PROGRAM GUIDE - ARS 69th Annual Meeting

American Rhinologic Society | american-rhinologic.org | PO Box 269, Oak Ridge, NJ 07438 | 973-545-2735

PROGRAM GUIDE

ARS 69th Annual Meeting

September 29-30, 2023 | Omni Nashville Hotel, Nashville, TN

The ARS Welcomes the

AAO-HNS Guest Countries

Canada, Dominican Republic,

India, United Arab Emirates

The ARS will again be featuring the Fall Film Fesstival

- a video seminar featuring the most educational,

unique and impressive videos of cases, complications

and challenges submitted by the membership.

The videos were reviewed by an appointed committee

and rated equally on rarity of pathology, technical

complexity, novelty of procedure, educational value,

and production quality. The top-rated videos (time-

permitting) will be showcased at the meeting with an

opportunity for the video editors to introduce each clip

and respond to questions from the audience.

FALL FILM FESSTIVAL

Friday, September 29, 2023

12:00 - 1:00 pm

Broadway Ballroom GHJK

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

WWW.AMERICAN-RHINOLOGIC.ORG

Presidential Welcome

Welcome to the 69th Annual Meeting of the American

Rhinologic Society in Nashville! Pete Batra, ARS

President-Elect and Program Chair, has formulated

a superb educational program that highlights new

rhinologic research, pathophysiology, innovations, patient

care and procedural methods, work-life integration, and

more.

A cornerstone of the ARS Annual Meeting is the David

W. Kennedy Lectureship. This year, Dr. Brent Senior

will be the honored Kennedy Lecturer – discussing his

extraordinary international work. The title of Dr. Senior’s

lecture is “Global Outreach in Rhinology: Lessons

Learned from a Quarter Century in Vietnam.”

The Hwang Family Lectureship was initiated in 2022,

SARAH WISE, MD, FARS

with a focus on mentorship. We are excited to have Dr. Donald Lanza as the second

Hwang Family Lecturer in 2023. Dr. Lanza has a long history of mentorship and teaching

in rhinology – we are excited to hear his perspective on this important topic.

The remainder of the 69th ARS Annual Meeting program is filled with top-rated basic

science and clinical research, as well as papers on chronic rhinosinusitis disease severity

and impact, sinus surgery and postoperative therapies, skull base surgery, and more.

Panels and targeted discussions will cover CRS endotypes and therapeutics, extramural

funding, artificial intelligence in rhinology, pediatric skull base surgery, office based

rhinologic surgery, and several other important topics. This meeting covers an incredible

range of rhinologic areas and should be an excellent educational experience all-around.

Thank you for allowing me to serve as ARS President this year. I look forward to seeing

everyone in Nashville.

Sarah K. Wise, MD, FARS

President, American Rhinologic Society

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Welcome from the President Elect and

Program Chair

I am thrilled to welcome you to the 2023 American Rhinologic Society

Annual Meeting!

As the memories of the pandemic and virtual meetings slowly recede from our

memory, the ARS is thriving after hosting several successful in-person meetings.

We will gather this fall in the beautiful city of Nashville to share exciting educational

content and networking opportunities with our colleagues, trainees, and industry

partners.

PETE S. BATRA, MD, FARS

The meeting will take place on September 29-30,

2023 at the Omni Hotel Nashville. The meeting will

showcase the best in clinical and translational

science in the ARS and highlight the tremendous

expertise on various panels and targeted

conversations. The ARS Annual Meeting promises

not to disappoint!

Original, innovative research is a bedrock of the

foundation of the ARS. The program will highlight 67

abstracts for oral scientic presentation and well over

100 posters. These presentations will cover a myriad

of salient topics including CRS diagnosis and medical

therapies, sinus surgery, rhinosinusitis

pathophysiology, allergy and immunology, and skull

base surgery. Congratulations to the scientic teams

from across the globe for sharing their cutting-edge

research at this meeting. Many thanks to the

Abstract Review Committee for their diligence to

compile this high-quality scientic content.

We are extremely honored to have Professor Brent

Senior present the David W. Kennedy lecture this

year. He will share his vast experience in global

health work titled “Global Outreach in Rhinology:

Lessons Learned from a Quarter Century in Vietnam.”

I am equally honored to share that Dr. Donald Lanza

will deliver the 2nd Hwang Family Lecture titled “The

Meaningfulness of Paying it Forward: My 40-Year

Journey.”

The ARS Annual Meeting has 3 breakout rooms on

Saturday morning, which are designed to grab the

interest of meeting attendees across various aspects

of rhinology. Our ARS Women in Rhinology, Allergy

and Immunology, Skull Base and Orbital Surgery, and

Rhinology in Private Practice Sections have been

instrumental in planning educational sessions in

these breakout rooms. The panels will highlight

several thought-provoking topics across the specialty.

Key panels will discuss Maintaining Balance &

Achieving the Quadripartite Mission, Success in Early

Career Extramural Funding, CRS Endotypes,

Subtypes, and Therapeutics, Pediatric Skull Base

Surgery in the 21st Century, Postoperative Care in

Skull Base Surgery, Setting Up and Maximizing an

ASC for Success, and How to Build a Rhinology

Niche in a Comprehensive ENT Practice. The ARS

and AAOA will hold a joint panel on Saturday

afternoon titled “Oce-Based Procedures Update:

Common Procedures & Dicult Cases.” We will

leverage our strong global partnerships in an

International Collaborative Panel titled “Assessing

Septoplasty Outcomes: An International Perspective.”

Friday’s session will be followed by the President’s

Reception, which oers a great venue for networking

and camaraderie with colleagues. Additional learning

opportunities are available at the Saturday morning

Meet the Authors Poster Viewing and Breakfast, as

well as several industry-sponsored satellite symposia

occurring during breakfast and lunch hours

throughout the meeting. Finally, I am excited to

announce the DEI Luncheon on Saturday titled

“Importance of Diversity and Improving the Pipeline in

Medicine” that will feature Dr. Andre Churchwell, Vice

Chancellor of Outreach, Belonging, and Inclusion at

Vanderbilt University and Dr. James Hildreth,

President of Meharry Medical College. I am grateful

to Dr. Troy Woodard for his leadership in developing

this amazing panel.

I hope it is readily apparent this will be another busy

and informative meeting that is sure to engage

attendees and stimulate conversation not only in the

clinical aspects of rhinology and skull base surgery,

but also the practice of medicine in both the

academic and private practice realms. I want to

extend in advance my sincerest gratitude to our

speakers, planners, and attendees. We truly

appreciate your continued support and engagement

with the American Rhinologic Society. Have a great

meeting, everyone!

Pete S. Batra, MD, FARS

President-Elect/Program Chair

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

American Rhinologic Society Executives - 2023

Sarah Wise, MD, FARS

President

Emory University

550 Peachtree Street

MOT 11th Floor

Atlanta, GA 30308

Tel: 404-778-3381

Fax: 404-686-4540

Email: skmille@emory.edu

Pete Batra, MD, FARS

President Elect

Rush University Medical Center

1611 W. Harrison Street, Suite 550

Chicago, IL 60612

Tel: 312-942-7182

Fax: 312-942-6653

Email: [email protected]

Rakesh Chandra, MD, FARS

Secretary

Vanderbilt University

Suite 7209, Medical Center E, South

Tower

Nashville, TN 37232

Tel: 708-689-0933

Email: [email protected]

Jivianne Lee, MD, FARS

Treasurer

UCLA Medical Center

1131 Wilshire Boulevard

Santa Monica, CA 90401

Tel: 424-259-6559

Email: [email protected]

Kevin Welch, MD, FARS

First Vice President

Northwestern University

675 N. St Clair Street

Suite 15-200

Chicago, IL 60611

Tel: 312-695-3115

Email: [email protected]

Amber Luong, MD, PhD, FARS

Second Vice President

First Vice President

McGovern Medical School

part of UT Health

6431 Fannin, MSB 5.036

Houston, TX 77030

Tel: 713-500-5421

Email: amber[email protected]

Rodney Schlosser, MD, FARS

Immdiate Past President

Medical University of South Carolina

135 Rutledge Ave., MSC 250550

Suite 1130

Charleston, SC 29425

Tel: 843-792-7165

Fax: 843-792-0546

Email: [email protected]

Michael Stewart, MD, FARS

Executive Vice President

Weill Cornell Medical College

575 Lexington Avenue

New York, NY 10022

Tel: 646-962-4777

Fax: 646-962-0388

Email: [email protected]

Brent Senior, MD, FARS

VP Development & Strategic Initiatives

UNC School of Medicine

Physician’s Office Building, G-190

170 Manning Drive, CB#7070

Chapel Hill, NC 27599

Tel: 919-966-3344

Fax: 919-966-7941

Email: [email protected]

Wendi Perez

Executive Administrator

P.O. Box 269

Oak Ridge, NJ 07438

Phone: 973-545-2735

Fax: 973-545-2736 x6

Email: [email protected]

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

ARS Board of Directors

ARS Consultants to the Board

Seth Brown,MD,

FARS

Timothy Smith,

MD, FARS,

(Editor in Chief, IFAR)

Stephanie Joe,

MD, FARS

Thomas Higgins,

MD, FARS

Erin O'Brien,

MD, FARS

ARS Staff

Wendi Perez

Executive Administrator

Susan Arias

Development Liaison

Tammy Lorimer

Administrative Assistant/

Office Coordinator

Bradford Woodworth,

MD, FARS

Benjamin Bleier,

MD, FARS

Raj Sindwani,

MD, FARS

Greg Davis, MD,

FARS

David Gudis,

MD, FARS

Zachary Soler, MD,

FARS

Marilene Wang,

MD, FARS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

RHINOLOGISTS IN

PRIVATE PRACTICE

SECTION

Greg Davis, MD, FARS

ARS Committee Chairs

AUDIT

Justin Turner, MD,

FARS

BY-LAWS

Bradford Woodworth,

MD, FARS

CME

Kent Lam, MD, FARS

ETHICS

Gretchen Oakley, MD, FARS

INTERNATIONAL

COMMITTEE

Jivianne Lee, MD, FARS

PEDIATRIC

RHINOLOGY

David Gudis, MD, FARS

RESEARCH

Vijay Ramakrishnan, MD,

FARS

MENTORSHIP

Murugappan Ramanathan,

Jr., MD, FARS

EDUCATION

INNOVATION

Abtin Tabaee, MD, FARS

AWARDS

Jean Kim, MD, FARS

HISTORIAN

Michael Benninger, MD,

FARS

INFORMATION

TECHNOLOGY

Chirag Patel, MD, FARS

RESIDENT/FELLOWS

IN TRAINING

Nicholas Rowan, MD

LIVE & ANCILLARY

COURSES

Garret Choby, MD, FARS

ONLINE EDUCATION

Jose Mattos, MD

QUALITY IMPROVEMENT

Zachary Soler, MD, FARS

DIVERSITY & INCLUSION

Troy Woodard, MD, FARS

MEMBERSHIP

Daniel Beswick, MD, FARS

EDUCATION

COORDINATOR

Raj Sindwani, MD, FARS

NEWSLETTER

Jean Anderson Eloy,

MD, FARS

DEVELOPMENT

Brent Senior, MD, FARS

FELLOWSHIP

Stacey Gray, MD, FARS

ALLERGY IN RHINOLOGY

SECTION

Jean Kim, MD, FARS

MARKETING

Sanjeet Rangarajan, MD,

FARS

PATIENT ADVOCACY

J. Peter Manes, MD, FARS

SKULL BASE & ORBITAL

SURGERY SECTION

Kibwei McKinney, MD

WOMEN IN RHINOLOGY

SECTION

Stacey Gray, MD, FARS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Pete Batra, MD, FARS

Program Chair

PROGRAM COMMITTEE

Program Committee

Rakesh Chandra, MD, FARS

Garret Choby, MD, FARS

Devyani Lal, MD, FARS

Kent Lam, MD, FARS

Michael Stewart, MD, FARS

Kevin Welch, MD, FARS

Sarah Wise, MD, FARS

Troy Woodard, MD, FARS

Program Abstract Reviewers

Benjamin Bleier, MD, FARS

Do Yeon Cho, MD

Mindy Rabinowitz, MD, FARS

Adam Deconde, MD

Kara Detwiller, MD, FARS

Angela Donaldson, MD, FARS

Carlos Ebert, MD, FARS

Matthew Geltzeiler, MD, FARS

David Gudis, MD, FARS

Jose Gurrola, MD

Ashleigh Halderman, MD, FARS

Elisa Illing, MD, FARS

Jean Kim, MD, FARS

Michael Kohanski, MD

Edward Kuan, MD, FARS

Stella Lee, MD

Victoria Lee, MD, FARS

Joshua Levy, MD, fARS

Patricia Loftus, MD, FARS

Nyall London, MD, FARS

Amber Luong, MD, PhD, FARS

R. Pete Manes, MD, FARS

Kibwei McKinney, MD

Caitlin McLean, MD

Pete Papagiannopoulos, MD

Zara Patel, MD, FARS

Katie Phillips, MD

Kenneth Rodriguez, MD

Lauren Roland, MD,

Bobby Tajudeen, MD, FARS

Charles Tong, MD, FARS

Elina Toskala, MD, FARS

Troy Woodard, MD, FARS

Carol Yan, MD

William Yao, MD, FARS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

ARS Mission Statement

The American Rhinologic Society’s mission is to serve, represent and advance the science and ethical

practice of rhinology. The Society promotes excellence in patient care, research and education in

Rhinology and Skull Base Disorders. The American Rhinologic Society is dedicated to providing

communication and fellowship to the members of the Rhinologic community through on-going medical

education, patient advocacy, and social programs. The ARS continuing medical education activities

serve to improve professional competence, performance, and promote research.

Business/ACCME

Continuing Education

Accreditation Statement

The American Rhinologic Society (ARS) is accredited by the Accreditation Council for Continuing

Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The ARS designates this live activity for a maximum of 10.50 AMA PRA Category 1 Credits

Physicians should claim only the credit commensurate with the extent of their participation in the

activity.

How to Obtain Your CME Certificate

At the conclusion of the meeting, you will be provided with a post-meeting link to claim your CME.

Learning Objectives

Upon completion of this session, participants should be able to:

• Advance the performance of clinical providers in the diagnosis and management of rhinology

diseases, including improving procedural/operative skills and leadership/organizational skills

• Improve healthcare quality through research presentations and panel discussions that incorporate

current health and practice data

• Recognize that the rhinologic health of populations involve factors beyond clinical care, including

economic, social, and environmental factors; healthcare and payer systems; and health disparities

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

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ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

ARS 2023 FRIENDS IN RESEARCH DONORS

DIAMOND

Adam Folbe, MD, FARS

Michael Stewart, MD, FARS

PLATINUM

J. Noble Anderson, Jr. MD

Michael Armstrong, MD

Roy Casiano, MD, FARS

Greg Davis, MD, FARS

John Del Gaudio, MD, FARS

Charles Ebert, Jr., MD, FARS

Jeb Justice, MD, FARS

Robert Kern, MD, FARS

Donald Lanza, MD, FARS

R. Peter Manes, MD, FARS

James Palmer, MD, FARS

Douglas Reh, MD, FARS

Marc Rosen, MD, FARS

Mas Takashima, MD, FARS

Jonathan Ting, MD, FARS

Eugenia Vining, MD

Marilene Wang, MD, FARS

Sarah Wise, MD, FARS

GOLD

Omar G. Ahmed, MD, FARS

Nadeem Akbar, MD

Benjamin Bleier, MD, FARS

Do-Yeon Cho, MD

Noam Cohen, MD, FARS

Michael Cruz, MD, FARS

Subinoy Das, MD, FARS

Steven Davis, MD

Diag-Nose.I0

David Gudis, MD, FARS

Yusuf Gulleth, MD

Corinna Levine, MD, FARS

Raj Sindwani, MD, FARS

Stephanie Smith, MD

Luisam Tarrats, MD, FARS

Elina Toskala, MD, FARS

Rhoda Wynn, MD, FARS

SILVER

John Craig, MD

John Chris Davis, MD

Brennan Dodson, MD

Judd Fastenberg, MD

Yusuf Gulleth, MD

Wayne Hsueh, MD

Aria Jafari, MD

Stephanie Joe, MD, FA

Kent Lam, MD, FARS

Andrew Lane, MD, FARS

Donald Lanza, MD, FARS

Ryan Little, MD

Brian Lobo, MD, FARS

Chadi Makary, MD, FARS

Michael Marino, MD, FARS

Edward McCoul, MD, FARS

Robert Pettis, MD

Hassan Ramadan, MD, FARS

B. Todd Schaeer, MD

John Ulrich, DO

Andrew Victores, MD

BRONZE

Sanford Archer, MD, FARS

Richard Bailey, MD

Jay Chavda, MD

David Conley, MD, FARS

Thomas Edwards, MD

Meha Fox, MD

Rohit Garg, MD, FARS

Thomas Higgins, MD, FARS

Eric Holbrook, MD, FARS

Eyad Khabbaz, MD

Tran Locke, MD

Li-Xing Man, MD, FARS

Sonya Marcus, MD

Michael McGhee, MD

Daniel O’Brien, MD, FARS

Jonathan Overdevest, MD

Katie Phillips, MD

Nicholas Rowan, MD

John Schneider, MD

Kristine Smith, MD

Brian Song, MD

Jason Talmadge, MD

Michael Yim, MD, FARS

FRIEND

Dole Baker, MD

Martin Hopp, MD

Alissa Kanaan, MD

Ramy Mahmoud

Nora Perkins, MD

Katie Phillips, MD

Russell Reitz, MD

David Rosen, MD

Jessica Southwood, MD

Ron Swain, Jr., MD, FARS

Dennis Tang, MD, FARS

As of 9/17/23

Thank you to all donors who have helped get the 2021 Friends in Research Campaign o to a great start!

We thank you for your generosity! With the monies donated over the past few years the ARS has heen

able to continue the Friends in Research sponsored grant which is in addition to our traditional CORE

eorts! New this year the ARS is also oering a three-year, multi-site Con-sortium Grant.

With your support, we can continue to fund the studies that provide clinical insights valuable to the care

of our patients. This work not only advances the care of our patients through scientic innova-tion, but

also generates important data establishing the ecacy and cost eectiveness of our care. In the current

nancial landscape, this is equally important to ensure that our patients have access to the treatment

necessary to address their complaints. We thank you again for your help in this worthy endeavor!

Visit american-rhinologic.org and join us in our 2024 year campaign.

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

1954 - 1955 Maurice H. Cottle, MD*

1955 - 1956 Ralph H. Riggs, MD*

1956 - 1957 Walter E. E. Loch, MD*

1958 - 1959 Kenneth H. Hinderer, MD*

1959 - 1960 Roland M. Loring, MD*

1960 - 1961 Ivan W. Philpott, MD*

1962 - 1963 Raymond I. Hilsinger, MD*

1963 - 1964 H. Ashton Thomas, MD*

1964 - 1965 Carl B. Sputh, MD

1966 - 1967 Walter J. Aagesen, MD*

1967 - 1968 Richard Hadley, MD*

1968 - 1969 Henry L. Williams, MD*

1970 - 1971 Charles A. Tucker, MD*

1971 - 1972 Pat A. Barelli, MD

1972 - 1973 Gerald F. Joseph, MD

1973 - 1974 Manuel R. Wexler, MD*

1974 - 1975 George H. Drumheiler, MD*

1975 - 1976 Joseph W. West, MD*

1976 - 1977 Albert Steiner, MD*

1977 - 1978 Anthony Failla, MD*

1978 - 1979 Clifford F. Lake, MD*

1979 - 1980 W. K. Locklin, MD

1981 - 1982 Eugene B. Kern, MD

1982 - 1983 Carlos G. Benavides, MD

1983 - 1984 Leon Neiman, MD

1984 - 1985 George C. Facer, MD

1985 - 1986 Larry E. Duberstein, MD

1986 - 1987 Glenn W. Drumheiler, DO

1987 - 1988 Alvin Katz, MD

1988 - 1989 Donald Leopold, MD, FARS

1990 - 1991 Pierre Arbour, MD

1991 - 1992 Fred Stucker, MD, FARS

1992 - 1993 David W. Kennedy, MD, FARS

1993 - 1994 Sanford R. Hoffman, MD

1994 - 1995 Richard J. Trevino, MD

1995 - 1996 Vijay K. Anand, MD

1996 - 1997 Dale H. Rice, MD

1997 - 1998 Michael S. Benninger, MD, FARS

1998 - 1999 William Panje, MD

1999 - 2000 Charles W. Gross, MD

2000 - 2001 Frederick A. Kuhn, MD

2001 - 2002 Paul Toffel, MD, FARS

2002 - 2003 Donald C. Lanza, MD, FARS

2003 - 2004 James A. Hadley, MD, FARS

2004 - 2005 Joseph B. Jacobs, MD, FARS

2005 - 2006 Michael J. Sillers, MD, FARS

2006 - 2007 Howard L. Levine, MD, FARS

2007 - 2008 Marvin P. Fried, MD, FARS

2008 - 2009 James Stankiewicz, MD, FARS

2009 - 2010 Stilianos Kountakis, MD, FARS

2010 - 2011 Brent A. Senior, MD, FARS

2011 - 2012 Michael Setzen, MD, FARS

2012 - 2013 Todd Kingdom, MD, FARS

2013 - 2014 Timothy L. Smith, MD, FARS

2014 - 2015 Roy Casiano, MD, FARS

2015 - 2016 Peter Hwang, MD, FARS

2016 - 2017 John DelGaudio, MD, FARS

2017 - 2018 Richard Orlandi, MD, FARS

2018 - 2019 James Palmer, MD, FARS

2019 - 2020 Robert Kern, MD, FARS

2020 - 2021 Joseph Han, MD, FARS

2021 - 2023 Rodney Schlosser, MD, FARS

*Deceased

Past Presidents

Past Secretaries

2019 - Present Rakesh Chandra, MD, FARS

2015 - 2019 Pete Batra, MD, FARS

2013 - 2015 James Palmer, MD, FARS

2009 - 2012 Peter Hwang, MD, FARS

2005 - 2008 Brent A. Senior, MD, FARS

1999 - 2005 Marvin P. Fried, MD, FARS

1995 - 1999 Frederick Stucker, MD, FARS

1990 - 1995 Frank Lucente, MD

1985 - 1990 George Facer, MD

1980 - 1985 Pat A. Barelli, MD

1975 - 1980 Glenn H. Drumhiller, MD

1970 - 1975 Ralph H. Riggs, MD

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

The American Rhinologic Society gratefully acknowledges the following

companies for their support of the 69th Annual Meeting

ARS 69th Annual Meeting Industry Supporters

AstraZeneca

Gold Sponsorship

GlaxoSmithKline

Medtronic

Sano & Regeneron

Silver Sponsorship

Medtronic

Grant Support

Medtronic

19th Annual David W. Kennedy Lectureship

Acclarent

2nd Annual Hwang Family Lectureship

KARL STORZ Endoscopy-America, Inc.

Diversity & Inclusion/Women in Rhinology/Mentorship/Residents & Fellows Combined Program

Stryker

Residents Course

Stryker

Residents Reception

Hemostasis Fiagon

Rhinologists in Private Practice Cocktail Reception

3NT Medical

Acclarent

Advanced RX Compounding

Pharmacy

Aerin Medical

Altus Biologics

AstraZeneca

Brainlab

GlaxoSmithKline

Hemostasis & Fiagon

KARL STORZ Endoscopy-America, Inc.

Lyra Therapeutics

Medical Center Specialty Pharmacy

Medtronic

Nasoneb

NeilMed Pharmaceuticals Inc.

Olympus America Inc.

Prosidio

Sano & Regeneron

Septum Solutions

Stryker

Xoran Technologies

Exhibitors

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Floor Plan & Exhibit Hall

BROADWAY BALLROOM

A B

G - K

GENERAL SESSION

Broadway

BALLROOM

CIRCULATION

Food & Beverage

36"

Food & Beverage

36"

36" 36"

36"

POSTER SESSION

101 103 105 107 109 111 115 117

201 203

204 206 208

Advanced RX

Compounding

Pharmacy

Aerin

Medical

100

Hemostasis Fiagon

Medical Center

Specialty

Pharmacy

Sanofi and

Regeneron

Medtronic

Acclarent

KARL STORZ

Endoscopy-

Stryker GSK

Lyra

Therapeutics

NeilMed

Pharmaceuticals

116

Olympus America Inc.

Septum

Solutions

BrainLabNasoneb

Altus

Biologics

3NT

Medical

Xoran

Tech

200 202

AstraZeneca

AIRSUPRA

AstraZeneca

PRECISION

66" / 8

36"

66" / 8

36"

POSTER SESSION

210

Prosidio

2023 ARS 69th Annual Meeting

September 29 - 30, 2023

Omni Nashville Hotel - Broadway Ballroom F - Nashville, TN

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

PROGRAM AT A GLANCE

Thursday,

September 28, 2023

Residents Didactic Course

Cumberland 1

12:00 pm – 5:00 pm

By Invitation Only

Residents Dissection Lab

Off Site Location

Details for Shuttle Service

forthcoming

12:00 pm – 5:00 pm

By Invitation Only

Residents Reception

Music Row 5

6:30 pm – 8:00 pm

By Invitation Only

Friday,

September 29, 2023

Residents Didactic Course

Cumberland 2

8:00 am – 12:00 pm

By Invitation Only

Residents Dissection Lab

Off Site Location

Details for Shuttle Service

forthcoming

8:00 am – 12:00 pm

By Invitation Only

Friday,

September 29, 2023

7:00 am – 12:00 pm

Broadway Ballroom ABC

7:00 am - 8:00 am

Board of Directors Breakfast

8:00 am - 12:00 pm

Board of Directors Meeting

Friday,

September 29, 2023

1:00 pm – 5:00 pm

General Session

Broadway Ballroom GHJK

12:00 pm - 1:00 pm

Fall Film FESStival

Broadway Ballroom GHJK

Moderators: Christopher Church, MD,

FARS;

Edward Kuan, MD, FARS

1:00 pm – 1:05 pm

Welcome & Introduction

Pete Batra, MD, FARS

1:05 pm – 1:20 pm

Presidential Address

Sarah Wise, MD, FARS

Top Rated Abstracts –

Clinical Rhinology

Moderators: Kara Detwiller, MD, FARS;

Devyani Lal, MD, FARS; Bobby

Tajudeen, MD, FARS

1:20 pm - 1:27 pm

Topical platelet-rich plasma for post-

COVID olfactory dysfunction – A

randomized controlled trial

Alexander Duffy, MD

1:28 pm – 1:35 pm

Efficacy and safety of EDS-FLU in

chronic rhinosinusitis – Two

randomized controlled trials

James Palmer, MD, FARS

1:36 pm – 1:43 pm

All CRS endotype clusters

demonstrate improvement in patient

reported and objective measures after

endoscopic sinus surgery

Nikita Chapurin, MD, MHS

1:44 pm – 1:51 pm

Peri-operative air quality and post-

operative endoscopic sinus surgery

outcomes

Amarbir Gill, MD

1:52 pm – 1:59 pm

Optimizing topical nasal

corticosteroid irrigations: A

randomized double-blind clinical trial

Zachary Root, BS

1:59 pm – 2:05 PM

Q&A

2:05 pm – 2:15 pm

Awards Ceremony

Jean Kim, MD, FARS

2:15 pm – 3:00 pm

David W. Kennedy Lecture

Introduction: Pete Batra, MD, FARS

Guest Speaker: Brent Senior, MD, FARS

“Global Outreach in Rhinology:

Lessons Learned from a Quarter

Century in Vietnam”

3:00 pm – 3:30 pm

Break with Exhibitors

Top Rated Abstracts – Basic

Science and Translational

Research

Moderators: Benjamin Bleier, MD, FARS:

Do-Yeon Cho, MD; Elina Toskala, MD,

FARS

3:30 pm – 3:37 pm

An eosinophil peroxidase activity

assay accurately predicts eosinophilic

chronic rhinosinusitis

Kristine Smith, MD

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

3:38 pm – 3:45 pm

Common cold viruses activate the

unfolded protein response in chronic

rhinosinusitis

Elizabeth Sell, Medical Student

3:46 pm – 3:53 pm

Timing of surgery on tissue IL-13

expression in CRSwNP patients on

dupilumab: A real-world study

Abdul Rahman Alenezi, MD

3:54 pm – 4:01 pm

Glutathione and bicarbonate

nanoparticles improve mucociliary

transport in cystic fibrosis epithelia

Nicholas Rivers, MD

4:02 pm – 4:09 pm

The effects of PM2.5 exposure on the

presentation of acute bacterial

rhinosinusitis

David Grimm, MS

4:09 pm – 4:15 pm

Q&A

4:15 pm – 5:00 pm

Panel: “Maintaining Balance &

Achieving the Quadripartite Mission”

Moderator: Nicholas Rowan, MD

Panelists: Stacey Gray, MD, FARS; Peter

Hwang, MD, FARS; Devyani Lal, MD,

FARS; Rodney Schlosser, MD, FARS;

Sarah Wise, MD, FARS

Sponsored by the Mentorship Committee

Scientific Oral Presentations:

Pathophysiology and Mechanisms

Moderators: Lauren Roland, MD; Nicholas Rowan,

MD; Kristine Smith, MD

8:35 am – 8:40 am

Acetate and propionate metabolism by

Pseudomonas aeruginosa contributes to significant

sinus inflammation in a rabbit model of sinusitis

Do-Yeon Cho, MD

Daniel Skinner, BS

Shaoyan Zhang, PhD

Dong Jin Lim, PhD

Natalie Dorin

Jessica Grayson, MD

Bradford A. Woodworth, MD, FARS

University of Alabama at Birmingham

Background:

Understanding how Pseudomonas aeruginosa adapts

to the in vivo nutritional environment has important

implications for treating airway infection. Anaerobe-

derived nutrient (e.g., acetate(AC), propionate(PR))

acquisition by P. aeruginosa may contribute to its

virulence. This study aims to assess the impact of

Pseudomonas AC and PR metabolism on sinusitis

pathogenesis.

Methods:

Rabbit’s sinuses were infected with wild-type (WT) B.

fragilis 638R on Day 0 after blocking the sinus opening

(n=8). On day 4, either WT P. aeruginosa PA14 or

mutantPA14 (ΔacsAΔprpB, cannot metabolize AC and

PR) was inoculated into the same sinus to induce

co-infection (n=4 each). On day 10, blockage was

removed, and rabbits were monitored for 5 more

weeks. Endpoints included colony-forming units,

computerized tomographic (CT) scores, histology, and

chloride (Cl-) transport capability.

Results:

All rabbits developed fulminant sinusitis by blocking the

sinus opening on day 10. A significant weight loss was

noticed in those rabbits infected with both WT bacteria

(638R+PA14) than with 638R+mutantPA14 on Day 10.

Mutant PA14 demonstrated growth defects relative to

WT PA14 (p=0.02) when grown in co-culture with 638R

at day 10. At week 6, subepithelia were significantly

thicker in those infected with both WT bacteria

(638R+PA14) than with 638R+mutantPA14 (p<0.01).

Sinus potential difference revealed greater Cl- transport

in the 638R+mutantPA14 compared to 638R+PA14

(p<0.05).

Conclusions:

Even with the restoration of sinus oxygenation on day

10, those sinuses infected with PA14 (metabolizing AC

and PR) developed significant tissue inflammation and

decreased Cl- secretion, compared to those infected

with mutantPA14, when co-cultured with WT B. fragilis.

8:41 am – 8:46 am

Identifying 5-hydroxymethylcytosine profiles in cell

free DNA from serum in patients with aspirin

exacerbated respiratory disease

Tiffany Toni

Phillip Hsu, Dr.

Emily Papazian, Dr.

Marco Rivas

Diana West-Szymanski

Arpit Panda

Robert Naclerio, MD

Christopher Roxbury, MD, FARS

Nishant Agrawal, Dr.

Chuan He, Dr.

Jayant Pinto, Dr.

Background:

Aspirin exacerbated respiratory disease (AERD) is an

airway disorder characterized by a proinflammatory

state. Although there are genetic and environmental

contributions, the molecular pathogenesis remains

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

unknown. We hypothesized that patients with AERD

would exhibit specific epigenetic (5-

hydroxymethylcytosine [5-hmC]) profiles, which could

identify dysregulated systemic pathways, aid in

diagnosis, and predict response to therapy.

Methods:

We compared the 5-hmC profiles in adults with AERD

(n=7) compared to control patients (n=6) without

asthma or polyposis; subjects taking systemic steroids

were excluded. Cell free DNA was isolated from

peripheral blood serum and sequenced. Expression

analysis identified differentially hydroxymethylated

genes (DhMGs) and differentially hydroxymethylated

regions (dhmRs). Metascape analysis of the resultant

DhMGs was used to generate a list of statistically

enriched functions.

Results:

AERD and control groups did not statistically differ by

age (AERD 49.4 ± 13.2 vs. 47.0 ± 12.8, p=0.74), sex

(χ2=0.93, p=0.34), race ( χ2=0.07, p=0.97), or smoking

status (χ2=0.03, p=0.85). According to preset criteria,

275 DhMGs and 246 DhMRs were identified. Principle

component and hierarchical clustering analyses

demonstrated distinct clustering of AERD samples

compared to control samples when both DhMGs and

DhMRs were analyzed. The top 20 statistically enriched

terms from Metascape analysis included differential

expression of immune modulators, cellular development

and differentiation, and response to exogenous

damage.

Conclusions:

In this pilot study, we demonstrate that analysis of

differential 5hmC profiles from cell free serum DNA is a

feasible approach to investigate AERD

8:47 am – 8:52 am

Increased staphylococcus abundance in the sinus

microbiome is associated with chronic

rhinosinusitis treatment resistance

David Hoying, BS

Naseer Sangwan, Director of Microbiome Composition

and Analytics Core

Mohamad Chaaban, MD, FARS

Case Western Reserve University School of Medicine

Introduction:

Chronic rhinosinusitis (CRS) significantly affects

patients’ quality of life. There is emerging evidence that

the sinonasal microbiome plays a role in CRS

phenotypes and treatment response. We performed a

microbial analysis of CRS-involved tissue to correlate

response to sinus surgery with the relative abundance

of distinct microbial populations.

Methods:

Using 16rRNA gene sequencing, we characterized the

microbiome of a cohort of adult patients with CRS with

and without polyps with at least bilateral total ethmoid

sinuses involvement undergoing FESS. DAtest was

used for differential abundance analysis using the

random-forest algorithm, and PERMANOVA was

performed on all principal coordinates. Resistance-to-

treatment (RTT) was defined as a less than 20%

reduction in post-operative SNOT-22 score up to four

months post-operatively compared to the pre-operative

baseline SNOT-22.

Results:

In the cohort of 25 CRS patients, there were four

patients with RTT disease (2 CRSsNP; 2 CRSwNP)

and 21 patients with a successful post-operative

response (5 CRSsNP; 19 CRSwNP). There was no

statistical difference in the mean age between the post-

operative responder and non-responder cohorts (48.4

+/- 15 vs. 45.5 +/- 20.6, p=0.80). At the genera level,

the relative abundance of Staphylococcus was

significantly higher in the non-responder groups

compared to the responder groups (p<0.05).

Additionally, Klebsiella was significantly decreased in

the non-responder group (p<0.05). A receiver operating

curve was able to accurately distinguish between

responders and non-responders based on the sinus

microbiome (AUC=0.92).

Conclusion:

The sinus microbiome could be a helpful predictor of

treatment response with FESS.

8:53 am – 8:58 am

Long non-coding RNAs related to extracellular

matrix and proteins are differentially expressed in

chronic rhinosinusitis

Tripti Brar, MBBS, MD

Chantal McCabe, Bioinformatician

Hirohito Kita

Devyani Lal, MD, FARS

Mayo Clinic in Arizona

Background:

Long non-coding RNAs (lncRNAs) are RNA molecules

greater than >200 nucleotides, without protein-coding

capability. They interact with many molecules, regulate

gene expression, genetic imprinting, histone

modification, DNA methylation, posttranscriptional

silencing etc and play a significant role in epigenetic

regulation. A few studies from China, most using pre-

existing GEO datasets, have investigated lncRNAs in

CRS. We performed an original lncRNA study

comparing CRS versus control tissue.

Methods:

RNA extraction and RNA-sequencing was performed

on ethmoid mucosa of 16 CRS subjects and inferior

turbinate mucosa of 4 control subjects. EdgeR software

was used for bioinformatics analysis; FDR<5%, and

log2 fold change >1.5 or <-1.5 was used to

characterize differentially expressed (DE) lncRNAs.

Pathway analysis was done with Metascape™

software.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Results:

Between CRS and controls, 942 DE lncRNAs were

identified; top pathways were Naba core matrisome

[matrisome: ensemble of ≥1000 genes encoding

extracellular matrix (ECM) and ECM-associated

proteins], hydrogen peroxide catabolic process, ECM

organization, sensory perception of bitter taste, and

Naba proteoglycans. CRSwNP versus controls

identified 2803 DE lncRNAs; top pathways were Naba

core matrisome, ECM organization, response to

wounding/burn healing. CRSsNP versus controls

identified 511 DE lncRNAs; top pathways were Naba

core matrisome, neuron projection development, Naba

proteoglycans and oxygen transport.

