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establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg 2004;131:S1–S62. 4. Marple BF, Stankiewicz JA, Baroody FM, Chow JM, Conley DB, Corey JP, Ferguson BJ, Kern RC, Lusk RP, Naclerio RM, et al. Diagnosis and management of chronic rhinosinusitis in adults. Postgrad Med 2009;121:121–139. 5. Benninger MS, Anon J, Mabry RL. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg 1997;117:S41–S49. 6. Lund VJ. Maximal medical therapy for chronic rhinosinusitis. Otolaryngol Clin North Am 2005;38:1301–1310. 7. Grzincich G, Capra L, Cammarata MG, Correlation between computed tomography scores and symptomatic improvement after endoscopic sinus surgery. Laryngoscope 2005;115:466–469. 94. Levine HL. Functional endoscopic sinus sugery: evaluation, surgery, and follow-up of 250 patients. Laryngoscope 1990;100:79–84. 95. Kennedy DW, Bolger WE, Zinreich SJ. Diseases of the sinuses. 1st ed. Hamilton, Ontario: BC Decker Inc; 2001. 140 PROCEEDINGS OF THE AMERIC Chronic rhinosinusitis (CRS) is one of the most common chronic medical conditions worldwide, affecting all age groups. Its estimated incidence is 12.3% in the USA, 10.9% in Europe and 13% in China [1,2,3]. CRS is also a condition leading to a significant decrease in the quality of life of patients [4]. It has been demonstrated that CRS had a greater effect on social function that ischemic heart disease or chronic heart failure [5]. Furthermore, it is documented that CRS is also an economic burden for society. It is estimated that in the USA, the direct costs associated with CRS are approximately USD 10–13 billion per year [6]. Moreover, indirect costs of CRS are due to missed workdays, absenteeism and productivity loss, and are estimated to exceed USD 20 billion per year in the USA [7]. It is well acknowledged that the Journal of Clinical Medicine (JCM) publishes well-performed basic research and well-conducted clinical studies. As a result of a demanding peer-review process and careful selection process, relevant articles to an extensive readership are issued regularly in the journal. The special issue of JCM, entitled Prevention, Diagnosis and Management of Chronic Rhinosinusitis exemplifies the attempt to deliver high-quality topics relevant for both clinicians and researchers. Staphylococcus aureus is one of the bacteria commonly found in CRS patients, and S. aureus biofilms are frequently associated with recalcitrant or recurrent disease [8]. It has been demonstrated that S. aureus is able to penetrate the barrier of the columnar epithelium of the paranasal sinuses, thus enhancing the inflammatory process [9,10]. In this issue of JCM, Hu et al. [11] studied the effects of sub-inhibitory clindamycin and azithromycin on the production of S. aureus exoproteins and the ensuing effect of decreasing inflammation, epithelial barrier disruption and invasion. The study was performed on primary human nasal epithelial cells (HNECs) from patients undertaking endoscopic skull base techniques without clinical or radiological evidence of CRS. This study emphasizes that S. aureus exoproteins induce severe cytotoxicity and interrupt the mucosal barrier, upsetting its function and decreasing inflammation.The authors demonstrated that sub-inhibitory clindamycin successfully blocked S. aureus exoprotein production, subsequently preventing toxicity, reversing the damaging effects on the mucosal barrier architecture and function and modulating its pro-inflammatory features. To a lesser degree, sub-inhibitory azithromycin had comparable effects on these actions. Moreover, the authors demonstrated that subinhibitory clindamycin or azithromycin was able to considerably decrease
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