Science and Research March Onward

As I prepared to write this Editorial for the American Journal of Rhinology and Allergy, I was impressed at the breadth of topics covered in this latest issue, and was reminded how science and research are expanding the boundaries of knowledge for the benefit of our patients. This insight re-awakened the excitement that first attracted me to study, perform research and practice in this field. I extend my congratulations and thanks to the authors whose work has contributed to the articles in this issue of the AJRA, with topics spanning from the pathophysiology of inflammatory upper airway disorders such as allergic rhinitis and chronic rhinosinusitis, to the outcomes of the medical and surgical treatments of these disorders as well as other pathologies of the sinonasal tract and skull base. In addition to providing clinicians with novel understandings relevant to patient care, it is my sincere hope that these articles will inspire the next generation of clinician researchers to march onward with their own scientific journeys. On the subject of academic achievement within Otolaryngology – Head and Neck Surgery, Mofatt et al sought to evaluate the impact of fellowship training on scholarly impact through the use of a cross-sectional analysis of academic otolaryngologists in the United States. What they discovered is that fellowship training did not have a significant impact on h-index scores – a correlate to academic influence. They did however note several interesting variations across different subspecialties of ourfield, including the fact that rhinologists had the highest average publication output per year. Articles delving into the pathophysiology of inflammatory upper airway diseases included two articles focussed on a molecule that is increasingly useful in the diagnosis and monitoring of chronic respiratory diseases, particularly by our lower airway counterparts: nitric oxide (NO). This molecule is of particular significance to me as it was the focus of my own initial foray into otolaryngology research nearly 2 decades ago; oh how time flies! Sutiratanachai et al examined NO levels in children with house dust mite (HDM)-induced allergic rhinitis and found that children with severe rhinitis had significantly higher nasal NO levels than those with moderate rhinitis. They went on to propose a cut-off value for the diagnosis of severe HDM-induced chronic rhinitis. In another article confirming the clinical effectiveness of sublingual immunotherapy (SLIT) treatment for children with allergic rhinitis, Parisi et al identified nasal NO, in addition to nasal cytology, as a useful biomarker to predict treatment efficacy in the short term. Staying within the theme of rhinitis, Deng and colleagues were able to demonstrate adverse effects on nasal patency using several objective measures such as nasal airway resistance following the acute consumption of alcohol; this effect appeared to be heightened in individuals with allergic rhinitis. Naturally, chronic rhinosinusitis (CRS) remains the focus of much of the research effort in our subspecialty, and was the subject of investigation in several articles in this issue. In a systematic review by Ma et al, 31 studies representing 8409 patients were analyzed to paint a portrait of the demographic variation of CRS patients across the US as assessed by region, supporting the observation that this heterogeneous disease has a considerable geographic disparity. Kawasumi et al assessed the paranasal sinus epithelium in patients with eosinophilic and noneosinophilic CRS for the presence of two receptor molecules that have gained widespread interest as a result of the recent SARS-CoV-2 pandemic, given their role as the primary receptor for viral infection and transmission. Furthermore, Fried and colleagues reviewed 16 studies in order to determine the effects of medical or surgical CRS treatment on sleep in patients not previously diagnosed with sleep apnea; although subjective improvements were reported using quality of life measures, objective improvements in sleep metrics were not so readily apparent. An important cornerstone in the management of CRS and various other pathologies of the upper airway is surgery. Ji Editorial