Otolaryngologic Clinics of North America RSS feed: Current Issue. Otolaryngologic Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in otolaryngology and is presented under the direction of an experienced guest editor.http://www.oto.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Otolaryngologic Clinics of North America0030-6665425October 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.oto.theclinics.com/article/PIIS0030666509001546/abstract?rss=yesContents10.1016/S0030-6665(09)00154-6Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8viixihttp://www.oto.theclinics.com/article/PIIS0030666509001558/abstract?rss=yesForthcoming Issues10.1016/S0030-6665(09)00155-8Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8xiixiihttp://www.oto.theclinics.com/article/PIIS0030666509001376/abstract?rss=yes Techniques in endoscopic sinus and skull base surgery have continued to evolve, often propelled forward by technological innovations. The introduction of the rigid nasal endoscope to the diagnosis and surgical management of sinonasal disorders is undeniably the single greatest advance in the field of rhinology to date. Rigid nasal endoscopy provided improved visualization of sinonasal anatomy and ushered in minimally invasive techniques of functionally oriented sinus surgery. Emboldened by the later application of powered microdebriders, drills, and surgical navigations systems, rhinologists continued to refine their endoscopic skills and began to follow disease processes that extended outside of the confines of the sinonasal tract. This evolution has led endoscopic surgeons to greatly expand their repertoires to safely and confidently address more complex pathologies involving the orbit, skull base, and even brain.PrefaceRaj Sindwani10.1016/j.otc.2009.08.020Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8xiiixvhttp://www.oto.theclinics.com/article/PIIS0030666509001005/abstract?rss=yesNew technologies continue to affect the practice of otolaryngology–head and neck surgery. Numerous financial and regulatory barriers must be overcome to develop an idea into a useful device or intervention. US Food and Drug Administration (FDA) approval focuses on safety, often leaving the medical community, in general, to determine the efficacy of the device after FDA approval has been granted. Physicians are involved throughout the technology development process, generating conflicts of interest that must be effectively managed. It is essential that physicians ethically maintain their leadership in developing and evaluating new advances in medical technology.Developing, Regulating, and Ethically Evaluating New Technologies in Otolaryngology–Head and Neck SurgeryRichard R. Orlandi, Bradley F. Marple10.1016/j.otc.2009.07.007Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8739745http://www.oto.theclinics.com/article/PIIS0030666509000966/abstract?rss=yesAdvances in instrumentation are part of the natural evolution of any surgical discipline. During this process, there are certain key junctures where the state of the art in technology truly augments the surgeon's ability to manage higher levels of pathology. The present era of endoscopic sinus surgery has been hallmarked by extension of minimally invasive techniques to complex pathologies including advanced inflammatory disease, and pathology involving the orbit, skull base, and brain. Evolution of the armamentarium for endoscopic visualization has been a central feature in this. In this article, key historical elements are reviewed and the technical principles behind these important advances in endoscopic visualization are discussed.Evolution of the Endoscope and Endoscopic Sinus SurgeryRakesh K. Chandra, David B. Conley, Robert C. Kern10.1016/j.otc.2009.07.010Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8747752http://www.oto.theclinics.com/article/PIIS0030666509001297/abstract?rss=yesSince the introduction of functional endoscopic sinus surgery (FESS) in the United States in 1985, the information gained from imaging has proved imperative in understanding regional morphology and guidance of surgical procedures. More than 20 years later, the importance of imaging continues to be the anatomic detail afforded by this technology, the roadmap it provides in planning the surgery, and the morphologic detail it provides in recurrent disease. The latest development in CT technology, cone beam CT instrumentation, may change the way imaging of the nasal cavity and paranasal sinuses is performed in the future. These topics are discussed in this article.Imaging of the Paranasal Sinuses and In-Office CTPaul D. Campbell, S. James Zinreich, Nafi Aygun10.1016/j.otc.2009.08.015Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8753764http://www.oto.theclinics.com/article/PIIS0030666509001303/abstract?rss=yesThe applications of endoscopic techniques have expanded beyond the treatment of inflammatory sinus disease and toward the resection of anterior and middle skull base lesions. Image-guided surgery has emerged as an important tool that compensates for the limitations of surgical endoscopy. The disadvantage of image-guided surgery, however, is its dependence on preoperative imaging data. Intraoperative imaging provides near real-time imaging that has the potential to improve surgical outcomes and reduce operative morbidity. The role of intraoperative imaging in endoscopic sinus and skull base surgery has demonstrated great promise in recent literature. It has had an impact on surgical decision-making during functional endoscopic sinus surgery and the resection of anterior skull base neoplasia. Advances in portable MRI and volumetric CT technology have enhanced