Conclusion:

DE of lncRNAs with pathways related to ECM matrix,

ECM glycoproteins, collagens and proteoglycans were

identified between controls and CRS. We identified

epigenetic mechanisms through which structural

integrity disruption associated with CRS may occur.

8:59 am – 9:04 am

Comparison between upper and lower airway

microbiome in chronic rhinosinusitis patients

Juan Carlos Hernaiz-Leonardo, MD, MSc

Changwan Ryu

Athenea Pascual, Research Coordinator

Judy Fan

Rogerio Pezato

Don Sin

Andrew Thamboo, MD

University of British Columbia

Background:

Dysregulation of the airway microbiota is thought to

contribute to airway inflammation in both chronic

rhinosinusitis (CRS) and asthma. However, the

relationship between the upper and lower airway

microbiome remains unclear.

Methods:

Sinus and lung swabs were collected from 29 CRS

participants undergoing sinus surgery. DNA was

extracted and submitted for 16s rRNA microbiome

sequencing. Alpha and beta diversity metrics,

taxonomic composition, and differences between

individual taxa were compared for paired sinus and

bronchial samples.

Results:

24 out of 29 participants had sufficient sample for

analysis. The mean (SD) age was 51.59 (14.57) years,

and 13 (40.6%) patients were female. Eighteen (56.3%)

patients had comorbid asthma. Nasal swabs had

significantly higher alpha diversity indexes (Shannon

and Faith) compared to bronchial swabs (p < 0.001).

Beta diversity metrics were not significantly different

between bronchial and nasal samples. However,

principal coordinate analysis showed no clustering of

paired nasal and bronchial samples. Nasal swabs had

significantly more Lawsonella spp., Corynebacterium

spp., and Staphylococcus spp. compared to bronchia

swabs, while the latter were enriched in Sphingomonas

spp. and Bradyrhizobium spp. (FDR adjusted P <0.01).

Finally, CRS patients with comorbid asthma had

significantly higher Pseudomonas spp. and lower

Staphylococcus spp. in nasal swabs and higher

Bradyrhizobium spp. in bronchial swabs compared to

non-asthmatics (FDR-adjusted P <0.01).

Conclusion:

The nasal and bronchial bacterial microbiomes differ in

important ways, with comorbid asthma being a

significant effect modifier. Nasal swabs alone cannot

predict the lower airway microbiome.

9:05 am – 9:15 am

Q&A

9:15 am – 9:45 am

Panel: “Generative Artificial Intelligence in

Rhinology”

Moderator: Chirag Patel, MD, FARS

Panelists: Martin Citardi, MD, FARS; Brian Logo, MD,

FARS; Martin Desrosiers, MD

9:45 am – 10:15 am

Break with Exhibitors

Scientific Oral Presentations: CRS

Impact and Disease Severity

Moderators: Angela Donaldson, MD, FARS; Amber

Luong, MD, PhD, FARS; Toby Steele, MD

10:15 am – 10:20 am

In vivo nasal micro-optical coherence tomography

imaging reveals mucociliary dysfunction in chronic

rhinosinusitis

Kadambari Vijaykumar

Do-Yeon Cho, MD

Huimin Leung

Amilcar Barrios

Bo Liu

Heather Hathorne

George M. Solomon, MD

Guillermo J. Tearney

Steven M. Rowe, Professor

Bradford A. Woodworth, MD, FARS

University of Alabama at Birmingham

Background:

Chronic rhinosinusitis (CRS) is known to be associated

with altered mucociliary transport (MCT). Micro-optical

coherence tomography (μOCT) has been used to

determine cellular and functional dynamics of

respiratory epithelia at the 1-μm resolution, enabling

quantification of ciliary motion and mucus transport.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

This study aims to compare the mucociliary parameters

between healthy controls (HC) and those with CRS,

with and without nasal polyps (CRSwNP, CRSsNP)

using human µOCT imaging.

Methods:

HC and subjects with CRSwNP and CRSsNP were

enrolled. Clinical histories were obtained, and a nasal

exam was performed prior to intranasal µOCT imaging.

Investigators blinded to the subjects’ conditions

analyzed the in vivo µOCT parameters, including

mucociliary transport (MCT), ciliary beat frequency

(CBF), periciliary liquid depth (PCL), airway surface

liquid depth (ASL), and epithelial thickness (ET).

Results:

Six HC participants (age, 38.7±14.5 years) and 16

subjects with CRS (CRSwNP=6 (age, 42.3±13.7years),

CRSsNP=10 (age, 49±4.1years)) were recruited. Of

those with CRSwNP, 100% had a history of allergic

rhinitis, and 67% had asthma. µOCT analysis showed

that MCT rates were significantly lower in the

cumulative CRS group (MCT (mm/min), 4.32±1.2 CRS

vs 6.98±0.9 HC, P< 0.01), and the decrement was

similar in individual CRS groups (CRSsNP:

4.13±1.7mm/min, P< 0.01; CRSwNP:4.68±1.4mm/min,

P=0.051). No differences in other µOCT parameters

were identified between groups.

Conclusion:

In vivo nasal µOCT imaging demonstrated decreased

MCT in CRS patients with and without NP. This novel

imaging method represents a technologic leap forward

and is feasible for assessing acquired MCT defects

impacting the upper airway epithelium.

10:21 am – 10:26 am

Multi-instance learning for eosinophil quantification

of sinonasal histopathology images

Yi-Tsen Li, MD, PhD

Ming-Sui Lee, Associate Professor

Te-Huei Yeh, Professor

National Taiwan University Hospital

Background:

Identification of eosinophilic chronic rhinosinusitis

(CRS) subtype is critical for treatment decision making

and prognosis prediction. Manual counting of

eosinophils distributed in the sinonasal tissues is time-

consuming and labor-intensive. In this study, we aimed

to develop an automatic system for eosinophil

quantification of sinonasal histopathology images using

a deep learning approach.

Methods:

Pathologic images of sinonasal tissues from 40 patients

with bilateral CRS were obtained and the number of

eosinophils was counted and labeled by medical

researchers. These images were randomly divided into

two groups: training and validation. Candidate images

were selected from each whole slide after filtering the

noise area and background. Each candidate image was

divided into patch images and appraised based on

intensity and colors. Through multi-instance learning,

the training data was used for model construction, and

the model was verified by test data.

Results:

A total of 83 whole slide images were processed, and

there were 15153 training patches and 1894 validation

patches. The validation performance was 86.99% in the

mean of baseline and 88.84% by method of confusion.

We compared the experimental results and pathologic

reports, and the testing performance was 90.90% for

the diagnosis of tissue eosinophilia and 91.67% for that

of non-eosinophilia.

Conclusion:

We established computer-assisted eosinophil

quantification of the sinonasal histopathology images.

This quantification system can aid in determining the

immunotypes of CRS and making treatment strategies

for CRS.

10:27 am – 10:32 am

Frailty is an independent predictor of post-

operative rescue medication use after endoscopic

sinus surgery

Andrea Lopez, BS

Kolin Rubel, MD

Rory Lubner, MD

Kristen Yancey, MD

Rakesh Chandra, MD, FARS

Naweed Chowdhury, MD, MPH

Justin Turner, MD, PhD, FARS

Vanderbilt University School of Medicine

Introduction:

The modified 5-item frailty index (mFI-5) is a validated

risk stratification tool for predicting adverse outcomes

following surgery. In this study, we sought to use mFI-5

to assess the potential relationship between unhealthy

aging and postoperative endoscopic sinus surgery

(ESS) outcomes.

Methods:

A retrospective review identified patients who

underwent sinus surgery at Vanderbilt between 2014

and 2018. Patients were assessed using the mFI-5,

which is calculated based on the presence of five

comorbidities: diabetes mellitus, hypertension requiring

medication, chronic obstructive pulmonary disease

(COPD), congestive heart failure (CHF), and non-

independent functional status. Multivariate analyses

were performed to assess the association of mFI-5

score on need for rescue oral antibiotics, oral

steroids, and antibiotic irrigations within one year

following ESS, adjusting for relevant potential

confounders.

Results: Four hundred and three patients met inclusion

criteria. Within 6 months of surgery, 312 (77%)

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

required rescue antibiotics, 243 (60%) required oral

corticosteroids (OCS), and 31 (8%) required

antibiotic rinses. Increasing mFI-5 scores were

significantly associated with higher rates of

postoperative use of rescue antibiotics (p<0.0001),

OCS (p=0.032), and antibiotic irrigation (p<0.0001).

Frailty scores remained as an independent predictor of

these outcomes after adjustment for age, polyp status,

pre-operative sinonasal outcomes test (SNOT-22)

score, and revision surgery status.

Conclusion: Modified frailty scores may be a useful

clinical tool to predict the risk of postoperative rescue

medication use after ESS.

10:33 am – 10:38 am

Cognition and saccadic eye movement

performance are impaired in chronic rhinosinusitis

David Cvancara, BS

Heather Wood

Ashton Lehmann, MD

Waleed Abuzeid, MD, FARS

Ian Humphreys, DO, FARS

Yoshiko Kojima, PhD

Aria Jafari, MD

University of Washington

Introduction:

Patients with chronic rhinosinusitis (CRS) can have

significant cognitive dysfunction. To date, these data

mostly comprise self-reported measurements. The goal

of this study is to utilize objective measures of cognitive

function, including saccadic eye movement

performance, to characterize brain function in patients

with CRS.

Methods:

Subjects were enrolled from rhinology clinic and

underwent sinonasal evaluation and quality-of-life

assessment using Sinonasal Outcome Test-22 (SNOT-

22). Twenty-four subjects met diagnostic criteria for

CRS, and 23 individuals without CRS served as

healthy controls. Cognitive performance was measured

using the Montreal Cognitive Assessment (MoCA) and

established eye movement paradigms (pro-, anti-,

express-, and delayed-saccade tasks) using a video-

based eye tracker.

Results:

Compared to controls, subjects with CRS performed

worse on the MoCA overall and specifically within the

executive functioning, language, and memory domains

(all p<0.05). Forty-two percent of subjects with CRS

demonstrated at least mild cognitive impairment (MoCA

<26). Compared to controls, CRS patients performed

worse on the anti-saccade task with comparatively less

suppression of pro-saccades (62.2% vs. 77.4% correct,

p<0.05), and this performance correlated with SNOT-22

(r=0.32, p<0.05).

Discussion:

This study is the first to utilize objective, researcher-

administered neuropsychiatric assessments to measure

cognitive performance in CRS. CRS significantly

influences cognition across several domains, including

necessary inhibition of reflexive saccades. These

results correlate with sinonasal-specific measures and

suggest impairment in neural pathways that underlie

response to stimuli and inhibitory control.

10:39 am – 10:45 am

Q&A

10:45 am – 10:50 am

Sleep dysfunction is greater in aspirin-exacerbated

respiratory disease than in other forms of chronic

rhinosinusitis

David Cvancara, BS

Ayush Sharma

Dhruv Sharma, MD

Ian Humphreys, DO, FARS

Aria Jafari, MD

Waleed Abuzeid, MD, FARS

University of Washington

Background:

Studies have previously demonstrated that patients

with chronic rhinosinusitis (CRS) experience significant

sleep dysfunction (SD). However, there is a paucity of

literature on SD in aspirin-exacerbated respiratory

disease (AERD). The purpose of this study was to

evaluate the risk and severity of SD in patients with

AERD and to compare this to SD in CRS with

(CRSwNP) and without nasal polyposis (CRSsNP).

Methods:

This cohort study prospectively enrolled adult patients

with CRSsNP (n=223), CRSwNP (n=39), and AERD

(n=32) from an academic tertiary care rhinology clinic.

SD was evaluated using the Neuro-Quality-of-Life

Sleep Function Short Form (Neuro-QOL). Sleep

dysfunction equal to or greater than “moderate” on the

Neuro-QOL is defined as >1.0 standard deviation from

the normalized population mean. Patient demographic

data and additional QOL data were collected using the

SNOT-22, Patient Health Questionnaire-2, and General

Anxiety Disorder-2 tools. Statistical analysis involved

bivariate analysis with the Student’s t-test and

multivariate logistic regression.

Results:

When adjusted for age, sex, SNOT-22 score,

depression, and cognitive function, patients with AERD

had worse Neuro-QOL scores than patients with either

CRSsNP (OR 0.948 95%CI 0.90, 0.99; p=0.02) or

CRSwNP (OR 0.933 95%CI 0.88, 0.98; p=0.016). The

risk of at least moderate SD was significantly greater in

the AERD population than in the CRSsNP (OR 2.9

95%CI 1.2, 6.2;p=0.008) or CRSwNP (OR 2.7 95%CI

1.02, 7.17;p=0.046) groups.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Conclusion:

Compared to patients with CRSsNP and CRSwNP,

patients with AERD reported significantly greater

deficits in sleep. The risk of SD in AERD was

independent of both disease severity and deficits in

mental health or cognition.

10:51 am – 10:56 am

Clinical characteristics and comorbidities

associated with non-eosinophilic chronic

rhinosinusitis

Tripti Brar, MBBS, MD

Shreya Pusapadi Ramkumar

Christopher Dodoo

Claire Yee

Devyani Lal, MD , FARS

Mayo Clinic in Arizona

Background:

Non-eosinophilic CRS (neCRS) is classically believed

to be less recalcitrant than eosinophilic CRS (eCRS).

Studies on neCRS are limited. We compared clinical

characteristics, histopathology, biomarkers and

comorbidities of neCRS versus eCRS.

Methods:

CRS subjects who underwent ESS at a tertiary care

center between 2011-2018 were studied. A cut-off value

of 10 eosinophil counts per high power field (eos/hpf) in

ethmoidal tissue was used to categorize subjects into

neCRS (<10 eos/hpf) or eCRS (≥10 eos/hpf).

Demographics, SNOT-22 and CT scores, tissue

histopathology, blood absolute eosinophil counts

(AEC), serum IgE, urinary LTE4 levels and

performance of subsequent revision ESS was

compared.

Results:

Of 426 CRS subjects, 191 subjects (44.84%) had

neCRS and 235 (55.16%) had eCRS. Patients with

neCRS were significantly older (Mean: 56.3 vs. 50.6

years; p <0.001) with lower pre-operative SNOT-22

score (Median 39.5 vs. 48.0; p <0.001), Lund-Mackay

CT score (Median 9 vs. 13; p <0.001), overall degree of

inflammation (p <0.001), blood AEC (Median 0.1 vs.

0.3; p <0.001) and asthma (39.5% vs. 63.8%; p

<0.0001). Nasal polyps were noted in 27.7% of eCRS

vs. 67.5% of eCRS (p <0.001). Revision ESS rate was

similar in both cohorts. neCRS tissue had significantly

higher lymphocytic predominance (38.2% vs.17%; p

value <0.001) but no differences for fibrosis or

neutrophilia. No significant difference was detected for

gender, depression status, urinary LTE4, serum IgE

and previous ESS history.

Conclusion:

neCRS affects older individuals. Though neCRS

subjects had lower objective and subjective disease

burden, the need for revision ESS was similar to eCRS.

Further characterization of neCRS and recalcitrant

subtypes is warranted.

10:57 am – 11:02 am

Impact of chronic rhinosinusitis local exacerbations

on granulomatosis with polyangiitis disease

progression and systemic exacerbations

Trisha Shang, BA

David Kaelber, Chief Medical Informatics Officer

Mohamad Chaaban, MD, FARS

Case Western Reserve University

Introduction:

Granulomatosis with polyangiitis (GPA) often presents

with chronic rhinosinusitis (CRS), and patients may

receive CRS medication for managing local sinonasal

flares. Our study aimed to determine the impact of CRS

treatment/flares on GPA systemic exacerbations.

Methods:

We used the TriNetX US Collaborative Network

platform to conduct a retrospective study. We searched

for adults with an ICD encounter diagnosis of CRS with

limited GPA (without renal involvement) and with a

RxNorm/HCPCS code for CRS medication (oral

bactrim, mupirocin, or budesonide). Then, we evaluated

outcomes of systemic exacerbation and disease

progression, including ICD encounter diagnoses of GPA

with renal involvement and acute sinusitis, RxNorm/

HCPCS codes of oral corticosteroid and antibiotic

(Augmentin or oral Azithromycin) prescriptions, and

CPT code of sinus surgery, within 1 month-5 years after

patients met all search criteria.

Results:

After a 1:1 propensity match on sex, ethnicity, race,

and age at index, we had 1,417 patients in each cohort.

We found a significantly greater incidence of ICD

encounter diagnosis of GPA with renal involvement

(RR: 2.20, 95% CI [1.61, 3.01]) and of acute sinusitis

(1.33, [1.02, 1.73]), RxNorm/HCPCS code prescriptions

of oral corticosteroids (2.10, [1.66, 2.66]) and antibiotics

(2.40, [1.92, 3.01]), and CPT code of sinus surgery

(2.40, [1.75, 3.29]), in patients prescribed CRS

medication compared to those who were not.

Conclusion:

Sinonasal exacerbations are associated with greater

incidence of GPA systemic exacerbation and disease

progression. Future studies are required to evaluate the

impact of treating local sinonasal flare ups and their

effect on systemic exacerbations and disease

progression.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

11:03 am – 11:08 am

Endotype evaluation of Hispanic/Latinx-American

patients with chronic rhinosinusitis with polyps

Arthur Wu, MD, FARS

Dennis Tang, MD, FARS

Kevin Hur, MD

Aria Jafari, MD

Omar Ahmed, MD, FARS

Philip Chen, MD, FARS

Anna Matthew

Benjamin Tam, Medical Student

Haodong Xu

Luv Amin

David Cvancara, MS4

Cedars-Sinai

Background:

Despite being the largest minority group, Hispanic-

Americans are underrepresented in the scientific

literature in the US. Very little has been presented in

terms of their CRS endotype, presentation, and

outcomes. The goal of this study was to evaluate

clinical factors and pathologic features in Hispanic-

American patients with CRSwNP.

Methods:

A retrospective chart review including five academic

centers was performed to review clinical and pathologic

factors in Hispanic-American patients with CRSwNP.

Preoperative SNOT-22, absolute eosinophil count,

absolute neutrophil count, serum IgE, allergy and

asthma status were reviewed when available. All

patients’ pathology was reviewed for overall degree of

inflammation, eosinophils/high powered field (HPF),

neutrophils/HPF, basement membrane thickening,

subepithelial edema, fibrosis, and fungal elements.

Results:

42 Hispanic-American patients were included in the

study. Using >10 eosinophils/HPF as a cutoff for tissue

eosinophilia, 80% of Hispanic-American patients had

tissue eosinophilia. Preoperative mean SNOT-22 score

was 40.2. Mean absolute eosinophil count was 342

cells/µl with 31% of Hispanic patients having peripheral

eosinophilia (>500 cell/µl). Mean serum IgE levels were

448. Comorbid atopic disease was common in Hispanic

patients (69% allergy, 63% asthma).

Conclusion:

Hispanic-American patients with CRSwNP have a

severe TH2 endotype based on more frequent tissue

and peripheral eosinophilia and common atopic

comorbidities of allergy and asthma. Further studies

are required to investigate this population’s treatment

outcomes and further delineate disease endotypes.

11:08 am – 11:15 am

Q&A

11:15 am – 12:00 pm

Panel: “CRS Endotypes, Subtypes, and

Therapeutics: Where are we and Where are we

Going?”

Moderator: Amber Luong, MD, PhD, FARS

Panelists: Jeremiah Alt, MD, PhD, FARS; Robert

Kern, MD, FARS; Stella Lee, MD; Justin Turner, MD,

FARS

12:00 pm – 1:00 pm

Lunch with Exhibitors

12:00 pm – 1:00 pm

Broadway Ballroom A

Diversity & Inclusion, Women in Rhinology,

Mentorship, Residents & Fellows Combined Lunch

Program

“Breaking Barriers: Insights on Improving Diversity

and the Pipeline in Medicine:

Moderator: Troy Woodard, MD, FARS

Panelists: Andre Churchwell, MD; Kimberly Vinson,

Saturday, September 30, 2023

8:00 am – 12:00 pm

Breakout 2

Skull Base

Broadway Ballroom CD

7:00 am – 8:00 am

Meet the Authors Poster Viewing & Breakfast

Grand View Terrace Foyer, Second Level

Session Chair: Bobby Tajudeen, MD, FARS

8:00 am – 8:30 am

Panel: “Pediatric Skull Base Surgery in the 21

Century: Advances and Frontiers”

Moderator: David Gudis, MD, FARS

Panelists: Nithin Adappa, MD, FARS; Garret Choby,

MD, FARS; Zara Patel, MD, FARS

Sponsored by the Pediatric Rhinology Committee

Scientific Oral Presentations: Skull

Base Surgery

Moderators: Mathew Geltzeiler, MD, FARS; Nyall

London, MD, FARS; Peter Papagiannopoulos, MD

8:30 am – 8:35 am

Mutational landscape and predictors of survival in

head and neck mucosal melanoma

Brandon Lehrich, BS

Arash Abiri, MS

Theodore Nguyen

Edward Kuan, MD, FARS

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Background:

Head and neck mucosal melanoma (HNMM) is a rare

and aggressive malignancy most commonly affecting

the sinonasal tract and oral cavity. The genetic profile

remains poorly understood.

Methods:

We interrogated the publicly available American

Association for Cancer Research (AACR) Genomics

Evidence Neoplasia Information Exchange (GENIE)

database (v13.0-public) which is a cancer registry

collecting de-identified clinico-genomic information

across 19 cancer centers. Kaplan-Meier log-rank test

was used to evaluate differences in overall survival

(OS).

Results:

Of the 6,802 melanoma patients, 108 (1.6%) had

HNMM. The average age of the cohort was 65.6 +/-

14.7 years. The average tumor mutational burden

(TMB) was 6.1 +/- 5.2. The 1-, 2-, and 5-year OS rates

were 84.2%, 69.6%, and 47.5%, respectively. The most

common mutations were NRAS (n=19; 17.6%), NF1

(n=15; 13.9%), ROS1 (n=14; 13.0%), TERT (n=11;

10.2%), and BRAF (n=11, 10.2%). Of the 19 patients

with NRAS mutation, 7 (47.4%) had Q61R mutation, 5

(26.3%) had Q61K mutation, 3 (15.8%) had G12A, and

2 (10.5%) had G12C. There were no differences in OS

for NRAS (p=0.66), NF1 (p=0.41), TERT (p=0.26), and

BRAF (p=0.47) mutated vs wild-type patients. However,

ROS1 mutated patients had improved OS as compared

to wild-type (5-year OS: 76.6% vs 41.8%; p=0.023)

patients. Lastly, there was improved OS for patients

with high vs low TMB (5-year OS: 66.7% vs 35.8%;

p=0.026).

Conclusions:

We identify ROS1 mutation, an actionable driver

oncogene, as a predictor of HNMM OS. Overall, our

findings improve the understanding of the somatic

mutational landscape of HNMM.

8:36 am – 8:41 am

Genomic and clinical analysis of olfactory

neuroblastoma

Theodore Nguyen, BS

Benjamin Bitner, Dr.

Brandon Lehrich, BS

Jonathan Pang, BA

Arash Abiri, MS

Sina Torabi, MD

Edward Kuan, MD, FARS

University of California, Irvine

Introduction:

Olfactory neuroblastoma (ONB) is a rare, malignant

neoplasm arising from the olfactory neuroepithelium

and affecting the sinonasal tract. The goal of this study

is to characterize the genomic pathogenesis of ONB.

Methods:

The American Association for Cancer Research

(AACR) Genomics Evidence Neoplasia Information

Exchange (GENIE) database (v13.0-public) was

queried for genomic and clinical data. Kaplan-Meier

analyses was performed to determine overall survival

(OS). High tumor mutational burden (TMB) was defined

as ≥5 mutations.

Results:

Of the 562 embryonal tumor samples, 31 (5.52%) were

ONB. 12 samples belonged to female patients (38.7%)

and mean age at time of sequencing was

55.97¬¬±2.53 years. Within these samples, 15

(48.39%) were from primary tumors and 13 were from

metastases (41.94%). 1-, 3-, and 5-year OS was

96.2%, 64.9%, and 43.3%, respectively. The average

TMB was 5.0±0.9. When comparing primary tumors vs.

metastases, there was no significant difference in

number of mutations (p=0.491) or fraction of genome

altered (p=0.65). The three most common mutations

were SMARCA4 (n=3, 9.7%), TP53 (n=3, 9.7%), and

mTOR (n=2, 6.5%). There was one patient (3.3%) that

had both SMARCA4 and TP53 mutations. There were

no differences in OS for mTOR (p=0.501) or SMARCA4

(p=0.310) mutated vs. wild-type patients. However,

TP53-mutated patients had worsened OS when

compared to wild-type (5-year OS: 0% vs. 46.2±16.0%;

p=0.021). When comparing high vs. low TMB, there

were no significant differences in OS (p=0.516).

Conclusion:

Understanding the genomic mutational landscape of

ONB may provide insight on potential therapeutic

targets.

8:42 am – 8:47 am

Genomic mutational analysis and predictors of

survival in nasopharyngeal carcinoma

Benjamin Bitner, MD

Theodore Nguyen, BS

Jonathan Pang, BA

Michael Warn, BS

Arash Abiri, MS

Brandon Lehrich, BS

Edward Kuan, MD, FARS

University of California, Irvine

Introduction:

Nasopharyngeal carcinoma (NPC) genetics is poorly

understood limiting development of new effective

therapeutic approaches. The objective of this study is

to report common genetic mutations and impact on

survival.

Methods:

We queried the American Association for Cancer

Research (AACR) Genomics Evidence Neoplasia

Information Exchange (GENIE) database (v13.0-public)

for patient clinico-genomic information and determined

differences in overall survival in patients affected by NPC.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Results:

Of the 2,200 head and neck cancer samples, 107

(4.86%) were NPC. Mean age at time of sequencing

was 51.42±1.32 years. Clinical and sequencing data

included tissue from 37 (34.6%) primary tumors and

from 61 (57%) metastases. Collectively, 1-, 3- and

5-year overall survival (OS) was 93.1%, 60.6%, 40.9%,

respectively. Considering sequencing results, the mean

fraction of the genome altered across samples was

0.19±0.03 with an average tumor mutational burden

(TMB) of 3.94±7.47. When comparing sequenced

tissue from primary tumors and metastases, there was

no difference in number of mutations (p=0.64) or

fraction of genome altered (p=0.66). The three most

common mutations were KMT2D (n=24, 22.4%), TP53

(n=20, 18.7%) and CYLD (n=10, 9.3%). There was no

difference in OS for CYLD mutated vs wild-type

patients (p=0.22). TP53 and KMT2D mutations were

associated with worse OS as compared to wild-type

with a 5-year OS of 0% vs 44.7% (p=<0.001) and

20.5% vs 45.9% (p=0.04), respectively. When

comparing high vs low TMB, there was no significant

difference in OS (5-year OS; 27.8% vs 50.4%; p=0.26).

Conclusion:

NPC is often driven by mutation of tumor suppressor

genes indicating potential targets for future therapeutic

strategies in treating NPC.

8:48 am – 8:53 am

SNOT-22 subdomain outcomes in sinonasal

malignancy: A prospective multi-center study

David Grimm, MS

Daniel Beswick, MD, FARS

Eric Wang, MD, FARS

Nithin Adappa, MD, FARS

Garret Choby, MD, FARS

Mathew Geltzeiler, MD, FARS

Anne Getz, MD, FARS

Ian Humphreys, DO, FARS

Edward Kuan, MD, FARS

Christopher Le, MD, FARS

Peter Hwang, MD, FARS

Background:

Sinonasal quality of life (QOL) after treatment for

sinonasal malignancy (SNM) is poorly characterized.

Our previous work indicates that global sinonasal QOL

improves with SNM treatment. This study aims to

characterize SNOT-22 subdomain outcomes in patients

with SNM.

Methods:

Patients with newly diagnosed SNM were prospectively

enrolled in a multi-center observational patient registry.

Demographics, histopathology, and SNOT-22 scores

were recorded over the pre and post treatment period.

Multivariable regression analysis was used to identify

drivers of variation in SNOT-22 subdomains.

Results:

234 SNM patients underwent treatment with curative

intent, with a mean follow up of 22-months. Rhinologic,

Psychological, and Sleep subdomains improved

significantly vs baseline (all P<0.05) while Extra-Nasal,

and Ear/Facial symptoms did not. Multivariable linear

regression showed that adjuvant chemoradiation was

associated with worse outcomes in Rhinologic

(adjusted odds ratio 2.49 [0.27, 4.72]), Extra-Nasal

(1.85 [0.39, 3.3]) and Ear/Facial (2.47 [0.55, 4.38])

subdomains. Pterygopalatine fossa involvement was

associated with worse outcomes in Rhinologic (3.88

[0.93, 6.96]), Extra-Nasal (1.51 [0.23, 2.78]), Ear/Facial

(3.8 [1.89, 5.70]), and Psychological (2.96 [0.07, 5.85])

subdomains. Positive margins were associated with

worse Psychological outcome (3.98, [0.17-7.79]).

Adjuvant radiation alone was associated with worse

Sleep outcome (1.46 [0.12, 2.81]).

Conclusion:

SNOT-22 improvement in SNM patients after treatment

is driven by Rhinologic, Psychological, and Sleep

subdomains. The degree of improvement is influenced

by chemoradiation, pterygopalatine fossa involvement,

and positive margins.

8:53 am – 9:00 am

Q&A

9:00 am – 9:05 am

Tranexamic acid in endoscopic sinus and skull

base surgery: A systematic review and meta-

analysis

Sarah Khalife, MD

Zahra Abdallah, BHsc, Medical Student

Phillip Staibano, Resident Physician

Kelvin Zhou, Resident Physician

Thomas Boi Vu Nguyen, Rhinology Fellow

Doron Sommer, MD

Objective:

Endoscopic sinus surgery (ESS) and endoscopic skull

base surgery (ESBS) approaches have revolutionized

the management of sinonasal and intracranial

pathology. Maintaining surgical hemostasis is essential

as bleeding can obscure visibility of the surgical field,

thus increasing surgical duration, risk of complications

and procedural failure. Tranexamic acid (TXA) acts to

reduce bleeding by inhibiting fibrin degradation. This

review aims to assess whether TXA improves surgical

field quality and reduces intraoperative blood loss

compared to control.

Methods:

We searched PubMed, MEDLINE, Embase, Web of

Science, and Cochrane Library from inception until

September 1, 2022. Two reviewers independently

screened citations, extracted data, and assessed

methodological quality using Cochrane Risk-of-Bias 2.

Data was pooled using a random effect model, with

continuous data presented as mean difference and

dichotomous data presented as Odds Ratio.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Results:

Seventeen ESS RCTS (n = 1377) and one ESBS RCT

(n = 50) were reviewed. Significant improvement in

surgical field quality was achieved with both systemic

TXA (six studies, p < 0.00001) and topical TXA (six

studies, p = 0.01) compared to control. Systemic TXA

(eight studies) and topical TXA (three studies) both

achieved a significant reduction in intraoperative blood

loss compared to control (p< 0.00001). There were

significant differences in operative times (p < 0.001) but

no significant difference in perioperative outcomes (p =

0.30).

Conclusion:

This meta-analysis demonstrated that utilization of TXA

in ESS can improve surgical field quality and reduce

intraoperative blood loss. TXA use did not result in

increased perioperative complications including

thrombotic events.

9:06 am – 9:11 am

The use of aprepitant to reduce postoperative

nausea and vomiting in endoscopic skull base

surgery

Daniel Lee, MD, FRCSC

Jennifer Douglas, MD

Jeremy Chang

Jadyn Wilensky

Christina Jackson

John Lee, MD

M. Sean Grady

Daniel Yoshor

Michael Kohanski, MD, PhD

James Palmer, MD, FARS

Nithin Adappa, MD, FARS

University of Pennsylvania

Introduction:

Postoperative nausea and vomiting (PONV) are

adverse effects following surgery, which may increase

the risk of complications, particularly in endoscopic

skull base surgery. Aprepitant is a neurokinin-1 receptor

blocker, which reduces PONV in other surgical

disciplines. However, its role in endoscopic skull base

surgery remains unclear. The objective of this study

was to investigate the effect of aprepitant in PONV

following endoscopic skull base surgery.

Methods:

A retrospective chart review between July 2021 and

February 2023 of 221 consecutive patients who

underwent endoscopic transsphenoidal surgery (TSA),

extended endonasal approach (EEA), transcribriform

approach or spontaneous CSF leak repair (sCSF).

Primary outcome was the incidence of PONV.

Secondary outcome measures included the number of

anti-emetic use, length of stay and postoperative CSF

leak.

Results:

Out of 221 patients (114 in aprepitant and 107 in non-

aprepitant), there were 162 in TSA, 34 in EEA, 8 in

transcribriform and 17 in sCSF cohorts. There were no

baseline demographic differences across all the groups.

In the overall cohort, the aprepitant group had a

significantly lower incidence of postoperative vomiting

than the non-aprepitant group (1.8% vs. 21.5%,

p<0.001). This trend was shown similarly in both TSA

and EEA groups. Anti-emetic use decreased with

aprepitant use in the TSA group (p<0.05). There was a

trend towards decreased length of stay with aprepitant

in the EEA group (4.8 vs. 9.8 days, p=0.07).

Multivariate analysis demonstrated aprepitant

decreased the incidence of postoperative vomiting with

odds ratio of 0.064.

Conclusion:

Aprepitant may serve as a useful preoperative

treatment to reduce PONV in endoscopic skull base

surgery.

9:12 am – 9:17 am

Predictors of prolonged length of stay following

intradural endoscopic skull base surgery

Jonathan Pang, BA

Madelyn Frank, BA

Kelsey Roman, BS

Jinho Jung, BS

Arash Abiri, MS

Theodore Nguyen

Benjamin Bitner , MD

Frank Hsu, MD, PhD

Edward Kuan, MD, fARS

University of California, Irvine

Background:

Establishing benchmarks for length of stay (LOS) may

inform strategies to reduce nosocomial infections,

improve resource efficiency, and decrease costs. We

explore factors contributing to postoperative LOS in

intradural endoscopic skull base surgery (ESBS).

Methods:

Retrospective chart review was conducted at a tertiary

academic skull base surgery program including

consecutive adult patients who underwent ESBS with

intraoperative cerebrospinal fluid (CSF) leak and

primary repair between July 2018 and February 2023.

LOS comprised the primary outcome and was

calculated as time between end of anesthesia to

discharge from hospital.

Results:

150 patients were included, with mean LOS of 6.7 ± 9.7

days. LOS did not differ significantly between high-flow

(n=86) and low-flow (n=64) CSF leak cohorts (7.0 ± 8.6

vs. 6.4 ± 11.0 days, p=0.697). Defects of the anterior

cranial fossa (n=24, 8.0 ± 12.7 days), suprasellar

region (n=64, 7.6 ± 9.8 days), sella (n=104, 6.3 ± 8.5

days), and posterior cranial fossa (n=13, 5.1 ± 3.0

days) had variable LOS (p=0.657). On multiple linear

regression, after controlling for numerous patient,

surgical, and postoperative factors, extended approach

(B[95%CI]=4.27[0.91, 7.62]), length of bedrest

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

(B=1.80[0.32, 3.29]), postoperative stroke

(B=17.09[7.33, 26.85]), postoperative pneumonia/

aspiration (B=5.07[0.06, 10.08]), and postoperative

hypernatremia (B=4.23[0.25, 8.21]) independently

predicted prolonged LOS.

Conclusion:

With healthcare utilization receiving increased attention,

understanding and mitigating factors that extend LOS

is important. The current study identified surgical

approach, bedrest duration, and certain postoperative

complications as key factors prolonging LOS in

intradural ESBS.

9:18 am – 9:23 am

Quality of life among patients undergoing

endoscopic pituitary gland resection with and

without middle turbinectomy

Narin N. Carmel Neiderman, MD, MSc

Orr Raved

Shay Kaufman

Anat Wengier

Avraham Abergel

TASMC

Introduction:

The endoscopic approach to skull base lesions is

considered less aggressive, and associated to

improved tumor related and nasal related quality of life.

However, there is an ongoing literature debate

regarding 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 life in patients undergoing endoscopic

endonasal resection of pituitary tumors with or without

middle turbine preservation.

Materials and Methods:

Prospective cohort study of all patients with pituitary

adenomas who underwent trans-sphenoidal surgery at Tel

Aviv Sourasky Medical Center between 2014 and 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 3-6 months post-operatively.

Results:

Our study included 56 patients, 46 patients underwent

middle turbinectomy and 10 did not. The overall score

difference of pre and post ASBS-Q score did not alter

significantly between both groups (0.15±0.64 among

those who underwent middle turbinectomy vs

0.19±0.74 among those who did not; p=0.87). SNOT-22

score 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

significant deterioration in nasal and tumor related QOL

in the post-operative course.

