further classification of opacities, our
AI-based method achieved an accuracy of 100% for polyps, 60% for cysts and 45% for mucosal
thickening. Conclusions: Our feasibility analysis shows a useful application for AI-based
classification of the maxillary sinuses

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1456
High resolution ultrasonography in nasal trauma at the emergency settings, is it the
new gold standard?

tameem zoabi, faranesh nabil1, sliman zaroura2

1
The Faculty of Medicine of Bar-Ilan University, Safed, Israel, 2The Faculty of Medicine of Bar-Ilan
University. Safed, Israel

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

Background: Although nasal bone fractures are the most frequent in maxillofacial trauma,
clinical diagnosis is still the common practice. Objective: The Aim of this study is to compare
the common practice in nasal trauma evaluation by clinical examination alone to HRUS.
Patients and methods: A retrospective study included all patients older than 4 years who were
examined in our ENT emergency room in 2019 for recent nasal trauma. Each patient was
diagnosed for nasal fracture based on clinical examination. Within 7-10 days, all the patients
underwent a further high-resolution ultrasonography of the nasal bone by an experienced
radiologist ,who was blinded to the clinical diagnosis, for establishing a sonographic diagnosis.
The sensitivity, specificity, positive predictive value, and negative predictive value of the
clinical diagnosis were calculated. Results: 104 patients finished the clinical and sonographic
evaluation. The sensitivity, specificity, positive predictive value, and negative predictive value
of the clinical diagnosis were: 74.4%, 86.6%, 92.7% and 37.1% respectively. Conclusions: The
low sensitivity and negative predictive value indicate that nasal bone trauma investigation in
the emergency setting should not rely only on clinical examination. High resolution
ultrasonography should be considered as a routine tool in these cases.

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1544
Radio-anatomic evaluation of the sphenoid sinus variations in a Colombian
population

Lucia C. Perez-Herrera1, Daniela Maria Torres Arevalo2, Hector A. Ulloque1, Peñaranda

Augusto3, Augusto Peñaranda3, Juan Nicolás Useche Gomez4, Erika Ramirez4, Sergio
Moreno5, Daniel Peñaranda6, Javier Ospina3

1
Otolaryngology Research Group, UNIMEQ-ORL, Bogotá, Colombia, 2Otolaryngology Research Group,
UNIMEQ-Orl, Bogotá, Colombia, 3Otolaryngology Department, Fundación Santa Fe de Bogotá, Bogotá,
Colombia, 4Neuroradiology section. Department of Radiology and diagnostic imaging, Fundación
Santa Fe de Bogotá. Bogotá, Colombia, 5School of Medicine, Universidad de Los Andes, Bogotá,
Colombia, 6Otolaryngology Section, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023

Background: The surgical approach to the sphenoid sinus is a complex procedure due to its
location and proximity to important neurovascular structures. Comprehensive knowledge of
the radiological anatomy of this region is crucial to select the best surgical approach and avoid
complications. Few studies assess the anatomic variations of these structures in ethnic and
LatinAmerican populations. This study aimed to assess the frequency of the anatomical
variants of the sphenoid sinus in a Colombian population.Methods: Observational,
descriptive, cross-sectional study. A randomized sample of 406 axial computed tomography
(CT) of the paranasal sinuses that included 812 sphenoid sinuses were collected during 2019
at the Fundación Santa Fe de Bogotá, Colombia. Results: The most frequent pneumatization
was sellar pneumatization with a frequency of 89.9%. The lateral pneumatization of the
sphenoid was found in 346 (42,6%) of the 812 paranasal sinuses; 33% contained Onodi cells,
and 40.81% contained a protruding vidian nerve into the sinus. Dehiscence of the optic nerve
and the internal carotid artery was found in less than 10% of the total CTs. Sphenoid sinus
hyperostosis was found in less than 3% of the cases. Conclusions: To carry out an adequate
approach to the sphenoid sinus, the surgeon should know the individual’s anatomical
configuration of the sinus and the variability that could lead to potential complications. This
study provides a better anatomic understanding in Colombian populations. However, further
studies in ethnic populations are needed.

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1711
Frontal Recess Anatomy in a Southern European Country Population: a Radiological
Study

Tiago Colaco1, Pedro Branco2, Luís Castelhano2, Filipe Correia2, Pedro Escada2

1
Serviço de ORL do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal, 2Serviço de
ORL do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portuga

Imaging and investigations 1| Room 9 Olympic Hall - Level 0 | Wednesday 21/06/2023l

IntroductionFrontal recess anatomy is highly variable. International Frontal Sinus Anatomy

Classification (IFAC) published in 2016 tried to establish a comprehensive and universal
assessment of facial recess cells. ObjectiveTo characterize the anatomy of the frontal recess
in the Portuguese population.MethodsEvaluation of frontal recess cells and frontal recess
measures of a sample of patients that attended our outpatient ENT clinic in the last 5 years
and underwent a CT scan.Results71 patients were included, which corresponded to 142 nasal
cavities: 60 without frontal disease and 82 with chronic rhinosinusitis with different grades of
frontal sinus opacification. 50.7% were female. Mean age was 48.7 years old (18-89). The most
frequent cell was agger nasi cell (97.2%) and the least frequent was supraorbital ethmoidal
cell (4.9%). There was no statistical difference between genders for the incidence of the
different cells. Anteroposterior frontal recess width was 9.97 ± 2.29 mm for female and
10.55 ± 2.87 mm for male (p>0.05). Nasofrontal beak thickness was also higher in male
population (7.80 ±1.93 mm) than in female (7.25 ± 2.0 mm) (p>0.05). ConclusionsPrevalence
of frontal recess cells in our population was similar to other studies with Caucasian and Asian
population. The thickness of the nasofrontal beak and anteroposterior width of frontal recess
seem to be higher in male population, which can affect our approach to the frontal sinus. ENT
surgeons should have a high level of knowledge of frontal recess anatomy to perform safe and
effective frontal sinus surgeries.

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Late breaking Abstracts 2

1791
RE-DESIGNING THE SALINE RINSE SQUEEZE BOTTLE AND TECHNIQUE TO OPTIMISE
SINUS LAVAGE AND TOPICAL MEDICATION DISTRIBUTION

Narinder Singh

1
University of Sydney/ Westmead Hospital

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023l

Aim: Saline squeeze bottles use 200-240mL, with a 5mm nozzle, aimed vertically with a 45
degree head angle. Evidence for these variables remains limited due to inadequate
experimental models (cadaveric, 3D printed, imaging of labelled dyes). We aimed to optimise
the design of squeeze bottles, in terms of volume, squeeze force and head angle, using
computational fluid dynamics (CFD). Methods: A sinonasal cavity computational model was
reconstructed from CT scans of a healthy 25-yo female. In a series of experiments: 1) A novel
CFD technique using the Eulerian Volume of Fluid method was developed. 2) Typical squeeze
forces and volumes were determined from electromechanical experiments. 3) Parametric
CFD experiments using a variety of a) irrigation volumes (70, 150, 200, and 400 mL) b) squeeze
forces (ramp time 0.1, 0.5, and 1.0 s) and c) head tilt angles (0° Straight, 45° Forward, 45° Left,
45° Right and 45° Backward) were performed. Velocity, pressure, and wall shear stress,
together with mapping of surface coverage and residual volumes were determined. Results:
Compared with standard squeeze bottles, higher volume irrigation (400 mL) and greater
squeeze force (ramp time 0.1 s), along with backward head tilt optimised irrigation coverage
and shear force on sinonasal mucosal surfaces. 400mL prototype squeeze bottles were
designed, prototyped and manufactured and are currently undergoing clinical
testing. Conclusion: Using multiple parametric CFD experiments our saline rinse squeeze
bottle design and technique improved sinonasal mucosal coverage (> 3X) and shear force.

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1792
AN ARTIFICIAL INTELLIGENCE ALGORITHM TO AUTOMATE PRE-OP SAFETY CHECKLIST
REPORTS ON SINUS CT SCANS

Narinder Singh1

1
University of Sydney/ Westmead Hospital

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Introduction: Pre-operative checklist assessment of paranasal sinus CT scans is critical for safe
sinonasal surgery. Radiologist reporting of sinus CT scans often does not meet the
requirements of rhinologists. We aimed to create a comprehensive package of Convolutional
neural network (CNN)-based Artificial intelligence (AI) algorithms that are able to
automatically produce consistent, detailed, pre-operative checklist reports from sinus CT
scans. Method: Consecutive sinus CT scans were retrospectively collected between January
2016 and December 2018 at a tertiary hospital. Key features (anterior ethmoid artery (AEA),
Keros classification, concha bullosa, sphenoid pneumatisation) were identified by two blinded
otolaryngology trainees and used as ground truth data. The classification layer of the Google
Inception-V3 CNN was retrained in Python using a transfer learning method. Segmentation
analysis was also performed to increase diagnostic accuracy. Discussion: 675 training images
and 197 test images were used. The algorithm was able to distinguish between an AEA in a
mesentery vs within the skull base with an accuracy of 82.7% (95 % CI: 77.7–87.8), kappa
statistic of 0.62 and AUC of 0.86. Concha bullosa was identified with an accuracy of 81% (95%
CI: 73.0–89.0), AUC 0.93. Keros classification achieved an accuracy of 73.6%, AUC 0.79.
Sphenoid classification achieved an accuracy of 85.9%, AUC 0.86.Conclusion: Our CNN based
algorithms demonstrate significant promise in identifying clinically important radiological
features on pre-operative sinus CT scans.

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1793
A NOVEL SPRAY NOZZLE TO PRECISELY DELIVER TOPICAL MEDICATION TO THE POST-
FESS MAXILLARY SINUS

Narinder Singh

1
University of Sydney/ Westmead Hospital

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Aim: Standard spray nozzles typically only achieve around 3% deposition in the post-FESS
sinuses for particles in the 4-20 µm range, with most particles deposited anteriorly within the
nasal cavity or passing through to the nasopharynx. Traditional methods of determining
deposition using cadaver or 3D printed models are inaccurate. We aimed to design a novel
spray nozzle to optimize topical medication distribution within the post-FESS maxillary sinus
using computational fluid dynamics (CFD).Methodology: A CT of a CRS patient was used to
create a virtual post-operative computer model. Particles of diameter 2 to 30 µm were tracked
through the sinonasal cavity at 5, 10 and 15 L /min flow rates using CFD. Reverse particle
simulations were performed and the optimal injection point identified. An optimised nozzle
position and shape was placed virtually and multiple parametric CFD experiments performed
to identify the ideal combination of particle size, injection velocity and inhalation
velocity.Results: CFD simulations demonstrated that the optimised combination of
parameters were 20 µm particles, delivered at 5 m/s (or 14 µm, delivered at 15 m/s) at an
inhalation rate of 5 L/min, released from a nozzle in an elliptical oblique-superior direction
into the superior half of the nasal valve. This significantly improved the maximum deposition
efficiency (from 3% up to 55%) in the post-operative maxillary sinus.Conclusion: Our novel
spray nozzle design improved topical medication distribution 18-fold.

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1794
Modelling the effects of post-FESS middle turbinate synechiae on sinonasal
physiology: A computational fluid dynamics study

Narinder Singh

1
University of Sydney/ Westmead Hospital

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Introduction: Middle turbinate (MT) lateralisation and synechiae formation is a common

cause of failed FESS. We aimed to use computational fluid dynamics (CFD) to analyse the
physiological effects of post-FESS MT synechiae. Methods: A 3D computational model was
created from CT-sinus DICOM data of a healthy 25-yo female. Virtual full-house FESS was
performed. Multiple synechiae models were virtually created in locations reflecting those
commonly seen in clinical practice. CFD analysis was performed and compared with a control
without synechiae. Mass-weighted averages for airflow velocity, humidity and mucosal/ air
temperature were calculated to assess changes in the presence of synechiae. Results: All
synechiae models demonstrated aberrant downstream sinonasal airflow. There was reduced
airflow and increased air temperature and humidity in the ipsilateral frontal, ethmoid and
sphenoid sinuses with increased airflow velocity and reduced air and mucosal surface
temperature in a concentrated central “jet” in the middle meatal region. The effects were
more significant with larger synechia. Despite the magnitude of these local effects, the effect
on bulk inspired airflow at the nasopharynx was almost negligible. Conclusion: Post-FESS
synechiae between the MT and lateral nasal wall significantly disrupt local downstream sinus
ventilation and nasal airflow. These findings may explain the significant persistent symptoms
seen in post-FESS patients with MT synechiae and reinforce the importance of prevention and
adhesiolysis.

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1796
Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational
Fluid Dynamics Study

Narinder Singh

1
University of Sydney/ Westmead Hospital

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Aims: Recent evidence suggests that detection of nasal mucosal temperature (NMT), rather
than direct airflow detection, is the primary determinant of subjective nasal patency. We
examine the role of NMT in the perception of nasal patency using in vivo and computational
fluid dynamics (CFD) measurements. Methods: Healthy adult participants completed Nasal
Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS) questionnaires. A
probe measured NMT at the vestibule, inferior turbinate, middle turbinate, and nasopharynx
bilaterally. A CT scan was used to create a 3D nasal anatomy model to perform CFD analysis
of nasal mucosal and inspired air temperature and heat flux along with mucosal surface area
where heat flux> W/m2 (SAHF50). Results: Eleven participants with a median age of 27 (IQR
24; 48) were recruited. Probe-measured temperature values correlated strongly with CFD-
derived values (r = 0.87, p < 0.05). Correlations were seen anteriorly in the vestibule and
inferior turbinate regions between NMT and unilateral VAS (r = 0.42 to 0.46 ; p < 0.05),
between SAHF50 and unilateral VAS (r = -0.31 to -0.36; p <0.05) and between NMT and
SAHF50 (r = -0.37 to -0.41; p <0.05). Subjects with high patency (VAS

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1798
Endotyping rhinosinusitis via nasal secretions: a pilot study

Stephan Vlaminck1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-
Allee 11, D-93053 Regensburg, Germany

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Introduction.The finding of eosinophil aggragates on histopathology indicates a T2 endotype..

The use of nasal secretions might be an underestimated and yet valid instrument to
characterise rhinosinusitis. patients at consultation. Methods. Twenty two patients with
acute rhinitis , 10 allrgic patienets and 9 difficult to treat allergic patients under
desensibilisation therapy at least for 1 year were sampled for analysis of cellulkar
content.compared to 10 controls.Results. In the rhinitis group 2 patients showed eosinophilic
aggregates, Two had poor cellular content and 16 showed a dominant neutrophil content. The
allergic group showed 2 neutral findings with epithelial shedding,, 4 had a main neutrophil
content and 3 patients showed eosinophilic aggregates. In the immunisation group 6 out of 9
patients showed eosinophilic aggregates.DiscussionThe early detection of eosinophilic
aggregates in the immusnisation group may confront us with a parallel a more agressive
inflammation patterns . The finding in allergy and rhinitis patients suggests this entity might
be more frequently present in a younger population. Conclusion. The finding of eosinophil
aggregates suggests a T2 inflammation pattern. Hence the finding opens new questions on
adequate treatment modalities if current treatment fails to control the inflammatory burden.
In the era of the epithelial barrier hypothesis growing concern needs close observation
criteria.

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1802
Management of Anterior Skull Base Cerebrospinal Fluid Leak: A Ten-Year Tertiary
Referral Center Analysis

Shapira Udi1, Butrus Fares1, Wengier Anat1, Avraham Abergel1, Udi Shapira1, Forsan Jahasan1

1
Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky
Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv,
Israel.

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Objectives: Anterior cerebrospinal fluid (CSF) leak can occur as a result of different etiologies
such as head trauma, skull base surgery, inflammatory diseases or spontaneously. Rapid
identification and treatment are essential to prevent complications and achieve successful
surgical repair. This study aims to outline the clinical characteristics of patients with anterior
CSF leak and the outcomes surgical treatment. Method: This is a retrospective analysis of 76
patients who presented with an anterior skull base CSF leak to our center and underwent
transnasal endoscopic repair by three different otolaryngologists surgeons between 2012 and
2022. Their medical notes were reviewed for demographic, clinical data including diagnostic,
surgical techniques and material used in the surgery. Results: Seventy patients underwent
endoscopic repair CSF leak, of which 45 (59%) were women and the average age was 46 years
old. The most common etiology was iatrogenic post skull base surgery followed by
spontaneous etiology. the most common CSF leak site was 20 followed by 18. Nasoseptal flap
was used in 45 patients, middle turbinates flap was used in 3 patients, whearse synthetic
materials were used in 64 patients. In 60% of the patients the first symptom was a runny
nose. Overall, the success rate was 92 percent on the first attempt and 98% on the second
attempt. Conclusions: Endoscopic transnasal approach seems to be effective and safe with a
high success rate. Moreover, the Hadad flap was used in most cases and found to be suitable
for most CSF leaks.

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1804
Impact of biologics on revision FESS numbers in CRSwNP patients
.
An-Sofie Viskens1, Judith Adriaenssens2, Elien Borgers3, Peter Hellings4

1
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. , 2:Faculty of Medicine, KU Leuven, Leuven, Belgium, 3: Department of
Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium., 4KU 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. : Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam,
Amsterdam, The Netherlands. 6: Department of Otorhinolaryngology, University of Ghent, Ghent,
Belgium.

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Background: Since 2022, two biologics are reimbursed for uncontrolled severe CRSwNP by
the Belgian medical health insurance. Biologics are often indicated in patients having
recurrent or persistent CRSwNP despite sinus surgery and medical standard-of-care
treatment. There are no data on the impact of the prescription of biologics on the number of
revision FESS procedures being performed in tertiary care centers.Aims: To evaluate the
impact of the prescription of biologics on the number of revision FESS procedures being
performed in a tertiary care center in a well-defined period of time after reimbursement of
biologics by health insurance.Method: Analysis of the number of patients undergoing
revision FESS for CRSwNP, and number of patients on prescription for biologics for CRSwNP
at the University Hospitals in Leuven in between September till December in the year 2020,
2021 and 2022.Results: A total of 61 revision FESS surgeries were performed the defined
periods in 2020, 2021 and 2022. With 34, 13 and 14 Revision FESS operations in 2020, 2021
and 2022 respectively. The percentage of revision surgeries compared to primary FESS
dropped from 68% and 46% in 2020 and 2021 respectively, to 42% in 2022. The number of
patients started on a biologic in the same defined period in 2022 was 22. Conclusion: The
reimbursement of biologics in Belgium reduced the number of revision FESS compared to
primary FESS surgeries in patients with CRSwNP.

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1805
Prevalence and impact of Chronic Rhinosinusitis in patients with severe asthma at a
national referral hospital in Chile

Galia Villarroel1, Paula Ruz1, Patricia Fernandez2, Paulina Trujillo2, Valentina Poblete2,
Constanza Valdes1

1
Department of Otolaryngology, Hospital del Salvador, Santiago, Chile, 2Department of Pulmonology,
Instituto Nacional del Tórax, Santiago, Chile

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

Chronic rhinosinusitis (CRS) is a common comorbidity in patients with asthma. However, the
prevalence and impact of CRS in severe asthmatic in Chile are poorly understood. The aim was
to determine the prevalence of CRS in severe asthmatic at the Instituto Nacional del Tórax in
Chile and to evaluate the impact of CRS on asthma control, quality of life and lung
function.This cross-sectional study enrolled 58 patients with severe asthma. CRS was
diagnosed based on the EPOS 2020 guideline. All patients underwent a comprehensive
evaluation including nasal endoscopy, computed tomography, spirometry and assessment of
nasal symptoms, quality of life using SNOT-22, and asthma control. The prevalence of CRS in
patients with severe asthma was 62%, and only half had a previous diagnosis of CRS. Among
patients with CRS, 56% had nasal polyps and 25% had aspirin-exacerbated respiratory disease.
There were no significant differences in the severity of nasal symptoms between patients with
and without CRS. However, patients with CRS had significantly worse quality of life, asthma
control, and lung function. Our study found a higher prevalence of CRS in severe asthmatic
patients than reported in the literature, likely due to the severity of asthma. Even though we
did not find differences in the severity of nasal symptoms, CRS is a significant comorbidity in
these patients and negatively impacts quality of life, asthma control, and lung function.
Therefore, we recommend that all patients with asthma, especially severe asthma, undergo a
thorough rhinology assessment to detect and manage CRS.

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1807

Hyaluronan and its association with the lymphatics may drive pathogenesis of
chronic rhinosinusitis

Vanessa Vivien PESOLD1, SK MUELLER1, Olaf WENDLER1, F GROHN2

1
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Otolaryngology, Head and Neck
Surgery, Germany, 2Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for
Molecular Materials, Department of Chemistry and Pharmacy, Erlangen/ Germany

Late breaking Abstracts 2 | Room 10 Peroto - Level 0 | Wednesday 21/06/2023

AbstractBackground: Pathomechanisms of chronic rhinosinusitis (CRS) with (CRSwNP) and

without nasalpolyps (CRSsNP) are not yet fully elucidated.Objective: To uncover possible
novel factors of CRS pathogenesis.Methods: In sections of different anatomical regions of
CRSwNP, CRSsNP and control patientsHyaluronan (HA) was localized (n=6 per group) and
lymphatic vessels (LVs) and selected immunecells were localized and counted (n≥6 per group).
HA and lymphatic vessel endothelial receptor 1(LYVE-1) were analyzed in lysates of the same
tissues (n=7 per group) and the secretions ofCRSwNP, CRSsNP, and control patients (n=30 per
group) using ELISA. Tissue HA levels werecorrelated to the numbers of immune cells and
LVs.Results: HA and immune cells were accumulated below the NP epithelium. There were
nosignificant differences in tissue HA expression while LYVE-1 was overexpressed in NP. The
mucusrevealed a significant underexpression of HA in both CRS groups and of LYVE-1 in
CRSsNP.There were less LVs in both CRS groups compared to the control. Tissue HA levels
revealedsignificant positive correlations with the numbers of macrophages and transporting
LVs, but notwith absorbing LVs.Conclusion: The mucosal accumulation of HA due to altered
synthesis, metabolism andinsufficient lymphatic evacuation might promote inflammation,
fluid retention, and thus polypformation.Key words: chronic rhinosinusitis, chronic
rhinosinusitis with nasal polyps, sinusitis, mucus,inflammation, hyaluronic acid, endothelial
cells, eosinophil, immunity, lymphangiogenesis

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Poster Abstracts

Acute Rhinosinusitis

1690
Application of acoustic rhinometry to evaluate infectious inflammatory conditions of
the upper respiratory tract

Krzych-Fałta Edyta1, Grzanka Antoni2, Samolinski Boleslaw2, Krzych-Falta Edyta1

1
Department of Basic of Nursing, Medical University of Warsaw, 2Department of Prevention of
Environmental Hazards, Allergology and Immunology, Medical University of Warsaw

Poster Session | Acute Rhinosinusitis | 18 June – 22 June, 2023, All day

The aim of the study was to demonstrate the correlation between the results of acoustic
rhinometry and symptomatology of acute inflammations of the upper respiratory tract. The
study group consisted of 37 people with the signs of infection of the upper respiratory tract
of viral or bacterial etiology. The method that was used in the study was an acoustic
rhinometry (Rhinoklack RK 1000, Stimotron, Germany) and a clinical assessment of subjective
nasal complaints. Results. Among the analysed nasal complaints including sneezing, free
discharge of watery mucus and nasal congestion, the last one demonstrated the strongest
correlation of concordance with the assessment of the intranasal spaces assessed with
acoustic rhinometry (r=-0.369, p=0.025). Conclusions. It has been observed there is a high
concordance between the symptomatology of the inflammation of the nasal mucous
membrane and the dynamics of changes measured with acoustic rhinometry.

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1546
Acute Rhinosinusitis Complicated with an Epidural Haematoma - A Case-Report

Anna-Maria Papadopoulou1, Aikaterini Tsagkovits2, Anastasia Liapi2, Evangelia

Zacharioudaki2

1
ENT Department, General Hospital of Athens, G. Gennimatas, 2ENT Department, General Hospital of
Athens G. Gennimatas, Athens, Greece

Poster Session | Acute Rhinosinusitis | 18 June – 22 June, 2023, All day

Intracranial complications of acute rhinosinusitis (ARS) carry a substantial risk of morbidity

and mortality. Epidural haematomas arising into the potential space between the cranial
bones and the dura mater, have been scantly reported in the literature, as sequelae of
sinusitis. We present a rare case of pansinusitis, complicated with an epidural haematoma in
the right frontal area. A previously healthy 16-year-old boy was brought to the Emergency
Department with a 3-day history of fever, headache, nasal obstruction and purulent
discharge. Within the last 12 hours he had developed a mild right eyelid oedema with frontal
bossing. Nasendoscopy revealed purulent secretions in both nasal cavities and neurological
examination was unremarkable. A contrast-enhanced CT scan showed a 2cm hypodense
collection with rim enhancement in the right frontal epidural space and opacification of the
paranasal sinuses. The patient underwent urgent full endoscopic sinus surgery combined with
right frontal trephination. On the third postoperative day he developed somnolence and an
urgent MRI demonstrated a 6cm biconvex, heterogenous mass in the right frontal area. An
urgent frontal craniotomy was performed by the neurosurgical team and an epidural
haematoma was discovered and evacuated. The posterior wall of the right frontal sinus was
found intact. The patient had an uncomplicated recovery and completed a 4-week course of
intravenous antibiotics.Complicated ARS warrants close monitoring for any signs of
deterioration with proactive investigation and multidisciplinary management approach.

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1645
ePROs (electronic patient reported outcomes) as primary outcome of pivotal
registration studies in rhinosinusitis and allergic rhinitis

Ralph Mösges1, Laura Simić2, Vlatka Vrdoljak2, Karina Vukelić2, Zdravka Knežević2, Susann
Fragel3, Lea Radtke3

1
IMSB Medical Faculty University at Cologne, 2Jadran Galenski Laoratorij, 3ClinCompetence Cologne

Poster Session | Acute Rhinosinusitis | 18 June – 22 June, 2023, All day

Acute rhinosinusitis is a self-limiting disease, characterized by numerous subjectively

perceived symptoms. The severity of the disease is therefore usually assessed using
standardized, validated symptom scales. These can be elegantly depicted in the form of a
smartphone application. The concept of “bring your own device” offers the advantage that
reminder functions and time windows can be seamlessly integrated into the patient's daily
routine. This makes it possible to increase the reliability of the recording to 90% or more of
the required data points. We report here on a study (Rhinnovate HA, EudraCT- 2022-002499-
35 ) with innovative nasal sprays in which a data quality of up to 94% was reached in a
population of more than 500 patients in different EU countries (Bulgaria, Germany, Croatia
and Poland). Such a high rate can only be achieved through close (daily) remote monitoring of
the devices. Only with this innovative technology, ePROs (electronic patient reported
outcomes) add the value to the primary outcome of pivotal registration studies in
rhinosinusitis.

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1646
A randomized double-blind placebo-controlled phase III clinical trial of
xylometazoline plus hyaluronic acid in acute rhinosinusitis

Ralph Mösges1, Laura Simić2, Vlatka Vrdoljak2, Karina Vukelić2, Zdravka Knežević2, Lea
Radtke3, Susann Fragel3, Silke Allekotte3

1
ClinCompetence Cologne , IMSB, 2Jadran Galenski Laoratorij, 3ClinCompetence Cologne

Poster Session | Acute Rhinosinusitis | 18 June – 22 June, 2023, All day

Rhinosinusitis is a common condition in most of the world, leading to a significant burden on

society in terms of healthcare consumption and productivity loss. Acute rhinosinusitis (ARS)
has a one-year incidence of 6 – 15% and is usually the consequence of a viral common
cold.Xylometazoline primarily relieves nasal congestion and has well-established use in acute
rhinosinusitis. The combination therapy of xylometazoline with hyaluronic acid (HA) would be
useful due to the contribution of HA to symptomatic relief in terms of nasal epithelial
dysfunction and protection of nasal mucosa. HA stimulates mucociliary clearance and thus
accelerates the removal of noxious agents (pathogens, allergens) from the nasal cavity. It also
accelerates recovery by restoring the integrity of epithelial barrier and relieves irritation by
hydrating nasal mucosa. All of these factors contribute to overall symptom control and
provide a basis for demonstrating superiority in efficacy of the combined treatment compared
to xylometazoline mono-treatment.We report on a randomized double-blind placebo
controlled phase III clinical trial with more than 500 patients comparing the combination
product with both mono-substances and placebo. Efficacy was assessed using the total nasal
symptom score, peak nasal flow, nasal endoscopy, odor and saccharine tests.

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Allergic Rhinitis

1658
Preliminary investigation of COVID-19 infection rate and symptoms in patients with
allergic rhinitis

Liu Kexin, Ma Zhiqi, Zhu Xiaocan, Xie Lin, Li Yong

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Objective To explore the COVID-19 infection rate and symptoms in patients with allergic
rhinitis.Methods The survey included the ENT out-patients from the Hangzhou First People's
Hospital as the subjects. The infection rate and symptoms of COVID-19 in patients with allergic
rhinitis were investigated and analyzed by sending online questionnaires. Result A total of 383
patients completed the questionnaire. AR patients or other Patients with a history of
respiratory allergic symptoms accounted for 39.95% of the patients, and COVID-19-positive
patients accounted for 93.22%. We found the most common symptoms in adults were fever,
cough, and nasal congestion by summarizing and analyzing the symptoms of COVID-19-
positive patients. The symptom scores of AR patients and other Patients with a history of
Respiratory allergic symptoms were compared with those of the control group and there was
no significant difference (P＞0.05). However, only the purulent mucus symptom of allergic
rhinitis patients had a slightly lower score than the control group, which was statistical
significance (P < 0.05). Conclusion The symptoms of patients with allergic rhinitis or other
patients with a history of respiratory allergic symptoms were not significantly milder than
other patients.

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1288
The influence of the social determinants of health (SDH) on the increase of specific
IgE in the Japanese patients

KAZUHIKO KUBO1, Takahiro Wakizono1, Takafumi Nakano1, Ayaka Koide1, Takamasa

Yoshida1, Eri Tomonobe1, Serika Sonoda1

1
Department of Otorhinolaryngology & Head and Neck Surgery, Chidoribashi General Hospital,
Fukuoka, JAPAN

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Introduction: WHO describes “The social determinants of health (SDH) are the non-medical
factors that influence health outcomes.” Various factors are reported to affect allergy as SDH
out of Japan. We have studied the relation between the poverty and various diseases as a
Japan’s first Health Promoting Hospital certified by WHO. The number of patients with allergy
has increased in the world. In this study, we evaluated the effect of poverty on the serum level
of specific IgE. This study was approved by the ethnic committee of our hospital.Materials and
Methods: The 426 subjects were recruited and the serum level of specific IgE were tested
against 16 kinds of allergens including pollen, house dust mite, fungus and insects by
ImmunoCap assay. An economic status was separated to two groups, poverty or non-poverty,
by the kind of insurance.Results: The rates of sensitization were significantly lower in the
poverty group than that in the non-poverty group about Japanese cedar pollen, cypress pollen
and house dust mite. It was significantly higher in the poverty group than in the non-poverty
group about the cockroach.Discussion: These results suggest that the poverty may also affect
the production of specific IgE in Japan.

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1311
The dietary n-6 and n-3 fatty acids ratio may affect the sensitization to Japanese
cedar pollen.

Ayami Nomura1, Chihiro Nakamura2, Taimu Yamaguchi2, Junko Takahata2, Atsushi

Matsubara2

1
Department of Otorhinolaryngology-Head and Neck Surgely, Hirosaki University Graduate School of
Medicine, 5 Zaifu-cho, Hirosaki , 2Department of Otorhinolaryngology Head and Neck Surgery, Hirosaki
University Graduate School of Medicine, Hirosaki, Japan

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Introduction: About 40% of Japanese suffer from Japanese cedar polinosis. Recent literature
suggests that the increased intake of n-3 (also called omega-3) fatty acids may reduce the risk
of allergic diseases. In the present study, we investigated whether the dietary n-6/n-3 fatty
acids ratio affects the sensitization to Japanese cedar pollen (JCP).Subjects and methods: The
study comprised 1109 residents who had participated in the health checkup called ‘the Iwaki
Health Promotion Project’ in Aomori Prefecture Japan in 2016. Blood samples were analyzed
for levels of allergen specific IgE against JCP. If the specific IgE score was above 0.35 kU/L, we
defined that they were sensitized to the JCP. The participants wrote BDHQ (Brief-type self-
administered diet history questionnaire), and we calculated the n-6/n-3 fatty acids ratio.
Sensitization rates to JCP were compared between those with high and low n-6/n-3 fatty acid
ratios. Results: In participants above 50 years, the JCP sensitization rate in the high n-6/n-3
fatty acids ratio group was significantly higher than in the low ratio group.

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1424
A hypertonic seawater-based nasal spray relieves seasonal allergic rhinitis symptoms
in adults

Oliver Chen1, Constance Prime1, Annahita Ghassemi1, Marita Alegre1, William Hooper1,
Anush Mnatsakanyan2, Howard Druce3, Josip Čulig4

1
Research & Development, Church & Dwight Co., Inc. , 2ClinChoice LLC, 3ClinChoice Inc., 4Klinpharma
D.O.O

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Seasonal allergic rhinitis (AR) causes inflammation-related nasal and ocular symptoms,
reducing patients' quality of life. This study aimed to investigate the safety and performance
of a hypertonic seawater-based nasal spray enriched with calcium and manganese to relieve
AR symptoms in adults. We conducted a prospective, single-cell, product-blinded clinical trial
with 59 adults (31.1 y; 27 M, 32 F) with ongoing symptomatic AR confirmed with a positive
skin prick test. Subjects applied 2 sprays in each nostril for 1 to 6 times daily for 14 days. During
the study, the nasal spray significantly reduced from the 7-day run-in period the daily morning
and evening severity scores of nasal congestion and itching, sneezing, runny nose, and eye
itching, watering, puffiness, and dryness (P <0.05). Daily sleep difficulty scores significantly
decreased from the 7-day run-in period (P <0.001). At 1- and 10-minutes post-nasal spray
application on Day 0, severity scores of nasal congestion and itching, sneezing, and eye itching,
watering, and puffiness significantly decreased from pre-application (P <0.05). The daily
intervals between the first and second nasal spray applications were longer than 4 hours (P
<0.05). There were no product-related adverse events. In conclusion, the nasal spray
effectively relieved AR-related nasal and ocular symptoms and improved sleep difficulty.

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1444
The effect of Immunotherapy on the voice quality of Allergic Rhinitis patients

Panayiota Mouteveli, GEORGIA Katsouli, Georgios Mireas

1
UNIVERSITY OF PELOPONNESUS

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Allergic Rhinitis (AR) is an inflammatory condition of non-infectious etiology, that affects the
voice quality. Subcutaneous and Sublingual Immunotherapy(SSI) is a major therapeutic
intervention to reduce the disease and treat allergic symptoms. We aim to investigate the
efficacy of SSI on voice quality in patients with(AR), using the Voice Handicap Index(VHI)and
the Voice Analysis software, Praat. We compared the phonetic parameters of 27 patients aged
18-58 years with(AR) before the beginning of SSI(group1)and after the completion of 3
years(group2). From the objective acoustic analysis of the voice through Praat, we studied the
fundamental frequency(F0), the amplitude variability (shimmer%)and the variability of the
fundamental frequency(jitter%), as well as the ratio of noise to the harmonic waves(NHR)of
the sound signal produced.The questionnaire(VHI) was used as a subjective indicator of self-
assessment of the voice of patients with allergic rhinitis pre- and post-
Immunotherapy.Results:The comparison of the variables of two groups showed that all
objective phonetic parameters improved upon completion of 3-year Immunotherapy,with a
statistically significant difference observed in all, except(F0),where improvement was not
significant(p>0.05). Also,the score in VHI improved after 3-year therapy, with a statistically
significant difference(p<0.05).Conclusion: The AR patients who have achieved symptomatic
depletion and reduction of inflammatory disease after 3 year Immunotherapy, had a
significant improvement of their voice analysis.

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1593
Effect of gut microbial composition and diversity on major inhaled allergen
sensitization and onset of allergic rhinitis

Taimu Yamaguchi, Atsushi Matsubara1, Ayami Nomura1

1
Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Background: Decreased gut microbiota diversity is associated with gut dysbiosis and causes
various diseases, including allergic diseases. We investigated the effect of gut microbial
composition and diversity on major inhaled allergen sensitization and onset of allergic rhinitis
Methods: This study included 1092 local residents who had participated in the Iwaki Health
Promotion Project in 2016. Blood samples were analyzed to ascertain specific IgE levels
against major inhaled allergens (JCP, HD1, Grass-mix, Weed-mix). Fecal samples were
analyzed for bacterial 16S rRNA using next generation sequencing. The diversity index (α-
diversity, β-diversity) and the composition of gut microbes in phylum/order levels were
compared between patients sensitized or unsensitized to allergen, and symptomatic and
asymptomatic groups.
Results: Some α-diversity metrics were significantly decreased in patients who were sensitized
to allergens. β-diversity differed significantly between those unsensitized and sensitized to
allergens. The relative abundance of Bacteroidales was significantly lower in the unsensitized
group. The composition and diversity of gut microbiota were similar between the
symptomatic and asymptomatic groups. Conclusions: Our results suggest that lack of diversity
in gut microbiota has an effect on sensitization to allergens. However, the onset of allergy
symptoms was not significantly associated with bacterial composition and diversity.

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1624
Alergic Rhinitis – Representation of symptoms and allergens

Mirjana Stracenski- Perge

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

ALERGIC RHINITIS – REPRESENTATION OF SYMPTOMS AND ALLERGENS Introduction Alergic

Rhinitis is caracterised by symptoms which arises as reaction of immune system on presens
of the specific alergen. The aim- Presentation of the frequenc y of symptoms and confirmed
allergens in patients with Allergic Rhinitis. Matherial- Set of standardised inhaled allergens
for Prick test. Method-Retrospective study. Data were obtained from Allergological
protocol in ENT ambulance in period from 3.10.2019- 1.11.2021. Result- 116 patients
participated in research,66 male and 50 women. The average age was 20.30 for male and
30.38 for women.All of them had positive result of Prick test. Symptoms in the form of
secretion,nasal obstruction,coughing,sneezing and headache were presented in varying
degrees. Discussion- It was found that 48 patients had one symptom where nasal obstruction
dominates, while other patients had associated symptoms. In relation to age more frequent
occurrence of certain symptoms wasnt found. From the whole number of patients,
55.17% had one allergen positive result of the Prick test , 33.62% had positive Prick test on
two allergens and 11.21% on three or more allergens. Conclussion- No higher frequency of
individual symptoms and allergens has been demonstrated. Symptoms and allergens were
equally represented.

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1732
Endoscopic Dacryocistorhinostomy

Orjeta Tonuzi1, Ali Tonuzi1

1
Deparment of otolaryngology, University Hospital Center "Mother Teresa" Tirana, Albania

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Methodology: To analise advantages, complications and recidivations of the Endoscopic

Dacryocistorhinostomy. To compare surgical results of the endoscopic
dacryocystorhinostomy with the classic surgical method which has been used until now in
our country and also to to review the literature of the endoscopic dacryocistorhinostomy. To
show the results of recurring external DCR and reoperation of these cases with endoscopic
DCR. We have used χ2 test to compare the percentage of categorical variables. For p value
of p≤0.05.Rezults and Discussion : This study is done at Albanian Eye Clinic during the period
from February 2016- February 2022. There has been involved 174 (16 - 82 years ) with
nasolacrimal duct obstruction. The success rate of the patients treated with endoscopic DCR
was 92.5% according to Umer et al at values 75-95 %.The success rate in the control group
with the external Dacryocystorhinostomy was 89.2% according to the authors Jack.J.Kanski
87.5% and Andre Aroni 98%. Concussion: Endoscopic DCRS is a valuable method with a high
success rate for the treatment of nasolacrimal duct obstruction. Endoscopic DCR is less
invasive preserves the anatomic structures, shortens the operation time and also a rapid
rehabilitation of the patient. The results of the operated patients with this method at our
clinic have a comparable result to the contemporary literature. Recurring (unsuccessful
cases) are mainly as a result of granulation tissue.

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1761
Allergic Fungal Rhinosinusitis complicated with sudden onset Diplopia

Konstantinos Garefis1, Panagiotis Dogantzis1, Stella Fotiadou1, Christos Chatzoglou1, Iliana

Efstathiou1, Angelos Chatziavramidis1, Panagiota Florou1, Konstantinos Markou1

1
2nd Department of Otolaryngology, Aristotle University of Thessaloniki, School of Medicine,
Papageorgiou General Hospital

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Allergic Fungal Rhinosinusitis is an IgE mediated reaction to fungi in the paranasal sinuses. It
can be either acute usually in immunocompromised patients or chronic usually in
immunocompetent patients. The infection can progress as a result of inflammatory invasion
form the paranasal sinuses to adjacent structures like the orbits or intracranial
dissemination. The disease usually has a chronic course but can be complicated from
infiltration of the surrounding structures resulting in proptosis, diplopia, visual impairment,
cranial nerve deficits.We present a 30 year old Caucasian female that was referred to the
Emergency department for sudden onset diplopia, nasal congestion and persistent
headache. Clinical examination revealed thick mucus plugs and nasal polyposis mainly in the
right nasal cavity. Moreover, the right orbit was deviated medially and superiorly. Imaging
showed right sphenoid sinus mucocele extending to the pterygoid process of the sphenoid
bone and posterior ethmoid cells. After 24 hours conservative therapy without resolution,
surgical intervention with FESS followed. Upon recovery all symptoms had subsided. The
pathology report showed Aspergilloma. The patient was discharged after two days of
hospital stay with medication and a planned follow up. Early diagnosis and prompt
treatment is essential in minimizing the potentially fatal outcomes of Allergic Fungal
Rhinosinusitis.

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1232

Middle turbinate oedema in allergic rhinitis

Ross O’Shea, Maire Gaffney, Majura Kaare, John-Eugene Fenton

Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Limerick

Poster Session | Allergic Rhinitis | 18 June – 22 June, 2023, All day

Objective: The association between allergic rhinitis (AR) and middle turbinate oedema has
been described however, to date no studies have used the same endoscopist nor the same
method of allergy testing.
The aim of this study was to determine if there was an association between middle turbinate
oedema and AR using a single clinician and an identical allergy test for all patients.
Methods: A retrospective assessment of all patients who underwent nasendoscopy by a single
otolaryngologist. The middle turbinate was visualized for the presence of polypoid changes.
Specific IgE immunoassay using radioallergosorbent test (RAST) was then performed on all
patients.
Results: Nine patients of 40 (22.5%) were classified as RAST positive and middle turbinate
oedema positive. Eleven patients (27.5%) were classified as RAST positive and middle
turbinate oedema negative. One patient (2.5%) was defined as RAST negative and middle
turbinate oedema positive. Nineteen patients (47.5%) were defined as RAST negative and
middle turbinate oedema negative. The sensitivity of middle turbinate oedema for AR was
45% and the specificity was 95%.
Conclusion: This study supports the association between middle turbinate oedema and AR. It
found oedema of the middle turbinate to be poorly sensitive but highly specific for the
presence of AR.

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Benign nasal tumours

1165
managing Pain in benign nasal tumor subjects

pal s1, T Roy1, Shah B1

1
SFCCP

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Background:When assessing QOl parameters of Benign-nasal-tumor, pain is very commonly

observed . No uniform approach on pain management. Ayurveda-Therapy highly preferred
by Asian-patients. Cultural/psychological/spiritual/social factors influence quality-of-life
(QOL) Current approach :work-up of pain in individual with nasal tumor subjects begins with
thorough pain assessment. But very few clinics have specialized pain-care-team in rural
areas.Past studies/experiences: management of pain due to Benign-nasal-tumor requires
sound understanding of therapy, primary categories of analgesics include non-opioids,
opioids, adjuvants. wide variety of non-opioids medications as anticonvulsants,
antidepressants, corticosteroids, local anesthetics also tried. therapy –with Ayurveda &
spirituality/psycho-social-support emerging new hope pain management. Spiritual well-being
prevents depression. Effect of spiritual/psycho-social-community support fertile ground for
further investigations in larger sample size.Methods:N= 53 [patients with completed Rx for
Benign-nasal-tumor] having intractable pain due to nas. Score on pain perception before &
after treatment noted. Any optional alternative therapy treatment [complimentary-
medicines ] taken noted. QOL analyzed. Result & Conclusions: 85% preferred Asian
complimentary/Ayurveda therapy compared to allopathic-medicines.> participants felt pain
due to Benign-nasal-tumor is distressing. comprehensive pain assessment strategy needed

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1166
Reducing tobacco smoking to reduce incidence of nasal tumors

Pal S1, R Gupta1, T Roy1

1
SFCCP

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Objectives:Tobacco major cause of Nasal-tumors. Adolescents highly susceptible to tobacco-

use. Aim was to reduce use of crude tobacco products. Methods: cross-sectional project.
Retrospective analysis of implementation of FCTC-WHO done. N=260 seven
targeted villages. Due representation to demographic pattern, socio-economic criteria. , age
group of 14-24. Traditional faith-healers mobilized by community leaders[total 13]. Tobacco
addicts graded clinically Traditional faith healers conducted 11 follow up sessions during
course of study.Results:Of total 260 tobacco users 250 continued to participate. [10
dropouts].227 showed positive-attitude towards quitting tobacco use. 215 subjects has quit
habit of tobacco use. 12 subjects able to abstain for short period but eventually restarted
habit. Post-project surveillance showed need for community help/Rehabilitation. Of 227 who
responded positively majority [220] started using tobacco due to peer-pressure [84%],
imitation of tobacco advertising [11%].Conclusions:scientific knowledge & expertise of
traditional faith healers is tribal areas controversial, they are only available resource for
influencing adolescents. this model can reduce incidence of nasal-tumors turning into
carcinomas. Recommendations:Developing nations have little resources & technologies. we
patients advocates need ERS-2023 platform to interact and learn from seniors.

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1249
Our experience in the treatment of patients with inverted papilloma of the paranasal
sinuses

Diana Zabolotna1, Dmytro Zabolotnyi1, Eldar Ismahilov1, Iryna Tsvirinko1, Oleh Shafinskyi2,
Yaroslav Kizim1

1
Department of Rhinology, Allergology and Radiology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sci, 2Department of Anesthesiology

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Introduction:Inverted papilloma is a benign epithelial tumor that belongs to Schneider's

sinonasal papilloma. The incidence of inverted papilloma is from 0.4% to 7% of all neoplasms
of the nasal cavity and paranasal sinuses.Objective:To summarize the results of diagnosis
and treatment of patients with inverted papilloma of the paranasal sinuses.Materials and
methods:The data of radiological examination methods were analyzed and the results of
treatment of 41 patients with paranasal sinus papilloma for 2018-2022 were
evaluated.Results:Inverted papilloma was more common in the ethmoid cells – in 21 (51.2%)
patients and in the maxillary sinus – in 14 (34.1%).In the area of the frontal sinus – in 5
(12.2%) of the examined patients. In one patient (2.4%), the inverted papilloma originated
from the sphenoid sinus and spread ipsilateral to the posterior cells of the ethmoid cells.In
the treatment of patients, endoscopic endonasal approach was applied. Recurrence of
inverted papilloma was diagnosed in 7 (17.1%) patients, with a mean time of recurrence of
14 months. Conclusions: A comprehensive determination of pathognomonic radiological
signs and the choice of the most optimal tactics of surgical treatment allows achieving
satisfactory postoperative results and reducing the incidence of relapses.

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1367
The case of patient with large osteoma of frontal sinus

Anna Olszewska-Staron1, Małgorzata Buksińska1, Marta Dziegielewska1, Piotr H. Skarzynski2

1
World Hearing Center, Institute of Physiology and Pathology of Hearing, Ul. Mochnackiego 10,
Warszawa, Poland, 2Department of Teleaudiology and Screening, Institute of Physiology and
Pathology of Hearing, Warsaw, Poland, Department of Heart Failure and Cardiac Rehabilitation,
Medical University of Warsaw, Poland, Institute of Sensory Organs, Kajetany, Poland

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Osteoma is common benign tumor frequently arising in paranasal sinuses. It can be

symptomatic, however usually it is diagnosed incidentally during a Ct scan of paranasal sinuses
in patients with chronic rhinosinusitis. A 58-year old male patient with occasional headaches
and chronic rhinosinusitis symptoms was examined in our Clinic. The computed tomography
of paranasal sinuses was ordered and revealed large hyperdense osseous lesion of right
frontal sinus as well as bilateral thickening of mucosa in frontal, ethmoid and maxillary sinuses.
The modified Lothrop procedure was performed and lesion of frontal sinus was removed.
Histopathology results confirmed osteoma. The patient had 10 years follow up.

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1419
JUVENILE NASAL ANGIOFIBROMA IN A PATIENT TREATED WITH GROWTH HORMONE

VIRGINIA GARCÍA GARCÍA, JUAN AGUILAR CANTADOR1, NURIA CRUZ CERÓN1, ELIZABETH
MORALES MOLINA1

1
Sociedad Española de Otorrinolaringología

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

INTRODUCTION: Juvenile nasal angiofibroma (JNA) is a rare, benign tumor of vascular etiology
with a tendency to bleeding and local aggressive behavior. Key to its development are the
expression of vascular endothelial growth factor (VEGF), insulin-related growth factor (IGF-I),
as well as receptors for steroid hormones.MATERIAL AND METHODS: A 15-year-old male
patient with a history of GH treatment due to familial short stature. His symptoms were nasal
respiratory failure and epistaxis, with a year evolution and no response to conservative
treatment. On examination, a hypervascular mass was detected that obstructed both nostrils
with extension to the cavum.RESULTS: Computed tomography (CT) and magnetic resonance
imaging (MRI) described a lesion consistent with Radkowsky's ANJ IIC or Fish's IIIA. Given the
findings, an endonasal endoscopic approach guided by neuronavigation was decided for
resection of the tumor, prior to its embolization. The pathology revealed
angiofibroma.DISCUSSION: Despite the lack of bibliography that supports the relationship
between ANJ and GH, hormonal stimulation of the receptors that are expressed in this tumor
is a factor to take into account in its etiopathogenesis. Therefore, it is essential to know them
for early detection.

