xRead - Nasal Obstruction (September 2024) Full Articles

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critical neurovascular structures, nonspecific signs and symptoms, and common presentation at an advanced stage, sinonasal tumors pose unique challenges for even the most experienced clinical teams. Nevertheless, the subfield of “sinonasal oncology” has grown rapidly over the past decade as our understanding of this diverse and heterogeneous group of diseases has improved. While much of the literature on sinonasal tumors in otolaryngology has been limited to retrospective, single institutional reports, there have been recent efforts to study this topic in a multi-institutional fashion. Several excel lent textbooks by world experts have been written about this topic. 11–13 Only recently have there been more con certed efforts to study this topic in a multi-institutional fashion. 14–16 The only other major collaborative project on sinonasal tumors involving international experts was the EPOS document on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses and Skull Base published in 2010. 6 Just as comprehensive care of the sinonasal tumor patient often involves a multidisciplinary team, the spirit of the ICSNT is to engage the expertise and experiences of a wide number of specialists spanning multiple disci plines (otolaryngology including rhinology and head and neck surgery, medical oncology, radiation oncology, neu rosurgery, pathology, and radiology) in order to provide a state-of-the-art, up-to-date summation of the current LOE regarding diagnosis, treatment, and prognostication of sinonasal neoplasms. The individual sections were com posed by authorship “teams,” simulating the teams-based environment of sinonasal tumor care, encompassing mem bers of institutional clinical, consortium, and/or research collaborations. The document is organized based on four major sections and is largely histopathology driven. The content is complementary to that presented in ICSB 2019 and serves as an update to the celebrated EPOS 2010 doc ument. Importantly, the ICSNT represents a summary of the evidence and does not serve as clinical guidelines or represent “standard of care.” Instead, it is intended to be a tool for clinicians to utilize evidence-based medicine in developing clinical decisions for patients. Given the rarity of each individual condition and the focus on histopathology-driven sections, the overall evi dence level of each section is variable, with some sections largely dictated by randomized controlled trials, while oth ers are limited to small case series. Based on this variability, the editorial team has attempted to select the best and most informative format by which to present each condi tion. One major windfall of this document is the valuable opportunity for otolaryngologists to learn from medical and radiation oncology colleagues who have driven the field forward in a parallel and complementary direction,

where the LOE is greatly elevated by the use of creative and thoughtful clinical trials. In conclusion, the ICSNT represents an effort toward advancing our field’s understanding of sinonasal tumor management principles. Just as comprehensive care of the sinonasal tumor patient often involves a multidisciplinary team, by engaging the expertise and experiences of a wide range of specialists, it aims to provide a valuable resource for clinicians seeking to develop individualized workup and treatment plans for their patients. Furthermore, the ICSNT offers a valuable opportunity for otolaryngologists to learn from colleagues in other specialties and to leverage evidence-based medicine in developing the best possible outcomes for their patients. Similar to prior ICAR documents, the main objective of the ICSNT document was to focus on the current LOE within the available literature, as opposed to expert opinion or experiential accounts, for the core topics facing the field of sinonasal tumors. 1–5 Also similar across other ICAR projects, the methodology for developing evidence-based recommendations was adapted from Rudmik and Smith. 7 Sinonasal tumors is an extremely broad topic, spanning multiple disciplines, and with ever evolving evidence being generated across simultaneous fronts. The initial topic out line was developed by the senior editor (JNP), the primary editor (ECK), chief associate editor (EWW), and the asso ciate editors (NDA, DMB, NRL, SYS, MBW) and aimed to classify all topics into four major topic areas: (1) General Principles; (2) Benign Lesions and Neoplasms; (3) Malig nant Neoplasms; and (4) Morbidity, Quality of Life, and Surveillance. Within each major topic area, subtopics were developed based on well-established oncologic principles as applied to sinonasal tumors and a histopathology-driven approach based on the World Health Organization (WHO) classification, as befitting of such a diverse set of diseases with individual biologic behaviors, treatment options, and outcomes. 17 The list of topics was also carefully reviewed to avoid significant overlap with topics covered in ICSB given recent summation of the evidence, and the ICSNT was designed to cross reference the ICSB in areas with common ground. 5 Some overlapping sections of particular relevance (e.g., ONB, SNEC) were updated with the most recent literature from the prior ICSB in order to reflect crit ical new work in these areas. This full outline of 48 sections was then reviewed by the editorial staff, consulted with the editorial leadership of International Forum of Allergy III METHODS A Topic development