the efficiency and safety of intraoperative imaging. Although further studies are required to quantify the precise utility of this new technology, it appears that intraoperative imaging will be an important tool for rhinologic surgery.Intraoperative Imaging for Otorhinolaryngology—Head and Neck SurgerySeth Isaacs, Samer Fakhri, Amber Luong, Martin J. Citardi10.1016/j.otc.2009.08.014Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8765779http://www.oto.theclinics.com/article/PIIS0030666509000954/abstract?rss=yesThe microdebrider has been one of the most significant innovations in the field of rhinology. The use of this instrument for endoscopic sinus surgery offers the advantages of mucosal preservation, improved precision, expeditious tissue removal, and better visualization. Recent advances in microdebrider technology now permit 360 degrees, blade rotation, continuous tracking of the instrument using surgical navigation, and the ability to control bleeding with bipolar energy. A variety of specialty blades are also available, each attempting to address a specific operative limitation encountered during endoscopic surgery. To use these devices effectively and safely, the limitations of microdebriders must be appreciated.Innovations in Microdebrider Technology and DesignSeth Bruggers, Raj Sindwani10.1016/j.otc.2009.07.003Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8781787http://www.oto.theclinics.com/article/PIIS0030666509001315/abstract?rss=yesThe modern rhinologist has a wide variety of powered tools at his or her disposal. Innovations in powered instrumentation include the suction-irrigation drill, the coblator, and the introduction of a bone-cutting ultrasonic aspirator. The primary drawback of powered instruments continues to be the higher costs associated with their use, whereas their main advantage is the ability to accomplish multiple functions, such as bone removal, suction, and irrigation, with one tool. The effective use of any powered instrument requires an intimate understanding of its capabilities and limitations. This article provides a brief review of powered instrumentation used in endoscopic sinus and skull base surgery and explores the history, technical details, and potential applications of these exciting tools. Evolution in the design and functioning of the microdebrider are discussed elsewhere.Evolving Trends in Powered Endoscopic Sinus SurgerySeth Bruggers, Raj Sindwani10.1016/j.otc.2009.08.016Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8789798http://www.oto.theclinics.com/article/PIIS0030666509000978/abstract?rss=yesSurgical navigation technology provides real-time intraoperative localization of surgical instruments within the field. These systems are highly accurate, assist with preoperative planning, and improve surgeon confidence. The industry has recently responded to the growing trend of treatment in ambulatory surgical centers by offering surgical navigation devices that are more compact, less expensive and more user-friendly than conventional devices. Surgical navigation is indicated for complex sinonasal disease and may reduce the risk of complications. The indications for surgical navigation continue to expand as the technology improves and imaging data synthesis evolves to include multimodality fusion and real-time intraoperative data-set updates. Although now widely available, navigation systems are still considered state of the art, and not standard of care.Advances in Surgical NavigationDary J. Costa, Raj Sindwani10.1016/j.otc.2009.07.004Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8799811http://www.oto.theclinics.com/article/PIIS0030666509001029/abstract?rss=yesAbsorbable biomaterials are commonly used after endoscopic sinus surgery, both for hemostatic and wound healing considerations. Although removable nasal packing is the traditional method of controlling ongoing bleeding and modulating wound healing, it is uncomfortable for patients and associated with several complications. Currently available absorbable agents frequently incite an inflammatory reaction and have been shown in animal and human trials to adversely affect the wound healing process. Newer agents offer distinct advantages because of their unique composition and rapid clearance profiles. The selection of packing material used in any given sinus procedure should be based on surgeon preference and the details of the specific case.Advances in Absorbable Biomaterials and Nasal PackingRowan Valentine, Peter-John Wormald, Raj Sindwani10.1016/j.otc.2009.07.009Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8813828http://www.oto.theclinics.com/article/PIIS003066650900098X/abstract?rss=yesTopical drug delivery for sinonasal disorders is influenced by a variety of factors. Macroscopically (or anatomically), the ability of the drug to reach the appropriate region of the paranasal system is paramount. Delivery techniques, surgical state of the sinus cavity, delivery device, and fluid dynamics (volume, pressure, position) have a significant impact on the delivery of topical therapies to the sinus mucosa. Once topical therapeutics actually reach the desired site, factors within the local microenvironment heavily influence local drug delivery. The presence and composition of the mucus blanket, mucociliary clearance, direct mucin-drug binding, and the permeability of pharmaceutical compounds will all impact drug delivery. In addition, the general therapeutic goal of topical management may lie between the potentially competing actions of mechanical lavage and pharmaceutical intervention. Techniques for the mechanical removal of mucus, antigen, and inflammatory products