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1440
Antrochoanal polyp - extension to the larynx: a case report

Tamara Tačigin, Gorazd Poje

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Antrochoanal polyp (ACP) is a benign lesion originating from the mucosa of the maxillary sinus,
growing and protruding to the nasal cavum, and then posteriorly toward choana and
nasopharynx. The most common presenting symptom of ACP is unilateral nasal obstruction.
ACP represents 4-6% of all nasal polyps in general population, but it constitutes 33% of all
nasal polyps in children.In this case report we present a 6 years old boy with a 1,5 year history
of nasal obstruction, snoring, obstructive sleep apnea, and foreign body sensation in the
throat. Endoscopy showed a polypous mass in left nasal cavum that extended from fontanelle
defect to the choana and nasopharynx, and intraoraly solid soft mass that was bulging soft
palate and behind the uvula extended below the superior edge of epiglottis. Diagnosis of ACP
was supported by CT and confirmed by histopathologic analysis. The treatment of ACP is
always surgical. Caldwell Luc procedure that was preferred in the past was replaced with
endoscopic sinus surgery. ACP should be considered in the differential diagnosis of unilateral
nasal obstruction, particularly in children. During surgery the exact origin of ACP in maxillary
sinus must be detected in order to prevent recurrence.

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1529
Dentigerous cyst mimicking “fungus ball”

Konstantinos Chantzis1, Christos Kakkos1, Sotirios Anastasopoulos1, Stavros Ioakeimidis2,

Eleni Stavrianou1

1
General State Hospital of Nikaia, Greece, 2Medical School, University of Patras, Greece

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

We present a case report of a 60 years old patient who came in the ER having signs and
symptoms of acute rhinosinusitis, for about 10 days. Clinical examination begun with nasal
endoscopy, finding nasal polyp and pus secretions flowing out of the middle meatus in the
right nasal cavity. Following those findings, a CT scan was performed showing abundance in
the right maxillary sinus, with calcinosis and the presence of dental inclusion, therefore fungal
sinusitis was taken under consideration. Further examination with an MRI was made,
confirming the imaging findings of fungal rhinosinusitis. Our team operated the patient with
F.E.S.S.. During the operation bony tissue was localized inside the lateral wall of the right
maxillary sinus at the sight of the ostium, making it hard to open. A maxillary antrostomy was
performed through the inferior meatus, by removing part of the inferior turbinate. Tissues
obtained from the inside of the right maxillary sinus were sent for biopsy and pathophysiology
examination. Results of these tissues examination showed squamous epithelium. By
connecting those pathology results with the dental inclusion inside the maxillary sinus, the
diagnosis of a dentigerous cyst was made. Our patient was sent and advised for further
maxillofacial treatment.

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1548
Inverted Papilloma of the Lacrimal Sac – A Rare Incidental Finding on a PET-CT Scan

Anna-Maria Papadopoulou1, Aikaterini Tsagkovits2, Athanasia Marinou3, Anastasia Liapi1,

Evangelia Zacharioudaki1

1
ENT Department, General Hospital of Athens G. Gennimatas, Athens, Greece, 2ENT Department,
General Hospital of Athens, G. Gennimatas, Athens, Greece, 3ENT Department, General Hospital of
Athens Giorgos Gennimatas, Athens, Greece

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Inverted papilloma (IP) originating primarily from the lacrimal drainage system is extremely
rare. Although a benign tumour, there is a propensity for recurrence and malignant
transformation with few cases reported in the literature. Surgical excision is the mainstay of
treatment.A 56-year-old male smoker with chronic left epiphora and a mild, painless swelling
on the left medial canthus since 15 years, presented to our department, complaining of a soft,
painless lump on the left parotid area since one month. A thorough head and neck
examination with skin inspection and cranial nerve examination did not reveal any significant
findings. A cytological diagnosis of squamous cell carcinoma (SCC) of the parotid was made
after FNA biopsy. A PET/CT scan was requested to exclude intraparotid lymphnode metastasis,
which showed a hypermetabolic lesion on the left parotid with SUVmax: 6.8 and a 1.5 cm
lesion on the left nasolacrimal sac with SUVmax: 10.9. The patient underwent left total
parotidectomy with elective neck dissection and an endoscopic biopsy of the left lacrimal sac
with standard endoscopic DCR procedure at the same sitting. Histopathology confirmed a
HPV+ IP of the lacrimal sac and parotid and neck specimens were reported as primary SCC of
the parotid, staged as pT2N0M0. The patient underwent adjuvant radiotherapy and he did
not consent for definitive surgical excision.FDG-avid lesions on PET/CT should be promptly
investigated with biopsy. Lacrimal IP demonstrated marked hypermetabolic activity
consistent with previous reports in the literature.

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1555
TRIGEMINAL NEURALGIA DURING AIRPLANE FLIGHTS

Carolina Alfonso Carrillo1, Blanca Mateos Serrano1, Blanca Mateos-Serrano1

1
Department of Otorhinolaryngology, La Paz Universitary Hospital, Madrid, Spain

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

A 56-year-old man who came to the office because of the appearance of pain in the right side
of the face during plane flights for several months. The patient had no symptoms suggestive
of chronic sinusitis. A nasofibroscopy was performed without pathological findings, so a
MRI was requested, with the following findings: Extensively pneumatized sphenoid sinus
associated with pneumatization of the pterygoid processes and clivus. Occupation of the right
side of the sphenoid sinus, hyperintense on T2 and hypointense on T1, minimally expansive,
protruding towards the ipsilateral maxillary sinus.A mucocele was suspected. Then a CT scan
was requested. The patient underwent endoscopic excision of the lesion and the symptoms
disappeared.Radiological images and surgical intervention are provided.

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1588
Plasma cell granuloma of the inferior turbinate - a rare entity

Tiago Soares Santos1, Miguel Campos Lopes1, Vera Miranda1, Alexandra Correia1, Carlos
Carvalho1

1
Department of Otolaryngology, Entre o Douro e Vouga Hospital Center, Santa Maria da Feira,
Portugal

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Introduction Plasma cell granuloma is a non-neoplastic proliferation of plasma cells. It

commonly involves the lungs and the oral cavity. However, the involvement of the nasal
mucosa is rare. We present a case of plasma cell granuloma involving the inferior turbinate in
an adult. Case ReportA 65-year-old man presented with a several-month history of fixed right
nasal obstruction, occasional epistaxis, and clear nasal discharge. Examination revealed an
irregular polypoid mass lesion, macroscopically heterogeneous, with apparent implantation
on the right inferior turbinate and occluding the nasal fossa. The CT scan revealed a space
occupying lesion in the right nasal fossa at the level of the head of the inferior turbinate,
without any suspicious features of malignancy. The patient underwent endoscopic removal of
the lesion, and the histopathologic report revealed a polyclonal population of lymphocytes,
CD38+/CD34-, confirming the diagnosis of plasma cell granuloma. Discussion Plasma cell
granuloma of the nose and paranasal sinuses is a rare occurrence. Surgical treatment remains
the preferred option, although corticosteroid therapy and radiotherapy have been used with
a limited degree of success. Despite its clinical similarities to a malignant process, it should be
differentiated from such diseases by thorough histopathologic and immunohistochemical
evaluation.

439
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1683
Frontal Sinus obliteration for mucocele in the endoscopic era

Georgia Liva1, Alexandros Karatzanis1, Maria Doulaptsi1, Ioannis Tsamandouras1, Ioulia

Fothiadaki1, Emmanouel Prokopakis1

1
Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine,
Heraklion, Crete, Greece.

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Background: Paranasal mucoceles are benign, epithelium lined cysts filled with mucoid
material. They usually behave like space-occupying lesions, and may cause bone erosion and
displacement of surrounding structures. Frontal sinus is most commonly involved, and
computerized tomography (CT) together with magnetic resonance imaging (MRI) are
sufficient for diagnosis, and surgical planning. Depending on specific characteristics, frontal
mucoceles are managed either by endoscopic transnasal, or by external
approach.Methodology/Principals: A 53 years-old male, presented in the outpatient ENT clinic
of a tertiary referral center complaining of left upper eyelid swelling and intermittent double
vision. He was operated twice for frontal sinus mucocele elsewhere endoscopically. New CT
and MRI were conducted which revealed a frontal mucocele with erosion of the floor, the
inferior and posterior wall of the sinus. Results: Osteoplastic frontal sinus obliteration with
autogenous abdominal fat was chosen in this case. Postoperative course was uneventful.
Patient completely recovered from diplopia, exophthalmo, and frontal swelling. Conclusions:
Despite the evolution of advanced endoscopic techniques for frontal sinus surgery, open
surgery remains a valid procedure in cases where endoscopic approach has failed, with orbital
and/or intracranial extension, and where district anatomy is unfavorable for a purely
endonasal approach.

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1695
CLINICAL PRESENTATION OF FIBRO-OSSEOUS BENIGN TUMOURS: HOSPITAL CASE
REPORT SERIES

Daniel Miranda1, Filipa Armada Ferreira1, António Fontes Lima1, Paula Campelo1, Filipa
Moreira1, Luís Dias1

1
Hospital of Braga

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Introduction: Fibro-osseous benign lesions of the paranasal sinuses are slow-growing tumours
characterised by the replacement of normal bone by a fibrous cellular stroma, with variable
quantity of bony content. These lesions are divided into three different entities: osteoma,
fibrous dysplasia (FD) and ossifying fibroma (OF), in this order of frequency. Osteoma most
frequently occurs in the frontal and ethmoidal sinuses, while FD and OF mostly involve the
maxilla. Normally these lesions are asymptomatic and incidentally found on imaging done for
another reason. Nevertheless, it can occur extra sinus complications, such as orbital or
intracranial involvement. When there is a surgical indication, the endoscopic approach is a
safe and effective treatment modality, and the prognosis is good.Case Report: In order to
further deepen the understanding of fibro-osseous lesions, we aim to present three different
case reports, one for each clinical entity. Therefore, describing the clinical presentation,
diagnosis and treatment. Conclusions: Fibro-osseous benign lesions share several similarities
in clinical and imaging manifestations, but their clinical behaviour is diverse. There is still
unclear whether to chose or not a surgical approach. Keeping that in mind, it is possible to
understand the relevance of sharing clinical information between different realities.

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1701
Giant Rhynophyma : A rare case report

IOANNIS TSAMANDOURAS, MARIA DOULAPTSI2, GEORGIA LIVA1, IOULIA FOTHIADAKI3,

ALEXANDROS KARATZANIS4, EMMANUEL PROKOPAKIS5

1
Otorhinolaryngology resident University Hospital of Crete, 2Otorhinolaryngology consultant University
Hospital of Crete, 3Otorhinolaryngology surgeon University Hospital of Crete, 4Otorhinolaryngology
Associate Professor University Hospital of Crete, 5Otorhinolaryngology Full Professor University
Hospital of Crete

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Giant rhinophyma : a rare case report Background: Rhinophyma is a disfiguring nasal

deformity due to the proliferation of sebaceous glands and underlying connective tissue.
Methodology/Principals: A 74 years-old male, presented in the outpatient ENT clinic of a
tertiary referral center due to a huge mass causing nasal deformity. Patient reported
respiratory issues, and psychological distress. The mass was obstructing both nostrils, expelled
sebum when pressed upon. Patient underwent laser CO2 partial thickness tissue removal for
rinophyma. Meticulous wound care with petroleum gel gauze soaked in antibiotic cream as
wound dressing was utilized post operatively. Results: The histological examination confirmed
the clinical diagnosis. Significant aesthetic improvement was noted immediately and three
months post surgery. Conclusions: Rhinophyma is nowadays a rare disfiguring skin condition
which if left untreated has a significant social isolating effect. Pathophysiology of rhinophyma
has still not been completely elucidated, although rosacea is considered a precursor condition
of the disease. The principal aim of surgery is to reduce the hypertrophied sebaceous glands
and re-contour the nose. This can be achieved using a wide variety of techniques. Additionally
scarring, and nasal cartilages destruction should be avoided at all costs.

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1702
INVERTED PAPILLOMA OF THE FRONTAL SINUS WITH PROPTOSIS: A RARE CASE-
REPORT

Adriana Cunha1, Francisco T. Marques1, Teresa Bernardo1, Clara Pedro Mota1, Simão Bessa1,
Nuno Lousan1

1
Centro Hospitalar do Tâmega e Sousa

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Introduction: Inverted papilloma (IP) is a benign sinonasal epithelial tumor that is

characterized by its locally aggressive nature, elevated recurrence rates and considerable risk
of malignant transformation. Frontal sinus involvement is relatively rare and is associated to
higher rates of recurrence. Materials and Methods: Case report and review of the literature.
Results: A 38 year-old black woman presented to our institution with left eye proptosis for
one year, ipsilateral epiphora, purulent nasal discharge and left frontal headache. Nasal
endoscopy revealed a polypoidal mass in the left nasal cavity. Computed tomography,
magnetic resonance and initial biopsy suggested an IP of the frontal sinus. The patient was
submitted to a draft type IIa frontal sinusotomy associated to frontal sinus trephination. The
posterior histologic examination confirmed the suspected diagnosis. Two months later, a
magnetic resonance showed residual disease, which motivated a more aggressive re-
intervention with an osteoplastic flap procedure combined with endoscopic approach. Orbital
decompression was not advised since the ocular function was preserved and there was a
considerable risk of recurrence demanding re-intervention.Conclusions: IP of the frontal sinus
demand an highly differentiated surgical approach. Prolonged surveillance is strongly advised
considering the risk of recurrence and metachronous carcinomas.

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1743
Nasal glial heterotopia: a systematic review of the literature and case report

Simona Negoias1, Montserrat Gallego Compte1, Thomas Menter2, Nicolas Guertler1

1
Department for Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Switzerland,
2
Department of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel,
University of Basel, Switzerland

Poster Session | Benign nasal tumours | 18 June – 22 June, 2023, All day

Nasal glial heterotopia (NGH) is a rare congenital, non-neoplastic displacement of cerebral

tissue in extracranial sites. Together with a case report of NGH, we present the first systematic
review of all published cases in order to summarise the relevant clinical findings and
appropriate therapy, making the available evidence accessible to decision makers. A total of
72 original publications including 152 NGH cases were identified. The male:female ratio was
3:2. Most patients were children under 18 years (130 patients) and only 8% of cases were
diagnosed in adults. The main clinical presentation forms were asymptomatic masses around
the nasal root as well as nasal congestion. Magnetic resonance imaging was performed in 39%
of patients, computed tomography in 22% of patients and a combination of both in 20% of
patients. A diagnostic biopsy was performed in only 7 patients. All patients underwent surgical
treatment and recurrence was reported in 14 patients within the first year of follow-up. In
conclusion, NGH should be considered as a differential diagnosis of nasal masses in children.
MRI is mandatory in order to exclude a connection to the central nervous system. Complete
resection is curative treatment.

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1799
Case of 69 years old patient with

Levon Torosyan1

1
"Nairi" MC, Yerevan, RA

Poster Session | Benign nasal tumours | 19 June – 22 June, 2023, All day

Nosebleeds, shortness of breath, loss of smell leaded the 69 years old patient to “Nairi” MC,
Yerevan. After appropriate examinations, the patient was diagnosed with very rare disease-
sinonasal inverted papiloma (Schnider’s papiloma). Papilloma is a benign neoplasm of the
nasal cavity, which has a tendency to relapse and malignancy. The causes of occurrence are
diverse, from the presence of human papillomavirus to chronic purulent rhinosinusitis. A
papilloma may not bother the patient for a long time, although, one day it may show up. The
location of it’s appearance may also vary. In the case of 69 years old patient also, papiloma
was located in the left part of nasal cavity, spread to ethmoidal recesses and maxillar sinus
and had quite big dimensions. In general, such neoplasms can spread to the cavities adjacent
to the nose, the orbit, destroying the surrounding tissues. Under the lead of "Nairi" MC ENT
doctor L. Torosyan, the rare tumor has been completely removed. In few days after the
operation patient’s breathing was restored. It’s important to note, that extraction of this
tumor requires a lot of experience and professional skills.

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CRS – diagnosis and investigations

1661
Reflux Finding Score (RFS) and PepsinA in Patients with Chronic Rhinosinusitis (CRS)
due to Laryngopharyngeal Reflux (LPR).

Aditya Wira Buana1

1
ORL-HNS Department Faculty of medicine, Airlangga University – Dr. Soetomo General Hospital,
Surabaya, Indonesia.

Poster Session | CRS – diagnosis and investigations | 19 June – 22 June, 2023, All day

Background and objectives: The incidence of Laryngopharyngeal reflux (LPR) disease is still
being debated and is suspected to be one of the causes of chronic rhinosinusitis. Exposure to
acidic refluxate and pepsin in the upper esophageal area is suspected of causing prolonged
inflammation of the nasal and paranasal sinuses mucosa. Reflux finding score (RFS)
assessment using Fiber Optic Laryngoscopy is still used today and can assist in diagnosing LPR.
The presence of pepsin can also be the main biomarker in LPR, considering that pepsin is only
produced in gastric parietal cells. This study aimed to see the correlation of pepsin findings as
a biomarker in patients with RFS>7 diagnosed with CRS.Methods: This study is a prospective
cross-sectional analysis using the Fisher exact test. All subject's symptoms of rhinorrhea and
or nasal obstruction for more than 12 weeks will be included in the study. Nasal endoscopy
(NE), fiber optic laryngoscopy (FOL), and Reflux Symptom Index (RSI) were performed on all
subjects. All subjects were taken specimens using a single nasal lavage at mealtime, then
analyzed with a rapid pepsin test device. Results: In this study, 25 patients with CRS and 28
patients were diagnosed with LPR out of 35 patients. While statistical findings showed positive
pepsin results in 22 samples with a value of p=0.027 (p<0.05). Conclusion: Pepsin can be a
biomarker in patients with RFS>7 diagnosed with CRS.

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1252
Determination of the influence of transferred SARS-CoV-2 on the course of chronic
polyposis rhinosinusitis with aspirin-associated respiratory disease

Diana Zabolotna1, Liudmyla Zabrodska2, Ivan Moldovanov1

1
Department of Rhinology, Allergology and Radiology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sci, 2Center of Allergology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sciences of Ukraine

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

It is not known whether SARS-CoV-2 affects the course of chronic rhinosinusitis with nasal
polyposis (CRSwNP) with aspirin-associated respiratory disease (AERD).Purpose of the study.
To differentiate symptoms of chronic CRSwNP from AERD at questionnaire level, to study
impact of SARS-CoV-2 on the course of disease.Materials and methods. A survey of 125
patients was conducted, from which 50 CRSwNP patients with AERD aged 20-60 years (28 men
and 22 women) were selected. The questionnaire was developed in form of a Google form,
which was built on basis of SNOT-22 questionnaire for identifying nasal symptoms. Results.
On basis of conducted study: for CRSwNP with AERD, bilateral nasal congestion 58%,
moderate nasal discharge 50%. Hyposmia was noted in 74%. Studying impact of COVID-19 on
CRSwNP with AERD, following results were obtained: among those surveyed, 58% had a
history of SARS-CoV-2, and in 50% of cases this worsened symptoms. Conclusions. Result of
conducted study, main nasal symptoms CRSwNP with AERD was depicted in percentage.
Correlation was found between a history of SARS-CoV-2 disease and worsening of symptoms.

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1406
Assessment of the expression levels of the MMP-12 in chronic rhinosinusitis with
nasal polyps

Athanasopoulos Michail1, Lygeros Spyridon1, Danielidis Gerasimos1. Gatsounia Alkmini1,

Naxakis Stefanos1, Mastronikolis Nikolaos1, Danielidis Vasileios1

1
Department of otorhinolaryngology, University General Hospital of Patras, Patra, Greece

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory

condition of the nasal mucosa and paranasal sinuses associated with frustrating symptoms
and low quality of life. The aim of this study was to assess the expression of matrix
metalloproteinase-12 (MMP-12), a pivotal regulator of the pathophysiology of several
inflammatory diseases, in patients with CRSwNP.
Methods: Tissue samples from 37 patients with CRSwNP treated with functional endoscopic
sinus surgery and 12 healthy mucosa specimens (control group) were excised intraoperatively.
Real-time polymerase chain reaction and Western blotting were used to measure the mRNA
and protein expression levels of MMP-12, respectively.
Results: mRNA levels of MMP-12 were found considerably increased in the CRSwNP
tissue samples compared to those determined in the control group. Aa far as the protein
levels, a non-statistical significant elevation trend was noticed. The “discrepancy” in
the expression profile among mRNA and protein levels could be attributed to post-
translational gene expression regulation.
Conclusion: The raise of MMP-12 in patients with CRSwNP could straighten its potential
implication in the pathogenesis of the disease. Our results indicate that MMP-12, in
combination with other matrix metalloproteinases, may serve as a biomarker and therapeutic
target for nasal polyposis.

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1467
Baseline characteristics of dupilumab-treated patients with chronic rhinosinusitis
with nasal polyps from a real-world non-interventional study in Germany
(ProGNOSE)

Adam Chaker1, Oliver Pfaar2, Ulrike Förster-Ruhrmann3, Kerstin Zeise4, Martin Wagenmann5,
Lucia De Prado Gomez6, Juby Jacob-Nara7, Matthias Hahn8, Markus Berns9, Niko Bretz8

1
Klinik für Hals-, Nasen- und Ohrenheilkunde und Zentrum für Allergie und Umwelt, Klinikum rechts der
Isar, Technische Universitä, 2Department of Otorhinolaryngology, Head and Neck Surgery, Section of
Rhinology and Allergy, University Hospital Marburg, Philipp, 3Klinik für Hals-, Nasen- und
Ohrenheilkunde, Universitätsklinikum Charité, Berlin, 4HNO Gemeinschaftspraxis Zeise & Chaoui
Kaiserdamm, Berlin, 5Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Düsseldorf,
6
Sanofi, Reading, UK, 7Sanofi, Bridgewater, NJ, USA, 8Sanofi, Frankfurt, Germany, 9Sanofi, Berlin,
Germany

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Introduction: Dupilumab is the first biologic approved for the treatment of severe,
uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) in adults. ProGNOSE is an
ongoing, prospective observational study in Germany, aiming to evaluate long-term
effectiveness and safety of dupilumab treatment in adult patients with CRSwNP in a real-world
setting. Here, we present baseline data from patients included during the first year.
Methods:Patient demographics, disease characteristics and medical history were
documented using electronic case report forms and patient questionnaires at baseline visits.
Clinical records were included based on availability, individual practice and clinical routine of
the study site. Results:For this interim analysis, 42 patients (men: 24; women: 18) who had
completed baseline visits were included. Mean±SD age was 53.14±11.02 years and disease
duration was 14.51±9.58 years. Mean±SD NPS (4.92±1.44), NCS (2.15±0.93) and VAS
(76.44±26.58) indicated severe disease in these patients. Anosmia/hyposmia patients
(71.4%/25%) and patients with type 2 comorbid conditions (76.2%) were of majority.
Mean±SD SNOT-22 (51.88±20.58) and CRS-PRO (26.66±9.63) showed impaired HRQoL.
Discussion: Patients included in ProGNOSE during the first year had uncontrolled disease with
high symptom burden and impaired QoL prior to initiating dupilumab. ProGNOSE data will
contribute to a better understanding of standard-of-care biological treatment of CRSwNP in
Germany.

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1476
Relationship between maxillary fungal sinusitis and odontogenic infection, dental
implant.

Yong Wan Kim1, Hyeon Woo Ahn1, Bo Soo Kim1, Tae Lim An1

1
Department of Otorhinolaryngology, Inje University Haeundae Paik Hospital

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Introduction The aim of this study was to investigate the association between chronic fungal
sinusitis and odontogenic infection, dental implant Matrials & methodsWe retrospectively
reviewed medical records and PNS CT scans. All patients were pathologically diagnosed with
fungal sinusitis, and based on PNS CT scan, a total of 396 maxillary sinuses were reviewed for
dental implants and dental problems (periapical abscess, periodontitis, tooth
extraction)Results We defined two groups of maxillary sinuses according to the presence of
fungal ball (fungal group; n=204 vs normal group; n=192). Pathologic diagnosis was fungal
sinusitis in all 204 cases. In the normal group, mean MS volume was 17.0 ± 6.2ml. In the fungal
group, mean MS volume was 13.8 ± 5.2 ml. The volumes of MS were statistically small in the
fungal group (P < 0.001). In 141 (69.1%) of 204 sinuses in the fungal group, findings suggestive
of odontogenic infection were confirmed on PNS CT scans and were statistically significant. (P
< 0.001 . odds ratio = 2.537). 26 (12.7%) of 204 sinuses in the fungal group had dental implants
and were not statistically significant. (P = 0.107 . odds ratio = 1.724). ConclusionThis study
suggests odontogenic infection is a risk factor for developing fungal sinusitis in the ipsilateral
maxillary sinus.

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1482
Identifying a sphenoid sinus fungus ball using a nomogram model

Chien-Chia Huang1, Pei-Wen Wu1

1
Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-
specific symptoms. SSFB could potentially lead to serious orbital and intracranial
complications. Computed tomography (CT) scan is usually the first imaging test of the
diagnostic workup in patients with specific clinical symptoms. This study aimed to compare
the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball)
chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most
common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database
review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for
analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and
histopathological diagnoses of USRS were enrolled as the control group. Clinical
characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal
obstruction, postnasal dripping, and hyposmia were the most common symptoms in both
groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface,
bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant
predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the
multivariate analysis. Based on the results of the regression analysis, a nomogram for
predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram
model as a novel preoperative diagnostic tool for identifying SSFB according to the pred

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1488
Differentiating features of fungal mucin and allergic mucin on CT imaging of the sinus

James Connell1

1
Department of Otorhinolaryngology, Queen Elizabeth Hospital, South Australia

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Background: Fungi within the sinus has the typical CT finding of hyper-densities, deriving
from the presence of manganese, iron and other paramagnetic elements related to fungal
hyphae. While this is readily recognisable in pathology like fungal mycetoma, the findings
are typically less pronounced in allergic fungal sinusitis (AFS) where 'serpiginous areas of
high attenuation' can also be attributed to highly proteinaceous 'fungal mucin'. Another
severe subgroup of CRS, eosinophilic mucin rhinosinusitis (eCRS) has similar mucinous traits
to AFS, with comparable radiological changes. Method: We undertook a retrospective series
of 40 cases of CRS to identify defining radiological traits between fungal and non fungal CRS
subtypes (AFS 10, non-allergic fungal CRSwNP (FRS) 10, eCRS 10, mycetoma 10). We
reviewed pre operative CT scans to calculate the distribution, mean, median and peak
attenuation.Results: Mean peak attenuation was highest in the mycetoma group (280.6
Hounsfield Units HU) which was significantly higher than AFS (135.9 HU), eCRS (135.2 HU)
and FRS (160.9), which all had comparable results. Mean attenuation for the affected sinus
was comparable between the AFS, eCRS and FRS groups, while mycetoma was significantly
higher. Lund-McKay scores (LMS) were higher in the eCRS group relative to AFS and
FRS. Conclusion: Attenuation and pattern of densities was highly comparable between
fungal (AFS and FRS) and non-fungal mucin (eCRS). eCRS was invariably bilateral with higher
LMS scores which may serve as a useful differentiation between AFS / FRS.

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1577
Chronic rhinosinusitis: is there a correlation between serum and tissue eosinophilia?

Elio Barbosa1, Mariana Toro1, Gustavo Vieira3, Fernanda Mariano3, Eulalia Sakano1

1
Dept of Otolaryngology - State University of Campinas, Brazil, 2 Dept of Otolaryngology, State
University of Campinas, Brazil, 3Dept of Pathology - State University of Campinas, Brazil

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease

of the nose and paranasal sinuses with multiple endotypes and phenotypes. There is a special
interest in classification of the eosinophilic chronic rhinosinusitis, which has grown lately due
to the immunobiologic drugs. The criteria most used is the EPOS criteria: 10 or more
eosinophils per high-power field (eos/HPF) in a tissue biopsy. However, there are still
controversies to determine the more accurate criteria to define the eosinophilic CRS
. Methods:Retrospective clinical study, with 220 patients with CRS (CRSwNP) from our
institution, who were submitted to nasal biopsy in the office or operation room (OR) from
2009 to 2019. Tissue and serum eosinophilia were quantified and after compared to
pulmonary disease, polyps relapse and radiologic score. Results: The median of the tissue
eosinophilia was 64 eos/HPF (OR) and 49 eos/HPF (office) and serum eosinophilia 320
eos/mm3. There was a positive correlation between serum eosinophils and tissue eosinophils
from surgical biopsy.After a sensitivity analysis the preoperative use of oral corticosteroids did
not affect the results. The ROC curve did not show high sensitivity and specificity between
serum or tissue eosinophilia and polyps relapse. There was a positive correlation between
pulmonary disease and serum eosinophilia, however there wasn’t any other correlation
between the variables and the eosinophilia.

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1632
A case of bilateral heterochronic fungal rhinosinusitis suspected to be Schizophyllum
commune

takayoshi ueno1, Kobayashi Eiji1, Yoshizaki Tomokazu1

1
Department of Otolaryngology-Head and Neck Surgery, Kanazawa University, 13-1 Takaramachi,
Kanazawa 920-8640, Japan.

Poster Session | CRS – diagnosis and investigations | 18 June – 22 June, 2023, All day

Schizophyllum commune is a mushroom known to infect humans and is a microorganism

belonging to the fungal family that is ubiquitous in Japan.It is frequently reported as an allergic
bronchopulmonary mycosis and is second in frequency only to Aspergillus spp.Some cases
have also been reported in the nasal sinuses, mainly in Japan.55 years old, female, visited a
general hospital in June 20XX-2 with a chief complaint of left posterior rhinorrhea.CT scan
showed hyperintense areas in the posterior ethmoid bone and sphenoid sinus.She underwent
endoscopic sinus surgery under general anesthesia at our hospital in April 20XX.A fungal ball
was found in the posterior ethmoid and sphenoid sinus.Pathologically, the fungal ball was
accompanied by calcification and was suspected to be Aspergillus.In April 20XX+3, the patient
returned to his previous physician with right rhinorrhea, the opposite side of his previous
condition.In October 20XX+3, a CT scan showed hyperintense areas in the right ethmoid sinus
and sphenoid sinus.In February 20XX+4, she underwent endoscopic sinus surgery under
general anesthesia.A fungal ball was found in the right posterior ethmoid and sphenoid
sinuses.Culture showed mushroom growth on a petri dish.On MALDI, Schizophyllum
commune 1024 score was 1.89.The left fungus was not cultured, so it cannot be confirmed,
but the course of the case was thought to be bilateral heterochronic fungal rhinosinusitis.The
residence was a house deep in the mountains, and environmental factors were speculated to
be involved in the development of this case

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CRS – medical management

1270
The effect of the premedication with systemic corticosteroids and antibiotics on
inflammation and intraoperative bleeding during sinonasal endoscopic surgery for
chronic rhinosinusitis with nasal polyps (CRSwNP)

Konstantina Chrysouli1

1
Department of Otorhinolaryngology, Penteli Children Hospital

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease characterized by

a variety of inflammatory mechanisms. Extensive genetic analyses have shown that among
the molecules that are involved in its genetic base, interleukins (ILs) play a critical role in
development and progression of CRSwNP . Interleukins, such us IL-4 (5q31.1), IL -5 (5q31.1),
IL-13 (5q31.11) and IL-25 (14q11.2) are found to be overexpressed. Purpose: Οur aim is to
investigate, through a systemic review, the effect of the premedication with systemic
corticosteroids and antibiotics on inflammation and intraoperative bleeding during sinonasal
endoscopic surgery for chronic rhinosinusitis with nasal polyps.Material and Methods: The
search period covered January 1979 to February 2021, using the scientific databases PubMed,
ScienceDirect, Scopus, Cochrane Library και Google Scholar. Search terms were ‘’effect,
premedication, systemic corticosteroids, antibiotics, intraoperative, bleeding, inflammation,
sinonasal, endoscopic surgery, chronic rhinosinusitis, nasal polypοsis.Results: From an initial
eighty titles found in the above medline databases, the evaluations led to the final inclusion
of fifteen papers. Eighty titles found in the above medline databases. Eleven titles were
excluded as they did not include a summary and full text in English language. Sixtynine titles
collected and duplicate references were searched. Twelve titles were excluded due to double
reporting. Fiftyseven articles remained for systematic review. Fourtytwo articles were
excluded after systematic review and correlation with the research field. Fifteen articles were
eventually included in the literature review.Conclusions: The effect of corticosteroids and
antibiotics on the size of nasal polyps, nasal symptoms and systemic markers of inflammation
is significant. Each of the above factors acts on different pathogenetic inflammatory
mechanisms.The use of perioperative corticosteroids reduces blood loss and operation time
and improves the quality of the surgical field. There are no other medications that have been
shown to improve the surgical field and outcome. Whether there is an additive effect on
systemic corticosteroids on top of nasal corticosteroids is unclear. The EPOS steering group
advises to use (nasal) corticosteroids before endoscopic sinus surgery. However, it should be
considered in future studies whether some miror differences are due to differences in the
initial doses of corticosteroids or during treatment in the preoperative period. It is worth
mentioning that while high doses of corticosteroids are required to control the progression of
rhinosinusitis with nasal polyps, the optimal initial dosage and the total duration of the
treatment have not yet been standardized in patients with CRSwNP and future studies are
required to determine the two above parameters (optimal dosage and duration of treatment).
There are, therefore, known risks from corticosteroid administration, and clinicians should
consider them when evaluating each patient. Each patient should be considered as an
individual case with individualized treatment.

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1169
Use Of Complementary Indian Medicine In chronic rhinosinusitis (CRS)

s pal1, T Roy1, G Panda1

1
SFCCP

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Introduction: patients of chronic rhinosinusitis (CRS) needs price discounted drugs & proper
nursing care. Appropriate public health program incorporating NGO’s in healthcare set-up are
necessary. Our-NGO used locally-available Complementary –Indian-Medicines [CAM] for
providing home-based-care. Aims: 1. provide CAM as supportive therapy 2. Evaluate cost-
efficacy/responses of CAM . 3. Develop policy paper Method: 217 patients of CRS
included, age 30-60 years enrolled. 60% females, 40% males. 80% returned to villages after
prolonged therapy in city hospitals on allopathic-drugs. subjects treated with Bach-flower
remedy 40%, Accupressure/Accupuncture 57%, Hydrotherapy 24%, Hypnotherapy 75%,
ayurvedic-therapy 82%, 26% Unani Medicines, 61% Homeopathic-medicines, 72% on Herbal-
Oil-TFH massage -therapy, 58% Aromatherapy. 8 sessions CAM. feedback
Performa responses evaluated. Sneezing/Rhinorrhea recorded scale of 1-10. mean score
pain fell from 8.2 (SD 1.4) to 3.8 (SD 2.7) point(p<0.001). Self report-
questionnaire evaluated Results: Group-1 H1-blockers [n=60], Group-2 CAM
[n=122], Symptom relief(n=90), Gr-1 preferred CAM to std drugs(n=95). CAM 52%
cheaper compared to Allopathic medicines. CAM-available locally/high-
acceptance. Conclusion: 184 patients preferred CAM. At ERS-2023 We unite
with researchers from USA/Europe to develop this policy to exchange
experiences/knowledge. conclusion/Recommendations: ERS must form common guideline
manual on CRS. We graphically show our project to all participants

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1233
Cycling Therapy for Eosinophilic Chronic Rhino-Sinusitis

Mikiya Asako1

1
Department of Otolaryngology, head & neck surgery

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Eosinophilic chronic rhino-sinusitis (eCRS) is refractory and recurrent even after surgical
treatment, and is often difficult to treat. About 80% of patients with eCRS have asthma, and
comprehensive control of upper and lower airway inflammation is important. Five biologics
are currently indicated in Japan, of which dupilumab, an anti-IL-4/IL-13 receptor antibody, is
the only one indicated for CRS W NP. However, all of the formulations have shown some
efficacy in eCRS and given that many of the formulations are in international phase III trials, it
is likely that in the near future the treatment ofeCRSwill involve the same issues of selecting
and switching biologics as in the treatment of asthma. The advent of Dupilumab has marked
a paradigm shift in the treatment of eCRS.Dupilumab's strong efficacy has been a relief to
many patients with eCRS, which in our data is over 90% effective, but there are some low
responder patients. In some cases, eosinophils are more involved and IL-4/IL-13 suppression
is insufficient to control upper and lower airway inflammation. We report a case in which
both asthma and eCRS were successfully controlled by systematically switching between anti-
IL-5 and anti-IL-5R antibodies and anti-IL-4/IL-13 receptor antibodies.

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1319
Relationship of lesion location to postoperative steroid use in eosinophilic chronic
rhinosinusitis

Miyamura Kosuke1, Nakashima Daiki1, Miura Masahiro1, Chiba Shintaro1, Otori Nobuyoshi1,
Eri Mori1

1
Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Objectives: Eosinophilic chronic rhinosinusitis (ECRS) is known to recur after surgery. The
treatment choice for recurrent ECRS, such as oral steroids or biological agents, must be chosen
carefully, and identifying the lesion location may be helpful. This study aimed to evaluatethe
postoperative course of ECRS patients and assess the relationship between endoscopic lesion
location and postoperative oral steroid use.Methods: Patients with ECRS who underwent
bilateral endoscopic sinus surgery from April 2018 to March 2020 were divided into two
groups based on the presence or absence of oral steroid use after surgery. We evaluated and
compared the lesion location on endoscopic findings during surgery in these two groups:
middle turbinate, middle meatus, superior turbinate, superior meatus, nasal septum, and
sphenoethmoidal recess.Results: Eighty-eight patients were diagnosed histologically with
ECRS (mean 48.98 ± 1.40 years, 67 males / 21 females), 23 patients were steroid-using, 65
patients were steroid-free. Patients with sphenoethmoidal recess lesions were significantly
more likely to require steroids (p=0.019) after surgery.Conclusion: A sphenoethmoidal recess
lesion may be a risk factor for requiring postoperative steroids. This finding calls for more
appropriate use of steroids in the postoperative management of ECRS.

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1320
Eosinophilic pneumonia caused by the treatment for chronic rhinosinusitis with nasal
polyps.

Mikiya Asako1, Airi Asako1

1
Otorhinolaryngology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi-shi,
Osaka, Japan

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Eosinophilic pneumonia is related to eosinophils for their mechanisms. It occurred by

infiltration of eosinophils to lung tissues. It is thought to be caused by medicines, fungi,
parasites, and other agents, but the cause is often unknown. Chronic rhinosinusitis with nasal
polyps (CRSwNp) is also eosinophil-related disease that is often associated with bronchial
asthma, so it is important to keep in mind that the complications of lower respiratory tract
lesions disease. This is one of the concepts of “Global airway disease” introduced in EPOS2020.
Eosinophilic pneumonia is often associated with increasing of eosinophil, severe dyspnea
without wheezing, and a strong pulmonary infiltration shadow. Although it is not easy for
otolaryngologists to diagnose eosinophilic pneumonia associated with CRSwNp, which is a
common complication of asthma, during COVID-19 epidemic. Dupilumab, an anti-IL-4/ IL-13
receptor antibody, has recently received attention for its high therapeutic effect in the
treatment of CRSwNp. We have reported that Dupilumab inhibit the migration of eosinophils
from blood vessels to the local tissues, resulting in a temporary increase of eosinophil in blood.
There have also been scattered reports of eosinophilic pneumonia during Dupilumab
administration. In this presentation, we report a case of eosinophilic pneumonia occurred
during treatment of CRSwNp, then discuss significant points in treatment.

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1330
A case of recurrent chronic eosinophilic pneumonia during dupilumab administration

Daiki Nakashima1, Eri Mori1, Nobuyoshi Otori1

1
Department of Otorhinolaryngology, The Jikei University School of Medicine

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Dupilumab (a humanized immunoglobulin-G4 monoclonal antibody) inhibits IL-4Rα and

suppresses the type2 inflammation. We need to administer it carefully, because it occurs an
increase in blood eosinophil counts due to a decrease in local eosinophil counts, sometimes
resulting in eosinophilic pneumonia or eosinophilic granulomatosis with polyangiitis. We
report a case of recurrent chronic eosinophilic pneumonia during dupilumab administration.
A 54 years old man (He had a history of eosinophilic pneumonia) started dupilumab
administration because his nasal symptom worsened regardless of twice sinus surgery. The
symptom showed steady improvement, the regular prednisolone (5mg/day) was gradually
reduced by 1mg. However, at the six months after dupilumab administration, he came to the
hospital with symptoms of cough, fever and phlegm. Chest Computed Tomography showed
right airspace consolidation predominantly in peripheral region and the eosinophil counts in
the blood were also markedly increased. Trans-bronchial lung biopsy also showed evident
eosinophil infiltration in bronchoalveolar lavage and lung. The patient was diagnosed
with eosinophilic pneumonia and received steroid pulse therapy. Finally, he recovered from
these symptoms. We need to monitor the eosinophil trends and pulmonary symptoms when
using dupilumab.

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1344
Odontogenic maxillary sinusitis - case report

Marta Dzięgielewska1, Małgorzata Buksińska2, Anna Olszewska-Staroń1, Piotr Henryk

Skarżyński1

1
Institute of Physiology and Pathology of Hearing, World Hearing Center, Poland, 2Institute of
Physiology and Pathology of Hearing, World Hearing Center, Poland

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Backgroud: One of the sinus complications after tooth extraction is the insertion of the tooth
root into the sinus. This can lead to odontogenic maxillary sinusitis, which accounts for 5-40%
of all chronic sinusitis. Odontogenic maxillary sinusitis has similar clinical symptomatology
compared to rhinogenic sinusitis. Case report: Case of a patient who was admitted to the
Institute of Physiology and Pathology of Hearing in Warsaw due to chronic sinusitis, many
months after tooth extraction. She reported pain in the projection of the maxillary sinus and
nasal blockage. In CT scan, massive changes in the sinus and the tooth root in the lumen of
the sinus. Treatment was based on endoscopic root removal. Conclusion: Endoscopic surgery
of the paranasal sinuses is currently most often used to remove foreign bodies, displaced
tooth roots and inflamed mucosa, while preserving the physiological function of the sinuses.
The Caldwell-Luc access is now less commonly used and recommended for wider sinus access.

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1713
Real-Life Experience of Monoclonal Antibodies in patients with Chronic
Rhinosinusitis with Nasal Polyposis

Sereina Küng1, Yves Brand2

1
Kantonsspital Graubünden, Department of Otorhinolaryngolgy, Chur, Switzerland and University
Basel, Switzerland, 2Department of Otorhinolaryngology, Kantonspital Graubünden, Chur, Switzerland

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

GoalsThe goal of this study is to compare five different antibodies in terms of effectiveness
regarding nasal symptoms and asthma.Material and MethodsWe retrospectively analyzed
the data of 15 patients treated with monoclonal antibodies. Previous history of nasal
surgery, steroid use, blood eosinophilia, nasal polyp scores, SNOT-20, smell and asthma
control were analyzed.ResultsThe 15 patients have received a total of 30 different therapies
with monoclonal antibodies. There is a positive effect of the monoclonal antibodies on
asthma and chronic rhinosinusitis symptoms. In our study, there is a trend that dupilumab
has the most pronounced effects on nasal symptoms. No major differences between
mepolizumab and benralizumab were observed.Conclusion Our analysis shows that most
patients benefit significantly from the treatment. Dupilumab has the most pronounced
effects on nasal symptoms in our study.

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1738
BIOLOGICAL THERAPY IN THE TREATMENT OF PATIENTS WITH RSCPN; ARE THEY A
REAL LIFE SAVE FOR OUR PATIENTS?

Cristina Garcia Garcia, Adriana Pardo Maza, Ithzel Villarreal Patiño, Gabriela Bosco Morales,
Mar Martínez Ruiz-Coello, Estefanía Miranda Sánchez, Guillermo Plaza Mayor

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

A retrospective study has been carried out, in which patients with CRScNP and asthma treated
with biological therapy at the University Hospital of Fuenlabrada have been included.
Biological treatments were administered to 21 patients who, in addition to suffering from
severe asthma, presented CRScNP. 63.6% of the patients underwent FESS an average of 1.6
times before starting the biologic, while only one patient required surgery during treatment.
Functional FESS was performed in 69% and radical-Draf-3 FESS in 31%. 33% are being treated
with mepolizumab, 23% with reslizumab, 19% with benralizumab, 14% are being treated with
omalizumab, and 4% with dupilumab. 66% of them required changing biological therapy. The
mean time in treatment with biologics was 41.28 months. Two patients presented adverse
effects with benralizumab, and only one required to change the biological therapy The Lund-
Mckay classification improved 4 points after therapy. In the NPS score, they represented an
improvement of two points after treatment with biologics with a statistically significant result
with p<0.001. Regarding the variables collected on the VAS scale, the improvement was 2
points in the case of nasal obstruction, nasal congestion and rhinorrhea, and 3 points in the
sensation of facial pressure. The results were statistically significant with a p<0.001 except in
the case of smell.

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1742
CRSwNP patients using biologicals: real-world experience in a reference center

Wilma Anselmo-Lima1, Vanessa Dinarti1, Gabriela Silveira1, Otavio Mieli1, José Lemos2,
Denny Garcia1, luisa Arruda2, Fabiana Valera1, Edwin Tamashiro1
1
Department of Ophthalmolgy, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical
School, University of São Paulo, 2Internal Medicine Department, Ribeirão Preto Medical School,
University of São Paulo

Poster Session | CRS – medical management | 18 June – 22 June, 2023, All day

Background: CRSwNP is predominantly a type 2 inflammatory disease in Western populations.

In difficult-to-control patients, anti-type 2 biologicals have been shown to be an effective
rescue treatment. However, there are limited data on CRSwNP patients undergoing biologicals
outside Europe and the US. Aim: To evaluate outcomes in difficult-to-control CRSwNP patients
undergoing dupilumab treatment in a reference center. Methods: 24 patients from São Paulo,
Brazil, unresponsive to conventional treatments who received dupilumab for at least 3
months were evaluated by blood eosinophil counts, Lund–Kennedy (LK) endoscopic score,
SNOT-22, and olfactometry. Pre and post-treatment parameters were compared. Results:
Patients presented a mean age of 49.4 years, 69% had AERD and 23.1% had asthma associated
only. Median blood eosinophilia was 600 cells/uL (P25-75= 350-1000) Median time of
Dupilumab use was 9 months (P25-75= 5.3-16 months). Dupilumab promoted a significant
improvement in SNOT-22 scores (Δ=-34.5, p<0.0001), LK score (Δ=-4.5, p<0.0001), and
olfactory test (p<0.0001). Length time of use was associated with better outcomes in LK and
olfactory test, but not for SNOT-22. Three patients discontinued the use of dupilumab (despite
sinonasal symptoms were controlled) due to adverse events. Conclusions: In our center, most
of patients experienced a significant improvement in symptoms and objective measures in
patients with CRSwNP treated with with Dupilumab. Prospective follow-up is necessary to
better elucidate long-term efficacy and incidence of side effects.

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CRS – outcome assessment

1722
Comparative short-term efficacy of endoscopic sinus surgery and biological therapies
in chronic rhinosinusitis with nasal polyps: a network meta-analysis

Jiani Chen1, Huan Wang1, Chen Zhang1, Li Hu1, Xicai Sun1, Qianqian Zhang1

1
ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University,
Shanghai 200031, PR China

Poster Session | CRS – outcome assessment | 18 June – 22 June, 2023, All day

To compare the safety and efficacy between endoscopic sinus surgery and different biologics
in treating chronic rhinosinusitis with nasal polyps in adults through reviewing the existing
clinical trials. We included randomized controlled trials involving endoscopic sinus surgery
(ESS) or biologics in treating adult patients with chronic rhinosinusitis with nasal polyps.
Studies involving other miscellaneous diseases, non-RCT design, and insufficient participants
or follow-up were excluded. In this systematic review, five RCTs and 1748 patients were
included. All the biologics, as well as ESS, could significantly improve key nasal outcomes in
CRSwNP . Dupilumab exhibited better efficacy versus ESS in improving SNOT-22 scores even
at one year. However, ESS showed its superiority over three biologics in improving nasal
congestion scores (NCS) both at 6 months and 1 year, except for better efficacy of Dupilumab
at 1 year. For loss of smell scores, a greater improvement was observed in Dupilumab cohort
compared with other biologics and even ESS counterparts. Safety analysis showed no
significant difference between the ESS cohort and biologics treatment. In summary, ESS
showed comparable improvement of quality of life and symptoms to Omalizumab,
Mepolizumab, and Benralizumab. Dupilumab seems to be more effective than ESS in selected
items, whereas head-to-head trials and real-world studies are urgent to compare their
efficacy. Our findings also supported that biologics could be applied as alternative or adjuvant
therapy for uncontrolled severe CRSwNP.

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1312
Efficacy of dupilumab in eosinophilic chronic rhinosinusitis associated with
eosinophilic otitis media

Mami Sato1, Ayami Nomura1, Jyunko Takahata1, Reiko Kudo1, Yuu Hukuoka1, Daisuke
Matsushita1, Tomoaki Fujita1, Atsushi Matsubara1

1
Department of Otorhinolaryngology,Hirosaki University School of Medicine & Hospital

Poster Session | CRS – outcome assessment | 18 June – 22 June, 2023, All day

Introduction: Eosinophilic chronic rhinosinusitis (ECRS) is characterized by nasal polyps with

eosinophil infiltration and frequently recurs after surgery, and is often associated with
bronchial asthma ,and sometimes eosinophilic otitis media (EOM). EOM is persistent otitis
media with mucinous middle ear effusions, marked eosinophilic inflammation, and a high risk
of progressive hearing loss. Recently, the IL-4Ra monoclonal antibody (dupilumab) has been
available for the treatment of refractory ECRS, has also been reported to be effective for EOM.
In the present study, we investigated the effect of dupilumab on both diseases in ECRS
associated with EOM. Methods: Subjects were five cases administered with subcutaneous
dupilumab for at least one year. Treatment effects were assessed by nasal polyps score, nasal
obstruction score in before and after dupilumab administrarion, steroid medications per 3
months, EOM severity score. Results: Nasal polyps score and nasal obstruction score
decreased after administration of dupilumab. The frequency of steroid medications and EOM
severity scores also decreased. Conclusions: The present results indicate that the
administration of dupilumab is useful of the treatment for ECRS associated with EOM.

