About The Book

Endoscopic Sinus Surgery: Optimizing Outcomes and Avoiding Failures

From the Preface

Since the 1990s, the subspecialty of rhinology has evolved faster than any other area within otolaryngology. Only in recent history, the primary pathophysiology of chronic rhinosinusitis was be believed to be primarily a result of structural obstruction of the osteomeatal complex with subsequent bacterial infection. Treatment algorithms revolved around systemic antibiotics and medical failures were treated with removal of diseased mucosa using non-physiologic surgical approaches. We have now gained a better understanding of the heterogeneous nature of chronic rhinosinusitis and the complex interaction between local and systemic immunity, impaired mucociliary clearance and the potential role for a variety of external insults to include bacteria, fungi, and other noxious stimuli. While surgery still plays a major role in the treatment of inflammatory disease, it is now performed in a physiologic fashion and its role as an adjuvant to aid in the delivery of novel topical therapies is better appreciated.

In parallel with technological advancements for use in inflammatory disorders, rhinologists pushed the envelope in the surgical treatment of neoplastic disorders of the skull base and paranasal sinuses. Minimally invasive approaches in collaboration with other specialities, notably ophthalmologists and neurosurgeons, have resulted in the nascent field of neurorhinology, which is still in its infancy and will undoubtedly continue to evolve.

In spite of these tremendous advances in rhinology and greatly improved success, doctors are still faced with difficult patients and failures of standard approaches. If we do not learn from our failures, we are destined to repeat them.

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