9:23 am – 9:30 am

Q&A

9:30 am – 9:45 am

Targeted Conversations on Important Topics: Next

Generation Sequencing in Skull Base Surgery

Moderator: Sanjeet Rangarajan, MD, FARS

Panelists: Corinna Levine, MD, FARS; Peter

Papagiannopoulos, MD

9:45 am – 10:15 am

Break with Exhibitors

Scientific Oral Presentations:

Rhinology Potpourri

Moderators: Charles Ebert, MD, FARS; Edward Kuan,

MD, FARS; Charles Tong, MD, FARS

10:15 am – 10:20 am

Stellate ganglion block for post-COVID-19

parosmia: Does it work?

Bita Naimi, BA

Emily Garvey, BA

Megha Chandna, BS

Alexander Duffy, MD

Stephanie Hunter, PhD

Marc Rosen, MD, FARS

Mindy Rabinowitz, MD, FARS

Elina Toskala, MD, MBA, PhD, FARS

Adam Zoga, MD, MBA

Gurston Nyquist, MD, FARS

David Rosen, MD

Thomas Jefferson University Hospital

Aim:

Evaluate stellate ganglion block (SGB) as a treatment

option for post-COVID olfactory dysfunction (OD) and

parosmia.

Methods:

Retrospective study of patients who underwent

unilateral (SGB1) or bilateral (SGB2) SGB for post-

COVID OD. Patients completed Brief Smell

Identification Tests (BSIT) before and after treatments,

and a post-treatment survey investigating subjective

symptom improvement.

Results:

43 patients with post-COVID OD underwent SGB. 30

patients had pre- and post-SGB BSIT scores (mean

OD duration 1.93 ± 0.52 years); 19 patients completed

surveys (mean OD duration 1.91 ± 0.46 years). Mean

BSIT pre-SGB was 8.10 ± 2.40, post-SGB1 8.76 ±

2.41, and post-SGB2 9.00 ± 1.58, with no significant

change in scores (p=0.224). Subjective parosmia

severity on a scale from 1 (not present) to 10 (worst)

improved from preSGB (8.95 ± 1.18) to SGB1 (6.37 ±

2.73) and to SGB2 (5.70 ± 2.45); differences were

significant from preSGB to SGB1 (p<0.001) and

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

preSGB to SGB2 (p<0.001). On a scale of 1 (not

present) to 5 (worst), there was a significant decrease

in distorted tastes (median preSGB 4.0 vs. postSGB

3.0, p=0.003), unpleasant odors in the nose (3.0 vs.

2.0, p=0.0042), unpleasantness of smells (3.0 vs. 2.0,

p=0.012), and number of parosmia triggers (4.0 vs. 3.0,

p=0.002) after the procedure (SGB1 or SGB2). After

SGB, patients reported significantly improved ability to

enjoy food (5.0 vs. 2.0, p=0.001), ability to prepare

meals (4.0 vs. 2.0, p=0.002), weight maintenance (4.0

vs. 2.0, p=0.002), and upkeep of personal hygiene (2.0

vs. 1.0, p=0.008).

Conclusion:

SGB may significantly improve subjective parosmia and

QOL for patients with post-COVID OD. Large placebo-

controlled trials are needed to further investigate this

treatment

10:21 am – 10:26 am

Stellate ganglion block for the treatment of COVID-

19-induced olfactory dysfunction: A prospective

pilot study

Andrew Peterson, MD, MSCI

Brevin Miller, Medical Student

Dorina Kallogjeri, MD

Aara Kukuljan, Manager, Division of Clinical Research

Jay Piccirillo, MD

John Schneider, MD, MA

Lauren Roland, MD, MSCI

Lara Crock, MD

Nyssa Farrell, MD

Washington University School of Medicine/Barnes

Jewish Hospital

Background:

There are few effective treatments for COVID-19-

associated olfactory dysfunction (OD), but anecdotal

evidence and case reports describe success with the

use of stellate ganglion blocks (SGBs). The objective of

this study was to explore the effectiveness and safety

of SGBs for the treatment of persistent COVID-19-

induced OD.

Methods:

In this single-arm, prospective pilot trial, adult

participants with a COVID-19 diagnosis ≥ 12 months

prior to enrollment with OD underwent bilateral SGBs.

Subjects were followed for 1 month after completion of

SGB. The primary outcome measure was the change

in 7-point Likert Clinical Global Impression -

Improvement scale for smell loss. Secondary outcome

measures included change in University of

Pennsylvania Smell Identification Test (UPSIT) and

Olfactory Dysfunction Outcomes Rating.

Results:

Twenty participants were enrolled with a mean (SD)

age of 46 (11) years and a mean (SD) duration of OD

of 21 (5) months. At 1-month, 10 (50%) participants

experienced at least slight subjective improvement in

their OD, 11 (55%) attained a clinically meaningful

improvement in smell identification using the UPSIT,

and 7 (35%) achieved a clinically meaningful

improvement in olfactory-specific QOL. The median

difference between UPSIT scores at baseline and

1-month was 6 (95% CI, 3 to 11), exceeding the MCID

of 4. There were no serious adverse events.

Conclusion:

This study found that sequential SGBs for COVID-19-

associated OD were safe and resulted in modest

improvements in subjective olfaction, odor identification,

and olfactory-specific QOL. A larger, placebo-controlled

trial is warranted to determine the efficacy of SGBs for

COVID-19-associated OD

10:27 am – 10:32 am

Sinonasal pathogenic bacteria in patients with

diabetes mellitus

Trisha Shang, BA

David Kaelber, Chief Medical Informatics Officer

Mohamad Chaaban, MD, FARS

Case Western Reserve University

Introduction:

Diabetes mellitus (DM) is known to affect the

microbiome and lower airway inflammation. Our study

aims to examine how DM can impact the development

of chronic rhinosinusitis (CRS) and its microbiome.

Methods:

We conducted a retrospective study using the TriNetX

US Collaborative Network platform. We searched for

adults that had an outpatient visit noted by CPT codes

who had one or more ICD encounter diagnosis of DM

and ever had an HbA1c ≥ 6.5% in their LOINC code.

We compared them to adults who had an outpatient

visit and were never diagnosed with DM and never had

HbA1c ≥ 6.5%. We evaluated an outcome of CRS

encounter diagnosis by ICD code and detection of

Staphylococcus aureus, Haemophilus influenzae, and

Pseudomonas aeruginosa in the nose or cultured

specimens by LOINC code. All outcomes were 1 month

to 5 years after patients met all search criteria.

Results:

After performing a 1:1 propensity match for sex, age at

index, and race, there were 1,770,623 patients in each

cohort. Those with DM were significantly more likely

than those without DM to have a CRS encounter

diagnosis (Risk Ratio: 1.86, 95% CI [1.84, 1.89]). They

were also significantly more likely to have the presence

of S. aureus (3.96, [3.77, 4.16]) detected in nose

samples, and P. aeruginosa (13.32, [10.38, 17.11]), and

H. influenzae (3.58, [3.01, 4.25]) detected in specimen

samples than those without DM.

Conclusion:

Patients with DM have a greater risk of developing

CRS and S. aureus, P. aeruginosa, and H. influenzae

infection than patients without DM. Further studies are

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

needed to determine mechanisms behind the

development of a pathogenic sinonasal microbiome in

patients with DM.

10:33 am – 10:38 am

The Role of CCL19 and atypical cytokine receptor

CCRL1 in chronic rhinosinusitis

Chengetai R. Mahomva, MD

Prince A.B. Minkah

Kristine Smith, MD

Gretchen Oakley, MD, FARS

Richard Orlandi, MD, FARS

Jeremiah Alt, MD, PhD, FARS

Abigail Pulsipher, MD

University of Utah

Background:

Chemokine CCL19 has been shown to predict disease

severity in COVID-19 and treatment response in

rheumatoid arthritis. CCL19 exerts both pro- and anti-

inflammatory effects and can be degraded by receptor

CCRL1. CCL19 is elevated in chronic rhinosinusitis

(CRS) but its role in CRS is unknown. This study seeks

to characterize the gene transcriptional changes of

CCL19, its receptors, and associated cytokines and

their correlations with disease severity in CRS.

Methods:

An established database was examined for patients

with CRS and controls. Controls with asthma and

allergy were excluded. mRNA was extracted from

ethmoid tissues and subjected to multiplex gene

expression analysis. Enrollment Lund-Kennedy, Lund-

Mackay, Sinonasal Outcomes Test 22 (SNOT-22), and

Rhinosinusitis Disability Index (RSDI) scores were

collected. Gene transcripts copy numbers were

compared to controls and correlated to disease

severity.

Results:

Thirty-eight subjects (n=7 control; n=31 CRS) were

included. CCL19, CCRL1, and TNFA were significantly

elevated in CRS compared to controls (p<0.05).

CCL19 expression was positively correlated with IL1B

and TNFA expression (p<0.05). TNFA expression was

positively correlated with SNOT-22 and RSDI scores

(p<0.03). CCL19 expression was positively correlated

with SNOT-22 but did not reach significance (p=0.067).

CCRL1 expression was inversely correlated with RSDI

(p=0.027).

Conclusion:

In CRS, CCL19 and CCRL1 may modulate TNF-α

driven pro-inflammatory signaling cascades and may

be predictive markers of disease severity. Further

mechanistic studies are needed to determine the

functional consequences of CCL19 and CCRL1 and

whether they can be identified as potential therapeutic

targets in CRS.

10:39 am – 10:45 am

Q&A

10:45 am – 10:50 am

Real-world comparison of nasal obstruction

outcome scores between medial flap turbinoplasty

and inferior turbinate submucous resection during

concurrent septorhinoplasty

Milinds Vasudev, BS

Amir Hakimi

Ashley Lonergan

Shannen Guarina

Sina Torabi, MD

Allison Hu

Theodore Nguyen, BS

Edward Kuan, MD, FARS

Brian Wong

University of California, Irvine

Objectives:

To compare longitudinal improvement in nasal

obstruction quality-of-life outcomes between medial flap

turbinoplasty (MFT) and inferior turbinate submucous

resection (SMR) concurrently performed with functional

septorhinoplasty.

Methods:

Retrospective review of a prospectively collected cohort

of patients undergoing functional septorhinoplasty

between 2015 to 2022 at a tertiary academic center.

Outcomes were assessed using the Nasal Obstruction

Symptom Evaluation (NOSE) questionnaire

preoperatively and over 12 months postoperatively.

Results:

373 patients were analyzed with longitudinal NOSE

questionnaires. Of these, 298 underwent SMR and 75

underwent MFT. The proportion of intraoperative

techniques including rim graft, spreader graft, auto-

spreader graft, intradomal sutures, interdomal sutures,

and alar spanning sutures were similar between the

two cohorts (p>0.05). Patients in all surgical groups

had a statistically and clinically significant improvement

in NOSE scores between their preoperative and

postoperative follow-up visits (p<0.001). MFT patients

had higher NOSE scores 1 month post-op (40.0 ± 30.5

vs. 31.0 ± 27.97; p=0.017), but lower scores after 10

months (15.2 ± 13.3 vs. 25.4 ± 23.5; p=0.036).

Similarly, patients in the MFT cohort in primary

rhinoplasty procedures reported higher scores initially

but lower after 10 months (p=0.024). Men in the MFT

cohort reported significantly better NOSE outcomes

than the SMR cohort, as early as 4 months post-

surgery and sustained throughout the follow-up period

(10.6 ± 12.3 vs. 22.6 ± 21.4; p=0.012).

Conclusion:

MFT may offer better long-term nasal breathing

outcomes compared to SMR for functional rhinoplasty

patients based on superior long-term NOSE scores.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

10:51 am – 10:56 am

Cadaveric and computed tomography analysis of

the arterial supply and mucosal dimensions of the

anterior ethmoid artery flap

Lane Donaldson, MD

John Craig, MD, FARS

Robert Deeb

Background:

The anterior ethmoid artery (AEA) flap has been

successful for repairing anterior septal perforations, and

has been presumed to be axially based from AEA

branches traversing the cribiform plate (CP). However,

limited evidence supports the flap’s axial supply. The

purposes of this cadaveric and computed tomography

(CT) study were to assess the arterial anatomy from

the CP to the septum, and to determine AEA flap length

to predict ideal flap base width should the flap be

random instead of axial.

Methods:

Ten fresh latex-injected cadavers were utilized for

endoscopic dissection to identify arteries traversing the

CPs on each side. First, arterial trajectories along the

septum from the CP were recorded. Measurements

were then made bilaterally along the septum from the

middle turbinate (MT) axilla to the first dominant artery

traversing the CP. Additionally, 100 sinus CTs were

reviewed to measure AEA flap lengths bilaterally.

Results:

From the 10 cadavers, 20 sides were utilized for

measurements. In all cadavers the AEA arterial

branches coursed along the septum diagonally or

horizontally, and never directly vertically from the CP.

The mean distance from the MT axilla to the first artery

traversing the CP was 1.24 ± 1.93 cm (range=1-1.5

cm). Based on CT, mean AEA flap length was 6.39 ±

5.95 cm.

Conclusions:

Based on the non-vertical courses of AEA septal

branches, the AEA flap is more likely a random

transposition flap. Assuming a 3-4:1 length:width ratio,

a flap base width of 1.5-2.5 cm may be necessary to

supply the AEA flap.

10:57 am – 11:02 am

Posterior nasal nerve ablation for management of

postnasal drip: A single center case series

Daniel Gorelik, Research Fellow

Yuki Yoshiyasu, Resident

Samuel Razmi, Medical Student

Masayoshi Takashima, MD, FARS

Omar Ahmed, MD, FARS

Houston Methodist Hospital

Background:

Postnasal drip (PND) is a common concern among

patients with chronic rhinitis and is multifactorial in

nature. Posterior nasal nerve (PNN) ablation is an

option for chronic rhinitis refractory to medical therapy

to typically treat symptoms of nasal congestion,

rhinorrhea, nasal itching and sneezing. The purpose of

this study is to review the efficacy of PNN ablation

among patients that report PND as their primary

symptom.

Methods:

Patients with chronic rhinitis undergoing PNN ablation

at a single institution were reviewed from January 2022

to January 2023. Patients who reported PND as a

primary concern were included in the case series.

Wilcoxon signed-ranks test was used to compare

patients with SNOT-22 pre- and post-procedure

assessments of PND.

Results:

105 chronic rhinitis patients underwent PNN ablation,

with 37 (35.2%) patients treated for a primary concern

of postnasal drip. Follow-up data was available for 31

patients and median follow up was 51 days (IQR,

42-128). 22 (71.0%) patients underwent radiofrequency

neurolysis and 9 (29.0%) patients underwent

cryotherapy ablation. 25/31 (80.6%) patients noted

subjective improvement at follow up. 11 (35.5%)

patients were refractory to reflux treatment. Ten

patients had pre- and post-procedure SNOT-22

assessments of PND. Mean SNOT-22 PND score

significantly improved during follow-up assessment (4.3

vs. 2.1, p=.006).

Conclusion:

Our experience identified that PND is a primary

concern in a substantial portion of chronic rhinitis

patients and PNN ablation may offer an effective

treatment option. This is the first study to look at the

use of PNN ablation for PND as a primary symptom.

Larger studies are needed to further assess the role of

PNN ablation for PND management.

11:03 am – 11:08 am

Insurance influence and reimbursement on

common rhinological procedures

Tyler Janz, MD

Masayoshi Takashima, MD, FARS

Diane Bernahl, MHA

Michael Yim, MD, FARS

Murugappan Ramanathan, MD, FARS

Omar Ahmed, MD, FARS

University of Texas Medical Branch, Galves

Background:

Rhinology procedures are often reimbursed via

healthcare insurance.

However, healthcare insurance’s role in both the

reimbursement and denial of common rhinology

procedures remains unknown. Thus, the goal of this

study is to better understand both initial denials and

final write-offs of procedures and encounters within an

academic rhinological practice.

Methods:

A retrospective chart review was conducted of patients

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

who underwent rhinological intervention at a tertiary

medical center from January 1, 2021 to January 1,

2023. Descriptive statistics and frequencies were then

calculated using SPSS 28.0 (IBM Corporation, Armonk,

NY).

Results:

After analysis, 21,767 procedures and encounters were

identified within the study. Of all rhinological procedures

and encounters, 2293 were initially denied (10.53%

denial rate). In-office procedures accounted for 59.4%

of denials. Final denials resulted in an estimated $190,

956.04 revenue lost. The three most costly denied

procedures were: 1. Posterior Nasal Nerve Ablation

(-$47363.20), 2. Nasal Endoscopy with Debridement/

Polypectomy (-$21456.51), and 3. Diagnostic Nasal

Endoscopy (-$17337.87). Blue Cross-Blue Shield,

Medicare, and AETNA had the highest percentage of

denials for the above procedures.

Conclusion:

This study demonstrates the extremely complex nature

of insurance processing and approval for common

rhinological procedures and encounters. A moderate

percentage of rhinological procedures and encounters

were denied even at a high-volume tertiary center

which accounted for a large loss in revenue. Rhinology

practices must continue to remain knowledgeable of

the changes and effects of insurance reimbursement

on their practice.

11:08 am – 11:15 am

Q&A

11:15 am – 12:00 pm

Panel: “Postoperative Care in Skull Base Surgery:

CPAP, Debridement, Rinses and More!”

Moderator: Mathew Geltzeiler, MD, FARS

Panelists: Nyssa Farrell, MD; Edward Kuan, MD,

FARS; Mindy Rabinowitz, MD, FARS; Bobby Tajudeen,

MD, FARS

Sponsored by the Skull Base and Orbital Surgery

Section

12:00 pm – 1:00 pm

Lunch with Exhibitors

12:00 pm – 1:00 pm

Broadway Ballroom A

Diversity & Inclusion, Women in Rhinology,

Mentorship, Residents & Fellows Combined Lunch

Program

“Breaking Barriers: Insights on Improving Diversity

and the Pipeline in Medicine:

Moderator: Troy Woodard, MD, FARS

Panelists: Andre Churchwell, MD; Kimberly Vinson,

Saturday, September 30, 2023

8:00 am – 12:00 pm

Breakout 3

Business of Medicine/Clinical

Rhinology

Broadway Ballroom GH

7:00 am – 8:00 am

Meet the Authors Poster Viewing & Breakfast

Grand View Terrace Foyer, Second Level

Session Chair: Greg Davis, MD, FARS

8:00 am – 8:30 am

Panel: “Setting Up and Maximizing an ASC for

Success”

Moderator: Douglas Reh, MD, FARS

Panelists: Karen Bednarski, MD, FARS; Leah Hauser,

MD; Michael Sillers, MD, FARS

Sponsored by Rhinologists in Private Practice Section

Scientific Oral Presentations: Sinus Surgery and

Postop Therapies

Moderators: Chadi Makary, MD, FARS; Katie Phillips,

MD; William Yao, MD, FARS

8:30 am – 8:35 am

Outcomes and histopathologic features for chronic

rhinosinusitis macrolide responders

Madelyn Frank, BA

Nyein Nyein Htun, Dr

Beverly Wang, Dr

Edward Kuan, MD, FARS

University of California, Irvine

Background:

Macrolides, though classified as antimicrobial drugs,

are known to have anti-inflammatory properties.

Patients with chronic rhinosinusitis (CRS) without

eosinophilic predominance have been proposed as

potential macrolide responders (MR). The aim of this

study is to evaluate outcomes and histopathological

findings of CRS patients who were MR.

Methods:

Patients that received bilateral comprehensive sinus

surgery for CRS followed by steroid irrigations were

retrospectively reviewed. 10 patients were identified as

potential MR and received low-dose azithromycin for

>6 months. 34 patients were included as controls.

Presumed macrolide response was made based on

tissue eosinophil count <10/HPF and persistent mucus

complaints despite steroid irrigations. Resected sinus

tissue was evaluated using structured histopathology.

Results:

MR were older (54.4±16.9 vs 49.1±17.3; p<0.001) and

had a lower rate of asthma (10% vs 62%; p=0.01).

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

There was no difference in gender and smoking history

(p>0.05). Histopathological differences between MR

and controls included tissue eosinophil count (5.3± 8.4

vs 24.5±16.0; p<0.001), basement membrane

thickening (40% vs 79%; p=0.04), subepithelial edema

(4% vs 29%; p=0.03), fibrosis (60% vs 12%; p=0.006),

and eosinophilic aggregates (20% vs 70%; p=0.01).

The MR group had lower preoperative SNOT-22 scores

(39.4 vs 46.2; p<0.001), though there was no difference

in subdomains (all p>0.05). At 12 months

postoperatively, both groups had comparable degree of

subjective improvement (-27.2 vs -27.0, p=0.864).

Conclusion:

Despite initial modest improvement with surgery and

steroid irrigations, MR, who have noted histopathologic

features, eventually achieve comparable outcomes to

other CRS subtypes.

8:36 am – 8:41 am

Outcomes of “full-house” versus limited

endoscopic sinus surgery for chronic rhinosinusitis

patients

Shreya Ramkumar, BS

Tripti Brar, Dr

Claire Yee

Michael Marino, MD, FARS

Amar Miglani, MD

Devyani Lal, MD , FARS

Background:

The extent of endoscopic sinus surgery (ESS) for CRS

is often chosen at the surgeon’s discretion. This study

investigates outcomes from full-house (bilateral

maxillary, ethmoid, sphenoid, and frontal sinusotomy)

vs. limited ESS (anything not full-house) performed by

a single surgeon. We study indications and outcomes

of limited vs. full-house ESS.

Methods:

Adult CRS patients who underwent ESS between 2010

to 2018 were retrospectively reviewed. Demographics,

Lund-Mackay CT scores, SNOT-22 scores,

histopathology, and subsequent revision ESS were

analyzed (SAS version 9.04).

Results:

In the study period, 556 patients underwent ESS; 290

underwent full-house and 266 underwent limited ESS.

Median CT score correlated significantly with

performance of full-house vs. limited ESS (13 vs. 8,

p<0.001). Median SNOT-22 score between full-house

(44) and limited ESS (40) was not clinically different.

SNOT-22 improvement at 6 and 12 months was not

significantly different between cohorts (p=0.22) by

repeated measures ANOVA. Significantly more

CRSwNP patients (62.4% vs. 24.4%, p<0.001)

underwent full-house ESS. Overall, 21 patients (7.2%)

underwent revision ESS in full-house vs. 20 (7.5%) in

limited ESS, a non-significant difference (p=0.9).

Limited ESS patients with eosinophil count <10/high-

powered-field were more likely than full-house (11.5%

vs.5.6%) to undergo revision ESS. Rates of revision

ESS were similar for those undergoing limited vs. full-

house for both CRSwNP (6.2% vs.7.2%) and CRSsNP

(8.0% vs.7.3%).

Conclusion:

CT scores appeared to correlate strongly with the

extent of surgery. With this approach, no significant

differences in SNOT-22 scores and revision rates were

found between those undergoing full-house vs. limited

ESS.

8:42 am – 8:47 am

Factors impacting follow-up care in allergic fungal

rhinosinusitis

Jorge Gutierrez, BA

Sofia Khan, BS

Nikita Chapurin

Rodney Schlosser, MD, FARS

Zachary Soler, MD, FARS

Medical University of South Carolina

Introduction:

Allergic fungal rhinosinusitis (AFRS) is associated with

high rates of revision surgery and requires long term

medical management. The purpose of this study was to

analyze barriers to medical care and follow up in

patients with AFRS.

Methods:

Subjects with AFRS and a chronic rhinosinusitis with

nasal polyps (CRSwNP) comparison were

prospectively recruited for completion of the Barriers to

Care Questionnaire (BCQ) and chart review.

Results:

Fifty-nine AFRS and fifty-one CRSwNP patients

participated. AFRS patients were more likely to be lost

to follow up within 6 months of surgery (35.6% vs.

17.7%, p=0.04) and no-show for at least one

appointment (20.3% vs. 5.9%, p=0.03) compared to

CRSwNP patients. Men with AFRS were more likely to

have a single follow-up visit (37.0% vs. 3.1%, p<0.001)

and be lost to follow-up within 6 months (66.7% vs.

9.4%, p<0.001) than women. There were no significant

differences in the BCQ between groups; however, rate

of questionnaire completion was lower in the AFRS

group than the CRS group (62.7% vs 80.4%, p=0.042).

AFRS patients who did not complete the BCQ were

more likely to be male (63.6% vs. 35.1%, p=0.034), lost

to follow-up (77.3% vs. 10.8%, p<0.0001), and have a

single follow up visit (40.9% vs. 5.4%, p<0.0001).

Decreasing age was associated with increased

likelihood of having a single follow-up visit (odds ratio

1.143, 95% CI 1.022-1.276).

Conclusion:

Young, male AFRS patients are more frequently lost to

follow-up after surgery and less likely to complete

questionnaires assessing barriers to care. Further

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

investigation is needed to assess barriers to follow-up

and optimize post-surgical treatment in these at-risk

groups.

8:48 am – 8:53 am

Efficacy of early postoperative debridement in

sinonasal cavity healing after functional

endoscopic sinus surgery: A randomized controlled

trial

Juan Carlos Hernaiz-Leonardo, MD, MSc

Bader M. Alim

Marwan Alqunaee, Dr.

Athenea Pascual, Research Coordinator

Judy Fan

Amin R. Javer, MD, FARS

University of British Columbia

Background:

Postoperative debridement (PD) after functional

endoscopic sinus surgery (FESS) is frequently

recommended and performed to improve the healing

process and prevent scar tissue (ST) formation. PD

can be uncomfortable and painful for patients.

Methods:

This open label randomized controlled trial determined

whether PD decreased ST formation compared to

rinsing alone after FESS. We recruited adult patients

with chronic rhinosinusitis (CRS) undergoing primary

FESS. Patients with secondary causes of CRS, primary

immunodeficiencies, or who underwent limited sinus

surgery (i.e., middle meatal antrostomy) were excluded

from the trial. The primary outcome was the presence

of ST at 3 months post FESS. Secondary outcomes

included middle turbinate (MT) lateralization, need for

in-office ST excisions, and revision surgery.

Results:

Ninety-six patients met inclusion criteria for the trial.

The mean age (SD) was 53(16) years, and 64(68%)

were male. Fifty-three patients were randomized to

early (i.e., within six days) PD and 43 received no

debridement. At three months follow-up, 14(33%) non-

debrided patients developed ST compared to 21(40%)

of PD patients (RR 1.21; 95%CI 0.71 - 2.09; p = 0.48).

Six (14%) non debrided patients had MT lateralization

compared to 13(24%) PD patients (RR 1.76; 95%CI

0.73 - 4.23; p = 0.21). Five (12%) non-debrided

patients required an in-office intervention compared to

10(19%) of PD patients (p = 0.35). One patient in the

no-debridement arm required revision FESS compared

to two patients in the PD group (p = 0.74).

Conclusion:

PD does not reduce the incidence of ST formation after

FESS. If PD is necessary, we would advise against

aggressive instrumentation given the high incidence of

ST postoperatively.

8:53 am – 9:00 am

Q&A

9:00 am – 9:05 am

The effect of low-dose long-term doxycycline on

postoperative outcomes in patients with

eosinophilic chronic rhinosinusitis

Jin Young Min, MD, PhD

Hye Kyu Min

Hyun Ji Lee

Suk Ju Ryu

Kyung Hee University School of Medicine

Objective:

Doxycycline (Dc) is a broad-spectrum bacteriostatic

antibiotic of the tetracycline class, which also has anti-

inflammatory action including reduction of ECP and

MMP-9, and antibiotic activity against S.aureus. The

purpose of this study was to investigate the effect of Dc

on postoperative outcomes in CRS patients.

Methods:

Of the CRS patients who underwent ESS from 2020 to

2021 December, 43 adult patients (18 patients taking

Dc after ESS for average 12weeks [200mg loading

dose, then 100mg daily] and 25 patients without Dc)

showing eosinophilic CRS were enrolled in this study.

Subjective symptoms (SNOT-22), postoperative

endoscopic scores (Lund-Kennedy score), and

olfactory outcome were compared between Dc-taking

group and Dc-free group to investigate the effect of Dc

on postoperative outcomes.

Results:

Compared to patients without Dc, there was a

significant improvement in total scores of SNOT-22 in

patients with Dc postoperatively (27.3±5.4 vs 18.7±7.7,

P=0.04). When we assessed 22 individual symptoms,

statistically significant decreases were found in

symptoms including post-nasal discharge and cough

(all, P<0.05). Additionally, patients with Dc had

significantly better outcomes in postoperative

endoscopic scores regarding mucosal edema,

compared to those without Dc (P=0.03). However, no

significant differences were observed in postoperative

olfactory outcomes between the two groups.

Conclusions:

Doxycycline may have a beneficial role for

postoperative disease control status in eosinophilic

CRS.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

9:05 am – 9:10 am

High dose ciprofloxacin and azithromycin sinus

stent for the treatment of chronic rhinosinusitis

Do-Yeon Cho, MD

Dong Jin Lim, PhD

Daniel Skinner, BS

Shaoyan Zhang, PhD

Jessica Grayson, MD

Bradford A. Woodworth, MD, FARS

University of Alabama at Birmingham

Background:

Previously, a novel double-coated sinus stent

containing ciprofloxacin (CPF, inner layer) and

azithromycin (AZT, outer layer) (CASS) was developed

but released drug concentrations were found to be

insufficient for clinical usage. This study aims to

improve drug release of CASS by increasing the

concentrations of the two drugs and to assess its safety

in the preclinical rabbit model.

Methods:

To create the CASS with 2mg CPF and 5mg AZT, dip-

coating was used. Scanning electron microscopy

(SEM) confirmed a uniformed double coating and

allowed for visualization of the release patterns of both

drugs, which were assessed over 14 days in saline

solution. The safety of the CASS was addressed using

the preclinical rabbit model through evaluating nasal

endoscopy, histology, and biomarkers before and after

CASS placement.

Results:

SEM confirmed the uniformity of the dual coating of

CPF and AZT and thickness (µm) was found to be

14.7+/-2.4 and 28.1+/-4.6, respectively. The inner

coated ciprofloxacin showed a sustained release over

14 days (release %) when soaked in saline solution

(Day 7, 86.2+/-3.4 vs. Day 14,99.2+/-5.1, n = 3). In vivo

analysis showed that after seven days, 53.1+/-8.2% of

CPF and 44.4+/-3.4% of AZT were released into the

sinus (n = 3). There were no significant differences in

body weight, white blood cell counts, and total protein/

albumin levels before and after CASS placement. Mild

subepithelial edema was noticed in the medial wall of

maxillary sinuses with CASS placement.

Conclusion:

These findings suggest that the CASS stent is an

effective method for delivering therapeutic levels of

antibiotics for CRS. Further studies are needed to

validate the efficacy of the stent in a preclinical model.

9:10 am – 9:15 am

Quantification of retained budesonide dose from

high-volume saline irrigation in post-operative

chronic rhinosinusitis

Paige Shipman, MS1

Kristine Smith, MD

Bhuvanesh Yathavan

Amarbir Gill, MD

Chelsea Pollard

Venkata Yelleppedi

Hamidreza Ghandehari

Abigail Pulsipher, Dr.

Jeremiah Alt, MD, PhD, FARS

University of Utah

Background:

Budesonide high volume saline irrigations (HVSI) are

used ubiquitously to treat chronic rhinosinusitis (CRS)

due to improved sinonasal delivery and efficacy

compared to intranasal corticosteroids sprays. The off-

label use of budesonide is assumed to be safe, with

several studies suggesting the systemically absorbed

dose of budesonide HVSI is low. However, the actual

dose of budesonide to the sinonasal cavity following

HVSI is unknown. The objective of this study was to

further quantify the retained dose of budesonide HVSI.

Methods:

Adult patients with CRS who had undergone

endoscopic sinus surgery (ESS) and had been

prescribed budesonide HVSI were enrolled in a

prospective, observational cohort study. Patients

performed budesonide HVSI (0.5 mg dose) under

supervision in an outpatient clinic and the irrigation

effluent was collected. High-performance liquid

chromatography (HPLC) was used to determine the

dose of budesonide retained after HVSI.

Results:

Twenty-four patients met inclusion criteria. The average

retained dose of budesonide across the cohort was

0.221 mg (SD=0.087, 42%). Increased time from ESS

significantly impacted the retained dose, with those <90

days day post-ESS retaining 56% of administered

budesonide and those >90 days post ESS retaining

32% (p=0.0004).

Conclusion:

The retained dose of budesonide HVSI was found to be

significantly higher than previously estimated and

decreases with time since ESS. Given that budesonide

HVSI is a cornerstone of care in CRS, defining the

retained dose and the potential systemic implications is

critical to understanding the safety of budesonide HVSI.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

9:15 am – 9:20 am

Medication adherence with intranasal corticosteroid

irrigations

Jorge Gutierrez, BA

Christian Shannon

Nikita Chapurin, MD

Rodney Schlosser, MD, FARS

Zachary Soler, MD, MSc, FARS

Medical University of South Carolina

Introduction:

The purpose of this study was to investigate real world

adherence to intranasal corticosteroid irrigations using

pharmacy data and assess factors associated with low

adherence.

Methods:

Patients undergoing treatment with corticosteroid

irrigations for any diagnosis during a 2-year period

were prospectively recruited. Subjects completed a

one-time set of questionnaires including the Barriers to

Care Questionnaire (BCQ), 22-item Sino-Nasal

Outcome Test (SNOT-22), and a questionnaire

assessing their experience with corticosteroid

irrigations. Pharmacy data was used to calculate the

Medication Possession Ratio (MPR), a measure of

medication adherence graded from 0 to 1, with 1

indicating the patient possessed the medication 100%

of days in an observed period.

Results:

Seventy-one patients were enrolled. Patients diagnoses

included chronic rhinosinusitis (CRS) without nasal

polyps (n = 37), CRS with nasal polyps (n = 24), or a

non-CRS diagnosis, most commonly chronic rhinitis (n

= 10). The MPR for the overall group was 0.44 ± 0.33.

Just 9.9% of patients had a perfect MPR of 1. Despite

low MPR, only 19.7% of patients reported problems

taking the medication when directly asked. Lower

education resulted in lower MPR (unstandardized B =

0.065, p = 0.046). Increasing BCQ score, indicating

higher barriers to care, was associated with lower MPR

(unstandardized B = –0.010, p = 0.033). The lower the

MPR, the worse patient SNOT-22 scores

(unstandardized B = -15.980, p = 0.036).

Conclusion:

Adherence to corticosteroid irrigations was low and

patients underreported issues with their medication.

Education and barriers to care were associated with

lower adherence which, in turn, was associated with

worse sinonasal quality of life.

9:20 am - 9:25am

Evaluation of LYR-220 corticosteroid matrices at

week 24 from the BEACON study in CRS

Brent Senior, MD, FARS

Vineeta Belanger, PhD

Randall Ow, MD, FARS

M. Scott Major

Stacey Silvers, MD, fARS

Jeffrey Rosenbloom, MD

Lindsay Brayton, Clinical Project Manager

Marina Mihova

Ela Sajjadi, Clinical Research Scientist

Richard Nieman

Robert Kern, MD, FARS

Background:

Endoscopic sinus surgery often fails to directly manage

the underlying inflammation in chronic rhinosinusitis

(CRS), resulting in symptom recurrence within the first

year following surgery in a significant number of

patients. Thus, there is a need for long-acting, local,

anti-inflammatory treatments for these patients. LYR-

220, a corticosteroid matrix being developed to provide

up to 24 weeks of treatment for CRS patients who have

had prior ethmoid surgery, showed promising early

feasibility data in the six patients enrolled in the

uncontrolled Part 1 of the Phase 2 BEACON study.

Here we report the primary analysis of safety and

efficacy of LYR-220 through week 24 from the

randomized, blinded, controlled Part 2 of the BEACON

study.

Methods:

Forty-two symptomatic adult subjects with CRS who

had prior bilateral ethmoidectomy were successfully

enrolled in the multicenter, blinded, randomized,

controlled Part 2 of the two-part BEACON study.

Subjects were randomized 1:1 to receive bilateral

administration of LYR-220 or sham-procedure. Primary

analysis from the 24-week treatment period included

summarization of adverse events and analyses of

change from baseline in SNOT-22 and the composite

score of the 3 cardinal symptoms of CRS (3CS; nasal

blockage, nasal discharge, and facial pain) through

week 24.

Results:

To be presented at the 69th Annual Meeting of the

ARS.

Conclusions:

To be presented at the 69th Annual Meeting of the

ARS.

9:25 am – 9:30 am

Q&A

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

9:30 am – 9:45 am

Targeted Conversations on Important Topics:

Correct Coding for Office-Based Rhinology Surgery

– Do’s and Don’ts

Moderator: R. Peter Manes, MD, FARS

Panelists: Seth Brown, MD, FARS; Toby Steele, MD

9:45 am – 10:15 am

Break with Exhibitors

Scientific Oral Presentations:

Diagnosis of Rhinosinusitis and QOL

Measures

Moderators: Jean Kim, MD, FARS; Victoria Lee, MD,

FARS; Mindy Rabinowitz, MD, FARS

10:15 am – 10:20 am

Development and validation of the sinonasal

endoscopic score (SINES) for chronic

rhinosinusitis

Juan Carlos Hernaiz-Leonardo, MD, MSc

Bader M. Alim

Athenea Pascual, Research Coordinator

Khalid Aldossari

Judy Fan

Saada Alsaleh, MBBS

Amin R. Javer, MD, FARS

University of British Columbia

Background:

Although there are several endoscopic grading systems

for chronic rhinosinusitis (CRS), they are limited in their

range and applicability. We aimed to develop and

validate a SiNonasal Endoscopic Score (SiNES)

applicable to all CRS subtypes and investigate its

correlation with patient-reported outcome measures

(PROMs).

