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Precision medicine in allergic rhinitis and chronic rhinosinusitis
Precision medicine (PM) with its ‘four Ps’ (personalised, predictive, preventive and participatory) is about appreciating differences between individuals when offering management options for health problems. Multiple groups interested in rhinology such as EPOS and ARIA supported a review of the...
Removing nasal polyps assists with sleep
This small Scandinavian study looked at sleep quality in patients with CRS and nasal polyposis and whether this is improved by surgery, rated by questionnaires. A cohort of 42 Swedish patients in 2013-14 filled out four different validated sleep and...
Handbook of Otolaryngic Allergy
This book is an excellent companion for doctors dealing with allergy and rhinological complications of allergy. It contains detailed information of immunological pathways, from cells to systemic effects, of cellular reaction. It is well organised and takes the reader through...
Surgery or medicine: when should we stop trying to be conservative?
Although most otolaryngologists would agree that surgery improves the outcomes of patients with CRS when medical treatment has failed, both Cochrane reviews state that there is no proof of improved efficacy of surgery over medicine – however, that was after...
Microbiome changes after endoscopic sinus surgery: all is not what it seems
As we keep fighting a losing battle with bacteria and antibiotics, it becomes clear that it is not about killing bacteria, not even diminishing the bacterial load, but rather about shifting the different types of bacteria that colonise and live...
Saline irrigation in CRSwNP after surgery
This article, largely from Germany, aims to prove the effectiveness of nasal saline irrigation in postoperative patients with CRS with nasal polyps. A prospective, single blinded randomised trial was designed with an irrigation and non-irrigation arm. Patients who underwent sinonasal...
3D is the future?
This is an interesting take on yet another way to incorporate modern technology into medical practice, and the novel use of a 3D printer to create a custom-made prosthesis for large and irregular nasal septal perforations. These prostheses have the...
Paediatric pituitary surgery - is it lagging behind?
Endoscopic sellar surgery, especially for adenomas, is a relatively safe, straightforward surgery with (mostly) reproducible results and few complications. However, the evolution of pituitary surgery was a long process, starting from open/transfrontal approaches all the way to transsphenoid to the...
FESS for recurrent acute rhinosinusitis: at last, some data
As noted in both the EPOS 2012 and in the (more recent) ICARS 2016, there is a paucity of evidence on the effectiveness of surgery for recurrent acute rhinosinusitis (RARS). The authors used a control group of patients with CRSsNP,...
Balloon dilatation is an effective adjunct
This is a good study design, sufficiently powered, comparing medical management to balloon sinus dilatation. All patients had failed medical management and were thoroughly assessed preoperatively with Lund-Mackay score confirming abnormal CT findings, SNOT 20 index score, chronic sinusitis score...
Sellar surgery – when to prepare for repair
Endoscopic sellar surgery, especially for adenomas, is a relatively safe, straightforward surgery with (mostly) reproducible results and few complications. One of the commonest complications is the creation of a CSF leak with the subsequent need for repair (there is usually...
