Advancing the Understanding of Complex Rhinologic Problems

Abstract

Advancing the understanding of complex rhinologic problems E ach issue of the American Journal of Rhinology and Allergy presents cutting edge basic and clinical research within the fields of allergy and rhinologic diseases. The current issue is no exception, with a diverse array of innovative studies from a worldwide collection of contributors. Readers will find basic and translational studies that explore the immunologic basis of allergic rhinitis (AR) and chronic rhinosinusitis (CRS), as well as clinical and technical studies that explore issues ranging from rhinoscleroma to cerebrospinal fluid leak repair. The July/ August issue certainly highlights the mission of the AJRA, with subject matter for basic scientists and clinicians alike. Chronic rhinosinusitis and allergic rhinitis are becoming increasingly prevalent, however, our understanding of the pathophysiology and immunologic contributors to disease development and progression remain poorly understood. Leading off the current issue, Shimizu et al 1 investigate the impact of tissue remodeling and the extrinsic coagulation cascade on the pathogenesis of CRS. They found that the coagulation pathway proteins, tissue factor and tissue factor pathway inhibitor, are expressed in nasal secretions and nasal epithelial cells and hypothesize that upregulation of these factors may play an important role in fibrin deposition, tissue remodeling, and nasal polyp architecture. Studies like this should ultimately lead to new and more effective therapies for CRS, but the mainstay for medical management continues to be glucocorticosteroids. In this issue, Kook et al 2 assess polyp-derived epithelial cell expression of enzymes involved in glucocorticosteroid metabolism and correlate enzyme expression with cortisol levels. Their results suggest that expression of the enzyme 11␤-hydroxysteroid dehydrogenase may mediate the anti-inflammatory effect of glucocorticosteroids by increasing levels of endogenous cortisol. CRS results in many symptoms that adversely affect quality of life, with olfactory dysfunction representing one of the primary complaints of many patients. As detailed by Joo et al 3 in this issue, loss of the sense of smell can be associated with both depressed mood and suicidal ideation. Unfortunately, regardless of etiology, there are few proven interventions for the long-term management of olfactory dysfunction. Improvement in olfactory outcomes following endoscopic sinus surgery is reported by Gupta et al, 4 however, aggressive removal of polyps from the olfactory cleft itself remains somewhat controversial. Kuperan et al 5 evaluated the benefit of endoscopic olfactory cleft polyp surgery on olfaction in a randomized singleblind study. Their results showed a statistically significant improvement in objective olfactory outcomes six months postoperatively for patients receiving surgery of the olfactory cleft. Though long-term data is still lacking, the current report suggests that directly addressing olfactory cleft polyps during endoscopic sinus surgery may prov...