Chronic Rhinosinusitis

Incidence of invasive fungal sinusitis has been increasing over the years. The understanding of its pathophysiology has improved with newer serological tests and diagnostic methods helping in earlier diagnosis and reducing patient morbidity. It was believed earlier that invasive fungal sinusitis is seen only in immune compromised patients but clinical reports suggest otherwise. More anti-fungal drugs are being added to improve incidence of patient survival. This book aims to compile all practical information about invasive fungal sinusitis into a single volume. Therefore, busy clinicians would not have to perform exhaustive literature studies to diagnose invasive fungal sinusitis. The book aims to provide an overview of diseases which could be mistaken for invasive fungal sinusitis and discuss how the management is different. Book sections consist of clinical, microbiological, serological, pathological, radiological and pharmacological features of the disease and its management. Each section is important in today’s context as it dynamically alters the management of the patient. Early clinical suspicion and rapid microbiological, pathological and radiological diagnosis with aggressive treatment with surgical debridement and medical therapy leads to favorable outcomes.

Chronic rhinosinusitis is a widely prevalent condition globally as well as in India. The chronicity of the condition and its multifactorial origin makes the detection of the underlying mechanism of the disease difficult to detect and renders the management challenging. This clinical update handbook put together by the eminent exponents of otolaryngology in India aims to simplify this elusive condition for the benefit of all practitioners involved in the management of this disease. The first chapter highlights socio-economic burden and the impact of this disease on the health related quality of life. The second chapter describes the underlying mechanisms involved in development of the disease. The third chapter showcases the various diagnostic modalities used to detect the disease, differentiate it from other similar conditions and assess its severity. The fourth chapter gives a very succinent overview of the various management modalities. The fifth chapter encapsulates the medical treatment and the sixth offers a lucid description of the latest surgical techniques for this disease. The seventh chapter deals with the other associated conditions that can confuse, complicate or impact the management of the disease as well as affect its prognosis. The eighth chapter describes fungal rhinosinusitis, which is of special importance because of its high prevalence in India.

This book is a comprehensive compendium on the medical and surgical treatment of chronic rhinosinusitis (CRS), with or without polyposis. Detailed coverage is provided of a wide range of topics, including medical and surgical management of CRS and its subsets, medical therapy in the pre- and postoperative period and specific medical therapeutic classes currently employed in CRS patients. Each chapter highlights key aspects of specific therapies, including mechanism of action, indications, dosages, side-effects and available clinical efficacy data and emphasizes practical management pearls and pitfalls. Operative techniques for endoscopic sinonasal procedures for CRS are also outlined. The book will be a valuable resource for practicing general otolaryngologists, rhinologists and allergists as well as residents and fellows in training. It will also serve as a reference guide for physician assistants, nurse practitioners and nurses involved in the care of CRS patients.

This issue will focus on treatments for Chronic Rhinosinusitis. Dr. Wyste Fokkens guest edits topics such as: "Inflammatory mechanisms in chronic rhinosinusitis with or without nasal polyposis," "European versus Asian Chronic rhinosinusitis. What did it teach us and what do we want to know," "Epithelium, cilia and mucus, their importance in chronic rhinosinusitis Noam Cohen Noam," "Aspirin intolerance: does desensitization alter the course of the disease," "Anti-inflammatory effects of macrolides: applications in CRS," and more!

It is with great pleasure that we present to you this Special Issue of Medical Sciences. In this issue, we present a comprehensive and contemporary review of the medical comorbidities that contribute to chronic rhinosinusitis, and, conversely, how our interventions as otolaryngologists can impact those systemic conditions. Our understanding of chronic rhinosinusitis has evolved tremendously over the last two decades. As we have learned, chronic rhinosinusitis—a chronic inflammatory condition of the nasal cavity and paranasal sinuses—is often a local inflammatory response to a systemic or mucosal disorder. The underlying systemic medical conditions not only influence the presentation and diagnosis of chronic rhinosinusitis, but also modify the patients’ response to medical and surgical interventions. Chronic rhinosinusitis associated with cystic fibrosis, for example, is a disorder quite distinct from that associated with aspirin-exacerbated respiratory disease. A clear understanding of the nuances that distinguish these unique and challenging disorders is critical for the practicing otolaryngologist. Equally important, however, is a clear understanding of the powerful benefits that our interventions as otolaryngologists can have for our patients’ rhinologic and systemic health. Knowing that our rhinologic interventions might spare an asthma patient a trip to an emergency room or reduce lung infections in a cystic fibrosis patient makes this a very exciting time to be a rhinologist. We hope you enjoy this Special Issue of Medical Sciences.

This issue of Otolaryngologic Clinics, guest edited by Drs. Abtin Tabaee and Edward D. McCoul, is devoted to Refractory Chronic Rhinosinusitis. Articles in this issue include: Classification of Chronic Rhinosinusitis: Working Towards Personalized Diagnosis; Bacterial Pathogens and the Microbiome; Biofilm and Osteitis; Refractory Chronic Sinusitis with Polyposis; Aspirin-Exacerbated Respiratory Disease; Systemic and Odontogenic Etiologies in Chronic Rhinosinusitis; Genetic and Immune Dysregulation in Chronic Rhinosinusitis; Office Procedures in Refractory Chronic Rhinosinusitis; Topical Therapies and Stents; Revision Functional Endoscopic Sinus Surgery; Extended Endoscopic and Open Sinus Surgery for Refractory Chronic Rhinosinusitis; and An Algorithm for Comprehensive Evaluation and Management of Refractory Chronic Rhinosinusitis.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a heterogeneous disease that impacts a significant portion of the population. Specific subtypes of the disease include cystic fibrosis, allergic fungal sinusitis, and aspirin-exacerbated respiratory disease. Unfortunately, the majority of patients with CRSwNP do not fall within one of these subtypes, and have variable responses to medical and surgical treatment. There are rapidly evolving theories describing the etiology of CRSwNP that involve alterations in innate immunity, acquired dysfunction of respiratory epithelial cells, and external or environmental factors. This book provides a comprehensive update on the latest theories on the etiology of CRSwNP as well as a review of innovative and effective medical and surgical therapies. Special thanks go to D.W. Kennedy, Philadelphia, Pa., for contributing the foreword. Otorhinolaryngologists and allergologists, as well as other physicians and medical providers treating patients with CRSwNP, will find this volume to be an indispensable source of current information.