NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker
During the past few decades, progress in the management of sinus disease has been tightly intertwined with advances in technology. The development of nasal endoscopy, image-guided navigation, and powered instrumentation have all played significant roles in helping otolaryngologists to perform effective, minimally invasive procedures on patients with sinus disease. At the same time, clinical researchers have been focusing on the cause of sinus disease on a molecular level, methodically unraveling the makeup of polyps, biofilms, and the complex series of inflammatory pathways that lead to sinus inflammation. This year's Rhinology section includes 13 articles that review recent developments and technological advancements in the management of sinus disease while also focusing in on clinical dilemmas that continue to challenge otolaryngologists who treat patients with sinusitis.
The section begins with an update on state-of-the-art advancements in the surgical management of sinus disease. Drs Singh and Saraiya review what may be the next stage in surgical endoscopy. Their close look at three-dimensional endoscopy shows us how far this technology has come, and also identifies some of the remaining obstacles to be overcome before three-dimensional systems can be incorporated into standard sinus and skull base surgery. Along similar lines, Drs Russell, Schneider, Burgner, and Webster take a close look at the application of robotic surgery – which has been so successfully adapted for surgeries ranging from the oral cavity to the prostate – to the small cavity of the sinuses and skull base. As with three-dimensional endoscopy, robotic surgery holds great promise but also has several challenges to overcome before integration into the sinus and skull base operating room.
Another example of technological innovation applied for the management of sinus disease – in-office balloon sinuplasty – is reviewed by Drs Sillers and Melroy. Although balloon technology has been applied to the management of sinus disease for nearly a decade, it is only recent years that have seen this technology used for the in-office treatment of patients with chronic sinusitis. Questions have arisen as to the efficacy and indications of in-office balloon procedures. Drs Sillers and Melroy review the safety, efficacy, and outcomes of these procedures so that clinicians can make informed decisions when considering balloon procedures for their patients.
Along the medical front-line, Drs Harvey and Chin take a close look at up-to-date management alternatives for patients with polyps, while Drs Govindaraj and Huang review current options for topical treatments of patients with sinus disease. Both of these articles present medical options that have taken advantage of our increased understanding of the pathways that lead to chronic sinus inflammation.
In the face of robots, balloons, and three-dimensional systems, clinicians continue to wrestle with effective management of patients with sinus disease. In many cases, the problems that challenge contemporary otolaryngologists are similar to those that otolaryngologists were wrestling with decades ago. For the surgical management of sinusitis, Drs Duncavage, Archilla and Schneider re-present five ‘nontraditional’ techniques – many of which are decades old – and which still can play a role in the surgical treatment of patients with persistent sinus disease. Similarly, Dr Georgalas takes a close look at our current understanding of osteitic changes in the paranasal sinuses and their impact on the nasal and sinus function, while Drs Stephens and Saleh review treatment options for isolated maxillary sinus disease.
Ultimately, technology – old and new – is applied by physicians in their attempts to simplify and improve the care of patients with sinus disease. Addressing the front-line management of sinusitis, Dr Gitterman provides a primary care provider's view of areas where improved coordination between otolaryngologists and primary care providers can lead to more streamlined and effective patient care. Along these same lines, Drs Adappa and Adelson review appropriate indications for antibiotics in the treatment of sinus disease, and address concerns associated with routine over-prescription. In the context of cross-disciplinary teamwork, Drs Becker and O’Malley present a template for the standardization of the sinus computed tomography interpretation, while Dr Hagaman presents a working model for integration of care among allergists, pulmonologists, and otolaryngologists based on the interactions between upper and lower airway diseases as described by Drs Kariyawasam and Rotiroti.
It is the hope of myself and the contributing authors that this edition of Current Opinion in Otolaryngology and Head and Neck Surgery provides readers with a taste of future developments in rhinology, as well as a useful look back on some of the patient management issues that continue to confront otolaryngologists and our colleagues in other medical disciplines who provide care to patients with sinus disease.
Conflicts of interest
I have no conflicts of interest.