Anthony Pagano

Consequences of Evolution: Is Rhinosinusitis, Like Otitis Media, a Unique Disease of Humans?

We hypothesize that if otitis media is most likely primarily a human disease due to consequences of evolution, rhinosinusitis may also be limited to humans for similar reasons. If otitis media, with its associated hearing loss, occurred in animals in the wild, they probably would have been culled out by predation. Similarly, if rhinosinusitis occurred regularly in animals, they likely would have suffered from severely decreased olfactory abilities, crucial for predator avoidance, and presumably would likewise have been selected against evolutionarily. Thus, both otitis media and rhinosinusitis—common conditions particularly in infants and young children—appear to be essentially human conditions. Their manifestation in our species is likely due to our unique evolutionary trajectory and may be a consequence of adaptations, including adaptations to bipedalism and speech, loss of prognathism, and immunologic and environmental factors.

Cranial indicators identified for peak incidence of otitis media

Acute otitis media (AOM) is one of the most common pediatric conditions worldwide. Peak age of occurrence for AOM has been identified within the first postnatal year and it remains frequent until approximately six postnatal years. Morphological differences between adults and infants in the cartilaginous Eustachian tube (CET) and associated structures may be responsible for development of this disease yet few have investigated normal growth trajectories. We tested hypotheses on coincidence of skeletal growth changes and known ages of peak AOM occurrence. Growth was divided into five dental eruption stages ranging from edentulous neonates (Stage 1) to adults with erupted third maxillary molars (Stage 5). A total of 32 three-dimensional landmarks were used and Generalized Procrustes Analysis was performed. Next, we performed principal components analysis and calculated univariate measures. It was found that growth change in Stage 1 was the most rapid and comprised the largest amount of overall growth in upper respiratory tract proportions (where time is represented by the natural logarithmic transformation of centroid size). The analysis of univariate measures showed that Stage 1 humans did indeed possess the relatively shortest and most horizontally oriented CETs with the greatest amount of growth change occurring at the transition to Stage 2 (eruption of deciduous dentition at five postnatal months, commencing peak AOM incidence) and ceasing by Stage 3 (approximately six postnatal years). Skeletal indicators appear related to peak ages of AOM incidence and may contribute to understanding of a nearly ubiquitous human disease. Anat Rec, 2017.

Anatomy of the Nose and Paranasal Sinuses

The study of paranasal sinus diseases spans a 2000-year history from the earliest known investigators to the present. After an exhaustive historical review of the classification for each sinus, an operational definition of the anatomical status of the paranasal sinus system is presented from a developmental perspective. A comprehensive examination of nomenclature is undertaken to clarify discrepancies and vagaries in anatomical terminology, which have been a major source of confusion among those studying or operating upon the nasal complex – nose and paranasal sinuses. Primary original sources of nomenclature were consulted to clarify persistent confusions encountered in the literature, which will permit better communication in addition to eliminating redundant terminology. Morphological entities such as the agger nasi versus agger nasi cells, frontal cell, frontal recess, lateral recess, ethmoid infundibulum, hiatus semilunaris, “nasofrontal duct,” and nasolacrimal duct are examined from an embryologic, comparative anatomical, and evolutionary frame of reference in order to identify their importance in sinus disease processes. Multiple approaches are used to describe the anatomy of the nasal complex utilizing the diverse backgrounds of the authors, who are comparative evolutionary anatomists, radiologist, and ENT surgeons from France and the USA with a combined clinical experience of 120 years of surgical practice. Methods used for this chapter include CT and endoscopic nasal imaging of living humans, examination of dry cranial material, fresh tissue anatomical dissections, and three-dimensional volume-rendering methods that allow for digitization of spaces within the nasal complex for graphical examination. Given the great complexity and extreme variability of the paranasal sinus system, otolaryngology is arguably among the most challenging of surgical fields. Indeed, when afflicted with a viral or bacterial infection, or presenting with one of many types of carcinomas, their formidable clinical manifestations challenge the depth of the ENT surgeon’s knowledge and experience. As such, a dizzying array of anatomical terms has been applied to these densely clustered, disease-prone spaces and their associated structures. It is thus the charge of the otolaryngologist to master the anatomy of the paranasal sinuses and greater nasal complex, which clinically may be considered the last frontier in craniofacial biology.