Advancing Rhinology Through Research

Rhinology is a field with many unknowns. We are constantly striving to increase our knowledge and understanding. The drive to not only to comprehend, but also apply our knowledge toward improving clinical care is precisely what drew me to rhinology. The sinonasal field is ripe for study, with many areas in need of better clinical and pathophysiologic understanding to further development of robust clinical care pathways and targeted treatments. As rhinologists, we have the opportunity to make a huge impact on the care of our patients by advancing knowledge in the field. This principal is embodied in the panel of outstanding research featured in this journal. The body of work in this issue not only explores a wide array of sinonasal diseases, but also demonstrates the impressive breadth of techniques rhinologists are employing to further the field. Specifically, you will find engaging articles that share important knowledge advances across a breath of diseases including chronic rhinosinusitis (CRS), sinonasal and skull base tumors, acute invasive fungal sinusitis (AIFS), allergic rhinitis (AR), dry nose, dacrocystitis, SARS-CoV-2, epistaxis, and nasal obstruction. Additionally, you will see research approaches that span the gamut from database reviews, case series, and cohort studies examining clinical outcomes to RNA sequencing and evaluation of cytokine profiles to characterize differences in sinonasal disease susceptibility and treatment response. As a group, the research presented in this issue gives us an exceptional opportunity to see how many researchers are striving to advance the rhinology field and facilitate opportunities to make a difference in clinical care. A particular opportunity to advance the field lies within improving our limited understanding of how sociodemographic factors impact sinonasal disease and treatment response. In this issue, Randhawa et al. used the National Inpatient Sample to evaluate the association of race and ethnicity with adverse outcomes in hospitalized patients who had procedural epistaxis treatment. In this study of over 83,000 cases of procedural epistaxis treatment, Black and Hispanic patients were more likely to have urinary or renal complications, prolonged length of hospital stay, and higher overall charges as compared to their White nonHispanic counterparts. While this database study cannot elucidate the etiology of these disparities in care outcomes, it does provide important fodder for future more granular research. The importance of understanding how and when to employ a more granular methodology has become essential as rhinologists wrestle with the mutli-factorial heterogeneity of CRS disease. Utilizing a precision medicine approach to elucidate CRS pathogenesis and pathophysiologic treatment response is an important way that we approach disease complexity. The current issue contains several articles on CRS with nasal polyps (CRSwNP), each taking a different precision medicine research approach. Tsiouma et al. evaluates the potential contributions of different genes in the pathogenesis of CRSwNP. Kato et al. uses quantitative immunohistochemical analysis to evaluate clinicopathologic differences among different disease severity categories within the eosinophilic subtype of CRSwNP. Finally, Matsuyama et al. examine the pathophysiologic impact of dupilumab on circulating T-cell subset and innate immune cells. David et al. also took a precision medicine approach in their study of AIFS. They evaluated differential gene expression in the sinonasal mucosa of AIFS and control subjects. This work located several transcriptional differences between AIFS patients and controls. The reader can clearly see how this information, once verified and further investigated, has Editorial