Rhinologic Innovation and Advancement Come in All Forms of Investigation

As I prepare this guest editorial for this month’s issue of American Journal of Rhinology and Allergy, I am in awe of the sheer breadth and advances in research, we, as a community publishing. It was not that long ago that we were limited to basic surgical technique and small single institution retrospective studies. Reviewing, this exciting issue, we really get a fantastic appreciation for advances in surgical technique, novel prospective investigations, large database studies, and high-quality basic science work. I really feel that we are in a golden era of innovation in our field, and this journal continues to demonstrate they are in the forefront of innovation. We were fortunate to see several publications discussing advanced surgical techniques. Li and colleagues evaluated the efficacy of a Denker’s approach versus a prelacrimal approach to the pterygopalatine fossa and infratemporal fossa. Utilizing cadaveric dissection, they found while both approaches can provide access to those areas, the Denker’s provides improved freedom of motion ultimately suggesting that this would be the preferred approach for pathology in the pterygopalatine and infratemporal fossa. Similarly, this month’s “how I do it” publication by Takaishi demonstrates a novel method of reconstruction of a medial orbital wall fracture. Here, Takaishi utilizes the patients nasal tissue, specifically septal cartilage to reconstruct the defect after any bone fragments are removed, and the orbital contents are reduced and avoids using alloplastic implants. Switching gears to a prospective investigation, we had an excellent study by Esmaeilzdeh et al prospectively identified 66 moderate to severe allergic rhinitis patients and placed them in 3 treatment arms; montelukast and steroid spray, intranasal antihistamine and steroid spray, and intranasal steroid with a placebo tablet. They found that the nasal antihistamine group with steroid spray was the superior outcomes arms in regard to SNOT-22 scores. Conversely, in their investigation, they found montelukast has no improvement over intranasal steroids alone. We also had several excellent retrospective studies published in this issue. Huang and colleagues published a retrospective study of chronic rhinosinusitis patients 55 and old and stratified by the Charlson Comorbidity Index and identified that even with worse medical comorbities, patients still had similar improvement in SNOT-22 scores. Interestingly, they also looked at complication rates but this needs to be looked into further. Another study very relevant to sinus surgeons was published by Ritter et al. Their group looked at detection and outcomes of invasive fungal rhinosinusitis in immunosuppressed children. They identified in their retrospective cohort that enhanced panfungal polymerase chain reaction and treatment with both novel antifungals and aggressive surgical approaches improved their outcomes in this challenging treatment population. Moving through this issue of American Journal of Rhinology and Allergy (AJRA), we get the opportunity to see the power of well-performed database studies. Han and colleagues performed a very interesting cross-sectional study of nationwide data in South Korea evaluating the association between the concentration of air pollutants and the prevalence of allergic rhinitis and chronic rhinosinusitis. They found the prevalence of allergic rhinitis was significantly associated with the particulate matter but chronic rhinosinusitis was not associated with air pollutant concentrations. Abdelshafy et al performed a systematic review and meta-analysis of the impact of bilastine, a novel oral second-generation H-1 antihistamine for both allergic rhinitis and chronic urticaria. They included 9 randomized trials including 3801 participants and found bilastine safely improved total symptoms in hyper histaminic allergic conditions involving nasal symptoms. Another great study by Son Editorial