Clinical Challenges and Commentaries

Abstract

“So, that’s my most recent puzzling patient,” said Dr A. “What would you have done with him?” “I think I would have handled it the same way,” Dr B answered, “but it’s not an easy problem to work up or treat.” With a deep sigh, Dr A said, “You know, I often wish I had the time to really research these cases—to do the literature search, get the articles, and really sit down and figure out all the details.” Nodding, Dr B agreed, “Yeah, me too, but the time we’ll have time to do that will be the same time we retire. . . . ” Does this sound familiar? It’s a wish I have several times a week. Now, the ARCHIVES wants to help us busy practitioners make the best use of the time we have for education by providing clinically relevant information about specific patient problems. The new series, “Clinical Challenges in Otolaryngology,” is designed to do what we all wish we had time to do when we encounter a patient with a challenging diagnosis, or when we try to figure out the latest word on the best treatment for a common problem. Each Clinical Challenge will be written by an experienced practitioner about a very specific clinical topic. Each review starts out with a Hypothesis, such as “Antibiotic prophylaxis is the best treatment for recurrent acute otitis media.” This first review, by Michael Stewart from Baylor College of Medicine in Houston, discusses this hypothesis: “Partial resection of the middle turbinate during functional endoscopic sinus surgery decreases the incidence of synechia formation and enhances long-term antral patency.” The author of each discussion first succinctly describes the most current data supporting (Pro) this hypothesis, against (Con) this hypothesis, and then sums up the conclusions about the best day-to-day care of such patients in the Bottom Line. Each presentation is accompanied by 1 or 2 “Commentaries” by senior clinicians, pointing out their conclusions based on years of patient experience. Your input is needed! What are the clinical problems that most often trigger your desire for more literature research time? What topics would you like to see discussed? Please send topics or hypotheses (30 words or less), as well as suggestions for clinician-authors.