AN OVERVIEW OF THE SPECIALTY

Rhinology is a subspecialty of otolaryngology that focuses on pathology of the sinonasal cavity and the skull base. The origins of Rhinology date back to the 18th and 19th centuries with the development and evolution of nasal septal surgery followed by the introduction of open techniques to address infections of the paranasal sinuses. Sporadic forays into less invasive intranasal surgery were fraught with high morbidity and even mortality.

The watershed moment in the history of our field was the introduction of the rigid endoscope in the 1950s by the English physicist, Harold Hopkins. By using glass rods held in perfect alignment within the endoscope and relying on fiberoptic technology to transmit light, image quality was dramatically improved. Resolution of fine detail was possible, colors were accurately rendered and, critically, the size of the endoscope was reduced to a few millimeters. This technology, and the concurrent improvement in imaging of the paranasal sinuses and skull base, led to the rapid development of endoscopic surgical technique over the past thirty years.

The modern endoscopic era, coupled with a better understanding of sinonasal physiology and anatomy, has broadened the scope of rhinologic practice dramatically. The modern day rhinologist treats inflammation and infection of the paranasal sinuses, significantly improving quality of life for these patients. Cerebrospinal fluid leaks, which were traditionally treated by neurosurgeons through a craniotomy, can now be repaired by rhinologists using endoscopic techniques. Malignant tumors of the sinonasal cavities and anterior skull base, although occasionally addressed through open surgery, can increasingly be tackled using endoscopic “expanded endonasal approaches”, significantly reducing the morbidity of surgery without compromising oncologic outcomes. The boundaries of what can be achieved with an endoscope continue to be pushed by rhinologists around the world with recent developments in endoscopic intraorbital surgery and transnasal access to the lateral skull base. Rhinologists, particularly those in tertiary care academic environments, work closely with other disciplines such as ophthalmology, neurosurgery, head and neck surgery, and medical/radiation oncology.

The field of Rhinology is continually evolving. By interfacing with industry, rhinologists have been at the forefront of the introduction of new technology in otolaryngology. State-of-the-art biomaterials that enhance healing, control bleeding, or suppress inflammation through the local delivery of steroids are now widely used by rhinologists. Endoscopes with adjustable viewing angles, powered instrumentation, and lasers facilitate safe and efficacious surgery. The opportunity to be involved in the design and testing of these new technologies is an exciting aspect of Rhinology. Our understanding of inflammatory sinus disease continues to expand through research and, yet, the mechanisms underlying the development of chronic rhinosinusitis remain incompletely understood and ripe for further investigation. As a rhinologist, you have the opportunity to contribute to a rapidly growing field that is, in many ways, still in its infancy.

Fellowships in rhinology are typically one year in length although two year fellowships that augment clinical training with a robust research component are available. There is no subspecialty board certification in Rhinology. Fellowships take place in either a private practice or academic environment. The content of these fellowships is dictated by the respective fellowship director and, as such, the content of each fellowship is not identical. Indeed, each fellowship offers a different mix of inflammatory and skull base training. For example, the majority of endoscopic skull base surgical training takes place in academic centers. An excellent place to obtain a summary of each fellowship is the online fellowship directory maintained by the American Rhinologic Society (ARS). Of note, the ARS does not regulate the duration or content of individual fellowships, but sponsors and enforces the rules of the fellowship match. The match itself is coordinated through the SF Match Program. The application process begins in the fourth year of Otolaryngology residency training.

If a fellowship in Rhinology is of interest to you, consider identifying a mentor as early as is feasible during residency to begin coordinating a strategy that will lead to a successful match. Fortunately, rhinologists congregate throughout the course of the year and can be found at the ARS Annual Meeting which immediately precedes the AAO-HNS Annual Meeting in September, the Combined Otolaryngology Spring Meeting (COSM), the North American Skull Base Society Annual Meeting, and the ARS Summer Sinus Symposium. These are wonderful venues to present research, to gain insight into the state-of-the-art, and to meet directly with fellowship directors.

The future of Rhinology is very bright and I hope you choose to become a part of our ever expanding field! Good luck!

Waleed M. Abuzeid, MD

Medical School: University College London, United Kingdom

Research Fellowship: University of Pennsylvania

Residency: University of Michigan

Fellowship: Stanford University

Current Location: Albert Einstein College of Medicine

Contact Dr. Abuzeid