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Contemporary Rhinology:
Science and Practice
Andrew C. Swift
Sean Carrie
Christopher de Souza
Editors
123

Contemporary Rhinology: Science
and Practice

Andrew C. Swift • Sean Carrie
https://t.me/medicina_free
Christopher deSouza
Editors
Contemporary
Rhinology: Science
and Practice

Editors
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Andrew C. Swift
Liverpool Head and Neck Centre
Liverpool University Hospitals
Foundation Trust
Liverpool, UK
Christopher deSouza
Department of Otolaryngology
Tata Memorial Hospital
Mumbai, Maharashtra, India
Sean Carrie
Otolaryngology
Freeman Hospital, Newcastle upon Tyne
Hospitals NHS Foundation Trust
Newcastle upon Tyne, UK
ISBN 978-3-031-28689-6 ISBN 978-3-031-28690-2 (eBook)
https://doi.org/10.1007/978-3-031-28690-2
© Editors 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword
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Since the 1980s, rhinology has genuinely experienced its “Golden Age” with
the advent of new diagnostic techniques, medical treatments, and surgical
approaches. This has been underpinned by an increasing understanding of the
anatomy, physiology, and pathophysiology of the respective conditions and
an appreciation of the interplay of the nose and sinuses with the lower respiratory tract and the rest of the body. Furthermore, rhinology has embraced the
application of an evidence-based approach with an exponential rise in randomized controlled trials and prospective cohorts, enabling individualized
precision medicine and surgery.
This book offers not only a contemporary approach to rhinology but also
one which is comprehensive. It covers both the scientic aspects of the speciality but also provides clear practical advice on clinical management in both
adults and children. It is, therefore, of use to a broad constituency of readers
and practitioners from the motivated medical student, through the ENT
trainee, interested primary care physician, to the general otorhinolaryngologist and tertiary care rhinologist. It is increasingly recognized that optimum
management of many rhinologic conditions, such as recalcitrant allergic rhinitis or chronic rhinosinusitis, sinonasal neoplasia, and rarities such as vasculitis and hereditary hemorrhagic telangiectasia, is ideally undertaken by
multidisciplinary teams that provide the widest range of expertise and greatest benet to patients and clinicians alike. Similar synergies exist at the sinoorbital interface and skull base. All of these topics are addressed in this book,
so there are also allergists, immunologists, pulmonologists, oncologists, ophthalmologists, neurosurgeons, gastroenterologists, and rheumatologists
among many others who would nd the contents of this book of value.
In commissioning this book, the editors have spread their net widely to
include an array of experts from many countries and subspeciality interests so
the advice represents a distillation of up-to-date information, irrespective of
the healthcare system.
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It is happenstance to be in the right place at the right time and that is certainly true for those of us with an interest in the nose and sinuses in recent
decades. However, one should recognize that it is more important to know
how to take advantage of being in the right place at the right time, and this
book facilitates that aspiration.
ProfessorValerieJ.Lund,CBE
Royal National Ear, Nose and Throat
and Eastman Dental Hospital, UCLH
London, UK
Foreword

Preface
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A complete understanding of the nose, paranasal sinuses, and the respiratory
tract is best regarded as a work in progress and a subject that is constantly
developing. Whilst the ongoing pandemic was a major setback, it also provided opportunities for discovery and became an important landmark in rhinological and olfactory knowledge. We have used this to our advantage and
included the newly learnt knowledge about the SARS-CoV-2 coronavirus
within this book.
Medical technology and computing have continued to rapidly improve,
enabling high-quality imaging and visualization of previously obscured
structures to be seen with outstanding clarity.
In parallel with this, our understanding of the basic science, the physiology, and medical disorders of the nasal and paranasal passages greatly
improved, facilitating better understanding of treatment strategies and modalities that led to better patient outcomes.
From the historical perspective, the eld of rhinology has gained much
scientic acclaim. In the 1970s and 1980s, studies on mucociliary ow, instigated by Professor Walter Messerklinger and aided by Heinz Stammberger,
underpinned a novel concept of surgical techniques for the nose and sinuses,
leading to the term “Functional Endoscopic Sinus Surgery (FESS).” This
term has stood the test of time but is now used loosely to describe any minimally invasive sinus surgery, even when extensive resection is performed.
The year 2004 marks a landmark event, when Linda Buck and Richard
Axel were awarded the Nobel Prize for their work on olfaction. The SARSCoV- 2 virus subsequently led to a huge expansion in olfactory research and a
whole wealth of new information.
The heightened prole of rhinology has led to a whole new generation of
endoscopic sinus surgeons, who have been at the forefront of a dramatic
expansion in the scale and scope of various endoscopic techniques. Surgical
procedures that were once considered “challenging and fraught with danger”
are now rendered as routine operations. This advance has been achieved by
certain more serious procedures being focused in specialist centers dedicated
to controlling risk and minimizing complications, leading to improved patient
outcomes.
The net effect of the above changes has been to place rhinology at the
forefront of surgery. This incredible journey began with the development of
the rigid endoscope, alongside dedicated CT and MRI imaging techniques.
We can only wonder as to what other advancements lie on the horizon, how
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these will affect our current management protocols and the outcomes for the
wide range of rhinological disorders.
We, the editors, are immensely grateful to our contributory authors, who
are all experts within their elds. Each author has produced a state-of-the-art,
extremely valuable contribution, each taking many hours of planning,
research, development, and writing. We thank each and every one of the
authors for their commitment and support.
We hope the readers of this book will be lled with awe and wonder at the
extreme complexity of the nose and the paranasal sinuses. We also hope that
this will lead to an unending desire to study this fascinating, complex, and
specialist organ that continues to surprise us all. We would strongly encourage our younger colleagues to develop an interest into the art and science of
the diseases of the nose, and hope that this book will be the catalyst for this
dedicated journey.
Liverpool, UK AndrewC.Swift
Newcastle, UK SeanCarrie
Mumbai, Maharashtra, India Christopherde Souza
Preface

