Amin R. Javer¹, Jin Ye Yeo²

¹Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada; ²ACR AME Publishing Company

Correspondence to: Jin Ye Yeo. ACR Editorial Office, AME Publishing Company. Email: acr@amegroups.com

Expert introduction

Prof. Amin R. Javer (Figure 1) completed his undergraduate education at Simon Fraser University in Burnaby, BC, earning a Bachelor of Science Degree in Molecular Biology achieving 1st class honors. Prof. Javer proceeded to the University of British Columbia where he earned his medical degree, graduating in 1991. Prof. Javer completed an additional four-year otolaryngology (one year core research) and one year core general surgery training, earning his specialist credentials. In 1998, Prof. Javer proceeded to complete a two-year fellowship at the Georgia Nasal and Sinus Institute in Savannah, Georgia, specializing in Advanced Rhinology and Sinus/Skull Base Surgery under the directorship of Dr. Frederick A Kuhn.

Prof. Javer has varied research interests with over 110 research publications and over 15 book chapters. Prof. Javer has a special interest in advanced FESS (functional endoscopic sinus surgery), frontal sinus surgery and fungal sinus disease. Prof. Javer has been awarded several awards and honors in research and in surgical teaching during his career at the University of British Columbia (UBC) including the prestigious ‘Richard Finlay Senor Scholar Award’ in 2017. He started the sinus fellowship-training program at the St. Paul’s Sinus Centre in 2001, which has graduated 23 subspecialized surgeons from eleven different countries. He presents internationally and is fluent in five languages. He is currently a full clinical professor in the department of surgery at the University of British Columbia, co-director of research in the division of Otolaryngology at UBC, and head/director of the St. Paul’s Sinus Centre.

Figure 1 Prof. Amin R. Javer

Interview

ACR: What drove you to specialize in advanced rhinology and sinus/skull base surgery?

Prof. Javer:During my residency, I was fortunate enough to spend time with a superb rhinologist at UBC by the name of Dr. Holly Stevens. She guided me and inspired me to take on rhinology as it was entering the exciting phase of endoscopic and image guidance in the early 1990s. She was the initiating force for me in pursuing advanced rhinology, and eventually helped secure a fellowship with Dr. Fred Kuhn in Savannah GA where I spent 2.5 years learning advanced rhinology from one of the best in the field.

ACR: Could you provide a brief overview of the recent publications in chronic rhinosinusitis (CRS)? Are there any alarming or promising findings that stood out to you?

Prof. Javer: There have been some incredibly important advancements in chronic sinusitis particularly in recalcitrant chronic sinusitis. The recent introduction of biologic medication to our armamentarium has really helped us help patients who were not cleared or cured with endoscopic sinus surgery and topical steroid irrigations (1,2). This has likely been the one most important advancement in the last five years. Despite this, we still have many challenges ahead of us, especially in the realm of type one and type three CRS. Recent publications on mucus transplants have been very exciting as this will allow us to hopefully treat patients in the most natural manner, especially those patients who were not cleared or cured with endoscopic sinus surgery and topical steroid irrigations (3,4). The development of biologics against type one and type three disease is also very exciting and we are all looking forward to seeing how well they work. Lastly, we need to keep in mind that these medications can have side effects and recent publications on adverse events from biologics have been somewhat concerning. This is an area of interest that needs to be further explored for the safety of our patients.

ACR: You have special interest in advanced functional endoscopic sinus surgery (FESS). Can you discuss some of the significant advancements in this area and their impacts on patient outcomes?

Prof. Javer: One of the areas that I really enjoy studying is the frontal recess and the frontal sinus. I find it quite disturbing that surgeons quickly resort to putting drills into the frontal recess when they cannot figure out how to operate in the frontal recess and frontal sinus. The use of extensive amounts of surgery is often not required to cure a lot of the chronic sinusitis patients. In most cases a well done Draf 2A will work as good as, if not better than a Draf 2B or 3 when done correctly. I find it especially disturbing when a young rhinologist wants to carry out a Draf 3 procedure on every NERD (NSAID Exacerbated Respiratory Disease) patient that is presented to him/her. We have published extensively on the use of imaging using the frontal ostium grade (FOG)/frontal ostium diameter (FOD) system that should aid young surgeons on what decisions to make prior to starting a difficult frontal sinus operation.

The other area of advancement is collaboration with our colleagues in ophthalmology and neurosurgery. This has developed nicely over the years and benefited patients greatly.

Lastly, the collaboration with our pulmonary, allergy, and rheumatology colleagues has been very useful for our patients as well. Running combined clinics on shared patients with these colleagues has created an excellent learning, teaching and beneficial environment for everyone involved.

ACR: You started a sinus fellowship-training program at St. Paul’s Sinus Center. What motivated you to establish this program, and what do you consider as its greatest successes?

Prof. Javer: The sinus fellowship program at St. Paul’s Sinus Centre was established to create a milieu of academia to further study the advancements in chronic sinusitis. Fellows, residents, and medical students are an essential component at our centre to help ask and answer study questions with controlled studies that are often randomized and double-blinded.  One of our recent publications on sinonasal mucosal transplants has been a catalyst for further research and for obtaining funding to carry out this research on 80 patients in a double-blinded randomized controlled trial (1). Without a fellowship program, such high-end academic studies would not be accomplished.

ACR: Your fluency in five languages and international presentations highlight your global perspective. How has this international exposure enriched your professional development and approach to rhinology and sinus surgery?

Prof. Javer: I have essentially got three passions: one being teaching, the other being operating, and the final one being looking after my patients in the most exemplary manner. Because of my love for teaching and passing my knowledge to others, I have managed to travel around the world carrying out international presentations and doing courses in endoscopic sinus surgery. Meeting others in the field from around the world continues to enrich my knowledge. It allows me to continually question myself and my techniques, and to develop new ones. This has been extremely rewarding for me.

ACR: Looking ahead, what do you envision as the next major breakthroughs in rhinology and sinus/skull base surgery, and how is your work at St. Paul’s Sinus Centre contributing to these advancements?

Prof. Javer: The last frontier in chronic sinusitis that I feel we need to figure out is recalcitrant disease. Those patients with dysbiotic microbiomes that nothing can fix (surgery, biologics, antibiotics, etc) are currently our greatest challenge. A successful treatment algorithm needs to be developed for these chronically ill patients. These patients are affected in every aspect of their lives and really do need help.

ACR: How has your experience been as an Editorial Board Member of ACR?

Prof. Javer: It has been quite easy and rewarding. I have enjoyed the experience.

ACR: As an Editorial Board Member, what are your expectations for ACR?

Prof. Javer: I feel like it is very important for ACR to publish high quality reports that everyone can learn from. Interesting cases need to be shared easily and that is very important for our otolaryngology community.

Reference

1. Bachert C, Han JK, Desrosiers M, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 2019;394(10209):1638-1650.
2. Han JK, Bachert C, Fokkens W, et al. Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2021;9(10):1141-1153.
3. Gill SK, Hernaiz-Leonardo JC, Edens TJ, et al. SinoNasal Microbiota Transfer to treat recalcitrant chronic rhinosinusitis: A case series. Int Forum Allergy Rhinol 2024;14(8):1386-1390.
4. Mårtensson A, Cervin-Hoberg C, Huygens F, et al. Upper airway microbiome transplantation for patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2023;13(6):979-988.