Reflecting on the Work of the Giants That Come Before You

“If I have seen further it is by standing on the shoulders of Giants”—Isaac Newton to Robert Hooke.

Considering the wealth of “Giants” within the field of Rhinology and Allergy it is an honor to be invited to be the Guest Editor of this issue of the American Journal of Rhinology and Allergy. Much as the pandemic has caused many to question their careers, relationships, and paths in life, it has also given us an opportunity to pause and consider how we practice our specialties—especially as an invisible enemy has revealed significant cracks in our healthcare delivery system. Uncovered were the tenuous nature of our manufacturing and supply chain infrastructure, the burnout and emotional distress caused by the unending onslaught of patients, the susceptibility of the medical establishment to political whims and societal pressures, and the dependence of the public on honest data reporting, just to name a few.

It has also, however, given us the opportunity to see how tremendous advances in science and technology can be applied at a startling pace to rapidly create diagnostics, medications, and how the worldwide sharing, mining, and analysis of data can provide insights that otherwise would have been impossible just a few years in the past.

It is with this latter lens that I hope we can look forward to appreciating the incredible advancements within our field over the past 3 to 4 decades, and the potential advancements of next 3 to 4.

In an attempt to review past efforts, Zocchi et al., describe long term outcomes of septal perforation repairs using a technique described by its senior author 10 years ago ¹ , and Ehmer et al., describe how a new technology may be useful in an already established technique for nerve ablation that provides treatment for recalcitrant rhinitis. ² Kim et al., examine the effect of low strength hypochlorous acid in the treatment of allergic rhinitis ³ , and Dor-Wojnarowska et al., examine the repeatability of peak nasal flow and its modulation by oxymetazoline. ⁴

Fiorenza et al., continue the long honored, but often forgotten, art of anatomical analysis through the interpretation of radiographic images ⁵ , and McKeon et al., return to the regularly lost art of simply speaking to their patients, as they analyze whether or not preoperative phone calls can actually improve outcomes and decrease questions after endoscopic sinus surgery. ⁶

It is incredible to think that over the past 30 years, the safety of general anesthesia has increased almost 60-fold, and Levi et al., examine whether pushing the age boundaries of elective anesthesia for endoscopic sinus surgery aligns with that trend—a point of importance for the large segment of our aging population. ⁷ It is also curious to see how comorbidities affect nonsurgical outcomes as Suh et al., examines BMI as it relates to histamine response ⁸ , and Amarbir et al., examine the functional comorbidity index and its relation to chronic rhinosinusitis. ⁹

Similarly incredible is the revolution biological therapies and immunomodulators have created in the treatment of sinusitis, asthma, and other ectopic diseases. One great limitation, acknowledged in the study by Damask et al., is our meagre understanding of which patients to target with which medications. ¹⁰ It is encouraging then, to see myriad researchers looking at the biomarkers ¹¹ (Carle et al.), histopathological changes ¹² (Ho et al.), and systemic responses to allergy immunotherapy ¹³ (Huo et al.), as we continue to improve our ability to specifically diagnose targetable areas in the immune system and their optimal effectors. It is also comforting to see continued interest in basic science research in the Allergy and Immunology realm, with Hara et al., and Takabayashi et al., examining cellular mechanisms in mucosal models.^14,15

Sinonasal malignancies continue to plague patients during the pandemic and Sharma et al., discuss the improvements in outcomes as endoscopic resections of sinonasal cancers have become more accepted as an appropriate treatment modality. ¹⁶ Meerwein et al., examine whether or not treatment of the nodal drainage basins of the sinonasal cavity affect treatment outcomes and survival ¹⁷ , and Wang et al., are examining heat shock proteins as a marker for Juvenile Nasopharyngeal Angiofibromas. ¹⁸

Olfactory dysfunction has taken a far more prominent place in the minds of North Americans as many afflicted with Covid-19 have experienced this directly. Roxbury et al., examine how chemosensory dysfunction affects nutrition and diet in US Adults ¹⁹ , and Kim et al., examine how urban particulate matter, increasing as pollution continues to increase in densely populated urban areas and as wildfires have affected air quality nationwide, affect the olfactory system. ²⁰

With the myriad trials and tribulations of the past 2 years, it is easy to ignore not only the progress we have made, but the advancements yet to come. I look forward to our readers taking a moment to pause and read not just AJRA, but the numerous academic publications which we are so lucky to have, and find a moment of separation from the hectic nature of our daily lives.

It is exciting not just to acknowledge the Giants that have come before us, but also to see the next generation of Giants flourish.

Take care and best wishes for 2022.