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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...
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...
Steroids pre-FESS
This meta-analysis and systematic review from the Netherlands and the UK aims to answer the question of whether corticosteroids inhaled and / or taken orally are beneficial to patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery. Refreshingly 18 RCTs...
Chronic rhinosinusitis and sleep
This is an interesting article from the Chung Shan Medical University in Taiwan. One-hundred-and-thirty-nine patients were enrolled into this five-year study. They all had chronic rhinosinusitis with or without polyposis and underwent sinus surgery. The aim was to investigate a...
The microbiological environment of the paranasal sinuses
This article reviews the ecology of the sinuses and tries to make sense of the confusing literature on the subject. This covers the details of molecular studies, particularly those which attempt to differentiate normal sinuses from those in patients with...
Olfactory neuronal damage in sinusitis
So many patients with nasal disorders have poor olfactory function, yet sometimes the nose may seem comparatively clear of conductive problems. This study postulated that neuronal damage in the olfactory apparatus would lead to a leakage of neuron specific enolase...
Smoking and immunotherapy – does it worsen outcome?
This interesting study aimed to address the issue of smoking in patients who had their allergic rhinits treated by sublingual immunotherapy (SLIT). Assessment was with validated quality of life questionnaires. There were 163 patients recruited in Greece who had completed...