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1530
Social factors in the development of chronic rhinosinusitis

IOANNIS GERAMAS1, Vasileios Chatzinakis2, Argyro Leventi2, GIOLINA PAPARGYRIOU3,

CHRISTOS GEORGALAS4

1
HYGEIA HOSPITAL, 2Endoscopic Skull Base Centre Athens, Hygeia Hospital, 4 Erythrou Stavrou Str. &
Kifisias Av., 151 23 Marousi, Greece, 3Department of Endoscopic Skull Base Centre Athens, Hygeia
Hospital, 4Department of Endoscopic Skull Base Centre Athens, Hygeia Hospital

Poster Session | CRS – outcome assessment | 18 June – 22 June, 2023, All day

Introduction: In an era where prevention is paramount, understanding social factors for

chronic rhinosinusitis (CRS) may facilitate preventive interventions that mitigate risk factors
associated with the initiation or progression of the disease.Aim and objectives: In this
systematic review, we try to describe and assess the available evidence that links CRS with
social factors, such as socioeconomic status and class, educational status, family sta- tus, living
and working location and conditions, and use of toxins or recreational drugs (smoke, alcohol,
or recreational drugs) as well as exercise and diet.Method: We assessed the available evidence
linking CRS with social factors. We included articles if “sinusitis” or “rhinosinusitis” or “nasal
polyps” and either one of the previous terms were mentioned in the title or abstract. We
excluded single-case reports or small case series or publications that, following review of the
full article, were deemed to not explicitly fulfill our criteria.Results: Thirty studies from 1995
onwards fulfilled our inclusion criteria and were used for this review. Conclusion: Social
deprivation and low socioeconomic level seem to be directly associated with rhinosinusitis, as
there are pollutants in living or working environment. A clear and direct association between
smoking (both active and passive) and rhinosinusitis was also shown. However, the link
between rhinosinusitis and education level, and exercise and diet, if any, seems to be more
complex.

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CRS – pathophysiology

1723
Decreased production of tissue plasminogen activator in endothelial cells from nasal
polyps

Qianqian Zhang1, Huan Wang1, Chen Zhang1, Dehui Wang1, Li Hu1, Xicai Sun1
1
ENT institute and Department of Otorhinolaryngology，Eye & ENT Hospital, Fudan University,
Shanghai, China

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

Background: Previous studies have demonstrated that chronic rhinosinusitis with nasal polyps
is characterized by excessive fibrin deposition which is related to impaired production of tissue
plasminogen activator by epithelial cells. This study aims to evaluate whether t-PA expression
in endothelial cells is also decreased under the inflammatory milieu of CRSwNP. Methods:An
immunohistochemistry and RT-PCR analysis of polyp tissues from eosinophilic and non-
eosinophilic CRSwNPs was conducted. RNA sequencing datasets from chronic rhinosinusitis
were retrieved to evaluate endothelial cells expression of t-PA.The expression of CD31 and t-
PA was evaluated by RT-PCR and ELISA, nasal endothelial cells were stimulated with or without
retinoic acid and IL-13. Results:We observed the increased expression of pro-angiogenic genes
and vascularity in both eCRSwNP and neCRSwNP. Single-cell RNA sequencing and
immunostaining revealed that t-PA expression was decreased in endothelial cells of polyp
tissues. In vitro study, IL-13 could significantly attenuate t-PA expression in endothelial cells,
which can be rescued by retinoic acid. Conclusions: Our findings showed significant
contribution of endothelial cells in the production of t-PA in sinonasal tissues. Furthermore,
the levels of t-PA in endothelial cells could also be impaired in the inflammatory environment
of CRSwNP. Retinoic acid is a promising therapeutic reagent which could restore t-PA
expression, thus degrading the deposited fibrin in polyp tissue.

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1230
The Influence of Inhibitors of Apoptosis Proteins (IAPs) on Chronic Rhinosinusitis with Nasal
Polyps

Wilma Anselmo-Lima1, Fabiana Valera2, Ivna Passos1, Marina Fantucci1, Adriana

Murashima1, Lilian Silva1, Denny Garcia1, Francesca Faria3, Ronaldo Martins4, Eurico Arruda
Neto4, Edwin Tamashiro1

1
Department of Ophthalmolgy, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical
School, University of São Paulo, 2Ribeirão Preto Medical School, São Paulo University, 3Department of
Pathology and Legal Medicine of Ribeirão Preto Medical School, University of São Paulo, 4The Virology
Research Center of Ribeirão Preto Medical School, University of São Paulo

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

Introduction: Inhibitors of apoptosis proteins (IAPs) could have a role in the CRSwNP or
interfere with the susceptibility of NP with topical nasal corticosteroids Objectives: To
compare the expression of IAPs between patients with CRSwNP and controls, to associate the
expression of IAPs with the response to nasal corticosteroids, and to correlate the expression
of IAPs to inflammatory markers. Methods: We obtained nasal biopsies from patients with
CRSwNP (n=27) and controls (n=16). The gene expression of IAPs (XIAP, BIRC2/IAP1 and
BIRC3/IAP2) and caspases (CASP3, CASP7, CASP9 and BCL2) were measured by qRT-PCR. The
dosages IFN-α, IL-5, IL-33, IL-10, IL-17, and TGF-β were measured by the Luminex. Principal
Component Analysis (PCA) was used to correlate the expression of the markers with the
response to nasal corticosteroids in the patients. Results: We found lower expression of the
three IAP genes and significantly higher expression of the cytokines INF-α, IL-5, and TGF-β in
patients compared to controls.BIRC2/IAP1 expression was significantly associated with poor
response to topical corticosteroids. PCA analysis identified that BIRC2/IAP1, XIAP, BCL2,
CASP9, IL-17 and IL-33 were increased in patients with better clinical response, while CASP7
and TGF- β were related to worse response to treatment. Conclusions: Our data suggest that
the decrease in IAPs expression is significant in the CRSwNP pathophysiology and may predict
worse outcome to clinical treatment.

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1259
The influence of parenteral vaccination against influenza on the clinical and immunological
condition of patients with chronic inflammatory diseases of the upper respiratory tract in
the remission phase

Diana Zabolotna1, Oleh Melnykov2, Maryna Sambur3, Oksana Rylska2, Natalia Peleshenko2,
Dmytro Zabolotnyi4, Tetiana Smahina2

1
Department of Rhinology, Allergology and Radiology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sci, 2Kolomiychenko Institute of Otolaryngology of National Academy of
Medical Sciences of Ukraine, 3Deputy director, Kolomiychenko Institute of Otolaryngology of National
Academy of Medical Sciences of Ukraine, 4Director, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sciences of Ukraine, 5Institute of Otolaryngology named after prof. O.
Kolomiychenko of the National Academy of Medical Science of Ukraine, Kyiv, Ukraine

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

One of the main sources of exacerbation of chronic inflammatory diseases (CID) of the
respiratory tract is respiratory viral infection (RVI), which facilitates bacterial colonization,
changes local protective mechanisms in respiratory tract, leads to easier adhesion of bacterial
cells, which increases inflammation, leads to increased symptoms diseases. The purpose of
the study was to determine the condition of patients with upper respiratory tract infection in
dynamics after systemic vaccination against influenza. It was shown that the administration
of influenza vaccine to patients with CID, who already had protective immunity against
influenza viruses, after 3 weeks led to increase in the frequency of detection of antibodies to
viral hemagglutinins in titers higher than the minimum clinically significant level from 59% to
84% with a decrease to 57% 3 months after vaccination. Within 9 months after vaccination, a
decrease in the number of episodes of acute RVI in patients was observed to 15.6%. The
clinical course of the main disease occurred without characteristic frequent exacerbations.
This was accompanied by a stimulating effect of vaccination on a number of non-specific
indicators of systemic and local immunity and a decrease in the amount of transient microflora
in the oropharyngeal secretions of such patients.

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1326
A distinct nasal eicosanoid signature in severe refractory chronic rhinosinusitis with
nasal polyps

Axel Nordström1, Mattias Jangard2, Marie Svedberg1, Michael Ryott2, Maria Kumlin1

1
Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden,
2
Department of Otorhinolaryngology, Sophiahemmet Hospital, Stockholm, Sweden

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

Arachidonic acid derived leukotrienes (LTs) and prostaglandins (PGs), i.e., eicosanoids, are
implicated in the disease severity of chronic rhinosinusitis with nasal polyps (CRSwNP).
However, their role in refractory CRSwNP is not well understood. We aimed to identify
potential endotypes based on nasally secreted eicosanoid levels by cluster analysis. Nasal
secretions and NP tissues from 38 patients with CRSwNP, destined for sinus surgery, were
collected at surgery and NP recurrence was assessed endoscopically 12-months post-surgery.
Levels of PGD2, PGE2, LTB4, LTE4, and 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) were
measured with specific immunoassays. Potential heterogenous eicosanoid patterns were
explored and compared with clinical characteristics of refractory disease. Clustering identified
three patient subgroups (clusters) with clinically relevant differences. Cluster 1 and 3 were
characterised by high and low eicosanoid levels, respectively. Cluster 2 featured higher levels
of PGD2 and LTE4, lower levels of PGE2 and LTB4, more cases of recurrent NPs and previous
NP removal by surgery. Levels of eicosanoids in NP tissue as well as health-related quality of
life will also be discussed in relation to NP recurrence. In conclusion, our findings suggest that
endotypes with distinctively different nasal eicosanoid signatures is present in CRSwNP which
may be used to identify the most severe and refractory cases prone to recurrent NP growth.

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1364
Effect of CHI3L1 on SERPINE1 mediated Fibrinolytic System Imbalance in Chronic
Rhinosinusitis with nasal polyp

Yang Hyun-Woo1, Shin Jae-Min1, Moon Jee Won1, Son Hyeong Guk1, Jo Yeong In1, park joo-
hoo1, Park Il-Ho1

1
Korea University College of Medicine

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and sinuses affecting over
10% of adults worldwide. CRS is classified into types based on immune response and
distribution of immune cells. Th2-based inflammation and eosinophilic dominant CRS are
associated with tissue remodeling and impaired fibrinolytic system. Using gene analysis, DEG
analysis, KEGG and GO analysis, and sc-RNA-seq data, we found that in nasal polyp tissue, the
expression of PAI-1, u-PA, and u-PAR was up-regulated, and the expression of t-PA was down-
regulated. Genes related to the fibrinolytic system had a significant positive correlation with
the expression of IL-6 and Th2 cytokines. CHI3L1 (YKL-40) was significantly increased in
differentiated EOL-1 and induced fibrin deposition by impairing the fibrinolytic system in
fibroblast and epithelial cells. Inhibition of CHI3L1 suppressed these alterations, suggesting
that regulation of CHI3L1 may be a potential treatment for eosinophilic CRS.

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1408
The influence of nasal microbiota on the development of chronic rhinosinusitis

Vjeran Bogović1, Stjepan Grga Milanković1, Anamarija Šestak1, Hrvoje Mihalj1, Željko Zubčić1

1
Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, Osijek

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

Numerous studies assume a harmful influence of bacteria on the development of chronic

rhinosinusitis (CRS), but there are conflicting opinions where it is considered that certain
microbiota have a protective effect on the mucous membrane against the development of
CRS.We have analyzed data from 80 patients, of which 55 were with CRS with nasal polyposis
(CRSwNP) and 25 control patients without CRS. Patients with CRSwNP were further divided
into two groups; with and without a significant level of eosinophils in the nasal swab. A
bacteriological swab of the right maxillary sinus was taken in all patients and analyzed by
MALDI TOF. Allergological treatment of patients included nasal swabs for eosinophils and total
IgE levels. All patients filled out the SNOT-22 questionnaire.The most frequently isolated
bacteria in all three groups of patients was E.coli and Citrobacter spp., but with no significant
difference compared to the number of other isolated bacteria (p=0.2). Patients with CRSwNP
who do not have a significant level of eosinophils in the smear have a significantly higher score
of the SNOT-22 questionnaire (p=0.01). There is no difference in the findings of bacteria of
patients with CRSwNP and patients without CRS. Further studies should resolve the role of the
microbiome in CRS.

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1528
The INHERITED LEVEL of IL-1β and IL-4 PRODUCTION as the RISK FACTORS of the
CHRONIC SINUSITIS in CHILDREN

Svitlana Levytska1

1
Department of pediatric surgery and otolaryngology, Bukovinian State Medical University, Chernivtsi,
Ukraine

Poster Session | CRS – pathophysiology | 18 June – 22 June, 2023, All day

Introduction The mutations of the interleukins genes may determine the balance between
cytokines production and affect the development of chronic inflammatory processes of the
paranasal sinuses. Aim The evaluation of the association between the single nucleotide
polymorphism (SNP) of the IL-1β gene (C-511T) and the IL-4 gene (C-590T) and chronic
rhinosinusitis (CRS) development in children. Patients and Methods We examined 100
children with CRS and 35 children of the control group (CG). All children were genotyped for
the IL-1β (C-511T) SNP and the IL-4 (C-590T) SNP by polymerase chain reaction and restriction
analysis. Results The mutant T-allele of С-511Т SNP of IL-1β gene was associated with
increasing of IL-1β production (71,17±3,23 pg/ml vs. 62,21±2,17 pg/ml; p<0,05) as well as the
mutant T-allele of С-590Т SNP of IL-4 gene was associated with increasing of IL-4 production
(65,73±3,98 pg/ml vs. 46,03±1,37 pg/ml, p<0,05). Significantly higher frequency of the T-allele
of the IL-4 SNP was revealed in CRS-children (43,5% vs. 24,3%, p<0,05). The CC-genotype of
the IL-1β dominated in the CRS-children (46% vs. 22,9%, OR - 2,9 (CI-1,2-6,9)) as well as
domination of the CT-genotype (65% vs. 42,9%, OR-2,5(CI-1,1-5,4)) and TT-genotype (11% vs.
2,9%, OR-4,2 (CI-0,5-33,8)) of the Il-4 SNP was revealed in CRS-patients. Discussion The T-allele
of the IL-1β (C-511T) SNP can be the protective factor whereas the T-allele of the IL-4 (C-590T)
SNP increases the risk of the development of the chronic sinusitis.

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1716
Histological Analysis of Respiratory Epithelial Adenomatoid Hamartoma

Tsuguhisa Nakayama, Shin-ichi Haruna1

1
Department of Otorhinolaryngology and Head&Neck Surgery, Dokkyo Medical University

Poster Session | CRS – pathophysiology | 19 June – 22 June, 2023, All day

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion that was first
described in 1995. REAH is a type of hamartoma, which is a developmental malformation that
results in the formation of disorganized tissue. Histologically, REAH is characterized by the
presence of secretory glands that are lined by respiratory epithelium-derived lineal
epithelium, and which extend from the surface epithelium into the subepithelial mucosa. To
gain a better understanding of the histological characteristics of REAH, this study employed
immunohistochemical staining to investigate the expression of various epithelial markers,
including Cytokeratin 5, p63, Cytokeratin 8, α-tubulin, and Mucin 5AC. The distribution of
these markers was examined in both epithelial mucosa and subepithelial mucosa in normal
tissue, chronic rhinosinusitis, and REAH cases. The findings revealed that certain types of nasal
polyps in chronic rhinosinusitis with submucosal glandular hyperplasia have a similar structure
to REAH, and that there is also a substantial amount of glandular tissue in normal tissues.
Nevertheless, the glandular cells of submucosal tissue are differentiated from those of normal
tissue by their positive expression of Mucin 5AC, and from those of nasal polyps in CRS by
their positive expression of α-tubulin.

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1637
Effect of topical thrombin on visual field quality for functional endoscopic surgery: a
double-blind randomized controlled study

Zhiqi Ma1, Yong Li1

1
Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine

Poster Session | CRS – surgical management | 19 June – 22 June, 2023, All day

Objective: To investigate the effect of topical thrombin application on the improvement of

surgical field bleeding and surgical field improvement in functional nasal endoscopic sinus
surgery. Methods: From January 2021 to October 2021, 60 patients with chronic sinusitis were
enrolled in the nasal endoscopic sinus surgery in Hangzhou First People's Hospital. In the
intervention group, 30 patients were dissolved in normal saline with thrombin lyophilized
powder to rinse the surgical cavity (5000U: 500ml normal saline), and the control group was
washed with normal saline. The retrospective surgical videos were reviewed by a third party
using blind Boezaart grading to assess blood loss and surgical field quality 15, 30, and 45
minutes after the start of surgery. Results: The surgical field quality in the intervention group
was better than that in the control group, with the first time (P = 0.002) and the second time
(P = 0.003), but not in the third quarter (P = 0.163). In addition, the amount of blood lost in
each period was significantly lower in the intervention group than in the control group (P =
0.001). Conclusion: Topical thrombin can effectively reduce bleeding in FESS patients and
improve surgical sinusitis. Based on these findings, topical thrombin lyophilized powder may
be a useful method to provide a suitable surgical field for surgery.

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1801
Association between smoking and outcomes following functional endoscopic sinus
surgery for chronic rhinosinusitis: a systematic review and meta-analysis

Jing-Wen Claire Tan1, Bryan Hao Wei Leow1, Benjamin Kye Jyn Tan2, Fong-Jun Sean Tan3, Tze
Choong Charn4, Neville Wei Yang Teo5

1
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Yong Loo Lin School of
Medicine, National University of Singapore, 3Lee Kong Chian School of Medicine, Nanyang
Technological University, Singapore, 4Departments of Otorhinolaryngology—Head & Neck Surgery,
Sengkang General Hospital, Singapore, 5Department of Otorhinolaryngology—Head & Neck Surgery,
Singapore General Hospital, Singapore

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

Objective: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease which can be

treated with functional endoscopic sinus surgery (FESS). Some clinicians avoid FESS in smokers
due to a perception of poorer surgical outcomes. We aim to clarify if first-hand cigarette
smoking in CRS is associated with quality of life (QOL), olfactory function, CT and endoscopy
scores following FESS. Methods: Three reviewers extracted data and evaluated study bias
using the Newcastle-Ottawa scale and Cochrane Risk of Bias tool, following PRISMA guidelines
and a PROSPERO-registered protocol (CRD42022345585). We used random-effects meta-
analyses to determine the association of smoking with QOL in CRS before and after FESS. We
also performed descriptive analysis of olfactory function, CT scores and endoscopy scores in
both groups before and after FESS. Results: We included 2 cross-sectional studies, 4 cohort
studies, and 1 prospective clinical trial. Post-FESS QOL was similar among non-smokers and
smokers (standardized mean difference =-0.09, 95%CI=-0.52-0.34, N=3, I2=75%). Descriptive
analysis showed no significant correlation of smoking with post-FESS olfactory function and
endoscopy scores. Conclusion: Smoking is not associated with poorer QOL, olfactory function
or endoscopy scores after FESS. The evidence does not support excluding patients from FESS
on the basis of smoking status alone.

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1136
Anterior Nasal Artery - A Key Landmark for Frontal Surgery

Andre Machado1, André Machado2, Hans Rudolf BRINER, Daniel Simmen3, Francisco Alvarez4

1
Faculdade de Ciências da Saúde - Universidade da Beira Interior, 2Otolaryngology Department,
CHUSA, Porto, Portugal, Faculdade de Ciências da Saúde - Universidade da Beira Interior, Covilhã,
Portugal, 3ORL-Zentrum, Hirslanden Klinik, Zurich, Switzerland, 4Faculdade de Ciências da Saúde -
Universidade da Beira Interior, Covilhã, Portugal

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

The position of the anterior ethmoidal artery (AEA) is also challenging when an approach to
the frontal sinus is planned – the AEA with its nasal branch is located at the most posterior
extent of dissection, near the first olfactory fibre, with its injury leading to retraction of the
vessel behind the orbit ultimately leading to a retro-orbital hematoma. Therefore, a
dissection of 20 halves of a dry injected skull was performed in order to understand the
location of the anterior nasal artery in relation to lamina cribrosa and first olfactory fibre and
also to determine its utility as a landmark to the correct coronal trajectory into the frontal
sinus away from the anterior skull base.It was found that in 100% of the specimen, the nasal
branch of the AEA is located anterior to the first olfactory fibre, being the first medial and
anterior structure in the lamina cribrosa area. The authors consider that the landmarks
proposed by the authors are useful when the frontal sinus is approached.

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CRS – surgical management

1200
Difficulties in FESS, and how can be resolved?

Khaled Mohamed Bofares, khaled bofares1

1
faculty of medicine-Omar ALmoukhtar university

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

Abstract FESS is considered now days as one of common and basic surgical
procedures in rhinology. Although it constitutes one of effective, preservative and functional
surgeries in rhinology but still it may be associated with some significant technical difficulties
that interfere with the proper performance of this procedure. Therefore, this will result in
increase the risk of intra-operative complications as well as post-operative residuals and
recurrences of different pathologies. For this reason and according to our own experience, we
tried through this overview to focus on some of these common difficulties and we tried in
same time to describe the most helpful ways to overcome these possible difficulties and find
out the best practical solutions for them. Key words: FESS difficulties, intra-
operative FESS difficulties, technical FESS difficulties

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1282
Unexpected foreign body of maxillary sinus

Vladimir Ljubić, Vladimir Ljubic1, Predrag Kavaric2, Marija Abramovic3

1
Department for endoscopic surgery of Otorhinolaryngology clinic, Clinical center of Montenegro,
2
Clinic for maxillofacial surgery, Clinical center of Montenegro, 3Radiology Clinic, Clinical center of
Montenegro

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

First case:In the first half of 2019, the dentist started treating the patient and implanting the
implant in the upper right jaw, but due to the Covid 19 pandemic, the treatment was stopped.
After year and a half he visit dentist, and found there is no implant in the upper jaw. An X-ray
panoramic orthography was taken and an implant was found outside the bone, completely in
the maxillary sinus on the right side. The patient was referred to the ENT, where after the CT
of the paranasal sinuses is done, presence of a metal foreign body in the maxillary sinus was
confirmed. After adequate preparation, FESS was performed under general anesthesia and
we extract dental implant. .Second case: The patient was referred to the ENT for examination
after CT of the paranasal sinuses due to suspicion of a tumor change in the left maxillary sinus
(differential dg Sinusitis chr.). Previously ophthalmologist treated him for the appearance of
ectropion on the lower eyelid on the same side. Anamnestic data obtained that more than 10
year ago he had an injury to the floor of the orbit and that he was surgically treated. After
adequate preparation, FESS was performed under general anesthesia, and when removing
the chronically altered mucosa, a foreign body was removed from the sinus, a material placed
during plastic surgery of the orbital floor - neuropatch, although there is a possibility that it is
a vascular graft.Coinclusion: Sometimes, after some surgical procedures we can expect
complication even couple of years after that procedure was done.

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1401
Surgical treatment of rhinosinusitis in AERD

Rumen Benchev1

1
Clinic of Otorhinolaryngology University Hospital Sofiamed Sofia

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

AERD is characterized with severe eosinophilic inflammation type 2 of the airways, causing
asthma and chronic rhinosinusitis with nasal polyposis. Both asthma and rhinosinusitis have
severe course which leads to frequent exacerbations of asthma and recurrence of nasal
polyposis. The main clinical characteristics of the rhinosinusitis in AERD are massive
involvement of the sinuses with nasal polyposis especially the posterior group of paranasal
sinuses, thick nasal discharge.The presentation is a short review of the contemporary surgical
concepts for treating rhinosinusitis in AERD.The goal of the surgical treatment of the
rhinosinusitis is to restore nasal breathing, to reduce the inflammatory load of the eosinophilic
infiltration of sinunasal mucosa, to open widely all the sinuses, providing anatomical
conditions for further local medical treatment. Because of its great rate of recurrence of nasal
polyposis after surgical treatment, the extend of the surgery is very important. The minimally
invasive FESS directed only to the most prominent pathology by opening the natural ostia of
the sinuses and reestablishing of their ventilation is not efficient in AERD. On the other hand,
more radical surgery with stripping of the inflamed mucosa, thus removing the reservoir of
eosinophils, leads to less recurrence, but it results scaring and new bone formation. At the
present moment wide opening of all the sinuses and removing of all the polyps up to their
basement with leaving the underlying mucosa is one of the recommended attitudes to the
surgical treatment of the rhinosinusitis in AERD.

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1430
COMBINED-APPROACH SURGERY FOR POTT’S PUFFY TUMOR DRAINAGE

Rita Peça1, João Rosa1, Rita Fernandes1, Mariana Correia1, Diogo Tomé1, Pedro Correia-
Rodrigues1, Leonel Luís1

1
Centro Hospitalar Universitário Lisboa Norte

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

Background: Pott’s puffy tumor (PPT) is a rare clinical entity characterized by a subperiosteal
abscess associated with osteomyelitis of the frontal bone. It usually occurs as a complication
of frontal sinusitis or trauma and is mostly seen in young adolescents. Methods: Clinical case
report of two PPT in adult patients. Results: Case 1: 37-year-old male admitted to the
emergency room with a history of visual impairment and progressive swelling of the
forehead.Case 2: 31-year-old male referred from the HIV outpatient clinic with frontal
headaches and recurrent swelling of the forehead over the previous month.PPT was
diagnosed by CT scan and MR. Both patients were immediately started on broad-spectrum
antibiotics (ceftriaxone in meningeal prophylaxis regimen) and intravenous corticosteroids.
Combined-approach surgery was performed to drain the abscess and ensure adequate sinus
ventilation (supraciliary/frontal incision with frontal sinusotomy and endonasal endoscopic
fronto-ethmoidectomy). In both cases, antibiotics were maintained over a long course of 6
weeks and there was no recurrence on follow-up after one year. Discussion: Both cases
highlight the importance of proper diagnosis and treatment of PPT for optimal outcomes,
namely avoiding potentially life-threatening intracranial complications. Although endoscopic
endonasal surgery is the gold standard treatment for complicated rhinosinusitis, classic
external approaches may still have a role in difficult-to-reach areas or when osteomyelitis is
present.

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1549
INVERTED PAPILLOMA FROM DIAGNOSIS TO TREATMENT

Adriana Neagos1, Cristian Mircea Neagos2, Alexandru Szabo2, Anastasia Balta2

1
University of Medicine Ppharmacy Science and Technology GEORGE EMIL PALADE of Targu Mures,
2
Emergency County Hospital of Targu Mures

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

Inverted papilloma is a tumor that occurs in adults 5th decade old. It produce a local
destruction, high rate of recurrence , and high risk of carcinomatous evolution. The etiology
is very little understood, but the early diagnosis is very important. The treatment is a surgical
one, but the endoscopic or external approach depending on extension. The seriousness of this
pathology lies in its association with carcinoma, which may be diagnosed at the outset or at
recurrence during follow-up.We have evaluate the incidence of sino-nasal inverted papilloma
at the patients with chronic rhinosinusitis with unilateral intranasal polips, and the time for
the recurrence after the first surgery. We have connected the results with occupational and
industrial exposures , with smoking, and other factors. Surgical procedures of sinonasal
inverted papilloma are planned . Origin targeted surgery and proper management of the site
of attachment are the key to achieve complete surgical resection of sinonasal inverted
papilloma. The advantages of endonasal method are small beeding, leaving maxillary sinus
and and inferior turbinate. Disadvantages and limits of the method are: not possible to
remove the tumor from frontal sinus, difficulty in removing the tumor from prelacrimal sac
recess

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1622
Efficacy of prophylactic preoperative desmopressin administration during functional
endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and
metaanalysis of randomized placebo-controlled trials

ahmad alharthi1, Alrajhi ABDULLAH3, Alghamdi Abdullah Shakhs1, Baali Mohammed Hassan5,
Altowairqi Abdulaziz Fahad6, Khan Meshal7, Albazee Ebraheem8, AHMED ABU-ZAID9

1
Department of Otolaryngology and Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif,
Saudi Arabia., 2ORL , HEAD AND ENCK SURGERY , ALHADA HOSPITAL FOR ARMED FORCES , TAIF ,
SAUDI ARABIA , 3Department of Otolaryngology and Head and Neck Surgery, Al-Noor Specialist
Hospital, Makkah, Saudi Arabia., 4Otolaryngology - Head and Neck Surgery, Alhada Hospital for Armed
Forces, Taif, SAU, 5Department of Otolaryngology and Head and Neck Surgery, King Faisal Medical
Complex, Taif, Saudi Arabia., 6Department of Otolaryngology and Head and Neck Surgery, King
Abdulaziz Specialist Hospital, Taif, Saudi Arabia., 7Department of Otolaryngology and Head and Neck
Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia, 8Kuwait Institute for Medical
Specializations, Kuwait City, Kuwait, 9College of Graduate Health Sciences, University of Tennessee
Health Science Center, Memphis, Tennessee, USA.

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

Objectives: To examine the efficacy of prophylactic desmopressin versus placebo among

patients undergoing functional endoscopic sinus surgery (FESS).Design: Systematic review and
meta-analysis of randomised controlled trials (RCTs).Setting: The Cochrane Central Register of
Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were
screened from inception until 18 March 2022.Participants: Patients undergoing FESS.Main
outcome measures: Primary efficacy endpoints comprised intraoperative blood loss, visual
clarity, and operation time. Secondary endpoints comprised side effects. The efficacy
endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence
interval (CI).Results: Five RCTs comprising 380 patients (desmopressin = 191 patients and
placebo = 189 patients) were included. Collectively, the included RCTs had an overall low risk
of bias. The pooled results showed that the mean intraoperative blood loss (n = 5 RCTs, MD =
-37.97 ml, 95% CI [-56.97, -18.96], p < .001), 5-point Boezaart scores (n = 2 RCTs, MD = -.97,
95% CI [-1.21, -.74], p < .001), and 10-point Boezaart scores (n = 2 RCTs, MD = -3.00, 95% CI [-
3.61, -2.40], p < .001) were significantly reduced in favour of the desmopressin group
compared with the placebo group. Operation time did not significantly differ between both
groups (n = 5 RCTs, MD = -3.73 min, 95% CI [-14.65, 7.18], p = .50). No patient in both groups
developed symptomatic hyponatremia (n = 3 RCTs, 194 patients) or thromboembolic events
(n = 2 RCTs, 150 patients).Conclusions: Among patients unde

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1694
Odontogenic sinusitis: Report of two representative cases and review of the current
literature

GEORGIOS PAPACHARALAMPOUS, ATHANASIA MILIONI1, PARASKEVI KOLLIA1, SOPHIA

ATHANASIOU1, EFSTATHIA NIKOLOPOULOU1, DIMITRIOS DAVILIS1, DIONYSIOS ANDRESAKIS2

1
ENT DEPT. ELPIS GENERAL HOSPITAL, ATHENS, GREECE, 2MAXILLOFACIAL DEPT, ELPIS GENERAL
HOSPITAL, ATHENS, GREECE

Poster Session | CRS – surgical management | 18 June – 22 June, 2023, All day

Introduction: Odontogenic sinusitis is an inflammatory condition of the maxillary sinus as a

result of dental pathology or dento-alveolar procedures, due to the close anatomical
proximity between maxillary sinus floor and posterior teeth root apices. Two cases of
odontogenic sinusitis, that followed endodontic treatment with consequent oro-antral
fistulas, are presented. Cases’ presentation: Case A, refers to a 56-year-old woman with
unilateral maxillary sinus symptoms starting after endodontic treatment of the left permanent
maxillary 1st molar. CT scan and panoramic radiograph revealed overextension of root filling
material into the maxillary sinus. Case B, concerns a 62-year-old woman with unilateral
maxillary sinusitis after endodontic treatment of the right permanent maxillary 1st molar and
oro-antral fistula. Dental scan showed maxillary sinus opacification, as well as the presence of
foreign body in it. Both patients underwent endoscopic medial maxillary antrostomy, dental
extraction of the causative tooth and repair of the oro-antral fistula with local mucosal flaps.
Conclusion: Unilateral maxillary sinus pathology with nasal obstruction, foul rhinorrhea and a
history of a recent dental procedure or poor dentition should raise the suspicion of a potential
dental cause of sinusitis. CT is the current gold-standard imaging modality. Treatment may
include antibiotics, oral and/or endoscopic surgery through a multidisciplinary team
approach.

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1194
Challenges and controversies in endoscopic management of cerebrospinal fluid
rhinorrhea

Mostafa ElTaher1, Taya Usama, Ismael Ahmad, ElTaher Mostafa, Ahmed mohamed

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

IntroductionEndoscopic management of cerebrospinal fluid (CSF) rhinorrhea is considered by

many asthe ideal approach due to its low morbidity and higher closure rate. However, many
challengesand controversies are still reported.ObjectiveThe aim was to discuss the challenges
of endonasal repair of CSF leaks and controversiesregarding the use of intrathecal fluorescein
(ITF) and the number of graft layers.Materials and methodsThis retrospective study included
30 patients who had had endoscopic repair for their CSFrhinorrhea in our institute between
July 2015 and June 2017. Fifteen (50%) patients weremanaged using the two-layer repair
without ITF injection (group I), while the remaining weremanaged using three or more graft
layers and ITF (group II).ResultsThe study included 30 patients: 17 (57%) women and 13 (43%)
men. Their age ranged from 4to 68 years with mean ± SD = 38 ± 15.86 years. Eighteen cases
presented with spontaneousleaks (nine of them had normal CSF pressure). Four (13.3%) cases
had defects in the posteriorwall of the frontal sinus while other defects involved the fovea
ethmoidalis, lateral lamella, andthe cribriform plate of the ethmoid. Success rate was equal in
both groups (93%).ConclusionEndoscopic management of CSF rhinorrhea has many
challenges including repair in thepediatric population and anatomical areas with difficult
accessibility, for example, frontal sinusleaks. It requires good endoscopic visualization and
endoscopic instrumentation facilities inaddition to experienced surgical hands. Double-layer
repair and avoidance of ITF show thesame success rate as other more time-consuming
strategies with life-threatening complications.

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1718
CSF LEAK DUE COMBINED FACIAL AND CRANIOCEREBRAL TRAUMATIC INJURIES DUE
TO ROAD TRAFFIC ACCIDENTS

NIKOLAOS SYRMOS1

1
Aristotle University Of Thessaloniki

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

Aim of this study is to present cases of CSF leaki due to combined facial and craniocerebral
traumatic injuries..10 cases are peresented. Rang of age between 29 and 59 years old.Ct and
mri were performed in all cases.Consrevative treatment in 8 cases (80%) and surgical
treatment in 2 (20%).Good outcome in 7 cases (70%),moderate outcome in 2 (20%) and poor
in 1 (10%).CSF leak remain a serious complication due to severe injuries.Appropriate
managmet is required.

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1181
Dr

Mostafa ElTaher

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

IntroductionEndoscopic management of cerebrospinal fluid (CSF) rhinorrhea is considered by

many asthe ideal approach due to its low morbidity and higher closure rate. However, many
challengesand controversies are still reported.ObjectiveThe aim was to discuss the challenges
of endonasal repair of CSF leaks and controversiesregarding the use of intrathecal fluorescein
(ITF) and the number of graft layers.Materials and methodsThis retrospective study included
30 patients who had had endoscopic repair for their CSFrhinorrhea in our institute between
July 2015 and June 2017. Fifteen (50%) patients weremanaged using the two-layer repair
without ITF injection (group I), while the remaining weremanaged using three or more graft
layers and ITF (group II).ResultsThe study included 30 patients: 17 (57%) women and 13 (43%)
men. Their age ranged from 4to 68 years with mean ± SD = 38 ± 15.86 years. Eighteen cases
presented with spontaneousleaks (nine of them had normal CSF pressure). Four (13.3%) cases
had defects in the posteriorwall of the frontal sinus while other defects involved the fovea
ethmoidalis, lateral lamella, andthe cribriform plate of the ethmoid. Success rate was equal in
both groups (93%).ConclusionEndoscopic management of CSF rhinorrhea has many
challenges including repair in thepediatric population and anatomical areas with difficult
accessibility, for example, frontal sinusleaks. It requires good endoscopic visualization and
endoscopic instrumentation facilities inaddition to experienced surgical hands. Double-layer
repair and avoidance of ITF show thesame success rate as other more time-consuming
strategies with life-threatening complications.

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CSF leaks and management

1255
Our experience of using fat tissue for repair of small defects of the skull base in
patients with spontaneous CSF leak

Diana Zabolotna1, Dmytro Zabolotnyi2, Eldar Ismahilov1, Iryna Tsvirinko1, Kostiantyn

Sarnatskyi3, Yaroslav Kizim1

1
Department of Rhinology, Allergology and Radiology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sci, 2Director, Kolomiychenko Institute of Otolaryngology of National
Academy of Medical Sciences of Ukraine, 3Department of Anesthesiology, Kolomiychenko Institute of
Otolaryngology of National Academy of Medical Sciences of Ukraine

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

Introduction:Spontaneous nasal CSF leak is characterized by the absence of a history of brain

trauma or surgery.Purpose of the study:To evaluate the effectiveness of the method for
reconstruction of a skull base defect in patients with spontaneous CSF leak using fat tissue
graft.Materials and methods:We have observed 46 patients with CSF leak. The size of the
defect varied from 0.3 to 0.5 cm. 20 patients who underwent surgery with fat tissue graft in
two layers. The second piece of fat tissue was applied on top of the first layer and was located
in the nasal cavity. 26 patients underwent repair of the skull base defect using the standard
overlay technique - a mucousal flap with vascular pedicle. Results:After 1 months, a patient of
group 1 had recurrence of CSF leak, patients of group 2 had a recurrence of CSF leak in 2
patients, after 6 months in 1 patients of group 2 there was a recurrence 2
patients.Conclusions: The technique with fat tissue grafts provides a tight closure of the bone
defect. The risk of a recurrence CSF leak is significantly reduced in comparison with the plastics
with the use of overlay grafts.

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1402
Cerebrospinal fluid leak treatment using endoscopic endonasal approach in our
department.

Ami Otoda1, Masayoshi Kobayashi1, Hiroyuki Morishita1, Kazuhiko Takeuchi1

1
Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of
Medicine

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

Recently, the treatment of cerebrospinal fluid (CSF) rhinorrhea is increasingly performed

using endoscopic endonasal approach. To reveal the success rate and factors of CSF leak
treatment using endoscopic endonasal approach, we reviewed CSF leakage cases in our
department. Subjects were 22 patients who underwent surgical treatment for CSF leak
during recent 13 years. They consist of 14 tumor, four surgical injury, two meningocele,
one traumatic and one idiopathic case. Since dura mater defects of less than 20 mm in
surgical injury, meningocele, traumatic and idiopathic cases were small we applied ‘bath-
plug’ technique with pedicled nasoseptal flap and bone fragments to those cases. Since
tumor cases had large dura mater defects of more than 20mm, multiple-layer reconstruction
with three or four layers using femoral fascia, bone or cartilage and pedicled nasoseptal flap
was used. The success rate was 100% in this study, while previous studies reported that the
success rates were about 90%. We conclude that the cases with small dura mater defect can
be closed using ‘bath-plug’ technique with one layer coverage and those with large dura
mater defect needs three or four layers with pedicled nasoseptal flap for successful
repairment.

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1664
Endoscopic Repair of Cerebrospinal fluid Rhinorrhoea: An Institutional Experience

Eleni Gkrinia1, Maria Minasidou1, Fani Saini1, Anna Mpouronikou1, Nikolaos Kalogritsas1,
Jiannis Hajiioannou2

1
Department of Otolaryngology - Head and Neck Surgery, University Hospital of Larissa, Greece ,
2
Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Thessaly,
Greece

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

Introduction: Cerebrospinal fluid (CSF) rhinorrhoea has been reported to be spontaneous or

secondary to head trauma, surgery, neoplastic invasion, congenital malformations. The aim
of this study is to report our experience regarding the etiopathogenesis, treatment modalities
and outcomes of patients that presented in our tertiary care centre with CSF
rhinorrhoea.Material and Methods: A retrospective study was performed for all cases of CSF
leak endoscopic repairs carried out in the ENT Department of University Hospital of Larissa,
Greece from January 2013 to January 2023.Results: A total of seven patients were recruited
in the study. The age of patients ranged from 54 to 58 years. Four patients were female and
three were male. The most common cause of CSF rhinorrhoea was spontaneous. All patients
underwent transnasal endoscopic repair using a multilayer graft. Intrathecal fluroscein was
used in every case, while a lumbar drain was placed in only two. CSF rhinorrhoea was resolved
in 100%. The patients were followed up for 2 months to 7 years. Conclusion: Transnasal
endoscopic repair of CSF rhinorrhoea is a safe treatment modality that offers good success
rate along with better visualization, less complications, low recurrence rate and high patient
satisfaction.

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1744
The necessity of laboratory tests in diagnosing CSF rhinorrhea

Ioannis Skoumpas1, Chrysoula Vardaxi2, Alexandros Poutoglidis2, Ahmad Alghoj2, Spyridon

Gougousis2

1
Department of Otorhinolaryngology - Head and Neck Surgery, ''G. Papanikolaou'' General
Hospital,Thessaloniki ,Greece, 2Department of Otorhinolaryngology – Head and Neck Surgery,
“G.Papanikolaou” General Hospital, Thessaloniki, Greece

Poster Session | CSF leaks and management | 18 June – 22 June, 2023, All day

Introduction: The limited availability of contemporary laboratory tests for confirmation of

cerebrospinal fluid (CSF) leak, like beta-2 transferrin and beta-trace protein, is a reality in
various regions including our country. The purpose of our study is to evaluate whether
diagnosis is possible without biochemical exams.Methods: Fourteen consecutive patients
were treated in our hospital with clinical suspicion of CSF rhinorrhea. All patients underwent
high resolution computed tomography (HRCT) for detection of skull base bony defects.
Magnetic resonance cisternography (MRC) was performed in 12 of them.Results: The cause
of CSF rhinorrhea was traumatic in 11 and spontaneous in 3 patients. MRC identified the
presence of CSF leak in all 12 cases. The remaining two were confirmed with HRCT. HRCT
depicted the bony dehiscence in 13. The site of origin was the lateral lamella of the ethmoid
bone in 10 and the cribriform plate in 4 patients. In 8 of them the fistula was confirmed and
repaired surgically, while lumboperitoneal shunt was performed in two of the
remaining. Conclusions: Combination of clinical suspicion, endoscopic findings, imaging
methods and surgical confirmation can lead to safe diagnosis of CSF rhinorrhea. Despite our
encouraging results, further investigation is necessary to support this hypothesis.

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Epistaxis and HHT

1128
Epistaxis Treatment options. Literature review.

Stylianos Mylonas1, Charalampos Skoulakis2, Vasileios Nikolaidis3, Jiannis Hajiioannou2

1
RCSI member, 2University Hospital Larissa, 3Papageorgiou General Hospital Thessaloniki

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

Introduction: Epistaxis is acute bleeding from nostrils, nasal cavity or nasopharynx. It is

common and usually resolves with or without medical intervention.Methods: Sixty articles of
epistaxis treatment options published in the last 20 years were included in this review.
Duplicate, irrelevant and inaccessible articles were excluded.Results: Epistaxis can be treated
with simple first aid measures, vasoconstrictors or newer drugs like tranexamic acid, with
chemical or electrical cauterization and nasal packing with various materials, absorbable or
not. For intractable cases, surgical methods can be applied like endoscopic cauterization,
ligation or embolization. Conclusions: Epistaxis can be dealt with variously depending on
patient's history and symptomatology, as well as experience and available resources of
healthcare providers. Newer nasal hemostatic agents in combination with endoscopic
methods have advantages over traditional methods.

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1210
EPIDEMIOLOGY AND MANAGEMENT OF EPISTAXIS IN THE EMERGENCY
DEPARTMENT. THE EXPERIENCE OF ENT DEPARTMENT OF “PAMMAKARISTOS”
HOSPITAL.

Maria Karela1, Georgios Grivas1, Maria Korodima1, Panagiotis Gonatidis1, Spyros Katsinis1,
Vasiliki Goulioni1, Eleni Chalkiadaki1

1
ENT department of “pammakaristos” hospital, Athens

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

Objective: Epistaxis is one of the most common rhinological conditions treated in an

emergency department (ER). The aim of this study is to provide and evaluate epidemiological
data and management options for epistaxis treated in the emergency department of our
hospital. Material and Methods: A retrospective study was conducted during the period
between December 2021 and January 2022. Patients with epistaxis presented in the ER at that
period were included. The distribution by gender, age, season of appearance were analysed.
Patients’ medical history (medication interfering with haemostasis) was considered and
treatment options were evaluated. Results: Overall, 106 patients presented with epistaxis in
the ER, from which men were 61% and women 39%. The age range of the patients was
between 18 and 93 years old and the disease was more common in patients over 60 years old.
Epistaxis was treated with chemical cauterization and/or anterior nasal packing with
satisfactory results in 97% of patients. In 3% of patients, anterior and posterior nasal packing
was performed simultaneously and they were admitted to hospital for further surveillance
and treatment. 30(28%) out of 106 patients, were on anticoagulant medication. Conclusions:
Epistaxis is a common condition of the emergency department, presenting in every age group
of adults and affects both genders but is more frequent in men and older patients. The
treatment of epistaxis with chemical cauterization and/or anterior nasal packing is effective
in the majority of patients (97%).

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1226
EPISTAXIS IN CHILDREN - OUR PERSONAL EXPERIENCE

Dilyana Vicheva1
1
Department of Otorhinolaryngology, Medical Faculty, Medical University of Plovdiv, Bulgaria

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

Introduction: Epistaxis is common in children. Most epistaxis in children is minor and is easily
managed with direct compression of the nasal alae for 5 to 10 minutes. For more significant
or recurrent epistaxis other techniques might include vasoconstrictor nose drops, cautery
with 75 percent silver nitrate, topical sealants or glue, nasal packing, or balloon catheters.
Most children with epistaxis have spontaneous anterior nasal bleeding without airway
compromise or hemodynamic instability. Rapid assessment of general appearance, vital signs,
airway stability, and mental status are still necessary to identify children who require airway
intervention and/or fluid resuscitation. Materials and methods: Twenty nine children were
recruited, they were with epistaxis (17 had crusting in the nasal vestibule; 12 did not). A
microbiology swab was taken from the anterior nasal cavity of each child. Results: All groups
were equally likely to have a positive culture. St. aureus was more common in the epistaxis
group (p=0.007) and Str. pneumoniae (p=0.005). There was no difference in the prevalence of
St. aureus and Str. pneumoniae between crust and noncrust groups. Epistaxis patients were
much less likely to have isolates of respiratory pathogens or a skin commensal. Conclusion:
Children with epistaxis are more likely to have nasal colonization with St. aureus and Str.
pneumoniae. Our data would support the hypothesis that these microorganisms causes
inflammation and new vessel formation. The management of epistaxis is very important in
our rhinology daily practice.

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1335
Family screening of Hereditary Hemorrhagic Telangiectasia in Hungary

Tamás Major1, Zsuzsanna Bereczky2, Réka Gindele2, Gábor Balogh3, Boglárka Brúgós4, György
Pfliegler5

1
Department of Otorhinolaryngology, Ferenc Markhot County Hospital, Eger, Hungary, 2Division of
Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of
Debrecen, Debrecen, Hungary, 3Division of Clinical Laboratory Science, Department of Laboratory
Medicine, Faculty of Medicine, University of Debrecen, DebreceDebrecen, Hungary, 4Division of Rare
Diseases, Department of Internal Medicine Block B, Faculty of Medicine, University of Debrecen,
Debrecen, HungaDebrecen, Hungary, 5Division of Rare Diseases, Department of Internal Medicine
Block B, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multisystemic

vascular disease with a prevalence of 1:5,000-1:10,000. Approximately 90 % of HHT cases have
heterozygous family-specific mutations in the ENG, ACVRL1 and rarely in the SMAD4 genes.
We present our results of systematic genetic and clinical screenings of Hungarian HHT families
between 2012 and 2023.Probands were diagnosed with HHT in our HHT Center by
otorhinolaryngological and internal physical examinations completed with characteristic
telangiectasis sites, a visceral arteriovenous malformation(AVM) screening and ENG / ACVRL1
/ SMAD4 / RASA1 /GDF2 Sanger or Next Generation Sequencing Analysis. At-risk individuals
underwent physical examination and testing for the family-specific mutation, followed by
AVM screening in the case of clinically suspected/definite HHT and/or in mutation
carriers.Eighteen ENG, 17 ACVRL1 and 1 SMAD4 mutations were identified in 21, 29 and 1
families, respectively, with 119 individuals (54 probands and 65 affected family members)
carrying the family-specific mutation. In 67 family members of HHT1 and HHT2 families the
wild-type ENG/ACVRL1 alleles were detected. Three additional probands with definite HHT
showed the wild-type alleles in all tested HHT loci. Clinically, pulmonary and hepatic AVMs
were significantly more common in HHT1 and HHT2, respectively.Systematic family screening
is the most beneficial recruitment method of HHT patients. The significance of genetic testing
is the confirmation or exclusion of HHT in young asymptomatic individuals

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1347
The influence of atmospheric factors on the incidence of spontaneous epistaxis.

Spyridon Lygeros1, Konstantina Alkmini Gatsounia1, Gerasimos Danielides1, Georgios

Schinas2, Michail Athanasopoulos1, Vasilios Danielides1

1
Department of Otorhinolaryngology, University Hospital of Patras, Greece, 2Medical School,
University of Patras

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

Introduction: Epistaxis is one of the most common ENT emergencies. Several reports have
indicated a possible correlation between epistaxis incidence and atmospheric parameters’
variation. We aimed to determine epistaxis’ seasonal variation and draw correlations to
monthly, weekly, and daily recordings of atmospheric measurements. Methods & Materials:
In this retrospective study, we included patients that presented with epistaxis at the
Emergency Department (ED) of a tertiary academic hospital in Western Greece between
January 2020 and December 2021. Cases of trauma or bleeding secondary to a known cause
were excluded. Hourly recordings of four atmospheric parameters (temperature, humidity,
precipitation and wind speed) were utilized. Results: In total, 289 cases of epistaxis were
recorded to present in the ED. A statistically significant negative correlation was noted
between the cumulative incidence of epistaxis and the mean Relative Humidity (RH) on both
a daily and a weekly basis (r=-0,21, p=0,025, and r=-0,11 p=0,019, respectively). Significantly
lower mean RH values were recorded during weeks with a high incidence of epistaxis cases.
No relationship was noted between other atmospheric factors and epistaxis
incidence. Conclusion: Mean RH values account for some of the variation observed in
spontaneous epistaxis’ incidence in the region of Western Greece. No seasonality was noted
in spontaneous epistaxis occurrence.