Contents
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Section I The Basic Science of Rhinology: Understanding
the Nose and Sinuses
1 Embryology of the Nose and Paranasal Sinuses . . . . . . . . . . . . . 3
Daniel W. Scholeld and Neil Cheng-Wen Tan
2 Applied Anatomy of the Nose and Sinuses . . . . . . . . . . . . . . . . . . 13
Rajiv K. Bhalla
3 Physiology: Nasal Airflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Giancarlo Ottaviano
4 Physiology of the Nose and Paranasal Sinuses:
Mucociliary Clearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Mikkel C. Alanin and Christian von Buchwald
5 Immunology of the Nose and Paranasal Sinuses . . . . . . . . . . . . . 51
Stephen Ball and Richard Douglas
6 Allergy and the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Cecilia Ahlström Emanuelsson and Nick Makwana
7 Genetics and Disorders of the Nose and Sinuses . . . . . . . . . . . . . 81
Emily Anderson and Victoria McKay
8 The Current Concepts of Biofilms and Superantigens . . . . . . . . 91
Sarah Vreugde and Peter-John Wormald
9 Bacteria, Viruses and Fungi in Healthy
and Diseased Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Tary Yin and Raymond Kim
10 Sleep Disorders and the Nose: What Is the Evidence Base? . . . . 117
Thomas Verse and Stefan Müller
11 The Nose and the Effects of SARS- CoV- 2 Pandemic . . . . . . . . . . 127
Carl Philpott
Section II The Assessment of the Nose and Sinuses
12 Clinical Assessment of the Nose and Olfaction . . . . . . . . . . . . . . . 141
Nirmal Kumar and John Rocke
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13 Outcome Metrics and Measurement Tools for Rhinological
Treatment Modalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Joanne Rimmer
14 Radiological Imaging in Rhinology . . . . . . . . . . . . . . . . . . . . . . . . 159
Andrew S. McQueen and Joanna K. Dixon
Section III Paediatric Sinonasal Disorders
15 Congenital Sinonasal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Grace C Khong and Raymond W. Clarke
16 Paediatric Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Peter George Deutsch and Ann-Louise McDermott
17 Paediatric Nasal Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Michelle Wyatt and Claire Frauenfelder
18 Paediatric Nasal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Claire Marie McLarnon
Section IV Inammatory Sinus Disorders
19 Non-allergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Wout Backaert and Laura Van Gerven
Contents
20 Allergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Quentin Gardiner
21 Current Scientific Understanding of Rhinosinusitis . . . . . . . . . . 267
Sietze Reitsma and Wytske J. Fokkens
22 New Innovations and Treatments
for Chronic Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Wytske J. Fokkens and Sietze Reitsma
23 Clinical Assessment and Management
of Acute Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Stephen R. Ell and Richard Wei Chern Gan
24 Clinical Assessment and Management of CRSsNP . . . . . . . . . . . 301
Sietze Reitsma
25 Clinical Assessment and Management of Chronic
Rhinosinusitis with Nasal Polyposis . . . . . . . . . . . . . . . . . . . . . . . 309
Claire Hopkins and Jo-Lyn McKenzie
26 Primary Atrophic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Isma Z. Iqbal
27 Fungal Sinus Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Christopher de Souza, Aishan Patil, Anish Patil,
and Rosemarie de Souza
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