may not be the most efficient approach for pharmaceutical delivery. This article reviews the evolving concepts in local drug therapy, both for the factors that influence anatomic distribution within the sinonasal system and those that affect mucosal absorption.Local Drug DeliveryRichard J. Harvey, Rodney J. Schlosser10.1016/j.otc.2009.07.005Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8829845http://www.oto.theclinics.com/article/PIIS0030666509000991/abstract?rss=yesChronic sinusitis affects millions of patients. Balloon technology is a tool that has enhanced the surgeon's ability to treat patients suffering from chronic sinusitis. Three companies have developed products to dilate sinus ostia. An extensive literature review reveals that balloon catheters have an impressive safety profile and seem to be an effective tool for ostial dilatation. These tools are particularly effective in frontal recess dilatation and have great potential for office use under local anesthesia.Balloon Dilatation of the Paranasal Sinuses: A Tool in Sinus SurgeryEsther Kim, Jeffrey L. Cutler10.1016/j.otc.2009.07.006Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8847856http://www.oto.theclinics.com/article/PIIS0030666509000930/abstract?rss=yesSynechiae and ostial stenosis are common and troublesome complications following endoscopic sinus surgery. Many investigators have advocated the use of stents to minimize the risk of postoperative stenosis while others have found their use to be of no benefit. This article reviews the advantages and disadvantages of various stents used in sinus surgery, and discusses such innovations as drug-releasing stents.Stents and Drug-Eluting StentsKaren A. Bednarski, Frederick A. Kuhn10.1016/j.otc.2009.07.001Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8857866http://www.oto.theclinics.com/article/PIIS0030666509001017/abstract?rss=yesChronic rhinosinusitis (CRS) is the single most common self-reported chronic health condition in the United States and is estimated to affect 16% of the adult population annually. Despite the prevalence of this disease, there still exists an incomplete understanding of CRS pathophysiology. In this review, the authors highlight technological advances in rhinology: real-time polymerase chain reaction, epithelial cell culture, flow cytometry, genomics/single-nucleotide polymorphism detection, microarrays, and genetic/nongenetic animal models of sinusitis. The purpose of this review is to describe these methodologies and their contributions toward achieving a better understanding of CRS.Technical Advances in Rhinologic Basic Science ResearchMurugappan Ramanathan, Justin H. Turner, Andrew P. Lane10.1016/j.otc.2009.07.008Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8867881http://www.oto.theclinics.com/article/PIIS0030666509001364/abstract?rss=yesNeuroendoscopic surgery encompasses minimally invasive approaches to the skull base using endoscopic techniques. There are unique technologic challenges with endoscopic endonasal skull base surgery, such as a limited working space, difficulty in visualization and identification of neurovascular structures and removal of tissue, hemostasis, and dural reconstruction. Technologic advances that have enabled this surgery include specialized operating suites, neurophysiologic monitoring, imaging and visualization technologies, dissection instrumentation, hemostatic materials, and reconstructive materials. Advances in each of these areas and the needs and challenges of the future of neuroendoscopic surgery are discussed.Technologic Innovations in Neuroendoscopic SurgeryCarl H. Snyderman, Ricardo L. Carrau, Daniel M. Prevedello, Paul Gardner, Amin B. Kassam10.1016/j.otc.2009.08.019Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8883890http://www.oto.theclinics.com/article/PIIS0030666509001157/abstract?rss=yesSurgical simulation technology has advanced significantly in recent years. Medical-simulation validation studies have established that surgical skills honed using a simulator significantly improved trainee performance by decreasing operating times, improving efficiency, and decreasing errors. Integration of surgical simulation technologies into the medical training and education system improves the quality of the graduating surgeon, reduces the time to proficiency, and improves overall patient safety. This article discusses the current state of medical-simulator technology research, development, and use. It points to growing support from the surgical governing and regulation agencies; and predicts that medical students and surgical residents will be able, and mandated, to develop procedural skills in a life-like and no-risk environment.Virtual Simulation in the Surgical WorldMarc Gibber, Rachel Kaye, Marvin P. Fried10.1016/j.otc.2009.07.011Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8891900http://www.oto.theclinics.com/article/PIIS0030666509000942/abstract?rss=yesAs the scope of transnasal cranial-base surgery expands, reconstruction of the complex residual defects remains a challenge. Laser welding is a novel technology that can be performed endoscopically and offers the potential of producing instantaneous, watertight repairs using a chromophore-doped biologic solder.Cranial-Base Repair Using Endoscopic Laser WeldingBenjamin S. Bleier, James N. Palmer10.1016/j.otc.2009.07.002Otolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8901906http://www.oto.theclinics.com/article/PIIS003066650900156X/abstract?rss=yesIndex10.1016/S0030-6665(09)00156-XOtolaryngologic Clinics of North America 42, 5 (2009)2009-10-01Otolaryngologic Clinics of North America2009-10-01425S0030-6665(09)X0005-8907913