How I changed my practice in the last five years and what is likely to change in the next five years

The fast development of our field in the last decades has had significant impact on the way we practice our profession. This year my editorials will focus on the impact of these develop- ments on my own daily practice. When I started in otorhinolaryngology functional endoscopic sinus surgery was the new kid on the Block. We learned to operate as functional as possible. The primary goal of FESS was to restore normal ventilation and remove irreversibly changed mucosa. The concept was that by restoring proper ventilation the sinus would heal itself. In the past decades, we have more and more discovered that CRS and especially CRS with nasal polyps is a mucosal disease that needs intensive medical treat- ment if necessary combined with ESS. The concept of FESS has moved from improving ventilation to opening up sinus for local medical treatment. Local medical treatment has been shown to be more effective when it is able to enter the sinus. Although we do not have all data available yet, rinsing with saline in which local corticosteroids have been dissolved seems to be more effective than using nasal drops and certainly more effective than nasal spray