Methods:

We recruited 79 CRS patients from two referral centres

from September 2021 to February 2022. Each patient

underwent a sinonasal endoscopy and completed

multiple PROM questionnaires, including SNOT-22 and

symptoms-specific VAS scores. Videos were graded

using the SiNES and modified Lund-Kennedy (MLK)

scores by three independent rhinologists.

Inter-rater and test-retest reliability were assessed via

the Intraclass correlation coefficient (ICC). SiNES and

MLK scores were correlated with PROMs using a

Spearman correlation.

Results:

The mean (SD) age was 54 (15) years, and 41 (51%)

were female. Inter-rater reliability was excellent for the

SiNES (ICC [95% CI]: 0.91 [0.87 to 0.94]) and good for

the MLK score (ICC [95% CI]: 0.82 [0.73 to 0.88]). Test-

retest reliability was excellent for both systems (ICC >

0.9 for all reviewers). No correlation was seen between

endoscopic scores and SNOT-22 or VAS scores.

However, olfactory cleft edema assessed using the

SiNES system was moderately correlated with self-

reported olfactory loss (rho 0.44, p < 0.001).

Conclusions:

The SiNES system is an accurate and reliable grading

framework applicable to any type of CRS. It can be

utilized in clinical and research settings and improves

upon previously published systems.

10:21 am – 10:26 am

Patient perspectives on recall period and response

options in patient-reported outcome measures for

chronic rhinosinusitis symptomatology: An

international multi-centered study

Ahmad Sedaghat, MD, PhD presented by Katie

Phillips, MD

Armo Derbarsegian

Victor Yu

Ahmed Alsayed, MBBS

Benjamin Bitner , MD

David Liu, MD

Sven Schneider

Sarah Adams

Firas Houssein

Zoe Walters

Sidhant Tripathi, Medical Student

University of Cincinnati College of Medicine

Background:

Existing patient-reported outcome measures (PROMs)

for chronic rhinosinusitis (CRS) use a variety of recall

periods and response scales to assess CRS symptom

burden. The global perspectives of CRS patients

regarding recall periods and response scales for CRS

PROMs are unknown.

Methods:

This was a multi-center, cross-sectional study recruiting

461 patients from sites across the United States, Saudi

Arabia, New Zealand, and Austria. Participants chose

which CRS symptom recall period (1 day, 2 weeks, 1

month, >1 month) was most reflective of their current

disease state and upon which to best base treatment

recommendations (including surgery) upon.

Participants also chose which of six response scales

(one visual analogue scale and five Likert scales

ranging from 4–8 items) was easiest to use,

understand, and preferred.

Results:

A plurality of participants (40.0%) felt the current state

of their CRS symptoms was best reflected by a 1

month recall period. However, most patients (56.9%)

preferred treatment recommendations to be determined

by symptoms experienced over a >1 month period.

The four- and five-item Likert scales were the easiest to

use (26.2% and 25.3%, respectively) and understand

(23.6% and 26.6%, respectively). The five-item (26.4%

rating it most preferred and 71.0% rating it preferred)

and four-item Likert (22.5% rating it most preferred and

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

56.4% rating it preferred) response scales were also

most preferred.

Conclusion:

Future PROMs for CRS symptoms should consider

assessment of symptoms over a one-month period and

use a four- or five-item Likert response scale to reflect

global patient preferences.

10:27 am – 10:32 am

The surprising impact of priming on the SNOT-22

Ibtisam Mohammad, MD

Stack Taylor, Student

Meghan Nicole Norris

Meredith Alexandria Meyer, Student

Sulgi Kim, Student

Adam Kimple, MD, FARS

Abdullah Zeatoun, Researcher

Cristine N. Klatt-Cromwell, MD

Charles Ebert, Jr., MD, MPH, FARS

Brian D. Thorp, MD, FARS

Brent A. Senior, MD, FARS

UNC

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:

206 consecutive patients with chronic rhinosinusitis

(CRS) and CRS with nasal polyps and chronic rhinitis

were blinded and randomized to be positively primed

(103)or negative primed (103)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 49 and in

the positively primed group 22, a significant difference

of 27 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.

10:33 am – 10:38 am

Nasal symptoms, medication usage, nasal

endoscopy and patient perspectives as

determinants of physician assessment of chronic

rhinosinusitis control

Ahmad Sedaghat, MD, PhD presented by Katie

Phillips, MD

David Caradonna, MD, FARS

Rakesh Chandra , MD, FARS

Christine Franzese, MD, FARS

Stacey Gray, MD, FARS

Ashleigh Halderman, MD, FARS

Claire Hopkins, MBChB, PhD

Edward Kuan, MD, FARS

Jivianne Lee, MD, FARS

Edward McCoul, MD, FARS

Erin O’Brien, MD, FARS

University of Cincinnati College of Medicine

Background:

Herein, we identify CRS manifestations associated with

how rhinologists assess CRS control, with a focus on

patient perspectives (patient-reported CRS control).

Methods:

Fifteen rhinologists were provided with real-world data

from 200 CRS patients. Rhinologists first classified

patients’ CRS control as “controlled”, “partly controlled”,

and “uncontrolled” using 7 CRS manifestations

reflecting European Position Paper on Rhinosinusitis

and Nasal Polyps (EPOS) CRS control criteria (nasal

obstruction, drainage, impaired smell, facial pain/

pressure, sleep disturbance, use of systemic

antibiotics/corticosteroids in past 6 months, and nasal

endoscopy findings) and patient-reported CRS control.

They then classified patients’ CRS control without

knowledge of patient-reported CRS control.

Results:

CRS control classification was highly consistent across

rhinologists. Rhinologist-assessed CRS control agrees

with patient-reported CRS control significantly better

when rhinologists have knowledge of patient-reported

CRS control than not (kw=0.736 vs. kw=0.554,

p<0.001). Patient-reported CRS control, nasal

obstruction, drainage, and endoscopy findings were

most greatly associated with rhinologist-assessed CRS

control. Rhinologist-assessed control weakly agreed

with EPOS guidelines. Rhinologists classified CRS as

more controlled than EPOS guidelines in almost 50%

of cases.

Conclusions:

This study directly demonstrates the importance of

patient-reported CRS control as a dominant influence

on rhinologists’ CRS control assessment. Knowledge

of patient-reported CRS control may better align

rhinologists’ CRS control assessments and treatment

decisions with patients’ perspectives.

10:39 am – 10:45 am

Q&A

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

10:45 am – 10:50 am

Variation in computed tomography opacification in

sinus disease: A snapshot in time

Glen D’Souza, MD

Thomas Jefferson University Hospital

Aim:

To investigate the variability in paranasal sinus

opacification on serial CT scans in patients with chronic

rhinosinusitis (CRS) or recurrent acute rhinosinusitis

(RARS).

Methods:

A retrospective longitudinal study involving adult

patients who underwent functional endoscopic sinus

surgery (ESS) for CRS or RARS and had at least 2

preoperative CT scans of the paranasal sinuses were

included. We excluded patients with prior ESS or

interval ESS between scans. We graded the 1st (CT1)

and 2nd CT (CT2) images using Zinreich modified

Lund-McKay staging system (ZLMS) and assessed the

change in overall and individual sinus scores between

time points.

Results:

Ninety-five patients were included with a median (IQR)

age of 51.9 (31.7) years and 59 (62.1%) females. The

median (IQR) time interval between imaging studies

was 103 (329) days, and the median (IQR) change in

ZLMS was 3.0 (7.5) between time points. Overall, 28

(29.5%) patients showed an interval change in their

overall ZLMS between time points with a median (IQR)

change of 5.0 (7.3). On assessment of individual sinus

scores, 83 (87.4%) patients had a change in score

between time points with 19 (20.0%) patients having a

score change of 2. On comparison of CT 1 and 2, 35

(36.8%) patients showed change from some to no

opacification within a sinus while 30 (31.6%) showed

change from no opacification to some opacification

within a sinus.

Conclusions:

CT scans provide valuable information on the state of

sinuses on the day they were taken, but the pathology,

such as mucosal thickening and opacification change

from day-to-day. While vital for surgical planning, CT

scans should not be the sole indicator for

recommending ESS or determining extent of surgery for

sinonasal disease.

10:51 am – 10:56 am

Determining the minimal clinically important

difference for the questionnaire of olfactory

disorders in people with Cystic Fibrosis and factors

associated with improvement after highly effective

modulator therapy

Jessa Miller, MD

Jennifer Taylor-Cousar, Professor

Jonathan Overdevest, MD

Aastha Khatiwada, Assistant Professor

David Gudis, MD, FARS

Jeremy Tervo, Medical Student

Emily DiMango, Professor

Claire Keating, Associate Professor

Douglas Li, Associate Professor

Jeremiah Alt, MD, PhD, FARS

Daniel Beswick, MD, FARS

University of California, Los Angeles

Introduction:

Olfactory dysfunction (OD) is a common comorbidity in

people with cystic fibrosis (PwCF). The Questionnaire

of Olfactory Disorders-Negative Statements (QOD) is a

validated olfactory outcome measure. The QOD

minimal clinically important difference (MCID) and

factors associated with improvement after highly

effective modulator therapy (elexacaftor/tezacaftor/

ivacaftor (ETI)) have not been determined for PwCF.

Methods:

Prospective observational data was pooled from 7

institutions evaluating PwCF and chronic rhinosinusitis

(CRS). QOD scores and disease characteristics were

assessed. To evaluate internal consistency and

calculate the MCID, Cronbach’s alpha and 4

distribution-based methods were employed,

respectively. For participants who enrolled prior to

starting ETI, QOD scores were also obtained both at

baseline and after ETI initiation. We used multivariable

regression to identify factors associated with QOD

improvement after ETI.

Results:

This study included 123 PwCF, 65 of whom received

ETI. Mean QOD score at baseline for all participants

was 6.5 (standard deviation (SD)=8.0). Mean

Cronbach’s alpha was >/=0.90. The mean MCID

calculated via distribution-based methods was 3.7

points. Of the 65 PwCF who received ETI, the mean

QOD score after ETI was 4.1 for the cohort (SD=5.8).

After ETI, QOD score improvement (decrease)

surpassed the MCID in 22% of participants (14/65).

Worse baseline QOD scores and presence of nasal

polyps were associated with improved QOD scores

after ETI (both p<0.035).

Conclusion:

QOD scores have strong internal consistency among

PwCF. QOD scores are relatively low and have a mean

MCID of 3.7 in PwCF. Worse baseline QOD scores and

nasal polyps were associated with improvement after

ETI.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

10:57 am – 11:02 am

Optimization of diagnostic and procedural codes to

identify patients with acute invasive fungal sinusitis

Marie-Ange Munyemana, BA

Omar Ahmed, MD, FARS

Dorina Kallogjeri, MD

Lauren Roland, MD

Washington University in St. Louis

Introduction:

Acute invasive fungal sinusitis (IFS) is a rare disease

with high mortality. Research on IFS has been limited

to small case series and the absence of a designated

international classification of disease code (ICD) has

hindered the use of administrative databases. This

study proposes a novel method to accurately identify

IFS cases using diagnostic and procedural codes

complimented by medications.

Methods:

We identified IFS patients from 2018 to 2022 using

Washington University of St. Louis’s pathology

database. Combinations of diagnostic and procedural

codes were used to query medical records through

EPIC’s data exploration tool, Slicer Dicer. Identified

cases were refined by combination of diagnostic codes

and medications to optimize diagnostic accuracy. Each

iteration of this model was compared to pathology

database. Sensitivity, specificity, and predictive value

were evaluated.

Results:

A total of 44 pathology proven cases were identified.

The highest performing model for detecting IFS was an

algorithm requiring immunocompromised, sinusitis, and

fungal infection ICD codes, presence of sinus surgery

codes and systemic antifungal for 10 days following

sinus surgery, or until time of death. This optimized

model had a positive predictive value of 92%(80%-

98%), classified positive cases with sensitivity of

80%(66%-84%) and negative cases with specificity of

88%(72%-96%).

Conclusion:

Individuals with IFS can be identified with high

sensitivity and specificity by optimizing diagnostic and

procedural codes with duration of antifungal

administration. This model can be applied to large

database studies with high accuracy and is

generalizable for identifying disease states for other

conditions that lack designated ICD codes.

11:03 am – 11:08 am

Impact of recurrent acute rhinosinusitis on quality

of life

Chadi Makary, MD, FARS

Jack Dewey, MD

Zayd Al-Asadi, BS

Dominic Lombardo, BS

Hassan Ramadan, MD, FARS

West Virginia University

Background:

Recurrent sinusitis is a common reason for referral to

otolaryngologists. Differential diagnosis includes

chronic rhinitis (CR), recurrent acute rhinosinusitis

(RARS), and chronic rhinosinusitis (CRS).

Goal:

To study the impact of RARS on the quality-of-life

(QoL) of patients.

Materials and methods:

Cross sectional analysis of patients referred to West

Virginia University from August 2020 to October 2022

for complaints of recurrent/chronic sinusitis was

performed. These patients were divided into RARS,

CRS, or CR according to published guidelines.

Patients’ characteristics, endoscopy scores, and SNOT-

22 scores were collected at their presentation.

Results:

80 patients with RARS were compared to 336 CRS,

and 530 CR patients. Patients with RARS had similar

age to CRS and CR patients (48.8 vs 49.9 vs 46 years

respectively, p=0.237), and were more likely to be

female (72.5% vs 49.4 % vs 64.5% respectively,

p=0.02). Median endoscopy scores in RARS patients

were smaller than CRS but higher than CR (0

[IQR=3,0] vs 4 [IQR=6,3] vs 0 [IQR=0,0]; p<0.0001).

Total SNOT-22 scores in RARS patients were similar to

CRS patients but higher than CR patients (45.9+/-17.8,

vs 41.7+/-20.9, vs 36.9+/-18.5 respectively, p=0.03).

RARS patients had similar rhinological and

extrarhinological domains to CRS patients but worse

than CR patients (p=0.038). Ear/facial domain in RARS

was worse than both CRS and CR patients (p=0.0009).

There were no differences in the sleep and

psychological domains among the three groups.

Conclusion:

QoL in RARS patients is affected similarly to CRS

patients although the objective burden of disease in

these patients is lower.

11:08 am – 11:15 am

Q&A

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

11:15 am – 12:00 pm

Panel: “How to Build a Rhinology Clinical Niche in

a Comprehensive ENT Practice”

Moderator: Greg Davis, MD, FARS

Panelists: Mary Ashmead, MD; Michael Cruz, MD,

FARS; Christopher Davis, MD; Michael Setzen, MD,

FARS

Sponsored by Rhinologists in Private Practice Section

12:00 pm – 1:00 pm

Lunch with Exhibitors

12:00 pm – 1:00 pm

Broadway Ballroom A

Diversity & Inclusion, Women in Rhinology,

Mentorship, Residents & Fellows Combined Lunch

Program

“Breaking Barriers: Insights on Improving Diversity

and the Pipeline in Medicine:

Moderator: Troy Woodard, MD, FARS

Panelists: Andre Churchwell, MD; Kimberly Vinson,

Saturday, September 30, 2023

1:00 pm – 5:00 pm

General Session

Broadway Ballroom GHJK

1:00 pm – 1:15 pm

ARS Business Meeting and Presidential Citations

Sarah Wise, MD, FARS; Michael Stewart, MD, FARS;

Pete Batra, MD, FARS

1:15 pm – 2:00 pm

Hwang Family Lectureship

“The Meaningfulness of Paying It Forward: My

40-Year Journey”

Introduction: Richard Orlandi, MD, FARS

Guest Speaker: Donald Lanza, MD, FARS

Scientific Oral Presentations: Nasal

Polyps and Biologics

Moderators: Elisa Illing, MD, FARS; Kenneth

Rodriguez, MD; Abtin Tabaee, MD, FARS

2:00 pm – 2:05 pm

Medication use for chronic rhinosinusitis with

nasal polyps (CRSwNP) pre and post dupilumab

Emily Garvey, BA

Bita Naimi, BA

Alexander Duffy, MD

Chase Kahn, MD

Douglas Farquhar, MD

Marc Rosen, MD

Mindy Rabinowitz, MD

Damaris Pena Evertz, MD

Jessica Most, MD

Elina Toskala, MD, MBA, PhD, FARS

Gurston Nyquist, MD, FARS

Introduction:

This study examines the impact of dupilumab on total

medication use for patients with chronic rhinosinusitis

with nasal polyposis (CRSwNP) and comorbid asthma.

Methods:

Retrospective review of patients with CRSwNP and

asthma at Thomas Jefferson University Hospital

(TJUH). Patients 18 years > and treated at TJUH for at

least one-year pre and post dupilumab initiation were

included. Outcome measures included inhaled

corticosteroid dosage, oral steroid dosage, topical/oral

antibiotics, nasal steroid sprays/rinses, and leukotriene

receptor antagonists (LTRA).

Results:

40 patients met inclusion criteria. The average age at

the time of biologic therapy initiation was 50.81 +/-

16.02 years. 32.5% of the cohort was male. In the year

after dupilumab initiation, patients required significantly

fewer oral steroids for asthma (pre: 800.95 mg +/- 1285

vs. Post: 393.59 mg +/- 932.52, p=0.02) and CRS

exacerbations (pre: 511.67 mg +/- 623.70 vs. Post:

91.03 mg +/- 155.76, p<0.001). Patients also required

fewer antibiotic prescriptions for CRS exacerbations

(3.08 prescriptions +/- 2.45 vs. 0.85 prescriptions

+/-1.29, p<0.001). Fewer patients required leukotriene

receptor antagonists (LTRA) p=0.01 and nasal steroid

sprays (p=0.05). There was no difference in steroid

rinses (p=0.59), or topical antibiotics(p=0.52). There

was also no difference in the number of patients on

high, medium, or low dosed inhaled corticosteroids

(p=0.54).

Conclusion:

Initiation of dupilumab for patients with CRSwNP and

asthma had a significant impact on medication use

including oral antibiotics, LTRA, and oral steroids for

both indications. This is the first study to examine

comprehensive medication use in patients with

CRSwNP and asthma while on dupilumab.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

2:06 pm – 2:11 pm

Nasal nitric oxide to compare endoscopic sinus

surgery versus dupilumab for CRSwNP

Daniel Lee, MD, FRCSC

Giovanni Paoletti

Gaia Giuletti

Elysia Grose

Roberto Pinto

Enrico Heffler

John Lee, MD

University of Pennsylvania

Introduction:

There is a need for real-life comparative data between

endoscopic sinus surgery (ESS) and dupilumab for

patients with chronic rhinosinusitis with nasal polyposis

(CRSwNP). The objective of our study was to compare

the outcomes of ESS and dupilumab using nasal nitric

oxide (nNO) as a biomarker of mucosal health, Lund-

Kennedy endoscopy score (LKES), and Sino-nasal

Outcome Test-22 (SNOT-22).

Methods:

A prospective observational cohort of CRSwNP patients

who underwent endoscopic sinus surgery followed by

standard postoperative therapy was compared with

another prospective cohort of CRSwNP patients who

underwent dupilumab therapy. In addition to baseline

characteristics, nNO production levels, LKES and

SNOT-22 levels were compared between the two

cohorts at 1-month and 6-month post-treatment.

Results:

A total of 28 and 37 patients were included in the ESS

cohort and the dupilumab group, respectively. At

1-month and 6-month post-treatment, nNO levels were

comparable between two groups. Compared to

baseline, the ESS cohort showed improvement of nNO

improvement at 1-month post-treatment, while the

dupilumab group did not. At 6-month post-treatment,

both groups exhibited significant improvement of nNO

levels. Similar trend was observed in LKES. SNOT-22

was improved at both 1-month and 6-month post-

treatment compared to baseline.

Conclusion:

ESS and dupilumab confer comparable benefits in

terms of changes in nNO, symptoms and endoscopy

findings at 6-months post-treatment. ESS may result in

more rapid improvement of the outcomes than

dupilumab as evidenced by the 1-month post-treatment

values.

2:12 pm – 2:17 pm

Quantifying Patient Preferences for Treating Nasal

Polyps: Biologics vs. Surgery

Somtochi Okafor, MD

Jessie Sutphin, Ms

Arjita Deb, Dr.

Jonathan Bernstein, Dr

Jui-Chen Yang, Ms

Matthew Wallace, Mr

Ralph Abi Hachem, MD

Shelby Reed, Prof

David Jang, MD, FARS

Duke University

Background:

Biologics are a relatively new treatment alternative to

revision endoscopic sinus surgery (ESS) for patients

with chronic rhinosinusitis with nasal polyps (CRSwNP).

Patient preferences for biologics vs ESS have not been

studied systematically. We conducted a discrete-choice

experiment (DCE) to quantify preferences for treatment

features and outcomes in CRSwNP.

Methods:

Subjects with CRSwNP and at least 1 previous ESS,

completed a DCE survey comprised of 72

experimentally-designed choice sets. In 12 randomly

assigned sets, subjects chose between 2 treatment

options or no additional treatment. 4 features likely to

influence patient decision-making were included:

treatment type (biologic or ESS), oral steroid courses/

year (0,1,2), symptom severity (none, mild, moderate),

and probability of severe symptoms returning within 2

years (10%,30%,40%). Data were analyzed using

mixed-logit (ML) and latent-class analysis (LCA).

Results:

ML (N=195) showed symptom severity had the highest

relative importance weight. LCA revealed 3 unique

classes. Class 1 (53% membership probability)

prioritized outcomes (symptom improvement,

reoccurrence) over treatment type. Class 2 (24%)

preferred ESS and Class 3 (23%) preferred biologics,

irrespective of outcomes. Class 2 & 3 would accept

moderate symptom severity, 2 courses of oral steroids/

year, or 40% chance of reoccurrence to have their

preferred treatment type. Characteristics associated

with class membership (p<0.05) included age,

education, and comorbidities.

Conclusion:

While many patients prioritize outcomes, others have

strong preferences for ESS vs biologics. Quantitative

patient data on treatment preferences offers a new

dimension to decision-making in CRSwNP.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

2:18 pm – 2:23 pm

Sinonasal symptom correlation with the

postoperative polyp scale (POPS)

Arthur Wu, MD, FARS

Thomas Higgins, MD, FARS

Dennis Tang, MD, FARS

Elisa Illing, MD, FARS

Taylor Carle, MD

Missael Vasquez

Jonathan Ting, MD, FARS

Satyan Sreenath, MD

Akaber Halawi, MD

Philip Chen, MD, FARS

Cedars-Sinai

Background:

Commonly used endoscopic nasal polyp grading scales

have been shown to correlate poorly with symptom

scores and quality of life metrics. The recently

published Postoperative Polyp Scale (POPS) is a

grading system that more accurately characterizes

polyp recurrence in postoperative sinus cavities,

describing incremental recurrence in relation to the

opened sinus cavities. This study sought to determine if

the POPS correlates with sinus symptoms.

Methods:

CRSwNP patients were prospectively administered

SNOT-22 questionnaires and graded according to the

POPS starting at their 1-month postoperative

appointments. Total POPS scores (sum of each side)

and Max POPS score (larger value of left and right)

were correlated with SNOT-22 total scores and

subdomains using Kendall correlation testing.

Results:

127 patients were enrolled in the study. Both Total

POPS or Max POPS were significantly correlated to the

SNOT-22 total score (p<0.001, p<0.001), Rhinologic

(p<0.001, p<0.001), Extra-Nasal Rhinologic (p<0.001,

p<0.001), Ear/Facial (p<0.001, p<0.001), and

Psychologic (p=0.028, p=0.017) subdomains. Kendall’s

tau indicated strong correlation (>0.3) with Rhinologic

subdomain, moderate correlation (0.21-0.29) with

Extra-Nasal Rhinologic and Ear/Facial subdomains,

and weak correlation (0.1-0.19) with Psychologic

subdomain.

Conclusion:

Previous endoscopic nasal polyp grading scales poorly

correlate with symptoms and patient reported outcome

measures. The new POPS moderately correlates with

the total SNOT-22 score and strongly correlates with

rhinologic symptoms.

2:23 pm – 2:30 pm

Q&A

2:30 pm – 2:35 pm

Blood IgE and eosinophils are not reliable

predictors of nasal inflammation

Andrew Thamboo, MD, MHSc

Judy Fan

Rogerio Pezato, ENT Surgeon

William Daniels

Athenea Pascual, Research Coordinator

Changwan Ryu, ENT Surgeon

Masih Sarafan

Miguel Soares Tepedino

Richard Louis Voegels, Prof

Marco Aurélio Fornazieri, Dr.

Don Sin

St. Paul’s Sinus Centre

Background:

Chronic rhinosinusitis with nasal polyposis (CRSwNP)

is a chronic inflammatory condition of the paranasal

sinuses that is mainly associated with Type 2

inflammation. IgE and eosinophils in blood and nasal

tissue have been suggested as biomarkers for

prognosis and severity of CRSwNP as well as

indications for biological treatment.

Objective:

This study aims to investigate if blood IgE and

eosinophil concentrations can reliably predict nasal

inflammation in CRSwNP by assessing their

relationships with nasal polyp eosinophil concentration.

Methods:

Nasal polyps from CRSwNP patients (N=73) were

collected for hematoxylin and eosin stain and

eosinophil concentration measurement. Blood was

collected to measure IgE and eosinophil

concentrations.

Results:

Weak correlations were found between blood and

tissue eosinophil concentrations (p=0.004, r=0.367)

and blood IgE and eosinophil concentrations (p=0.007,

r=0.372). There is no statistically significant correlation

between blood IgE and tissue eosinophil

concentrations. When dividing patients based on nasal

polyp eosinophil concentration, blood eosinophil level

was higher (p=0.002) in the severely eosinophilic group

(≥100 eos/HPF) than that of the non-eosinophilic group

(<10 eos/HPF).

Conclusion:

Grouping CRSwNP patients based on their tissue

eosinophil level (eosinophilic vs. non-eosinophilic) and

then comparing their blood IgE and eosinophil levels is

not an accurate way to assess the relationships

between tissue and blood biomarkers. Blood IgE and

eosinophils are not reliable biomarkers to predict the

inflammatory condition in CRSwNP and be adopted as

indications for biological treatment. Further research is

needed on the clinical roles of these biomarkers.

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

2:36 pm – 2:41 pm

Ocular surface adverse events associated with

dupilumab for treatment of nasal polyps

Austin Swisher, BS

Rijul Kshirsagar, MD

Priscilla Vu, MD

Jonathan Liang, MD, MPH, FARS

Objectives:

Dupilumab was approved to treat chronic rhinosinusitis

with nasal polyps (CRSwNP) in 2019. Ocular surface

reactions (OSR), such as conjunctivitis, have been

associated with dupilumab for atopic dermatitis (AD)

treatment. However, the association of dupilumab-

associated OSR (DA-OSR) for non-AD treatment has

not been adequately studied. We sought to evaluate

DA-OSR for CRSwNP treatment using the FDA Adverse

Event Reporting System (FAERS).

Methods:

FAERS was queried for any general ocular reactions

(DA-GOR) from 2019Q1 to 2022Q4. DA-OSR were

subcategorized from DA-GOR and quantitatively

compared between treatment groups (CRSwNP,

asthma, AD). Simple logistic regression was used to

predict DA-OSR.

Results:

There were 60,198 total observations, of which 5344

were treated for CRSwNP. The prevalence of DA-GOR

and DA-OSR was greatest for AD (15,3%, 7.7%),

followed by CRSwNP (12.2%, 5.0%) and asthma (9.2%,

3.5%). The most commonly reported OSRs were dry

eyes (35.9%), conjunctivitis (15.7%), increased

lacrimation (11.0%), and eye discharge (5.5%). The

reported odds ratio (ROR) of CRSwNP-treated DA-OSR

was 0.84 [0.73-0.97, p=0.015], compared to 1.29 [1.20-

1.40, p<0.001] for AD and 0.66 [0.59-0.73, p<0.001] for

asthma. For CRSwNP treatment, the DA-OSR ROR

was 0.97 [0.90-1.03, p=0.3] for men and 0.78 [0.73-

0.83, p<0.001] for older adults (age >50).

Conclusions:

While there are limitations to FAERS, this database

study confirms the association between dupilumab and

OSR for AD treatment, and does not support a strong

association between dupilumab and OSR for both

CRSwNP and asthma treatment. Younger adults

experience more DA-OSR in CRSwNP treatment

without a specific predilection for gender.

2:42 pm – 2:47 pm

Real world trial for weaning dupilumab from every 2

to every 4 week administration

Emily Garvey, BA

Bita Naimi, BA

Alexander Duffy, MD

Chase Kahn, MD

Paavali Hannikainen, BS

Douglas Farquhar, MD

Marc Rosen, MD, FARS

Elina Toskala, MD, MBA, PhD, FARS

Mindy Rabinowitz, MD, FARS

Jessica Most, MD

Gurston Nyquist, MD, FARS

Introduction:

Initial trials demonstrated that patients receiving

dupilumab for chronic rhinosinusitis with nasal polyps

(CRSwNP) that transitioned to every 4 week

administration after six months experienced continued

improvements. This study is real-world data for weaning

from every 2 to 4 weeks for CRSwNP patients.

Methods:

CRSwNP patients treated with dupilumab for > 6

months with subsequent weaning from every 2 to 4

weeks were included. Outcomes included sinonasal

outcome test (SNOT-22) and polyp scores (Meltzer

Scoring).

Results:

13 patients were included, 12 had comorbid asthma.

Median treatment prior to weaning was 612.5 days.

Weaning rationale included remission (9) coverage/

compliance issues (2), and adverse drug effects (1).

The combined baseline polyp score before dupilumab

was 3.46 +/- 1.55, prior to weaning: 0.15+/-0.36 and at

6 months after weaning: 0.11 +/- 0.33. Baseline SNOT-

22 was: 40.08 +/- 19.12, prior to weaning: 13.78 +/-

14.35 and at 6 months after weaning: 12.33 +/- 10.12.

Remission and 6 month follow up polyp scores

(p<0.001, p=0.003) and SNOT-22 scores (p<0.001 and

p=0.001) were significantly reduced compared to

baseline. 5 patients’ symptoms were adequately

controlled with monthly injections. 1 patient reported

subjective worsening of nasal obstruction, the remaining

6 returned to every 2 weeks due to subjective

worsening of asthma. However, there were no changes

in the asthma control test (ACT) (p=0.49) and FEV1%

(p=0.61) for patients who failed. No patients required

antibiotics or steroids for CRSwNP symptoms during

weaning.

Conclusion:

Every 4-week administration of dupilumab is safe for a

subset of CRSwNP patients to trial. No negative

impacts were noted on objective or subjective measures

of CRSwNP.

PROGRAM ABSTRACTS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

2:48 pm – 2:53 pm

Real-world adverse events after type 2 monoclonal

antibody use in chronic rhinosinusitis with nasal

polyps

Marisa Dorling, BSc

Juan Carlos Hernaiz-Leonardo, Clinical Fellow

Athenea Pascual, Research Coordinator

Andrew Thamboo, MD

Amin Javer, MD, FARS

Arif Janjua, MD

University of British Columbia

Purpose:

To investigate the frequency and nature of adverse

events related to type 2 biologic use in patients with

chronic rhinosinusitis with nasal polyps (CRSwNP),

including dupilumab and mepolizumab.

Methods:

This is a single-center retrospective study of real-world

patient data. Patients were included if they have a

diagnosis of CRSwNP, have undergone at least one

endoscopic sinus surgery, and have taken at least two

doses of dupilumab or mepolizumab. Data collected

include demographic information such as age, sex,

past medical and surgical history. The primary

outcomes are the incidence of adverse events and the

types of adverse events observed. Adjusted odds ratio

was calculated to compare the two biologics using

logistic regression modeling.

Results:

42 patients on dupilumab and 29 patients on

mepolizumab were included in this study. 13 (31%) and

5 (17%) patients respectively encountered any adverse

events. The adjusted odds ratio of the adverse event

rates between these two treatment groups was 6.04

(95% confidence interval 1.29-39.15). The most

common adverse events for dupilumab were arthralgia

(12%), injection site reaction (10%), and conjunctivitis

(7%). The most common adverse events for

mepolizumab were headache (7%), arthralgia (3%),

conjunctivitis (3%), cough (3%), and fatigue (3%). Two

patients on dupilumab and one patient on mepolizumab

experienced adverse events leading to discontinuation

of therapy.

Conclusion:

Dupilumab and mepolizumab have significantly different

adverse event profiles. This study contributes to

available data to help guide clinicians’ decision-making

on the use of type 2 biologics in patients with CRSwNP.

2:53 pm – 3:00 pm

Q&A

3:00 pm – 3:30 pm

Break with Exhibitors

3:30 pm – 4:15 pm

Combined ARS/AAOA Panel: Office-Based

Procedures Update: Common Procedures &

Difficult Cases”

Moderator: Jean Kim, MD, FARS

Panelists: Omar Ahmed, MD, FARS; Charles Ebert,

Jr., MD, FARS; Monica Patadia, MD; Elina Toskala,

MD, FARS

4:15 pm – 5:00 pm

International Collaborative Panel: “Assessing

Septoplasty Outcomes: An International

Perspective”

Moderator: Michael Stewart, MD, FARS

Panelists: Sean Carrie, MB, ChB, FRCS,

FRCS(ORL); Chang-Hoon Kim, MD; Jern-Lin Leong,

MD; Ramandeep Virk, MBBS, MS (ENT)

5:00 pm

Meeting Adjourns

5:00 pm – 7:00 pm

Rhinologists in Private Practice Cocktail Reception

Date Night Bar at Assembly Food Hall

5055 Broadway Place

PROGRAM ABSTRACTS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #001

A comparative analysis of nasal packing with and

without bupivacaine for postoperative pain control

after endoscopic endonasal transsphenoidal

surgery

Karol Avila-Castano, Research Fellow

Andrea Otamendi-Lopez

Anyull Dayanna

Bohorquez Caballlero

Angela Donaldson, MD, FARS

Osarenoma Olomu, MD

Introduction:

Postoperative pain control is important after

Endoscopic Endonasal Transsphenoidal Surgery

(EETS). While intravenous and oral methods for pain

control are available, we examined a topical approach

using routine nasal packing for decreasing systemic

medication. Bupivacaine (BP), a long-acting topical

analgesic was applied to the nasal packing used in the

first 24 hours after surgery. We evaluated its effect on

pain control and systemic pain medication use after

EETS.

Method:

A retrospective cohort of 100 patients who underwent

EETS at the Mayo Clinic in Florida between 2019 and

2022 was conducted. Groups were divided based on

whether they received nasal packing soaked with BP

vs no BP. The BP group had an inflatable sponge nasal

packing (Merocel) inflated with BP. The control group

had a non-adherent gauze nasal pack (Telfa). The use

of acetaminophen, use of opiates, and subjective pain

scores (Visual Analogue Scale (VAS)) was compared.

Multiple linear regression models were used to identify

factors influencing VAS postoperatively.

Results:

58% patients were male. The mean age at ETTS was

57 ±16.5 years. 45% received nasal packing with BP.

There was a significant difference in VAS scores

between the two groups at 12 to 24 hours after surgery

with the BP group reporting higher scores for pain

perception (β=0.87, p=0.011). There were no significant

differences in analgesics used between the groups.

Multivariate linear regression identified the length of

surgery, and steroid use as potentially influencing pain

perception after EETS.

Conclusion:

This study is the largest cohort describing the use of

BP in nasal packing after EETS. BP was not found to

reduce pain medications nor improve pain perception

after surgery.

Poster #002

A computational analysis to investigate anatomical

factors associated with increased likelihood of

epistaxis from intranasal sprays usage

Katherine Gonzalez, BS

Amanda Balash

Sarah M. Russel, MD, MPH

Dennis O. Frank-Ito, PhD

Duke University Medical Center

Background:

Intranasal corticosteroids are often recommended as a

first line of treatment for many sinonasal conditions. A

known and potentially serious adverse effect of

intranasal spray therapy usage is epistaxis. Despite

following usage instructions correctly, some patients

may have an increased predisposition of epistasis. This

study uses computational modeling to investigate the

role of nasal morphology on intranasal drug delivery to

the nasal septum.

Methods:

Radiographic images from four adult subjects were

retrospectively selected for three-dimensional

reconstruction of the nasal cavity. Three subjects (N1,

N2, and N3) had a healthy normal nasal anatomy, and

a subject who underwent functional endoscopic sinus

surgery (FESS) for treatment of chronic rhinosinusitis.

Airflow and intranasal spray drug transport were

simulated in each nasal cavity at resting inspiration of

15L/min using computational fluid dynamics modeling.