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1468
Endoscopic control of a severe bleeding after Le-Fort I fracture through a lateral
transmaxillary approach

Sinisa Milenovic1, Yves Brand1

1
Department of Otorhinolaryngology Kantonsspital Graubünden Chur, 7000 Switzerland

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

We present a 73-year-old patient with a severe bleeding after reduction and osteosynthesis
of a Le-Fort I fracture. 13 days postoperative severe bleeding originated from the vestibular
incision from the prior surgery. Haemoglobin concentration initially at the emergency
department was 51g/l. After opening the former vestibular incision and removal of
granulation tissue the origin of the bleeding was endoscopically identified and controlled. The
opening of the sinus was used for an endoscopic (0° scope) approach. We achieved control of
the bleeding through clipping of the internal maxillary artery. In addition, seven erythrocyte
concentrates were necessary to compensate blood loss. The patient had a speedy recovery
with no bleeding after the surgery.Diagnostic angiography followed by endovascular
treatment is the approach of choice, although other approaches have shown good results as
well. Due to the acute live-threatening blood loss and incompliant patient we have chosen to
omit an angiopraphy. This unusual lateral transmaxillary approach to ligate the internal
maxillary artery was chosen since this approach allowed endoscopic control through the Le-
Fort I fracture.We recommend decision making according to the specific situation as well as
availability of an interventional radiologist and/or endoscopically skilled ENT-surgeon.

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1758
Young's Procedure for Refractory epistaxis in Hereditary hemorrhagic telangiectasia
complicated with Septal perforation

Hannah Finney1, Thomas Jennings1, Nikhil Solomon Sundara Raj1, Paresh Pramod Naik1

1
University of Northamptonshire

Poster Session | Epistaxis and HHT | 18 June – 22 June, 2023, All day

Hereditary haemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-

Rendu syndrome, is an autosomal dominant disorder. 85% of cases are associated with the
ENG or ACVRL1 genes[i], and is characterised by the presence of multiple arteriovenous
malformations (AVMs). A lack of elastic fibrin fibres cause fragile blood vessels to dilate, giving
them a tendency to bleed. The manifestation of these vascular abnormalities is varied and can
affect multiple organs, frequently occurring in the nasal mucosa, exposing the patient to a
high risk of spontaneous epistaxis. Thus, epistaxis is one of the most common symptoms in
patients with HHT, affecting up to 98% of patients, with the risk increasing with age. In
managing patients with HHT, controlling recurrent epistaxis is often of primary importance,
due to the risk of a potentially fatal massive haemorrhage. We present a case of a 76 year old
gentleman who had recurrent, uncontrolled epistaxis, with a background of HHT. Definitive
management of his epistaxis was achieved following a Youngs procedure, complicated by a
septal perforation. To our knowledge the Youngs procedure has not previously been described
in combination with a septal perforation in a patient with recurrent epistaxis secondary to
HHT.

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Facial Pain

1286
A case of ALK- positive Diffuse large B cell lymphoma occured on maxillary sinus

Woo Yong Bae1, Young Bin Yun2

1
Department of Otorhinolaryngology, Head and Neck Surgery, Dong-A University, College of Medicine,
Busan, Korea, 2Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine,
Dong-A University

Poster Session | Facial Pain | 18 June – 22 June, 2023, All day

Malignant lymphoma is the most common form of non-squamous cell cancer occurring in the
head and neck regions and includes Hodgkin's lymphoma and Hodgkin's lymphoma. Diffuse
large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma and is a
disease that rapidly invade surrounding tissues, and rapidly progress its oncogenic
course. The primary part of DLBCL can be any organ, but most of it is known to occur
frequently in the digestive system (GI-tract). DLBCL has a variety of subtypes, one of which is
the subplastic lymphokinase (ALK)-positive giant B cell lymphoma. ALK-positive hyperbolic B
cell lymphoma is reported to account for less than 1% of DLBCLs worldwide and is known as
the most aggressive lymphoma.ALK-DLBCL has rich and variable eosinophilic cytoplasm, large
circular nuclei, and prominent nucleophilic morphology, and is not expressed in markers such
as CD20, CD79a, and CD3, but is characterized by plasma markers such as CD30, CD138, CD38
and EMA.We report a case in which extra-marrow plasma cell lymphoma was suspected on
biopsy at first, but was finally diagnosed as ALK-positive sub-positive giant B cell lymphoma
through additional examination.

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Facial Plastic surgery beyond the nose

1160
Surgical Outcomes and complications after External Approach Septoplasty

JI YUN CHOI1

1
Department of otolaryngology, Chosun University Hospital, Gwangju, Korea

Poster Session | Facial Plastic surgery beyond the nose | 18 June – 22 June, 2023, All day

Background and Objectives This study aims to investigate the indications of external approach
septoplasty and improvement in subjective symptoms and objective parameters in patients
who underwent external approach septoplasty to correct septal deviation with various types
of deformities. Subjects and Method Thirty-one patients who underwent external approach
septoplasty from October 2014 to January 2019 were classified by direction, location, and
degree of nasal septal deviation, septal shape and surgical techniques. Through acoustic
rhinometry, the minimum cross-sectional area and nasal volume were measured before and
after surgery. To evaluate the improvement in symptoms, the Nasal Obstruction Symptom
Evaluation (NOSE) survey and nasal congestion visual analogue scale (VAS) were also
measured. Results We found significant correlations between: the direction and degree of
nasal septal deviation; the location and degree of nasal septal deviation; septal shape and
location of the nasal septal deviation; septal shape and surgical techniques; and the degree of
nasal septal deviation and presence of spreader grafts. The NOSE scale following external
approach septoplasty improved from 14.7±4.4 to 3.1±3.2 (p<0.001), while the VAS score
improved from 7.2±2.3 to 1.2±1.4 (p<0.001). Also, acoustic rhinometry showed that the
minimum cross-sectional area and nasal volume at the convex side of nasal cavity significantly
increased after surgery. Conclusion The external approach septoplasty is a surgical technique
that is effective not only in improving subjective symptoms, but also in improving objective
parameters. External approach septoplasty could be used in case of caudal and/or dorsal nasal
septal deviation

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Granulomatous diseases of the nose

1289
Sinonasal Cavity Changes in Granulomatosis with Polyangiitis

Dimitar Pazardzhikliev1, Taniel Minkov2

1
Department of Otolaryngologyl, Medical University of Plovdiv, Plovdiv, Bulgaria , 2Department of
Otolaryngologyl, University Hospital Kaspela Plovdiv, Bulgaria

Poster Session | Granulomatous diseases of the nose | 18 June – 22 June, 2023, All day

Background: Granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis) is a

systematic autoimmune disease in which the sinonasal cavity is the most frequently affected
site, and initial presentation in many cases. Methodology/Principal: We describe two cases of
GPA presenting with subacute rhinosinusitis refractory to long-term outpatient treatment.
Despite the standard conservative and surgical treatments in both patients, their symptoms
aggravated.Results: The CT scans of both patients showed bone destruction of the posterior
wall of the maxillary sinuses, as well as of lamina papyracea of the ethmoidal bone. The
patients underwent FESS which found a thick membranous exudate covering a pale and fragile
mucosa, and biopsies were taken with unusually minimal bleeding. The histology reports were
inconclusive, showing only inflammation. CT scans found pulmonary nodules in both patients.
We placed the diagnosis on the basis of the clinical, histological and CT scans results and
initiated treatment with high doses of steroids.Conclusions: Even though a majority of GPA
cases affect the sinonasal cavity, the overall low incidence of the disease increases the
likelihood for a delayed diagnosis. Therefore, physicians must be aware of the possible
sinonasal changes on CT scan and the importance of this imaging modality in early diagnosis
of GPA.

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1504
A case of nasal Extranodal Natural killer/T-cell Lymphoma mimicking granulomatous
inflammation of the nose

Konstantinos Choulakis1, Athanasia Marinou1, Aikaterini Tsagkovits1, Anastasia Liapi1

1
General Hospital of Athens "G.Gennimatas"

Poster Session | Granulomatous diseases of the nose | 18 June – 22 June, 2023, All day

IntroductionNasal type of extranodal natural killer/T-cell lymphoma (ENKL) is responsible for

most cases previously known as midline lethal granuloma. It is a rare manifestation of non-
Hodgkin lymphoma difficult to treat, resulting in poor outcomes. Case presentation A 73-year-
old patient presents with nasal obstruction, nasal purulent discharge, and facial pain,
suggestive of chronic sinusitis, that has been treated elsewhere for the last 6 months without
any improvement. He also suffers from ear fullness. Endoscopy reveals friable-necrotic,
erythematous, and granulomatous nasal epithelium and an asymmetric thickening of the right
lateral wall of nasopharynx on the area of eustachian tube orifice. Otoscopy shows signs of
otitis media with effusion. Head CT shows near complete opacification of the paranasal
sinuses and thickening of nasal mucosa that is more pronounced adjacent to the right
eustachian tube orifice. The patient underwent right antrostomy, nasopharyngeal biopsy and
right tympanostomy tube placement. The histological examination revealed nasal type of
ENKL. The patient is treated with chemotherapy. Conclusion A high index of suspicion is
needed to diagnose nasal type of ENKL. In this case, endoscopic findings were suggestive of
granulomatous disease, but surprisingly the histologic examination revealed ENKL. We
conclude that ENKL may sometimes mimic endoscopic finding of granulomatosis with
polyangiitis.

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1560
LOBULAR CAPILLARY HEMANGIOMA

Ahmad Alghoj1, Chrysoula Vardaksi2, Paraskevi Karamitsou2, Sotiria Sotiroudi2, Rova

Konstantina2, Spyridon Gougousis2

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany, 2Department of Otorhinolaryngology-Head and Neck Surgery,''G.
Papanikolaou''General Hospital,Thessaloniki ,Greece

Poster Session | Granulomatous diseases of the nose | 18 June – 22 June, 2023, All day

Background: The lobular capillary hemangioma (LCH), commonly reported in the literature as
“pyogenic granuloma,” it is a rapidly growing lesion characterized by a proliferation of
capillaries arranged in lobules and separated by a loose connective tissue stroma, often
infiltrated by inflammatory cells. The etiopathogenesis of lobular capillary hemangiomas is
still obscure. Trauma, hormonal factors (such as puberty, pregnancy, and contraceptive use),
underlying microscopic arteriovenous malformations, and local production of angiogenic
growth factors have all been advocated as potential etiopathogenetic factors.Case report: A
57 year old female has presented to our emergency department with 4 months history of
unilateral nasal obstruction and complaint of recurrent epistaxis. The medical history and
endoscopic examination were obtained, and CT scan and MRI were performed. The mass was
radically resected through an endoscopic approach. Conclusions: Unilateral nasal obstruction,
facial pain, and epistaxis are the leading symptoms in patients with LCH of the sinonasal tract.
The nasal endoscopy, imaging studies and histologic examination are important to establish
an accurate diagnosis. Surgery and radical excision is the treatment of choice for LCH to avoid
the risk of recurrence.

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1677
Granulomatosis with polyangiitis limited to the nose in cocaine addict patient

roman carlos zamora1, roman carlos1, ELIZABETH MORALES MOLINA1, CESAR GONZALEZ
CUELLO1, FRANCISCO MUÑOZ DEL CASTILLO1

1
Department of Otolaryngology and Head and Neck Cancer of Hospital Universitario Reina Sofia,
Cordova, Spain

Poster Session | Granulomatous diseases of the nose | 18 June – 22 June, 2023, All day

A 49 year old female presented to the ENT clinic for nose bleeding and pain for 8 weeks. She
had a history for cocaine consumption. On physical exam there were ulcers in the septum and
lateral wall bilaterally seen with a 30º endoscope.There were signs of infection with yellow
mucous from various areas of the mucosa. Antibiotic was prescribed orally with nasal and oral
corticoids. She had a good evolution, but the next week she sinusitis appeared again. She
denied cocaine consumption and autoimmune and vasculitis markers were ordered. There
was a marked elevation of the c-ANCA. Internal medicine was consulted to aid in the study,
and they concluded that it was a granulomatosis with polyangiitis limited to the nose with no
systemic involvement with the aid of biopsies taken to pathology. Surgical pathology
concluded always necrosis after 5 biopsies. Methrotexate was given to the patient with
marked improvement, but after 4 weeks the clinical scenario returned. It was concluded that
she was still consuming cocaine. Patient was advised to go to a drug addiction aid facility. After
1 year clinical signs are better, but she has an absent tip nose and no cartilaginous septum.
Nose reconstruction is still being evaluated upon a committee.

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Imaging and investigations

1803
Modern approaches to the treatment of chronic polyposis rhinosinusitis.

Yulia Sukhareva1, Evgeniya Bezrukova1, Radik Galeev1

1
North-Western State Medical University named after I.I. Mechnikov

Poster Session | Imaging and investigations | 18 June – 22 June, 2023, All day

Relevance. Chronic polyposis rhinosinusitis is a persistent inflammation of the nasal mucosa

and paranasal sinuses. Targeted biological therapy is being actively introduced, however, its
effectiveness and safety have not been fully studied at the moment. Purpose of the study. To
evaluate the effectiveness of the use of IL-4 and IL-13 receptor inhibitor in treatment of
chronic polyposis rhinosinusitis for 12 months. Materials and methods. During 12 months, on
the basis of the otorhinolaryngological department 12 patients were treated: 5 women and 7
men aged 30 to 62 years. The average age of patients is 47 years. In the treatment were used
subcutaneous injections of 300 mg of the drug once every 2 weeks of an inhibitor of the IL-4
receptor, IL-13 in combination with intranasal glucocorticosteroids. Research results. At the
initial examination polyps obturated the common nasal passage, the average polyp size score
reached 5.66±0.26. Till 12 month - 0.66±0.94. Before treatment, the mean score on the SNOT-
22 scale was 54.25±4.88. By the 12th month the quality of life of patients was 8.1±0.45. The
severity of anosmia at the initial examination averaged 9.36±0.24. By the 9th month of
therapy, patients do not complain of anosmia. Before therapy the score of sinus
pneumatization according to LMC-CT was 18.9±0.83. By 12 months of therapy paranasal
sinuses sinuses were airy. No serious side effects of therapy were observed. Conclusions.
Biological therapy demonstrates significant efficacy in reducing the symptoms of chronic
polyposis rhinosinusitis.

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1704
Flexible Nasendoscopy documentation by Junior Doctors in a Tertiary Ear, Nose and
Throat (ENT) Emergency GP Referrals Unit (GPRU)

Robert Maweni, Jerocin Vishani Loyala, Mridul Rana, Haleema Siddique, Ayeshah Abdul-
Hamid

Poster Session |Imaging and investigations | 18 June – 22 June, 2023, All day

IntroductionFlexible nasendoscopy (FNE) is a diagnostic tool used by ENT surgeons to examine

the upper aerodigestive tract (UADT) identifying pathology ranging from malignancies to
severe infections(1). Currently there are no formalised minimum standards for
documentation; literature review yields a short communication by Singh and Lyons in 2004(3).
We audited current FNE documentation practice amongst Junior Doctors (JDs) in our GPRU
against Singh and Lyons’ guideline. MethodsRetrospective review of patients who attended
GPRU in January 2023. JDs were also surveyed on their confidence identifying normal
anatomy, foreign bodies and parapharyngeal swelling. Results:31 patients underwent FNEs
with 52% (N=16) by a JD alone. The main indication was assessment of suspected UADT
foreign body (16%, N=5), followed by peritonsillar abscesses (13%, N=4). No patients had all
the pertinent anatomy documented, and some were never documented. 13/13 junior doctors
reported high confidence levels in identifying FNE findings. Conclusion:Despite high
confidence levels of knowledge, our JD’s documentation was poor. It is unclear if this is due
to poor anatomical knowledge or a lack of insight into the importance of documentation. This
highlights the need for formalized standards and ensuring that clinicians are well-trained in
identifying and documenting all pertinent FNE anatomy.

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Lacrimal Surgery

1253
Our experience in diagnosis of the lacrimal sac tumor

Diana Zabolotna1, Iryna Tsvirinko1,Yehor Cherniak2, Vladyslav Haiduk3

1
Department of Rhinology, Allergology and Radiology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Science, 2Kolomiychenko Institute of Otolaryngology of National
Academy of Medical Sciences of Ukraine, 3Medical Director, Kolomiychenko Institute of
Otolaryngology of National Academy of Medical Sciences of Ukraine

Poster Session |Lacrimal Surgery | 18 June – 22 June, 2023, All day

Introduction. Lacrimal sac and duct tumors are rare. Only about 775 cases have been reported
worldwide in the literature from the 1930’s to the present day. Mesenchymal
tumors constitute 12-14% of lacrimal sac tumors.
Case presentation. Patient B, 47-year-old male сomplained about the lacrimal mass and
epiphora.
Нe was treated by an ophthalmologist during the last 6 months, without effect.
On CT tumor confined to the lacrimal sac, the nasolacrimal bony canal was smoothly expanded
without erosive changes.
Considering with nonspecific symptoms, we suggestived of chronic dacryocystitis.
Dacryocystectomy was performed. A neoplasm of a lobular structure was found and removed
from the lacrimal sac during surgery. The patient felt improvement in the postop period.
But according to histopathological research - а spindle-shaped tumor of a high degree of
malignancy was detected. An immunohistochemical study was performed - a solitary fibrous
tumor, not otherwise specified. There are planning to remove the nasolacrimal sac with
surrounding tissue.
Conclusion. During the surgical treatment of chronic dacryocystitis, differential diagnosis with
neoplasms should be carried out.

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Miscellaneous

1492
Lifestyle Factors Impacting TB Relapse: An East Indian Observational Study

Stella Lee1, Rajeev Ranjan1

1
Chest Clinic

Poster Session |Miscellaneous | 18 June – 22 June, 2023, All day

Introduction: One of the many elements that can cause a TB relapse that is still unknown is
lifestyle. These elements could differ from nation to nation and region to region within a
nation. We are attempting to analyse key characteristics within this category for recurrence
of TB in an East Indian district in Bihar in order to research important lifestyle factors,
diabetes, and HIV in the aetiology of tuberculosis.Methods: The trial includes all sputum-
positive relapse patients in the Chapra district in Bihar for two quarters beginning in January
2022. Health professionals with training evaluate them using a standardised, previously
proven questionnaire about potential lifestyle risks, diabetes, and HIV risk for
recurrence.Results: 80 cases that met the study's inclusion criteria were included. They
belonged to the 20–85 age range. In the relapse instances, men outnumbered women by a
ratio of 3.8:2. Most of the patients were in the age range of 41 to 50 pounds. Up to 40% were
in the 3+ grade. According to the study's factors, there are 24 people with diabetes (30%), 0
people with HIV, 48 alcoholics, and 56 smokers. Most patients had previously received care
with the RNTCP regimen. All were recommended by government physicians. Most have been
successfully treated in the past.Conclusions: The most significant lifestyle factor that
contributes to TB recurrence is smoking.

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1587
THICKENED MILK FORMULA TREATMENT OF INFANTS WITH GERD AND
EXTRAESOPHAGEAL SYMPTOMS

Nia Rasheva1, Miglena Georgieva1, Martina Galabova1

1
Department of Pediatrics, University Hospital "St. Marine"Varna, Bulgaria

Poster Session |Miscellaneous | 18 June – 22 June, 2023, All day

Introduction: Gastroesophageal reflux disease (GERD) occurs with esophageal and

extraesophageal symptoms. One of the first steps in the treatment of GERD with
extraesophageal manifestations is the introduction of thickenedmilk formulas to formula-fed
infants.AIM: To examine the effect of carob-bean gum (CBG) thickened milk formulas on reflux
and tolerance indices in infants with gastro-esophageal reflux (GER).METHODS: For the period
March 1 2017 - April 1 2019 56 infants 0 –6 months of age were examined and treated with
thickenedmilk formulaat the Second Paediatric clinic, UMHAT “St. Marina”. The infants
exhibited clinical symptoms of GERD, covering reflux data according to the Orenstein
questionnaire. They were followed for one month, within 4 visits. On49 patients were
performed two multichannel intraluminal pH-metry with impedance, i. e. they have
completed the examination. RESULTS: Extraesophageal GERD symptoms are detectedin
infants with GERD, diagnosed with pH impedance – apnea with cyanosis, wheezing, reflux
laryngitis, recurrent pneumonia, cough attacks, bronchial obstruction, general reflux, reflux
ethmoiditis, reflux etmoides (187 in total). After one month of treatment with thickened milk
formula, the symptoms greatly subsided in 44 patients.Without follow-up control pH-metry,
it is not possible to be certain that GERD is cured as the pH-metry measurements: Boix Ochoa
score, SI, SSI, SAP do not change significantly. Treatment with thickened milk formula reduces
postprandial reflux in 69% of the patients. CONCLUSION:Infants treated with thickened milk
formula improve some of the esophageal and extraesophageal symptoms, leading to
improved quality of life for the family.

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1228
Host Immunity and Nasal Fungal Colonization

Kai-Li Liang1

1
Department of otolaryngology, Taichung Veterans General Hospital, Taichung , Taiwan

Poster Session |Miscellaneous | 18 June – 22 June, 2023, All day

Objective: Fungal colonization causes opportunistic infection that may manifest when the
host’s immune status deteriorates. The purpose of this study was to determine the prevalence
of fungal colonization in immunocompromised subjects compared to healthy controls. In
addition, we evaluated the efficacy of nasal irrigation for restoring the balance of the nasal
microbial community. Methods: Forty-one immunocompromised patients and 17 healthy
volunteers were enrolled from 2019 to 2021. Nasal lavage was performed, and the lavage
fluids (NLFs) were collected for analyses of fungal microbiota, galactomannan test
(GM), Aspergillus qPCR, and fungal culture. Twenty-eight immunocompromised subjects were
willing to receive nasal saline irrigation and to collect nasal lavage after nasal irrigation once
daily for one month. Results: There was reduced richness and diversity, and an increased
proportion of Aspergillus spp. in the nasal microbiota of immunocompromised subjects
compared to those of controls. Aspergillus DNA concentration, the positive rates of GM test
and fungal culture of NLFs from immunocompromised subjects were significantly higher than
those of controls. After one month of daily nasal irrigation, the richness and diversity of the
nasal microbiota of the immunocompromised subjects increased. In addition,
the Aspergillus DNA concentration decreased. Conclusion: Our study demonstrated immune
deficiency was associated with the prevalence of nasal Aspergillus colonization and dysbiosis.
Nasal irrigation is a promising method for restoring balance of fungal microbiota.

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1459
Pott puffy tumor due to loss of follow-up

Ayoze Lemes Robayna1, Pedro Masegosa Zapata2, María Gabriela Muñoz Cordero1

1
Department of Otorhinolaryngolgy, University Hospital of Canarias, Tenerife, Spain, 2Department of
Otorhinolaryngolgy, University Hospital of Albacete, Spain

Poster Session |Miscellaneous | 18 June – 22 June, 2023, All day

A 70-years-old woman is seen in our office with a growing frontal swelling for 2 months
associated with nasal congestion and pain. As personal background stand out asthma, chronic
rhinosinusitis with nasal polyps and glaucoma. She went into a functional endoscopic sinus
surgery 2 years ago but afterwards she lost her medical appointments. Only anterior bilateral
ethmoidectomy and maxillary antrostomy was made.In our exploration we can see a
fluctuating forehead mass that measures 4×3 cm and nasal polyps which produce blockage of
both middle meatus. In CT scan is seen a complete blockage of ethmoid and frontal sinuses
and a subperiosteal abscess of the frontal bone and soft tissue swelling of the forehead.After
antibiotics, a Draf III procedure was made with external access for reconstruction of the
external frontal lamina. The recovery of the patient was excellent and until today there is no
recurrence. A Pott puffy tumor describes a frontal edema resulting from osteomyelitis of the
frontal bone associated to subperiosteal abscess which its common cause is a complication of
a sinonasal infection. Head CT with contrast is important for diagnosis. Management consists
in broad-spectrum IV Antibiotics and surgery (minimally invasive endoscopic frontal
sinusotomy is preferred).

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1522
Endoscopic Transbuccal approach for Excision of Cheek lesion

Hannah Finney1, Paresh Pramod Naik1, Charlotte Thomas2

1
University of Northamptonshire, 2University of Northamptonshire UK

Poster Session |Miscellaneous | 18 June – 22 June, 2023, All day

Introduction of Endoscopes have revolutionised ENT surgeries. Endoscopes invariably form

the base of the rhinology surgeries. The concept of "minimal invasive surgeries" have led to
quicker post operative recovery. The patient satisfaction is higher as these are scarless
procedures. This is a technical note where in we describe Transbuccal Endoscopic approach
for lesions over the zygoma. The benefits of the procedure being avoiding scar over the face
and faster healing.

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1675
AIRBORNE PARTICULATE MATTER INDUCES NLRP3 INFLAMMASOME-MEDIATED
PYROPTOSIS VIA ACTIVATION OF ROS IN HUMAN AIRWAY EPITHELIAL CELLS

Dong Chang Lee1, Hyunsu Choi2, Jeong-Min Oh2, Byung Guk Kim1, Jin Hee Cho1

1
Department of Otorhinolaryngology HNS. Catholic university of Korea, 2 CLINICAL RESEARCH
INSTITUTE, DAEJEON St. MARY'S HOSPITAL

Poster Session |Miscellaneous | 18 June – 22 June, 2023, All day

Objects: Nowadays Air pollution is known to cause serious respiratory problems, and particul
ate matter(PM) is an important part of it. Therefore, we would like to find out the effect and
mechanism of PM on human respiratory epithelial cells.Methods: After treating PM on hum
an bronchial epithelial cells, cell viability was measured using MTT. Also NLRP3, IL-1b, IL-
18 was analyzed using western blotting analysis and ROS was measured by DCFDA.Result: T
he cell viabilty was decreased in proportion to the concentration of PM. NLRP3, IL-1b, and IL-
18 increased when the concentration of PM increased. In DCFDA measurement, ROS increas
ed when PM concentration increased. The action of PM was suppressed when antioxidant(N
AC) was treated. Conclusion: PM causes NLRP3 inflammasome mediated pyroptosis through
the activation of ROS in human respiratory epithelial cells.

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1756
Establishing a Clinical Nurse Practitioner-led Nasal Fracture Clinic: Our Experience

Siew Keh1, Niall Woodley2, Sara Lim2, Louise McBlain1, Karen Herity1

1
New Victoria Hospital, Glasgow, Scotland, 2Queen Elizabeth University Hospital, Glasgow, Scotland

Poster Session |Nasal and Facial Trauma | 18 June – 22 June, 2023, All day

Objectives In NHS Greater Glasgow and Clyde, an ENT Clinical Nurse Practitioner-led nasal
fracture clinic was established in 2021. The service aims to expedite reviews and treatment of
patients with nasal fractures and decrease ENT consultant workload to optimise ENT clinic
use. Our main objective is to analyse the outcomes of this clinic to determine its
effectiveness.MethodsRetrospective analysis of all patients reviewed in the Clinical Nurse
Practitioner-led nasal fracture clinic since its conception in April 2021 to December 2022. This
was achieved through reviewing patient medical records and the ENT Nurse Led Nasal
Fracture Virtual Clinic Proforma. The main point of focus were clinic outcomes and common
reasons for consultant referral.ResultsA total of 234 patients were reviewed. 95 (41%)
patients underwent closed nasal fracture reduction (CNFR). 35 (15%) were discharged having
declined treatment. 63 (27%) were discharged with no treatment required. 41 (17.5%) were
referred for consultant review. Common reasons for referral included: complex cases, patients
with longstanding nasal congestion and patients unhappy with the outcome after
CNFR.ConclusionA Clinical Nurse Practitioner-led nasal fracture clinic is feasible and appears
effective in reducing the number of patients requiring consultant input, thereby optimising
clinic use.

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Non-allergic rhinitis

1511
Endoscopic endonasal radiosurgery (RFITT) in Eustachian tube dysfunction due to
chronic catarrhal and vasomotor rhinitis

Yutii Nikolov1, Marta Nikolova2

1
MBAL St. Paraskeva Pleven, 2Kopfzentrum Menagement Leipzig

Poster Session |Non-allergic rhinitis | 18 June – 22 June, 2023, All day

Endonasal deformations, chronic inflammatory and allergic processes of the nasal mucosa,
accompanied by hypertrophic changes are the main cause of the development of chronic
Eustachian tube dysfunction (ETD). Of particular interest in the etiology of ETD are the chronic
catarrhal and vasomotor rhinitis. Objective: the aim of the present work is to show the
existence of an effective etiological relationship between chronic catarrhal and vasomotor
rhinitis and ETD, and also to analyze the results of the use of endoscopic endonasal
radiofrequency thermotherapy (RFITT) in the treatment of this pathology. Material:for a
period of 5 years, with the help of video-assisted optics and RFITT technique, 52 patients
suffering from chronic catarrhal and vasomotor rhinitis with ETD were operated. Method:with
video-assisted endoscopic endonasal optics and RFITT technique, were performed a
peripheral selective uninasal parasympathetic denervation (PSEPD) and submucosal
radiodestruction of the posterior poles of the lower and middle turbinates and the peritubar
complex.Results: after PSEPD, endonasal and epipharyngeal radiodestruction, was observed
an improvement of complaints from the nasal symptom complex (restoration of nasal
breathing and copying of nasal discomfort) and almost complete disappearance of symptoms
from ETD (hearing loss, crackling, deafness, vertigo) in 90% of patients. Conclusions: the
extremely good postoperative results of the endoscopic RF Surgery for ETD due to chronic
catarrhal and vasomotor rhinitis make these surgical method of treatment reliable and
promising.

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Nasal and facial trauma

1678
How common is Rhinitis Medicamentosa in an ENT outpatient Clinic?

MARIA KORODIMA1, GEORGIOS GRIVAS1, AIKATERINI DRYLLI3

1
ENT Department of “Pammakaristos” hospital, Athens, 2,ENT Department of “Pammakaristos”
hospital, Athens., 3ENT Department, Health center of Athens

Poster Session |Non-allergic rhinitis | 18 June – 22 June, 2023, All day

Maria Korodima1 , Georgios Grivas 2 , Aikaterini Drylli 3 . 1 Resident, ENT Department of

“Pammakaristos” hospital, Athens. 2 Consultant, ENT Department of “Pammakaristos”
hospital, Athens. 3 Consultant, ENT Department, Health center of Athens. Abstract Rhinitis
medicamentosa (RM) is a form of non-allergic irritation and inflammation of the nasal mucosa.
It is usually induced by the prolonged use of intranasal decongestants for more than 5 days
straight. In the ENT outpatient clinic, 56 patients presented by persistent nasal obstruction
from 01/05/2022 to 31/10/2022. Five women and two men were diagnosed with RM (12.5%).
Five patients were adults aged from 31 to 68 years old. In contrast, 28.6% were up to 15 years
old. The vast majority (71.4%) had a pale and edematous nasal mucosa as well as a positive
history of continued use of topical decongestants for a period between two weeks to three
years. Subjects who used intranasal sympathomimetic amines (20%) had chronic sinusitis and
nasal polyposis while patients with allergic or viral rhinitis applied imidazolines (80%).
Furthermore, in two patients the nasal examination revealed an atrophic and crusted mucosa
following oral systematic use of contraceptives by a young woman and beta-blockers
antihypertensives by a middle-aged man. All patients received intranasal treatment by saline
rinses and steroids as well as the cessation of medication that cause RM. The early diagnosis
of RM is vital for the interruption of the medication that caused the nasal blockage.

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Orbital surgery

1223
A case of nontraumatic subperiosteal orbital hematoma secondary to frontal sinus
mucocele

Jing Zhou1, Ruowu Liu1, Jintao Du1

1
Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University,
China

Poster Session |Orbital surgery | 18 June – 22 June, 2023, All day

Background: Nontraumatic subperiosteal orbital hematoma (NTSOH) secondary to paranasal

sinus mucocele was rarely reported.Methods: Herein, we report a case of 40-year-old man
presented to our hospital for acute proptosis, periorbital pain, diplopia and hypopsia of the
right eye. Computed tomography (CT) and magnetic resonance imaging (MRI) were
performed for diagnosis. External approach into frontal sinus accompanied endoscopic sinus
surgery (ESS) was performed for treatment.Results: CT and MRI showed a mass in the superior
area of right orbit and a mass in the right frontal sinus. NTSOH of right orbit and mucocele in
frontal sinus were definitely diagnosed and completely removed via ESS and external
approach into frontal sinus. No recurrence of hemorrhage occurred during follow-
up.Conclusion: NTSOH should be suspected when orbital mass presented with sinus
mucocele. Surgical investigation is vital for diagnosis and treatment of NTSOH secondary to
sinus mucocele.

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1231
Perspicuous Treatment Algorithm for Pediatric Orbital Blowout Fractures

Kosuke Takabayashi1, Yohei Maeda1

1
Department of Otorhinolaryngology

Poster Session |Orbital surgery | 18 June – 22 June, 2023, All day

Aim: Pediatric orbital blowout fractures occasionally include cases that require urgent
treatment to prevent serious sequelae. Sometimes physicians cannot confirm findings
because pediatric patients may not be cooperative with examinations. Hence, we advocate
for a simple, practical treatment algorithm for pediatric orbital blowout fractures. Methods:
This retrospective cohort study included patients with pediatric orbital blowout fractures
treated at Japanese Red Cross Asahikawa Hospital from April 2000 to August 2020 based on
the algorithm. At follow-up, ocular movements were evaluated based on percentage of Hess
area ratio (HAR%) and subjective diplopia. Patients were divided into two age groups: 0–12
years and 13–18 years. Differences in the frequency of urgent cases and HAR% were
compared across groups.Results: There were 9 patients who underwent urgent release, 16
who underwent repair, and 36 who underwent conservative treatment. Mean age was
13.10±3.72 years. HAR% on follow-up was 98.0% ±4.7% (range, 77.6%–100%). Postoperative
diplopia was observed in 4% of patients. More patients aged 0–12 years had urgent needs
than those aged 13–18 years (p=0.0051). There were no differences in HAR% between the
groups.Conclusion: The algorithm is suitable for pediatric orbital blowout fractures.

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1502
Orbital Pseudotumor. Report of two cases

Konstantinos Choulakis1, Anastasia Liapi1, Athanasia Marinou1, Evangelia Zacharioudaki1

1
General Hospital of Athens "G.Gennimatas"

Poster Session |Orbital surgery | 18 June – 22 June, 2023, All day

IntroductionOrbital pseudotumor is a benign process affecting the orbit and sometimes the
surrounding structures. Its pathogenesis has not been elucidated yet, but some evidence
points out to autoimmune, infectious and aberrant healing processes.Case presentationWe
present two cases of orbital pseudotumor. Both cases presented with unilateral orbital pain,
blepharoptosis and proptosis. The first patient had a one-month history of unilateral
edema/erythema of the upper eyelid and purulent conjunctival discharge. The second patient
had a history of recurrent rhinosinusitis for which he had endoscopic surgery thirty years
ago. Imaging studies revealed a contrast enhanced mass, compressing the lateral rectus
muscle and lacrimal gland in the first case, whereas in the second case there was compression
of the superior rectus muscle, ipsilateral frontal sinus empyema and a bony defect of the floor
of the frontal sinus. Both patients underwent biopsy of the orbital mass combined with Draf
II procedure, in the patient with the frontal empyema. The histological examination revealed
inflammatory tissue, characteristic of orbital pseudotumor. The patients were put on
therapeutic treatment with high-dose corticosteroids.Conclusion Οrbital pseudotumors may
sometimes be related with sinonasal inflammatory processes. High index of suspicion, careful
history-taking and multi-disciplinary approach are mandatory for optimal decision-making
and management.

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1552
Atypical process of orbital complication in acute rhinosinusitis

Květoslav Červený1, Zuzana Balatková1, Jan Plzák1

1
Department of Otorhinolaryngology, Head and Neck Surgery The First Medical Faculty of the Charles
University Motol University Ho

Poster Session |Orbital surgery | 18 June – 22 June, 2023, All day

Infection of the soft tissue of the orbit as an extension of acute bacterial rhinosinusitis (ABRS)
is serious complication, with high risk of visual loss or progression into intracranial spreading
making it life threating condition. Despite being relatively rare thanks to adequate antibiotic
treatment, orbital cellulitis still accounts of almost 80% of all complications associated with
ABRS. Our case describes unusual process of orbital cellulitis in 31 years old man with ABRS
complicated by formation of abscesses in the submucosal space of nasal septum, medial and
lateral part of the orbit. Patient underwent CT scan and the examination by ophthalmologist
and was immediately hospitalized and operated on the same day. Several control imaging
methods (including MRI) were performed after the operation revealing formation of another
abscess laterally from the bulb requiring combination of endoscopic and external approach.
Patient condition in the upcoming period was gradually improving leaving him without any
visual impairment. Management of orbital complications due to ABRS highly depends on the
fast and proper diagnosis, based on the endoscopic examination and findings on the imaging
methods following aggressive treatment with antibiotics and, when indicated, early surgical
procedure. Adequate follow-up is an important part of the management.

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1595
Orbital apex syndrome in difficult-to-treat Pseudomonas Aureginosa sinusitis

Blanca Mateos-Serrano1, Carolina Alfonso1, Teresa Langeber1, Coloma Grau2

1
Department of Otolaryngology, La Paz University Hospital, 2Department of Otolaryngology, La Paz
Universitary Hospital

Poster Session |Orbital surgery | 18 June – 22 June, 2023, All day

Orbital apex syndrome (OAS) involves optic neuropathy and ophthalmoplegia secondary to a
variety of conditions.We present an 80-year-old male diagnosed with diabetes mellitus who
was admitted in the emergency department for presenting rapidly progressive right eye
amaurosis, proptosis and VI palsy. Angio-CT showed intraconal cellulitis with oedema of
orbital apex, opacification of ethmoidal cells, bone-dehiscence of optic nerve in an Onodi cell,
and normal cavernous sinus. OAS was diagnosed. Treatment with corticosteroids and
antibiotics were initiated, and emergency ethmoidectomy and optic nerve decompression
were performed. Cultures were positive for pseudomonas aeruginosa. Patient showed initial
good clinical progress but recurrent hyperglycemias. A week after finishing antibiotic therapy
symptoms worsened, and a new culture showed persistence of quinolone-resistant
pseudomonas. Strict glucose-level control and targeted antibiotics were necessary for 6 weeks
more. During follow-up, patient slowly recovered eye-movement and visual-acuity. Treatment
of OAS is directed at the underlying cause. Anti-inflammatory drugs as corticosteroids may be
useful if an inflammatory etiology is suspected. Targeted long-term antibiotics are mandatory
in drug-resistant bacterial infections. Although it is more frequently used in traumatic OAS,
surgical decompression is helpful in inflammatory conditions with visual loss.

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1687
Purely Transorbital Endoscopic Resection Of Gastrointestinal Stromal Tumor
Metastasis Extending From Temporal Fossa To The Masticator Space

Hazan Basak1, R. Arjin Oksuz1, Tugba Akyuz1, Suha Beton1, Cem Meco1

1
Ankara University Medical School Department of ORL

Poster Session |Orbital surgery | 18 June – 22 June, 2023, All day

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common malignant
subepithelial lesions (SELs) of the gastrointestinal tract in the daily clinical setting. To the best
of our knowledge, this is the first case purely transorbital endoscopic (TEA) removal of a GIST
metastasis from orbit and masticator space.Case: A 58-year-old woman presented with a
history of right eyelid swelling and orbital pain. She had a history of a prior stomach
gastrointestinal stromal tumor (GIST) with a large metastasis to the frontotemporal lobe;
brain tumor removed but intraorbital and masticator part was left untouched. On examination
eye motility restrictions to lateral and superior with no relative afferent pupillary reflex and 4
mm of right-side proptosis were detected. On CT and MRI there is a heterogeneous
contrasting solid mass lesion in size of 55x40 mm in the temporal bone squamous part on the
right sphenoid greater wing, which reaches the masticator space, destroys the pterygoid
plates that cause pressure from the posterolateral to the orbit and proptosis. The squamous
portion of the right temporal bone and the right orbital lateral wall are destroyed. Total tumor
resection were achieved with purely TEA. Patient discharged 1 day after surgery. In
postoperative 6 months eye movements are completely normal no sign of recurrence were
detected by oncological follow ups. Conclusion: In suitable cases transorbital approaches can
be use to remove tumors extending from skull base to masticator space in minimally invasive
way.

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Paediatric rhinology

1272
NASAL SEPTAL ABSCESS COMPLICATING ACUTE SPHENO-ETHMOIDITIS IN A CHILD

Konstantina Chrysouli1

1
Department of Otorhinolaryngology, Penteli Children Hospital, Athens, Greece

Poster Session |Paediatric rhinology | 18 June – 22 June, 2023, All day

Ιntroduction: Nasal septal abscess is rare, but more common in children as a result of post-
traumatic as a result of post-traumatic causes from hematoma septal hematoma infection
(75-85), immunosuppression, dental infections, acute sinusitis and recurrent polychondritis.
Nasal and ocular complications are the most common complications of septal abscess, while
intracranial complications are rarer but fatal. Purpose: Presentation of a case of nasal septum
abscess in a 15-year-old girl with acute sphenoethmoiditis. Case presentation: A 15-year-old
girl presented with frontal and parietal headache since one week, severe nasal congestion and
fever since three days. From the anterior rhinoscopy of the nose, bilateral edema of the
mucous membrane of the nasal septum, red in color, easy to press, pasty with obstruction of
the nasal cavities is found.Abundant retronasal discharge is seen from the oropharynx.
Individual history negative for injury, allergies, immunosuppression, dental pain, bleeding
disposition, other past chondritis, and autoimmune diseases. A puncture is performed with
aspiration of serous fluid without the presence of β2 transferrin. An urgent visceral skull CT is
performed without fracture image, bony deficit of anterior skull base with almost complete
occupation of ethmoid cells and sphenoid sinus and fluid collection in osseous and
cartilaginous part of nasal septum. He is placed on intravenous treatment with ceftazidime
3gr/day and clindamycin 2.4gr/day. Results: Surgery is performed with a Killian incision,
cleaning and packing for 72 hours in order to drain the nasal septum abscess. Culture of
material revealed Strept. Intermedius sensitive to administered antibiotics. On the 6th day,
the child is discharged with complete remission of symptoms. Re-examined at 7, 14, 30, 60
days with endoscopy without signs of recurrence. Conclusion: In a child with worsening nasal
congestion and rhinosinusitis with bilateral swelling of the mucous membrane of the nasal
septum, urgent CT scan of the visceral skull, immediate surgical drainage with initiation of
intravenous antibiotic treatment and regular follow-up for at least two years are necessary.
The aim is to prevent complications and speedy recovery.

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1225
Pediatric Chronic Rhinosinusitis – from Diagnosis to Management

Dilyana Vicheva1

1
Department of Otorhinolaryngology, Medical Faculty, Medical University of Plovdiv, Bulgaria

Poster Session |Paediatric rhinology | 18 June – 22 June, 2023, All day

The nose contains organ of smell and respiration. It warms, cleans and humidifies the inspired
air, cools and remove the water from the expired air. The ENT surgeon should distinguish
normal nasal function from pathological symptoms to prevent unnecessary surgery. Although
the nose is a paired structure divided coronally into two chambers, it act as a functional unit.
Development of the Maxillary sinus seen on plain films at 4-5 months and slow expansion until
18 years. The Ethmoid sinus seen on radiographs at 1 year and enlarges to reach adult size at
age 12. The Sphenoid sinus pneumatization begins at age 3 rapid growth to reach sella by age
7 and adult size at age 18. The Frontal sinus seen on radiographs at age 5-6 and grows slowly
to adult size by adolescence. The predisposing factors of the pediatric rhinosinusitis are:
Allergic rhinitis; Immunodeficiency: IgG subclasses, IgA; Genetic/congenital; Cystic fibrosis,
Ciliary dyskinesia; Anatomic obstruction, Gastroesophageal reflux; Microorganisms;
Pollutants, Medications, etc. by Clinical Consensus Statement on PCRS (AAO-HNSF): 20
consecutive days of Antibiotic Management may produce a better response than 10 days
therapy. The daily nasal saline irrigations and intranasal steroid use with or without AB are
useful. When the reason for pediatric chronic rhinosinusitis (PCRS) is adenoid hypertrophy,
then adenoidectomy has been shown to decrease the load of nasopharyngeal pathogens
associated with PCRS. Adenoidectomy is an appropriate surgical intervention in children from
6 to 12 ye

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1409
Surgical treatment of bilateral choanal atresia with diode laser in premature – case
report

Stjepan Grga Milanković1, Josip Maleš1, Tihana Mendeš1, Vjeran Bogović1, Anamarija
Šestak1, Željko Zubčić1

1
Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, Osijek

Poster Session |Paediatric rhinology | 18 June – 22 June, 2023, All day

Bilateral choanal atresia appears immediately after birth as respiratory distress,

cyanosis,intermittent apnea. The incidence of this malformation is between 1:5000 and
1:8000 livebirths. It is more often unilateral than bilateral (60% vs. 40%) and occurs more
frequently infemales than in males (ratio 2:1).We represent a male prematurity, body weight
only 1571 grams, born in the 34th week ofpregnancy. Primarily resuscitated, intubated
immediately after birth because of respiratoryinsufficiency. We performed trans-nasal fiber
endoscopy, followed by computedtomography confirming the diagnosis of bilateral bone
choanal atresia.Fifth day of birth, under general anesthesia nose airway was recanalized by
trans-nasalendoscopic approach with diode laser. After bone perforation, we placed catheters
number6 through choana. During postoperative follow-up, secretion was aspirated every day,
andcatheters mobilized to prevent granulation and stenosis. Two weeks later, catheters
wereremoved. The child was extubated , breathing independently through the nose with
optimalperipheral oxygenation.Bilateral bone choanal atresia can be successfully treated with
delayed surgery along promptprenatal diagnosis and endotracheal airway restoration
intubation. Diode laser is one of thetherapeutic options. It can effectively remove mechanical
barrier to establish physiological respiration.

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1418
NASAL RESPIRATORY OBSTRUCTION IN A NEONATE WITH CHOANAL ATRESIA AND
STENOSIS OF THE PYRIFORM APERTURE IN THE CONTEXT OF CROUZON SYNDROME

NURIA CRUZ CERÓN, CARLA ACOSTA VASQUEZ1, VIRGINIA GARCIA GARCIA1, JUAN AGUILAR
CANTADOR1

1
Sociedad Española de Otorrinolaringología (SEORL)

Poster Session |Paediatric rhinology | 18 June – 22 June, 2023, All day

INTRODUCTION:Nasal airway obstruction can be life threatening to newborns because they

are obligate nasal breathers. Some of the causes are choanal atresia (CA) and pyriform
aperture stenosis (PAS).Clinically they present as breathing distress, desaturation and
cyanosis, reverted by crying. The diagnosis is with computed tomography (CT) and nasal
endoscopy.CA is the congenital obliteration or narrowing of the posterior nasal choana.PAS is
a congenital narrowing during to mandibular bone growth, is defined as <1 mm of the piriform
aperture.MATERIALS AND METHODSTerm newborn with prenatal history of polyhydramnios,
cyanosis reverted by crying, hypertelorism, proptosis, and ogival palate. Catheter can't be
passed through both nostrils. CT confirmed the nostrils occupation and choana narrowing, the
pryriform orifice was 6mm.With these findings we decided surgical intervention in two stages.
Actually the patient is extubated, with oral feeding.DISCUSSIONNasal airway obstruction can
be life threatening to newborn.The causes are inflammatory or infectious processes, and
congenital causes as CA and PAS.The definitive treatment of CA is surgical, with endoscopic
approach.The treatment of PAS begins with corticosteroids, indicating surgery if the
symptoms persist or worsen after four weeks of treatment.

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1517
HEMINASAL AGENESIS, EXPERIENCE FROM THE 30th WEEK OF GESTATION

Miguel Saro- Buendía1, Catalina Bancalari Díaz3, Roberto Llorens Salvador4, Eva López
Blanco5, María José Lesmas Navarro3, Lourdes Pardo Mateu3, Isabel Ibáñez Alcañiz3, Agustín
Alamar Velázquez3, Noelia Muñoz Fernández3, Lucas Fito Martorell3, Alfonso García Piñero3,
Miguel Armengot Carceller6

1
Department of Otorhinolaryngology- Head and Neck Surgery, La Fe University and Polytechnic
Hospital, University of Valencia, Sp, 2Department of Otorhinolaryngology- Head and Neck Surgery, La
Fe University and Polytechnic Hospital, University of Valencia, Spain, 3Department of
Otorhinolaryngology- Head and Neck Surgery, La Fe University and Polytechnic Hospital, Spain.,
4
Department of Radiology, La Fe University and Polytechnic Hospital, Spain., 5Department of Plastic
Surgery, La Fe University and Polytechnic Hospital, Spain., 6 Department of Otorhinolaryngology- Head
and Neck Surgery, La Fe University and Polytechnic Hospital, University of Valencia, Spain

Poster Session |Paediatric rhinology | 18 June – 22 June, 2023, All day

INTRODUCTION:Heminasal agenesis (HA) is extremely rare. It consists of the absence of half

of the nose (ala, nostril, columella, choanae and nasal bone) with persistent nasal septum.
CASE REPORT: A 45-year-old woman was referred to our hospital after a foetal doppler
ultrasound (US) diagnosis of duodenal atresia and left HA. It was confirmed by prenatal MRI
performed at 32nd week of gestation. Immediately after birth, duodenal atresia was
successfully addressed with surgery. Nasal endoscopy and CT evidenced a normal right
heminasal cavity. On the left side, there was no epiphora and a para-columellar orifice seemed
to drain mucus. To date (1- year follow up) management is multidisciplinary and nasal surgery
has not been needed.DISCUSSION:Prenatal diagnosis of HA is possible by means of US and
MRI. Related life- threatening malformations should be ruled out. HA functional aspects
(permeability, mucus drainage, nasolacrimal patency, visual accuracy, olfaction or feeding)
may be addressed early. Although there is no consensus, aesthetic aspects seem to be
optimally addressed during adolescence. CONCLUSIONS: HA is extremely rare and case
reports are needed to optimize diagnostics and the management of functional and aesthetic
aspects.

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Pituitary Surgery

1304
Changes in olfaction after transnasal endoscopic pituitary surgery

Lubojacky Jakub1, Marek Plášek1, Petr Matoušek1, Radim Lipina2, Tomáš Krejčí2, Jakub
Lubojacky1

1
ENT department, University hospital Ostrava, 2Department of neurosurgery, University hospital
Ostrava

Poster Session |Pituitary Surgery | 18 June – 22 June, 2023, All day

IntroductionTransnasal endoscopic transsphenoidal approach is the gold standard in the

treatment of pituitary adenomas. Nasal function can be deteriorated by surgical procedure.
The aim of the study was to determinate the effect of surgical procedure on olfaction and
other nasal functions.MethodsAdult patients diagnosed with a pituitary adenoma and
scheduled for transnasal endoscopic resection, underwent preoperative olfactory evaluation
using an odorized markers test. Postoperative testing was performed four months after
surgery. Patients also assessed their smell and nasal obstruction using visual analog scale prior
and 4 months after surgery.ResultsTotal of 82 patients (42 females, 40 males) were enrolled
into study between 2010 and 2020. Anosmia was detected preoperatively in eleven patients.
Olfactory deterioration was observed in 2/71 patients (2.8%). Subjective deterioration of
smell was observed in 9/82 (10.9%) patients and subjective deterioration of nasal patency
after surgery was observed in 3/82 (3.6%) patients. Conclusion Transnasal endoscopic
pituitary surgery may be associated with a very low risk of postoperative deterioration of
olfaction and other nasal functions. Olfactory testing should be part of the preoperative and
postoperative examination and patients should be informed of the possible occurrence of
olfactory impairment.

