We show a high percentage of CRS patients (28.6%) whose sinonasal mucopurulence has biofilm-forming capacity. Postsurgical patients had a high prevalence of biofilm-forming bacteria, a possible reflection of the severe nature of their disease. Additional studies are warranted.

Background: Olfactory dysfunction in patients with allergic rhinitis has long been thought to be secondary to coexisting chronic rhinosinusitis and polyposis with obstruction of airflow over the olfactory epithelium. Recent evidence suggests that the allergic inflammatory infiltrate may itself affect olfaction in the absence of mucosal hypertrophy. Objective: We undertook a study to determine olfactory function in patients with allergic rhinitis in the presence and absence of chronic sinusitis. Methods: Fifty-one subjects with symptoms of rhinitis who presented for allergy testing were administered the University of Pennsylvania Smell Identification Test. In addition each patient underwent computed tomography (CT) scanning of the sinuses. Results: Eighty percent of subjects were allergic. Subjects with allergic rhinitis and no evidence of sinusitis scored on average in the 30th percentile (95% CI 20–40th percentile) on objective olfactory testing compared to age- and gender-specific norms. Half the allergic patients were classified as normosmic, while half had some degree of hyposmia. Conclusions: Our study demonstrates that even in the absence of mucosal disease on CT scan, a significant subset of patients with allergic rhinitis will exhibit hyposmia, mostly to a mild or moderate degree. The pathophysiology and potential treatments for olfactory loss in these patients should be further explored.

The increased complexity of medicine, the imperative of reducing health care costs, and the goals of improving quality and patient satisfaction require that we rethink current models of practice. Such reevaluation will receive additional impetus from workforce changes within medicine and the specialty. Furthermore, as chronic disorder care becomes more complex, it may increasingly be provided within a specialty setting. Our goal is to stimulate discussion regarding the potential for alternative health care delivery models within the specialty in the face of predicted workforce shortages and the impetus toward health care reform. A collaborative practice model utilizing midlevel health care providers increases productivity and patient satisfaction and provides the potential to deliver an exceptionally high level of care for chronic disorders when such care is sufficiently complex to require specialty management.

In this prospective study, automated facial recognition software significantly improved the accuracy of image guidance registration when compared to conventional surface registration.

Meningoencephalocele is an uncommon condition in which brain tissue, meninges, or both protrude through a defect in the anterior cranial fossa and into the ethmoid sinus or nasal cavity. Much less often, brain tissue, meninges, or both protrude through a defect in the middle cranial fossa and into the sphenoid sinus. We report an unusual case of a middle fossa encephalocele that appeared as a lytic lesion of the skull base. The patient was treated successfully via a unique endoscopic transpterygoid approach—that is, an endoscopic approach through the maxillary sinus and pterygopalatine fossa and into the pterygoid process.