Intranasal drug delivery was simulated to mimic

recommended usage instructions from manufacturers’

package inserts, with the release of drug particles into

the nasal cavity at 5m/s. Drug particles depositing at

the anterior nasal septal (AS) wall were quantified.

Results:

Subjects NI, N2, and N3 had approximately zero

deposition on the right AS. Left AS depositions were:

N1=63%, N2=45%, and N3=83%. AS depositions in

the subject who underwent FESS were: Left=29% and

Right=87%.

Conclusion:

Preliminary results indicate that anatomical factors

contributing to increased unilateral anterior septal wall

drug depositions even under correct intranasal spray

usage by patient include nasal cycling, septal deviation,

and narrowing of the nasal vestibule.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #003

WITHDRAWN

Poster #004

A rare case of chronic invasive curvularia fungal

sinusitis

Samuel Hopper, BS

Benjamin Stevens, MD

Abdullah Shaheen, MD

Gina D. Jefferson, MD, MS, FACS

Charlotte S. Taylor, MD

Keonho A. Kong, MD

UMMC

Introduction:

Fungal rhinosinusitis (FRS) encompasses a wide

spectrum of diseases that are classified via timeline

and invasiveness. We present a case of a large fungal

mass with osseus erosion without angioinvasion in an

immunocompetent patient.

Case:

A 46 yo immunocompetent AAM presented with a left

nasopharyngeal mass with two-years of left-sided nasal

congestion, epistaxis, hyponasal voice, and ear

fullness. Nasal endoscopy revealed friable tumor in

both nares extending into the left maxillary sinus. MRI

showed a nasopharyngeal mass extending into the

oropharynx and left infratemporal fossa with osseous

destruction of the left pterygoid process. Biopsy

revealed fibroconnective granulation tissue,

multinucleated giant cells, and fungal hyphae, without

evidence of malignancy or angioinvasion. Flow

cytometry was negative. In endoscopic resection the

mass was debulked from the maxillary sinus, posterior

nasopharynx, and the pterygopalatine and

infratemporal fossa. Osseus erosion was noted in the

posterior maxillary wall and pterygoid process. Final

pathology was congruent with original biopsy, and

speciation resulted in Curvularia. Follow up showed

marked clinical improvement with no recurrence after

oral voriconazole for 6 weeks.

Discussion:

Curvularia is generally associated with allergic fungal

sinusitis (AFS). However, the lack of eosinophils

excludes AFS. Chronic granulomatous invasive fungal

sinusitis (CGIFS) due to Curvularia has been reported,

but this case lacked the typically associated

noncaseating granulomas. There has been report of

AFS converting to CGIFS which is a consideration. This

case doesn’t fit into an already defined disease process

highlighting the broad spectrum of FRS and limitations

of current categorization.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #005

Academic productivity trends of fellowship-trained

U.S. academic rhinologists

Michael Warn, Medical Student

Daniella Chan

Theodore Nguyen, BS

Sina Torabi, MD

Benjamin Bitner, MD

Edward Kuan, MD, FARS

Introduction:

Academic productivity is believed to be correlated with

experience and institutional rank, yet there is paucity of

granular academic data between faculty with regard to

institutional rank and industry engagement, and how

these relate to experience.

Methods:

Demographics, academic metrics (publications,

citations, h-index), program rankings, and industry

compensation for academic US rhinologists through

June 2022 were collected and compared between

academic rank and experience.

Results:

A cohort of 278 rhinologists were included. Full

professors had greater academic metrics (all p<0.001)

and industry compensation (all p<0.05) than

associates, assistants, and private practice rhinologists.

Full professors were also more likely to receive NIH-

funding than other groups (p<0.001). Experience and

industry compensation positively correlated with each

other and with academic metrics (all p<0.001) with

significant jumps between the 5-10th and 10-15th year

of practice (p<0.001). However, early career (≤8 years)

rhinologists published more articles per year than late

career (> 8 years) rhinologists (p<0.001). Rhinologists

at Doximity top 10 and 25 programs by reputation and

research output and top 50 USNWR institutions had

significantly greater academic metrics and NIH funding

compared with those who were not (p<0.001). Top 10

and 25 reputation was associated with increased

industry compensation (p=0.024).

Conclusions:

Although early career rhinologists published more

frequently, ascending professorship rank, experience,

and employment at a top-ranked institution were

significantly associated with total academic productivity.

Industry engagement was linked to reputation and

experience.

Poster #006

Acinic cell carcinoma in the nasal cavity: A case

report of a 69-yearold female complaining of nasal

congestion

Aileen Beatrice Antonio, MD

Amando Virgilio Santos, Dr.

Cristina Nieves, Dr.

Ospital Ng Makati

Acinic cell carcinoma (ACC) is a rare, low-grade

primary salivary gland malignancy that represents 2.4

% of all salivary neoplasms. Salivary gland neoplasms

are extremely rare in the nasal cavity. Pleomorphic

adenoma is the most common benign salivary gland

tumor type in the nasal cavity. ACC have been

previously reported in minor salivary glands in the

sinonasal cavity. About 18 cases of acinic cell

carcinoma have been previously described in the

sinonasal cavity. This case of ACC arising from the

nasal cavity presented is the first reported case in this

institution and the Philippines to the best of the

researchers’ knowledge.

The case is as follows: a 69 year old female came in

with a chief complaint of right nasal mass. Two years

prior to admission, the patient now had noticeable

enlargement of fleshy mass with (+) epiphora on the

right which prompted consultation. Biopsy and CT scan

were requested which revealed inverted papilloma and

the patient was advised for surgery. The patient

underwent a medial maxillectomy via lateral rhinotomy

with lip split on the right and excision of infected right

lacrimal sac. Histopathology showed heterogeneous

morphology with epithelial cells resembling ductal cells

or myoepithelial cells arranged as irregular tubules.

This lead to it being reported as acinic cell carcinoma

instead of the initial biopsy result of inverted papilloma.

Results showed that acinic cell carcinoma in the nasal

cavity is extremely rare. Proper interpretation of the

histomorphologic features of this type of tumors should

be done. Acinic cell carcinomas are considered low-

grade neoplasm thus complete surgical resection is

curative but this tumor has shown to have local

recurrence, thus, follow up is essential.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #007

An assessment of the quality of artificial

intelligence-generated patient counseling for

sinusitis

Gregory Hill, MD

Charles Alexander Riley, MD

Jakob Fischer, MD

Anthony Tolisano, Associate Professor

Walter Reed National Military Medical Center

Background:

The quality of online health information is highly

variable and source dependent. Artificial intelligence

language models (AILMs) such as ChatGPT-4

(OpenAI) are likely to become another option for

patients seeking health information.

Methods:

Ten commonly asked questions regarding sinusitis

were derived from Google trends over the past 5

years using the keywords “sinusitis” and “sinus

surgery”. Responses were generated from three

sources: (1) published human expert source, (2)

relevant text from the top 3 links derived from a

Google search, and (3) ChatGPT-4. Three blinded

experts scored the quality of information utilizing the

DISCERN instrument. Fleiss’s kappa was used to

assess interrater reliability. ANOVA one-way testing

evaluated for differences in DISCERN scores by

source type.

Results:

There was no significant difference in response word

count by source type (p>0.05). Interrater reliability

showed moderate correlation (0.59) among the three

blinded reviewers for overall DISCERN scores. The

quality of each source was moderate (human expert

source: 39.9±6.1; Google: 39.2±3.0; ChatGPT-4:

45±9.9). No significant differences in total DISCERN

score was detected among the sources (p>0.05).

The average DISCERN score was higher for

treatment options compared to symptoms or

diagnoses (difference 13.0 points; 95% CI 7.7, 18.3)

for all information sources.

Conclusions:

Similar quality of health information was noted for a

human expert source, Google search, and

ChatGPT-4. All responses were judged to produce

moderate quality information. This has potential

implications for patient education and counseling,

which warrants additional study.

Poster #008

Artificial intelligence based semi-automatic

segmentation for orbital tumors radiomic

measurement

Angela Zhu, BA

Ryan A. Bartholomew

Benjamin Bleier, MD, FARS

Barak Ringel, MD

Massachusetts Eye and Ear; Warren Alpert Medical

School of Brown University

Objectives:

Imaging is essential in the classification and surgical

planning for orbital lesions. New advanced artificial

intelligence (AI) based platforms may allow for

improved tumor assessment, management, and

planning. This study aims to explore the feasibility of

semi-automatic tumor segmentation and to

determine the associations between tumor

morphology, radiomic features, and presenting

symptoms.

Methods:

The open-source 3D-slicer software was used for

MRI-based three-dimensional tumor segmentation

and radiomic features analyses for patients

diagnosed with benign orbital lesions. Sphericity is a

radiomic shape feature that describes how close a

given volume is to a perfect sphere.

Results:

Of the 118 tumors, 94 (79.7%) benign intraconal

tumors were identified. The average patient’s age

was 52.7±17.1 years, with slight female predilection

(57.6%). The mean tumor volume was 336.4mm^3.

Intraconal ORBIT class 2 tumors were larger than

lateral compartment lesions (483.1mm^3 vs.

230.9mm^3, p<0.05). Class 3 tumors’ mean volume

was 262.9mm^3. No significant differences in tumor

volume nor sphericity were identified between tumors

of the remaining ORBIT stages or those located

lateral to the optic nerve. Intraconal tumors

presenting with proptosis (p<0.05) or orbital swelling

(p<0.2) tended to have larger tumor volumes.

Tumors presenting with proptosis (p<0.2), diplopia

(p<0.2), or orbital swelling (p<0.05) tended to be less

“spherical” in shape.

Conclusions:

Orbital tumors’ morphology and volume can

correspond to specific symptom development and

orbital compartment location. The utilization of

3-dimensional semi-automatic segmentation for

treatment planning, outcome measures, and follow-

up warrants further exploration.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #009

WITHDRAWN

Poster #010

Assessing nasal function after definitive

rhinoplasty for unilateral cleft lip nasal deformity

repairs: A pilot analysis

Elaine Lin, BS

Dennis O. Frank-Ito, PhD

Duke University School of Medicine

Background:

Patients with unilateral cleft lip nasal deformity

(uCLND) experience significant nasal obstruction

and olfactory dysfunction, and very little is known of

whether definitive cleft rhinoplasty improves patients’

nasal function. This study aims to assess patient-

reported satisfaction and objective assessments

before and after surgery.

Methods:

Three patients (P1, P2, P3; 18-23 years) with

uCLND were prospectively recruited. Data collected

before and >6 months after definitive cleft rhinoplasty

were: [1] Nasal Obstruction Symptom Evaluation

(NOSE) scores; [2] Standardized Cosmesis and

Health Nasal Outcomes Survey scores to evaluate

nasal obstruction (SCHNOS-O) and nasal cosmesis

(SCHNOS-C); [3] Nasal resistance (NR)

measurement using the NR6 Clinical/Research

Rhinomanometer; and [4] the University of

Pennsylvania Smell Identification Test (SIT).

Results:

NOSE improvement post-surgery were: P1=20, P2=0

and P3=70. P1 was within one standard deviation

(SD) of reported minimal clinically important

difference (MCID; 24.4±15.3), P2 no improvement,

and P3 over 2SD of MCID improvement. SCHNOS-O

post-surgery improvement: P1=25, P2=-5 and

P3=55. P1 and P3 were within 1SD of reported

SCHNOS-O MCID (28.3±17.3) and P2 was worse.

SCHNOS-C post-surgery improvement: P1=3,

P2=17 and P3=80; reported SCHNOS-C MCID was

18.0±12.8. Post-surgery NR decreased by 40% (P1),

2% (P2) and 71% (P3), while SIT improved by 3%

(P2) and 10% (P3) but worsened by 21% (P1).

Conclusions:

Preliminary findings suggest stronger agreement

between patients’ satisfaction and improvement in

their nasal patency compared to their olfactory

improvement. Further, definitive rhinoplasty for

uCLND repairs may not adequately address patients’

olfactory dysfunction.

Poster #011

Association of alcohol use with olfactory

function among older adults

Khamis Suleiman, Medical Student

Richard Chiu, Medical Student

Sharmilee Nyenhuis

Kamal Eldeirawi

Victoria Lee, MD, FARS

University of Illinois College of Medicine

Background:

Olfactory dysfunction (OD) is a common condition

predominantly affecting the elderly population. This

study aims to explore the association between

alcohol consumption and OD. Investigating the

relationship between alcohol consumption and OD is

crucial due to its potential consequences for public

health and to gain insight into the mechanisms

underlying OD.

Methods:

This cross-sectional study was conducted on data for

1,107 adults from Round 3 of the National Social

Life, Health, and Aging Project. Normal olfactory

function was defined as correctly identifying 4–5

odors in the 5-item Sniffin’ Sticks test, and OD was

defined as 0–3 odors correctly identified.

Associations between alcohol use and olfaction were

assessed using logistic regression, and adjusted

odds ratios (OR) were calculated. Analyses were

weighted to account for the sampling design.

Results:

OD was present in 18.9% of adults. The weighted

average age was 76.5 ± 6.7 years among those with

OD and 74.7 ± 5.7 years among those with normal

olfaction. 37.9% of adults with OD reported alcohol

consumption in the last 3 months, compared to

48.0% of adults with normal olfaction. After adjusting

for age, gender, race, education, recent stroke,

dementia, diabetes, and mental health, alcohol

consumption was not associated with OD (OR: 0.77;

95% CI: 0.51–1.17).

Conclusions:

Alcohol consumption was not associated with OD

after controlling for covariates. While this study

provides insight into the relationship between alcohol

consumption and OD, further research is needed

due to conflicting results in previous studies. The

inconsistencies in previous research were likely due

to factors such as study population, study design,

and confounding variables.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #012

Association of chronic rhinosinusitis and

autoimmune disorders

Chadi Makary, MD, FARS

Zayd Al-Asadi, BS

Dominic Lombardo, BS

Sairisheel Gabbi Reddy

Brian Peppers, Assistant Professor

Hassan Ramadan, MD, FARS

West Virginia University

Introduction:

Increasing evidence suggests that autoimmune

disorders and their immunomodulating medications

may increase the risk of rhinosinusitis.

Goal:

To determine if autoimmune disorders are associated

with increased risk of rhinosinusitis.

Methods:

Cross-sectional study of patients referred to West

Virginia University from August 2020 to October 2022

for rhinologic complaints was performed. These

patients were diagnosed either with chronic

rhinosinusitis (CRS) or recurrent acute rhinosinusitis

(RARS) according to published guidelines. Patients’

characteristics, diagnoses, and type and treatment of

autoimmune disorders were reviewed.

Results:

544 rhinosinusitis (463 CRS and 81 RARS patients)

were compared to 595 non-rhinosinusitis (530

chronic rhinitis and 65 facial pain/headache) patients.

Patients with rhinosinusitis were older (50.1 vs 45.8

years old, p=0.0001), more likely to be males (46.7%

vs 35.2%, p<0.0001), more likely to have asthma

(33.6% vs 25.4%, p=0.002), and more likely to have

current and past smoking history (14.3% vs 8.7%,

p=0.003; 28.5% vs 19.7%, p<0.0001 respectively).

Autoimmune disorders were more common in

rhinosinusitis patients (16.4% vs 9.4%, p<0.0001).

Psoriasis and rheumatoid arthritis were the most

common autoimmune disorders in rhinosinusitis

patients (2.9% and 2.5% respectively). Multivariate

logistic regression adjusting for confounders showed

that autoimmune disorders were strongly associated

with rhinosinusitis [OR=2, CI=1.4-2.9]. Subgroup

analysis showed CRS and RARS were equally

associated with autoimmune disorders.

Conclusion:

Autoimmune disorders increase the risk of both CRS

and RARS. Further studies are needed to explore

their role in the treatment outcome of rhinosinusitis.

Poster #013

Association of prior military service with

olfactory function among older adults

Richard Chiu, BS

Khamis Suleiman, Medical Student

Sharmilee Nyenhuis

Kamal Eldeirawi

Victoria Lee, MD, FARS

University of Illinois College of Medicine

Background:

Olfactory dysfunction (OD) is a common condition

primarily affecting the elderly. Several factors have

been implicated in OD, such as age, socioeconomic

status, and neurocognitive disorders; however, the

effect of military service on OD is unclear. It has

been hypothesized that toxins and

neuropsychological changes related to military

deployment may negatively impact olfaction. This

study aims to investigate this association.

Methods:

This cross-sectional study was conducted on data for

992 adults from Round 3 of the National Social Life,

Health, and Aging Project. Normal olfaction was

defined as correctly identifying 4–5 odors in the

5-item Sniffin’ Sticks test, and OD was defined as

0–3 odors correctly identified. Associations between

military service and olfaction were assessed using

logistic regression, and adjusted odds ratios (OR)

were calculated. Analyses were weighted to account

for sampling design.

Results:

OD was present in 18.4% of adults. The weighted

average age was 76.8 ± 6.6 years among those with

OD and 74.6 ± 5.6 years among those with normal

olfaction. About 20% of adults with OD served in the

military, compared to 23.6% of adults with normal

olfaction. After adjusting for age, gender, race,

education, recent stroke, dementia, mental health,

and smoking, participants with prior military service

were less likely to have OD (OR: 0.48; 95% CI:

0.26–0.89).

Conclusions:

Prior military service was unexpectedly protective of

normal olfaction after controlling for covariates. This

may be a result of data limitations, as the military

service variable is self-reported and does not capture

length of service. Further research is needed to

investigate mechanisms or confounders behind this

result.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #014

Baseline olfactory function and prospective

assessment of patient-reported outcome

measures in patients with nasal septal

perforation

Shreya Ramkumar, BS

Bansberg Stephen, Consultant

Michael Marino, MD, FARS

Amar Miglani, MD

Background:

This study evaluated baseline olfactory function and

patient-reported outcome measures (PROMs) of

conservative treatment (saline gel moisturization)

followed by surgical closure in patients with nasal

septal perforation (NSP) of any etiology.

Methods:

Patients who underwent NSP repair at Mayo Clinic

between September 2022 and March 2023 were

prospectively enrolled. Patients with <15 days

between the date of presentation to surgery were

excluded. NOSE-Perf scores, UPSIT scores prior to

surgery, NSP size, and demographics were collected

and analyzed using descriptive statistics.

Results:

Our cohort consisted of 15 patients (10 females, 5

males) with a median of 83 days (IQR: 37.0, 124.5)

between presentation and surgery, during which

patients were treated with saline gel moisturization.

Most patients had normosmia (N=7) or mild

hyposmia (N=5). Patients with normosmia were

younger than patients with any degree of smell loss

(median: 44.0 vs. 55.5 years). Most patients (63%)

with perforation height >1cm had normosmia.

Successful perforation closure was achieved in all

patients using bilateral nasal mucosal flaps

supported with an interposition graft. Median NOSE-

Perf scores at presentation, pre- and post-operatively

were 24 (IQR: 19.0,30.5), 25 (IQR: 13.5,31.5), and 9

(IQR: 7.0,17.0), respectively.

Conclusion:

Although NSP has been postulated to affect

olfaction, most patients in our study had normosmia.

NSP size may not correspond with the degree of

olfactory loss, and further studies are warranted. In a

cohort of NSP patients undergoing surgical repair,

conservative management with saline gel

moisturization provided little symptom benefit. NSP

repair remains a promising option for perforation

closure and improving PROMs.

Poster #015

Biologic therapies for treating chronic sinusitis

with nasal polyps: What do patients want to

know?

Samuel Razmi, BS

Lexi Goehring, Medical Student

Daniel Gorelik, Research Fellow

Kenneth Sims IV, Medical Student

Yuki Yoshiyasu, Resident

Masayoshi Takashima, MD, FARS

Omar Ahmed, MD, FARSTexas A&M School of

Medicine – ENMED

Biologic therapies for chronic rhinosinusitis with

nasal polyps (CRSwNP) are emerging as promising

treatment options for patients with refractory disease.

The objective of this study is to explore the questions

patients are commonly asking online about these

therapies and the quality of the available content.

Most common search terms were identified via

Google Trends. People Also Ask (PAA) questions

were identified and extracted with their associated

website using a freely available program (SEO

Minion). Questions were categorized according to

Rothwell’s criteria by two independent reviewers and

organized into subtopics and categorized. Sources

were evaluated using Flesch Kincaid Grade Level

(FKGL) score for readability and JAMA Benchmark

criteria for quality assessment (0-4, 4 = all criteria

met).

A total of 143 unique questions from 143 unique

websites were collected across 4 search terms.

Questions regarding facts about biologics including

side effects (38.5%) were most common, followed by

facts about CRSwNP (37.8%), and finally treatment

options for CRSwNP (23.7%). FKGL score gave a

mean 12.2 (3.30) grade US reading level - much

higher than the recommended 6-8th grade level.

JAMA benchmark gave a mean of 0.95 (0.85).

Sources answering the PAA questions were mainly

commercial (60.1%) followed by medical practices

(14.0%), academic (13.3%), and government

(12.6%).

Given the novelty of biologic therapies as treatment

for CRSwNP, patients are seeking more information

about biologics. Existing online resources regarding

biologics for CRSwNP should be improved with

material that is easier to read. More academic

sources and scholarly information is needed.

Physicians should be aware of these areas and

counsel accordingly.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #016

B-LBL presents as sinonasal mass: A case report

Brandon Vilarello, BA

Patricia Jacobson, Medical Student

David Gudis, MD, FARS

Jonathan Overdevest, MD, PhD

Columbia University Vagelos College of Physicians

and Surgeons

Introduction:

B-cell lymphoblastic leukemia/lymphoma (B-ALL/

LBL) is primarily a disease of childhood that presents

with lymphadenopathy, fatigue, fever, night sweats,

and weight loss. Initial presentations prompted by

head and neck manifestations are exceedingly rare.

Case Report:

A 5 year-old girl with no significant past medical

history presented with right facial swelling and mild

proptosis on ophthalmologic evaluation. She was

referred to a tertiary care facility by her local

otolaryngologist for further management after CT

imaging revealed right maxillary sinus opacification

and erosion of the anterior maxillary bone. Her

symptoms were initially responsive to prednisone

and amoxicillin-clavulanate, and only right unilateral

nasal discharge persisted with resolution of other

sinonasal/systemic symptoms. Notably, laboratory

values, including complete blood count, were within

limits. Given concern for the etiology of the bony

erosion, the patient presented for a second opinion,

where imaging and recommendation for biopsy

resulted in flow cytometry findings consistent with

B-ALL/LBL. After bone marrow biopsy, the ultimate

diagnosis was Murphy’s stage III B-lymphoblastic

lymphoma.

Conclusions:

Malignant neoplasms of the sinonasal region are rare

in children, where primary sinonasal B-LBL is a

unique occurrence. Clinical features of sinonasal

B-LBL in the paranasal sinuses may masquerade as

pathologies such as acute sinusitis, orbital cellulitis,

and benign tumors or polyps that can lead to a

confounding diagnosis. In this case presentation, an

initial response to steroids and antibiotics should not

provide false reassurance when other features and

signs, such as maxillary bone erosion, may suggest

the presence of malignancy.

Poster #017

WITHDRAWN

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #018

Case report: Rare angiomyolipoma of the nasal

cavity

Akash Halagur, BA

Galit Almosnino, MD

Ryan Little, MD

Geisel School of Medicine at Dartmouth

We report a patient with a rare case of an

angiomyolipoma (AML) arising from the nasal cavity

presenting with nasal obstructive symptoms.

The mass was broadly pedicled to the right lateral

nasal side-wall and excised endoscopically. The

patient’s post-operative course was complicated by

epistaxis requiring Merocel placement but was

without recurrent epistaxis. Immunohistochemical

studies revealed positive SMA, S100, CD61 and

MPO and negative HMB45 and Melan A staining

indicating the presence of spindled smooth muscle

cells, vasculature, lipomatous content, and lack of

melanocytic markers consistent with previous reports

of mucocutaneous AMLs.

Nasal AMLs are exceedingly rare with fewer than 21

cases reported in literature to date. The majority of

the cases have been reported from Asia and the

Middle East with fewer than five cases reported in

the United States. The majority of non-tuberous

sclerosis-related cases are immunophenotypically

distinct from the family of perivascular epithelioid cell

neoplasms (PEComas) typically associated with

renal and extra-renal AML.

Our case of highlights the clinicopathologic features

of AML that are distinct from its broader family of

PEComas, and provides support for their further

classification to ‘angiomyolipomatous hamartoma’ as

suggested by Wang et al. (2021) to distinguish their

lack of epithelioid morphology, lack of melanocytic

immunophenotype, and non-neoplastic nature from

PEComatous AML. Although rare, based on both our

experience and the recent literature, AML should be

included in the differential diagnosis of unilateral

nasal masses.

Poster #019

Cavernous sinus immunoglobulin G4-related

disease- A case report

Erika Bradley, RN, BSN

Mark Arnold, MD

Upstate Medical University

Immunoglobulin G4- related disease (IgG4-RD) is a

rare immune-mediated fibroinflammatory condition.

Symptoms at presentation vary; however, each

organ involved has tumor-like involvement. Diagnosis

relies on biopsy showing histopathological findings

including storiform fibrosis, large amounts of IgG4

plasma cells, and lymphoblastic infiltrates.

We report a rare presentation of IgG4-RD in a

68-year-old Caucasian male who suffered from left-

sided facial pain, superior gaze deficit, left otalgia,

and left-sided visual loss. CT showed left sphenoid

opacification and osteitic changes, and MRI showed

pachymeningeal enhancement of the bilateral

cavernous sinuses, greater on the left side, left

orbital apex, and optic nerve sheath. He underwent

left endoscopic sphenoidotomy, and was treated with

steroids and antibiotics. Tissue biopsies of the left

sphenoid mucosa showed moderate

lymphoplasmocytic inflammation and of the

sphenoid-ethmoid polyp showed prominent IgG4

restricted plasma cell infiltrate. The IgG4/IgG ratio

was greater than 90%, and blood serum IgG4 levels

were elevated at 227 mg/dL, consistent with IgG4-

RD. There was no storiform fibrosis of the biopsied

tissue. Given his complex presentation,

ophthalmology and rheumatology physicians were

involved. His visual acuity improved with IV and later

oral steroids. However, due to persistent

pachymeningeal enhancement on MRI and changes

to color vision, rituximab was given.

This is a unique case of IG4-RD due to a mass in

the nasal cavity outside of the sphenoid sinus

showing IgG4-RD and pachymeningeal

enhancement causing inflammation of the cavernous

sinus due to IgG4-RD. Increased awareness of this

rare presentation of IgG4-RD will improve future

patient outcomes.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #020

Characteristics of patients requiring revision

endoscopic sinus surgery- An 11 year single-

institution study

Madison Buras, MD

Matthew Mitchell

Background:

Chronic rhinosinusitis refers to a sinonasal

inflammatory process which commonly requires

surgical intervention in patients who have failed

medical management, sometimes requiring multiple

revision surgeries to achieve disease control. This

can significantly reduce quality of life and have a

large socioeconomic impact.

Methods:

A retrospective review was performed to identify

patients that underwent endoscopic sinus surgery at

our institution between 2011-2022. The study

included 448 patients who underwent one primary

endoscopic sinus surgery and 307 patients who

underwent multiple surgeries. Data collection

included patient demographics and the presence of

various co-morbidities. The patients who required

only one surgery were compared to those who

required multiple surgeries to determine

characteristics that were predictive of the need for

multiple procedures to achieve disease control.

Results:

In terms of demographics, males were only slightly

more likely to require revision surgery (43% vs 38%).

There was not a statistically significant difference

between patients with diabetes, smoking or asthma.

Patients with allergic fungal rhinosinusitis, polyps,

Samter’s triad, cystic fibrosis, and primary ciliary

dyskinesia were all much more likely to require

revision sinus surgery.

Conclusion:

This study has demonstrated that revision sinus

surgeries were required more often in men and in

patients with allergic fungal rhinosinusitis, polyps,

Samter’s triad, cystic fibrosis, and primary ciliary

dyskinesia. These findings will help us have a more

knowledgeable pre-operative discussion with at-risk

patients, identify controllable characteristics in

patients, and reduce the socioeconomic burden of

this disease process.

Poster #021

Characterization of chronic rhinosinusitis by

associated medical comorbidities

Tiffany Toni

Gengjie Jia, Dr.

Jay Shah, Dr.

Robert Naclerio, MD

Carole Ober, Dr.

Andrey Rzhetsky, Dr.

Jayant Pinto, Dr.

Introduction:

Chronic rhinosinusitis (CRS) is a multifactorial

disease process theorized to arise through the

complex interaction between the host genetic and

inflammatory state induced environmental and

infectious exposures. The relationship between CRS

and other medical comorbidities remains an under

investigated area of CRS research that we

hypothesized would allow for patient disease

stratification.

Methods:

In the following study, we utilized a multi-institutional

database to investigate a total of 5,415,401 patients

aged 18-70 with a diagnosis of CRS. Patients with

respiratory congenital anomaly and cystic fibrosis

were excluded from the study. Supervised machine

learning was used to cluster patients based on

medical comorbidities. These clusters were further

analyzed individually to investigate the percentage of

patients with severe disease, as characterized by

CRS with nasal polyposis (CRSwNP).

Results:

Twenty-three distinct clusters emerged and were

grouped according to similar pathogenesis into the

following nine disease signatures: atopic, cell

epithelial dysfunction, autoimmune, neuropsychiatric,

metabolic syndrome, hormonal, vascular, immune

deficiency, and infectious. Of patients with CRS,

4.0% of patients were also coded as having nasal

polyposis. CRSwNP patients were more likely to be

categorized as having an atopic or infectious disease

signature as compared to chronic rhinosinusitis

without nasal polyposis (CRSsNP) patients.

Conclusions:

Chronic rhinosinusitis can be classified into multiple

subcategories by comorbidity mapping. Furthermore,

CRSwNP is associated with a concomitant diagnosis

of atopic and/or infectious sinonasal disease.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #022

Choosing wisely in ESS in the era of biologics

(CHESS)

Neil Verma, MDCM, MSc FRCSC

Martin Desrosiers, MD

Centre Hospitalier de l’Université de Montréal

Background:

Chronic rhinosinusitis with nasal polyposis

(CRSwNP) is a disease characterized by Th2

inflammation. Approval of biologic therapies has

transformed the landscape of treatment for CRSwNP

with modulation of the immune response to manage

the disease. Endoscopic sinus surgery remains an

important component in the management of

CRSwNP and biologic therapy may influence the

difficulty or complication rates seen in surgery and

post-operatively with respect to surgical recovery.

The goal of this study is to document and

characterize the experiences of Canadian

rhinologists with ESS for CRSwNP performed under

biologic treatment that target Th2 inflammation.

Methods:

An online survey was sent to Canadian fellowship

trained rhinologists to capture their experiences

regarding ESS for patients under biologic therapy

including intra-operative ease, bleeding and

purulence during surgery as well as post-operative

assessment of symptoms and endoscopy compared

to non-biologic therapy standard ESS. We performed

subgroup analysis based on demographic

parameters, primary vs revision surgery and type of

biological agent received.

Results:

We expect that the results of this exploratory

assessment will offer novel and much-needed

information on potential impacts of type-2 targeting

biologics on ESS surgery and identify relevant items

suitable for inclusion in a future clinical registry of

ESS performed in patients under biologic therapy.

Conclusions:

There is a paucity of information on the effect of

biologics on ESS and surgeons would benefit from

recommendations and information when operating

on patients with concomitant biologic therapies.

Improved guidelines would help optimize surgical

interventions and improve surgical outcomes.

Poster #023

Clinical outcomes and complications of

endoscopic odondoidectomy: A single institution

experience

Ann Powers, MD

David Lerner, MD

Janki Shah, MD

Anthony Del Signore, MD

Madeleine Schaberg, MD

Satish Govindaraj, MD, FARS

Raj Shrivastava, MD

Alfred-Marc Iloreta, MD

Introduction:

Odontoidectomy is indicated for anterior

decompression of the cevicomedullary junction to

address a wide variety of pathologies. Endoscopic

approaches reduce perioperative morbidity

associated with the traditional open approaches,

namely gastrostomy and tracheostomy tube

placement.

Methods:

This is a retrospective review of patients undergoing

endoscopic odontoidectomy between 2015-2022.

The electronic medical record was reviewed for

patient factors, operative variables, and post-

operative complications.

Results:

8 patients underwent endoscopic odontoidectomy

with a median age of 55yrs. Indications included

basilar invagination (4), rheumatoid pannus (2),

pathologic fracture with cord compression (1), and

odontoid osteoradionecrosis (1). Endoscopic

odontoidectomy was achieved via transnasal route in

5 patients, while 3 patients required a combined

transnasal-transoral endoscopic approach. All

patients undergoing a combined transnasal-transoral

approach received a temporary tracheostomy at time

of surgery, whereas only 2/5 patients undergoing the

transnasal approach required a tracheostomy

perioperatively. We found all patients undergoing a

combined approach required at least a temporary

gastrostomy tube compared to 2/5 patients

undergoing a purely transnasal approach.

Discussion:

Endoscopic odontoidectomy is associated with

reduced morbidity than the traditional open

approach. Optimally resection is carried out

endoscopically purely via a transnasal route but

sometimes a transoral corridor is necessary to

achieve decompression inferiorly. Our results

suggest a purely transnasal route is preferred with

better post-operative swallowing outcomes. We will

expand on this series with patients from preceding

years.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #024

Clinical outcomes of bioabsorbable nasal

implants for nasal valve collapse: A meta-

analysis

Felisha Li, BA

Matthew Saleem, BS

Travis Peng

Sarah Van der Els

Carol Wang

Tristan Tham

Donald and Barbara Zucker School of Medicine

Introduction:

While Latera has been shown to improve NOSE

scores long-term in patients, adverse events of the

implant have not been extensively studied. To our

knowledge, this is the first meta-analysis for clinical

outcomes of Latera bioabsorbable implants for nasal

valve collapse.

Methods:

English full-text articles were searched for on

PubMed, Scopus, and Embase databases. Articles

had to report the use of Latera implants; report

adverse events such as complications, inflammation,

and implant retrieval; be from a clinical trial, cohort,

or case-control study. Two reviewers screened

articles and a third settled disagreements. Preferred

Reporting Items for Systematic Reviews and Meta-

Analyses guidelines and the Risk of Bias in Non-

randomized Studies of Interventions tool were used.

After Freeman-Tukey transformation, weighted

proportions were analyzed in a random effects

model.

Results:

Seven studies, three retrospective and four

prospective, representing a total cohort of 513

patients were included in this study. Pooled adverse-

event rate after Latera implant was 13.4% (95% CI:

6.0-23.1%) and implant retrieval rate was 6.8% (95%

CI: 3.8-10.6%). Subgroup analysis found comparable

implant retrieval rates between retrospective (2.5%,

95% CI: 0.1-8.2%) and prospective (8.7%, 95% CI:

6.2-11.6%) studies. There was moderate

heterogeneity in pooled analysis for adverse events

(I2 = 83.8%) and implant retrieval rate (I2 = 42.6%).

Notably, there was no heterogeneity in the

prospective subgroup for implant retrieval rate

(I2=0%).

Discussion:

Implant retrieval is a relatively uncommon

complication of Latera absorbable implant. While the

adverse-event rate was higher, most events in these

studies were mild such foreign body sensation.

Poster #025

Clinical productivity of fellowship-trained

academic rhinologists: An analysis of Medicare

metrics

Michael Warn, Medical Student

Daniella Chan

Theodore Nguyen, BS

Sina Torabi, MD

Benjamin Bitner, Dr.

Edward Kuan, MD, FARS

Introduction:

Current data regarding reimbursement trends in

Medicare services and the types of patients treated

as physicians progress in their academic career is

conflicting, and no such work has been undertaken

for rhinologists.

Methods:

Demographics, professorship rank, and years of

experience of US academic rhinologists were

collected. Those with associated Medicare services,

charges, and patient complexity risk scores (based

on hierarchical condition category coding) were

compared by rank and experience.

Results:

A cohort of 211 rhinologists were included. Private

practice rhinologists performed the most services

(791 [207-1036] vs 404 [182-572]; p =0.016), while

full, associate, and assistant professors billed more

per service ($791.53 [$491.69-1,052.46], $706.85

[$473.48-941.15], $590.34 [$429.91-853.07] vs

$326.08 [$223.37-482.36]; all p<0.001). Full

professors also had higher charges per service

(p<0.001) and total charges (p=0.012) than associate

and assistants, but lower risk scores than assistants

(1.37 [1.26-1.52] vs 1.49 [1.29-1.68]; p =0.013) and

similar risk scores to associates (1.47 [1.25-1.64];

p=0.061). Increasing years of practice was inversely

correlated with risk scores (R=-0.358; p<0.001). As a

cohort, significant declines in risk scores occurred

between the 5-10th and 10th-15th year of practice

(p=0.032) and after the 15th-20th year (p=0.038).