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1663
SELLAR CHOLESTEROL GRANULOMA

COVADONGA SUAREZ ARANGUEZ1, JUAN AGUILAR CANTADOR, MARTA ORDOÑEZ

CARMONA, HOUDA BEN ABDELLAH OUAZZANI, CARLOS DOVAL ROSA

1
Otorhinolaryngology, Hospital Reina Sofia, Cordoba, Spain

Poster Session |Pituitary Surgery | 18 June – 22 June, 2023, All day

INTRODUCTIONSellar xhantogranulomas are intrasellar-suprasellar cholesterol

granulomas.This entity has been suggested clinically and phatologically different from
adamantinomatous craniopharyngiomas.They are mostly diagnosed in adolescents and young
adults.MATERIAL AND METHODS14-year-old patient followed up by endocrinology for short
stature and visual defect.MRi revealed a sellar and suprasellar lesion consistent with a
craniopharyngioma.Surgery was performed.A transsphenoidal endonasal approach was
performed.The solid nodule located in the sphenoid sinus was resected.The floor of the sella
was opened and the sellar and suprasellar cystic components were removed. The cyst was
marsupialized to the nostrils, maintaining the capsule due to adhesions to both carotid
arteries.No cerebrospinal fluid leak was identified.Closure with nasal flaps was not
performed.RESULTS The anatomopathological result of the specimen was sellar
xanthogranuloma.The patient presents permanent visual deficit and hypopituitarism.In
control MRI,the lesion has grown again.The marsupialized cavity to the nostrils was closed
spontaneously 6 years after the first intervention,so a new intervention is
pending.CONCLUSIONCholesterol granuloma of the sellar region is a rare tumor, little known
about its etiology and evolution. It should be included in the differential diagnosis of other
lesions of the sella.More studies are required to understand the natural hiMore studies are
required to allow better understand the natural history of these lesions and therefore allow
optimize the management of these patients.

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Rhinology – miscellaneous

1178
Influenza viral infection is a risk factor for severe illness in COVID-19 patients: a
nationwide population-based cohort study

Kim Jong Seung1, SamHyun Kwon1

1
Jeonbuk National University Hospital

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

In order to prepare for the twindemic of influenza and SARS-CoV-2 infection, we

investigated the association between influenza infection and subsequent severity of SARS-
CoV-2 infection. A population-based nationwide cohort study was performed using data from
the National Health Insurance Service (NHIS) in the Republic of Korea. This study included
274,126 individuals who underwent SARS-CoV-2 PCR testing between 20 January 2020 and 1
October 2020. Among these patients, 28,338 tested positive for SARS-CoV-2, and 4,003 of
these individuals had a history of influenza. The control group was selected through 1:1
propensity score matching. In the group of 4,003 COVID-19-positive individuals with no
history of influenza, 192 (4.8%) experienced severe illness from COVID-19 infection. In the
group of 4,003 COVID-19-positive individuals with a history of influenza, 260 (6.5%) had
severe illness from COVID-19, and the overall adjusted odds ratio (aOR) was 1.29 (95%
confidence interval 1.04–1.59). Among the 4,003 COVID-19-positive individuals with a history
of influenza, severe COVID-19 infection was experienced by 143 of 1,760 (8.1%) with an
influenza history within 1 year before the onset of COVID-19, 48 of 1,129 (4.3%) between 1
and 2 years, and 69 of 1,114 (6.2%) between 2 and 3 years before COVID-19 onset, and the
aORs were 1.54 (1.20-1.98), 1.19 (0.84-1.70), and 1.00 (0.73-1.37), respectively. In conclusion,
individuals who had an influenza infection less than 1 year before COVID-19 infection were at
an increased risk of experiencing severe illness from the SARS-CoV-2 infection. T

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1254
Increased incidence of rhino-orbital mucormycosis in patients after COVID-19

Diana Zabolotna1, Dmytro Zabolotnyi2, Iryna Tsvirinko1, Eldar Ismahilov1, Tetiana Smahina3,
Yaroslav Kizim1

1
Department of Rhinology, Allergology and Radiology, Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Sci, 2Director, Kolomiychenko Institute of Otolaryngology of National
Academy of Medical Sciences of Ukraine, 3Kolomiychenko Institute of Otolaryngology of National
Academy of Medical Sciences of Ukraine

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Introduction. Mucormycosis is a multisystem, aggressive and opportunistic fungal infection.

The most common type is rhino-orbito-cerebral mucormycosis, which accounts for about 40%
of all cases.There are no patients with rhinoorbital-cerebral mucormycosis were observed on
the territory of Ukraine. Therefore, this disease was considered characteristic of the spread in
countries with a tropical and subtropical climate.Materials and methods. During 2020-2022 5
patients presented with signs of an aggressive fungal infection to our institution.Results. 5
patients had acute rhinosinusitis symptoms of varying degrees of severity and it began to be
observed after the experienced COVID-infection. After a few weeks, osteomyelitis of the skull
bones varying extent appeared. Slow-flowing phlegmon of the orbit and a fistula in the inner
corner of the eye began in 3 patients. In 2 patients was observed the destruction of endonasal
structures. 1 patient suffered from ptosis, amaurosis and thrombosis of both cavernous
sinuses.From anamnestic data: 4 out of 5 patients had diabetes of varying degrees of severity.
1 patient was HIV-infected and had hepatitis C.All patients noted facial numbness at the
beginning of the disease.3 patients underwent surgery and mucormycosis was detected.
Patients were prescribed treatment with amphotericin B. Conclusions. The spread of invasive
fungal infections has expanded.

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1274
Presentation of a patient with a left nasolabial cyst treated with transnasal
endoscopic marsupialization

Ioannis Komnos1, Georgios Tsirves1, Lentiona Basiari1, Maria Michali1, Eleni Litsou1, Georgios
Psychogios1

1
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Nasolabial cysts are rare soft tissue non-odontogenic developmental cysts. More commonly
they affect females typically on the fourth and fifth decades and in 90% of the cases they are
localized unilaterally. Diagnosis usually depends on clinical evaluation, but also imaging
techniques may be helpful. Nasolabial cysts do not present any finding on plain radiographs.
Computed Tomography and Magnetic Resonance Imaging can reveal the extent and relation
of lesion to surrounding structures. Sublabial excision and endoscopic marsupialization are
the alternative treatment options. We present the case of a 60-year-old woman with no
significant medical history that presented to our department with a painless swelling of the
left nasal vestibule and symptoms of slight nasal blockage during the last 6 months. Clinical
examination revealed a painless mass which caused obliteration of the left nasolabial sulcus,
nasal vestibule, and maxillary labial sulcus and which was soft on palpation with no signs of
inflammation. Nasal endoscopy revealed protrusion of the mass inside the nasal cavity. CT
scan scan showed the presence of a cyst with no bone erosion. We performed a transnasal
endoscopic marsupialization under general anesthesia.

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1481
External approach of the frontal sinus: when is it still useful?

Daniel Miranda, Alina Martín Fernandes1, Filipa Moreira2, António Fontes Lima2, Miguel Sá
Breda2, Luís Dias2

1
SPORL, 2SPORL; Serviço de Otorrinolaringolgia e Cirurgia Cérvico Facial do Hospital de Braga

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Introduction: Over the years, multiple frontal sinus surgical options have been described, but
the main challenge is selecting the most convenient approach based on the patient’s anatomy
and disease. Despite the impressive advances in endoscopic endonasal approaches and
instrumentations there are still cases when the frontal sinus must be approached externally,
alone or in combination with endoscopic sinus surgery.Case report: We aim to present 4
particular cases with different frontal pathologies (osteoma, chronic rhinosinusitis, mucocele,
and Pott’s puffy tumor) where the open approach with or without combination with
endoscopic surgery was successful. We use different surgical techniques, namely frontal sinus
trephination, frontal osteoplastic flap with obliteration of the frontal sinuses, frontal
osteoplastic flap with cranialization of the frontal sinus, and frontal osteoplastic flap in
combination with endoscopic surgery.Conclusion: The frontal sinus remains a challenging
area. The appropriate selection of cases appears to be of outstanding importance to obtaining
successful outcomes. Because not all patients can be treated only endoscopically, we should
consider an external approach in selected patients.

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1518
Quality of life after septoplasty in patients with nasal obstruction

Piotr H. Skarzynski1, Justyna Dabrowska-Bien2, Henryk Skarzynski2, Sebastian Gorski2

1
Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing,
Warsaw, Poland 3. Department of , 2World Hearing Center, Institute of Physiology and Pathology of
Hearing, Kajetany/Warsaw, Poland, 3Department of Teleaudiology and Screening, Institute of
Physiology and Pathology of Hearing, Warsaw, Poland, Department of Heart Failure and Cardiac
Rehabilitation, Medical University of Warsaw, Poland, Institute of Sensory Organs, Kajetany, Poland

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Introduction: This paper aims to present the evaluation of the quality of life in adult patients
with nasal obstruction after septoplasty, and the effectiveness of this type of surgery. Nasal
obstruction is one of the most frequent symptoms reported to ENT which may have a
significant impact on the patient’s life. Moreover, septoplasty is one of the most common
types of surgery in ENT. Material and methods: The study group consisted of 51 patients
(patients over 18 y.o., with septal deviation and chronic nasal obstruction lasting at least 3
months, and persistent symptoms after a 4-week of medical therapy (such as nasal steroids,
oral or topical decongestants, oral antihistamine/decongestant combination). Patients were
asked to complete the Nasal Obstruction Symptom Evaluation (NOSE-POL), the Visual
Analogue Scale (VAS), as well and the Clinical Global Impression Scale (CGI-S). Results: The
statistical analysis has shown that there was a significant improvement in nasal obstruction
after septoplasty (observed in 3 and 7 months after the surgery) in comparison to the
baseline NOSE-POL scores (tested 2 weeks before the surgery). However, the comparison
between 3-month follow-up and 7-month follow-up scores was statistically significant. The
VAS scores before and after septoplasty also show a statistically significant improvement in
nasal congestion. Conclusions: Nasal obstruction may impact the patient’s life. However,
septoplasty as one of the nasal surgeries leads to significant quality of life improvement in
patients with nasal congestion.

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1521
BILATERAL SEVERE HYPOPLASIA “LIMITED” TO PARANASAL SINUSES AND
TURBINATES: A UNIQUE CASE

Miguel Saro- Buendía1, Maria José Gómez Gómez3, Lucas Fito Martorell4, Noelia Muñoz
Fernández4, Natalia Jaramillo Angel4, Javier Cabrera Guijo4, Saúl Astray Gómez4, Santiago
Almanzo4, Alfonso García Piñero4, Miguel Armengot Carceller5

1
Department of Otorhinolaryngology- Head and Neck Surgery, La Fe University and Polytechnic
Hospital, University of Valencia, Sp, 2Department of Otorhinolaryngology- Head and Neck Surgery, La
Fe University and Polytechnic Hospital, University of Valencia, Spain, 3Department of
Otorhinolaryngology, General Hospital of Valencia, Spain., 4Department of Otorhinolaryngology- Head
and Neck Surgery, La Fe University and Polytechnic Hospital, Spain., 5 Department of
Otorhinolaryngology- Head and Neck Surgery, La Fe University and Polytechnic Hospital, University of
Valencia, Spain

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

INTRODUCTION: Anatomical variations in the paranasal sinuses (PNS) and turbinates are
consequence of a complex embryologic process in which the cartilaginous nasal capsule is
involved.CASE REPORT: A 44-year-old male presented bilateral nasal obstruction,
bronchiectasis, and azoospermia. Nasal endoscopy showed severe hypoplasia of the
turbinates and a well- developed nasal septum. Computed tomography revealed the aplasia
of ethmoidal cells and frontal sinuses and a severe hypoplasia of both maxillary and
sphenoidal sinuses. Also, a tracheocele was evidenced. Diagnostic studies were negative for
primary ciliary dyskinesia and cystic fibrosis (PCD and CF) but demonstrated
hypogammaglobulinemia. DISCUSSION: We do not find previous cases of isolated severe
hypoplasia of both, PNS and turbinates. Developmental anomalies of the cartilaginous nasal
capsule (around 8th week of pregnancy) may have occurred. PCD and CF can cause
bronchiectasis, azoospermia, and some degree of PNS hypoplasia, but tests were negative.
Hypogammaglobulinemia may cause bronchiectasis and the tracheocele could be secondary
to chronic cough, or congenital due to developmental anomalies (around 6th week of
pregnancy). CONCLUSIONS: We report a case of bilateral severe hypoplasia of PNS and
turbinates. Moreover, our patient might present an apparently unique syndrome related with
developmental anomalies (around 6th- 8th week of pregnancy) and hypogammaglobulinemia.

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1525
Clinical evaluation of a Polish translation and cross-cultural adaptation of the Nasal
Obstruction Symptom Evaluation (NOSE) Scale

Piotr H. Skarzynski1, Justyna Dabrowska-Bien2, Henryk Skarzynski2, Elzbieta Gos2, Iwonna

Gwizdalska2, Katarzyna Lazecka2

1
Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing,
Warsaw, Poland 3. Department of , 2World Hearing Center, Institute of Physiology and Pathology of
Hearing, Kajetany/Warsaw, Poland, 3Department of Teleaudiology and Screening, Institute of
Physiology and Pathology of Hearing, Warsaw, Poland, Department of Heart Failure and Cardiac
Rehabilitation, Medical University of Warsaw, Poland, Institute of Sensory Organs, Kajetany, Poland

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Nasal obstruction is the most common rhinologic ENT disorder. This paper aims to present the
evaluation of a Polish translation, and the cross-cultural modification of the Nasal Obstruction
Symptom Evaluation (NOSE) scale (developed by Stewart et al. 2004). The Scale is a widely
used for the evaluation of symptoms and quality of life in patients with nasal obstructions.
Material and methods: The study group consisted of 51 volunteers (aged 18-62) with nasal
obstruction after septoplasty. The control group consisted of 51 patients without rhinology or
Eustachian tube dysfunctions (18-62). The inclusion criteria: over 18 y.o., septal deviation with
chronic nasal obstruction, persistent symptoms after a 4-week of treatment (e.g. nasal
steroids, oral antihistamine/decongestant combination). Patients from the study group
completed the NOSE questionnaire three times (2 weeks before surgery, a day before, and 3
months after the surgery), when patients from the control group only once. Results: The Polish
translation (NOSE-POL) was performed by two translators and verified by two senior ENT
consultants. Next, it was given to a group of 15 patients to check their understanding of the
translation. Taking patients’ comments, the final version of NOSE-POL was developed. Results
of the study have shown good internal consistency, reproducibility, validity, responsiveness,
and interpretability of the NOSE-POL. Conclusions: The NOSE-POL is the first questionnaire
adapted and validated for the assessment of the quality of life in patients with nasal
obstruction after nasal surgery.

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1563
Complications in septoplasty – an experience of World Hearing Center, Poland

Piotr H. Skarzynski1, Justyna Dabrowska-Bien2, Henryk Skarzynski2

1
Department of Teleaudiology and Screening, Institute of Physiology and Pathology of Hearing,
Warsaw, Poland, Department of , 2World Hearing Center, Institute of Physiology and Pathology of
Hearing, Kajetany/Warsaw, Poland, 3Department of Teleaudiology and Screening, Institute of
Physiology and Pathology of Hearing, Warsaw, Poland, Department of Heart Failure and Cardiac
Rehabilitation, Medical University of Warsaw, Poland, Institute of Sensory Organs, Kajetany, Poland

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Introduction: This poster aims to present possible complications after septoplasty and
septoplasty with turbinate reduction. Nasal airway obstruction is one of the most common
diseases reported to ENT and septoplasty is one of the most frequent types of surgery in ENT.
Material and methods: The study was performed between 2009-2016 (7 years) in 5639
patients aged 16-69, including 2855 patients after septoplasty with turbinate surgery. The
predominance of male patients was observed. The occurred complications were collected by
analyzing the patient’s medical records. Results: Numerous complications after septoplasty
and septoplasty with turbinate reduction were observed. Different types of complications
were observed in 193 patients. The most frequent complication in septoplasty and septoplasty
with turbinoplasty was excessive bleeding. We noticed also septal perforation, hyposmia,
prolonged healing, adhesions, tooth/upper lip anesthesia, and ocular complications (such as
a temporary reduced visual activity). Among these, hyposmia, adhesions, hemorrhage,
infection, and ocular complications were more often observed in the group with concomitant
turbinoplasty, as well as full recovery after septal surgery was longer in that group.
Conclusions: One of the most frequent complications of septoplasty, and septoplasty with
turbinoplasty was excessive bleeding. Additionally, some complications were more frequent
in the second group. Precision in identifying the anatomy and maintaining good visualization
is crucial in performing safe and effective septoplasty in general.

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1601
Unilateral choanal atresia masquerading as chronic rhinosinusitis - Two case reports

Hannah Finney, Thomas Jennings1, Paresh Pramod Naik1, Nikhil Solomon Sundara Raj1

1
University of Northamptonshire

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Introduction: Choanal atresia is a rare congenital malformation of the nasal cavity. In cases of
bilateral obliteration of the posterior choanae, diagnosis of this condition is made soon after
birth. Infants will become temporarily cyanotic as they tend to breathe through their nose,
this normally causes the infant to cry and thus causes oral ventilation. Recognising the
condition and establishing an immediate airway is extremely important. Conversely, patients
with unilateral defects often do not have any breathing difficulties after birth and so are not
identified in infancy. Symptoms are less specific and diverse in nature, leading to its
misdiagnosis and unwanted treatment. We report two cases of adults with unilateral choanal
atresia, both of whom regrettably followed the path of delayed treatment due to lack of
awareness particularly in adults. Once diagnosed, initially by CT scan and confirmed by
endoscopic evaluation, surgical treatment remains the mainstay of definitive
treatment.Methods: Surgery was performed using endoscopic transseptal approach which
involved corrective surgery, treatment of the posterior third of the septum to create the
choanal opening, mucosal preservation and creation of flaps. Results: Complete resolution of
symptoms and patency of the new choanal opening was achieved in both cases.Conclusion:
Awareness and detailed history, examination and exploratory investigations are essential to
diagnose unilateral choanal atresia in adulthood. This pioneering transseptal repair technique
is highly effective in treatment of unilateral choanal atresia

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1725
Validation of the Korean version of NOSE-Perf scale on patients with nasal septal
perforation

kyungwon kwon1

1
Department of otorhinolaryngology, Samsung changwon hospit al

Poster Session |Rhinology - miscellaneous | 18 June – 22 June, 2023, All day

Background: Generally, nasal septal perforation (NSP) treatment is considered only when
there are symptoms due to septal perforation. However, the lack of validated NSP-specific
symptom assessment instrument limits treatment decisions and evaluation of treatment
effectiveness. Considering crusting, whistling sound, and epistaxis are frequently reported
perforation symptoms, previous nasal obstruction symptom evaluation (NOSE) scale or
sinonasal outcomes test-22 (SNOT-22) have limitation in usefulness. The NOSE-Perf scale was
recently proposed and validated by Cullen M et al. for assessing NSP symptoms. In this study
we evaluated the validity of the Korean version of NOSE-Perf scale. Methods: The 12-item
NOSE-Perf scale was designed using a 5-item NOSE scale and an additional 7 non-obstruction
questions. Questionnaires were completed by 36 patients with NSP, 40 with only nasal
obstruction, and 40 without any complaints. Results: Nasal congestion and nasal obstruction
were noted in 88.9% of patients, respectively, and nasal dryness/crusting, and trouble
breathing through nose followed in prevalence. Cronbach’s alpha was 0.788, indicating good
internal consistency. The mean NOSE-Perf score was significantly different among the 3
groups, which was highest in NSP, followed by nasal obstruction, and control group (16.97 vs.
13.03 vs. 1.30), while the mean NOSE score was highest in nasal obstruction, followed by NSP,
and control group (12.20 vs. 8.72 vs. 0.50).Conclusions. The Korean version of NOSE-Perf scale
is a valid clinical assessment tool that can be applied to NSP patient.

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Rhinoplasty

1755
Overview of dorsum camouflage grafts in rhinoplasty

Olga Chernova, Yuri Rusetsky

Poster Session |Rhinoplasty | 18 June – 22 June, 2023, All day

Camouflage grafts in rhinoplasty show a good aesthetic result both in revision rhinoplasty and
primary rhinoplasty in patients with thin skin on the dorsum of the nose. The variety of
materials and their behavior in the postoperative period remains a topical issue. The
presentation will provide an overview of grafts, highlighting their benefits and limitations of
use. Clinical examples will also be presented depending on the type of material.

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1346
Ultrasonic septoplasty

Yordanov Ivan1

1
Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-
93053 Regensburg, Germany

Poster Session |Rhinoplasty | 18 June – 22 June, 2023, All day

Ultrasonic septoplasty /USS/ is a new technique to correct deviations and spurs on bony part
of nasal septum– perpendicular plate, vomer, anterior nasal spine and maxillary crest. Using
the ultrasonic scalpel with precise accuracy and atraumatic approach , all part of the bony
anatomy of nasal cavity could be fixed in the midline. All surrounding soft tissues and are not
torn and avoid damaging underlying blood vessels and nerve supplies .As a result post surgery
recovery is fast and easy with minimal risk of post surgical complications.

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1360
Complications in septorhinoplasty

Małgorzata Buksińska1, Marta Dzięgielewska1, Anna Olszewska-Staroń1, Piotr Henryk

Skarżyński1

1
World Hearing Center, Institute of Physiology and Pathology of Hearing, Poland

Poster Session |Rhinoplasty | 18 June – 22 June, 2023, All day

Introduction: Septorhinoplasty is a surgical procedure used to correct nasal obstruction

caused by a deviated septum and to correct the shape of the external nose. Complications
that can occur after this procedure include excessive bleeding, septal perforation, wound
infection, septal abscess, saddle nose, abnormal nasal tip shape, anterior nostril asymmetry,
hyposmia and ocular or intracranial complications. The aim of the study was to identify
complications in septorhinoplasty and analyse the incidence based on material from 20011-
2021. Methods: Material consisted of 156 medical records from patients aged 17-64,
operated in the tertiary referral center. 109 patients gave a history of nasal trauma. Only 10
of them had nasal bone repositioning performed after the injury. Results: Among the whole
study group, different types of complications were noted in 25 patients (16%). The most
frequent complication was deviating nasal tip and nasal bones asymmetry. 5 patients (3,2%)
underwent reoperation. Conclusion: In our material the most common complication after
septorhinoplasty was persistent asymmetry of the external nose, which was related to
massive post-traumatic deformities. There were no serious complications such as hyposmia
or ocular or intracranial complications. Commitment to proper postoperative care must be
emphasised to the patient and is crucial to the healing process. Meticulous attention to detail
in identifying the correct anatomy and maintaining good visualisation is key to a safe and
successful functional septorhinoplasty that results in improved nasal passage.

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1480
Complications of Nonsurgical Rhinoplasty: A Systematic Review

MARIA KORODIMA1, GEORGIOS GRIVAS2, MARIA KARELA3, VASILIKI GKOULIONI3, SPYROS

KATSINIS3, ELENI CHALKIADAKI3

1
DEPARTMENT OF ENT PAMMAKARISTOS HOSPITAL ATHENS, 2Department of Otorhinolaryngology,
University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany, 3ENT
department of “Pammakaristos” hospital, Athens

Poster Session |Rhinoplasty | 18 June – 22 June, 2023, All day

Maria Korodima1, Georgios Grivas2, Maria Karela2, Vasiliki Gkoulioni2, Spyros Katsinis2, Eleni
Chalkiadaki31Intern, ENT department of “Pammakaristos” hospital, Athens2Consultant, ENT
department of “Pammakaristos” hospital, Athens 3Director, ENT department of
“Pammakaristos” hospital, AthensAbstractBackground: Nonsurgical rhinoplasty using filler
injections has become one of the most common noninvasive cosmetic procedure. It is a safe
technique for addressing conditions requiring facial sculpturing offered to patients that mainly
prefer to avoid general anesthesia. Although rare, complications with this procedure may
occur. Methods: We conducted a systematic review of literature using PubMed, Cochrane
Library and Embase database regarding complications of nonsurgical rhinoplasty. We included
publications and reviews of the last decade. Results: Nonsurgical rhinoplasty with injectable
fillers has low rate of complications. The most common adverse effects reported are bruising
and hematomas. However, there are reports of serious complications such as allergy, vascular
compromise, skin necrosis, blindness and infection. Conclusions: Nonsurgical rhinoplasty is
not without potential risk. Further studies are needed to optimize delivery of injectable fillers
in the nose to decrease the rate of adverse outcomes.

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1681
NASAL RESHAPING WITH HYALURONIC ACID – A SYSTEMATIC REVIEW

MARIA KORODIMA1, GEORGIOS GRIVAS2, AIKATERINI DRYLLI3

1
ENT department of “pammakaristos” hospital, Athens, 2ENT Department of “Pammakaristos”
hospital, Athens, 3ENT Department, Health center of Athens

Poster Session |Rhinoplasty | 18 June – 22 June, 2023, All day

Maria Korodima1 , Georgios Grivas 2 , Aikaterini Drylli 3 . 1 Resident, ENT Department of

“Pammakaristos” hospital, Athens. 2 Consultant, ENT Department of “Pammakaristos”
hospital, Athens. 3Consultant, ENT Department, Health center of Athens. Introduction: Nasal
reshaping using hyaluronic acid (HA) is a popular alternative solution to surgical
intervention. Non surgical rhinoplasty technique is a fast, painless and relatively simple
procedure, lasting approximately 15 minutes, that improves the shape of the nose. This
technique, does not require significant rehabilitation time and the success rate results can be
similar to those of classic surgical rhinoplasty, in selected patients. The aim of this review is to
present the latest data in literature regarding non surgical rhinoplasty, a safe technique for
addressing conditions requiring facial sculpturing. Material and Methods: We conducted a
systematic review of literature using PubMed, Cochrane Library and Embase database
regarding non-surgical rhinoplasty using hyaluronic acid (HA), in particular, technique
description, risks and benefits of the procedure. We included publications and reviews of the
last decade. Results: Nasal reshaping with (HA) is a safe procedure of facial sculpturing to
correct minor anatomic defects, including nasal tip defects as well as those of nasal bridge,
with satisfactory results. Complications are rare. In order to minimize potential risks and
complications, the procedure should be performed by an experienced physician with deep
knowledge of facial anatomy and appropriate training. Conclusions: Nasal reshaping with
hyaluronic acid (HA) is a common and minimally invasive procedure, which improves the
nasal appearance and provides an efficient alternative to surgical intervention in specific
cases. The use of well selected appropriate material and medical expertise are the keystone
to ensure a successive result.

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Septal and turbinate surgery

1180
Coblation Nasal Septal Swell Body Reduction for Treatment of Nasal Obstruction: A
Preliminary report

JUNG HO BAE1, JUNG BAE1

1
Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, Ewha Womans
University

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

The nasal septal swell body(NSB) comprises thickened mucosa of the anterior nasal septum
located superior to the inferior turbinate and anterior to the middle turbinate, and is thought
to play a role in the regulation of nasal resistance. The midportion of the NSB is located in or
near the internal nasal valve, which can increase nasal resistance. However, little attention
has been paid to the NSB, and few studies on clinical impacts of abnormally thickened NSB
have been conducted. Coblation (short for cold ablation) is effective and safe technique for
the treatment of soft tissue, and frequently used electrosurgical submucosal technique for
the treatment of inferior turbinate hypertrophy. In this report, we describe the results of
coblation NSB reduction in eight patients with nasal obstruction and abnormally thickened
NSB.

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1193
A decellularized mucosa patch derived from porcine tracheal tissue prevents septal
perforations in a rabbit model of nasal mucosa injuries

JUNG HO BAE1, SO JEOUNG KIM1

1
Ewha Womans University, Seoul Hospital, Seoul, Korea, 2Department of Otorhinolaryngology - Head
and Neck Surgery, College of Medicine, Ewha Womans University

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Several studies have reported that interpositional grafts composed of acellular biocompatible
materials may be effective for closing nasal septum perforations, but no previous study has
tested whether such interpositional grafts are effective for preventing nasal mucosa injuries
from developing into septal perforations. To determine whether decellularized mucosa
patches derived from porcine tracheal tissue can prevent nasal mucosa injuries from
developing into septal perforations. Bilateral nasal injuries were surgically induced in 36
rabbits. In the control group (n = 12), silastic sheets were applied to the injuries. In the
experimental groups, decellularized mucosa patches were unilaterally (n = 12) or bilaterally (n
= 12) applied to the injuries. At postoperative timepoints between 1 and 8 weeks, the rabbits
were sacrificed, and the cartilaginous septa were extracted and examined for perforations.
Mucosal defect areas were measured. Hematoxylin and eosin staining and safranin O staining
were used to visualize mucosal regeneration and cartilage remodeling, respectively.Septal
perforations occurred in 5 control group rabbits (42%), 1 rabbit that received a unilateral
patch (9%), and none of the rabbits that received bilateral patches. Relative to the control
group, the rabbits that received patches had smaller mean mucosal defect areas at the 1-week
(P = 0.027) and 4-week (P = 0.039) postoperative timepoints. Mucosal regeneration was
observed around the patches, and cartilage remodeling was seen in patch-treated septa.

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1195
Septal perforation closure with temporalis fascia and nanofat

Roman Denysenko1, Volodymyr Pavlyshyn1, Bohdan Danyliuk1, Oleksandr Dikhtiaruk1

1
National Medical University named after O.O.Bogomolets, Kyiv, Ukraine

Poster Session |Septal and turbinate surgery 18 June – 22 June, 2023, All day

IntrudactionThe main reason of perforation development lies in the trophic disorder of

cartilage and mucous membrane. Material and methods Group of patients n=32. The average
size of the perforation was 20mm x 30mm. Operation technique: separating the
mucoperichondrium of the septum, renewing the edges of the perforation. A deep leaf of the
temporal fascia was removed. The next stage was a superficial fat collection.The obtained
mass was settled to separate fatty tissue and blood then it was centrifuged. 20 cm3 of microfat
was obtained. Grinding of fat was carried out> passes through sieves with a diameter of 25,
50, 100 microns. The obtained fraction of nanofat (4 ml) was infiltrated into the temporal
fascia with implantation into the pocket of the septum mucose with complete closure of the
defect.ResultsAs a result of the observation of 32 patients within 3 months after the
operation, in 29 patients there was a complete closure of the perforation of the nasal septum,
in 4 of which small defect of graft tissue was determined, which slightly disturbed nasal
breathing. СonclusionsThis method provides complete closure of the perforation of the
nasal septum up to 3.5 x 4.2 cm.

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1246
A novel surgical technique to correct caudal and high dorsal septal deviations: L-
shape cutting and suturing on the septal L-strut (L-septoplasty)

Sanhyok Suk1, Taehoon Lee1, Sanghyok Suk1

1
Department of Otorhinolaryngology-Head & Neck Surgery, Ulsan University Hospital, 877
Bangeojinsunhwando-ro, Dong-gu, Ulsan, South Korea

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Objectives: In general, deviation of the L-strut of the nasal septum is more challenging to
correct than the middle and has less favorable results. This study aimed to develop a
technique to correct the L-strut while preserving nasal support effectivelyand introduce the
L-septoplasty technique and its effects.Methods: Patients with caudal and high dorsal septal
deviations who underwent the L-septoplasty technique were retrospectively analyzed.
Preoperative and three month postoperative comparative assessments included the Nasal
Obstruction Symptom Evaluation (NOSE) scale and minimal cross-sectional area
(MCA).Results: Thirty patients seen at a tertiary care center were included. NOSE scale scores
improved from 47.2 to 13.6, which was statistically significant (P < .001). MCA increased from
0.43 cm2 to 0.74 cm2 (P < .001). During the 3-month follow-upperiod, deviation correction
was well maintained in all patients, and no surgical complications, such as saddle nose
deformity, occurred.Conclusion: The L-septoplasty technique is effective in simultaneously
correcting caudal and high dorsal septal deviations without any complications.

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1260
Radiofrequency treatment of the inferior Nasal Turbinate hypertrophy

Giorgi Khvedelidze1, Merab Khvadagiani1

1
Iv.Javakhishvili State Univercity Medical Faculty, Department of Clinical Surgery; Medical Center
„Vivamedi“ D.Agmashenebeli All

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Introduction: The hyperplasia of the inferior nasal turbinate is a widespread reason for the
chronically obstruction of the nasal respiration. A variety of surgical procedures are perfomed
for reduction of hyperplastic inferior nasal turbinates. The multitude of methods reflects the
challengefor an ideal treatment. RF generator BM-780 for the treatment of concha
hyperplasia by Ravor is evaluated clinically.Material and Methods: 1017 patients (age 5-72)
who undervent submucosal turbinotomy with RF generator BM780,between 2010-2022,were
etamined preoperatively and 1-3-5 weeks postoperatively by endoscopy and rinomanometry.
175 patients were examined also 1-11 years postoperatively. After local anesthesia the
“Binner” bipolar needle electrode was inserted (5-9 sec all intensive level 2-2.5) in the
submucosal tissue of the inferior turbinate head , body and posterior part. Results: RF surgery
is performed under local anesthesia without postoperative use of nasal tampons. Intra and
postoperative pain is extreamely low. A shrinkage of the concha coul already be observed
during the coagulation. During 1-3 weeks postoperatively 900 of 1017and during 3-5
weekspostoperatively 117 of 117 patients showed a reduction of inferior turbinate volume.

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1345
Effect of nasal packing in the postoperative recovery od the patient

Drasko Cikojević1

1
Department of Otorhinolaryngology, University Hospital Split

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Nasal packing it used after septoplasty with the goals of decreasing the risk od postoperative
bleeding, septal haematoma and adhesiones. There is no generally standard for which types
of materials should be used or how longs pack shouls remaind placed. On the market, there
are many diferent product for use after septoplasty: Merocel, sponge, splint, Rapid Rhino,
Netcell, Sugomed, Miculicz packs et al. Results of this work confirm that nasal packing with
Merocel has significant advantages over the Miculicz packs with a sponges.

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1635
Exploration of surgical treatment of posterior nostril atresia after radiotherapy for
nasopharyngeal carcinoma

Yong Li1, Zhiqi Ma1

1
Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

To investigate surgical interventions for radiotherapy-induced posterior nostril atresia in

nasopharyngeal carcinoma patients, identifying factors associated with postoperative
recurrence and assessing treatment efficacy. 10 patients with radiotherapy-induced
posterior nostril stenosis after treatment for nasopharyngeal carcinoma from January 2010
to December 2022 (8 males, 2 females). All of them underwent nasal endoscopic posterior
nostril plasty at our hospital, involving the use of a Coblation and removal of bone to enlarge
the bony posterior nostril. Postoperatively, the cavity was tamponaded and absorbable sinus
stents were inserted. Patient symptoms and complications were monitored, and all 10
patients showed significant improvement in nasal congestion, runny nose, mouth breathing,
and dry mouth. At mean follow-up of 16.5 months, no restenosis or atresia was observed,
and nasal endoscopic posterior nostril plasty was found to be the primary treatment. To
minimize recurrence rates, consider intraoperative factors such as post-plasty nostril size,
mucosa preservation, mucoperiosteal flap use, and regular endoscopic monitoring.

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1218
Changes in Subjective Outcomes during the Early Period after Septoturbinoplasty

Kyung-Su Kim1, Ju Wan Kang1, Geun Cheol Shin1, Eun Jung Lee2

1
Dept. of Otorhinolaryngology, Gangnam Severance Hospital, Gangnam-gu, Seoul, 2Dept. of
Otorhinolaryngology, Wonju Severance Christian Hospital, Wonju

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Introduction: Septoturbinoplasty is frequently performed to correct nasal obstruction;

however, there is still a lack of research on changes in nasal and nose-related symptoms early
after septoturbinoplasty. Therefore, we aimed to investigate changes in subjective outcomes
within 6 months after septoturbinoplasty.Materials and Methods: The medical records of
patients who underwent septoturbinoplasty at Gangnam Severance Hospital were
retrospectively analyzed. Symptom scores were evaluated using the Sino-nasal Outcome Test
(SNOT-22) and obstruction scores. The SNOT-22 and obstruction scores were investigated
before surgery and at 1, 3, and 6 months after surgery.Results: We noted significant decreases
in both SNOT-22 and obstruction scores at 1 month after surgery, compared to those before
surgery (p<0.001). However, there were no significant changes at 3 and 6 months after
surgery, compared to scores at 1 month after surgery. Using multivariate logistic regression
analysis, a larger difference between SNOT-22 scores preoperatively and 1 month after
surgery was significantly associated with a significant improvement in symptoms at 3 or 6
months after septoturbinoplasty (p=0.029). Conclusion: These results imply that subjective
outcomes and degree of improvement in the first month after septoturbinoplasty can be used
as a predictor of the results thereof and for counseling patients about its progress.

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1242
Endonasal approach septorhinoplasty: Is it coming back in fashion?

Sevasti Konstantinidou1, Ana Chioralia1, Maryuma Bader1, Emma Rose Dyson1, Jie Lily
Huang1, Muhammad Alvi1, Irfan Syed1, Anastasia Rachmanidou1

1
University Hospital Lewisham

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

ObjectivesSurgical intervention for nasal and septal deviation is frequently undertaken, but
there is an ongoing debate regarding open and closed approach. The aim of this project is to
contribute to this debate by presenting our evaluation of a single surgeon performing only
endonasal approach septorhinoplasty surgery for three years. MethodsRetrospective data
collection was conducted regarding patients with endonasal septorhinoplasty. The
postoperative results were assessed in terms of nasal airway and cosmetic appearance. Early
and late complications as well as revision surgery rates were also noted. ResultsEighty-eight
patients had endonasal septorhinoplasty over the course of three years with an average
follow-up time of 3.4 months. The nasal breathing improved post-operatively in seventy
patients. Only three patients were not satisfied with the external nasal appearance post-
operatively. Sixteen patients had residual septal deformity. Eighteen cases of early and seven
of late post-operative complications were documented, including pain, epistaxis, infection,
hyposmia and septal perforation. Two patients needed revision surgery. ConclusionEndonasal
septorhinoplasty is a successful and safe surgical technique that can be utilised in most cases
of septal deformity, as it was used by one surgeon in our department for all of their cases in a
three-years span with good results.

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1395
Narrow band imaging accentuates differences in contrast between cartilage and
perichondrium in the elevation of the muco-perichondrium flap during septoplasty
and open septorhinoplasty

Keisuke Yamamoto, Tsuyoshi Okuni1, Makoto Kurose1, Takuya Kakuki1, Masaya Nakano1,
Hiroshi Sakamoto1, Kenichi Takano1

1
Department of Otolaryngology-Head and Neck Surgery Sapporo Medical University

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Objective: In the elevation of the muco-perichondrium flap during septoplasty and

septorhinoplasty, it is important to elevate the subperichondrial layer. Narrow band imaging
(NBI) is an optical technology that facilitates detailed observation of microvessels in the
mucosal surface layer. In this study, we investigated whether NBI is better than white light
(WL) in accentuating differences in contrast between cartilage and perichondrium in the
elevation of the muco-perichondrium flap during septoplasty and
septorhinoplasty. Methods: Twenty-six sides of 15 patients with elevated muco-
perichondrium flaps were studied under WL endoscopy and NBI. The brightness of the
perichondrium and cartilage and the differences between the two tissues were compared
between WL and NBI using ImageJ 1.53a. Results: Under WL, the perichondrium appeared
reddish-white and the cartilage appeared white, whereas under NBI the perichondrium
appeared greenish-gray, differentiating it from the white cartilage. The difference in
brightness between the cartilage and perichondrium was significantly higher on NBI than on
WL imaging(p<0.001). Conclusions: NBI is better than WL at accentuating the difference in
contrast between cartilage and the perichondrium during the elevation of the muco-
perichondrium flap during septoplasty and septorhinoplasty.

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1412
Septoplasty: Are we listing patients correctly?

Muhammad Ibaad Alvi, Muhammad Alvi1, Irfan Syed1, Sam Village1, Marawan Eltarabily1,
Antonio Aymat1, Anastasia Rachmanidou1

1
Lewisham and Greenwich NHS Foundation Trust

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Background: Septoplasty (surgery to correct a deviated septum) is a common ENT

procedure, however many patients are listed for this procedure without adequate symptom
assessment.We assessed the severity of symptoms of the patients waiting for septoplasty
using the NOSE (Nasal Obstruction Symptom Evaluation) questionnaire. The NOSE
questionnaire is a validated five-item symptom scoring system. A score of 30/100 or above is
considered as meeting the threshold for surgery.Method:A telephone or email survey was
addressed to a total of 270 patients on the waiting list. We also had additional questions
regarding previous nasal surgery, trauma or unilateral symptoms.Results: 136 patients from
the 270 patients responded to the survey. Results demonstrated that only 11/136 (8%)
patients had a score below 30. 60/136 (44.1%) had a score above 80 considered ‘extreme’
severity. Notably 15.4% had a history of previous nasal surgery whilst 38.2% had a history of
nasal trauma. 50.7% of patients had unilateral symptoms.Discussion:The NOSE
questionnaire provides a valuable tool to quantify and monitor symptoms. Our study
demonstrated that the majority of patients (92%) were correctly listed for the procedure. It
also showed that unilaterality of symptoms is not part of the indication for septoplasty.
Future studies of improvement in NOSE score following septoplasty are needed.

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1425
How common are permanent complications following septoplasty, with or without
concomitant turbinate surgery in Scania, Sweden. Review of the Swedish National
Septoplasty Register

Magnus Gunnarsson1

1
Helsingborg hospital, Department of Otorhinolaryngology, Sweden

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Background: The aim of this project was to collate the registered permanent complications of
septoplasty in our province. Furthermore, we sought to investigate, both the link between
permanent complications and whether concomitant turbinate surgery was performed, and
the link between unplanned postoperative follow-up and reported complications. The final
aim was to try to verify self-reported septal perforations in the registry. Methodology: A
retrospective register study was performed analysing data from operated patients in the
southern part of Sweden between 2013-11-1 and 2019-12-31 collected from the Swedish
National Septoplasty Register. The registry contains information from patient questioners 1
and 12 months postoperatively about among other data the presence of a permanent
complication and unplanned visits within 30 days after surgery. Results: 28,3% of patients
reported a permanent complication on the 12 month postop-questioner (46% of the patients
answered). There was no statistical significant difference (p=0,235) in the complication rate
weather concomitant turbinate surgery was performed or not. The patients who reported an
unplanned follow-up were also more likely to report a complication (p=0,003). Of the 12 self-
reported septal perforations only 1 was verified. Conclusion: Unplanned visits were
associated with permanent complications at 12 months and routine follow-up should be
considered.

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1561
Post-Septoplasty Neuralgia: A Case Report

Anita Paupério, Helena Rosa1, Cláudia Santos1, Mariana Neto1, Ana Claro1, Luís Antunes1

1
Hospital Garcia de Orta

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Introduction: Septoplasty is a common surgical procedure, with persistent subjective nasal

obstruction being the most frequent complication. However, post-septoplasty neuralgia is an
uncommon complication. This case report presents a rare case of persistent nasal and palatal
pain after primary septoplasty.Case study: A 41-year-old female smoker presented to an ENT
consultation with persistent nasal and palatal pain one month after an uncomplicated
septoplasty. The pain was associated with thermal stimulation, and there was no persistent
septal deviation or contact point with lateral nasal walls. Symptoms were refractory to oral
analgesics and oral rinses with Chlorhexidine, and the patient was referred to a Neurology
consultation.Discussion: Intraoperative nerve damage is a well-known clinical risk factor for
chronic postsurgical pain; however, there are only three published articles related to post-
septoplasty neuralgia. Nonoperative management through peripheral maxillary nerve blocks
followed by radiofrequency ablation (RFA) has demonstrated complete resolution of
symptoms. Furthermore, a combination of medication and cognitive-behavioural therapy can
also lead to significant improvement in symptoms. Conclusion: Post-septoplasty neuralgia is a
rare complication of septoplasty, with only three other case reports published in the medical
literature. Successful management strategies include peripheral maxillary nerve blocks
followed by RFA. Further research is needed to evaluate both pharmacological and non-
pharmacological management strategies.

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1726
USTIFICATION OF SURGICAL TREATMENT OF MALFUNCTION OF THE NASAL
BREATHING DUE TO NASAL SEPTAL DEFORMATION IN CHILDREN AND ADOLESCENTS

Kristine Harutyunyan1, Gnel Ananyan2, Artur Shukuryan3, Sona Khosrovyan1, Satenik

Grigoryan1

1
"Mikayelyan" MC, "Muratsan" MC, 2"Nairi", 3"Astghik" MC, "Shengavit" MC

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Impaired nasal breathing in childhood leads to hypoxia of the growing body which can lead to
malfunction of the other organ-systems. Although, septoplasty in children still remains a
controversial issue in otorhinolaryngology. The aim of this study was the clinical and functional
justification for necessity of surgical treatment of trespassing nasal breathing due to
deformated nasal septum in children. The research involved 452 children aged 4-14 years,
that have been operated on ENT department of Nairi MC in the period of 2013-2019 and
Muratsan MC in the period of April 2021 to February 2023. Septum deformation, combined
with adenoid growths were in 291 patients, 20 children also had unilateral choanal atresia
(membranous). Septoplasty with reimplantation of septal cartilage, lateroposition and
coagulation of the inferior nasal conchae were performed in this cases, also adenotomy and
excision of choanal atresia if necessary. A 6-month postoperative observation was performed
in 155 patients, was done rhinoendoscopy, 4 phases anterior active rhinomanometry. Clinical
examination revealed that nasal breathing was restored in 140 patients (90%), while
insufficient restoration of the respiratory function of the nose due to repeated nasal septal
deformation (spontaneous or post-traumatic) was observed in 18 patients (12%). Hereby, can
be concluded that septoplasty with the reimplantation of the nasal cartilage, performed with
modern gentle methods, is necessary for the restoration of the respiratory function in
children.

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1748
Endonasal Endoscopic Septal Perforation Repair

Mohsen Naraghi1

1
Rhinology Research Society

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Nasal septal perforation is a frequent problem which may be caused may by primary or
secondary etiologies. However, in both etiologies, bilateral disruptions of septal
mucoperichondrium and destruction or resection of quadrangular cartilage have been
occurred. While patients with posterior perforations are usually asymptomatic, most
patients may have different symptoms which depends on the location and size the
perforation. With the large perforations, laminar airflow will be displaced by turbulence with
resultant sensation of nasal obstruction, decreased nasal temperature and humidity and
finally dryness and mucosal injury. Secondary rhinorrhea, crusting, epistaxis and infectious
are consequences of septal perforations. In extensive perforations, loss of dorsal support
may cause saddle nose deformity. Septoplasty with or without rhinoplasty is the most
common cause of septal perforation. Repair of the large septal perforations has been a
challenge for most of rhinologists and facial plastic surgeons. Various methods have been
explained for repair of a septal perforation. Using a 0 degree 4mm endoscope, an incision
was made in the lateral nasal wall mucosa, just below the inferior turbinate. Then the
incision was extended to posterior direction, where it was turned up to get more mobility
before transposition. The most important key for success is to provide very large
vascularized floor of nose flaps to make a relaxed closure without any tension.

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1774
Septal perforation repair: revisiting different approaches

Antonio Fontes Lima, Daniel Miranda, Fernando Mar, Berta Rodrigues, Luis Dias

Poster Session |Septal and turbinate surgery | 18 June – 22 June, 2023, All day

Nasal septal perforation corresponds to a defect of the cartilaginous and/or bony nasal
septum. Besides being a rare entity, its surgical correction remains one of the most
challenging nasal septal procedure. Endoscopic repair has revolutionized the approach of
this type of defect.Depending on the location, size, and remaining osteocartilaginous
support, flaps such as the anterior ethmoidal artery flap, the lateral wall flap, pericranial
flap, amongst others may be used.The authors present different clinical cases that have one
thing in common: the nasal septal perforation. With different etiologies, sizes, and locations,
the technique used was different.Moreover, we revisit the different approaches, describing
advantages and disadvantages of each one of them

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Sinonasal malignancy

1500
NK- and T-cell lymphoma of the nasal cavity and paranasal sinuses in Denmark 1980-
2017: a nationwide cohort study

Patrick René Gerhard Eriksen1

1
Rigshospitalet, Copenhagen, Denmark

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Compared to Asian and Latin American populations, sinonasal NK- or T-cell lymphoma is rare
in Europe. All patients with sinonasal NK- or T-cell lymphoma in Denmark from 1980 to 2017
were validated histologically, and the disease behavior and demographics were extracted
from medical records and national registries. Prognostic factors associated with mortality
were determined using survival statistics. We included 56 patients: 40 extranodal NK/T-cell
lymphoma (nasal type) (ENKTCL) and 16 peripheral T-cell lymphoma (not otherwise
specified) (PTCL). The median age was 66, and most patients were male (72%). The ENKTCL
and PTCL 5-year overall survival was 48% and 50%, respectively; progression-free survival
was 38% for both. With ENKTCL, stage and performance status increased mortality
significantly (HR = 8.6; p

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1142
Non-intestinal type sinonasal adenocarcinoma: A case report

Ángeles Mercedes Oviedo Santana1, María Soledad Cabrera Ramírez1, María Sandra
Domínguez Sosa1, Sara Soria Medina, Rocío Andreu Abeledo1

1
Hospital Universitario de Gran Canaria de Doctor Negrín

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Introduction: Primary adenocarcinomas of the sinonasal tract are a group of malignant

neoplasms that represent 10%-20% of all primary malignant neoplasms of the nasal cavity and
paranasal sinuses and are classified into salivary types (10%) and non-salivary, within this last
group they are classified as intestinal type adenocarcinoma (ITAC) and non-intestinal. Material
and methods: We present the case of an 87-year-old female patient with hypertension,
diabetess, operated on for breast cancer and knee replacement who was referred by the
Radiologyst due to the discovery of a mass in the skull and nostril right. The patient had
previously been seen by a private otolaryngologist for an occupying and bleeding lesion in the
right nostril with a progressive evolution of one year and causing right nasal respiratory
failure, for which a CT scan of the paranasal sinuses was requested. Nasofibroscopy revealed
a bleeding mass that occupied the entire right nostril. A biopsy of the mass was taken for
analysis. Results: CT revealed a solid frontobasal extraaxial hyper-uptake mass of the right
anterior cranial fossa that entered into the right nasal fossa and extended to the right
ethmoid, cavum, and extraconal fat infiltration of right orbit . The biopsy revealed the result
of infiltrating adenocarcinoma, compatible with "non-intestinal type" sinonasal
adenocarcinoma of intermediate grade.The patient was taken to the tumor committee,
however, before making a therapeutic decision for the patient, she died. Conclusion: In
summary, the etiology and risk factors are unknown.

