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Current Opinion in Otolaryngology & Head & Neck Surgery:
doi: 10.1097/MOO.0000000000000021
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa

Rhinology: clinical questions, practical answers

Adappa, Nithin D.a; Becker, Samuel S.b

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aDepartment of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

bBecker Nose & Sinus Center, LLC, Princeton, New Jersey, USA

Correspondence to Nithin D. Adappa, MD, Assistant Professor, Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Ravdin 5, Philadelphia, PA 19104, USA. Tel: +1 215 662-2360; fax: +1 215 614-0071; e-mail:

The field of rhinology has exploded over the last decade. There have been dramatic advances in our understanding of the pathophysiology of chronic rhinosinusitis, as well as developments of a wide range of new therapeutic options. Clinicians must decipher how some of our new understanding and new tools can be applied to our daily practice. The goal of this issue of Current Opinion in Otolaryngology and Head and Neck Surgery is to ask the question: How can we incorporate new evidence into our practice?

This edition starts with a study by Dr Kennedy and Dr Campbell, which reviews the latest studies on drug-eluting stents in sinus surgery. This technology has garnered great interest as a potential means to help us better treat our patients and to improve the surgical outcomes. Dr Poe and Dr Adil discuss the treatment options for Eustachian tube dysfunction discussing the most recent studies and treatment algorithms. Similarly, Dr Douglas and Dr Jain keep us up to date on the role of biofilms on chronic rhinosinusitis, and reviews the treatment protocols for patients suspected to have biofilms.

Other authors focus on common rhinologic questions with the goal of improving both our practice guidelines and our surgical technique. Dr Russell and Dr Bekeny address the issue of when oral antibiotics should be used in chronic sinusitis. Our pediatric otolaryngology colleagues, Dr Kazahaya and Dr Rizzi review the current literature and address the question of when we should operate on pediatric chronic rhinosinusitis. Dr Mullol, Dr Enriquez, and Dr Lehrer review the current guidelines on the evaluation and management of patients with gradual-onset hyposmia and anosmia.

Addressing the issues of patients with less common disease, Dr Adappa and Dr Crosby review the management recommendations for cystic fibrosis patients with chronic rhinosinusitis. With the interest in human papillomavirus (HPV) in head and neck cancer, many otolaryngologists are faced with patient queries on the role of HPV in inverted papillomas. Dr Govindaraj and Dr Wang review the literature on this topic.

Changing the focus to improvements in surgical technique, Dr Palma and Dr Khodaei review the range of treatments available for the surgical management of the deviated caudal septum. Similarly, Dr Daniel Becker and Dr Hahn discuss some tips and pearls for preserving and improving nasal function when performing cosmetic rhinoplasty. Addressing the surgical management of chronic rhinosinusitis, Dr Sama and Dr Wei describe the evidence for the utilization of mucosal flaps in Draf III procedures to improve surgical outcomes. Keeping with the theme of revision sinus surgery, Dr Constantinidis and Dr Konstantinidis address the surgical management of recalcitrant maxillary sinusitis and discuss when, why, and how to perform a medial maxillectomy in these situations.

This edition concludes by addressing malpractice claims associated with sinus surgery. Dr Sam Becker, Dr Cotrill, and Mr. DeLaurentis review the malpractice claims in otolaryngology, and present some tips and pearls that we might incorporate to minimize our exposure to claims of malpractice.

It is our goal, as well as the goal of the contributing authors, that this edition of Current Opinion in Otolaryngology and Head and Neck Surgery addresses some of the increasingly common questions in the sub-specialty of rhinology.

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Conflicts of interest

The authors have no conflict of interests.

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