The 150 pages in this hard-cover textbook are easy to read and well laid out. The book is nicely illustrated with appropriate colour photography and radiological images, and is accompanied by a DVD containing a number of selected surgical procedures.

As the title might suggest, the text has been predominantly authored by North American-based otolaryngologists, but despite the widely differing working environments which the international ENT community is accustomed to, the content does have a wider relevance.

It is generally accepted by otolaryngologists, particularly rhinologists, that adopting a ‘less is more’ approach to surgical procedures is often the more effective option. This gradual shift, paralleled with the advances in endoscopic technology and instrumentation, has allowed for the development of more minimally invasive techniques, applicable to the awake patient in the outpatient setting.

Early chapters in this textbook provide a comprehensive overview on sinonasal anatomy and radiology, with excellent radiological illustrations and descriptions of common pathologies. The subsequent chapters are dedicated to describing the ideal room setup, recommended instruments, patient selection and local anaesthetic techniques, which were particularly useful as a foundation to the rest of the book.

The remaining chapters focus on a variety of common rhinological procedures. The contributing authors discuss the relevant anatomy, pathophysiology and diagnosis, before going on to describe how they effectively perform these procedures under local anaesthesia in the outpatient /‘office’ setting. This is well supplemented by the illustrations and accompanying DVD. What might have been additionally useful, however, is some specific evidence to demonstrate how well accepted and tolerated these procedures are under local anaesthetic, and how efficacious they are in the long term compared with their general anaesthetic counterparts.

The appeal of this textbook to ENT surgeons would be very dependent on their current practice and their experience of local anaesthetic surgical techniques. Most will be very familiar with the endoscopic assessment of the paranasal sinuses, the management of epistaxis and reduction of nasal fractures. Inferior turbinate reduction, nasal polypectomy and draining mucocoeles, on the other hand, may be a different matter altogether.

Overall this is a well written text which would be particularly useful to aspiring rhinologists, and in the current era of expanding our ‘office-based’ horizons, its publication is quite timely.

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Naveed Kara

(FRCS ORL-HNS), Freeman Hospital, Newcastle upon Tyne, UK.

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