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1177
Comparison of Primary B/NKT non-Hodgkin lymphomas in Nasopharynx, Nasal cavity
and Paranasal sinuses

Song Yao1, Ren Jianjun1, Zhao Yu1

1
Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan
University

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Objective: We aimed to compare clinical and survival differences of B-cell (B-NHL) and NKT-
cell non-Hodgkin lymphomas (NKT-NHL) located in nasal cavity, nasopharynx and paranasal
sinuses which always categorized as onesinonasal type.Methods:
Patients diagnosed with primary B-NHL and NKT-NHL in nasal cavity,
nasopharynx and paranasal sinuses from SEER database were included(1975–2017). We
conducted Cox regressions and Kaplan–Meier analysis to examine survival outcomes
of B/NKT-NHL in nasal cavity, nasopharynx and paranasal sinuses,
respectively.Results: Overall, most B-NHL cases originated from nasopharynx, while majority
of NKT-NHL cases occurred in nasal cavity. Notably, the CSS outcomes improvedsignificantly
in all sinonasal B-NHL cases over time, whereas no such
improvement trend was observed in each sinonasal NKT-NHL type.
Additionally, increasing age was linked with an elevated risk of death in B-NHL, particularly in
nasal cavity(HR: 3.37), rather than in NKT-NHL. Compared with B-NHL, adverse
effect of higher stage on CSS were more evident in NKT-NHL, particularly in its nasopharynx
site(HR: 5.12). Furthermore, radiotherapy was beneficial for
survival in patients with sinonasal B-NHL and NKT-NHL, except in nasopharynx NKT-NHL.
However,
chemotherapy has only been beneficial for CSS in patientswith paranasal sinuses B-NHL(HR:
0.42) since 2010, rather than in other typesof B/NKT-NHL.Conclusions: Although B-NHL and
NKT-NHL in nasal cavity, nasopharynx andparanasal sinuses have similar anatomical locations,
their clinicodemographics and prognoses are largely different.

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1183
Malignant Mucosal Melanoma of the Nasal Cavity: A Rare Case Report - No Local
Recurrence with a Follow-up of 3 years

Sirinkarn Sookdee1

1
Department of Otorhinolaryngology, Faculty of Medicine, Burapha University, Chonburi, Thailand

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Malignant mucosal melanoma of the nasal cavity is a rare and aggressive tumor with a poor
prognosis. Epistaxis and unilateral nasal obstruction are the most common presenting
symptoms. Accurate diagnosis is immunohistochemical staining analysis for HMB-45, S-100
and Melan-A. The treatment of choice is surgical resection if the tumor is resectable. In our
case report, a 72-years-old male came with left epistaxis for 2 months. An endoscopic
examination showed a bleeding tumor at the left inferior turbinate with protrusion into the
left sided nasopharynx. CT and MRI revealed the enhancing mass in posterior left nasal cavity
involving left inferior turbinate with protrusion into left sided nasopharynx, measured about
3.3x1.5x1.4 cm. No gross bony destruction is detected. An incisional biopsy was performed
and the immunohistochemical staining analyses are positive for HMB-45 and S-100. The
findings indicated stage III, T3N0M0. Endoscopic medial maxillectomy with partial
nasopharyngectomy with PE tube insertion was performed under general anesthesia and the
frozen sections are negative intraoperative margins. Then he was receiving postoperative
radiotherapy. At a 3-year follow-up, the patient showed no evidence of local recurrence.

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1250
Sinonasal adenoid cystic carcinoma: surgical resection and reconstruction case
report

Gustavo Pedrosa Rocha1, Patrícia Lopes2, Ana Hebe3, Lígia Ferreira3, Pedro Montalvão3,
Miguel Magalhães3

1
Hospital Prof. Dr. Fernando da Fonseca, 2Centro Hospitalar do Funchal, 3Instituto Português de
Oncologia de Lisboa

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Objective: Adenoid cystic carcinoma (ACC) is a rare salivary gland malignant cancer of the head
and neck and particularly rare in the sinonasal area compared to the major salivary glands.
ACC displays a combination of an indolent growth pattern but an aggressive progression, with
local recurrence and distant metastasis. We purpose to present the case of sinonasal ACC and
its surgical treatment and reconstruction.Material and Methods: Clinical examination, medical
imaging and immunohistochemical stains were checked. We also briefly review the relevant
literature about ACC and sinonasal tumors resections.Results: We describe a 50-year-old man
who presented with two-year intermittent rhinorrhea and epistaxis. Clinical examination
revealed a mass occupied both nasal cavities and hard palate. The peculiar anatomical
location and the extent in the midcheek region make this case a hard “challenge” for the
surgeon to guarantee wide surgical margins of resection. A subtotal bilateral maxillectomy
was accomplished by means of the Weber-Ferguson approach, preserving the orbital floor.
The excised portion was reconstructed using the free scapula osteocutaneous flap.
Postoperative radiotherapy was given to the area adjacent to the lesion.Conclusion: A
combined clinico-radiological approach aided by histopathology examination helps in better
management of this carcinoma. Vascularized free scapular flap bone graft is very interesting
for the reconstruction of maxillary discontinuity, secondary to oncologic resections.

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1256
Total Maxillectomy with Orbital Exenteration for Carcinoma of Maxilla and
Latissimus Dorsi Free flap Reconstruction

Gustavo Pedrosa Rocha1, António Trigueiros2, Ricardo Pacheco3, Lígia Ferreira3, Pedro
Montalvão3, Miguel Magalhães3

1
Hospital Prof. Dr. Fernando da Fonseca, 2Hospital Beatriz Ângelo, 3Instituto Português de Oncologia
de Lisboa

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Objective: Orbital involvement in maxillary tumors is an important prognostic predictor of

recurrence-free, disease-specific, and overall survival. Defects resulting from total
maxillectomy require a complex reconstruction procedure. We present the case of a
squamous cell carcinoma of maxilla with orbital involvement and its surgical treatment and
reconstruction. Material and Methods: Clinical examination, medical imaging and
immunohistochemical stains were checked. We also briefly review the relevant literature
about maxillary tumors resections.Results: We describe a 69-year man who presented with a
2 month history of progressive swelling of the left malar and left sporadic epistaxis. These
symptoms had worsed and started to present diplopia and left tearing. On clinical
examination, the growth was arising from the left maxilla with involvement of orbital floor.
On anterior rhinoscopy the growth was abutting the nasal septum. She underwent total
maxillectomy with orbital exenteration by Weber Ferguson incision with subciliary and
supraciliary extension. The reconstruction was completed with a Latissimus dorsi
myocutaneous free flap. Post operative period was uneventful.Conclusion: The multivector
extensions of this carcinoma obliged the a complete resection of the maxilla, including orbital
floor. The muscle compartment is suitable to fill the orbital and maxillary cavities and skin
compartments are used for cheek, palate and lateral nasal wall as a three-dimensional folded
free flap.

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1296
Orbital exenteration in sinonasal malignancies: has it still a role in nowadays?

José Miranda1, Fernando Mar1, António Lima1, Luis Dias1

1
Hospital of Braga, Braga, Portugal

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Background: sinonasal malignancies are a rare group of lesions corresponding to less than 3%
of head and neck malignant neoplasms. They include a large variety of histological subtypes
with different biological and clinical behavior. Despite the greater accessibility of
complementary diagnostic tools, these tumours still present in advanced stages, with invasion
of neighboring structures such as orbit and the skull base. Orbit invasion has a negative impact
on survival and functional outcomes. Methods: description of two clinical cases of sinonasal
malignant tumours with orbital invasion at presentation, who underwent orbital
exenteration, and review the current literature on this topic. Discussion: in spite of a recent
trend to preserve orbit in cases of minimal involvement, the presence of undoubtedly signs of
intraconal invasion such as: visual loss, restriction of ocular mobility or infiltration of the
eyeglobe, may help surgeon in decision making process. In borderline situations, confirmation
of orbital involvement should be performed intraoperatively, through endoscopy and frozen
sections.

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1297
Signet-Ring Cell Adenocarcinoma of Sinonasal Tract: description of 4 clinical cases

José Miranda1, Fernando Mar1, António Lima1, Luis Dias1

1
Hospital of Braga, Braga, Portugal

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Background: sinonasal malignancies correspond to less than 3% of head and neck malignant
neoplasms. Adenocarcinoma is one of the most prevalent histotypes and is classified into 4
categories: salivary-type, intestinal-type, nonintestinal-type, and metastatic. Signet-ring cell
carcinoma (SRCC) is the rarest form of intestinal-type adenocarcinoma (ITAC). As with the
other variants, they are suspected to be associated with exposure to wood dust and to be
associated with a poor prognosis. Methods: description of a series composed of 4 consecutive
patients managed in our institution with histological diagnosis of SRCC focusing on the most
relevant clinical, imaging and histopathological aspects. Discussion: SRCA is a uncommon
subtype of ITCA rarely reported in literature. Is a high-grade and aggressive tumor with a poor
prognosis. Immunohistochemical study with p53 protein and MIB-1 may help in diagnosis.

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1321
RHINOCEREBRAL INTRAVASCULAR LARGE B-CELL LYMPHOMA

Elizabet Morales Molina1, Nuria Cruz Ceron1, Román Carlos Zamora1, Juan Aguilar
Cantador1, Francisco Muñoz Del Castillo1

1
ENT Department at Reina Sofia University Hospital

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

INTRODUCTION Intravascular large B-cell lymphoma is a rare type of extranodal large B-cell
lymphoma within the lumen of vessels, particularly capillaries. There are two main patterns
of clinical presentation: a classic pattern characterized by symptoms related to the main organ
affected, predominantly neurological or cutaneous; and another type associated with an
hematophagocytic syndrome. MATERIAL AND METHOD Immunocompromised 57-year-old
patient, diagnosed of nasal polyposis, epistaxis and clear rhinorrhea. Months later, he requires
admission for myoclonic encephalopathy, with persistent fever and elevated acute phase
markers despite antibiotic treatment. Examination of the cerebral spinal fluid (CSF) shows
abundant lymphocytes. Flexible nasal fibroscopy revealed bilateral polyposis. MRI: bone
erosion of the clivus and involvement of the paranasal sinuses. CT: full occupation of the
maxillary sinuses with an expansive behavior; marked mucosal thickening with hyperdense
content and areas of bone erosion, probably related to infectious/inflammatory involvement.
RESULTS An incisional biopsy was taken for surgical pathology, being diagnosed with
intravascular large B-cell lymphoma (immunohistochemistry: ALC +, CD10+, CD20 +, high Ki67)
The patient is referred to Hematology and treated with R-CHOP therapy alternating with
cycles of MTX + CYTARABINE A. CONCLUSION Rare type of non-Hodgkin lymphoma.
Intravascular involvement of blood vessels, especially capillaries. It can occur in any organ.
Aggressive and with a poor prognosis. Treatment with Rituximab: 3-year survivaL

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1341
Atypical approach in a recurrent orbital-ethmoidal tumor. A case report.

Daniela Vrinceanu1

1
ENT Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Introduction. Local recurrences in operated medial canthus carcinomas involve orbital and
ethmoid invasion (1). CT scan imaging should be performed with small sections to correctly
assess the lesion extension. Oncologic salvage surgery concerns orbital exenterating and
ethmoidectomy in a mixed approach to ensure negative margins (2). Materials and method.
Case report. Results. We present a 75-year-old patient with carcinoma of the medial canthus
of the left eye, initially operated on in 2018 in a plastic surgery service, for coverage using a
frontal flap. The patient presented to our service in 2019, with a recurrence in the internal
orbital quadrant that was removed through an eyebrow approach. The patient presented a
new ethmoidal-orbital recurrence in 2022 for which we performed oncological salvage
surgery on an atypical approach with left orbital exenterating, left ethmoidectomy, left medial
maxillectomy, and covering the defect with a translated cervicofacial flap. The patient is being
monitored. Conclusions. Carcinomas of the medial canthus present a therapeutic challenge
for the patient and the doctor. The combined surgical approach in a multidisciplinary team
approach offers the best chance for radicality, which is difficult to achieve due to the complex
loco-regional anatomy. Keywords: medial canthus, recurrent tumor, ethmoid, orbital
exenterating, mixed approach. References: Leibovitch I, McNab A, Sullivan T, Davis G, Selva D.
Orbital invasion by periocular basal cell carcinoma. Ophthalmology. 2005 Apr; 112(4):717-23.
Sun MT, Wu A, Figueir

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1348
Rare non-Hodgkin lymphomas found in the sinonasal tract: a case series

Chrysoula Vardaxi1, Ahmad Alghoj1, Pavlos Pavlidis1, Paraskevi Karamitsou1, Ioannis

Dimitriadis2, Spyridon Gougousis1

1
Department of Otorhinolaryngology - Head and Neck Surgery, “G. Papanikolaou” General Hospital,
Thessaloniki, Greece, 2Department of Pathology, “G. Papanikolaou” General Hospital, Thessaloniki,
Greece

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Background: Non-Hodgkin lymphomas (NHL) are the most common solid tumors among
lymphomas, usually presented in the lymph nodes. Although the extra-nodal expression of
NHL represents only one-third of cases, finding a lymphoma in the nasal cavity or nasopharynx
is even scarcer. Cases: We present three cases of male patients, with a chief complain of
lasting nasal obstruction. In the first case, the otolaryngology physical examination revealed a
mass in the anterior part of the left nasal cavity. The histopathological report demonstrated a
diffuse large B cell lymphoma (DLBCL), non-Germinal center B-cell (non-GCB) subtype. In the
other two cases, the mass was found in the nasopharynx and the histopathological
examinations revealed a mucosa associated lymphoid tissue (MALT) and a mantle cell
lymphoma (MCL) respectively. All the patients were referred to the Hematology Department
of our hospital for further treatment. Conclusion: NHL can seldom be found in the sinonasal
tract or the nasopharynx. A full physical examination and high clinical suspicion are important
for a timely diagnosis and treatment. The treatment could comprise of immunotherapy or
chemotherapy or a combination of them.

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1404
METASTATIC NASAL MALIGNANT MELANOMA TO THE BRAIN

Valentin Stoyanov1, Atanas Vlaykov1

1
Department of Otorhinolaryngology, Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

INTRODUCTION: Melanoma arises from melanocytes in pigment-containing tissues. They

occur predominantly on the skin, but can also develop on the mucous membranes of the
mouth, genital and rectal areas, and conjunctiva. Mucous membrane contains melanocytes
with melanin pigment which are found in the basal layer of the epidermis, and in the eyes.
They origin from the neural crest. Melanocytes in the nasal cavity can be found in the
respiratory epithelium, in the nasal septum stroma, nasal glands and in the middle and inferior
turbinates.MATERIAL AND METHODS: The authors reported a case of malignant melanoma
with sino-nasal region origin in a 65 y.o. female. She presented at ENT Clinic in University
Hospital of St. Zagora with unilateral trouble nasal breathing six months ago and some
episodes of spontaneous nosebleeds from the same nostril. RESULTS: Nasal cavity surgery has
been performed for tumor formation removal. 11 months later, the patient was admitted to
a neurosurgery clinic at the University Hospital - St. Zagora due to left hemiparesis and
symptoms of increased intracranial pressure. CT scan have been performed and two oval
formations were found in the supratentorial region. CONCLUSION: Metastasis correlates with
the depth of penetration into the dermis. Local metastases occur as satellite papules or
nodules located near the tumor, which may or may not be pigmented. The diagnosis is made
on the basis of biopsy data. Wide surgical excision is the rule when removing resectable
tumors. Metastatic disease requires systemic chem

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1450
FESS in treatment of the sinonasal tumors. Where is the limit?

Hristo Zlatanov, Anastasiya Korkova1

1
Military Medical Academy – Sofia

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Sinonasal tumors both benign and malignant can be a challenge in surgical management
regarding their size, location and growth. While in most malignant cases and in cases of big
benign tumors craniofacial resection is the gold standard, the advancement of endoscopic
surgery in the last decades allows for expanding its indications. The aim of this presentation
is to show different cases of malignant and benign tumors in the nasal cavity and paranasal
sinuses managed with an endoscopic approach. We emphasize on the advantages considering
the recovery of the patient and share our view on the limitations of endoscopic surgery.
Nevertheless, we always consider the possibility to switch to a combined or open approach in
these cases as a plan B.

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1453
An extremely rare nasopharyngeal malignant tumor

Paraskevi Karamitsou1, Alexandros Poutoglidis1, Chrysoula Vardaxi1, Ahmad Alghoj1,

Spyridon Gougousis1

1
Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital,
Thessaloniki, Greece

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Nasopharyngeal papillary adenocarcinoma (NPAC) is an extremely rare primary malignant

tumor. There is only a limited number of cases of NPACs reported in the literature. The
neoplasm presents as an exophytic mass with a papillary or polypoid appearance derived from
the nasopharyngeal surface epithelium. It can potentially involve any part of the nasopharynx,
but it most commonly involves the roof, the lateral, and the posterior wall. The prognosis is
very good and no recurrences or metastases have been reported. Nasal obstruction is the
most common manifestation. Surgical excision is considered the most appropriate treatment
method. There are also reports of patients undergoing radiation therapy. However, its role in
the treatment has not been clarified. The presence of this tumor in the nasal cavity could be
easily underestimated, because of its appearance. As a result, an index of suspicion is
necessary for a timely diagnostic and therapeutic intervention. We present a case of NPAC in
a 26-year-old female treated in our hospital.

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1484
Sinonasal hemangiopericytoma - a rare case report

Daniel Petkov, Valentin Stoyanov, Tsvetelina Grigorova

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

AbstractIntroduction: Hemangiopericytoma is a rare tumor of the sino-nasal cavity. It is a

perivascular myoid neoplasm that account less than 0.5% of the tumors in maxillofacial area.
Here we would like to describe a case of an adolescent male who underwent 2 surgeries for
this diagnosis because of a recurrence. We make a comparison between the current literature
and our experience.Materials and methods:The case is from the archive of the clinic from
2015. We evaluated identical cases published in the data base of PubMed and Elsevier. We
made of a systematic review of the collected data and our clinical report.Results:Our patient
presented for the first time with recurring epistaxis, progressive nasal obstruction and
anosmia. Rhinoscopic examination and imaging studies showed a mass occupying the left
nasal cavity without bone destruction. An endoscopic surgical excision was performed. The
anatomopathology examination with immunohistochemistry confirmed the diagnosis of
hemangiopericytoma. After 1 year the patient came back with nasal obstrucuion and pain in
the forehead. Open approach was used to remove tumor from the frontal sinus with bone
lesion of the supraorbital fossa. The diagnosis was the same. Conclusion:Although the
literature review support a more indolent course with low recurrence rates following
complete endoscopic resection, our experience reports an aggressive tumoral behavior to
hemangiopericytoma of the sinonasal tract.

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1508
A Rare Case of Leiomyosarcoma Arising from the Inferior Turbinate

Anna-Maria Papadopoulou1, Anastasia Liapi1

1
Department of Otorhinolaryngology, G.Gennimatas Athens General Hospital

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Leiomyosarcomas (LMS) are aggressive mesenchymal neoplasms with malignant smooth

muscle differentiation. They comprise less than 7% of all soft tissue sarcomas and only 3 %
affect the head and neck area. In this case report, we present a patient with sinonasal LMS
and review the clinical, pathological and prognostic characteristics, as well as the available
treatment strategies, contributing to the limited literature of this rare malignancy.A 60-year-
old Caucasian female presented to the ENT department with a three-month-history of right-
sided nasal obstruction and occasional bleeding. Nasendoscopy revealed a smooth, firm and
well-circumscribed lesion in the caudal part of the right inferior turbinate obstructing the right
choana. CT scan showed a soft tissue mass arising from the right inferior turbinate, without
signs of bone erosion or extension into the paranasal sinuses. A wide excisional biopsy of the
lesion was performed and the histopathology and immunochemistry analysis demonstrated
sinonasal LMS. Despite negative margins of 1 cm, a radical resection of the entire inferior
turbinate was decided, because of the high incidence of tumor local recurrence and
persistence. The patient remains asymptomatic 18 months postoperatively.Sinonasal LMS is
a rare entity which should be included in the differential diagnosis of sinonasal masses. The
diagnosis is established by histopathology and immunochemistry. Wide surgical excision is the
gold standard of treatment and long term follow up is mandatory due to its aggressive and
infiltrative nature.

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1510
A Rare Case of Sinonasal Lymphoepithelial Carcinoma

Anastasia Liapi1, Anna-Maria Papadopoulou1, Athanasia Marinou1

1
Department of Otorhinolaryngology, G.Gennimatas Athens General Hospital

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Sinonasal lymphoepithelial carcinoma (SLEC) is an extremely rare malignant tumor of the

sinonasal tract. In this case report, we present a case with locally advanced disease of the
posterior ethmoid cells. A 75-year-old male presented with a 6-month-history of unilateral
nasal congestion, recurrent epistaxis, aural fullness, diplopia and visual disturbance.
Outpatient nasendoscopy was negative for abnormal findings, except for bulging of the
posterior wall of the nasopharynx with no obvious mucosal changes. CT scan revealed an
extensive osteolytic lesion of the right ethmoidal sinuses with invasion of the middle cranial
and pterygoid fossae. There was also erosion of the right orbital floor. The patient underwent
diagnostic endoscopic ethmoidectomy and biopsies. Histopathological examination of
posterior ethmoid cell mucosa demonstrated undifferentiated malignant cells, associated
with lymphoplasmacytic infiltration, while the immunohistochemistry was positive for
pancytokeratin. A final diagnosis of EBV-positive SLEC was rendered and the patient was
referred for concomitant chemo-radiotherapy. To our knowledge, this is the first case report
of SLEC arising from the posterior ethmoid cells with invasion of the orbit and middle cranial
fossa.SLEC should be differentiated from other sinonasal malignancies, such as lymphomas,
nasopharyngeal and sinonasal undifferentiated carcinoma. Its prognosis remains favorable
mainly because of its radiosensitivity. We recommend chemoradiotherapy for locally
advanced disease and regular follow-up with CT scans.

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1558
Sociodemographic and clinical characteristics of unilateral sinonasal tumors in
Bogotá, Colombia

Daniel Peñaranda1, Catalina Jaramillo1, Martín Pinzón Navarro1, Antonieta Gomez1

1
Otolaryngology Section, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Introduction: Sinonasal masses are common findings in the Otolaryngology consult. Up to 2.6-
5% of head and neck tumors are sinonasal tumors. Unilateral sinonasal masses can be
classified into benign or malignant. Differential diagnosis workup needs special attention
given the overlapping clinical presentations. This study aimed to describe clinical,
epidemiological and histopathological characteristics of patients with unilateral sinonasal
tumors from the Otolaryngology department at two hospitals in Bogotá, Colombia.Methods:
Records of patients with unilateral sinonasal tumor resection or biopsy over 5 years (2015-
2020) were reviewed. Analyzed data included demographic variables, clinical and imaging
characteristics of the tumors and surgical approaches. Statistical analysis was performed using
STATA package version 14. Results: 163 patients were reviewed. Unilateral sinonasal masses
were benign in 133 (82%) cases and malignant in 30 (18%) cases. Juvenile nasopharyngeal
angiofibroma (18%) was the most common benign unilateral sinonasal mass. Older age was
associated to malignancy (p<0.005). Radiological symptoms and signs associated with
malignancy were: facial pain, facial hypoesthesia, bone erosion and invasion of adjacent
structures (p <0.005). Conclusions: Factors associated with malignancy were advanced age,
facial hypoesthesia, facial pain, and radiological signs such as bone erosion and invasion of
adjacent structures. Further studies are required to determine risk factors associated to
histopathological subtypes.

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1566
Nasopharyngeal Carcinoma

Ahmad Alghoj1, Paraskevi Karamitsou1, Chrysoula Vardaksi1, Spyridon Gougousis1, ioannis

skoumpas2, alexandros poutoglidis2

1
Department of Otorhinolaryngology-Head and Neck Surgery,''G. Papanikolaou''General
Hospital,Thessaloniki ,Greece, 2Department of Otorhinolaryngology-Head and Neck
Surgery,''G.Papanikolaou''General Hospital,Thessaloniki ,Greece

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

ABSTRACT:BACKGROUND: Nasopharyngeal carcinoma (NPC) is a common neoplasm in

certain ethnic groups, with highest incidence in southern China, Northern African and
Southeast Asia. Genetic factors and epstein-bar virus (EBV) infection have a significant role in
NPC oncogenesis. The majority of NPC patients are symptomatic only in advanced
stages. CASE PRESENTATION: A 40-year-old woman presented to our outpatient department
with a 3 month history of a right neck lump and parotid gland swelling, obstructive sleep apnea
and otalgia one week after right molar extraction. EBV-VCA IgG and EBV-DNA tests were
positive. Imaging tests demonstrated a nasopharyngeal neoplasm. The patient underwent
endoscopic nasopharyngeal biopsy which showed a non-keratinizing carcinoma (WHO II). The
disease treated with concurrent radiotherapy and chemotherapy . Conclusions:
Nasopharyngeal carcinoma is rare in Europe and is commonly misdiagnosed in the early
stages. Epstein‐Barr virus (EBV) DNA is a useful marker for detection, monitoring, and
prognostication of NPC .

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1605
Effectiveness of nivolumab for sinonasal carcinomas

Kobayashi Eiji1, Eiji Kobayashi1, Takayoshi Ueno1, Tomokazu Yoshizaki1

1
Department of Otolaryngology - Head and Neck Surgery, Kanazawa University

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Nivolumab, an anti-programmed death 1 (PD-1) monoclonal antibody, has been approved as

the first immune checkpoint inhibitor in head and neck malignancies. The phase III trial,
Checkmate 141 trial, does not include sinonasal carcinoma cases, and efficacy of nivolumab
against sinonasal carcinomas is still unclear.We performed retrospective analysis of 39 cases
of head and neck malignancies, including 7 sinonasal carcinomas, which were adminisitered
nivolumab at our institute between June 2017 to September 2020.Mean age were 67.3 (43 -
85) years old. 30 were male, and 9 were female. 30 were squamous cell carcinoma (SCC), 4
were malignant melanoma, and 5 were other histologies. Of those, 7 cases were sinonasal
carcinomas including 2 SCCs, 2 malignant melanomas, and 3 others. Median duration of
follow-up was 235 days. Median overall survival (OS) of all cases was 10.1 months. OS of
sinonasal carcinomas and those of other primary sites were 7.29 months and 11.4 months (p
= 0.119). Analysis excluding malignant melanoma had similar results. These results
demonstrated effectiveness of nivolumab for sinonasal carcinoma resembles that of other
head and neck carcinomas. Our results suggest that nivolumab is also effective for sinonasal
cacinomas, although numbers of cases were limited.

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1611
Preservation of the orbit in case of periorbital infiltration by sinonasal malignancies –
the retrospective study

Štěpán Novák1, Zuzana Balatkova1, Jan Plzak1

1
Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles
University, University Hospital Motol, Prague, Czech Republic

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Objective: One of the possible risks of sinonasal malignancies is its possible spread into orbit.
The aim of the study was to demonstrate that a periorbital infiltration without involvement
of deeper orbital tissues is not an indication criterion for a orbital exenteration. Methods: The
retrospective analysis over a 14-year period of patients undergoing surgical treatment for the
sinonasal malignancies with the histologically verified periorbital infiltration or deeper
invasion into the orbit was performed. A total of 32 patients were included in the study.
Results: The orbital preservation was performed in 18 patients and the orbital exenteration
was performed in 14 patients. The 2-year and 5-year overall survival rate were respectively
61% and 43.8% for the orbital preservation group and respectively 50 % and 30.7 % for the
orbital exenteration group. The vision in the orbital preservation group was graded as intact
in 11 and functional with impairment in 3 patients. Conclusion: The orbital preservation in the
case of the periorbital infiltration allowed the preservation of vision in the majority of patients
and did not lead to worse survival compared to patients indicated for the orbital exenteration
or compared to the results of other research groups.

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1615
The surgical challenge behind the treatment of malignant nasal vestibule carcinomas
– report of two cases

Cláudia Rosa1, Mariana Caetano1, Diogo Conduto2, Paulo Pereira1, Tiago Eça1, Leonel Luís1,
Claudia ROSA1

1
Serviço de Otorrinolaringologia, Hospital de Santa Maria | Centro Hospitalar Universitário Lisboa
Norte, 2Serviço de Cirurgia Plástica, Reconstrutiva e Estética, Hospital de Santa Maria | Centro
Hospitalar Universitário Lisboa Norte

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Background & Aim: Basosquamous carcinoma (BSC) and squamous cell carcinoma (SCC) are
cutaneous neoplasms with distinct incidences, both aggressive with an increased risk of
recurrence and metastases. The first line of treatment is complete surgical excision with
histopathological control of excision margins. In head and neck cancers, this requires multi-
stage reconstruction and a multidisciplinary approach throughout the treatment period. We
aim to present two cases of nasal vestibule BSC/SCC and their treatment. Methods:
Consultation of the clinical records and iconography.Results: We present two cases of patients
with a nasal mass with progressive growth whose biopsies revealed SCC. Despite different
extents of the nasal lesions, both patients were submitted to partial rhinectomy and
reconstruction of the defect with free flap and frontal extensor in a two-staged surgery. One
of the patients underwent reconstruction of the nasal dorsum with costal cartilage. The
histopathology showed a BSC and a SCC with free margins and no adverse features in each
case with no need for further treatment. None of the patients showed signs of local
recurrence or metastatic disease at 4-month follow-up. Reasonable aesthetic and functional
results were achieved, and both remain under close surveillance. Conclusions: Although BSC
and SCC are histologically different, complete surgical excision remains the best treatment
choice. Aesthetic and functional outcomes are critical in these cases, and free flaps have
considerably reduced the morbidity associated with surgical treatment.

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1642
Nasopharyngeal carcinoma with multiple cranial nerve palsy: A case report

Mariana Caetano1, Cláudia Rosa1, Rita Peça1, Mariana Correia1, Ana Rita Santos1, Diogo
Tomé1, Leonel Luís1

1
Department of Otorhinolaryngology, North Lisbon University Hospital Center, Lisbon, Portugal

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Background: Cranial nerve (CN) involvement may occur as a complication in locally advanced
nasopharyngeal carcinoma (NPC), representing a poor prognostic factor. Most frequently
involved cranial nerves are the trigeminal, abducens, and hypoglossal nerves. Nevertheless,
facial and vagus nerve palsies are particularly uncommon, with an incidence of 3% and 2%,
respectively.Methods: Observational case report.Results: We report a case of a 52-year-old
male who presented to the emergency department with a 6-month history of left-sided facial
paralysis, proptosis, dysphonia, and dysphagia. Physical examination showed leftward tongue
deviation and flexible endoscopy demonstrated a nasopharyngeal mass and left vocal cord
palsy. Contrast-enhanced computed tomography imaging confirmed the presence of a large
mass in the nasopharynx, with extension into the cavernous sinus, petrous temporal bone,
temporal lobe, orbit, pterygopalatine fossa, masticatory muscle space and to the soft palate.
Punch biopsy established the diagnosis of Epstein-Barr virus positive squamous cell
carcinoma, and the patient was subjected to induction chemotherapy. Conclusions: NPC has
a locally infiltrative behavior, with the potential for skull base invasion or intracranial
spread. This case is illustrative of a rare and aggressive presentation of NPC, with an unusual
combination of multiple CN palsies (CN VII, X and XII).

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1643
Alveolar Radomyosarcoma in the Paranasal Sinuses

Maria Muñoz1, GABRIELA MUÑOZ1

1
Department of Otorhinolaringology, University Hospital of the Canary Islands

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Introduction: Rhabdomyosarcoma is a rare soft tissue malignancy that arises from myogenic
cells. The alveolar subtype is aggressive and infrequent in the paranasal sinuses and in the
adult population, but it should be considered at the time of diagnosis. Myoglobin, Myo D1,
and myogenin appear to be the most specific markers. Materials and Methods: The case of a
patient diagnosed with Alveolar Rhabdomyosarcoma of the paranasal sinuses is
presented. Results: A 49-year-old patient, operated on for Macroprolactinoma in 1995 +
complementary radiotherapy, presented epistaxis, anosmia, right nasal obstruction and
retroocular pain of months of evolution. MRI and CT: right nasal neoformation of
approximately 6cm with extension to the anterior cranial fossa without invasion of brain or
orbital tissue. A biopsy of the lesion and a positive immunohistochemical study were
performed for Alveolar Rhabdomyosarcoma with rearrangement of the FKHR gene (FOXO1,
13q14) stage 3 (TNM classification), IRSG IIIa. She was treated with Vincristine-Dactinomycin-
Cyclophosphamide with partial response, followed by weekly adriamycin plus complementary
radiotherapy. After 1 year, she did not present signs of locoregional or distant
recurrence. Conclusion: Immunohistochemical confirmation is the most important criterion
to establish its diagnosis. Treatment involves surgery in localized cases and chemotherapy
followed by complementary radiotherapy.

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1647
Sinonasal olfactory neuroblastoma – case report

Andreea Elena Bejenariu1, Alex-Iulian Milea1, Daniel Lupoi2, Codrut Sarafoleanu2

1
”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 2ENT&HNS Clinical
Department, “Sfanta Maria” Clinical Hospital, Bucharest, Romania

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Olfactory neuroblastoma or esthesioneuroblastoma is a rare malignant tumor that appears in

approximately 3-5% of sinonasal neoplasms and arises from the olfactory nerve epithelium.
The current treatment option includes surgical resection in association with radiotherapy. We
report a case of a 34 years old patient who presented to our clinic for recurrent unilateral
epistaxis. Computed tomography of the sinuses with intravenous contrast revealed a tumor
with contrast enhancement located in the upper 2/3 of the left nasal fossa, invading the left
olfactory fossa, eroding the cribriform plate, partial left frontal sinus and adjacent anterior
ethmoid cells. The histopathological result was esthesioneuroblastoma (G4¬). Carotid
angiography showed that the vascularization of the tumor was provided by the left ophthalmic
artery and the maxillary artery. Previous surgery was performed and after this procedure, an
increased volume of the tumor appeared. The patient underwent surgical resection of the
tumor through a combined approach (external and endoscopic). Postoperative, the patient
was referred to the oncology department and is currently undergoing oncological treatment.
It is known that esthesioneuroblastoma is more aggressive in younger patients and the
prognosis is usually unfavorable. The 5-year overall survival rate ranges between 70-94%,
depending on the Kadish stage. Particularly, this case presented a rapid growth of the tumor
and it is interesting to follow up on the evolution.

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1736
PRIMARY BURKITT’S LYMPHOMA IN THE MAXILLARY SINUS: A CASE REPORT

ANGELIKI VASILIKI PAVLOU, THEODOROS DRAKOS - GALANIS, ANNA-MARIA

PAPADOPOULOU, ATHANASIA MARINOU, EVANGELIA ZACHARIOUDAKI, SOTIRIOS
PAPOULIAKOS

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

IntroductionBurkitt’s lymphoma is a highly aggressive, small B-cell non-Hodgkin’s lymphoma.

The sporadic form of this high-grade lymphoma affects the Head and Neck region, usually
involving cervical lymph nodes. Primary extranodal involvement, such as of the nasal cavity or
the paranasal sinuses is highly uncommon.Case presentationA 38-years-old Caucasian male
presented with progressively deteriorating facial pain of the left side, without any
accompanying symptoms. His past medical history and physical examination were
unremarkable, but the CT and MRI scan revealed a mass arising from the superior and lateral
wall of the left maxillary sinus, eroding the posterior wall and surrounding the infraorbital
nerve. Functional Endoscopic Sinus Surgery was performed and a biopsy of the lesion was
taken. The histomorphological analysis of the excised tissue revealed a “starry-sky”
appearance, characteristic of Burkitt’s lymphoma, so the patient was referred to the
Hematology department and was initiated on Chemotherapy and Radiotherapy. Two years
after the end of the treatment, the patient remains free of disease.ConclusionThis case
highlights a rather unusual primary site of a Burkitt’s lymphoma. In patients presenting with
intense, unilateral symptoms and especially constant midfacial pain, a thorough diagnostic
work-up should be performed, so as to achieve an early diagnosis of possible malignant
causes.

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1750
Maxillary lesions in children with acute leukemia

Margarita Kalinina, Nikolay Grachev, Ilya Zyabkin, Natalya Myakova, Ayna Magomedova

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Introduction: changes of the skull and facial bones in children with acute leukemia are
commonly presented by lytic lesions. Leukemic infiltration of the maxilla or maxillary masses
are very rare. Materials and methods: After 10 years of observation in pediatric tertiary care
center of head and neck pathology, we included 6 cases of maxillary lesions in 5 (3 female
and 2 male) pediatric patients with acute leukemia. Mean age was 7 years, min – 1 y.o., max
– 14 y.o. 4 patients had acute lymphoblastic leukemia,one patient – acute myeloblastic
leukemia. Main clinical manifestations: swelling in maxillary area – 83 %, nasal breathing
difficulties – 50%, reactive edema of lower eyelid – 16%, unilateral otitis media with
effusion – 16 %. None of the patients had fever, weakness, or tendency to excessive
bleeding. All the patients had radiology confirmed presence of tumor site in maxilla.There
has been orbital involvement and orbital growth in 2 cases, orbital and intracranial
involvement in one case.Biopsy performed in all the cases. Lesions totally dissolved after on
average 3 months of treatment of underlying disease.

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1763
A rare case report of primary epithelioid hemangioendothelioma in the maxillary
sinus

Yves Brand1, Leong Wai Yee1

1
Kantonsspital Graubünden, Department of Otorhinolaryngology, Chur, Switzerland, 2Kantonsspital
Graubünden, Department of Otorhinolaryngology, Chur, Switzerland and University Basel, Basel,
Switzerland

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Introduction: Epithelioid hemangioendothelioma (EHE) is a rare vascular soft tissue

neoplasm. It is arising from the endothelial layer of blood vessels and it has variable clinical
behavior. It can behave ranging from that of a low-grade malignancy to that of a high-grade
sarcoma. Systemic involvement is not unusual. The most affected organs were liver, bone and
lung. To date, there were only three cases reported in the literature in which EHE primarily
arising from the paranasal sinus. Case Summary: A 85-years-old man presented to
outpatient clinic with a history of left facial fullness. No other nasal symptoms were noted. On
physical examination, no facial swelling and his nasal endoscopy examination is normal.
Magnetic resonance imaging (MRI) was done and showed an extensive mass in the left
maxillary sinus extending into the infratemporal fossa. The patient was ultimately diagnosed
with epithelioid hemangioendothelioma (EHE) and underwent transnasal endoscopic tumour
resection. He received adjuvant radiotherapy. He had regional cervical lymph node metastasis
after a year which he underwent neck dissection. A year later he developed lung metastasis
and he underwent thoracoscopic wedge resection successfully. Two years of close follow-up,
he is well and tumour free clinically and radiographically. Conclusion: The treatment of
choice for confirmed unifocal EHE is surgery. The key for treatment is complete surgical
resection with clear microscopic margins. Post operative adjuvant radiotherapy is
recommended.

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1785
Orbital apex squamous cell carcinoma

KELVIN YONG JIE LIM1, Chengyao Alex Tham1

1
Tan Tock Seng Hospital

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

BackgroundOrbital apex squamous cell carcinoma (SCC) is a rare entity. It often occurs from
direct invasion from the nasopharynx, nasal cavity/paranasal sinuses, or secondary spread via
a haematogenous route. We report a rare case of a patient diagnosed with a primary orbital
apex SCC, on a background of nasopharyngeal carcinoma (NPC) in complete remission after
curative chemoradiation. There are only five documented cases of primary orbital apex SCC
documented in literature. Case summaryA 68-year-old lady, with a history of NPC in 2003 in
complete remission after curative chemoradiation, was referred to the Department of
Otolaryngology in consideration for an endoscopic biopsy of a right orbital apex mass. She had
presented to the eye clinic complaining of right eye proptosis and worsening vision. On
examination, her right eye had no perception to light, right pupil was amaurotic, and there
was restriction of extraocular movement in all directions of gaze. Hertel’s ophthalmometer
showed that there was proptosis and there was loss of corneal sensation in the right eye.
Magnetic resonance imaging of the orbits revealed an enhancing right orbital apex mass with
extension into the cavernous sinus. The patient underwent an endoscopic trans-sphenoidal
biopsy of the right orbital apex lesion. Histopathology demonstrated SCC. Systemic workup
did not reveal any other site of primary SCC nor metastasis. Result. She was managed with
best supportive care as the tumour was deemed unresectable and she was also a poor
candidate for chemotherapy and radiotherapy.

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1788
Whole Exome Sequencing analysis for the investigation of malignant transformation
mechanism in sinonasal inverted papilloma

Jee Hye Wee1, Hyojin Kim2, Min Woo Park3, Sung-Woo Cho4, Chae Seo Rhee4, Jeong-Whun
Kim4

1
Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital,
Hallym University College of Medicine, 2Departments of Pathology, Seoul National University Bundang
Hospital, Seoul National University College of Medicine, 3Department of Otorhinolaryngology-Head &
Neck Surgery, Kangdong Sacred Heart Hospital, 4Departments of Otorhinolaryngology-Head and Neck
Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine

Poster Session |Sinonasal malignancy | 18 June – 22 June, 2023, All day

Sinonasal inverted papilloma (IP) has the potential to transform into squamous cell carcinoma
(SqCC), but the mechanism is still uncertain and there is no diagnostic method to predict
malignant transformation. We investigated genetic mutations involved in stepwise
progression of sinonasal IP to SqCC and explored biomarkers that can predict malignant
transformation. Fourteen patients diagnosed with SqCC arising from IP ("premalignant IP")
and six patients diagnosed with "benign IP" were included. DNA was separately extracted from
areas of normal tissue and area of IP, dysplasia, and SqCC, respectively. Whole exome
sequencing and immunohistochemistry (IHC) was performed. Major oncogenic mutations
were observed with high frequency in the stepwise progression from IP to SqCC. TP53 was the
most frequently mutated gene (39%), followed by CDKN2A (27%), TTN (27%), PIK3CA (21%),
and ARID1A (15%). Mutations in TP53 and/or CDKN2A were observed in three out of six
premalignant IPs, whereas none of the mutations were observed in benign IPs. Tumor
mutational burden increased from IP to SqCC. IHC staining of the benign IP group without
genetic mutation showed all patchy positive for both p53 and p16. However, among the six
IPs with malignant transformation, three IPs with genetic mutation showed a diffuse strong
or null pattern in p53 and p16. Our result suggests that the assessment of TP53 and CDKN2A
status can be a predictive marker of malignant transformation of IP. Furthermore, the
assessment of p53 and p16 expression using IHC can be a surrogate marker for TP53 and
CDKN2A status.

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Skull base surgery

1666
Endoscopic endonasal transsphenoidal approach to sellar and parasellar lesions: An
Institutional Experience

Eleni Gkrinia1, Anna Maria Ntziovara1, Nikolaos Kalogritsas1, Charikleia Maiou1, Ioannis
Tsitiridis1, Jiannis Hajiioannou2

1
Department of Otolaryngology - Head and Neck Surgery, University Hospital of Larissa, Greece ,
2
Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Thessaly,
Greece

Poster Session |Skull base surgery | 18 June – 22 June, 2023, All day

Introduction: The endoscopic transsphenoidal approach to the sella and parasellar regions is
increasingly used for removal of lesions localized in the ventral skull base. The aim of this study
is to report our experience regarding the surgical management of patients with sellar and
parasellar lesions that presented in our tertiary care centre.Material and Methods: A
retrospective study was performed for all cases of endoscopic transsphenoidal surgical
management of sellar and parasellar lesions that were performed in the ENT Department of
University Hospital of Larissa, Greece during the last decade.Results: A total of 16 patients
were recruited in the study. The age of patients ranged from 30 to 79 years. Ten patients were
female and six were male. The most frequent lesion was pituitary adenoma in 68.8%. Visual
field and acuity deficit was the commonest symptom in 81.3%. Postoperatively, nasal
adhesions were reported in 4 cases. In one patient, reoperation was needed due to
cerebrospinal fluid leak. The patients were followed up for 1 to 7 years. Conclusion: Sellar and
parasellar lesions represent a challenge because of their variable features. Endoscopic
transsphenoidal approach offers enhanced visualization, resulting in successful removal of the
tumor, along with lower complications’ rate.

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Smell and taste

1152
Efficacy of topical steroids for the treatment of olfactory disorders caused by COVID-
19: A systematic review and meta-analysis

SeHwan Hwang1

1
Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of
Medicine, The Catholic University of, 2Department of Otolaryngology-Head and Neck Surgery, Bucheon
St. Mary’s Hospital, College of Medicine, The Catholic University o

Poster Session |Smell and taste | 18 June – 22 June, 2023, All day

This study was aimed to assess the effect of topical steroids on acute-onset olfactory
dysfunction in patients infected with COVID-19 Patients infected with COVID-19.Main
outcome measures: PubMed, Embase, the Web of Science, SCOPUS, Cochrane database, and
Google Scholar were searched for articles. We analyzed studies comparing the improvement
of olfactory dysfunction between topical steroid treatment and control groups (placebo or no
treatment). In addition, we performed a subgroup analysis by study type. The improvement
of olfactory score at 2 (standardized mean difference [SMD] = 0.7272,
95% confidence interval = [0.3851, 1.0692], p

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1247
Rehabilitation of patients with a decrease in olfative function after covid-19
infection.

Roman Davydov1, Ksenia Kartashova1, Hiyir Abdulkerimov1, Ksenia Shamanskaya1

1
Ural state medical university, Ekaterinburg, Russia Otolaryngology Department

Poster Session |Smell and taste | 18 June – 22 June, 2023, All day

106 patients with post-covid syndrome (ICD - U09.9) (n=106) were observed for the period
from January 2021 to December 2021. Statistical data processing was carried out in the
Statistica 10.0 package. Olfactometry to determine the degree of smell reduction was
performed according to the Voyachek method and included determining the degree of smell
reduction with 4 standard solutions. Patients of the experimental group (n=86), NCVI therapy
was combined with olfactory training course using various combinations of essential oils 5
times a day for 4 weeks. Patients in the control group (n=20) received standard therapy.
Essential oil combinations for olfactory training were divided according to the combination of
scents used. The olfactory training technique consists in regular stimulation of respiratory
olfactory neurons with odorous substances. To assess the quality of life the generally accepted
standardized questionnaire SNOT-22 was used. In the course of treatment of the experimental
group, the sense of smell was completely restored in 52.97% of patients, which significantly
differs from the control group, where this figure was 32.82%. In 9.30% of cases, patients who
at the beginning of therapy had a fourth degree of decrease in olfactory function, after the
end of the course, the third degree was diagnosed, the sense of smell improved and the
patients began to distinguish the smell of pure wine alcohol. In 31.72% of cases, patients of
the first group had the first degree of smell reduction.

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1516
UP TO DATE IN SMELL AND TASTE DISORDERS

Gabriela-Violeta Melinte1, Codrut Sarafoleanu1

1
ENT and HNS Department of "Sfanta Maria" Clinical, Bucharest, Romania

Poster Session |Smell and taste | 18 June – 22 June, 2023, All day

Smell function is being studied for many years given its importance in our lives, but in the last
three years, during the pandemics the number of papers regarding smell and taste has
significantly increased.Incidence of smell and taste impairment varies between 5% and 95%
and ¼ people with COVID-19 report smell and taste loss as the first symptom.It has been
demonstrated that smell testing is as important as smell function assessment, because half of
the patients accusing smell and taste loss have normal gustatory function.In what concerns
the treatment of olfactory and taste disturbances, there are currently multiple options such
as oral and intranasal corticosteroids, olfactory training, oral vitamin/mineral
supplementation, amongst others. The majority (> 90%) of COVID-19 patients recover their
smell and or taste 2 weeks after onset of the sensory dysfunction. Olfactory training is the
only current evidence-based therapeutic option for post-viral olfactory loss.

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1290
Effectiveness of olfactory rehabilitation in patients affected by post-viral olfactory
disfunction after SARS-Cov2 infection

Umberto Tanzini1, Roberta La Vela1, Matteo Trimarchi1

1
Vita-salute San Raffaele University, Milan, Italy, San Raffaele Hospital, Milan, Italy

Poster Session |Smell and taste | 18 June – 22 June, 2023, All day

Introduction: Olfactory dysfunction or "loss of smell" is an early symptom of COVID-19, with

prevalence estimated between 40% and 75%. In Italy, about 33.9% of patients reported
changes in taste and smell and 11% of subjects reported the alteration of both senses. Loss of
smell often has a relevant impact on quality of life and overall health, directly affecting daily
activities. There is evidence that olfactory training is effective in treating olfactory loss,
improving regenerative ability and allowing proper survival and targeting of neurons during
recovery. Other studies claim that the benefits of olfactory training may be similar to
spontaneous recovery. The purpose of the study is to demonstrate the effectiveness of
olfactory re-education in subjects suffering from chronic olfactory disorders (>6 months) post
Covid infection. Materials and methods: we analyzed 60 patients (mean age 40,15 years ([18-
60])) with chronic olfactory disorders (6 months) and confirmed history of Covid-19, negative
nasal endoscopy and negative MRI. The exclusion criteria were: pregnancy, the presence of
phantosmia or parosmia, cigarette smoke, rhinosinusitis in the six months preceding Covid
infection, allergies, previous olfactory disorders, neurodegenerative disease, previous
sinonasal surgery. Patients underwent a 24-week olfactory training, exposing themselves
twice a day to 4 odors for 20 seconds with an essence change every 4 weeks, for a total of 9
essences. Patients were randomly divided into two groups of 30 subjects each: an Olfactory
Training Group (OT), treated with essential oils at therapeutic concentrations, and a group
Not Olfactory Training (NOT), treated with essential oils at subtherapeutic concentration. At
the beginning and at the end of the training, all subjects performed the smell identification
test (UPSIT). Results Mean UPSIT increased from 19.8 to 25.3 in the OT group, and from 19.6
to 21.9 in the NOT group. Considering an increase in the UPSIT score of 5.5 points as a clinically
significant minimum difference for the improvement of olfactory function, our results show
that 60% of the OT group and 34% of the NOT group have an improvement of olfactory
function, with a statistically significant change in the OT group (p<.05).
Conclusions Olfactory training is effective in improving the olfactory threshold in people with
chronic PVOD.

