ABSTRACT Background: Nasal endoscopic features of post nasal drip (PND) is well described but not formally studied. This study aims to assess the nasal endoscopic features of PND among rhinitis. Design: Cross-sectional study Settings: Otorhinolaryngology (ORL) outpatient clinic at a tertiary referral center. Participants: Adults (18 years and older) with chronic rhinitis grouped into either “Rhinitis with PND” or “Rhinitis only”. Main outcome measures: The endoscopic features of PND were scored as: Secretions in the posterior nasal cavity (Yes/no), erythema in the nasopharynx (none, roof only, diffuse), hemorrhagic spots (yes/no) and granular posterior pharyngeal wall(patchy/diffuse) and compared between groups. Results: There were 98 patients included (age 32.32±11.33, 61.2 % female, 61.2% PND). Presence of secretions in the posterior nasal cavity was associated with PND (“Rhinitis with PND” vs “Rhinitis only”, 78.3 v 55.3%, p=0.02). This gave 78.3% sensitivity and likelihood ratio positive of 1.41 to predict bothersome PND among rhinitis patients. The other nasal endoscopic features were not associated with PND. Conclusion: Secretions in posterior nasal cavity supports PND among rhinitis patients. Further studies to assess the endoscopic features of PND in other patient populations are needed. Keywords: laryngopharyngeal reflux, postnasal drip, rhinitis, nasal endoscopic, bothersome, inflammation, reflux symptoms index, reflux findings score Key points: rhinitis, nasal endoscopic features, postnasal drip sign, secretions posterior nasal cavity, quality of life

Introduction: Immunotherapy has proven its efficacy in multiple randomized control trials (RCT) in treating allergic rhinitis (AR) as it induces induces long term remission after discontinuation and prevent new sensitization. Objective: Our aim is to look into earliest improvement of quality of life (QOL) in AR patient treated with Sublingual immunotherapy (SLIT). Methodology: Patients who were sensitized to dust mites (Dermatophagoides farinae, Dermatophagoides pteronyssinus and Blomia tropicalis) were enrolled into the study. All patients were treated with SLIT for 6 months. The patients were assessed using rhinoconjunctivitis quality of life questionnaires (RQLQ) and peak nasal inspiratory flow (PNIF) pre-treatment at 1, 3 and 6 months post SLIT. The usage of intranasal corticosteroids (INS) and antihistamine were documented in medication diary. The data for pre and post treatment for RQLQ results were analysed using paired T-test and medication diary were analysed using ANOVA test. Results: A total of 53 patients were enrolled in the study. The mean RQLQ score showed significant result at 3 and 6 months post SLIT (p<0.05). Significant improvement seen in the mean PNIF value pre-treatment (81.54 L/min ±29.36 ) compared to mean PNIF value at 3 months (92.0L/min ±29.03 ) and 6 months (96.13L/min ±26.67) post SLIT (p<0.05). The dependency of patients towards pharmacotherapy also showed a significant reduction at 3 and 6 months post SLIT (p<0.05). Conclusion: Our study showed a significant improvement of patients’ quality of life as early as 3 months of post SLIT treatment.

Aims: To correlate the HPV genotypes with recurrence of disease and malignant transformation. Methods: A prevalence cross-sectional study. The tumour tissue was isolated from the paraffin-embedded tissue (PET). The DNA was extracted from the tissue using the QiAamp DNA Mini Kit (Qiagen, Germany). Gel electrophoresis was performed to determine the presence of genomic DNA. HPV detection and genotyping were carried out using SACACE HPV High Risk and Low Risk Typing Real-TM kit (SACACE, Italy). Two different types of kits were used, that is HPV 6,11 Real-TM and HPV 16,18 Real-TM kits. Results: A total of 44 patients, 36 were male and 8 were female with a ratio of 5:1. 61.4% was Malay, 22.7% was Chinese, 11.4% Indian 4.5% other races. 15 out of 44 patients had HPV positive (34%). The recurrence rate of positive HPV infection compared to negative HPV was not statistically significant (p>0.05). There was a significant correlation of HPV 16 and 18 infection with malignant transformation (p<0.05). A high detection rate of a high-risk HPV type (67%) was observed in patients with inverted papilloma with malignant transformation. Conclusion: The prevalence of HPV in inverted papilloma is 34%. Our result supports that HPV infection is an aetiological factor in sinonasal inverted papilloma. A high-risk HPV plays a role in the oncogenesis of sinonasal inverted papilloma. Further studies should be conducted to further elaborate this relationship.