Book Review

Sinusitis: Pathophysiology and Treatment

N Engl J Med 1994; 330:1397May 12, 1994

Article

Sinusitis: Pathophysiology and Treatment
(Clinical Allergy and Immunology [1].) Edited by Howard M. Druce. 337 pp., illustrated. New York, Marcel Dekker, 1993. $135. ISBN: 0-8247-8845-1

Sinusitis is a term that physicians and patients often use, though they have grave difficulty in defining it precisely. Nevertheless, we know it is a common disorder with manifestations that vary from acute illness after a viral upper respiratory tract infection to an unremitting chronic ailment associated with a genetic abnormality in the epithelium of patients with cystic fibrosis. It can even present as a life-threatening intracranial infection. Sinusitis is the most common chronic health problem described by Americans; it affects all age groups, including 17 percent of people over the age of 65 years. Patients make millions of office visits each year and spend billions of dollars on medical and surgical treatment for this condition.

Sinusitis: Pathophysiology and Treatment is intended to educate physicians about our current state of knowledge. It is the first in a projected series of books on clinical allergy and immunology whose stated purpose is to fill the gap between review articles in journals and large, comprehensive textbooks. Current textbooks devoted exclusively to sinusitis focus on surgical techniques. The target audience for this book is clinicians and scientists interested in the topic.

The authors represent the many disciplines involved in the care of patients with sinusitis: otolaryngologists, allergists, internists, infectious-disease specialists, epidemiologists, representatives of the pharmaceutical industry, pediatricians, academicians, private practitioners, and radiologists. The view of the family practitioner or another generalist appears to be the only clinical perspective missing. In gathering such a mixed group to prepare a textbook, one not only gains the strength of diverse opinions but also encounters some of the usual problems related to multiauthored works.

This book accomplishes its purpose. It brings physicians up to date on sinusitis. The anatomy is clearly described. The discussion of pathophysiology, though quite good, is limited by our understanding of the disease process. The sections on microbiology, radiology, and medical and surgical management in adults and children provide solid information and allow the reader to discern where opinions diverge. The chapter on complications of sinusitis provides the requisite balance, as do those on its relation to asthma, AIDS, fungal disease, aspirin sensitivity, cystic fibrosis, and immunodeficiency disorders. These chapters run the gamut from an outstanding dissertation on cystic fibrosis to a mediocre one entitled “Sinusitis and Related Tissues.”

Stronger editing to reduce overlap would have been helpful for the person planning to read this 300-page textbook from cover to cover. One strategy might be to read the first half in its entirety and then choose the chapters in the second half that relate to areas of particular interest. The conversion of color illustrations to black and white weakens the effect of the endoscopic views and diminishes the feeling of a state-of-the-art textbook. The absence of arrows undermines the educational value of the illustrations.

The biggest problem with this textbook lies in the limits of our understanding of sinusitis. How can such a common disease have been ignored by the scientific community for so long? When will basic scientists join with clinicians to produce the studies that will direct our therapeutic approach to this multifaceted problem? When that happens, we can stop discussing the “chewing of horseradish roots” as an adjuvant treatment for sinusitis and can stop begging for answers to practical clinical problems, such as how long to treat with antibiotics.

Robert M. Naclerio, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD 21287