International Forum of Allergy & Rhinology | 2019
Rhinologic and skull‐base surgery: an evidence‐based reevaluation
Abstract
An article previously published in the International Forum of Allergy and Rhinology (IFAR) raised the question as to whether the conservative management of spontaneous cerebrospinal fluid (CSF) leaks with acetazolamide presented a viable option to surgery.1 That study created significant concern with many experienced rhinologists. The findings appeared to be contrary to a prior publication that had looked at the long-term outcome of patients with traumatic CSF rhinorrhea, and had demonstrated a significant incidence of meningitis in the absence of surgical closure.2 An additional concern with the more recent article1 was that conventional teaching has suggested that a steady flow of CSF would actually decrease the incidence of meningitis as a result of mechanical cleansing, and that when CSF flow decreases, the incidence of meningitis could rise. In this issue of the Journal, a multiinstitutional study by Allensworth et al.3 shows conclusively that the incidence of intracranial complications is markedly reduced with surgical closure (from 22.7 per 100 patient years to 0.8 per person-years). The authors also found an inverse relationship between body mass index (BMI) and the risk of complications, a finding which they interpret as being supportive of the conventional wisdom that low-flow CSF leaks are associated with a higher risk of complications. Finally, they found that the risk of complications was higher when leaks were in the frontal or lateral sphenoid sinuses. Chronic rhinosinusitis (CRS) often appears to be precipitated by a viral infection “that never got better.” Basharat et al.4 report on an extensive review of the role of rhinovirus (RV) infections, and their role in predisposing to airway inflammation and CRS. The study also evaluates the data regarding therapies for RV and potential future targets. The comprehensive review provides a useful reference source for those working in this field. Several studies in this issue of IFAR evaluate different aspects of the symptoms associated with CRS and the role of surgical intervention. Yancey et al.5 evaluate the effects of age on symptom scores. After dividing the patients into 3 different age groups, the authors showed that the middleaged patient group had the highest symptom burden, and