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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...

Medical control of allergic rhinitis in children

The authors of this randomised trial aim to answer an important question – which is better: daily versus on demand use of intranasal steroids (fluticasone probionate) or antihistamines (levocetirizine dihydrochloride) for symptomatic control of allergic rhinoconjunctivitis secondary to pollen? The...

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...

Sinus surgery effects on asthma patients

Chronic rhinosinusitis (CRS) and asthma are related. The authors identified a gap in the literature and designed this study with a relatively large sample size of 86 patients. They included patients with comorbid asthma and CRS with or without polyps...

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...

Balloon dilatation is an effective adjunct

This is a good study design, sufficiently powered, comparing medical management to balloon sinus dilatation. All patients had failed medical management and were thoroughly assessed preoperatively with Lund-Mackay score confirming abnormal CT findings, SNOT 20 index score, chronic sinusitis score...

Mobile phones to assess productivity in rhinitis

Uncontrolled and moderate to severe allergic rhinitis (AR) has significant negative impact on work productivity. Work Productivity and Activity Impairment Allergic Specific Questionnaire (WPAI:AS) used to measure that impact showed this. Work productivity seems to improve when AR is treated....

IL-25 and nasal polyps, another target

Immune response in chronic rhinosinusitis with nasal polyps (CRSwNP) is mainly via type 2 T-helper (Th2) cells while Th1 cells characterise chronic rhinosinusitis without nasal polyps (CRSsNP) immune response. CRSwNP is heterogeneous on a cytological level causing a varied response...

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...

Is epistaxis affected by the weather?

In this Bosnian study, the authors attempted to determine if air pressure, temperature and humidity had any effect on idiopathic epistaxis. The study took place over a three-year period and included 300 patients. A comparison was performed of meteorological data...