EDITORIAL
CURRENT
OPINION Emerging frontiers in rhinology and skull
base surgery
Nithin D. Adappa a and Edward C. Kuan b
Following an unprecedented year involving the
coronavirus pandemic, rhinology and skull base
surgery have nevertheless continued to advance
through the efforts of experts on multiple fronts
and along opposite coasts. A common theme of
the current issue is emerging frontiers, where new
understanding of disease processes, advanced
knowledge and insights in surgical care, and para-
digm shifts are changing the way we think about
and practice, ultimately translating to improve
patient care. In light of current events, Professor
Hopkins’s (pp. 19–25) review of coronavirus disease
2019 (COVID-19)-related hyposmia serves a critical
need for otolaryngologists who have certainly seen
increased prevalence of this condition in the out-
patient setting.
Inflammatory disease remains a major focus of
our field, with efforts directed towards understand-
ing pathophysiology and optimal treatment strate-
gies. Despite a persistent interest in adult chronic
rhinosinusitis, a comparatively scarce amount of the
literature has been dedicated to pediatric chronic
rhinosinusitis. Dr Ference (pp. 68–77) provides her
expertise in this area with an overview of diagnosis,
treatment, and outcomes related to the care of the
pediatric patient with chronic rhinosinusitis. Simi-
larly, there is a growing body of research in the role
of fungus in pathogenesis of chronic rhinosinusitis,
with Dr Luong (pp. 58–62) providing an updated
review on this topic. On the technical front, Dr
Roxbury (pp. 40–45) evaluated the current literature
on management of the middle turbinate during
sinus surgery, which has received renewed attention
and created some debate regarding its risks and
impact on outcomes.
Some common problems may not be as simple
as once thought to be, and two articles in this issue
shed new light into our understanding of epistaxis
and sinus headaches. Drs Macoto Kosugi and Stamm
(pp. 13–18) present their experience with the
‘S-point’, which may be an elusive source of refrac-
tory epistaxis that is underrecognized. Dr Jang and
colleagues (pp. 63–67) have assembled a rich review
of the differential diagnosis of sinus headaches,
providing helpful direction in elucidating diagnosis
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Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
and engaging other specialists in the multidisciplin-
ary management of this complaint.
Over the last several years, especially following
reclassification and identification of new histologic
subtypes, there has been increasing research interest
in sinonasal neoplasms. Dr Kamel and colleagues
(pp. 26–32) delineate surgical treatment strategies
for inverted papilloma, one of the most common
benign neoplasms treated in our specialty, with a
comprehensive account of surgical techniques to
access tumors in locations previously thought chal-
lenging to do so via endoscopic approaches. Addi-
tionally, of critical need is a deeper understanding of
molecular mechanisms in pathogenesis of sinonasal
malignancies, along with associated implications for
treatment. To address this, Dr London (pp. 33–39)
reports on state-of-the-art basic research on sinonasal
undifferentiated carcinoma, intestinal-type adeno-
carcinoma, and olfactory neuroblastoma, highlight-
ing exciting research efforts in this area. Furthermore,
as outcomes for sinonasal tumors has improved,
more attention has been drawn towards quality of
life related to treatment, and Professor Georgalas
(pp. 46–57) presents an overview of this topic.
Finally, nasopharyngeal carcinoma was once
thought to be a largely nonsurgical disease but
description of endoscopic nasopharyngectomy as
reviewed by Professor Lan (pp. 3–12) has added a
new tool to the arsenal of the rhinologist.
We hope that this issue will inform the reader-
ship of Current Opinion in Otolaryngology & Head and
Neck Surgery of the latest advances and stimulate
additional interest in the growing field of rhinology
and skull base surgery.
a
Department of Otorhinolaryngology-Head and Neck Surgery, University
of Pennsylvania, Philadelphia, Pennsylvania and bDepartment of Otolar-
yngology-Head and Neck Surgery, University of California, Irvine Medical
Center, Orange, California, USA
Correspondence to Edward C. Kuan, MD, MBA, Department of Otolar-
yngology-Head and Neck Surgery, University of California, Irvine, 101 The
City Dr. S, Orange, CA 92868, USA. Tel: +1 714 456 5753;
fax: +1 714 456-5747; e-mail: eckuan@uci.edu
Curr Opin Otolaryngol Head Neck Surg 2022, 30:1–2
DOI:10.1097/MOO.0000000000000785
www.co-otolaryngology.com
Nose and paranasal sinuses

Acknowledgements Financial support and sponsorship

The editors would like to thank the editorial team and None.
leadership for their support in the production of the issue,
as well as to thank all authors for contributing their Conflicts of interest
expertise during these unprecedented times. There are no conflicts of interest.

2 www.co-otolaryngology.com Volume 30  Number 1  February 2022

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