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Snoring and OSA

1174
Surgical treatment of mild and moderate OSA

Mariam Dzhafarova1

1
Department of Otorhinolaryngology, GMS Hospital, Moscow, Russia

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

In most cases decrease of soft palate muscle tone causes snoring and mild/moderate OSA. To
solve this problem a soft palate stiffening surgery was introduced. The aim of the study was
to improve the surgical treatment of mild and moderate OSA.Methodology. This study
included 108 patients with mild and moderate OSA who underwent surgical treatment from
2015 to 2022. Three clinical groups were formed. Group I included 30 patients who underwent
Pillar-procedure simultaneously with cold ablation of uvula and posterior arches. Group II
consisted of 40 patients, in whom anterior palatoplasty was performed. Group III - 38 patients
who underwent anterior palatoplasty alongside with cold ablation of uvula and posterior
arches. Polysomnography, drug-induced sleep endoscopy and special questionnaires (visual
analogue scale of snoring intensity (VAS), Epworth Sleepiness Scale (ESS)) were use to rule out
more appropriate surgical strategy. Results. Postoperative pain was significantly lower
(p<0,01) in the group II. During the follow-up period of 1 year there were a significant
reduction of VAS and ESS (p<0,01) in group III. Apnoe/hypopnoe index decreased significantly
(p<0,05) in groups II and III. Conclusion. We recommend anterior palatoplasty with/or without
cold ablation of uvula and posterior arches as an effective surgical treatment of mild and
moderate OSA.

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1147
Sleep time on back as a predictor of adherence to positive airway pressure therapy

Ha-Nee Kwon1, Ji-Hwan Park1, Sung-Dong Kim1, Kyu-Sup Cho1

1
Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University
School of Medicine, Pusan Natuion

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

Objective: Although upper airway collapse can be effectively dealt with by positive airway
pressure (PAP), patient adherence is considered a major determining factor for the success of
PAP therapy. This study was performed to analyze the potential factors affecting adherence
to PAP in patients with OSA by using polysomnography parameters recorded for diagnosis of
OSA.Methods: The data of 158 patients between December 2018 and July 2021 were
collected. They were categorized into adherent and non-adherent groups according to the
criteria of good adherence as use of PAP ≥ 4 hours per night on 70% of nights. Demographic,
clinical characteristics and PSG results were reviewed.Results: Among 158 patients engaged
in PAP therapy, 121 patients (76.6%) met the criteria of good adherence. No significant
differences were found in good adherence rates regarding demographic and clinical
characteristics. None of the polysomnographic factors showed significant differences
between adherent and non-adherent groups. However, the percentage of sleep time on back
in the adherent group was significantly higher than in the non-adherent group (p = 0.041).
Conclusion: Only the percentage of sleep time on back appeared to be a polysomnographic
predictor for identifying good adherence to PAP therapy in OSA patients.

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1170
The relationship between metabolic syndrome and obstructive sleep apnea
syndrome: a nationwide population-based study

Soo Whan Kim1

1
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of
Medicine, The Catholic University of Korea, Seoul, Korea

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

There has been a need for research on the association between metabolic syndrome (MetS)
and obstructive sleep apnea syndrome (OSAS) using large data such as nationwide population-
based data that adjusts important confounding factors. Therefore, we investigated the
relationship between MetS and OSAS. The data source we used was the National Health
Insurance Service claims database managed by the Republic of Korea government, in which
10,113,560 individuals were enrolled in 2009 and followed up until 2018. The independent
association of MetS with the risk of OSAS was determined using a Cox proportional hazards
model with adjustment for age, sex, smoking status, alcohol consumption, regular physical
exercise, and body mass index. Our results showed that MetS were strongly associated to
OSAS which was adjusted for several confounding factors. Also, we found men, increased
waist circumference and increased triglyceride are important risk factors for OSAS.

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1176
Predictors of surgical outcomes for limited palatal muscle resection in patients with
obstructive sleep apnea

JIWON Jang1, Cho Kyu-Sup2, Ji-Hwan Park1, Kim Sung-Dong2, Hye-Jin Park1

1
Department of Otorhinolaryngology, Pusan National University Hospital, Busan, Republic of Korea,
2
Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University
School of Medicine

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

Objective This study aims to determine the factors affecting the success and cure rate of
LPMR in patients with OSA, thus guiding patient selection and improving surgical outcome.
Methods Thirty-five OSA patients underwent LPMR were enrolled. All patients received
routine physical examination, preoperative DISE, and PSG. Clinical, polysomnographic,
cephalometric variables, and DISE findings were evaluated. These measurements were
compared between the surgical success and surgical failure group based on the results of
preoperative and postoperative PSG. Furthermore, we compared the cured and non-cured
groups in the surgical success group.Results Among 35 patients, a total of 20 patients met the
success criteria, and the overall success rate was 57%. Patients with Friedman stage II had a
significantly higher success rate (p=0.032). According to DISE results, tongue base obstruction
affected the surgical outcome (p<0.001). The success rate was 100% in the no tongue base
obstruction during DISE, 72.2% in the partial obstruction, and 9.1% in the total obstruction.
Tonsil size is also helpful in predicting surgical success rate (p=0.044). However, none of the
variables showed statistically significant differences between the cured and non-cured
groups.Conclusion Calculating the Friedman stage and evaluating the tongue base
degree through DISE helps predict the surgical effect before LPMR surgery. Patients with large
tonsil size and no tongue base obstruction may have a high chance of surgical success with
LPMR.

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1258
Analysis of relationship between obstructive sleep apnea and non-alcoholic fatty
liver disease using Korean NHIS-HealS data

Hyo Jin Chung1, Jung Hyun Chang1, Jung Hwa Hong2

1
Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 2Research
Institute, National Health Insurance Service Ilsan Hospital

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

Currently, obstructive sleep apnea (OSA) is believed to be a disorder related to metabolic

syndrome, however, the association between nonalcoholic fatty liver disease (NAFLD) and
OSA has not yet been established. This study analyzed the relationship between NAFLD and
OSA using data from the Korean National Health Insurance Service-National Health Screening
(NHIS-HealS) data from January 2007 to December 2012. The study enrolled 80,139 patients
with OSA and 365,080 control participants. NAFLD was defined as 1) a fatty liver index (FLI)
≥60, 2) a hepatic steatosis index (HSI) ≥36, or 3) clinically diagnosed as NAFLD (ICD-10 code
K758 and K760). OSA was identified using claims data (ICD-10 code G473). In the study, 29.1%
of the 80,139 patients had a FLI score of 30-60, 31.4% had a score over 60, 40.9% had a
30≤HSI<0, and 39.3% had a HSI≥60. In multivariate analysis, the risk of OSA was significantly
higher in the higher FLI groups (HR 1.784, 95% confidence interval [CI] 1.757-1.812) and higher
HSI groups (HR 1.781, 95% CI 1.754-1.808). This finding was consistent across age subgroups
(young age 20-39, middle age 40-64, and old age ≥65. In conclusion, a high FLI or/and HSI score
obtained from national health screening data may help identify patients with a high risk of
OSA. Understanding the association between NAFLD and OSA may have important
implications for the risk-stratification of patients with NAFLD.

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1331
Frequency of upper respiratory obstructive disease in patients with sleep-disordered
breathing

Takahiro Nakajima1, CHIBA SHINTARO2, Masahiro Miura1

1
Ota general hospital, 2Jikei University School of Medicine / Ota Memorial Sleep Center

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

IntroductionFor CPAP failure patients, the consultation of alternative treatments, including

upper airway surgery is strongly recommended. In this study, we investigated the frequency
of upper airway disease in patients with sleep-disorder who visited a sleep clinic.Methods739
patients who visited the Ota Memorial Sleep Center between January 1 to December 31, in
2016 were included. Otolaryngologists performed upper airway examination using a
nasopharyngolaryngoscope(evaluated degree 0 to 4), sinus CT scan, and rhinomanometry and
acoustic rhinometry in the sitting and lying positions, as needed.Results and discussionIn this
study, 125/576 patients (21.7%) had hypertrophy of the palatine tonsils of degree 2 or more,
76/579 (13.1%) had nasal septal deviation degree 3 or greater, and 16/579 (3%) had
hypertrophic rhinitis degree 3 or higher. 139/739 (18.8%) patients were diagnosed with
chronic sinusitis, and 46/759 (6.1%) had nasal resistance of 0.35 pa/cm/３sec or higher in the
supine position. These are reported as the independent factors for CPAP
intolerance.Therefore, after the diagnosis of OSA and prior to the start of conservative
treatment such as CPAP, a detailed evaluation of the upper airway is necessary, and there are
many cases in which otolaryngologists should intervene appropriately with their expertise.

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1462
Modified barbed reposition pharyngoplasty(CWICKs) for OSA

CHIBA SHINTARO1

1
Jikei University School of Medicine/Ota Memorial Sleep Center

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

Objective: Uvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the

oropharyngeal level for obstructive sleep apnea, but there are problems with variations in
treatment effects and postoperative complications. Therefore, effective and less invasive
surgical methods are required.Methods: So-called CWICKs is one of modified methods of
barbed reposition pharyngoplasty that use resorbable wound closure devices to pull the
posterior palatal arch outward and elevate it anteriorly and superiorly to maintain an open
upper airway during sleep at the soft palate level. We compared the therapeutic effects of 46
patients with CWICKs and 96 patients with UPPP.Results: In 46 patients with CWICKs,
significant improvement was observed after surgery on AHI, %CT 90, ESS and PSQI. The
improvement rate of AHI was 61.5%, and the surgical success rate was 58.7%. No
postoperative complications such as dysphagia or scar stenosis were observed in CWICKs
group. Compared with UPPP, there was no significant difference in the improvement rate of
AHI, but significantly improved in AI, %stage 1 and %stage 3. Conclusion: The treatment
outcome of CWICKs was equal to or better than that of the conventional UPPP. CWICKs are
considered to be minimally invasive, simple, and effective surgical procedures for OSA.

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1535
THE ROLE OF THE BERLIN QUESTIONNAIRE IN ASSESSING THE FREQUENCY OF
OCCURRENCE OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN PATIENTS WITH
ASSOCIATED RISK FACTORS

Adriana Neagos1, Cristian Mircea Neagos2, Anastasia Balta1, Alexandru Szabo2

1
University of Medicine Ppharmacy Science and Technology GEORGE EMIL PALADE of Targu Mures,
2
Emergency County Hospital of Targu Mures

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

Sleep is a complex biological process. It is a reversible state of unconsciousness in which

metabolism and motor activity are reduced. There are two different types of sleep: rapid eye
movement (REM) sleep and non-REM (NREM) sleep. Sleep disorders are one of the most
common clinical problems encountered. Inadequate or non-restorative sleep can interfere
with normal physical, mental, social and emotional functioning. Sleep disorders can affect
your overall health, safety and quality of life.In this retrospective study, we aimed to
investigate patients with suspected obstructive sleep apnea syndrome based on the
appropriate response of the Berlin Questionnaire. The total number of patients who met the
study inclusion criteria was 77, each of whom completed the Berlin Questionnaire. The lot was
then divided into two main groups according to the result obtained as follows: Gr.I (Low Risk),
Gr.II (High Risk). The conclusion of this study was that the association of the suspicion of
obstructive sleep apnea syndrome and comorbidities known as factors for the onset and
progression of the syndrome.

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1699
Nasal pathology in adult patients with obstructive sleep apnoea syndrome

Kyriaki Vallianou1, Christos Terzoudis1, Vasileios Lachanas1, Chaido Pastaka2, Ioannis

Hajiioannou1, Konstantinos Gourgoulianis2, Konstantinos Chaidas3

1
Department of Otorhinolaryngology, University Hospital of Larissa, Greece, 2Department of
Pulmonary Medicine, University Hospital of Larissa, Greece, 3Department of Otorhinolaryngology,
University Hospital of Alexandroupoli, Greece

Poster Session |Snoring and OSA | 18 June – 22 June, 2023, All day

Introduction: Obstructive sleep apnoea (OSA) is a common sleep breathing disorder in which
airflow is interrupted or significantly reduced during breathing effort. As the nose is the first
anatomical structure of the upper airway, nasal pathology causing obstruction may contribute
to sleep-disordered breathing. Aim: The aim of this study was to investigate the possible
association of nasal pathology and symptoms with the presence and severity of OSA. Materials
and methods: This was a prospective observational study involving patients who attended the
Sleep Study Clinic of the University Hospital of Larissa and were diagnosed with moderate-
severe obstructive sleep apnoea, following a full polysomnography. Apnoea/hypopnoea
index, oxygen desaturation index, and Epworth Sleepiness Scale scores were assessed. Based
on AHI scores, all study participants were divided into three categories of OSA severity:
moderate, severe and very severe OSA. Patients evaluation included a complete
otolaryngological examination and the use of questionnaires for allergic rhinitis screening
(SFAR) and nasal breathing quality assessment (VAS Scale, SNOT-22 and NOSE). Results: Forty-
three patients, aged 26-73 years old, participated in the study. The comparison of subgroups
revealed a statistically significant difference in the body mass index and neck circumference,
but not in nasal pathology and symptoms. Conclusion: Nasal pathology and associated
symptoms do not seem to significantly affect OSA severity. Further research in larger patient
samples is needed to draw definitive conclusions.

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Technological advances

1434
ARTIFICIAL INTELLIGENCE IN MANAGEMENT OF NASAL TUMORS – REVIEW AND
PERSPECTIVES

Mihai Dumitru1, Iulian Alexandru Taciuc1, Daniela Vrinceanu1, Adrian Costache1

1
Carol Davila University of Medicine and Pharmacy

Poster Session |Technological advances | 19 June – 22 June, 2023, All day

Artificial intelligence (AI) applications in healthcare system is increasing. These “tools” are
being explored and applied to help us diagnose, classify, predict, treat and manage different
diseases. Although the AI software still has some challenges to overcome, the results obtained
so far look promising [1]. Through the machine learning process, the AI could prove useful in
the management of nasal tumors as it has been already applied both in imaging and
pathological studies. Deep learning process has been used on MRI images to differentiate
small round cell malignant tumors and non-small round cell malignant tumors in two studies.
One used the T2 signal images and the apparent diffusion coefficient values and obtained 0.83
accuracy, 0.87 sensitivity, 0.78 specificity [2], and the other analyzed the textures of the T2-
fat suppressed signal images, obtaining 0.89 accuracy, 0.88 sensitivity and 0.92 specificity.
Could we increase the accuracy of the results on MRI images using an AI for automatic facial
bone segmentation to make the software understand the exact position of the lesion?
Bibliography:1. Martinez-Millana A, et al. Artificial intelligence and its impact on the domains
of universal health coverage, health emergencies and health promotion: An overview of
systematic reviews. Int J Med Inform. 2022 Oct;166:104855.2. Chen C, et al. Machine learning
to differentiate small round cell malignant tumors and non-small round cell malignant tumors
of the nasal and paranasal sinuses using apparent diffusion coefficient values. Eur Radiol. 2022
Jun; 32(6):3819-3829

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 Authors
A
Aanaes, Kasper 1263
Abdul-Hamid, Ayeshah 1704
Abdulaziz F, Altowairqi 1621
Abdulaziz Fahad, Altowairqi 1622
Abdulkerimov, Hiyir 1247
Abdullah Alrajhi 1622
Abdullah Shakhs, Alghamdi 1622
Abdulrahman, Shawkat 1352
Abergel, Avraham 1148, 1155, 1156, 1157, 1790, 1802
Abhinav, Kumar 1752, 1754
Abiri, Arash 1150, 1205, 1333
Abramovic, Marija 1282
Abu-ZAID, AHMED 1622
Acharya, Vikas 1477
Acosta Vasquez, Carla 1418
Adams, Sarah M. 1584
Adappa, Nithin 1205, 1333
Adriaenssens, Judith 1804
Aguilar Cantador, Juan 1321, 1418, 1419, 1663
Ahel Ledić, Ema 1415
Ahmad, Ismael 1194
Ahn, Hyeon Woo 1476
Airlangga, Trijuda 1471
Akamatsu, Maki 1285, 1299, 1299
Akyuz, Tugba 1687
Alamar Velázquez, Agustín 1517
Alegre, Marita 1424
Aleksic, Aleksandra 1414, 1414
Alevizopoulos, Konstantinos 1243, 1243, 1243
Alexandre, Pedro 1491, 1540, 1540
Alexandri, Maria 1494
Alexandru, Mihaela 1342
Alexiou, Maria 1667
Alfayez, Abdulrhman 1302, 1303
Alfonso, Carolina 1340, 1595
Alfonso Carrillo, Carolina 1555, 1555
Alghoj, Ahmad 1348, 1453, 1560, 1560, 1566, 1566, 1744
Alharthi, Ahmad 1269, 1269, 1621, 1621, 1621, 1622, 1622, 1622
Alharthi, Saud 1269, 1621
Allekotte, Silke 1646
Almanzo, Santiago 1521
Alnofaie, Marwan 1269
Alobid, Isam 1305, 1410, 1411, 1541, 1542, 1672, 1673
Alshaikh, Nada 1375, 1375, 1378, 1385, 1385, 1387, 1387, 1388, 1388

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Alswat, Shrooq 1269, 1621
Altowairqi, Abdulaziz 1269
Alvarez, Francisco 1132, 1136
Alves, António 1619, 1759
Alvi, Muhammad 1242, 1412, 1413, 1413
Alvi, Muhammad Ibaad 1412
Alwashahi, Mohammed 1692
An, Tae Lim 1476
Ananyan, Gnel 1726
Anastasiadou, Sofia 1515, 1515
Anastasopoulos, Sotirios 1529
Anat, Wengier 1802
Ando, Mizuo 1244
Andorfer, Kornelia 1127, 1127, 1318, 1318, 1586, 1586
Andrade, António 1491
André, Carla 1570
Andresakis, Dionysios 1694
Andreu Abeledo, Rocío 1142, 1143
Andujar, Pascal 1343
Anselmo Lima, Wilma 1383
Anselmo-Lima, Wilma 1230, 1230, 1742, 1742
Antoni, Grzanka 1690, 1690
Antunes, Luís 1561, 1570
Aparicio - Parrado León, Alba 1545
Aparicio- Parrado León, Alba 1353
Arafat, Abdullah 1753, 1753
Aránguez Suárez, Covadonga 1435
Araújo, Catarina 1570
Arias Marzán, Francisco 1353
Ariza, Mar 1562
Arkadi, Yakirevitch 1219
Armada Ferreira, Filipa 1695
Armengot Carceller, Miguel 1517, 1521, 1599
Arosio, Alberto Daniele 1447, 1538, 1538, 1707
Arruda, Luisa 1742, 1742
Arruda Neto, Eurico 1230, 1383
Asako, Airi 1320
Asako, Mikiya 1233, 1233, 1320
Asimakopoulou, Panagiota 1324
Aster Dm Healthcare Dubai Uae,
1659
Vishwanath
Astray Gómez, Saúl 1521
Athanasiou, Sophia 1694
Athanasopoulos, Michail 1347, 1406, 1406
Attrache Al- Attrache, Nabil 1599

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Augusto, Peñaranda 1544
Augusto De Lima Marson, Fernando 1550
Aymat, Antonio 1412
Azad, Zahra 1655, 1655
Azevedo, Sara 1134
B
B, Shah 1165
Bachert, Claus 1261, 1398, 1486, 1537, 1541, 1542
Backaert, Wout 1220, 1686
Backer, Vibeke 1263, 1541, 1542
Badali, Elham 1655, 1655
Bader, Maryuma 1242
Bae, Jung 1180
Bae, Jung Ho 1180, 1193, 1193
Bae, Woo Yong 1286, 1286
Bainaud, Matthieu 1329
Balakumar, Ramkishan 1752, 1754
Balash, Amanda 1221, 1221, 1384, 1384
Balatková, Zuzana 1552, 1552, 1611
Baldea, Vasilica 1697
Balica, Nicolae 1682, 1688
Balogh, Gábor 1335
Balta, Anastasia 1535, 1549
Bancalari Díaz, Catalina 1517
Bandino, Fabrizio 1746, 1746
Bandol, Geanina 1697
Bangert, Christine 1569
Bansberg, Stephen 1417, 1417, 1417
Bantulà, Marina 1672
Barberi, Federico 1454, 1454
Barbosa, Elio 1577, 1577
Baroni, Silvia 1485, 1524
Bartaire, Emmanuel 1342
Bartier, Sophie 1329, 1334, 1336, 1342, 1343, 1351
Bartosik, Tina 1569
Bartra, Joan 1672
Basak, Hazan 1684, 1687, 1737, 1737, 1737
Basiari, Lentiona 1274
Basile, Landis 1433
Basses, Sarah 1343
Battaglia, Paolo 1438, 1447, 1454, 1455, 1538, 1707, 1764
Bech, Magne 1379, 1379
Becker, Benjamin 1322, 1427, 1745
Beguignon, Emilie 1542
Bejenariu, Andreea Elena 1647, 1647, 1647, 1729, 1729
Bektaş, Murat Can 1585, 1585

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Belanger, Vineeta 1420, 1423
Bella, Zsolt 1739
Ben Abdellah, Houda 1705
Ben Abdellah Ouazzani, Houda 1663
Benazzo, Marco 1728
Benchev, Rumen 1401
Benítez Del Rosario, Jesús Javier 1216
Benndorf, Götz 1497, 1559
Bennett, Catherine 1576
Bennett, Warren 1752, 1754
Benoite, Gonda 1342
Bensafi, Moustafa 1332
Bequignon, Emilie 1329, 1334, 1336, 1342, 1342, 1343, 1343, 1343, 1351, 1351
Bereczky, Zsuzsanna 1335
Bergsneider, Marvin 1333
Bernardo, Teresa 1702
Berns, Markus 1467
Bessa, Simão 1702
Beton, Ozlem Ergin 1737
Beton, Suha 1684, 1687, 1737
Bettio, Giulia 1542
Betz, Christian 1322, 1322, 1427, 1745
Beule, Achim 1214, 1214
Beule, Achim Georg 1451
Beyersdorff, Dirk 1427
Bezrukova, Evgeniya 1803
Bhavesh, Tailor 1607, 1609
Bickerton, Robert 1477, 1477, 1477
Bignami, Maurizio 1287, 1438, 1447, 1454, 1455, 1707, 1764
Bilaus, Ran 1790, 1790
Bill Nai-Chau, Sun 1209
Biswas, Kristi 1356, 1357, 1358, 1359
Bitner, Benjamin 1150, 1205, 1333
Bleier, Benjamin 1172
Blijleven, Esther 1162
Boak, Duncan 1581
Boek, Wilbert 1162, 1640
Boesveldt, Sanne 1162, 1640
Bofares, Khaled 1200, 1201
Bofares, Khaled Mohamed 1200, 1200, 1201, 1201
Bogdan, Nacu 1728
Bogović, Vjeran 1408, 1408, 1409
Bohr, Christopher 1127, 1586
Boia, Eugen 1682, 1688
Boia, Simina 1682
Bois De Fer, Beatrice 1786

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Boleslaw, Samolinski 1690
Bollens, Laura 1519
Bonani, Eliane 1775
Bonis Redondo, Mario 1353
Borgers, Elien 1519, 1804
Borin, Marco 1369
Böscke, Robert 1696
Bosco Morales, Gabriela 1738
Bosraty, Hossam 1265
Bouras, George 1576,
Bozsanyi, Lajos 1271
Brahmbhatt, Hemang 1772
Branco, Paula 1134
Branco, Pedro 1354, 1709, 1711
Branco, Tiago 1710
Brand, Yves 1468, 1713, 1713, 1763, 1763, 1766, 1766, 1773, 1773, 1773, 1773
Brannan, Alexander 1292, 1292
Braverman, Itzhak 1800, 1800, 1800
Brayton, Lindsay 1420, 1423
Brenner-Muslera, Eduardo 1239
Brescia, Giuseppe 1186
Bretz, Niko 1467
Briner, Hans Rudolf 1132, 1136
Brkic, Faris F. 1185
Brudasca, Ioana 1332
Brüggen, Marie-Charlotte 1167
Brúgós, Boglárka 1335
Brühlmann, Catrin 1167
Buana, Aditya Wira 1661, 1661, 1661
Buchwald, Christian 1497, 1559
Bui, Anh-Tram 1150
Büki, András 1442
Buksińska, Małgorzata 1344, 1360, 1360, 1361, 1367
Bullock, Lizzie 1477
C
Cabrera Guijo, Javier 1521
Cabrera López, Carlos 1216
Cabrera Ramírez, María Soledad 1142, 1142, 1143, 1143
Cadri, Shirin 1762, 1762, 1762
Caetano, Mariana 1589, 1610, 1615, 1623, 1641, 1641, 1642, 1642
Calha, Mariana 1641, 1706
Callejas, Borja 1672
Calvo-Henriquez, Christian 1594
Cameron, Alan 1358
Campbell, Raewyn 1580, 1580
Campelo, Paula 1695

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Campion, Nicholas 1569, 1653, 1653, 1653
Campos Lopes, Miguel 1588
Caneira, Tiago 1506
Cano, Neus 1562
Canoui-Poitrine, Florence 1342
Cantiani, Alessandro 1437, 1565
Cantone, Elena 1571
Cao, Ping-Ping 1679, 1679
Cardella, Arianna 1479, 1479, 1479
Carena, Paolo 1730
Carlos, Roman 1677
Carlos Zamora, Román 1321, 1677
Carmel Neiderman, Narin 1155, 1155, 1156, 1157, 1157, 1790
Carmel Neiderman, Narin N 1148, 1155, 1790
Carneiro, José 1680, 1680, 1680
Carrillo, Díaz 1216
Carsuzaa, Florent 1329, 1329, 1336, 1342
Caruana, Francesco 1507
Caruana, Francesco F. 1503
Carvalho, Carlos 1553, 1554, 1588
Carvalho, Liliana 1700, 1700
Carvalho, Tomás 1641
Castelhano, Luís 1355, 1709, 1710, 1711
Castelnuovo, Paolo 1287, 1447, 1454, 1455, 1536, 1538, 1707, 1764
Castelnuovo, Paolo Giocondo Maria 1438
Castillo, Laurent 1342
Catalano, Salvatore 1730
Cataldo Russomando, Alessandra Maria 1175
Catherine, Decates 1607, 1608
Cavaliere, Carlo 1541, 1542
Ceballos Cantu, Juan Carlos 1305
Cecily Rou-Yun, Sun 1209
Çelik, Muzaffer 1212, 1212, 1212, 1213, 1213
Červený, Květoslav 1552, 1552, 1552
Cervin, Anders 1325, 1420, 1423
Cervin-Hoberg, Charlotte 1325
Chae, Mi-Hyun 1257
Chaidas, Konstantinos 1534, 1650, 1654, 1699
Chaker, Adam 1374, 1467, 1467
Chalkiadaki, Eleni 1210, 1480
Chan, Robert 1537
Chang, Jung Hyun 1258
Chantzis, Konstantinos 1529, 1529
Charn, Tze Choong 1801
Chatziavramidis, Angelos 1761, 1776

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Chatzinakis, Vasileios 1530, 1539, 1539, 1539, 1568, 1568, 1573
Chatzisouleiman, Ipek 1534
Chatzoglou, Christos 1761
Chee Rui Tzen, Justin 1267
Chen, Fenghong 1474, 1474, 1575, 1597
Chen, Jiani 1722, 1722
Chen, Oliver 1424, 1424
Chen, Xiaodong 1628
Cheng, Bastian 1322
Cherniak, Yehor 1253
Chernova, Olga 1755, 1755
Chiang, Yi-Fang 1251
Chioralia, Ana 1241, 1242
Chiriac, Maria 1682, 1688, 1688
Chitsuthipakorn, Wirach 1217, 1217, 1245, 1245, 1280
Cho, Jin Hee 1675
Cho, Kyu-Sup 1147
Cho, Sung Woo 1717, 1717
Cho, Sung-Woo 1469, 1469, 1788
Choi, Bo Yoon 1240
Choi, Hyunsu 1675
Choi, Ji Yun 1158, 1158, 1159, 1159, 1160, 1160
Choo, Tse-Hwei 1503
Choulakis, Konstantinos 1502, 1504
Chrysouli, Konstantina 1270, 1270, 1272, 1272
Chung, Dean 1333
Chung, Hyo Jin 1258, 1258
Cieslik, Joanna 1689, 1689, 1689
Cikojević, Drasko 1345
Ciofalo, Andrea 1541, 1542, 1571
Cirstea, Anca 1806
Cirstea, Anca Ionela 1337
Claro, Ana 1561
Cláudia, Rosa 1623
Clemente, Ignacio 1731
Clijsters, Marnick 1686, 1686
Coban, Axelle 1351
Cobzeanu, Bogdan Mihail 1697
Cobzeanu, Maria Luiza 1697
Cobzeanu, Mihail Dan 1697, 1697
Coenye, Tom 1236
Cohen, Suzanne 1653
Colacicco, Giovanni 1168
Colaço, Tiago 1709, 1709, 1710, 1710, 1711, 1711, 1765, 1765
Comert, Ayhan 1684
Conduto, Diogo 1615, 1623

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Cong, Nguyen Thanh 1313
Connell, James 1370, 1373, 1488, 1712, 1712
Constantinou, Christoforos 1746, 1746
Conti, Patricia 1464
Corbò, Marco 1437, 1524
Corré, Alain 1342
Correia, Alexandra 1588
Correia, Filipe 1354, 1355, 1709, 1710, 1711
Correia, Joao 1134
Correia, Mariana 1430, 1642, 1706, 1706
Correia Rodrigues, Pedro 1610
Correia-Rodrigues, Pedro 1430, 1589
Costache, Adrian 1434
Costan, Victor Vlad 1697
Coste, André 1329, 1336, 1342, 1343, 1351, 1541, 1542
Cote, David 1625
Coucke, Birgit 1527, 1527
Couloigner, Vincent 1342
Coutinho, Gil 1491, 1540
Cruz Cerón, Nuria 1321, 1418, 1418, 1419, 1435, 1435, 1435, 1705
Cruz Toro, Paula 1377, 1731
Čukman, Mateo 1633
Čulig, Josip 1424
Cunha, Adriana 1283, 1702
Cunha, Fernanda 1464, 1464
Cyberski, Thomas 1405
D
D'agostino, Giuseppe 1524
D'aleo Canova, Giulia C. 1287, 1287, 1287
D'auria, Leandro Maria 1437
Dabrowska-Bien, Justyna 1518, 1525, 1563
Daiki, Nakashima 1319
Dalfino, Gianluca 1455, 1455, 1707, 1764, 1764
Dalge Severino, Silvana 1550
Daloiso, Antonio 1186
Damy, Thibaud 1351
Dané, Giulia 1452
Danielides, Gerasimos 1347
Danielides, Vasilios 1347
Danielidis, Gerasimos 1406, 1421
Danielidis, Vasileios 1406, 1421
Danyliuk, Bohdan 1195
Daskalou, Dimitrios 1317, 1317, 1362, 1363, 1441, 1443, 1789
Daveau, Clémentine 1342
David, Cote 1292
Davies, Finley 1241

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Dávila Quintana, Carmen Delia 1216
Davilis, Dimitrios 1694
Davydov, Roman 1247, 1247
De Bernardi Di Valserra, Francesca 1438
De Boissieu, Paul 1342
De Bonnecaze, Guillaume 1342
De Corso, Eugenio 1369, 1437, 1483, 1485, 1524, 1565, 1571
De Filippis, Cosimo 1186
De Gabory, Ludovic 1342, 1572, 1572
De Haas, Charlotte 1640
De Maio, Gabriele 1565
De Prado Gomez, Lucia 1261, 1389, 1467
Debayan, Bhattacharya 1427
Debry, Christian 1342
Decramer, Thomas 1527
Delbos, Léo 1342
Delchev, Ivan 1382, 1382
Demaria, Michele 1730
Deniz, Yamo 1483, 1486
Dennis, Simon 1428
Denoix, Luna 1332
Denysenko, Roman 1195, 1195
Deraedt, Simon 1342
Derbarsegian, Armo 1584
Desrosiers, Martin 1483, 1483, 1536, 1536
Devanand, D. P. 1507
Devanand, D.P. 1503
Dewaele, Frank 1527
Di Bella, Giuseppe Alberto 1485, 1485
Di Cesare, Tiziana 1437, 1485
Diamant, Zuzana 1399, 1536, 1541, 1542
Dias, Luís 1296, 1297, 1481, 1695, 1774
Dib-Estephan, Andrea 1239
Dibildox, Daniel 1239, 1239
Dikhtiaruk, Oleksandr 1195
Dimitriadis, Ioannis 1348
Dimitrios, Ioannidis 1609
Dimitriou, Eleni 1494
Dimitrov, Liuben 1222
Dimitrov, Stoyan 1222, 1556, 1556
Dinarti, Vanessa 1742
Dóczi, Tamás 1442
Dogantzis, Panagiotis 1761
Domínguez Sosa, María Sandra 1142, 1143, 1143, 1216, 1216
Domínguez Sosa, Sandra 1142
Dougherty, Melisa 1463

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Douglas, Jennifer 1205, 1333
Douglas, Richard 1356, 1357, 1358, 1359
Doulaptsi, Maria 1683, 1701
Doval Rosa, Carlos 1663
Drakos - Galanis, Theodoros 1736
Druce, Howard 1424
Drylli, Aikaterini 1678, 1681
Du, Jintao 1223, 1224, 1465
Duarte, Ana 1765
Dufour, Xavier 1329, 1336, 1342
Duhlenski, Boris 1487, 1487, 1501, 1501
Dülgeroglu, Jacqueline 1167
Dumitru, Mihai 1434, 1434
Dupont, Lieven 1235, 1236, 1262
Dyson, Emma Rose 1242
Dzhafarova, Mariam 1174
Dzhambazov, Karen 1499, 1499, 1499, 1499
Dziegielewska, Marta 1344, 1360, 1361, 1367
E
Ebraheem, Albazee 1622
Eça, Tiago 1589, 1615, 1623
Eckl-Dorna, Julia 1541, 1542, 1569, 1653
Edalati, Shaun 1148
Edwards, Richard 1754
Edyta, Krzych-Falta 1690
Edyta, Krzych-Fałta 1690
Efstathiou, Iliana 1761
Eide, Jacob 1205, 1333
Eiji, Kobayashi 1605, 1632
El Bakkouri Madi, Wissame 1342
El Haddouchi, Mohamed 1497, 1497, 1559, 1559, 1559
Elbosraty, Hussam 1264, 1266
Eliashar, Ron 1175
Eloi, Isa 1680
Elsharnouby, Mohamed 1651
Elsherif, Hossam 1629
Eltaher, Mostafa 1181, 1181, 1194, 1194, 1194
Eltarabily, Marawan 1412
Elumeeva, Anna 1407, 1407
Emilie, Bequignon 1541
Endiyarti, Febriyani 1471
Enea, Alexandru Gabriel 1337
Eren, Erdem 1585
Eriksen, Patrick 1559
Eriksen, Patrick Gerhard 1497
Eriksen, Patrick René Gerhard 1500

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Escada, Pedro 1354, 1355, 1709, 1710, 1711
España Gregori, Enrique 1599
Estêvão, Roberto 1283
Estrada, Joaquim 1759
Evans, Catrin 1445
F
Faber, Adrian 1766
Facco, Carla 1538
Fantin, Francesco 1186
Fantucci, Marina 1230, 1383
Fares, Butrus 1802
Faria, Cláudia 1641
Faria, Francesca 1230
Favier, Valentin 1606, 1606
Favot, Laure 1329, 1336
Fehr, Danielle 1167
Feng, Lan 1182, 1182
Fenghong, Chen 1520, 1596
Fenix, Kevin 1576
Fenton, John Eugene 1232
Ferdenzi, Camille 1332
Fernandes, Rita 1430
Fernandez, Patricia 1805
Ferreira, Lígia 1250, 1256, 1298
Ferreira, Miguel 1133, 1134
Fieux, Maxime 1329, 1329, 1332, 1332, 1334, 1334, 1336, 1336, 1342, 1342
Figueroa, Eduardo 1600, 1600
Filipe, Correia 1708
Finney, Hannah 1515, 1522, 1601, 1601, 1758, 1758, 1772
Finnie, John 1576
Fischer, René 1127, 1586
Fito Martorell, Lucas 1517, 1521, 1521, 1599
Florou, Panagiota 1761
Focke-Tejkl, Margit 1653
Fokkens, Wytske 1399, 1400, 1426
Fokkens, Wytske J 1391, 1537
Fokkens, Wytske J. 1541, 1542
Fontes Lima, Antonio 1481, 1695, 1774
Ford, Rebecca 1754
Forer, Boaz 1173
Formánek, Martin 1206
Fornazieri, Marco Aurelio 1760
Förster-Ruhrmann, Ulrike 1458, 1467
Fothiadaki, Ioulia 1683, 1701
Fotiadis, Georgios 1534, 1534, 1534
Fotiadou, Stella 1761

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Fountarlis, Athanasios Luca 1526, 1526, 1526
Fountarlis, Athanasios-Luca 1669
Fournel, Arnaud 1332
Fragel, Susann 1645, 1646
Francis, Rousset 1433
Franco, Rodrigo 1641
Frank-Ito, Dennis 1199, 1221, 1384, 1740, 1740
Franz, Leonardo 1186
Friedland, Peter 1356
Friedman, Michael 1175
Frolov, Sergey 1403
Fröschl, Renate 1653, 1653
Frosolini, Andrea 1186
Fuentes, Mireya 1672, 1673
Fujita, Tomoaki 1312
Fujiwara, Kazunori 1394
Furlan, Daniela 1538
Furno, Daniela 1437, 1524
Furtado, Miguel 1680
Fyrmpas, Georgios 1534
G
Gaffney, Máire 1232
Gagnieur, Pierre 1334
Galabova, Martina 1587
Galeev, Radik 1803
Gallagher, Liam 1507
Gallagher, Liam W. 1503
Gallego Compte, Montserrat 1743
Gallet, Patrice 1606
Galli, Jacopo 1437, 1485, 1524, 1565
Gallo, Oreste 1284
Gallo, Stefania 1287
Gameiro, Juliana Gutschow 1760
Gander, Thomas 1168
Gane, Simon 1541, 1542
Gangl, Katarina 1653
Gangl, Katharina 1569
Gani, Kaamil 1354, 1354, 1355, 1355, 1709
Garaycochea, Octavio 1410, 1410, 1411
Garcia, Denny 1230, 1742
Garcia Garcia, Cristina 1738, 1738
Garcia Garcia, Virginia 1418, 1419, 1419, 1435, 1435, 1435
García Piñero, Alfonso 1517, 1521, 1521, 1599
Garefis, Konstantinos 1429, 1652, 1652, 1761, 1761, 1776, 1776, 1776
Garolera, Maite 1562
Garside, Jordan 1292

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Gartung, Allison 1420, 1423
Gary, Joseph 1507
Gary, Joseph B. 1503
Garzon, Juan 1532
Gatsounia, Alkmini 1406
Gatsounia, Konstantina Alkmini 1347
Gavilan, Javier 1340
Genetzaki, Sotiria 1652
Georgalas, Christos 1530, 1539, 1568, 1568, 1573
Georgiev, Konstantin 1291, 1291
Georgieva, Miglena 1587
Georgiou, Stella 1243
Geramas, Ioannis 1530, 1530, 1539, 1568, 1568, 1573
Geum, Sang-Yen 1257
Gevaert, Philippe 1536, 1541, 1542
Ghantous, Jameel 1173, 1173
Ghassemi, Annahita 1424
Gheorghe, Liliana 1697
Gilain, Laurent 1342
Gindele, Réka 1335
Giulia, Bettio 1541
Gkolias, Nikolaos 1654
Gkoulioni, Vasiliki 1480
Gkrinia, Eleni 1664, 1664, 1666, 1666, 1667, 1667, 1667, 1669
Goh, Xin Lei 1267, 1267
Goldberg, Terry 1507
Goldberg, Terry E. 1503
Goldie, Simon 1390, 1390, 1392, 1392
Golet Fors, Mireia 1731
Gomez, Antonieta 1558
Gómez Gómez, Maria José 1521
Gonatidis, Panagiotis 1210
Gonçalves, Paulo 1553, 1554
González, Luis Antonio 1353
Gonzalez Cuello, Cesar 1677
González García, Jaime 1668
Gonzalez-Compta, Xavier 1731
Gonzalez-Garcia, Jaime 1693
Goodall, Stephen 1356
Gorica, Armela 1190, 1190
Gorris, Senne 1220, 1220
Gorski, Sebastian 1518
Gos, Elzbieta 1525
Gougousis, Spyridon 1348, 1453, 1560, 1566, 1744
Goulioni, Vasiliki 1210
Gourgoulianis, Konstantinos 1699

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Grachev, Nikolay 1403, 1750
Grau, Coloma 1340, 1340, 1595
Greiff, Lennart 1325
Grgić, Marko Velimir 1633, 1633
Grigore, Raluca 1337
Grigorova, Tsvetelina 1484
Grigoryan, Satenik 1726
Grivas, Georgios 1210, 1480, 1678, 1681
Grohn, F 1807
Grose, Elysia 1205
Gross, Menachem 1175
Grønlund, Mathias Peter 1379
Gu, Qingjia 1603
Guan, Bing 1648, 1648, 1648
Gudis, David 1507
Gudis, David A. 1466, 1503
Guerra, Marta 1759
Guerra-Arellano, Daniel 1239
Guertler, Nicolas 1743
Guldager, Mads 1490, 1490
Gunnarsson, Magnus 1425
Gupta, R 1166
Gwizdalska, Iwonna 1525
Gyenesei, Attila 1386
H
Haas, Markus 1185
Haddadin, Dani 1470, 1472
Hagemann, Jan 1458, 1458
Hahn, Matthias 1467
Hähner, Antje 1300
Haiduk, Vladyslav 1253
Haili, Ma 1209
Hajiioannou, Ioannis 1699
Hajiioannou, Jiannis 1128, 1526, 1664, 1666, 1667
Hakami, Khalid 1547
Hakim, Fernando 1532
Hale, Sam 1356, 1356, 1357, 1357, 1358, 1358, 1359, 1359
Halevy, Nir 1155
Halewyck, Stijn 1519
Hallenberger, Tim 1773
Hammel, Anne Laure 1342, 1342
Han, Joseph K 1536
Han, Jun 1612
Hannink, Gerjon 1426
Hans, Stephane 1342
Hansel, Trevor 1653

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Haoran, Lin 1520
Hara, Yannis 1374
Haran, Devakumar 1609
Harries, Philip 1390, 1392
Harris, Jacob 1333
Harris, Paul 1358
Hartie, Bogdan 1688
Haruna, Shin-Ichi 1716, 1716
Harutyunyan, Kristine 1726, 1726
Hassanzadeh, Sajad 1655, 1655
Hattori, Kazuhiro 1626
Hautefort, Charlotte 1342
Hazan, Itai 1191
Hebe, Ana 1248, 1250
Heffler, Enrico 1261
Heidemann, Mathias 1696
Hellings, Peter 1220, 1261, 1262, 1804
Hellings, Peter W 1536
Hellings, Peter W. 1519, 1541, 1542
Helvik, Anne-S 1294
Helyes, Zsuzsanna 1386
Heng, Liu 1209, 1209
Henry, Dunne 1608
Herity, Karen 1756
Hermann, Ruben 1342
Hettige, Roland 1618, 1620
Hicks, Alexandra 1374
Hideaki, Kouzaki 1372
Higaki, Takaya 1244
Hirata, Eduardo 1671
Hirata, Yuji 1285
Hoang, Minh 1245
Hoang, Phuoc Minh 1277, 1277, 1280, 1280
Hoffman, Veena 1389
Hoffmann, Anna Sophie 1427, 1427, 1745
Hoffmann, Anna-Sophie 1322, 1427, 1427
Holbaek-Haase, Christiane 1541, 1542
Holzmeister, Clemens 1541, 1542
Hong, Jung Hwa 1258
Hongzhou, Yang 1209
Hooper, William 1424
Hopkins, Claire 1261, 1486, 1541
Horhat, Delia 1682, 1688
Horvath, Lukas 1766
Hot, Amra 1745
Houtak, Ghais 1576, 1576,

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Howarth, Peter 1537, 1537, 1551
Hox, Valérie 1189, 1519, 1541, 1542
Hsieh, Julien 1441, 1473
Hsieh, Julien W. 1317
Hsieh, Julien Wen 1362, 1363, 1433, 1433, 1443, 1443, 1463, 1463, 1789
Hsu, Frank 1150, 1333
Hsu, Timothy 1150
Hu, Li 1660, 1722, 1723
Huang, Chien-Chia 1482
Huang, Jie Lily 1241, 1242
Huart, Caroline 1541, 1542
Hugentobler, Marianne 1443
Hukuoka, Yuu 1312
Hummel, Thomas 1300
Hut, Alexandru 1682, 1682, 1688
Huygens, Flavia 1325
Hwang, Jihyeon 1301
Hwang, Peter 1531, 1533
Hwang, Sehwan 1152, 1152
Hwee, Jeremiah 1551
Hyeong Guk, Son 1364
Hyun-Woo, Yang 1364, 1364
Hyvrard, Clémentine 1351, 1351
I
Ibáñez Alcañiz, Isabel 1517
Il-Ho, Park 1364
Ilinca, Laurentiu 1688
İmre, Abdulkadir 1585
Introini, Sveva 1730
Ioakeimidis, Stavros 1529
İpek, Emre 1585
Iro, Heinrich 1172
Isaac, Shochat 1800
Isaman, Danielle 1531, 1533
Ishigaki, Hirohito 1313
Ishigami, Eisuke 1670
Ismahilov, Eldar 1249, 1254, 1255
Ismail, Mostafa 1141, 1141
Itoh, Yasushi 1313
Iván, Dominik 1442
Ivan, Yordanov 1346, 1346
Ivaška, Justinas 1161
Izquierdo, Iñaki 1673
Izquierdo-Domínguez, Adriana 1562
J

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Jacob, Tommy 1327
Jacob-Nara, Juby 1389, 1398, 1467, 1483, 1486, 1531
Jacob-Nara, Judy 1261, 1533
Jacobson, Patricia 1466, 1503, 1507
Jae Hwan, Oh 1505
Jae-Min, Shin 1364
Jahasan, Forsan 1802
Jahshan, Forsan 1148
Jakobsen, John 1497, 1559
Jakub, Lubojacky 1304
Jalessi, Maryam 1655, 1655
Jang, Jiwon 1176, 1176
Jang, Yong Ju 1365
Jangard, Mattias 1326
Jankowski, Roger 1342, 1541, 1542
Jaramillo, Catalina 1558
Jaramillo Angel, Natalia 1521
Järnstedt, Jorma 1422
Jee Won, Moon 1364
Jenerowicz, Dorota 1564, 1720
Jennings, Thomas 1601, 1601, 1758, 1758
Jeruzal-Świątecka, Joanna 1293, 1293
Jeyaretna, Sanjeeva 1746, 1746
Jha, Mithilesh Kumar 1374
Jianbo, Shi 1520, 1520, 1596
Jiang, Rong-San 1251, 1251
Jiang, Yuchen 1428, 1428
Jianjun, Ren 1177
Jimenez-Hakim, Enrique 1532
João, Subtil 1506
Joel, Vavrina 1168
Jones, Huw 1390, 1392
Jong Seung, Kim 1178
Joo-Hoo, Park 1364
Jorge, Dentinho 1715
Jorissen, Mark 1220, 1519, 1527, 1541, 1542
Joseph, Paule 1507
Joseph, Paule V. 1503
Joshua, Michaels 1607
Juhász, Levente 1442
Jung, Joo Hyun 1505, 1505
Junhong, LI 1202, 1202
Junqué, Carme 1562
Jurkiewicz, Dariusz 1146
Jurušaitė, Jurgita 1161, 1184, 1184
Jussi, Virtanen 1171, 1171, 1171

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Justin, Michel 1342
K
Kaare, Majura 1232
Kakkos, Christos 1529
Kakuki, Takuya 1395
Kaleva, Anna 1691, 1691
Kalinina, Margarita 1403, 1750, 1750
Kalogritsas, Nikolaos 1664, 1666
Kamal, Nehal 1389
Kamalski, D.M.A. 1162, 1640, 1640
Kamalski, Digna 1162, 1163, 1163
Kampel, Liyona 1148, 1148
Kanai, Kengo 1244, 1285, 1285, 1299
Kang, Ju Wan 1218
Kanjanawasee, Dichapong 1245
Karamitsou, Paraskevi 1348, 1453, 1453, 1560, 1566
Karanth, Varsha 1509
Karatzanis, Alexandros 1683, 1701
Karela, Maria 1210, 1210, 1210, 1480
Karelis, Andreas 1539
Kariya, Shin 1244
Karligkiotis, Apostolos 1438, 1447, 1454
Karoni, Eleni 1654
Kartashova, Ksenia 1247
Kas, Tal 1155
Kasaboglu, Julide 1381, 1381, 1393, 1393, 1393, 1397, 1397, 1397, 1556
Katotomichelakis, Michael 1534
Katsilidou, Melina 1650
Katsimpris, Petros 1534
Katsinis, Spyros 1210, 1480
Katsouli, GEORGIA 1444, 1444
Kaufman, Shay 1156, 1157
Kavaric, Predrag 1282
Kawauchi, Hideyuki 1614, 1614, 1616
Keeley, Tom 1537
Keh, Siew 1756, 1756
Kejun, Zuo 1596
Keller, Andreas 1463
Kento, Kawakita 1372, 1372
Kento, Kwakita 1275
Kern, Robert 1416, 1420, 1423
Kexin, Liu 1658
Khan, Asif 1261, 1374, 1389, 1398, 1483, 1486, 1531, 1533
Khan, Mona 1686
Khanmohammadi, Mehdi 1655, 1655
Khosrovyan, Sona 1726