Conclusion:

Academic rhinologists submitted fewer services than

private practice colleagues but had greater total

charges and charges per service. Full professors

charged the most per service and treated patients

with lower risk scores than more junior academic

colleagues. Risk correlates negatively with

experience with significant drops in mid and late

career.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #026

Cohort study: Pluripotent pituitary adenomas are

at higher risk for SIADH

Sabrina Goyal, BS

Jake Lee, MD, MSCI

Kaleigh Roberts, MD, PhD

Sonika Dahiya, MD

Nyssa Farrell, MD

John Schneider, MD, MA

Albert Kim, MD, PhD

Julie Silverstein, MD

Lauren Roland, MD, MSCI

Introduction:

Plurihormonal pituitary adenomas (PPAs), tumors

producing more than one hormone, are exceedingly

rare. The natural history of PPAs, in comparison to

single-secreting pituitary adenomas (PAs), is poorly

understood.

Methods:

Data for 407 resected transsphenoidal PAs was

obtained through a patient repository from a single

tertiary level center. Primary outcomes including

demographics, pre- and post-op endocrinopathies,

tumor morphology, histology, and readmission were

compared between monohormonal and

plurihormonal tumors with bivariate analysis using

Chi-square and unpaired nonparametric Mann-

Whitney tests.

Results:

A total of 383 monohormonal and 24 plurihormonal

tumors were identified between 2015-2023 with an

average age of 51 years. Co-expression patterns

included Prolactin/FSH/LH (n=7), Prolactin/GH (n=3),

ACTH/FSH/LH (n=3), Prolactin/ACTH (n=2),

Prolactin/TSH (n=2), ACTH/FSH/LH/TSH (n=2),

Prolactin/ACTH/FSH/LH (n=2), Prolactin/ACTH/GH

(n=2), Prolactin/ACTH/FSH/LH/TSH (n=1), Prolactin/

GH/FSH/LH/TSH (n=1). Pre- and post-operative

endocrinopathies were present in 16 and 18 cases,

respectively. Ki67 was 2.8 on average with elevated

proliferation in 3 cases. Crooke changes (n=3) and

apoplexy (n=1) were identified. Readmission within

30 days occurred in 6 patients. Compared to

monohormonal tumors, post-operative SIADH

(p=0.024), prolactin (p<0.001), GH (0.0011), FSH/LH

(0.0189), and TSH expression (<0.0001) were higher

in PPAs.

Conclusions:

In this study, we describe our experience with a large

series of PPAs. When determining appropriate post-

operative care of PPAs, higher incidence of SIADH

should be considered.

Poster #027

Combined transnasal, transoral approach for

excision of odontogenic cysts offers reduced

recurrence rates and favorable sinonasal

outcomes

Jennifer Douglas, MD

Kimberly Wei, Medical Student

Kush Panara, MD

Daniel Lee, MD

Michael Kohanski, MD, PhD

Rabie Shanti, Associate Professor

Neeraj Panchal, Assistant Professor

James Palmer, MD, FARS

Nithin Adappa, MD, FARS

University of Pennsylvania

Background:

Odontogenic cysts are fluid-filled, epithelial lined

cavities of dental origin that damage the adjacent

dentition, maxilla, and maxillary sinus, with standard

of care being transoral excision. However, a high

rate of recurrence (14-35%) has been reported. We

present the largest series of odontogenic cysts

managed jointly by rhinologic and oral and

maxillofacial surgeons through a combined

transnasal, transoral endoscopic approach.

Methods:

Retrospective case series of patients undergoing

combined transnasal, transoral endoscopic approach

for excision of odontogenic cysts from 2014-2023.

Records were reviewed for demographics, radiology

and histopathology reports, sinonasal outcomes (via

the 22 item Sinonasal-Outcome Test), and

perioperative course.

Results:

Twenty-three patients met inclusion criteria, 56.5%

male with mean age 44.6 years. Cysts were 3.4 cm

in average maximal diameter with varying pathology

(47.6% odontogenic keratocysts, 28.6% dentigerous

cysts, 14.3% cyst with ameloblastic transformation,

4.8% each ossifying fibroma and chondromyxoid

fibroma). They demonstrated on average no changes

in sinonasal outcomes above the SNOT-22 MCID

and the majority reported improved scores compared

with pre-operative baseline. There were two

episodes of recurrence (9.5%) over a mean follow-up

time of 2.7 years.

Conclusions:

A combined transnasal, transoral endoscopic

approach for excision of odontogenic cysts is a safe

alternative to the transoral approach with a reduced

recurrence rate and favorable sinonasal outcomes.

Herein we report the largest published case series of

a combined approach, with the recommendation it be

considered for improved treatment outcomes for

odontogenic cysts involving the maxillary sinus.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #028

Comparing physical and virtual “digital twin”

models of endoscopic skull base disorders for

preoperative planning

David Ahmadian, BS

Shireen Samargandy, Dr.

Nirushan Narendran, Research Specialist, Senior

Allan Hamilton, Dr.

Minsik Hong

Jerzy Rozenblit, Dr.

Christopher Le, MD, FARS

Michael Avery, Dr.

Eugene Chang, MD, FARS

University of Arizona, College of Medicine – Tucson

Introduction:

A significant challenge in preoperative planning of

endoscopic skull base procedures is visualizing

critical anatomical structures in 3D space.

Wehypothesized that a “digital twin,” or dynamic

personalized 3D image

encapsulating biophysical properties of a patient’s

anatomy might be beneficial in resident surgical

training.

Methods:

Residents in an endoscopic skull base course were

given a traditional

curriculum-based lecture on the hierarchical task

analysis (HTA) steps of an endoscopic approach to

the pituitary gland. They were then exposed to three

different methods of visualizing the patients’

anatomy: 1. DICOM viewer of 3-plane merged CT

and MRI scans, 2. 3D printed model of the patient’s

anatomy, and 3. A virtual reality model created in the

UNITY platform. They were then assessed on their

surgical performance during a cadaveric dissection

of an endoscopic pituitary approach. Residents were

asked to identify critical structures in the dissection,

and their performance was graded using our

published evaluation method by fellowship-trained

attendings. Afterwards, the residents were asked to

complete a Likert-based scale questionnaire on their

opinions regarding the methods of preoperative

planning.

Results:

All trainees completed the three different training

methods. The majority of trainees felt that 3D printed

models and VR simulation were superior in terms of

spatial anatomy localization compared to viewing

traditional 2-dimensional DICOM images. Residents

had significant improvements in cadaveric

dissections after preoperative training.

Conclusions:

3D printed and virtual models of patient-specific

anatomy improves resident awareness of critical

structures in endoscopic skull base surgery.

Poster #029

Complications of novel radiofrequency device

use in otolaryngology: A MAUDE analysis

Sina Torabi, MD

Benjamin Bitner, Dr.

Eric Abello

Theodore Nguyen

Brian Wong

Edward Kuan, MD, FARS

University of California, Irvine

Introduction:

With the widespread development and adoption of

intranasal radiofrequency (RF) devices, the objective

herein was to report national adverse events

associated with their use.

Methods:

The Food & Drug Administration’s Manufacturer and

User Facility Device Experience was queried for

adverse events reported after Celon ProBreath

(Olympus), Vivaer (Aerin) and Rhinaer (Aerin) use

since database inception to February 2nd, 2023. The

event descriptions were reviewed and categorized by

three independent reviewers, with any discrepancies

discussed and resolved.

Results:

A total of 22 device-related adverse events were

reported, 11 (50.0%) for Celon, 3 (13.6%) for Vivaer,

and 8 (36.4%) for Rhinaer. 7 (63.6%) of the Celon-

related complications were related to tissue necrosis,

including a palatal perforation, that appeared to be

related to user error. Notably, 1 (9.1%) episode of

pediatric ocular palsy was also reported. Vivaer

complications included synechiae formation that

required excision, a mucosal perforation secondary

to tissue necrosis, and a case of empty nose

syndrome reported directly by the patient. 7 (87.5%)

of the 8 Rhinaer complications were related to

epistaxis. 3 (37.5%) of these epistaxis episodes

required transfusions. Only 1 (14.3%) was

successfully treated with packing, and 6 (85.7%)

required operative intervention.

Conclusion:

Surgeons should exercise vigilance and tissue-

appropriate device settings when utilizing RF

devices. Epistaxis and tissue necrosis may occur, as

well as more rare, but devastating, complications.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #030

Comprehensive patient-focused medical

illustrations to supplement the rhinology surgical

consent process

Chase Kahn, MD

Bita Naimi, BA

Alexander Duffy, MD

Emily Garvey, BA

Douglas Farquhar, MD

Elina Toskala, MD, MBA, PhD, FARS

Gurston Nyquist, MD, FARS

Marc Rosen, MD, FARS

Mindy Rabinowitz, MD, FARS

Thomas Jefferson University

Introduction: Previous studies have demonstrated

improved patient satisfaction and comprehension

when patients are provided education in a focused

manner. In surgical populations, supplemental media

materials have been used to educate patients on

disease pathophysiology and treatment and have

been deemed of limited usefulness and poor overall

validity for patient information. Anatomically accurate

illustrations can be linked to written or spoken text,

which can markedly increase a patient’s attention,

comprehension, and recall of clinical information.

Currently, there are no studies that have investigated

the practicality of medical illustrations to supplement

the surgical consent process for rhinology surgery.

Objective: This study aims to investigate the benefits

of incorporating specifically designed anatomic

illustrations to improve patient health literacy during

the surgical consent process.

Methods: Detailed anatomically accurate illustrations

were developed in concert with the study PI and a

medical illustrator. Pre-and post-operative images

along with common disease states created to cover

common rhinologic procedures including the surgical

management of epistaxis, dacryocystorhinostomy,

endoscopic sinus surgery, and endonasal pituitary

surgery. Double-sided documents were created with

illustrations on one side and a narrative on the

reverse reiterating the surgical intervention

associated with those images. These were designed

to mimic the pre-operative surgical discussion.

Conclusion: Providers can use these documents

during their surgical discussion to reiterate the

highlights of the discussion and send the patient

home with a visual reminder.

Poster #031

Contemporary update on the microbiology of

paranasal sinusitis

Alan Workman, MD, MTR

Margaret Mitchell, Resident Physician

Richard Lu, Medical Student

Neil Bhattacharyya, MD

Introduction:

Rhinosinusitis, whether acute, recurrent, or chronic,

is thought to be at least in part be characterized by a

disruption of microbiology. Existing studies on the

microbiology of sinusitis, however, are limited by

their sample size.

Methods:

We identified patients within a large health system

that had sinus cultures taken by an otolaryngologist

with a concurrent diagnosis of acute or chronic

rhinosinusitis. These cultures were analyzed based

on their culture type and result.

Results:

A total of 2,302 culture samples were collected,

2,012 (87%) of which were bacterial cultures and

287 (13%) which were fungal cultures. More than

half (1142, 57%) of the bacterial cultures resulted

positively, or with a named genus, while 592 (29%)

were normal sinus flora, 16 (0.8%) resulted as

normal oral flora, and 183 (9%) resulted as no

growth. The most common genus identified was

Staphylococcus (383, 34%), most commonly S.

aureus (311, 81%), 42 of which (14%) showed

methicillin resistance (MRSA). Of the positive

bacterial cultures with named genera, those

represented were Propionibacterium (145, 13%),

Haemophilus (101, 9%), Pseudomonas (94, 8%),

and Streptococcus (83, 7%). Of fungal cultures, 265

(92%) resulted in no growth.

Discussion:

Within a sample of over 2,000 sinus bacterial

cultures, 57% resulted positively with identification of

a named genus, highlighting the utility of this assay.

Alternatively, the vast majority of fungal cultures

showed no growth, suggesting a lack of utility when

treating patients with sinus symptoms. This update

on the microbiology of sinusitis offers both insight

into the baseline nasal microbiology of a broad

population as well as commenting on the potential

utility of sinus culture data.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #032

Cranial neuropathies secondary to allergic fungal

rhinosinusitis

Ashleigh Halderman, MD, FARS

Sei Chung, MD

Kendra Stephen

Nina Stephen

Jenny Kim

University of Texas Southwestern

Background:

Though allergic fungal rhinosinusitis (AFRS) is a

benign, noninvasive process, advanced disease can

result in orbital and skull base erosion resulting in

cranial neuropathies. This review examines the

demographic and clinical characteristics of such

patients.

Methods:

This review describes 55 patients with AFRS, of

which 6 presented with cranial nerve (CN) deficits.

Data on demographics, clinical findings, and patient

anatomy were analyzed using independent t-and

Pearson’s chi-squared tests as appropriate.

Results:

The average age of AFRS patients who presented

with cranial neuropathies was 36 years, which did

not significantly differ from the remaining AFRS

cohort (34 years). Among AFRS patients with CN

deficits, 3 were Black and 3 were White, and there

was an equal distribution by gender. AFRS patients

with CN deficits had significantly higher eosinophil

levels (p=0.01) and absolute eosinophil counts

(p=0.02), compared to AFRS patients without cranial

neuropathies. The total Lund-Mackay scores did not

significantly differ between those with or without

cranial neuropathies. Among AFRS patients with CN

deficits, one patient demonstrated pansinus complete

opacification, and all others had sphenoid-

predominant disease with a posterior pattern of

expansion and erosion. Patients presented with

vision loss (n=6) secondary to optic canal

dehiscence, or CN III or VI palsy (n=2) due to

posteriorly erosive disease at the sphenoclival skull

base.

Conclusions:

AFRS can rarely present with cranial neuropathies

when the disease pattern is sphenoid-predominant

and expansile in a posterior direction towards the

sphenoclival skull base. There may be a propensity

to develop this form of advanced AFRS in those with

greater peripheral.

Poster #033

Craniofacial pain locations and outcomes after

endoscopic sinus surgery for unilateral sphenoid

sinusitis: A multi-institutional study

Richard Pellizzari, BS

John Craig, MD, FARS

Alberto Saibene, MD, MA

Luigi De Donato, MD

Benjamin Bitner , MD

Rijul Kshirsagar, MD

Jennifer Douglas, MD

Edward Kuan, MD, MBA, FARS

Nithin Adappa, MD, FARS

Jacob Eide, MD

Henry Ford Health

Introduction:

Unilateral radiographic sphenoid sinus opacification

is caused by a variety of pathologies including

inflammatory and infectious sinusitis, tumors, and

encephaloceles. The purpose of this study was to

report craniofacial pain locations and outcomes in

unilateral sphenoid sinusitis (USS) patients who

underwent endoscopic sinus surgery (ESS).

Methods:

A multi-institutional retrospective cohort study was

conducted on all adult patients who had ESS for

USS from 2015-2022. Patient demographics,

presenting symptoms and nasal endoscopy findings,

surgical extent, and craniofacial pain outcomes were

recorded. Exclusion criteria included age <18 years,

immunodeficiency, invasive fungal sinusitis, and

neoplasia. Descriptive statistics were calculated.

Results:

Of the 52 study patients, mean age was 61 +/- 15

years, and 71.2% were female. Craniofacial pain

was present in 65.4% of patients in the following

locations: retrobulbar (47.1%), frontal/forehead

(47.1%), whole head/face (17.6%), maxillary/cheek

(17.6%), occipital (14.7%), and vertex (8.8%). Most

patients had normal nasal endoscopies, while 26.9%

had mucopurulence, 11.5% edema, and 7.7% polyps

in the sphenoethmoid recess. The most common

pathologies were fungal ball (36.5%) and chronic

rhinosinusitis without nasal polyps (23.1%). Of the

34 patients with craniofacial pain, 76.5% resolved by

their first postoperative visits (mean 10.6 days) and

88.2% resolved by their second postoperative visits

(mean 38.9 days).

Conclusion:

In USS patients, the most common craniofacial pain

locations were retrobulbar and frontal/forehead, with

a minority having occipital and vertex pain. ESS

resolved the craniofacial pain in nearly 90% of

patients.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #034

CRSwNP patients using biologicals: real-world

experience in a reference center

Wilma Anselmo-Lima, MD, PhD

Vanessa Dinarti, PhD

Gabriela Silveira, MD

Otavio Mieli, MD

José Lemos, MD

Marcio Nakanishi, PhD

Denny Garcia, PhD

Luisa Arruda, PhD

Fabiana Valera, PhD

Edwin Tamashiro, PhD

Ribeirão Preto Medical School of University of São

Paulo

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.

Poster #035

Current otolaryngologic applications of the novel

self-assembling RADA-16 peptide matrix

Arthur Wu, MD, FARS

Kaitlynne Pak

Dennis Tang MD, FARS

Satyan Sreenath, MD

Christopher Ito, MD, FARS

Brent Senior, MD, ARS

Kent Lam, MD, FARS

Thomas Higgins, MD, FARS

Kevin Hur, MD

Benjamin Tam

Cedars-Sinai

Background:

PuraGel® is a novel RADA-16 based self-

assembling peptide matrix gel intended to prevent

adhesions between mucosal surfaces, control

minimal bleeding following surgery or nasal trauma,

and act as an adjunct to aid in the natural healing

process. Current literature is sparse but includes use

in nasopharyngeal stenosis, turbinate reduction, and

sinus surgery. The goal of this study is to determine

current use patterns and possible complications

among US otolaryngologists.

Methods:

A list of current US academic institutions who have

used RADA16 was obtained and a brief survey was

distributed. Number and type of cases as well as

complications were queried.

Results:

7 of the 13 current academic sites using the product

responded, including seven academic rhinologists.

The product was used in 174 cases including 84

FESS, 41 septoplasty/turbinate reduction, 11

nasoseptal flap donor sites, 4 Draf III, 14 medial

maxillectomies, 6 sinonasal tumor resections (non-

inverted papilloma), 8 tonsillectomies, and 5 nasal

stenosis. There were 13 complications encountered.

Complications mostly were related to stensosis and

bleeding. There were 6 instances of sinonasal

scarring/stenosis, 4 of which required reoperation.

There were 2 tonsil bleeds and 3 episodes of

epistaxis.

Conclusion:

As with any novel technology, there is a learning

curve with the usage of this product. The RADA-16

gel appears to have novel uses for promoting

mucosal healing, providing a matrix for migrating

cells to repopulate and heal denuded tissue.

However, when used in tight areas where it might fill

potential space, there is a possibility for creating

stenosis. Further studies will be helpful to determine

appropriate use and applications of this novel

product.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #036

Development of a novel quantitative PCR assay

for diagnosis of rhinocerebral mucormycosis

Tom Maxim, MD

Jivianne Lee, MD, FARS

Eri Srivatsan

Albert Ko

Ashraf Ibrahim

Yiyou Gu

David Beenhouwer

Nicholas Jackson

Daniel Manzoor

David Geffen School of Medicine at UCLA

Introduction:

Rhinocerebral mucormycosis (RCM) is an

angioinvasive disease targeting the paranasal

sinuses and surrounding soft tissues, typically in

immune-compromised hosts. Frozen tissue analysis

is relied upon for expedited diagnosis but suffers

from reduced sensitivity (83-87.5%) in comparison to

permanent pathology, risking false negative results

and treatment delays. The Mucorales CotH3 protein

is a key mediator of host cell invasion, representing

a promising target for PCR development as an

alternative diagnostic method.

Methods:

Four custom primers/probes were developed

targeting highly conserved sequences of the CotH3

gene. Purified DNA from four of the most common

invasive Mucorales strains (Rhizopus delemar,

Mucor circinelloides, Lichtheimia, Rhizomucor) were

used to test primer performance in quantitative PCR.

Aspergillus fumigatus DNA served as negative

control. Cycle threshold (Ct) values were

established.

Results:

Average Ct values demonstrate primers 1, 2 and 4

amplified the target sequence of Rhizopus delemar

DNA at cycle 26 and dilute Rhizopus DNA at cycle

30-32. Primers 1 and 4 are most sensitive to

Rhizopus delemar, with Ct values 9-12 cycles lower

compared to the other Mucorales strains. Primer 4

showed highest sensitivity to Lichtheimia and Mucor

circinelloides. Rhizomucor was not amplified.

Aspergillus DNA showed no amplification of the

target sequence using primer 1, and non-specific

low-level amplification in 1 of 3 wells using primers 2

and 4.

Conclusions:

A novel quantitative PCR targeting the CotH3 gene

detects Mucorales DNA with high specificity and

sensitivity. Primer 4 showed the best overall

performance across multiple Mucorales strains and

merits further testing in human subjects.

Poster #037

Differences in patient characteristics with

unilateral versus bilateral allergic fungal

rhinosinusitis

Sei Chung, MD

Kendra Stephen

Nina Stephen

Jenny Kim

Ashleigh Halderman, MD, FARS

University of Texas Southwestern

Background:

Allergic fungal rhinosinusitis (AFRS) is a noninvasive

form of fungal sinusitis and is a subtype of chronic

sinusitis with nasal polyps (CRSwNP). Unlike other

forms of CRSwNP, AFRS can be unilateral or

bilateral. While various demographic factors as they

relate to disease severity and recalcitrance have

been previously evaluated, little work has looked at

potential differences between patients who present

with unilateral versus bilateral AFRS.

Methods:

A retrospective review identified 55 patients with

AFRS. Data on demographics, insurance status,

comorbidities, anatomic features, and CT findings

were analyzed using independent t-and Pearson’s

chi-squared tests.

Results:

32.7% had unilateral AFRS and 67.3% had bilateral

AFRS. Those with bilateral disease were older (38 vs

28 years, respectively; p=0.02), more likely to be

Black (p=0.04), and had active or prior tobacco use

(p=0.025). There was no significant difference in

insurance status. Neither septal deviation nor the

presence of concha bullosa were associated with

unilateral versus bilateral disease. There were no

significant differences in the presence of asthma or

self-reported allergic rhinitis. There was a trend

towards greater peripheral eosinophilia in those with

bilateral AFRS. Patients with bilateral AFRS were

significantly more likely to present with cranial nerve

deficits (p=0.02) secondary to expansile and erosive

disease at the sphenoid, petrous, and clival skull

base.

Conclusions:

Compared to patients with unilateral AFRS, those

with bilateral AFRS were older, more likely to be of

Black race, and have positive smoking history. To our

knowledge, this is the first study to describe

differences in patients with unilateral versus bilateral

disease.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #038

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

Prof. Claire Hopkins

Martin Wagenmann, MD, PhD

Asif Khan, Dr.

Claus Bachert, Dr.

Jerome Msihid, Dr.

Scott Nash, Dr.

Yamo Deniz, Dr.

Paul Rowe, Dr.

Harry Sacks, Dr.

Juby Jacob-Nara, Dr.

Düsseldorf University Hospital

Background:

In CRSwNP, a nasal polyp score (NPS) of 8/8

signifies complete bilateral nasal obstruction.

Dupilumab is efficacious in severe CRSwNP; here

we report outcomes in patients (pts) with NPS=8.

Methods:

Post-hoc analysis of pts with NPS=8 at

randomization (after 28 days’ intranasal

corticosteroids [CS]) in SINUS-24/52 (NCT02912468/

NCT02898454), receiving dupilumab 300 mg/

placebo every 2 weeks.

Objective assessments:

NPS (0−8), peak nasal inspiratory flow (PNIF),

Lund‒Mackay computed tomography (LMK-CT;

0−24); pt-reported assessments: nasal congestion,

loss of smell (NC, LoS; 0−3), 22 item Sino-Nasal

Outcome Test (SNOT-22; 0−110).

Results:

98/724 (13.5%) pts 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 vs placebo at Week 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 Week 52. At Week 24,

69.1%/10.0% pts (dupilumab/placebo) achieved NPS

improvement ≥1; 51.5%/0% LMK-CT 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=0.001). Fewer pts

required systemic CS or sinonasal surgery through

Week 24 with dupilumab than placebo

(11.8%/36.7%, P=0.0005).

Conclusions:

In pts with CRSwNP and NPS=8, dupilumab

demonstrated significant, clinically relevant reduction

in NPS, improved nasal inspiratory flow, symptoms,

and health-related quality of life, and reduced need

for systemic CS/surgery vs placebo.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #039

Efficacy of olfactory training after unilateral

anterior skull base resection in patients with

olfactory neuroblastoma: A single-center

prospective study

Teppei Takeda, MD

Omura Kazuhiro

The Jikei University School of Medicine

Introduction:

Unilateral skull base resection for selected patients

with olfactory neuroblastoma is useful in controlling

the tumor while ensuring a minimally invasive

approach to the patient. Furthermore, unilateral skull

base resection has been reported to be useful in

preserving the sense of smell. However, not all cases

preserve the sense of smell. In the present study, we

investigated whether postoperative olfactory training

is useful in preserving the sense of smell after

unilateral anterior skull base resection.

Methods:

This study is a single-center case-control study. At

our institution, postoperative olfactory training has

been offered to patients who have undergone

unilateral anterior skull base resection since 2022.

Patients who underwent unilateral anterior skull base

resection only for ONB patients from 2018 to

December 2021 were defined as the control group,

while patients who underwent unilateral anterior skull

base resection and postoperative olfactory training

after January 2022 were defined as the case group,

and the olfactory preservation rate in each group was

examined. The same surgeon and anterior skull base

resection reconstruction method were used. Olfactory

function tests were conducted using Open Essence

to evaluate olfactory identification ability.

Results:

Six patients in the control group and seven patients

in the case group were analyzed. In an Open

Essence olfactory function test, 2 out of 6 (33%) in

the control group and 5 out of 7 (71%) in the case

group had a preserved sense of smell.

Conclusion:

Although the number of cases in this study is limited,

we believe that olfactory training intervention may

improve the

postoperative olfactory preservation rate.

Poster #040

Epithelial-myoepithelial carcinoma of the nasal

cavity. An interesting case report and review of

the literature

Ariel Waitzman, MD

Jacob Waitzman, Medical Student

Jeremy Powers Chief, Dept of Pathology

Rohan Deraniyagala, Assistant Professor

Epithelial-Myoepithelial carcinoma is an extremely

rare malignancy. We present a case study of a

patient with Epithelial-Myoepithelial carcinoma of the

nasal cavity, with presentation of clinical, radiologic

and pathologic images. The case report involves a

67 year old female presenting with nasal obstruction

and recurrent mild unilateral epistaxis. CT and

endoscopy demonstrated a friable polypoid mass

involving the septum and middle turbinate on the

right side. Endoscopic biopsy was consistent with an

Epithelial-Myoepithelial carcinoma, intermediate

grade. The case was presented at our Head and

Neck Tumor Board with a recommendation for

surgery, reserving radiation therapy for positive

margins or recurrent disease. The patient underwent

endoscopic resection with clear clinical margins.

Final pathology (the pathologist did not feel frozen

sections would be reliable with this tumor type)

revealed microscopic positive margins in 2 areas. A

second endoscopic resection was performed

removing tissue up to the skull base, again with no

clinically detectable tumor. Final pathology, however,

again revealed a microscopic positive margin at the

skull base. The patient subsequently underwent full

course radiation therapy to the right nasal cavity

including the skull base. The patient remains

disease free at this time and is closely followed.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #041

Eustachian tube recanalization via CO2 guidewire

and ureteral stent

Christopher Pool, MD

David Keschner

Kaiser Permanente Orange County

Patulous eustachian tube dysfunction is a rare

disorder that can be treated with different

medications and procedures aimed at improving

quality of life by decreasing or eliminating the

diameter of the eustachian tube orifice. Complete

obliteration of the eustachian orifice risks chronic

serous otitis media which can itself create substantial

morbidity. We describe a case of eustachian tube

recanalization after prior obliteration using a CO2

laser guidewire and a ureteral stent. The patient

underwent myringotomy with endoscopic placement

of the guidewire through the hypotympanic

eustachian tube orifice, combined with transnasal

endoscopic balloon dilation of the eustachian tube,

and subsequent retrieval in the nasal cavity. A

ureteral stent was then placed via Seldinger

technique. The stent was removed after three

months and with long term patency and resolution of

symptoms. This is the first case report to describe

recanalization using both balloon dilation and

ureteral stenting.

Poster #042

Evidence for a role of metformin in preventing

olfactory dysfunction among older adults

Sahar Assi, MD

Wuyang Zhang

Nicholas Reed

Andrew P. Lane, MD, FARS

Murray Ramanathan, MD, FARS

Nicholas Rowan, MD

Johns Hopkins Bloomberg School of Public Health

Background:

Olfactory dysfunction (OD) is increasingly recognized

as a hallmark of unhealthy aging and mortality, but

therapies remain elusive. Recognizing the increased

prevalence of OD in individuals with diabetes, and

the potential anti-aging effects of metformin, we

examined the association of metformin use with OD.

Methods:

Asynchronous cross-sectional study of participants

with diabetes from the National Social Life, Health,

and Aging Project (NSHAP), Waves 2 (2010-11) and

3 (2015-16). Olfactory sensitivity (OS), the ability to

detect the presence of an odorant, and olfactory

identification (OI), the ability to identify the odorant,

were tested. Weighted multivariable logistic

regression was used to examine the association

between metformin use at Wave 2 and odds of OS/

OI dysfunction at Wave 3, adjusted for age, sex,

race/ethnicity, education, BMI, HbA1c, and years

since diabetes diagnosis at Wave 2.

Results:

In a sample of 228 participants with diabetes (mean

age=69 years, 53% female, 21% Black), 112 (49%)

were metformin users. In the adjusted model, relative

to nonusers, metformin users had 63% lower odds of

OS dysfunction at Wave 3 (Odds Ratio [OR]=0.37,

[95% Confidence Interval=0.15-0.90] p=0.030). A

more pronounced association was observed in a

subgroup of 61 participants with normal OS function

at Wave 2, where metformin users had 96% lower

odds of OS dysfunction at Wave 3 (OR=0.04 [0.01-

0.16] p<0.001). While not statistically significant,

metformin use was associated with lower odds of OI

dysfunction (OR=0.56 [0.28-1.14]).

Conclusion:

Metformin use is associated with lower odds of OS

dysfunction among individuals with diabetes,

suggesting a potential protective effect mediated

through peripheral mechanisms of olfac

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #043

WITHDRAWN

Poster #044

Extramedullary plasma cell neoplasm in the

nasal cavity: Case presentation

Guillermo Antonio Ramirez, MD

Cesar Alfonso Gutierrez Espinoza, Dr.

Extramedullary plasmacytoma is a rare neoplasm,

however when it occurs, the ENT area is the most

frequently affected site. The few series of patients

reported in the literature, and especially in our

environment, mean that current management is not

very widespread. Diagnosis is somewhat difficult to

perform only with clinical elements, which makes the

laboratory and histopathological study with specific

techniques of vital importance. It is known that its

transformation into multiple myeloma constitutes the

main prognostic factor, hence the patient must

undergo to rigorous monitoring.

The case of a 78-year-old woman is presented, who

is registered as a secondary to a chest wall tumor

corresponding to a plasma cell neoplasm, which is

later evaluated due to presenting symptoms of nasal

obstruction predominantly left with outlet of mucous

discharge of months of evolution, which was

diagnosed as an extramedullary plasma cell

neoplasm

Clinically, they can manifest as a nasal mass,

increased volume and facial pain, airway obstruction,

epistaxis, rhinorrhea, proptosis, dysphagia or

dysphonia. In relation to its extension, 3 stages are

distinguished. The diagnosis of extramedullary

plasmacytoma is based on histological evidence of a

plasma cell tumor in an extramedullary location (not

bone) and without clinical, histological or radiological

evidence of multiple myeloma.

In the following work we address the presentation of

a clinical case and follow-up of a patient with plasma

cell neoplasia.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #045

Functional and structural correction of over-

reduced noses by non-rib grafts

Mohsen Naraghi, MD, FARS

Orphans World Wide

Introduction:

The selection of the ideal graft has been an issue of

concern for its donor site morbidity and other

possible problems such as graft visibility and

irregularities, infection, and inflammatory reactions.

This retrospective result describes the author’s

experience with non-rib diced cartilage fascia graft in

over-reduced Noses.

Methods:

Thirty-seven secondary rhinoplasty cases underwent

non-rib diced cartilage grafts with facia temporalis

augmentation from 2015 to 2022. Combining open

and endoscopic approaches provided good material

for structural support and camouflage purposes

exclusively from the non-rib sources, including

septum and concha cartilage.

Results:

Functional and aesthetic results revealed significant

improvement in all patients. Three cases with more

resorption in the supra-tip area were managed non-

surgically. Four cases underwent postoperative

massage to refine the molding of cartilages up to two

weeks after surgery. Improvement of over-resected

dorsum on profile and restoration of parallel aesthetic

lines were our cases’ most common improvement

items.

Conclusion:

Advantages of non-rib graft include: Avoiding any

incision in the chest to harvest rib cartilage; Using

minimal cartilage from dierent sources; Less

visibility over time; Decreased risk of torsion and

warping of the graft; Complete attachment of the

graft to the recipient bed, ensuring more stability;

More compatibility with an asymmetric bed with bony

and cartilaginous irregularities and more eectively

camouﬂaging such asymmetries; Flexibility and

compliance of the soft cartilage fascia graft to be

massaged and modified meticulously even in

postoperative visits.

Poster #046

Gender differences in quality of life in patients

with skull base pathologies

Parker Tumlin, MD

Meghan Turner, MD

Hassan Ramadan, MD, FARS

Chadi Makary, MD, FARS

Background: Recent studies showed that female

patients with chronic rhinosinusitis (CRS) suffer a

worse disease-specific quality of life (QoL).

Goal: To investigate gender differences in QoL in

non-rhinosinusitis patients with sinonasal and skull

base pathologies.

Methods:

Cross-sectional analysis of patients presenting to

West Virginia University Otolaryngology clinic from

August 2020 to November 2022 with inverted

papilloma (IP), spontaneous CSF rhinorrhea, Grave’s

orbitopathy (referred for orbital decompression), and

skull base tumors was performed. Baseline QoL was

measured using the sinonasal outcome test-22

(SNOT-22). Patients’ demographics and

comorbidities were reviewed. Patients with

concomitant CRS were excluded.

Results:

98 patients were included (50 with skull base tumors,

19 Grave’s orbitopathy, 15 CSF rhinorrhea, and 14

IP). Mean age was 53.6 years (12-4-81.5), 52% were

female. There was no age difference between

females and males. Smoking history, asthma, and

allergic rhinitis were also similar between the two

groups. Males were more likely to have nasal septal

deviation (38.2% vs 17.8%, p=0.04). Overall SNOT-

22 was similar between females and males (30.3 vs

22.7, p=0.06). However, females had significantly

worse scores in the ear/facial, psychological, and

sleep subdomains (5.2 vs 3.2, p=0.019; 12 vs 6.9,

p=0.004; 10.1 vs 6.9, p=0.035 respectively). Similar

results were obtained in patients with skull base

tumors.

Conclusion:

Female patients with non-rhinosinusitis sinonasal

and skull base pathologies show higher non-

rhinological subjective disease burden. Further

studies with larger sample sizes are needed to

confirm these findings.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #047

Granulomatosis with polyangiitis presenting with

skull base inflammation mimicking petrous

apicitis: A case report and literature review

Michael Castle, MD

Matthew Carter, Medical Student

Alexander Poulakis, Medical Student

Li-Xing Man, MD, FARS

Isaac Schmale, MD

University of Rochester Medical Center

Background:

Granulomatosis with polyangiitis (GPA) is an

autoimmune granulomatous disease. Non-classic

clinical presentations of GPA can provide diagnostic

challenges and lead to delays in diagnosis. We

present a unique case highlighting rare

manifestations of GPA including primarily skull base

inflammatory findings.

Case Description:

A 29-year-old male presented with headache, right

otorrhea, cranial neuropathies, and hearing loss.

Labs showed an elevated ESR and CRP. Initial CT

and MRI demonstrated enhancement of the petrous

apex. Flexible laryngoscopy showed nasal crusting

and a large septal perforation. Despite normal vital

signs and normal white count, his initial management

was for an infectious etiology. Further workup

revealed proteinuria and c-ANCA positivity, and a

kidney biopsy established a diagnosis of GPA. Later

nasal endoscopy confirmed extensive nasal crusting

and large septal perforation consistent with GPA.

Discussion and Review:

There are approximately 20 studies that describe

GPA presentations involving the skull base. In the

largest retrospective review of 29 patients, no

patients had otorrhea. To date, otorrhea has been

reported in 2 patients with GPA. In one report,

otorrhea and skull base findings on imaging led to

infectious treatment, thus highlighting the confusion

seen in this rare pattern of GPA presentation.

Conclusion:

Autoimmune workup should be considered in

patients with skull base enhancement on imaging

that is not consistent with neoplasia or severe

infection. Likely to be consulted in such cases, the

otolaryngologist should keep a high index of

suspicion for GPA in the setting of unexplained skull

base inflammation, coexistent septal perforations,

and nasal crusting.

Poster #048

Histopathologic features of patients with

noninvasive fungal rhinosinusitis

Tamara Simpson, BA

Ali M. Baird, Medical Student

Pete Batra, MD, FARS

Peter Filip, MD

Hannah J. Brown, MD

Sarah Khalife, MD

Paolo Gattuso, MD

Bobby A. Tajudeen, MD, FARS

Peter Papagiannopoulos, MD

Rush Medical College

Introduction:

Noninvasive fungal rhinosinusitis (FRS) can be

subclassified into allergic fungal rhinosinusitis

(AFRS) or fungal ball (FB). This study investigates

the histopathologic features of noninvasive FRS to

further understand its distinct pathogenesis from

other types of chronic rhinosinusitis (CRS). Currently

there are no studies that examine histopathologic

features of noninvasive fungal disease.

