By Dr Abdulmohsen Ebrahim Alterki
Most people are familiar with ear, nose, and throat (ENT) medicine as a single specialty. Few realize, however, that modern ENT now is called Otolaryngology, Head & Neck Surgery and it contains highly sophisticated subspecialties dedicated to very specific diseases and surgical techniques. Among the most rapidly evolving of these fields is rhinology, the branch focused on disorders of the nose and sinuses.
Today, Rhinologists manage conditions ranging from chronic sinusitis and nasal polyps to smell disorders, allergies, cerebrospinal fluid leaks, and even certain skull base diseases located only millimeters from the eyes and brain. Yet only a few decades ago, the field looked remarkably different.
Over the past thirty years, rhinology has undergone a transformation so profound that many younger physicians may find it difficult to imagine how these conditions were once treated. My own journey with this evolution began in 1996 when I joined the ENT Department at Al-Sabah Hospital in Kuwait. At the time, many traditional techniques were still part of routine clinical practice. Among them was the nasal snare, a simple mechanical instrument used to remove nasal polyps in patients suffering from chronic inflammatory sinus disease.
In 1997, I traveled to Canada for my five years residency training in ENT. During those years, I worked with the late Dr Cyril Isaac Woolf (1930–2012), one of the consultants during my residency. I still remember Friday afternoon clinics where multiple nasal snare procedures were performed for patients with severe nasal polyps. Patients often experienced temporary improvement in breathing, only to return months later when the polyps recurred. At the time, this represented standard care.
But medicine was changing rapidly. The late 1990s witnessed one of the most important technological breakthroughs in rhinology: computer-assisted image-guided navigation surgery. Before navigation systems existed, sinus surgery depended heavily on the surgeon’s anatomical expertise and interpretation of preoperative CT scans. Operating deep inside narrow sinus cavities near the orbit and skull base demanded extraordinary precision.
Navigation systems changed everything. For the first time, surgeons could track their instruments in real time during surgery using CT-based guidance, functioning almost like a GPS system inside the sinuses. The technology significantly improved surgical orientation and safety, particularly in complex cases involving the eyes or skull base.
I consider myself fortunate to have witnessed the early adoption of navigation surgery during my training years in Canada, as it gradually became integrated into rhinology practices worldwide throughout the late 1990s and early 2000s. The specialty continued advancing at remarkable speed. Endoscopic sinus surgery evolved with high definition cameras, angled telescopes, powered instruments, and increasingly refined minimally invasive techniques.
Procedures that once required external facial incisions could now often be performed entirely through the nostrils, resulting in faster recovery, less tissue disruption, and improved patient outcomes. In 2002, after my residency, I completed a one year fellowship in rhinology in Montreal, Canada before returning to Kuwait, where I continued witnessing the evolution of the specialty both internationally and locally.
Another milestone followed around 2005 with the introduction of balloon sinuplasty, a minimally invasive technique designed to dilate sinus drainage pathways while preserving normal tissue in carefully selected patients. Yet perhaps the most revolutionary chapter in modern rhinology arrived in 2019. That year, dupilumab (Dupixent) received FDA approval for chronic rhinosinusitis with nasal polyps, marking the beginning of the biologics era in rhinology.
For decades, treatment for severe nasal polyps relied primarily on repeated surgery and corticosteroids. Biologic therapies introduced an entirely different concept: targeting the specific inflammatory pathways responsible for the disease itself.
For many patients, these medications dramatically improved nasal obstruction, restored the sense of smell, reduced dependence on steroids, and lowered the need for repeated operations.
Smell dysfunction itself has also gained increasing medical attention in recent years, particularly after the COVID-19 pandemic highlighted how profoundly loss of smell can affect nutrition, safety, emotional well being, and overall quality of life. Looking back, it is remarkable to witness how rhinology evolved within a single professional generation, from outpatient nasal snares to precision surgery guided by computer navigation and advanced biologic therapies tailored to the immune system.
Few medical specialties have transformed so profoundly in such a relatively short period of time. Today, rhinology stands at the intersection of surgery, technology, and immunology, offering patients safer operations, better long term outcomes, and increasingly personalized care. And perhaps even more remarkably, the next chapter of rhinology may already be beginning.
NOTE: Dr Abdulmohsen Ebrahim Alterki is the Chairman of Otolaryngology, Head & Neck Surgery Faculty, Kuwait Board of Postgraduate Training Program, Kuwait Institute for Medical Specialization (KIMS), Ministry of Health, Kuwait.
