Book Review

Diseases of the Sinuses: A comprehensive textbook of diagnosis and treatment

N Engl J Med 1996; 334:1614-1615June 13, 1996

Article

Diseases of the Sinuses: A comprehensive textbook of diagnosis and treatment
Edited by M. Eric Gershwin and Gary A. Incaudo. 589 pp., illustrated. Totowa, N.J., Humana Press, 1996. $150. ISBN: 0-89603-317-1

Although the function of the paranasal sinuses remains unknown, we know that they are susceptible to disease and a major cause of misery for patients. The influence of sinusitis on health is only beginning to be recognized. It is estimated that 30 million Americans suffer from sinus disease, missing 200 million days of work each year and spending $5 billion on medications, doctors' visits, imaging studies, and surgery each year. Though these estimates can be challenged, the enormous scope of the problem is apparent.

Eighty-seven percent of patients with sinusitis are seen by primary care physicians, with the remainder consulting otolaryngologists, allergists, infectious-disease specialists, pulmonologists, and immunologists. Thus, a basic understanding of sinusitis is essential for practicing physicians.

An important issue is the definition of sinusitis. Acute sinusitis, frequently a bacterial complication of a viral upper respiratory tract infection, is relatively easy to define. In contrast, the definition of chronic sinusitis defies consensus and is constantly changing. Most recently it was defined as an illness whose symptoms lasted longer than 12 weeks despite medical treatment, in which an imaging study showed mucosal thickening within the sinuses. In this definition, the symptoms and the treatment were also poorly defined. The editors of this book cleverly chose the title Diseases of the Sinuses. This title, while including all problems affecting the sinuses, even the rare tumors, circumvents the restraints of a definition of sinusitis when its pathophysiology and natural history are not well defined.

The technological advances of endoscopy and coronal computed tomographic scanning in the 1980s renewed interest in sinusitis. The improved ability to visualize the sinuses and their openings into the nose introduced new options for management. The aim of this textbook, the editors state, is “to bring to the practicing physician many of the newer concepts that can be applied in a beneficial way to patients.” By obtaining contributions from 46 European and American specialists, the editors have attempted to create a comprehensive textbook with broad appeal. To provide the broadest scope possible, they have permitted the chapters to overlap in subject matter. Although this approach permits divergent views to be represented — for example, in chapters 3 and 19 — it greatly lengthens the book. Some chapters are focused and excellent (such as chapter 5), whereas others take an enormous number of pages to review the authors' studies and ignore relevant epidemiologic studies (such as chapter 6). Other chapters are excellent but seem irrelevant. For example, in Philip Cole and Renato Roithmann's excellent chapter on rhinomanometry, the measurement of nasal air flow, the technique's only link to sinus disease is that sinus disease can affect nasal air flow.

The chief problem with this textbook is the quality of the editing: the talent of the authors is not united into a whole greater than the sum of the parts. Figures are not fully described; for example, Figure 20 in chapter 1, which presents normal nasal anatomy, shows a large septal perforation, but the text and legend do not comment on this finding. The grouping of the chapters in the table of contents does not aid the reader. Rhinomanometry and endoscopy are grouped in the section on clinical disease, whereas surgery is given its own section. The index does not list dental problems, a frequent cause of sinusitis in adults. Finally, how would one use this textbook? Reading it in one sitting would be a formidable task. Using it as a reference is difficult because opinions may vary from chapter to chapter. The surgical sections are excellent, but they provide insufficient detail for surgeons and probably too much detail for generalists. In the preface, the editors seek advice for the next edition. I would suggest that next time they focus on one audience, have all authors write concisely about their topics, and organize the material so it is easy to find.

Robert M. Naclerio, M.D.
University of Chicago Pritzker School of Medicine, Chicago, IL 60637