KEYSTONE, COLO. – Surgical treatment of chronic rhinosinusitis has come a long way from the earlier "grab and tear" days, but referring physicians need to understand that not all otolaryngologists are providing state-of-the-art care.
"I am critical of some of my colleagues," Dr. Todd T. Kingdom said at a meeting on allergy and respiratory diseases sponsored by National Jewish Health.
"If I leave you with one message, it’s to set high expectations of your consultants in otolaryngology. You should find colleagues who are interested in sinus disease, who are committed to it, and who are excellent," added Dr. Kingdom, professor and vice chairman of the department of otolaryngology, head and neck surgery, at the University of Colorado, Denver, and immediate past president of the American Rhinologic Society.
Dr. Todd Kingdom
One fine source is the pool of graduates of U.S. subspecialty surgical rhinology fellowship programs. Each year, 30 surgeons complete one of these fellowships, he said.
Technical innovations over the past 15 years have driven major advances in endoscopic sinus surgery. Powered microdebriders are used to precisely and efficiently remove hyperplastic mucosal disease and restore mucociliary clearance. Mucosal preservation is now a central tenet. Forward-thinking surgeons place a priority on creating exposure for delivery of topical medications. The procedures are routinely done on an outpatient basis, and they are less invasive than in former times. The outcomes are better, too, with this modern patient-centered, symptom-based approach.
"We have efficient ways now to take care of very severe disease atraumatically," Dr. Kingdom explained.
He emphasized that postoperative care is critical to successful sinus surgery outcomes. "My biggest criticism of my colleagues in otolaryngology is that many of them cut and go. There isn’t an emphasis on postoperative care," he said. "That’s a clear, clear deficiency in our approach.
"My postop schedule is to see patients at 1, 3, and 6 weeks and 3 and 6 months after surgery – and that’s if they’re doing perfectly. My point is you should have your otolaryngologist really fussing over these people. It’s not, ‘Well, it’s been a couple of weeks, you look fine, you can go back to your allergist now, I’ll see you later.’ It shouldn’t be that way," Dr. Kingdom said.
He reported having no financial conflicts of interest.