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Khoury, Majd 1676
Khvadagiani, Merab 1260
Khvedelidze, Giorgi 1260, 1260
Killick, Helen 1653, 1653
Kim, Bo Soo 1476
Kim, Byung Guk 1675
Kim, Doyeon 1365
Kim, Hyojin 1788
Kim, Jeong-Whun 1788
Kim, Jin Kook 1240
Kim, Jong-Yeup 1301, 1301
Kim, Kyung-Su 1218, 1218
Kim, Minheon 1208
Kim, Pyung-Hwan 1301
Kim, Raymond 1356, 1357, 1358, 1359
Kim, Seon Tae 1505
Kim, So Jeoung 1193
Kim, Soo Whan 1170, 1170
Kim, Sung-Dong 1147
Kim, Yohan 1205
Kim, Yong Wan 1476, 1476
Kim, Yong-Dae 1149
Kimple, Adam 1592
Kis, Andreea 1688
Kishimoto, Yuji 1724, 1724
Kitagawa, Yoshinori 1313
Kivekäs, Ilkka 1171, 1422
Kizim, Yaroslav 1249, 1254, 1255
Kjeldsen, Anette 1541, 1542
Klain, Ayala 1148
Klimek, Ludger 1458
Klimenko, Ksenia 1590, 1590, 1591, 1656
Knežević, Mislav 1633
Knežević, Zdravka 1645, 1646
Knipps, Lisa 1541, 1542
Ko, Myungjun 1333
Kobayashi, Eiji 1605, 1605
Kobayashi, Masayoshi 1402, 1670, 1670
Koide, Ayaka 1288
Kokkos, Nikolaos 1494
Koller, Michael 1127
Kollia, Paraskevi 1694
Komínek, Pavel 1206
Komnos, Ioannis 1274, 1274
Kondamuri, Neil 1405, 1405
Kongsvad, Maria 1497, 1559

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Konstantina, Rova 1560
Konstantinidis, Iordanis 1652, 1776
Konstantinidou, Sevasti 1241, 1241, 1242, 1242
Kontunen, Anton 1171
Kónya, Janos 1271
Kopacheva -Barsova, Gabriela 1306, 1308, 1310
Korakovouni, Kalliopi 1323, 1324
Korkova, Anastasiya 1449, 1450
Korodima, Maria 1210, 1480, 1480, 1678, 1678, 1678, 1681, 1681
Korsgaard Pedersen, Christian 1263, 1379
Kosaraju, Nikitha 1333
Kosuke, Miyamura 1319
Kouzaki, Hideaki 1275, 1275
Kover, Zsanett 1271
Kowatanamongkon, Patlada 1217
Koyama, Satoshi 1394
Koyama, Takahisa 1285
Krawczyk, Maciej 1564, 1720
Kraxner, Helga 1784, 1784
Krejčí, Tomáš 1304
Krestinidis, Georgios 1669
Kronborg Jakobsen, Kathrine 1379
Krstulovic, Claudio 1599
Kshirsagar, Rijul 1205, 1333
Kuan, Edward 1150, 1150, 1205, 1205, 1333, 1333
Kuang-Hsuan, Shen 1279
Kubo, Kazuhiko 1288, 1288
Kudo, Reiko 1312
Kühnel, Thomas 1127, 1586
Kumar, Nirmal 1445, 1461
Kumlin, Maria 1326
Kun, József 1386
Küng, Sereina 1713, 1713, 1713
Kunos, László 1703
Kurose, Makoto 1395
Kvasha, Olena 1207, 1207
Kwiatkowska, Marta 1146, 1146
Kwon, Dong Hwan 1208
Kwon, Ha-Nee 1147, 1147
Kwon, Jae Hwan 1649, 1649, 1649
Kwon, Kyungwon 1725, 1725
Kwon, Samhyun 1178
Kyu-Sup, Cho 1176
L
La Croix, Candice 1342
Labus, Milica 1179

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Lachanas, Vasileios 1654, 1699
Ladias, Alexandros 1323, 1323, 1324, 1324
Lai, Yubin 1628
Lakner, Zoltán 1703
Lambertoni, Alessia 1447, 1455, 1538, 1707
Lammering, Karin 1399
Lampropoulou, Maria 1534
Lamprou, Kallirroi 1650
Landegger, Lukas 1569
Landis, Basile 1441, 1441, 1443, 1463, 1473
Landis, Basile N. 1317
Landis, Basile Nicolas 1362, 1363, 1789
Lane, Andrew 1483
Langdon, Cristobal 1305
Lange, Bibi 1541, 1542
Langeber, Teresa 1595
Larsen, Kenneth 1541, 1542
Laulajainen-Hongisto, Anu 1541, 1542
Lawpoolsri, Saranath 1217
Lazecka, Katarzyna 1525
Lazzari, Elisa Maria 1707
Le Bon, Serge 1473, 1473
Le Corguillé, Lise 1343, 1343
Leal, Manuel Mendes 1491
Lebedeva, Anastasia 1656, 1656
Lecam, Marie Thérèse 1343
Lecanu, Jean-Baptiste 1342
Lecocq, Marylene 1189
Lecron, Jean Claude 1329, 1336
Lee, Daniel 1205, 1333
Lee, Dong Chang 1675, 1675, 1675
Lee, Eun Jung 1208, 1208, 1218
Lee, Heung-Man 1145, 1145
Lee, Hyojun 1505
Lee, Hyun Su 1208
Lee, Jae-Eun 1240
Lee, John 1205
Lee, Joo Hyung 1208
Lee, Ki-Il 1301
Lee, Lauren 1551
Lee, Liam 1581, 1581, 1581
Lee, SANG JAE 1149
Lee, Seung Hyun 1240
Lee, Stella 1398, 1398, 1483, 1531, 1533
Lee, Taehoon 1246, 1246, 1246
Lee, Young-Ha 1149

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Lefantzis, Dimitrios 1493
Lehtimäki, Lauri 1422
Lehtinen, Antti 1422
Lelkaitis, Giedrius 1497, 1559, 1559
Lemes Robayna, Ayoze 1459, 1459, 1545
Lemmens, Winde 1519
Lemos, José 1742
Lenoir, Vincent 1443
Leone, Federico 1538
Leow, Bryan 1644, 1644
Leow, Bryan Hao Wei 1801
Lesinskas, Eugenijus 1161, 1184, 1184, 1211
Lesmas Navarro, María José 1517
Lestari, Niken 1471
Leszczynska, Malgorzata 1564, 1564, 1564, 1720, 1720
Leventi, Argyro 1530, 1539, 1539, 1568, 1568, 1568, 1573
Levy, Joshua 1389, 1389
Levytska, Svitlana 1528
Lheritier-Barrand, Michele 1786
Li, Hongbing 1660
Li, Jian 1598
Li, Shi-Chang 1679
Li, Yong 1635, 1635, 1636, 1636, 1636, 1637, 1638, 1638, 1714, 1714
Li, Zhengqi 1598
Lialiaris, Stergios 1650, 1650
Liang, Kai-Li 1228, 1228, 1251
Liapi, Anastasia 1502, 1504, 1508, 1508, 1510, 1512, 1514, 1546, 1548
Liaudet, Nicolas 1433
Libera, Laura 1538
Licci, Giuseppe 1284
Lim, Kelvin Yong Jie 1785, 1785
Lim, Sara 1756
Lima, António 1296, 1297
Lin, Haoran 1597
Lin, Xie 1658
Lindstedt, Malin 1325
Liodakis, Andreas 1568
Lipina, Radim 1304
Lisan, Quentin 1332
Litsou, Eleni 1274
Liu, David 1541, 1542, 1569
Liu, David T. 1185, 1185
Liu, Jianfeng 1612, 1612
Liu, Quan 1657
Liu, Ruowu 1223
Liu, Wendong 1597, 1597, 1598, 1598

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Liu, Xing 1598
Liva, Georgia 1683, 1683, 1701
Ljubić, Vladimir 1282, 1282
Llorens Salvador, Roberto 1517
Lo Verde, Simone 1565
Lobacheva, Viktoriya 1698
Loeckx, Dirk 1220
Lompas, Oleksandr 1151
Lopes, Miguel 1553, 1554
Lopes, Patrícia 1250, 1298
Lopez, Edgar Mauricio 1542
López Blanco, Eva 1517
López Campos, Daniel 1353
López Chacón, Mauricio 1305
López González, Nuria 1668, 1668, 1668
Louis, Bruno 1329, 1334, 1336
Lourijsen, Evelijn 1426, 1426, 1426
Lousan, Nuno 1283, 1702
Lovato, Andrea 1186, 1186
Loyala, Jerocin Vishani 1704
Loyala, Vishani 1618, 1618
Loyola-Nieto, Fernando 1239
Loyola-Nieto, Paula 1239
Lu, Tong 1598
Lubojacky, Jakub 1304
Lucas, Julien 1351
Luceri, Andrea 1728, 1730
Lucic, Mateo 1185
Ludanyi, Kristof 1784
Luhana, Mitanshi 1445, 1445, 1461, 1461
Luís, Castelhano 1708
Luís, Leonel 1430, 1589, 1610, 1615, 1623, 1641, 1642, 1706
Lujber, Laszlo 1271, 1271, 1271
Luke, Louis 1581
Lund, Valerie 1541, 1542
Lundström, Johan 1443
Lunicheva, Anna 1760, 1760
Lupoi, Daniel 1647
Lux, Christian 1356, 1357, 1358
Luzi, Livio 1479
Lygeros, Spyridon 1347, 1347, 1406, 1421
M
Ma, Zhiqi 1635, 1636, 1637, 1637, 1638, 1714, 1714
Macario, Soina 1441
Macario, Sonia 1317, 1362, 1362, 1362, 1363, 1363, 1473, 1789, 1789
Machado, Andre 1132, 1132, 1133, 1133, 1134, 1134, 1135, 1135, 1136, 1136, 1594, 1594

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Machuca, Mônica 1775
Maeda, Yohei 1231
Magalhães, Miguel 1248, 1250, 1256, 1298, 1700, 1765
Maggiore, Giandomenico 1284
Magomedova, Aina 1403, 1403
Magomedova, Ayna 1750
Mahmoud, Mohammad 1651
Maiorano, Eugenia 1728, 1728, 1730, 1730
Maiou, Charikleia 1666, 1667, 1669
Major, Tamás 1335, 1335
Makihara, Sei-Ichiro 1299
Makihara, Seiichiro 1244, 1244, 1285
Malard, Olivier 1342
Maldonado-Cobá, Armando 1239
Maleš, Josip 1409
Malhotra, Mahesh 1515
Malyavina, Uliana 1350, 1350
Manestar, Dubravko 1415, 1415
Manole, Felicia 1682
Manuel, Cunha E Sá 1715
Mao, Minzi 1144, 1144
Mar, Fernando 1296, 1297, 1774
Marada, Gyula 1271
Marcrum, Steven 1586
Mardhatillah, Yessy 1471
María Soledad, Cabrera Ramírez 1216
Mariani, Luigi 1766, 1773, 1773
Mariano, Fernanda 1577
Mariën, Gert 1541, 1542
Mariline, Santos 1133
Marin, Alin 1682
Marin, Concepcio 1672
Marino-Sanchez, Franklin 1680
Marinou, Athanasia 1502, 1504, 1510, 1512, 1514, 1548, 1736
Marinov, Tsvetomir 1397
Marinov, Tzvetomir 1222
Marioni, Gino 1186
Mark, Brewin 1428
Markou, Dimitrios 1776
Markou, Konstantinos 1761, 1776
Markovski, Dimce 1295
Marrero Ramos, Miriam Del Carmen 1216
Marson, Fernando 1464
Mårtensson, Anders 1325, 1325
Martín Fernandes, Alina 1481
Martín Jiménez, Daniel Iván 1668

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Martín Martín, Silvia 1353
Martin-Jimenez, Daniel 1693, 1693
Martínez Ruiz-Coello, Mar 1738
Martinez-Devesa, Pablo 1746
Martins, Ronaldo 1230
Martins Junior, Ronaldo 1383
Martu, Marius Cristian 1697
Maruyama, Ryo 1626
Marwan, Alnofaie 1621
Masahiro, Miura 1319
Masegosa Zapata, Pedro 1459
Masieri, Simonetta 1541, 1542
Masoud, Mohamed 1651
Mastrapasqua, Rodolfo 1437, 1524, 1565
Mastrapasqua, Rodolfo Francesco 1485
Mastronikolis, Nikolaos 1406
Matas, Jessica 1411
Mateos, Blanca 1340
Mateos Serrano, Blanca 1555
Mateos-Serrano, Blanca 1555, 1595, 1595
Matoušek, Petr 1206, 1304
Matsubara, Atsushi 1311, 1312, 1315, 1593
Matsushita, Daisuke 1312
Matthias, Christoph 1458
Matti, Elina 1728, 1730
Mattoo, Hamid 1374
Maweni, Robert 1618, 1618, 1620, 1620, 1704, 1704
Mayer, Bhabita 1537
Mayer, Carola 1322
Mayr, Susanne 1172
Maza Solano, Juan Manuel 1668, 1668
Maza-Solano, Juan 1238, 1238, 1693
Mcblain, Louise 1756
Mcglone, Megan 1631
Meco, Cem 1684, 1687, 1737
Medina, Luiza 1671, 1775
Mehtani, Nikita 1477
Meireles, Luis 1133, 1134, 1135, 1594
Melchiors, Jacob 1490
Mele, Dario 1437
Melinte, Gabriela-Violeta 1516, 1516
Mellídez Acosta, Raúl 1599
Melnykov, Oleh 1259
Memmedli, Turkan 1585
Mendeš, Tihana 1409
Mendez, Adrian 1475, 1625

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Menter, Thomas 1743
Meshal, Khan 1622
Meulemans, Jeroen 1527
Meytel, Irina 1470, 1470, 1472, 1472
Michaels, Joshua 1608
Michali, Maria 1274
Michoula, Aspasia 1526
Mickeviciene, Vaiva 1211
Mieli, Otavio 1742
Mihalj, Hrvoje 1408
Miksa, Loredan 1682, 1688
Milanković, Stjepan Grga 1408, 1409, 1409
Milea, Alex-Iulian 1647, 1729, 1729
Milenovic, Sinisa 1468, 1468
Mileva, Sevda 1291
Milioni, Athanasia 1694
Miller, Jessa 1333
Minasidou, Maria 1664, 1669, 1669
Ming, Xie 1209, 1209
Minjuan, Zhang 1596
Minkov, Taniel 1289
Miranda, Daniel 1481, 1481, 1695, 1695, 1774
Miranda, José 1296, 1296, 1297, 1297
Miranda, Vera 1553, 1553, 1554, 1554, 1588
Miranda Sánchez, Estefanía 1738
Mireas, Georgios 1444
Mitkova, Milena 1381
Miura, Masahiro 1331
Miyake, Marcel 1383, 1383, 1671, 1671, 1671, 1775, 1775
Miyamura, Kosuke 1227
Mladenov, Tsvetan 1487, 1501
Mladoňová, Michaela 1206, 1206
Mnatsakanyan, Anush 1424
Modestou, Eirini 1494
Moe, Kris 1168
Mohamed, Ahmed 1194
Mohamed, Hany 1651
Mohammad, Ibtisam 1457, 1457, 1592, 1592
Mohammed Hassan, Baali 1622
Moiseeva, Yuliya 1613
Mokoyan, Zhanna 1698, 1698
Moldovanov, Ivan 1252
Molin, Magnus 1653
Molloy, Peter 1356
Molnár, Viktória 1703, 1703
Mombaerts, Peter 1686

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Momjian, Shahan 1473
Mongkolkul, Kittichai 1217
Montalvão, Pedro 1248, 1250, 1256, 1298, 1700
Monti, Giulia 1438, 1438, 1707, 1707
Montuori, Claudio 1437, 1437, 1565
Morales Molina, Elizabet 1321, 1321
Morales Molina, Elizabeth 1419, 1677
Moreira, Filipa 1481, 1695
Moreno, Sergio 1544
Moreno Luna, Ramón 1668
Moreno-Lopez, Sergio 1532
Moreno-Luna, Ramon 1238, 1693
Morgenstern, Christina 1569
Mori, Eri 1300, 1319, 1330, 1724, 1724
Morishita, Hiroyuki 1402
Moroni, Luca 1452
Mortuaire, Geoffrey 1541, 1542
Mösges, Ralph 1645, 1645, 1645, 1645, 1645, 1646, 1646
Mosquera, Nezly 1599
Most, Sam 1133, 1134
Mostafa, Eltaher 1194
Mot, Cristian 1682, 1688
Mota, Clara Pedro 1702
Mourão, Márcia 1619, 1619, 1759, 1759
Mouteveli, Panayiota 1444
Moyaert, Mathilde 1541, 1542
Mozzanica, Francesco 1479
Mpouronikou, Anna 1664
Msihid, Jérôme 1486
Mueller, Christian A. 1185
Mueller, Sarina 1172
Mueller, Sk 1807
Muhammad, Alvi 1241
Muhanna, Nidal 1148
Müller, Sarina 1172
Mullol, Joaquim 1537, 1541, 1542, 1672, 1673
Munnings, Amberley 1650
Muñoz, Gabriela 1643
Muñoz, Maria 1643
Muñoz Cordero, Gabriela 1545
Muñoz Cordero, Maria Gabriela 1353, 1459
Muñoz Del Castillo, Francisco 1321, 1677
Muñoz Fernández, Noelia 1517, 1521, 1521, 1599
Muñoz-Bravo, José Luis 1238
Muñoz-Cano, Rosa 1673
Murai, Aya 1244

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Murashima, Adriana 1230
Murrieta-Aguttes, Margarita 1786
Myakova, Natalya 1750
Mylonas, Stylianos 1128, 1128
Myuran, Tharsika 1608
N
Na, Hyung Gyun 1149
Nabil, Faranesh 1456
Nacu, Bogdan 1730
Nada, Alshaikh 1378
Naelten, Gaelle 1572
Nagai, Monami 1724
Nahli Yahloull, Mohamed Rida 1545
Naik, Paresh Pramod 1509, 1509, 1515, 1522, 1522, 1601, 1758, 1772, 1772
Nakajima, Takahiro 1331, 1331
Nakamori, Motoki 1394
Nakamura, Chihiro 1311
Nakamura, Yosuke 1394, 1394
Nakano, Masaya 1395
Nakano, Takafumi 1288
Nakashima, Daiki 1330, 1330
Nakayama, Misako 1313
Nakayama, Tsuguhisa 1716, 1716
Naraghi, Mohsen 1741, 1741, 1747, 1747, 1748, 1748, 1749, 1749
Narang, Ved 1631, 1631
Narayanan, Prepageran 1766
Nascimento, Joana 1298
Nash, Scott 1374, 1389, 1398, 1483, 1486, 1531, 1533
Natella, Pierre-André 1342
Natesh, Vishwanath 1659, 1659
Naxakis, Stefanos 1406, 1421
Neagos, Adriana 1535, 1535, 1535, 1549, 1549
Neagos, Cristian Mircea 1535, 1549
Nedelcu, Ruxandra Ioana 1337
Negida, Ahmed 1762
Negoias, Simona 1743, 1743
Nepal, Roshan 1576,
Nepp, Nelli 1386, 1386, 1442, 1442
Neto, Mariana 1561, 1570
Nevoux, Jerome 1342
Nguyen, Cecilia 1150
Nguyen, Lily 1606
Nguyen, Theodore 1150, 1333
Nguyen, Yann 1342
Nhung Tran Khai, Christine 1342
Nickol, Annabel 1650

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Nicolai, Piero 1571
Niederberger-Leppin, Verena 1653
Nierkamp, Inga 1214, 1451, 1451
Nikolaidis, Christos 1534
Nikolaidis, Vasileios 1128
Nikolaidis, Vasilios 1776
Nikolopoulou, Efstathia 1694
Nikolov, Yutii 1511
Nikolova, Marta 1511
Nishida, Kohei 1670
Nitro, Letizia 1369
Nizamova, Nezi 1222
Nobuyoshi, Otori 1319, 1724
Nomura, Ayami 1311, 1311, 1312, 1593
Nordström, Axel 1326, 1326
Nottoli, Madeline 1150
Novák, Štěpán 1611, 1611
Ntrigiou, Vaia 1323, 1324
Ntziovara, Anna Maria 1666
Numminen, Jura 1171, 1422
O
O'carroll, Mark 1359
O'neill, Rory 1352, 1352
O'shea, Ross 1232, 1232
Oetliker, Christoph 1773
Oh, Chung-Sik 1240
Oh, Jeong-Min 1675
Oka, Aiko 1244, 1285, 1299
Okano, Mitsuhiro 1244, 1285, 1299
Okayoshi, Yohei 1626
Oksala, Niku 1171
Oksuz, R. Arjin 1687
Okuni, Tsuyoshi 1395
Oliveira, Luís 1700
Oliveira, Vitor 1610, 1641, 1706
Olivieri, Carla 1728
Olszewska-Staroń, Anna 1344, 1360, 1361, 1367, 1367
Omura, Kazuhiro 1227, 1457
Onori, Maria Elisabetta 1485, 1524
Ordoñez Carmona, Marta 1663
Oren, Ziv 1191
Orengo, Jamie 1374
Órfão, Tiago 1540
Orlando, Pietro 1284, 1284
Osipova, Irina 1470, 1472
Ospina, Javier 1544

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Otoda, Ami 1402, 1402
Otori, Nobuyoshi 1227, 1330
Otsuka, Koji 1626, 1626
Ottaviano, Giancarlo 1571, 1571
Otten, Josje 1396, 1396
Overbeck, Clara 1300
Overdevest, Jonathan 1466, 1507
Overdevest, Jonathan B. 1466, 1503
Oviedo Santana, Ángeles Mercedes 1142, 1142, 1143, 1143
P
Pablo-Martinez, Devesa 1746
Pacheco, Inês 1283
Pacheco, Ricardo 1248, 1256
Pacholova, Yana 1291
Pagella, Fabio 1728, 1730
Pais, José 1765, 1765
Pal, S 1169, 1169
Palacios-García, José María 1238
Palade, Dragos Octavian 1697
Palla, Effrosyni 1654, 1654
Palma, Pietro 1190
Palmer, James 1205, 1333
Panagiotopoulos, Vasileios 1421
Panda, G 1169
Pang, Jonathan 1150, 1333
Pang, Wendu 1182
Papacharalampous, Georgios 1694, 1694
Papadakis, Chariton 1323, 1324
Papadopoulou, Anna-Maria 1508, 1510, 1512, 1514, 1546, 1546, 1548, 1736
Papanikos, Vasileios 1421, 1421
Papargyriou, Giolina 1530, 1539, 1568, 1573, 1573
Papon, Jean-François 1342, 1342
Papouliakos, Sotirios 1736
Para, Diana 1682
Paramasivan, Sathish 1735
Pardo, Laura 1731
Pardo Mateu, Lourdes 1517
Pardo Maza, Adriana 1738
Pardo Muñoz, Laura 1377, 1377
Pareek, Mitalee 1509, 1515
Park, Hye-Jin 1176
Park, Ji-Hwan 1147, 1176
Park, Min Woo 1788
Pascutti, Juliana 1671
Passali, Giulio Cesare 1565
Passos, Ivna 1230

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Pastaka, Chaido 1699
Pastorčić Grgić, Marija 1633
Pasztor, Zsolt 1271
Patron, Vincent 1342
Paupério, Anita 1561, 1561, 1570
Paval, Cristian Costel 1337
Pavlidis, Pavlos 1348
Pavlou, Angeliki Vasiliki 1736, 1736
Pavlyshyn, Volodymyr 1195
Pazardzhikliev, Dimitar 1289
Peça, Rita 1430, 1430, 1589, 1610, 1610, 1642, 1706
Pedersen, Christian 1263
Pedro, Branco 1708
Pedro, Escada 1708
Pedro Mota, Clara 1283
Pedrosa Rocha, Gustavo 1248, 1248, 1250, 1250, 1256, 1256, 1256, 1298, 1298
Peer Mohamed, Syed Ahamed 1140, 1140
Peev, Kiril 1397
Peleshenko, Natalia 1259
Peñalver, María José 1562, 1562
Peñaranda, Augusto 1532, 1544
Peñaranda, Daniel 1532, 1532, 1544, 1544, 1558, 1558
Penazzi, Daniele 1524
Pereira, Gonçalo 1570
Pereira, Joyce 1775
Pereira, Paulo 1615, 1623
Pereira, Paulo Rocha 1706
Perez Orribo, Alicia 1545
Pérez Orribo, Alicia Maria 1353, 1353
Pérez-González, María 1673
Perez-Herrera, Lucia C. 1532, 1544, 1544, 1544
Peric, Aleksandar 1179, 1179
Perkmann, Thomas 1653
Pertsinidou, Eleftheria 1653, 1653
Pervaiz, Arbaaz 1746, 1746
Pesold, Vanessa Vivien 1807
Peters, Anju 1398, 1531, 1533, 1536
Peters, Anju T 1536
Peters, Anju Thomas 1261
Petersen, Elina 1322, 1427
Petersen, Marvin 1322, 1427
Petersen, Tonny 1263
Petitjean, Margaux 1351
Petkov, Daniel 1484, 1484
Petruski-Ivleva, Natalia 1531, 1533
Pettenon, Fabiana 1538

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Pfaar, Oliver 1467
Pfliegler, György 1335
Phillips, Katie 1205, 1333
Phillips, Katie M. 1584
Philpott, Carl 1581
Pichler, Franziska 1185
Pietruszewska, Wioletta 1293
Pilette, Charles 1189
Piñeros, Lina 1305, 1541
Pinheiro Guedes, Lara 1283
Pinto Moura, Carla 1491, 1540
Pinzón Navarro, Martín 1532, 1558, 1558
Pipolo, Carlotta 1369
Pires, Rafael 1715
Piski, Zalán 1442
Plášek, Marek 1304
Plaza Mayor, Guillermo 1738
Plzak, Jan 1552, 1611
Poblete, Valentina 1805
Poenaru, Marioara 1682, 1688
Poglitsch, Katharina 1569
Pohóczky, Krisztina 1386
Poje, Gorazd 1440
Polatoglou, Nataly 1494
Popov, Todor 1222, 1222, 1381, 1397
Porras-González, Cristina 1238
Porru, Davide Paolo 1485, 1565, 1565
Portillo, Alex 1731
Postma, Elbrich 1640
Poutoglidis, Alexandros 1453, 1566, 1744
Preti, Andrea 1479
Prigent, Marine 1342
Prime, Constance 1424, 1424
Proimos, Efklidis 1323, 1324
Prokopakis, Emmanouel 1683
Prokopakis, Emmanuel 1701
Pruliere-Escabasse, Virginie 1342
Psaltis, Alkis 1735, 1735
Psaltis, Alkis James 1576
Psychogios, Georgios 1274
Pyne, Justin 1292, 1475, 1475, 1625, 1625, 1625
Pyrgakis, Panagiotis 1573
Q
Qi, Gao 1209
Qiu, Ke 1144
Quadros, Gonçalo 1619, 1759

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Quinn, Alanna 1460
Quint, Tamara 1569
Quitter, Christian 1496
Qureishi, Ali 1746, 1746
R
Rachmanidou, Anastasia 1241, 1242, 1412, 1413
Radtke, Lea 1645, 1646
Radulesco, Thomas 1342, 1594
Rafael, Pires 1715
Raherison-Semjen, Chantal 1572
Ramirez, Erika 1544
Rampi, Andrea 1452, 1452
Rana, Mridul 1618, 1704
Rangachev, Julian 1381, 1393, 1397
Rangachev, Lubomir 1222
Ranjan, Rajeev 1492, 1492
Raposo, Sérgio 1619, 1759
Rasheva, Nia 1587
Rauba, Darius 1184, 1184
Rauch, Clemence 1786, 1786
Rautiainen, Markus 1171, 1422
Raved, Orr 1156, 1156
Redzheb, Sibel 1382
Reis, Luís 1354, 1355
Reitsma, Sietze 1396, 1399, 1400, 1426, 1531, 1531, 1533, 1541, 1542
Ren, Jianjun 1144, 1182, 1202
Renaud, Marion 1342, 1351
Rennie, Catherine 1477
Retretre, Ertretret 1429
Rhee, Chae Seo 1788
Rhee, Chae-Seo 1469, 1717, 1717
Ribeiro, João Carlos 1680
Ribeiro, Jose Dirceu 1464, 1550
Rimmer, Joanne 1420, 1423
Riss, Dominik 1185
Ristl, Robin 1653
Roca-Ferrer, Jordi 1673
Rocca-Ferrer, Jordi 1672
Rocha-Hasler, Marianne 1569
Rodrigues, Bárbara 1619, 1759
Rodrigues, Berta 1774
Rodrigues, Filipe 1759
Rodrigues Da Cunha, Fernanda 1550, 1550
Rodriguez Van Strahlen, Camilo 1411, 1411, 1541
Roethlisberger, Michel 1766, 1773, 1773
Roine, Antti 1171

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Rojas Lechuga, María Jesús 1305, 1410, 1411, 1542
Rojas-Lechuga, Maria Jesus 1410
Roman, Kelsey 1333
Rombaux, Philippe 1541, 1542
Ronit, Vogt Sionov 1175
Rosa, Claudia 1589, 1589, 1610, 1615, 1615, 1615, 1623, 1642
Rosa, Francisco 1134
Rosa, Helena 1561
Rosa, João 1430
Roschel, Luis 1775
Rosu, Andrei 1697
Rovers, Maroeska 1426
Rowe, Paul 1261, 1389, 1483, 1486
Roxbury, Christopher 1405
Roy, T 1165, 1166, 1169
Rudack, Claudia 1214, 1451
Ruggeri, Carlos 1600
Rumeau, Cécile 1342, 1606
Ruowen, Guo 1209
Ruseckij, Juriy 1350
Rusetsky, Yuri 1470, 1472, 1755
Rusetsky, Yury 1350, 1407
Ruz, Paula 1805
Rychen, Jonathan 1766, 1773
Rylska, Oksana 1259
Ryott, Michael 1326
Ryser, Fabio 1167
Ryu, Sung Seok 1365, 1365
S
S, Pal 1164, 1164, 1164, 1165, 1165, 1166, 1166
Sá Breda, Miguel 1481
Saak, Tiana 1507
Saak, Tiana M. 1503
Saccardo, Tommaso 1571
Sacks, Harry 1389, 1398, 1483, 1486
Sacramento, Beatriz 1545
Sacramento García, Beatriz 1353, 1545, 1545
Safadi, Ahmad 1155
Safadi, Ahmed 1523
Sagarribay, Amets 1506
Sahnane, Nora 1538
Saini, Fani 1664
Sakamoto, Hiroshi 1395
Sakano, Eulalia 1464, 1550, 1577
Sakellariou, Christina 1325
Sakurai, Rinko 1227, 1724

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Saldanha, Inês 1540
Salem, Osama 1651, 1651
Salib, Rami 1390, 1392
Salman, Manal 1651
Salmon, Dominique 1342
Salmon, Mandy 1205
Sam, Dewhurst 1607, 1608
Samaras, Vasileios 1494
Sambur, Maryna 1259
Samuthpongtorn, Jompol 1277
Sánchez Gómez, Serafín 1668
Sánchez Montalvo, Alba 1189, 1189
Sánchez-Gómez, Serafín 1238, 1693
Sangalli, Valentina 1287
Sangubol, Melissa 1217, 1217
Sannasardo, Roberto 1730
Santos, Ana Rita 1642
Santos, Cláudia 1561, 1570, 1570, 1570
Santos, Maria José 1610
Santos, Mariline 1134, 1594
Santos, Tiago 1553, 1554
Sarafoleanu, Codrut 1281, 1516, 1647, 1729
Saraiva, José 1506
Saratziotis, Athanasios 1667
Sarlo, Francesca 1524
Sarnatskyi, Kostiantyn 1255
Sarnoch, Sven Ole 1745, 1745
Saro- Buendía, Miguel 1517, 1517, 1521, 1521, 1521
Saro-Buendía, Miguel 1599, 1599
Saroul, Nicolas 1342
Sato, Mami 1312, 1312
Scadding, Guy 1262
Schepens, Emma 1162, 1640, 1640
Schiavo, Gloria 1515
Schinas, Georgios 1347
Schipor Diaconu, Elena Teodora 1337, 1337
Schläfer, Alexander 1427
Schmid-Grendelmeier, Peter 1167
Schneider, Sven 1541, 1542, 1569, 1569, 1653
Schrijvers, Rik 1220
Scott, Ian 1653
Scussiato, Henrique Ochoa 1760
Seccia, Veronica 1524
Sedaghat, Ahmad 1205, 1333
Sedaghat, Ahmard R. 1584, 1584
Seebauer, Caroline 1127, 1318, 1586, 1586

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Segura, Barbara 1562
Sekine, Rumi 1300, 1300, 1300, 1724
Senior, Brent 1416, 1416, 1420, 1420, 1423, 1423, 1457, 1592
Senn, Pascal 1317, 1433, 1443
Seo, Eun-Hye 1240, 1240
Seresirikachorn, Kachorn 1245, 1280
Serrano, Elie 1342
Serrano, Thiago 1464
Servidoni, Maria De Fatima 1550
Sessa, Fausto 1538
Šestak, Anamarija 1408, 1409
Settimi, Stefano 1437, 1485
Severin, Florentina 1697
Seys, Sven 1220, 1541, 1542, 1542
Seys, Sven F. 1541
Shafik, Amr 1651
Shafinskyi, Oleh 1249
Shaghayegh, Gohar 1576
Shamanskaya, Ksenia 1247
Shao, James 1420, 1423
Shapira, Udi 1802
Shi, Jianbo 1574, 1597
Shi, Zhaohui 1627, 1627, 1628, 1628, 1634, 1634, 1634
Shih, Ryan 1333
Shihada, Rabia 1676, 1676
Shilo, Shahaf 1327
Shimizu, Aiko 1244
Shimizu, Shino 1313, 1316, 1316
Shimizu, Takeshi 1313, 1313, 1316
Shin, Geun Cheol 1218
Shin, Seung-Heon 1257, 1257
Shinmura, Hajime 1724
Shintaro, Chiba 1319, 1331, 1462, 1462
Shiomi, Takayuki 1299
Shochat, Isaac 1800
Shopen, Yoni 1328
Shukuryan, Artur 1726
Siddique, Haleema 1618, 1620, 1704
Sileo, Giorgio 1447, 1447, 1538, 1707
Silva, Ana 1133, 1134, 1135, 1594
Silva, César 1641, 1706
Silva, José 1760
Silva, Lilian 1230
Silveira, Gabriela 1742, 1742
Silver, Jared 1536

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Simão, Diogo 1641
Simić, Laura 1645, 1646, 1646
Simmen, Daniel 1132, 1136
Singh, Narinder 1791, 1791, 1792, 1793, 1794, 1794, 1795, 1796, 1796, 1797, 1797
Sinz, Christoph 1569
Sipione, Rebecca 1433, 1443
Siqueira, Bruno 1671, 1775
Siragusa, Vera 1728, 1730
Sirakov, Stanimir 1393
Skalias, Antonis 1526
Skarzynski, Henryk 1518, 1525, 1563
Skarzynski, Piotr H. 1367, 1518, 1518, 1525, 1525, 1563, 1563
Skarżyński, Piotr Henryk 1344, 1360, 1361, 1361
Skoulakis, Charalampos 1128, 1526, 1667, 1669
Skoumpas, Ioannis 1566, 1744, 1744
Slosser, Dmytro 1151, 1151, 1151
Smahina, Tetiana 1254, 1259
Small, Mark 1551
Smith, Steve G 1551
Smith, Steven G 1537
Snidvongs, Kornkiat 1217, 1245, 1277, 1280
Snyder, Clayton 1503
Soares Santos, Tiago 1588, 1588, 1588
Soler, Zachary 1389
Solomi, Euthymios 1669
Sommerfeld, Connor 1292, 1475, 1625
Song, Jin Soo 1292
Sonoda, Serika 1288
Sookdee, Sirinkarn 1183, 1183
Sooriyamoorthy, Thushanth 1691
Soria Medina, Sara 1142, 1143
Sotiroudi, Sotiria 1560
Sotnikova, Larisa 1470, 1472
Soudry, Ethan 1328
Sousa, Francisco 1135
Sousa, José Maria 1491
Souza, Aline 1464
Souza Gomes, Carla Cristina 1550
Sovardi, Fabio 1728, 1730
Soyka, Michael 1167, 1167, 1168, 1168
Spahn, Franziska 1458
Spanu, Camilla 1524, 1524
Speleman, Kato 1519, 1527
Speth, Marlene M. 1584, 1584
Spinozzi, Giuseppe 1728
Spirito, Luca 1287

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Spratley, Jorge 1540
Stack-Pyle, Taylor 1592
Stanek, Victoria 1569, 1653, 1653
Staufenberg, Rebekka 1458
Stavrianou, Eleni 1529
Steelant, Brecht 1262
Stefanovici, Ana 1682
Stegeman, Inge 1162, 1640
Steinberg, Doron 1175
Steiner, Urs 1167
Stephens, Joanna 1691
Stokroos, Robert 1162, 1640
Stoyanov, Orlin 1397, 1556
Stoyanov, Valentin 1404, 1404, 1484
Stracenski- Perge, Mirjana 1624
Stradling, John 1650
Suárez, Covadonga 1705
Suarez Aranguez, Covadonga 1663
Sue-Chu, Malcolm 1294
Suk, Sanghyok 1246, 1246, 1246
Suk, Sanhyok 1246, 1246
Sukhareva, Yulia 1803
Šukytė Raubė, Donata 1161, 1184, 1184, 1184, 1184, 1211, 1211
Šukytė-Raubė, Donata 1161
Sulejmanova, Zalina 1470, 1472
Sun, Xicai 1722, 1723
Sun, Yi 1628
Sundara Raj, Nikhil Solomon 1601, 1758
Sundaraj, Nikhil 1772
Sung-Dong, Kim 1176
Svedberg, Marie 1326
Svistushkin, Valery 1698
Syed, Irfan 1241, 1242, 1412, 1413
Syrmos, Nikolaos 1718, 1718
Syrogiannopoulos, George 1526
Szabo, Alexandru 1535, 1549
Szabo, Arpad 1271
Szalenko-Tőkés, Ágnes 1739, 1739
Szalóki, Tibor 1617, 1617
Szczygielski, Kornel 1146
T
T, Gupta 1164
T. Marques, Francisco 1283, 1702, 1702
Tačigin, Tamara 1440
Taciuc, Iulian Alexandru 1434

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Tai, Chih-Jaan 1276
Tailor, Bhavesh 1608
Takabayashi, Kosuke 1231, 1231
Takahashi, Masahiro 1227
Takahata, Junko 1311
Takahata, Jyunko 1312
Takano, Kenichi 1395
Takeda, Atsuo 1626
Takeshi, Shimizu 1275, 1372
Takeuchi, Hiromi 1394
Takeuchi, Kazuhiko 1402, 1670
Tal, Marom 1191
Tamás, László 1703
Tamashiro, Edwin 1230, 1383, 1742
Tamminen, Pekka 1422, 1422
Tan, Benjamin 1644
Tan, Benjamin Kye Jyn 1801
Tan, Claire 1644
Tan, Fong-Jun Sean 1801
Tan, Jing-Wen Claire 1801, 1801
Tanaka, Hirotaka 1724
Tanzini, Umberto 1452
Tarabichi, Shirley 1281, 1281
Tarle, Andro 1633
Tavakoli, Yasaman 1655, 1655
Tei, Masayoshi 1724
Teitelbaum, Tali 1800, 1800, 1800
Teixeira Marques, Francisco 1283
Teo, Neville 1644
Teo, Neville Wei Yang 1801
Tervo, Jeremy 1507
Tervo, Jeremy P. 1466, 1503
Terzakis, Dimitrios 1493, 1493
Terzoudis, Christos 1699
Tewfik, Marc 1606
Tham, Chengyao Alex 1267, 1785, 1785
Thamer, Mustafa 1752, 1752, 1754, 1754
Tharsika, Myuran 1607, 1607, 1607, 1608, 1609, 1609
Theys, Tom 1527
Thomas, Charlotte 1522
Thompson, Mark 1220
Thornton, Mona 1460
Thorstensen, Wenche Moe 1294
Thüring, Christian 1168
Thwaites, Ryan 1653, 1653
Tiago, Caneira 1506

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Tiago, Colaço 1708, 1708, 1708
Tinoco, Catarina 1765
Tobi Porat, Tamar 1523, 1523
Tomazic, Peter Valentin 1541, 1542
Tomé, Diogo 1430, 1641, 1642
Tomokazu, Yoshizaki 1632
Tomonobe, Eri 1288
Tong, Charles 1205
Tonuzi, Ali 1732
Tonuzi, Orjeta 1732
Tooyama, Ikuo 1316
Toppila-Salmi, Sanna K. 1541, 1542
Toro, Mariana 1577
Torosyan, Levon 1799, 1799
Torres Arevalo, Daniela Maria 1544
Toth, Josef 1653, 1653
Tóth, Péter 1442
Tournegros, Romain 1332
Triantos, Stylianos 1493, 1494
Tricarico, Laura 1485
Trigueiros, António 1256, 1298
Trimarchi, Matteo 1452
Tringali, Stephane 1329, 1332, 1342
Trinta, Renato 1775
Tripathi, Siddhant 1205, 1333
Trujillo, Paulina 1805
Truy, Eric 1342
Tsagkovits, Aikaterini 1504, 1512, 1514, 1546, 1548
Tsakiropoulou, Evangelia 1652
Tsamandouras, Ioannis 1683, 1701, 1701
Tsarikayev, Alan 1591
Tsekova-Chernopolska, Miroslava 1393
Tsirves, Georgios 1274
Tsitiridis, Ioannis 1666
Tsoumaridou, Aikaterini 1493, 1493, 1494, 1494
Tsukahara, Kiyoaki 1626
Tsvirinko, Iryna 1249, 1253, 1254, 1255
Tu, Aldine 1541, 1542, 1569
Tubita, Valeria 1672, 1672, 1673, 1673
Tucker, Simon 1356
Turri Zanoni, Mario 1447, 1455, 1707, 1764
Turri-Zanoni, Mario 1538
Turumoto, Yuika 1724
Twerenbold, Raphael 1322
Tze Choong, Charn 1644
Tzima, Konstantina 1323

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Tzur, Nir 1328
U
Udi, Shapira 1802
Ueno, Takayoshi 1605, 1632, 1632
Ulloque, Hector A. 1544
Uluc, Deniz 1737
Uraguchi, Kensuke 1244
Urbán, Péter 1386
Usama, Taya 1194
Useche Gomez, Juan Nicolás 1544
Usmanova, Nilufar 1203
Uyttebroek, Saartje 1220, 1235, 1235, 1236, 1236
Uzakov, Aziz 1203, 1203
V
Valdes, Constanza 1805
Valenta, Rudolf 1653
Valentini, Marco 1438, 1447, 1454
Valera, Fabiana 1230, 1383, 1742
Valero, Antonio 1672, 1673
Valkov, Aleksandar 1487, 1501
Vallet, Sophie 1572
Valli, Yasin 1445
Vallianou, Kyriaki 1526, 1654, 1699, 1699
Van Broeck, Dorien 1262, 1262
Van Den Berg, Nadia 1460, 1460
Van Der Lans, Rik 1391, 1391, 1541, 1542
Van Der Pluijm-Avdeeva, Klemenitna 1399
Van Der Pluijm-Avdeeva, Klementina 1399, 1400, 1400
Van Dijk, Birgit 1640
Van Gerven, Laura 1220, 1235, 1236, 1519, 1527, 1541, 1542, 1686
Van Hoylandt, Anaïs 1527
Van Loon, Johannes 1527
Van Zele, Thibault 1541, 1542
Van Zele, Thibaut 1527
Vander Poorten, Vincent 1527
Vandersteen, Clair 1342
Vanderveken, Olivier 1519
Vantomme, Nikolaas 1527
Vardaksi, Chrysoula 1560, 1566
Vardaxi, Chrysoula 1348, 1348, 1453, 1744
Vasudev, Milind 1333
Veil, Raphael 1342
Veleda, Tiago 1248
Venkatesh, Sanjena 1205

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Verillaud, Benjamin 1342
Vertu-Ciolino, Delphine 1334
Vicente, Alice 1680
Vicheva, Dilyana 1225, 1225, 1226, 1226
Vieira, Gustavo 1577
Vigna, Chelsea 1389
Vilarello, Brandon 1503, 1507, 1507, 1507
Vilarello, Brandon J. 1466, 1503
Village, Sam 1412
Villarreal Patiño, Ithzel 1738
Villarroel, Galia 1805, 1805
Villazala-Merino, Sergio 1653, 1653
Viñas, Marta 1562
Virkkula, Paula 1541, 1542
Viskens, An-Sofie 1519, 1519, 1804
Vitor, Proença 1715
Vizcarra Melgar, Julissa Aida 1668
Vlaminck, Stephan 1204, 1204, 1639, 1639, 1798, 1798, 1798
Vlaykov, Atanas 1404
Vleming, Marleen 1426
Voelker, Axel 1775
Volpi, Leonardo 1671
Volpi, Luca 1454
Von Buchwald, Christian 1263, 1379, 1490, 1497, 1541, 1542
Voruz, François 1317, 1362, 1363, 1441, 1789
Vosshall, Leslie 1463
Vrdoljak, Vlatka 1645, 1646
Vreugde, Sarah 1576
Vrinceanu, Daniela 1341, 1341, 1434
Vukadinovic, Tijana 1179
Vukelić, Karina 1645, 1646
Vukomanovic Djurdjevic, Biserka 1179
Vyskocil, Erich 1735, 1735
W
Wagenmann, Martin 1261, 1261, 1261, 1467, 1486, 1486, 1541, 1542
Wagner Mackenzie, Brett 1356, 1357, 1358, 1359
Wakizono, Takahiro 1288
Walls, Andrew 1390, 1392
Walsh, Michael 1460
Wang, Bai-Yang 1679
Wang, Bao-Feng 1679
Wang, Dehui 1657, 1657, 1660, 1660, 1723
Wang, Huan 1660, 1722, 1722, 1722, 1723
Wang, Jian 1628
Wang, Marilene 1333
Wang, Yibei 1612

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Wang, Ying-Ying 1679
Waran, Vicknes 1766
Wardani, Retno 1471, 1471
Waring, Nicholas A. 1466
Warman, Meir 1191, 1191
Wee, Jee Hye 1788, 1788
Wei, Yi 1598
Wen, Qiao 1465
Wen, Weiping 1598
Wen, Yihui 1598
Wendler, Olaf 1172, 1807
Wendong, Liu 1520, 1596, 1596
Wengier, Anat 1148, 1155, 1156, 1157, 1790
Witkiewicz, Joanna 1564, 1720
Won, Tae-Bin 1469
Woodley, Niall 1756
Wormal, Peter John 1735
Wormald, Peter-John 1576
Wrobel, Agnieszka 1420, 1423
Wrzodeck, Mona 1214
Wu, Pei-Wen 1482
Wytske, Fokkens 1396
X
Xia, Changming 1483
Xiaocan, Zhu 1658
Xing, Jun 1261
Xu, Min 1628
Xu, Yang 1202
Y
Yacoub, Mona-Rita 1452
Yakirevitch, Arkadi 1219
Yamaguchi, Taimu 1311, 1315, 1315, 1593, 1593
Yamamoto, Keisuke 1395, 1395
Yanagi, Norihiro 1724
Yancey, Steve W 1537
Yang, Dazhang 1612
Yang, Lu 1657
Yang, Seung Koo 1717, 1717
Yang, Shibing 1551
Yao, Song 1177, 1177
Yap, Darren 1746
Yatomi, Masanori 1626
Ye, Mi-Kyung 1257
Yee, Leong Wai 1763
Yeh, Te-Huei 1309
Yeong In, Jo 1364

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Yildiz, Malik 1487, 1501
Ying-Piao, Wang 1279, 1279, 1279
Yokoyama, Yuko 1394
Yong, Li 1658
Yoni, Shopen 1328
Yordanova, Teodora 1222
Yoshida, Takamasa 1288
Yoshizaki, Tomokazu 1366, 1605
Yu, Zhao 1177
Yui, Ryosuke 1227, 1227
Yun, Young Bin 1286, 1286
Yunhua, Liu 1209
Yunhyuk, Ko 1505
Z
1207, 1249, 1249, 1252, 1252, 1253, 1253, 1254, 1254, 1255, 1255, 1259,
Zabolotna, Diana
1259
Zabolotnyi, Dmytro 1249, 1254, 1255, 1259
Zabrodska, Liudmyla 1252
Zacharioudaki, Evangelia 1502, 1546, 1548, 1736
Zaroura, Sliman 1456
Zeatoun, Abdullah 1592
Zeise, Kerstin 1467
Zeman, Florian 1127
Zerah-Lancner, Françoise 1343
Zeroli, Chiara 1190
Zghaebi, Mohammed 1653, 1653
Zhang, Chen 1722, 1723
Zhang, Huankang 1657, 1660
Zhang, Mei 1261
Zhang, Nan 1598
Zhang, Qianqian 1722, 1723
Zhang, Yun-Yun 1679
Zhao, Jianhui 1612
Zhao, Tianfeng 1634
Zhao, Weidong 1657
Zhao, Yu 1144, 1182, 1202, 1612
Zhiqi, Ma 1658
Zhou, Jiao 1224
Zhou, Jing 1223, 1223, 1224, 1224, 1465, 1465
Ziani Zeryouh, Aaron 1189
Zimbru, Razvan 1688
Zlatanov, Hristo 1449, 1449, 1450, 1450
Zlotsower, Elchanan 1191
Zoabi, Tameem 1456, 1456, 1456, 1456
Zolotova, Anna 1698

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Zubčić, Željko 1408, 1409
Zyabkin, Ilya 1403, 1750
Ø
Øie, Marte Rystad 1294

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 POSITION PAPER ON OLFACTORY DYSFUNCTION: 2023

Official Journal of the European and International Rhinologic Societies

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 ISSN: 0300-0729

VOLUME 61 | SUPPLEMENT 32 | JULY

CONTENT
Official Journal of the European and International Societies
ERS 2023 abstract book

VOLUME 61 | SUPPLEMENT 32 | JULY 2023

29th congress of the European Rhinologic Society

Sofia, Bulgaria

June 18-22, 2023 ERS 2023

abstract book

2023
29th congress of the
European Rhinologic
Society

Sofia, Bulgaria

June 18-22, 2023

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