Methods:

A retrospective review of 468 patients undergoing

functional endoscopic sinus surgery (FESS) was

performed. Data was collected on patient

demographics, medical comorbidities, and structured

histopathology reports consisting of 13 variables.

Results:

Of 36 patients with noninvasive FRS, 21 (58.3%) had

FB and 15 (41.7%) had AFRS. Patients with AFRS

had increased tissue eosinophilia (>5 per HPF)

compared to FB (86.7% vs 19.0%, p<0.001). 432

patients comprised the CRS control group. The

mean age for the noninvasive FRS group was 54.1

years compared to 50.1 years for the CRS group.

The noninvasive FRS group had higher rates of

severe overall inflammation compared to the CRS

controls (33.3% vs. 3.9%, p<0.001). The noninvasive

FRS group showed increased fungal elements

(27.8% vs. 4.4%, p<0.001), subepithelial edema

(63.9% vs. 43.8%, p=0.02), and Charcot-Leyden

crystals (17.1% vs. 4.6%, p=0.002).

Conclusion:

Histopathologic analysis of noninvasive FRS showed

increased extra mucosal fungal elements, moderate

to severe overall degree of inflammation,

subepithelial edema, fibrosis, and Charcot-Leyden

crystals compared to non-fungal CRS. These

variables represent unique differences in the

pathogenesis of noninvasive fungal disease;

therefore, possible targets in diagnosis and treatment

could benefit disease progression.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #049

WITHDRAWN

Poster #050

Impact of insurance status on CSF leak

presentation

Ali M. Baird, BS

Jamie Masliah, Resident

Peter Filip, MD

Sarah Khalife, MD

Peter Papagiannopoulos, MD

Pete Batra, MD, FARS

Bobby Tajudeen, MD, FARS

Rush Medical College

Introduction:

Spontaneous cerebrospinal fluid (CSF) leaks are

known complications of idiopathic intracranial

hypertension (IIH), a disease that disproportionally

affects Black and Hispanic women. Prior studies

demonstrated that patients with IIH had lower

median household incomes and lived in food

swamps. The aim of this study is to identify

relationships between health disparities, measured

by insurance status, and the clinical presentation of

CSF leaks in patients with IIH.

Methods:

A retrospective chart review was conducted of

patients with IIH who underwent surgical

management for spontaneous CSF leaks from 2009

to 2022. Data was collected on patient

demographics, health insurance status (Medicaid,

Medicare or private), zip codes, and CSF leak

presentation.

Results:

50 patients undergoing treatment for spontaneous

CSF leaks were analyzed with a mean age of 56.1

+/- 12.6 years and a mean BMI of 38.9 +/- 7.38. 13

patients had Medicaid insurance, 7 had Medicare

insurance, and 30 had private insurance. Black (n=8,

61.5%) and Hispanic patients (n=3, 23.1%) made up

the majority of the Medicaid group. Although not

statistically significant, patients with Medicaid

compared to patients with Medicare or private

insurance were more likely to present with

preoperative meningitis (38.5% vs 14.3% and 16.7%,

p= 0.247) and have a higher number of skull base

dehiscences (2.38 vs 1.86 and 1.87, p=0.441).

Conclusion:

Insurance status acts as one marker for the social

determinants of health and may predict severity at

presentation in patients with spontaneous CSF leaks.

Patients with Medicaid coverage were more likely to

present with preoperative meningitis or multiple skull

base dehiscences, indicating a prolonged

presentation.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #051

Impact of LYR-210 corticosteroid matrices on the

incidence of acute exacerbations of chronic

rhinosinusitis in patients from the LANTERN

randomized controlled study

Vineeta Belanger, PhD

Brent Senior, MD, FARS

Agnieszka Wrobel

Anders Cervin, MD, PhD

Lindsay Brayton, Clinical Project Manager

Allison Gartung

Lyra Therapeutics, Inc.

Background:

LYR-210 is an implantable corticosteroid matrix

designed to provide up to 24 weeks of localized

sinonasal treatment for surgically naïve chronic

rhinosinusitis (CRS) patients. LYR-210 (7500µg)

demonstrated safety and significant efficacy

improvements compared to control at week 24 in the

LANTERN study. This presentation reports the

impact of LYR-210 on the incidence of acute

exacerbations of CRS (AECS) in patients from the

LANTERN study.

Methods:

Symptomatic adult CRS patients who failed previous

medical management were enrolled in a multicenter,

blinded, randomized, controlled Phase 2 LANTERN

study, and received bilateral administration of LYR-

210 (7500µg) (N=21) or LYR-210 (2500µg) (N=23) or

sham-procedure control (N=23). Percentages of

patients experiencing AECS, defined as a sudden

worsening of symptoms resulting in the treating

physician reporting an escalation of treatment, was

prespecified as an exploratory endpoint and

assessed at weeks 4, 8, 12, 16, 20, and 24. The

number and proportion of patients experiencing

AECS, along with two-sided 90% confidence

intervals (CIs) vs. control were determined.

Results:

Two LYR-210 (7500µg)-treated patients (9.5%) [CI:

-0.4, -0.019], five LYR-210 (2500µg)-treated patients

(21.7%) [CI: -0.3, 0.13], and seven control patients

(30.4%) experienced an AECS by week 24. The first

incidence of AECS in the control group occurred by

week 4, compared to week 20 for the LYR-210

(7500µg) group.

Conclusion:

There was a reduction in the occurrence of AECS in

the LYR-210 (7500µg) group compared to control

during the 24-week treatment period in the

LANTERN study. This important clinical effect is

being studied further in the pivotal Phase 3 trials of

LYR-210 (ENLIGHTEN I & ENLIGHTEN II).

Poster #052

Impact of social determinants of health in

chronic rhinosinusitis disease severity: A

scoping review

Avigeet Gupta, MD

Julian Purrinos, Medical Student

Kibwei McKinney, MD

Renata Grozovksy, Clinical Research Scientist

Corinna Levine, MD, FARS

The University of Oklahoma Health Sciences Center

Background:

While social determinants of health (SDoH) are

known to influence chronic rhinosinusitis (CRS), little

is known regarding the specific impact of SDoH on

CRS disease severity. This comprehensive scoping

review summarizes the existing body of literature to

assess the size and scope of the current literature

examining the impact of SDOH on objective markers

of CRS severity.

Methods:

We performed a scoping review of the PubMed,

Ovid, and EMBASE databases with assistance of

senior librarian in accordance with the Preferred

Reporting Items for Systematic Reviews and Meta-

Analysis extension for Scoping Reviews (PRISMA-

Scr) checklist.

Results:

A total of 1516 references were identified, of which

1285 underwent title and abstract screening. 215 full-

text articles were reviewed, and 21 articles met

inclusion criteria for analysis of outcomes data.

Several SDoH themes with regards to outcome

measures for CRS were ascertained from the

literature search including sex, race, ethnicity,

socioeconomic status, behavioral and lifestyle

outcomes, and environmental exposures. The

majority of articles contained heterogenous

outcomes without statistically significant differences

for Lund-McKay and Lund-Kennedy Scores among

the identified SDoH themes. Several articles found

worse radiographic or endoscopic CRS disease

severity associated with SDoH categories of male

sex, African-American race, smoking, and lower

socioeconomic status.

Conclusions:

This scoping review highlights the paucity of

rhinology literature regarding the influence of SDoH

on objective CRS disease severity. Further research

efforts should be directed towards understanding

these differences in various populations with CRS.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #053

Incident diagnosis of granulomatosis with

polyangiitis in chronic rhinosinusitis receiving

sinus surgery

Trisha Shang, BA

David Kaelber, Chief Medical Informatics Officer

Mohamad Chaaban, MD, FARS

Case Western Reserve University

Purpose:

Granulomatosis with polyangiitis (GPA) is a disease

that can first present with chronic rhinosinusitis

(CRS). Patients are sometimes diagnosed with GPA

after sinus surgery. Our study aimed to determine

GPA incident diagnosis in CRS patients with and

without sinus surgery.

Methods:

We conducted a retrospective study using the

TriNetX US Collaborative Network platform. We used

encounter diagnosis ICD codes and surgery CPT

codes. We included adults with a CRS encounter

diagnosis who had sinus surgery after a CRS

encounter diagnosis versus those without sinus

surgery. Our outcome was a GPA encounter

diagnosis 1 month-5 years after CRS diagnosis and

sinus surgery (if received). We analyzed time to GPA

diagnosis by the proportion of patients with GPA in

each group diagnosed annually for 5 years after their

first CRS diagnosis. For GPA patients in each group,

we also compared nasal septal perforation (NSP)

incidence.

Results:

After a 1:1 propensity match on sex, ethnicity, and

race, n=246,525 in each cohort. CRS patients with

sinus surgery had higher incidence of a GPA

encounter diagnosis versus those without sinus

surgery (RR: 3.44, 95% CI [2.83, 4.17]). A

significantly greater proportion of patients with sinus

surgery had a GPA encounter diagnosis in years 1-3

post-CRS encounter diagnosis than those without

sinus surgery. GPA patients with sinus surgery had

significantly higher (4.88, [2.04, 11.66]) NSP

incidence than those without sinus surgery.

Conclusion:

Incident GPA encounter diagnosis is higher and

earlier in patients with at least one CRS encounter

diagnosis and sinus surgery. With higher risk for

complications like NSPs, more awareness and

research are needed to help identify these patients

preoperatively.

Poster #054

Insight into the mutational landscape of

sinonasal squamous cell carcinoma

Arash Abiri, MS

Brandon Lehrich, BS

Theodore Nguyen, MD

Benjamin Bitner, MD

Edward Kuan, MD, FARS

University of California, Irvine

Introduction:

Genetic mutations play a crucial role in the

development and progression of sinonasal

squamous cell carcinoma (SNSCC). Understanding

how these mutations drive disease progression and

impact patient survival can help guide cancer

management and patient counseling.

Methods:

We queried the American Association for Cancer

Research (AACR) Genomics Evidence Neoplasia

Information Exchange (GENIE) database (v13.0-

public), which is a publicly available cancer registry

collecting de-identified clinic-genomic data across 19

cancer centers. Cox Proportional Hazards and

Kaplan-Meier analyses were used to evaluate

differences in all-cause mortality and overall survival

(OS), respectively.

Results:

Of 59 SNSCC patients, 34 presented with primary

malignancies, 10 (29.4%) of whom were female. The

average age of this cohort was 58.4 ± 14.9 years,

and the median tumor mutational burden (TMB) was

6 (range: 1-59). The 1-, 2-, and 5-year OS of the

cohort was 88.2%, 56.1%, and 35.6%, respectively.

The most common gene mutations were TP53

(38.2%), FANCA (17.6%), PIK3CA (17.6%), KMT2D

(17.6%), and FBXW7 (14.7%). Higher TMB was

associated with increased all-cause mortality (HR

1.077; 95% CI, 1.008-1.151; p=0.029). Tumors with

TP53 mutations were associated with lower OS

(p=0.046).

Conclusions:

Higher tumor mutational burden and TP53 mutation

were found to be predictors of lower OS in patients

with primary SNSCC.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #055

Interleukin(IL)-4 induces loss of smell in mice

without disrupting olfactory sensory neuron and

epithelial integrity

Hamid Mattoo, Dr.

Yannis Hara, PhD

Mithilesh Kumar Jha, Dr.

Scott Nash, Dr.

Asif Khan, Dr.

Jamie Orengo, Dr.

Alexandra Hicks, Dr.

Sanofi

Background:

Recent studies in mice showed that administration of

IL-4, but not IL-13, induces loss of smell, and IL-4

has a dominant effect on transcriptome, including

activation of immune pathways and impairment of

olfactory neuronal signaling. Here, we conducted

histological analysis of the effects of IL-4 and IL-13 in

the olfactory epithelium to further explore the

mechanism of IL-4-evoked loss of smell.

Methods:

BALB/cJ mice received intranasal administration of

IL-4 and/or IL-13 daily for 5 days and the olfactory

epithelium subjected to histological analysis.

Immunofluorescence was used to detect immune cell

infiltration (anti-CD45, anti-CD68, and anti-tryptase

for total immune cells, macrophages, and mast cells,

respectively), apoptosis (anti-cleaved caspase-3),

proliferation (anti-Ki67), immature olfactory neurons

(anti-GAP43), mature olfactory neurons (anti-OMP),

and horizontal basal cells (anti-Krt5).

Results:

IL-4, but not IL-13, induced significant infiltration of

immune cells, including mast cells and macrophages.

Neither cytokine induced apoptosis, affected

immature or mature olfactory neuronal integrity, or

altered basal cell proliferation.

Conclusions:

IL-4 administration elicits loss of smell in mice

without inducing structural modification of the

olfactory mucosa, suggesting that a direct effect of

IL-4 on olfactory neuronal signaling may underlie this

pathophysiology. Furthermore, inflammatory cell

mechanisms may play an additional role in IL-4

evoked loss of smell.

Poster #056

Is it NPC? Endoscopic image recognition of NPC

using narrowing band imaging versus white light

using deep learning network analysis

Shuhui Xu, MBBS,MRCS(Ireland),MMed(ORL)

Chwee Ming Lim, Senior Consultant

Neville Teo, MBBS

Singapore General Hospital

Purpose:

Develop an AI model that assists in cancer detection

in the post-nasal space during nasoendoscopic using

narrow band imaging versus white light.

Method:

Nasoendoscopy of patients with and without NPC

were recorded in both white light and narrow band

imaging. From each video, image frames were

sampled at 5 images per second and subdivided into

sub-directories based on the light source and nasal

region with malignant/normal annotations. Of the 82

videos, image frames from 63 videos (44 normal and

19 with malignant lesions) were used to train the AI

model and images from 17 videos (12 normal and 5

with malignant lesions) to test the model

performance. Convolutional Neural Networks (CNN)

(ResNet18 and ResNet50), and a transformer model

(ViT) were used in the experiments. As the dataset is

severely long-tailed for both “all region” and “Post-

nasal space” only region experiments, a class-

balanced sampling approach was adopted during the

training regimeIn all experiments, all models were

trained based on binary cross-entropy loss and using

adam optimizer. All experiments followed a batch

size = 64, a learning rate = 1x10^(-6) and trained for

41 epochs. The model performances were evaluated

based on accuracy, recall, precision and F1 score.

Results:

ResNet50 model trained using class-balanced

sampling was observed to perform better than the

model models. It was observed that the model

trained on a white-light source image performed

better than models trained on blue-light source

images. When we consider the class-specific

accuracy, the malignant lesion detection accuracy

was 83.7%.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #057

WITHDRAWN

Poster #058

Locally recurrent nasopharyngeal carcinoma

treated with minimally invasive combined

transoral robotic and transnasal endoscopic

resection: A case report

Abdurrahman Al-Awady, Mr.

David Lerner, MD

Michael Berger, MD

Alfred-Marc Iloreta, MD

Scott Roof, Dr.

Background:

Recurrent nasopharyngeal carcinoma (NPC) after

treatment with radiation represents a surgical

challenge due to the close proximity to skull base

structures and difficult access. Traditionally, open

approaches were employed, but are associated with

significant morbidity. We present a case of locally

recurrent NPC involving the clivus which was

resected using a combined transoral robotic and

endoscopic transnasal approach.

Case:

Patient is 73 year old male with history of cT3N2M0

EBV-related nasopharyngeal squamous cell

carcinoma treated with chemoradiation, which

recurred locally in the left nasopharynx and clivus 7

months after completion of treatment. Resection was

performed using a combined transoral robotic and

endoscopic approach, achieving negative margins.

The transoral robotic approach allowed excellent

visualization of the inferior and lateral margins (torus

tubarii). The transanasal endoscopic portion was

used to accomplish the superior extent of the

nasopharyngectomy and drilling of the clival bone.

Reconstruction was performed with anterolateral

thigh free fascial flap (ATL) combined endonasal and

transoral corridor. Microvascular anastomosis

employed facial vessels at the facial notch, avoiding

a standard neck incision. Patient is currently with no

evidence of disease, velopharyngeal insufficiency or

aspiration.

Discussion:

We present a case in which a combined transoral

robotic and transnasal endoscopic approach was

used to accomplish a salvage nasopharyngectomy.

Reconstruction was performed using an ATL free

fascial flap, with minimal invasive microvascular

anastomosis. This combined approach allowed for

superior visualization of the salvage resection as well

as a minimally invasive reconstruction.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #059

Long term quality of life among patients

undergoing endoscopic pituitary gland surgery

Narin N. Carmel Neiderman, MD, MSc

TASMC

Introduction:

The endoscopic approach to Pituitary adenoma

resection is less aggressive associated with

decreased morbidity, yet to date it was not evaluated

for long term nasal and tumor related quality of life

(QOL).

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 and Methods:

Prospective cohort study of all patients with pituitary

adenomas who underwent transsphenoidal surgery

at Tel Aviv Sourasky Medical Center between 2014

and 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

and 3 to 5 years after surgery. Demographic and

clinical data was collected.

Results:

Our study included 43 patients. The 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 was found to be

0.81[-4.84-6.58], 3.35[-4.32-11.02], 3.73[-2.22-9.68]

accordingly, and were not found statistically

significant. ASBS-Q score difference also did not

alter significantly (0.24[0.02-0.45], 0.18[-0.05-0.404],

0.101[-0.12-0.32] accordingly). 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 a significant effect on

QOL.

Conclusion:

Patients undergoing extended endoscopic approach

for pituitary lesions maintained high nasal and and

tumor related QOL in the 5 post-operative years.

Poster #060

WITHDRAWN

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #061

Metastatic anterior skull base adenocarcinoma

presenting as hearing loss

Margaret Mitchell, MD, MS-HPEd

Lillian Dattilo, Dr.

Obinna Nwosu, Dr.

Bradley Welling, Dr.

Eric Holbrook, MD, FARS

Harvard Medical School/Mass Eye and Ear

Objective:

To describe a case of metastatic adenocarcinoma to

the cribriform plate region and leptomeninges

presenting as bilateral hearing loss.

Methods:

Retrospective chart and histopathological review

were utilized.

Results:

A 62 year-old man presented to the emergency

department with two months of progressive bilateral

hearing loss, otalgia, and imbalance. His otologic

exam was normal with audiogram demonstrating

bilateral profound sensorineural hearing loss. He

underwent CT imaging which showed no

abnormalities of temporal bones but abnormal

demineralization of the right fovea ethmoidalis and

cribiform plate; MRI then demonstrated an enhancing

lesion in this region extending intracranially as well

as multiple nodularities of his anterior skull base and

along cranial nerves III, V, VIII, IV and X. CSF fluid

analysis was without diagnostic results.

He was thus taken to the operating room for

endoscopy and biopsy of his right olfactory cleft

region which was notable for polypoid edema. Final

pathology returned as mucinous adenocarcinoma

with signet ring features concerning for metastatic

spread of a gastrointestinal primary malignancy.

Subsequent imaging with PET CT revealed moderate

update in the sigmoid colon. Given the

leptomeningeal spread of the metastatic lesion, the

patient underwent whole brain palliative radiation

with plan for subsequent systemic chemotherapy

pending further workup findings of the GI primary.

Conclusions:

This case demonstrates a metastatic skull base

lesion presenting with an unusual symptom of

bilateral hearing loss requiring endoscopic biopsy for

diagnosis.

Poster #062

Mutational landscape and predictors of survival

in sinonasal undifferentiated carcinoma

Brandon Lehrich, BS

Arash Abiri, MS

Theodore Nguyen, BS

Edward Kuan, MD, FARS

Background:

Sinonasal undifferentiated carcinoma (SNUC) is a

rare primary neuroendocrine tumor of the nasal

cavity and paranasal sinuses with limited data

available on the mutational landscape and genetic

drivers of disease.

Methods:

We interrogated the publicly available American

Association for Cancer Research (AACR) Genomics

Evidence Neoplasia Information Exchange (GENIE)

database (v13.0-public) which is a cancer registry

collecting de-identified clinic-genomic data across 19

cancer centers. Kaplan-Meier log-rank test was used

to evaluate differences in overall survival (OS).

Results:

Of the 2,200 head and neck cancer patients, 25

(1.1%) had SNUC. The average age of the cohort

was 52.4 +/- 17.9 years. The average tumor

mutational burden (TMB) was 6.7 +/- 3.7. The 1-, 2-,

and 5-year OS rates were 67.3%, 35%, and 29.1%,

respectively. The most commonly mutated genes

were TP53 (n=10; 40%), IDH2 (n=8; 32%), ARID2

(n=4; 16%), and PIK3CA (n=3; 12%). Only 1 (4%)

patient had a mutation in SMARCA2, and 1 (4%)

patient had a mutation in SMARCB1. Of the 8

patients with IDH2 mutations, 6 (75%) had R172S

mutation, 1 (12.5%) had R172T, and 1 (12.5%) had

R172M mutation. There were no differences in OS

for TP53 mutated vs wild-type (p=0.34) and ARID2

mutated vs wild-type (p=0.22) patients; however,

there was a trend towards increased OS in IDH2

mutated vs wild-type (p=0.056) patients. There was

improved OS for patients with high vs low TMB

(p=0.0019).

Conclusions:

SNUC diagnosis and classification of disease

remains challenging, but high mutational burden may

impact survival through higher likelihood of

actionable mutations.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #063

Nasal septal perforation endoscopy score

correlates with symptom burden in patients with

nasal septal perforations

Amar Miglani, MD

India Rangel

Cody Smith, MD

Bansberg Stephen, Consultant

Michael Marino, MD, FARS

Mayo Clinic Hospital, Phoenix, AZ

Background:

Nasal septal perforations (NSP) are a heterogenous

group of disorders that may present with varying

degrees of inflammatory changes observed during

endoscopic examination. Recently, a validated NSP

endoscopic scoring system was developed

demonstrating fair-to moderate interrater agreement

and substantial intrarater agreement. The objective of

this study was to determine correlation of NSP

endoscopy scores with patient reported symptoms.

Methods:

Video nasal endoscopy recordings were obtained for

patients with NSP. Nasal endoscopies were

independently reviewed using previously validated NSP

endoscopy scoring system for the following physical

exam findings: edema, crusting, scarring, granulation

tissue, and septal deviation. Scoring for each exam

finding was reported on a 3-point scale. Endoscopy

scores were correlated with the NOSE-perf scores – a

validated patient reported outcome measure assessing

NSP symptom burden.

Results:

Video nasal endoscopies for 33 patients with NSP were

reviewed. The mean (+ SD) NOSE-perf score and

mean (+ SD) NSP endoscopy score were 20.5 (+ 9.1)

and 5.6 (+ 2.7), respectively. The NSP endoscopy

scores were moderately correlated with NOSE-perf

scores (r=0.44)(p=0.008).

Conclusion:

NSP endoscopy score is a validated endoscopic

scoring system to assess NSP inflammatory changes.

NSP endoscopy correlates moderately well with patient

reported symptoms. The NOSE-perf score and NSP

endoscopy score may be useful tools for standardized

assessment of NSP outcomes.

Poster #064

New techniques of reducing intraoperative bleeding

in endoscopic sinus surgery for eosinophilic

chronic rhinosinusitis cases with asthma

Yoichiro Narikawa, MD

Yasuyuki Hinohira, Professor

Naruo Shoji

Takatoshi Tokudome

Sei Kobayashi, Associate Professor

Introduction:

Eosinophilic chronic rhinosinusitis (eCRS) is known as

refractory sinusitis with nasal polyps showing

remarkable eosinophil infiltration. Nasal polyps

frequently recur in eCRS cases with bronchial asthma

even if endoscopic sinus surgery (ESS) was performed

on. eCRS cases with asthma are classified into severe

type by Japanese epidemiological study. Intraoperative

bleeding disturbing surgical field is a significant factor

to cause recurrence in surgical treatment of eCRS. Our

new techniques of reducing intraoperative bleeding in

ESS are shown, and the outcome is compared with

previous method.

Cases & methods:

ESS was performed on 39 eCRS cases with asthma,

under general anesthesia and image-guided system.

Prior to ESS procedure, 1% lidocaine with 1: 100000

epinephrine was injected around sphenopalatine artery

(SPA) and Ager nasi. In 20 cases (new group),

hydrophilic urethane sponge (HUS) dipped in 0.1%

epinephrine was put on the region injected for 3 to 5

minutes. After removing HUS, the contracted blood

vessels in the mucosa were cauterized. SPA was also

cauterized after dissected and identified. HUS was

used for reducing bleeding instead of tampon gauzes

on demand during surgery. In the remaining 19 cases

(previous group), only regional injection and tampon

gauze hemostasis were done during surgery.

Outcomes and conclusion:

No complication was found during and after surgery in

all cases. Intraoperative bleeding was statistically

reduced in the new group from 194.8 to 97.5 ml,

compared with the previous group. Our new

techniques of reducing intraoperative bleeding in ESS

for severe ECR cases is considered as acceptable.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #065

WITHDRAWN

Poster #066

Novel use of urinalysis dipsticks for

differentiating patients with diverse sinusitis

complaints

Michela Borrelli, BA

Martin Hopp, MD, PhD

Sarah Ustrell

Jonathin Raskin

Tasha Nasrollahi

Cedars Sinai Medical Center

Introduction:

Various clinical diagnoses present themselves to

ENT clinics with nonspecific “sinus” symptoms that

require an in-depth history and physical exam for

proper diagnosis. To make an accurate diagnosis,

most physicians use costly diagnostic testing such as

nasal endoscopy and computed tomography to

differentiate between various clinical diagnoses. The

objective of our study was to determine if using a

urine dipstick provides a cost-effective tool that could

help differentiate between the multitude of “sinus”

disorders in otolaryngology clinics.

Methods:

Patients presenting with “sinus” complaints were

prospectively enrolled in this IRB-approved study

with a goal of 100 patients in total. Nasal mucus was

sampled using a nasal culture swab from each

patient that presented to the otolaryngology clinic.

These cultured swabs were subsequently placed on

a urinalysis dipstick to assess for leukocytes, nitrites,

protein, and pH. Results were converted to a

numerical score. Lund-Kennedy nasal endoscopy

scores and Lund-McKay CT scores were

documented when available. The final clinical

diagnoses were recorded after the standard testing

was completed.

Results:

Significant findings include reporting that ARS vs.

normal using the whole dipstick score was

significant. ARS vs. normal using the leukocyte value

was close to significant with a p-value = 0.055.

Further stat analysis may be valuable if a higher

dipstick score correlates to a higher Lund-McKay

score for all comers.

Conclusions:

Urinalysis dipsticks may be an incredibly valuable

and cost-effective tool not only in the otolaryngology

specialty but in many other specialties as well.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #067

Olfaction and neurocognition after COVID-19: A

scoping review

Brandon Vilarello, BA

Patricia Jacobson, Medical Student

Jeremy Tervo, Medical Student

Nicholas Waring, Medical Student

David Gudis, MD, FARS

Terry Goldberg, Professor

D. P. Devanand, Professor

Jonathan Overdevest, MD

Columbia University Vagelos College of Physicians

and Surgeons

Introduction:

COVID-19 can include symptoms reflective of acute

and chronic neurological changes. Prior research

has identified that chemosensory changes,

particularly olfactory loss, may reflect greater, central

neurological dysfunction in neurodegenerative

diseases like Alzheimer’s. This review examines

current literature to look at the relationship between

neurocognition and olfaction in otherwise healthy,

young to middle-aged adults following COVID-19.

Methods:

A systematic literature search of PubMed, Ovid

Embase, Web of Science, and Cochrane Library was

conducted with bibliographic review, per PRISMA-

ScR guidelines. Published studies underwent title/

abstract and full-text screening to identify those

evaluating the coincident outcomes of cognition and

olfactory deficits.

Results:

Seventeen studies were eligible for data extraction

after the review process. Eleven studies found

statistically significant poorer cognition in those

suffering from olfactory dysfunction. Three studies

showed no association, and one study reported

lower anosmia prevalence in patients with cognitive

impairment.

Conclusion:

To date, the majority of studies suggest that olfactory

dysfunction is associated with poorer cognition.

Higher level of evidence studies are needed to

further elucidate the relationship between olfaction

and cognition following COVID-19 illness.

Poster #068

Open access artificial intelligence and rhinology

patient education

Alice Huang, MD

Michael Chang, MD

Jayakar Nayak, MD, PhD

Peter Hwang, MD, FARS

Zara Patel, MD, FARS

Background:

ChatGPT is a language processing tool launched by

OpenAI, with more than 100 million users as of

January 2023. This powerful artificial intelligence (AI)

tool has unknown accuracy or reliability in medical

settings. This study sought to analyze the accuracy

of ChatGPT-generated responses to common

rhinologic patient questions.

Methods:

Four rhinologists developed consensus a priori on

responses to a list of 10 common questions from

rhinology patients. The questions were posed to

ChatGPT, with responses individually graded by the

surgeons on a scale of 0 to 3: 0=incorrect

information that could lead a patient to miss or

misunderstand a potential diagnosis, or imply a

treatment option that is not correct or possible;

1=incorrect information that would not significantly

change a patient’s understanding, OR correct but

incomplete information; 2=complete and correct

information; 3=correct information beyond the

“expert” response.

Results:

Mean grade for ChatGPT responses was 1.65. For 3

questions, raters agreed that ChatGPT responses

were equal to or better than expert responses. For 6

questions, ChatGPT provided responses that were

incorrect or incomplete based on at least 2

rhinologists’ scores, with 4 rated this way by mean

rater grades. Interclass correlation coefficient (ICC)

was 0.602, indicating only moderate reliability among

raters.

Conclusion:

Open access AI tools will be resources for patients

seeking health information. This preliminary study of

ChatGPT responses to rhinologic questions

demonstrates mixed accuracy and completeness as

well as provision of incorrect information in some

cases. Patient education and further study is needed

to understand the limitations, role, and impact of this

technology.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #069

Optimizing strategy for pre-operative sinonasal

irrigation through 3D Printing

Kanghyun Kim, BS

Raymond Wen

Kai Zhao, Associate Professor

The Ohio State University

Background:

While topical sinus irrigation remains a key strategy

in management of sinonasal disease, the variability

in nasal structure among patients often demands an

individualized strategy. We investigate different

permutations of irrigation strategy to optimize

outcomes through 3D printing.

Methods:

Eleven pre-operative models were 3D printed with a

FormLabs Form 3 SLA printer based on individual

CT scans. Irrigations were performed by squeeze

bottle through a silicon putty water tight seal. The

four head positions of 45° to-the-side, 90° to-the-

side, 45° forward and 45° to-the-side and 45°

forward were filmed, with varying fluid entry through

the upper (conventional) or lower (backfill) nostril.

Results:

Due to restrictive ostia, all models showed filling of

the maxillary sinus only. Among the different head

positions, optimal penetration was recorded for 90°

to-the-side backfill (n=6), 90° to-the-side conventional

(n=4), 45° to-the-side backfill (n=2), 45° to-the-side

conventional (n=2), 45° forward and 45° to-the-side

backfill (n=3), and 45° forward (n=1). The average

penetration score for the optimal position across all

models was significantly higher (p<0.05) for all head

position permutations with the exception of 90°

to-the-side backfill, which saw a notable but not

significant increase.

Conclusions:

Nasal anatomy variation among patients is not

conducive to a one-size-fits-all irrigation strategy.

Even though 90° to-the-side backfill showed the

highest average score among the standard positions,

optimal individualized head positions demonstrated a

higher average score. Therefore, 3D printing can

serve as a method to identify an individual optimal

strategy and improve irrigation outcomes.

Poster #070

Oral corticosteroid (OCS) burden and healthcare

resource utilization (HCRU) in patients with

chronic rhinosinusitis with nasal polyps

(CRSwNP) undergoing functional endoscopic

sinonasal surgery (FESS): A US real-world

retrospective cohort study

Stella Lee, MD

Danielle Isaman , Ms.

Asif Khan, Dr.

Anju Peters, MD

Peter Hwang, MD, FARS

Sietze Reitsma, MD

Natalia Petruski-Ivleva, Dr.

Scott Nash, Dr.

Juby Jacob-Nara, Dr.

Sanofi

Background:

The impact of FESS on OCS burden and HCRU for

patients (pts) with CRSwNP is understudied.

Methods:

Retrospective cohort study of adult CRSwNP pts

undergoing vs not undergoing FESS, using US

claims data (Optum; 2011−2021). Pts were

propensity score matched to adjust for confounding.

OCS burden (cumulative dose in mg prednisone

equivalents), other medications, procedures/

diagnostic tests, HCRU, and costs were compared

among FESS vs non FESS pts in the 1 year post

index date. Intervention/follow-up periods were

defined as Day 0−44/45−365, respectively.

Results:

Each group included 8,909 pts. During follow-up,

OCS cumulative dose was 18% lower in FESS vs

non-FESS pts (mean difference in mg prednisone

equivalent dose: −40 mg [95% CI −64 to −16] per

pt). In pts who filled an OCS prescription (34.6%

[FESS] vs 36.0% [non-FESS]), OCS burden

remained high in both groups (mean [SD] cumulative

dose: 521 [786] vs 612 [906] mg). Mean total

healthcare costs in FESS vs non-FESS pts were

$28,832 vs $2,537 per pt during the intervention

period, but similar during follow-up ($15,659 vs

$15,926, respectively). During follow-up, HCRU was

similar between FESS and non-FESS pts, except

that FESS pts had higher odds of visiting an

otolaryngologist (odds ratio [OR] 2.9 [95% CI 2.7,

3.1]). FESS pts had higher odds than non-FESS pts

of polypectomy (OR [95% CI] 5.7 [4.9, 6.7]) and

airway endoscopy (3.6 [3.4, 3.9]) during follow-up.

Overall, 20.7%, 22.5% and 29.2% of all pts filled a

prescription for leukotriene antagonists, NSAIDs, and

oral antibiotics during follow-up, respectively.

Conclusion:

In real-world US practice, pts with CRSwNP who

underwent FESS had similar OCS and HCRU

burden to those who did not, and similar costs during

follow-up.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #071

Paranasal sinus and nasal cavity squamous cell

carcinoma and adenocarcinoma: A SEER

database analysis

Lacy Brame, DO

Spencer Hall, MPH

Daniel Zhao, PhD

Aniruddha Parikh, MD

Kibwei McKinney, MD

Lurdes Queimado, MD, PhD

Oklahoma State Center for Health Sciences

Background:

Paranasal sinus malignancies are rare and make up

3% to 5% of head and neck cancers in the United

States. They are aggressive malignancies with poor

prognosis. Previous studies have reported poorer

survival with advanced age, stage, and other social

factors. In our study, we sought to identify factors

associated with worse survival for squamous cell

carcinoma (SCC) and adenocarcinoma (AC)

specifically.

Methods:

Data was collected from the Surveillance,

Epidemiology, and End Results (SEER) database

from 2000-2019. SCC and AC of the paranasal

sinuses and nasal cavity were included in the study.

Variables such as gender, age, marital status,

income, race, and stage were collected. Kaplan-

Meier curves were generated and log-rank tests

were performed to analyze variables associated with

survival.

Results:

A total of 5,810 individuals with SCC and 84

individuals with AC of the nasal cavity and paranasal

sinuses were identified. Sixty-six percent of patients

were male and 87% were older than 50 years.

Median overall survival was 53 and 133 months for

SCC and AC patients, respectively. Among SCC,

survival was significantly different by age (p

<0.0001), race (p <0.0001), marital status (p

<0.0001), and stage (p <0.0001). No significant

differences in survival were identified by income or

gender.

Conclusions:

Consistent with the literature, overall survival was

higher for AC than for SCC patients. Of importance,

this analysis demonstrated that several individual

factors such as age, race, marital status, and stage

impact survival. Understanding the factors

associated with poor survival from these tumors will

aid in guiding treatment and understanding

disparities that exist among this patient population.

Poster #072

Perioperative strategies for improving quality of

life and sinonasal morbidity after endoscopic

skull base surgery: A systematic review

Satyan Sreenath, MD

Walter Fitschen, Medical Student

Elisa Illing, MD, FARS

Vijay Ramakrishnan, MD, FARS

Jonathon Ting, MD, FARS

Indiana University School of Medicine

Background:

Though the endonasal corridor in endoscopic skull

base surgery (ESBS) avoids invasive approaches,

significant postoperative morbidity exists. Several

studies have explored surgical techniques, nasal

dressings, and perioperative management for

optimizing quality of life (QOL) following ESBS. This

systematic review provides a global understanding of

strategies for optimizing sinonasal healing and

morbidity following ESBS.

Methods:

Using PRISMA guidelines, PubMed, Ovid, and

Cochrane databases were searched for articles

reporting QOL measures and/or endoscopic grading

of sinonasal healing after ESBS. Articles were

stratified based on intervention including operative

technique, donor site grafting after nasoseptal flap

(NSF) harvest, nasal dressings, and use of topical

irrigations.

Results:

27 studies comprising 1775 patients were included.

