Bringing Together Multiple Perspectives in Rhinology and Allergy.

Abstract

It is a pleasure to introduce this issue of the American Journal of Rhinology and Allergy. In my practice as an allergist, I have had the privilege of running a multidisciplinary clinic, which has enriched my career in many ways, not only through the delivery of coordinated care but also the opportunity to work and learn side by side with incredible collaborators across disciplines. This issue brings together the same vibrancy of a community dedicated to examining disease, pathogenesis and clinical care from multiple perspectives. Together, bringing these diverse disciplines together provides a unique forum to address the unmet needs of our fields. Persistent olfactory dysfunction after COVID19 infection has been a challenging issue which significantly impacts the quality of life of affected patients. Abdelazim et al employed a prospective randomized clinical trial of an ethylene diamine tetra acetic acid (EDTA) nasal spray for 3 months in patients who were all also provided olfactory training. The addition of the EDTA nasal spray treatment increased the rate of clinical improvement from 88% from 60%, which would provide a significant improvement in clinical management of persistent olfactory dysfunction secondary to COVID19 infection. Another well-designed, prospective placebo controlled clinical trial of omega-3 fatty acid supplementation did not find short or long term benefit from high doses of omega-3 fatty acid supplements on olfactory dysfunction. As a result of our need for a better understanding of olfactory mechanisms, mechanistic work to dissect the molecular etiology has been particularly valuable. Kim et al propose that intermittent hypoxia in a mouse model can damage the olfactory neutrepithelium, inducing changes in both olfactory marker genes and neurogenesis. These advances not only bring hope in finding both novel avenues of therapy but also in developing methods of clinical and mechanistic investigation for evaluation of olfactory dysfunction caused by COVID-19. In allergy, increasingly the field is focused on early intervention in prevention to disrupt the natural progression of the atopic march. Therefore, predictive biomarkers to identify those individuals most at risk for progression provide clinical utility. Cirillo et al focus on using office spirometry for measurement of forced expiratory flow at 25–75% of vital capacity (FEF25-75) to identify bronchial impairment in individuals with allergic rhinitis. Spirometry evaluation of individuals with allergic rhinitis might be helpful in evaluating individuals at risk for progression to asthma. Despite the significant advances made in treatment of allergic inflammation recently, eosinophilic chronic rhinosinusitis with nasal polyps commonly recurs soon after surgical intervention. Wang et al identified that a lower ratio tissue lymphocytes to eosinophils predicts recurrence within 5 years after surgery, which may help identify those who warrant more aggressive medical management. Moreover, patients who undergo transplantation may be at particular risk for recalcitrant sinus disease requiring surgery. Retrospective analysis of patients chronic rhinosinusitis (CRS) with both solid and nonsolid organ transplants found an increased need for surgery and more recalcitrant disease. The authors further identified specific factors, including certain immunotherapy medications, pancytopenia, and rejection, which correlate to the need for surgery, suggesting that this population warrants close monitoring. Surgical management of chronic maxillary sinusitis can be complicated by a loss of mucocillary compliance. Seresirikachorn et al describe a modification of the endoscopic-modified medial maxillectomy (EMMM) procedure performed in adults with nonfunctioning maxillary sinuses managed with EMMM. Most patients had improvement in both symptoms and mucostasis, complicated by rare events of blooding and temporary dysesthesia. Complications of surgical management, particularly those requiring emergent care, are particularly concerning. Yu et al took on the task of retrospectively studying databases across the United States to identify risk factors for postoperative emergency room (ER) visits 30 days after the sinus procedure. About half the visits occurred within the first week Editorial