QOL measures included the ASK-12, SNOT-22, and

olfactory testing. Endoscopic grading of healing was

scored on Likert and visual analog scales.

Modifications to the EEA with preservation of

sinonasal structures decreased morbidity with

improved QOL. Reconstructive techniques and

grafting of the NSF donor site improved

mucosalization rates and decreased crusting. Few

studies exist on the impacts of nasal dressings and

nasal irrigation on healing and QOL.

Conclusions:

This systematic review provides a landscape of

current techniques for improving QOL and morbidity

after ESBS. Modifications to the EEA and grafting

approaches allow for preservation of sinonasal

structures with the intent of decreasing crusting and

preserving mucociliary function. Further study is

required to understand the impact of intranasal

dressings and nasal irrigations on postoperative QOL

following ESBS.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #073

Predictors of headache/facial pain associated

with cryotherapy ablation of the posterior nasal

nerve for the treatment of chronic rhinitia

Samuel Razmi, BS

Daniel Gorelik, Research Fellow

Yuki Yoshiyasum, Resident

Masayoshi Takashima, MD, FARS

Omar Ahmed, MD, FARS

Texas A&M School of Medicine

Cryotherapy ablation of the posterior nasal nerve is

an effective treatment for patients with chronic rhinitis

but is associated with postoperative headache/facial

pain in some patients. The purpose of this study is to

understand factors that may be associated with this

complication.

Patients who underwent cryotherapy ablation at a

single institution from January 2021 to January 2023

were included. Demographics and information

regarding clinical characteristics were collected and

reviewed. Mann-Whitney U and Chi-square tests

were used to assess significance in quantitative and

categorical data, respectively (alpha = 0.05).

29 patients underwent cryotherapy ablation. None of

these patients received preoperative pain

medication. Thirteen (44.8%) patients reported

having a severe headache/facial pain occurring

immediately after the procedure, with a mean

duration of 57.1 minutes (SD=50.5). The average

age of patients experiencing this adverse event was

53.4 years (SD=21.5) which was significantly lower

(p=0.03) than patients who did not experience

headache/facial pain (69.9 years, SD=9.4).

Headaches/facial pain occurred most in Caucasians

(84.6%) and females (65.1%), but neither association

was statistically significant (p>0.05). There was no

association of previous medication use or sinus

surgery, nor smoking status with headaches/facial

pain.

Postoperative headaches/facial pain are more

common in our cohort compared to previously

reported rates in the literature. In our sample,

younger age appears to play a significant role in

likelihood of headache/facial pain. Physicians should

consider this factor when counseling patients, though

larger studies are needed to confirm these findings.

Poster #074

Predictors of surgical intervention in children

with complicated orbital cellulitis

Erica McArdle, MD

John Behnke, Resident

Amani Kais, Post Graduate Research Fellow

Chadi Makary, MD, FARS

Hassan Ramadan, MD, FARS

West Virginia University

Background:

Orbital cellulitis in children, while rare, can lead to

serious complications, sometimes requiring surgical

intervention.

Objective:

To evaluate specific variables at presentation that

can predict when surgical intervention will be

required for pediatric orbital cellulitis.

Methods:

Retrospective case-control study of children referred

to West Virginia University children’s hospital from

January 2012 to July 2022 was performed. Children

who were diagnosed with preseptal cellulitis, orbital

cellulitis, and orbital abscess were included.

Diagnosis was based on clinical presenting

symptoms, physical exam findings and CT imaging.

Patients’ characteristics, CT imaging, inflammatory

markers and associated acute bacterial rhinosinusitis

were reviewed. Orbital cellulitis secondary to trauma,

tumor, cutaneous infection were excluded.

Results:

118 children were identified. Mean age was 7.3 years

and 65 (58.1%) were males. Mean Lund-McKay (LM)

CT score was 5.3. 53 (44.9%) children had orbital

cellulitis/abscess with the remaining having pre-

septal cellulitis. 18 (15.3%) children required surgery;

17 (94.4%) were for orbital abscess and 1 (5.6%) for

pre-septal cellulitis (p<0.0001). Univariate analysis

showed a high CRP, large abscess volume, female

gender, high LM CT score, older age were predictors

of surgery. Multivariate logistic regression analysis

showed age older than 10 years, LM CT score

higher than 5, female gender, large abscess volume

were predictors of surgery.

Discussion:

Females older than 10 years, large abscess, high LM

CT score had higher rates of surgery for complicated

orbital cellulitis. This may be valuable for clinical

decision making in attempt to provide timely care

and reduce length of stay.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #075

Proof of concept: How to use Zoom to set up a

remote telementoring experience for teaching

endoscopic sinus surgery

Angela Yang

Rachel Daum

Michael Yong, Dr.

Michael Chang, Dr.

Peter Hwang, MD, FARS

Background:

Remote surgical training remains an unmet need in

the field of rhinology. This is especially valuable for

learners who are geographically distant from highly-

skilled instructors. Our study aimed to validate a

telementoring model for endoscopic sinus surgery

(ESS), and develop an accurate description of the

technical setup.

Methods:

Surgical trainees at Stanford University (SU)

underwent live-virtual teaching sessions of ESS

taught by a remote mentor. An endoscopic view of

the surgery was live-streamed through Zoom, a

secure cloud-based video platform. Interviews were

conducted and surveys were administered to

trainees and mentors after each session.

Results:

2 post-graduate senior surgical resident trainees and

2 remote mentors were included, and a total of 4

live-virtual sessions were conducted. Surgical trainee

and mentor satisfaction for the in-progress model

were moderate. Participants indicated that the

experience approximated in-person mentorship

moderately well, with all participants indicating that

they would use the system again for remote

mentoring. Highlights from interviews included the

good audio quality and the ability for remote 2-way

feedback through both still-image capture and

telestration. Live annotation was noted to be better

than still-image capture, and occasionally better than

in-person verbal guidance. Areas for improvement

included ergonomics of screen placement, video lag,

and video resolution.

Conclusion:

ESS lends itself well to live-telementoring, with the

operative field being projected remotely through a

high-definition endoscope with 2-way audio and

video feedback. Establishment of a reliable

telementoring model will aid future surgical training

as the set-up improves over time.

Poster #076

Purasinus, a novel self-assembling peptide, in a

draf-III frontal sinusotomy

Kaitlynne Pak, MD

Arthur Wu, MD, FARS

Dennis Tang, MD, FARS

Cedars Sinai Medical Center

Introduction:

Stenosis and adhesions are known complications in

a Draf-III frontal sinusotomy. Various techniques

have been proposed to maintain patency but no

technique has been proven as more superior.

RADA16 hydrogel is a self-assembling synthetic

peptide shown to promote wound healing and

prevent adhesion formation. RADA16 has been

studied in animal models, which shows wound

healing and tissue regeneration properties through

creation of an extracellular matrix; however, there’s a

paucity of described application in patients.

Presently, there are no reports of RADA16 use in a

Draf-III frontal sinusotomy. We report two successful

cases of a patient with history of chronic

rhinosinusitis who underwent sinus surgeries with

Draf-III frontal sinusotomies.

Cases:

A 59F with aspirin-exacerbated respiratory disease

presented with recurrent polyps. A revision sinus

surgery was performed with a Draf-III using RADA16

and a steroid eluting stent in the Draf-III cavity. At 3

week postop, there was no exposed bone and the

cavity remained widely open with minimal

debridement. Cavity was patent at 2 months postop.

A 62M with recurrent nasal polyps with prior sinus

surgery presented with recurrent polyps. He

underwent a Draf-III and RADA16 and silastic stents

were placed. The silastic stent was removed at 2

weeks postop. No exposed bone was seen and the

cavity remained widely open. At 5 months, the cavity

remained open, but polyps had recurred and were

managed with biologic injections.

Conclusion:

We present the first described cases of using

RADA16 after a Draf-III in combination with both

dissolvable and nondissolvable stents. This

technique can help in accelerating mucosalization of

denuded bone during sinus surgery.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #077

Radiographic enhancement of the longus colli

muscle in skull base osteomyelitis

Grant Owen, BA

Peter Filip, MD

Alana Ravasio, Medical Student

Jamie Masliah, Resident

Peter Papagiannopoulos, MD

Bobby Tajudeen, MD, FARS

Rush Medical College, Rush University Medical

Center

Introduction:

Several radiographic findings have been reported in

skull base osteomyelitis (SBO). However, the role of

longus colli muscle enhancement has not been

reported. This study aimed to determine the

frequency of longus colli muscle enhancement on

imaging in SBO.

Methods:

A retrospective institutional chart review examined

patients with SBO between January 2017 and

February 2023. Along with demographic information,

computerized tomography (CT) and magnetic

resonance imaging (MRI) reports were reviewed for

infection location (rhinologic origin, otologic origin,

other origin) and longus colli enhancement. Scans

reporting enhancement of the longus colli,

prevertebral musculature, or prevertebral space were

considered positive. Fisher’s exact test was used to

compare rates of enhancement by infection location.

Results:

22 patients with confirmed SBO were included,

average age was 69.1 years (range 23-89 years).

Otologic origin was the most common site of

infection (n=9, 40.9%), followed by rhinologic (n=8,

36.4%) and other origin (n=5, 22.7%). Longus colli

enhancement was observed in 11 patients (50.0%),

with most being rhinologic origin (n=8) followed by

otologic (n=2) and other origin (n=1). The rate of

longus colli enhancement was significantly higher in

rhinologic origin compared to otologic and other

origins (100.0% vs 22.2% vs 20.0%, p=0.001). CT

was positive in 4 of 9 cases, while MRI was positive

in 9 of 11 cases.

Conclusion:

This case series suggests a potential link between

longus colli muscle enhancement on radiographic

imaging and SBO, particularly in cases of rhinologic

origin. Further research is needed to determine

biostatistical significance and overall clinical utility of

this finding.

Poster #078

Rare case of a giant disfiguring frontal sinus

mucocele causing globe subluxation

Caroline Christmann, MD

James Eng, Dr.

Sunthosh Sivam, Dr.

Baylor College of Medicine

Background:

Mucoceles are expansile lesions of the paranasal

sinuses that may cause compression and remodeling

of surrounding structures. Giant mucoceles are rare

but may cause vision impairment, erosion of the

anterior and posterior tables, and disfigurement.

Learning Objectives:

Understand the natural history of mucoceles, discuss

multidisciplinary approaches to repair, and identify

open approaches that best preserve future cosmesis.

Methods:

The case of a 28-year-old male with a frontal sinus

mucocele was reviewed. A literature review was

performed to find similar cases of frontal mucoceles

with orbital complications.

Results:

The patient presented with a 7-year history of an

enlarging forehead mass causing compression of the

nasal bones and subluxation of the right globe with

exposure keratopathy, microbial keratitis, and corneal

perforation. CT scan revealed a 15.8x11.8x10.0cm

frontal mucocele with foci of posterior table erosion

and an eggshell remnant of the anterior table. The

patient underwent emergent open resection,

including frontal sinus obliteration and reconstruction

with titanium mesh by Facial Plastics and

Reconstructive Surgery. Neurosurgery assisted with

posterior table repair, and Oculoplastic Surgery

performed a temporary tarsorrhaphy.

Conclusion:

Giant frontal sinus mucoceles are rare, with only one

other case report of a frontal mucocele causing

globe subluxation. Multidisciplinary management in

an open approach to the frontal sinuses was critical

in providing a safe outcome and creating the

foundation for a cosmetic result in subsequent

stages.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #079

Readability and quality analysis of patient

education materials in aspirin exacerbated

respiratory disease

Kush Panara, MD

Daniel Lee, Fellow Physician

Elysia Grose

Jenelle Safadi

Jennifer Douglas, Fellow Physician

Michael Kohanski, MD, PhD

James Palmer, MD, FARS

John Lee, MD

Nithin Adappa, MD, FARS

John Bosso, MD

Background:

Aspirin exacerbated respiratory disease (AERD) is a

complex disease that requires patients to strictly

adhere to treatment regimens for successful

outcomes. Therefore, patient education is integral in

the successful management of AERD. We aim to

evaluate the readability and quality of online patient

education material (PEMs) on AERD.

Methods:

An online search for PEMs on AERD was conducted.

PEMs were categorized based on origin from either

academic medical institutions/hospitals or

government, private, or professional organizations.

Readability was evaluated with the Flesch-Kincaid

Grade level (FKGL), Flesch Reading Ease (FRE),

Coleman Liau Index (CLI), and SMOG Index. The

DISCERN tool with two raters was used to calculate

quality. Summary statistics were calculated and

unpaired two-tailed t-tests was used to evaluate

continuous variables.

Results:

Out of 99 initial results, a total of 34 PEMs were

included after excluding non-education materials.

The average FRE score was 39.6 equivalent to a

“difficult” interpretation. The average grade level of

the PEMs was above the twelfth grade with FKGL,

CLI and SMOG index. Most of the studies (26/34,

76.4%) had DISCERN scores indicative of good or

excellent quality. There were no significant

differences between PEMs originating from medical

institutions and PEMs originating from other sources

in terms of quality or readability.

Conclusion:

PEMs on AERD are good or excellent quality.

However, the interpretation of the educational

material may be difficult to comprehend for an

average individual. We highlight the need for quality

improvement and optimization of readability of

PEMs.

Poster #080

Real-world effectiveness of Mepolizumab on

upper and lower airway diseases

Jonathan Bernstein, Dr.

Elizabeth Packnett, Ms.

Carolyn Lew, Dr.

Yvonne Robles, Ms.

Arjita Deb, Dr.

University of Cincinnati

Background:

Asthma and nasal polyps (NP) frequently co-occur,

share similar pathophysiology, and incur

considerable airway disease burden, including OCS

exposure. In this study we evaluated the

effectiveness of mepolizumab in a real-world

population of patients with comorbid asthma and NP.

Methods:

MarketScan Commercial and Medicare Databases

were used to study 189 patients with comorbid

asthma and NP who initiated mepolizumab between

November 2015 and September 2020, ≥18 years of

age at mepolizumab initiation (index date), and 12

months continuous enrollment before and after the

index date. NP and asthma outcomes, adherence

and persistence following mepolizumab initiation,

were compared in the 1-year baseline and variable

follow-up period with a post-hoc analysis comparing

outcomes in the first year of follow-up to the 1-year

baseline.

Results:

On mepolizumab, patients experienced fewer

asthma-related exacerbations compared to baseline

(first year of follow-up: 54.7% relative reduction,

p<.001; variable follow-up: 61.6% relative reduction,

p<.001). Sinus surgeries per patient per year (PPPY)

decreased by 14.7% in the first year of follow-up and

by 51.6% during the variable follow-up (p<.001) from

baseline. The OCS mean daily-dose decreased by

76.9% in the first year of follow-up and by 81.1%

during the variable follow-up (p<.001). OCS bursts

PPPY decreased by 58.8% in the first year of follow-

up and by 61.7% during the variable follow-up

(p<0.001). Nearly ¾ of patients were persistent

(74.1%) and 67.2% were adherent to mepolizumab

in the first year following initiation.

Conclusion:

Mepolizumab treatment in comorbid patients

correlated with clinically impactful outcomes for

upper and lower airway disease.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

Poster #081

Reconstruction of sellar defects with laterally-

pedicled native sphenoid sinus mucosa

Samuel Floren, MD

Merica Xiong

Timothy McCulloch

Azam Ahmed

Ian Koszewski, MD, FARS

University of Wisconsin

Background:

While purely endoscopic endonasal approaches to

the sella turcica have emerged as a favorable option

for resection of most pituitary tumors, optimal

reconstruction after transsphenoidal pituitary surgery

remains poorly established. Goals of reconstruction

include avoiding complications such as postoperative

CSF leak, minimizing short- and long-term morbidity,

and optimizing sinonasal functional outcomes. Here

we describe a single-institution experience of a novel

reconstructive technique using laterally-pedicled

native sphenoid mucosal flaps.

Methods:

A retrospective single armed chart review was

performed of all patients who underwent primary

transsphenoidal pituitary resection with

reconstruction using the described pedicled septal

mucosal flaps between the dates of 01/01/2018 and

02/02/2023.

Results:

44 patients underwent the above-described

reconstruction with an average age of 53 (range:

25-77) and an average tumor size of 2.0 cm (range:

0.4-4.5cm). No patients developed postoperative

CSF leak. There was one complication of

postoperative pneumocephalus after aggressive

nasal blowing. 9 patients (20%) used topical

corticosteroids in the postoperative setting,

compared to 6 patients (14%) pre-operatively. For

patients who completed a postoperative Sino-Nasal

Outcome Test-22, the average score 2 months

postoperatively was 18.

Conclusions:

In appropriately selected patients, the use of

laterally-pedicled native sphenoid mucosal flaps is a

safe, effective, and intuitive reconstructive adjunct for

small to medium sized sellar lesions.

Poster #082

Referral patterns: Number of providers and

duration of loss before definitive intervention for

olfactory disorders

Bruna Castro, MD

David Grimm, BS

Lei Shi

Farideh Hosseinzadeh, MD

Zara Patel, MD, FARS

Stanford University School of Medicine

Background:

Patients with olfactory disorders (OD) often first

present to primary or urgent care settings. However,

knowledge about recommended treatment options in

this setting may vary. This study sought to evaluate

the referral pattern and management of patients with

OD before being seen by a smell expert.

Methods:

Retrospective cohort study in a tertiary care center.

Adult patients seen between 2016-2022 with

anosmia, hyposmia, parosmia or phantosmia with a

documented psychophysical smell test were

identified by diagnosis codes. Demographic and

other patient factors, well as etiology, treatment

options tried at each provider, and University of

Pennsylvania Smell Identification (UPSIT) scores

were collected.

Results:

A total of 100 patients were included, with 53 female,

47 male and 1 unknown gender. The mean age was

57 years old (range: 24-90). UPSIT mean score was

19.58 (range: 4-39). Post viral infection was the

principal cause of smell loss corresponding to 43%,

idiopathic 34%, head trauma 8%, post-surgery 6%,

CRS 5%, chemical exposure 2%, and

neurodegenerative disease 1%. The mean total

number of providers seen prior to seeing a smell

expert was two. The average time of smell loss until

the first provider visit was 31 months (range 1 - 480

months). The average time from first provider visit to

visit with a smell expert was an additional 9.8 months

(range 1-120 months). As most patients were not

started on a definitive treatment option for smell loss

until seeing a smell expert, this equalled an average

of 3.4 years before definitive intervention.

Conclusion:

Knowledge of treatment options for smell loss is

lacking amongst primary and urgent care providers

and the timeline to see a smell expert remains too

long.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

100

Poster #083

WITHDRAWN

Poster #084

Report of a novel reconstruction method using

sternocleidomastoid flap and nasoseptal flap for

nasopharyngeal tumors after

nasopharyngectomy

Bita Naimi, BA

Alexander Duffy, MD

Jay Trivedi

Emily Garvey, BA

Chase Kahn, MD

Marc Rosen, MD, FARS

Elina Toskala, MD, MBA, PhD, FARS

Mindy Rabinowitz, MD, FARS

James Evans, MD

Gurston Nyquist, MD, FARS

Adam Luginbuhl, MD

Thomas Jefferson University Hospital

Introduction:

The sternocleidomastoid (SCM) flap has been widely

utilized in head and neck reconstruction. We

describe two cases utilizing a novel reconstruction

method after expanded endonasal and transcervical

resections of nasopharyngeal (NP) tumors using a

combined pedicled SCM flap with a nasoseptal flap

(NSF) onlay.

Technique:

Combined endoscopic, endonasal and transcervical

approach to NP tumors allows for expanded

resection and proximal control of the internal carotid

artery. Adjuvant therapy including cesium seeds may

be placed. SCM flap is superiorly pedicled and

rotated into the defect to provide bulk and coverage

of neurovascular structures. NSF is raised and laid

endonasally along the lateral pharyngeal defect.

Cases:

1: A 39-year-old male with a history of EBV+

nasopharyngeal carcinoma presented two years after

chemoradiation with rT1N0 EBV+ disease. He

underwent a combined endonasal and transcervical

approach to a right nasopharyngectomy with cesium

seed brachytherapy placement and closure with a

right SCM flap and left NSF. There were no

complications or fistula at 5-months follow-up.

2: A 77-year-old female with T2N1 nasopharyngeal

adenoid cystic carcinoma underwent a combined

approach to left nasopharyngectomy, left neck

dissection, right NSF, and left pedicled SCM flap.

The flap remained patent with no evidence of fistula

at follow-up and through adjuvant radiation.

Conclusion:

We describe the novel use of the SCM-NSF

combination for reconstruction of lateral pharyngeal

defects after nasopharyngectomy. A pedicled SCM

flap with NSF onlay can limit scarring, prevent

infection and fistula formation, and protect critical

neurovascular structures through adjuvant treatment

for primary and recurrent NP tumors.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

101

Poster #085

WITHDRAWN

Poster #086

Restarting antithrombotic drugs following

functional endoscopic sinus surgery: A scoping

review

Trinithas Boyi, MA

Rhys Richmond, BS

R. Peter Manes, MD, FARS

Ryan Rimmer, MD, FARS

Yale School of Medicine

Background:

Anticoagulant and antiplatelet agents are routinely

discontinued preoperatively to reduce the risk of

hemorrhage. There are no clear guidelines on when

to resume these agents in otolaryngologic patients

following functional endoscopic sinus surgery

(FESS). Our goal was to identify and systematically

review existing literature related to this topic.

Methods:

We systematically queried PubMed, Embase, Ovid,

Web of Science, Cochrane, and CINAHL databases,

following the Preferred Reporting Items for

Systematic Reviews and Meta-Analyses (PRISMA)

guidelines, to identify publications reporting

antithrombotic use in endoscopic sinus surgery. The

primary outcomes were recommendations on the

timing of resuming antithrombotic use.

Results:

We identified 104 unique articles, which underwent

independent title and abstract review by two

reviewers, with 20 undergoing full-text review and 7

meeting eligibility for analysis. Only 3 publications

were case-control studies, 1 was a cohort study, and

3 were literature reviews. All publications discussed

when to stop antithrombotic agents; however, only 3

articles discussed when to restart agents, with mixed

recommendations.

Conclusions:

A paucity of literature exists related to resuming

anticoagulant or antiplatelet agents following

functional endoscopic sinus surgery. Additional

research is needed to establish consensus

guidelines.

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

102

Poster #087

Role of allergic rhinitis in recurrent acute

rhinosinusitis

John Behnke, MD

Zayd Al-Asadi, BS

Dominic Lombardo, BS

Hassan Ramadan, MD, FARS

Chadi Makary, MD, FARS

West Virginia University

Background:

While recurrent acute rhinosinusitis (RARS) is a

relatively common diagnosis with significant

healthcare burden, few reports have evaluated its

association with other comorbidities.

Goal: To evaluate the association between allergic

rhinitis (AR) and RARS.

Methods:

A retrospective case-control study was conducted

using patients presenting to the West Virginia

University rhinology clinic from August 2020 to

October 2022. Cases included patients diagnosed

with RARS, and controls were patients diagnosed

with headache and/or facial pain syndrome. Patients’

characteristics and comorbidities were reviewed.

RARS was diagnosed based on the International

Consensus Statement on Allergy and Rhinology

criteria of four or more independent episodes of

acute rhinosinusitis per year with at least one

episode documented by objective findings, and

complete resolution of the infection between

episodes. Patients with concomitant chronic

rhinosinusitis (CRS) or recurrent exacerbations of

CRS were excluded.

Results:

The study cohort contained 143 patients, 82 patients

with RARS and 61 control patients. Patients with

RARS were older (49 vs 43.5, p=0.05). There was

no difference in gender, smoking history, obstructive

sleep apnea (OSA), or nasal septal deviation

between the RARS patients and controls. AR and

asthma were significantly associated with RARS

(OR=11.1, p<0.0001; OR=2.75, p=0.013

respectively). RARS patients had similar proportions

of seasonal and perennial allergies (21.9%), with

14.1% affected by both.

Conclusion:

Allergic rhinitis is strongly associated with RARS;

therefore, evaluation for AR should be considered

when treating these patients. Future studies with

larger sample sizes are needed to confirm these

results.

Poster #088

Safety of proton beam therapy in patients with

sinonasal carcinoma: A systematic review

Srivatsa Surya Vasudevan, MD, MS

Estephania Candelo, Research Fellow

Alireza Sharifi, Research Fellow

Angela Donaldson, MD, FARS

Mayo Clinic

Introduction:

In sinonasal carcinomas (SNC), treatment with

proton therapy (PT) is noted to provide excellent

local control, especially after gross total resection.

However, depending on dose and duration, PT can

be associated with both acute toxicity (AT) and late

toxicity (LT). We reviewed published studies on PT

toxicity after treatment for SNC.

Methods:

PubMed, Embase, EBSCO, Scopus, Science Direct,

Web of Science, and Cochrane library were

searched for articles discussing PT toxicity in the

SNC population. Full-text screening was performed

to extract data on AT (within 3 months) and LT (more

than 3 months). The data comparing toxicity groups

as well as controls were analyzed using STATA.

Results:

We identified 13 studies that met inclusion criteria.

Pooled data from these studies included 684 patients

who underwent PT for SNC. 272/684 (39.7%)

patients with a mean age of 58.6 (SD ± 8.85)

developed PT-mediated toxicity. 107/684 (15.6%) of

the patients developed AT and 165/684 (24.1%)

developed LT. Among all toxicity patients: dermatitis,

oral mucositis, and facial pain were the most

common toxicities noted in 48.5%, 29.7% and 20.2%

of the patients, respectively. 41.9% of AT and 70.2%

of LT were grade 2 toxicities based on the Common

Terminology Criteria for Adverse Events. There was

no statistically significant difference in the incidence

of AT compared to LT (P=0.345). There appears to

be a correlation between higher grades of AT and

presence of LT (P <0.121).

Conclusion:

More studies are needed to confirm the correlation

between AT and LT as well as risk of developing AT

versus LT. The outcomes of this study can help

physicians infer toxicity in different stages of PT and

educate the patients regarding such occurences.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

103

Poster #089

Severe epistaxis after posterior nasal nerve

ablation requiring surgical intervention: A single

center case series

Yuki Yoshiyasu, MD

Brian Wang, Physician/Surgeon

Daniel Gorelik, Research Fellow

Masayoshi Takashima, MD, FARS

Omar Ahmed, MD, FARS

University of Texas Medical Branch

Background:

Posterior nasal nerve (PNN) ablation is an emerging

treatment option for refractory chronic rhinitis. These

cryoablation (Clarifix) and radiofrequency heat

ablation (Rhinaer, Neuromark) procedures are well-

tolerated and can generally be safely performed in

an office setting under local anesthesia. Given the

novelty of PNN ablation, there is limited literature on

procedure related complications. This objective of

this case series is to report rare but severe epistaxis

requiring surgical intervention following PNN

ablation.

Methods:

Medical records were reviewed for patients who

underwent PNN ablation between August 2018 and

January 2023 at a tertiary care medical center.

Results:

192 patients were included in our case series, of

which 5 patients (2.6%) had significant epistaxis

requiring further intervention. All 5 patients had

in-clinic PNN ablation. Devices used for ablation

were the following: 2 Clarifix, 2 Rhinaer, 1

Neuromark. The complications occurred at mean 22

days (range 18 -24 days) post-operatively. 4 patients

were treated with endoscopic sphenopalatine artery

ligation (3 unilateral, 1 bilateral); 1 patient required

unilateral endoscopic cauterization. No further

epistaxis events were reported after interventions. 4

patients had history of hypertension on

antihypertensives. Only 1 patient was on blood

thinners (ASA 325mg).

Conclusion:

Our experience indicates that PNN ablation can be

associated with major complications such as

significant posterior epistaxis. While overall reported

complication rates are low and most adverse events

are minor complications (headache, dry eye, minor

bleeding not requiring intervention etc.), PNN

ablation should be performed with appropriate

caution.

Poster #090

Severe unilateral refractory epistaxis arising from

the septal branch of the anterior ethmoid artery

Theodore Nguyen, BS

Benjamin Bitner , MD

Jonathan Pang, BA

Li Tang Meller, BS

Katelyn Dilley, BS

Sina Torabi, MD

Arash Abiri, MS

Milind Vasudev, BS

Edward Kuan, MD, FARS

University of California, Irvine

Introduction:

The septal branch of the anterior ethmoidal artery

(sbAEA) may manifest as an arterial vascular pedicle

in the superior mid-nasal septum, has become

increasingly linked to severe refractory epistaxis.

Here we describe the presentation, predisposing

factors, treatment, and outcomes of severe refractory

epistaxis originating from the sbAEA.

Methods:

Patients presenting with severe refractory epistaxis

from July 2020 through July 2022 were

retrospectively identified. Those with intraoperative

confirmation of sbAEA-associated epistaxis were

included. Patient demographics, presentation,

imaging and laboratory studies, treatments, and

treatment outcomes were recorded.

Results:

Seven patients (5 males) with unilateral (n=6) and

bilateral (n=1) sbAEA epistaxis were identified. The

mean age was 63.7±4.5 years and mean BMI was

29.4±0.9. The most common comorbidity was

hypertension (n=5), with none having a history of

bleeding disorders. Five patients had undergone

previous treatment attempts without epistaxis

resolution. One patient had previously undergone

SPA ligation and one with contralateral packing

placement prior to hospitalization. Preoperatively,

imaging was unremarkable in all patients and

hemoglobin was 8.86±0.89 g/dL, with 2 patients

requiring one and three units of blood transfusion,

respectively. All patients underwent directed

cauterization with complete resolution of symptoms,

no complications, and uneventful follow-up visits

(8.0±3.5 months).

Conclusions:

sbAEA-associated severe refractory epistaxis may

be challenging to recognize, but is associated with

high treatment success through directed cautery.

Increased awareness of this source of severe

bleeding may increase epistaxis treatment success

POSTERS

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

104

Poster #091

Severity of chronic sinonasal symptoms after a

major acute inhalational event: A world trade

center retrospective cohort study

Jerlon Chiu, MD

Hannah Sfreddo

David Lehmann

Sonya Marcus, MD

Stony Brook Medicine

Background:

Chronic air pollution exposure is a known risk factor

for the development of upper airway disease. Less is

known about the effect of acute occupational

exposure. The purpose of this study was to

determine the relationship between intensity of acute

air pollutant exposure and chronic sinonasal

symptoms in World Trade Center (WTC) Health

Program patients.

Methods:

WTC patients who were referred to the

otolaryngology clinic at a tertiary-care medical center

for sinonasal symptoms (2010-2020) and had sinus

imaging available were included in this retrospective

cohort study. Pollutant exposure was categorized as

“low,” “intermediate,” “high,” and “very high,” based

on location and duration of exposure to WTC

pollutants, which is consistent with previous

literature. Lund-Mackay (LMK) and Sinonasal

Outcome Test (SNOT-22) scores were used to

evaluate severity of disease. Statistical analysis was

performed to determine the relationship, if any,

between pollutant exposure and LMK/SNOT-22

scores.

Results:

141 patients were included in this study. Average age

at presentation was 44.7 years (SD 8.6) and was

normally distributed. 13.5% were female. Most

patients had “high” exposure (47.5%). Median LMK

score was 2 (IQR: 0 – 5). Mean SNOT-22 score was

42.8 (n=30). “Very high” exposure was associated

with a higher LMK score than “low” exposure (U =

177, p = 0.016). Number of days worked at WTC-

sites was associated with a higher SNOT-22 score (r

= 0.43, p = 0.019, 95% CI [0.07, 0.69]). All other

results were not significant.

Conclusions:

This study found that there is a significant positive

association between the number of days worked at

WTC-sites and a higher SNOT-22 score.

Poster #092

Sex-based differences in severity of chronic

rhinosinusitis as reported by SNOT-22 scores

Snehitha Talugula

Richard Chiu, Medical Student

Sharmilee Nyenhuis

Kamal Eldeirawi

Victoria Lee, MD, FARS

University of Illinois College of Medicine

Background:

Chronic rhinosinusitis (CRS) is a widely prevalent

condition, however its degree of severity according

to sex requires further study. The literature shows

that sex-based differences exist in the severity of

asthma and allergic airway disease in the population.

These findings point to a potential hormonal cause

for this difference, but there is no study suggesting

the role of sex in CRS. The purpose of this study

was to determine the association of sex and CRS

severity in the United States.

Methods:

This study was conducted on data gathered from

181 participants documented in the NAVIGATE 1 and

NAVIGATE II randomized control trials within the

OPTINOSE database. US participants were

analyzed based on sex controlling for airway related

comorbidities, including history of asthma, race, and

ethnicity. SNOT-22 scores were assessed as a

measure of CRS severity. The association between

sex and SNOT-22 scores were determined using

multiple linear regression.

Results:

There were 81 female and 100 male patients. SNOT-

22 scores were significantly higher in females.

Average reported SNOT-22 scores in females were

53.8 ± 16.5 and 46.8± 18.8 in males. On adjusted

regression, the association of sex and SNOT-22

scores approached but did not reach significance (β:

-4.97; 95% CI: -10.68 - 0.73; p = 0.09).

Conclusions:

On average, females had more severe

manifestations of CRS in comparison to men, with

the adjusted association approaching significance.

Further studies, potentially looking at hormones as a

cause of pathogenesis, are needed to better

elucidate the role of sex in CRS.

POSTERS

AMERICAN-RHINOLOGIC.ORG

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

105

POSTERS

Poster #093

Shared decision making for patients with nasal

polyposis: Needs assessment utilizing social

media and clinical cohorts

Isaac Schmale, MD

Minjoo Jo, Medical Student

Li-Xing Man, MD, FARS

University of Rochester Medical Center

Background:

The management of chronic rhinosinusitis with nasal

polyps (CRSwNP) has become increasingly complex

with no single best treatment option. As such,

CRSwNP treatment involves shared decision making

(SDM). However, little is known regarding patient

treatment and counseling preferences. This study

investigates patient and provider needs relating to

CRSwNP treatment and SDM.

Methods:

We conducted REDCap surveys among CRSwNP

patients from CRSwNP Facebook groups. Surveys

assessed patient understanding, concerns, and

preferences regarding treatment. Additionally,

providers who work with CRSwNP patients at our

institution were surveyed. Responses were

categorized and analyzed for emergent themes.

Results:

44 patients and 6 providers completed surveys.

Physician counseling (21) and the internet (17) were

considered to have the biggest influence on patient

treatment decisions while lack of information was the

top factor that made treatment decisions difficult (24).

The top two patient goals for therapy were nasal/

breathing improvement (49) and improved quality of

life (26). From provider surveys, all six providers

stated that improved delivery of credible treatment

information would help patients and improve SDM.

Conclusion:

Both patients and providers believed that reliable

information and SDM were important for improving

CRSwNP care. Although most patients felt that their

providers supported their decisions, many patients

considered lack of information from physicians as the

number one reason their treatment decision was

difficult. A patient decision aid incorporating accurate

treatment options, costs, and risks/benefits could

help CRSwNP patients and allow for future well-

designed trials looking at SDM outcomes.

Poster #094

Sinonasal renal cell-like adenocarcinoma:

Learnings from a case In pregnancy

Andrew Lee, BS

Ryan Little, MD

Linton Evans, MD

Maggie Mouzourakis, MD

Geisel School of Medicine at Dartmouth

Sinonasal Renal Cell-Like Adenocarcinoma

(SNRCLA) is an extremely rare sinonasal tract

malignancy with a characteristic clear cell histology

reminiscent of clear cell renal cell carcinoma. There

have been at least 16 confirmed cases of SNRCLA.

We report the case of a 42-year-old Ukrainian

refugee female presenting to our clinic at 32 weeks

gestation with a recurrent right nasal cavity mass

measuring 8.1 x 4.1 x 4.4 cm. Associated symptoms

included bilateral nasal obstruction, anosmia,

epistaxis, diplopia and right proptosis. To our

knowledge, this is the first case of SNRCLA in a

pregnant patient. Cesarean section was performed

15 days prior to primary resection. A combined

endoscopic endonasal resection and bifrontal

craniotomy was required to achieve gross total

resection of this vascular tumor with negative

surgical margins. The tumor involved a large portion

of the bilateral nasal septum as well as the cribriform

plate. Anterior cranial fossa reconstruction was

performed using a pericranial flap. Interventional

radiology (IR) performed diagnostic angiography with

embolization of the bilateral sphenopalatine arteries.

There was significant vascular supply from the

bilateral anterior and posterior ethmoid arteries as

well as a large contribution from the right vidian

artery. This unique case underscores the challenges

from the accentuated hypervascularity of SNRCLA

malignancies in setting of unknown contributions

from pregnancy as well as the unclear role of IR

embolization.

ARS 69TH ANNUAL MEETING • SEPTEMBER 29-30, 2023 • NASHVILLE, TN

106

POSTERS

Poster #095

Stop scrolling: A social media quality review of

sinusitis videos on TikTok

Rose Dimitroyannis, BA

David Fenton, Medical Student

Stella Cho, Medical Student

Christopher Roxbury, MD, FARS

Social media has emerged as a way to inform

healthcare decisions. TikTok is a social media

platform that allows users to post short-form videos.

The study aimed to assess the quality of sinusitis-