As a medical student, I was initially introduced to the writings and aphorisms of the celebrated physician and scholar, William Osler. Returning not infrequently to his commentaries, I have been impressed as to how universal and timeless his observations were. Furthermore, not uncommonly, the citations recorded in his writings reflect prescient insights, as well as time-tested truths. Tucked within his 1904 Aequanimitas is the following passage:

Every physician will make, and ought to make, observations from his own experience, but he will be able to make a better judgment and juster observations by comparing what he reads and what he sees together. It is neither an affront to any man's understanding, nor a cramp to his genius, to say that both the one and the other may be usefully employed, and happily improved in searching and examining into the opinions and methods of those who lived before him, especially considering that no one is tied up from judging for himself, or obliged to give into the notions of any author, any further than he finds them agreeable to reason, and reducible to practice. No one therefore need fear that his natural sagacity, whatever it is, should be perplexed or misled by reading. For there is as large and fruitful a field for sagacity and good judgment to display themselves in, by distinguishing between one author and another, and sometimes between the several parts and passages in the same author, as is to be found in the greatest extent and variety of practice... It has not usually been looked upon as an extraordinary mark of wisdom for a man to think himself too wise to be taught; and yet this seems to be the case of those who rely wholly upon their own experience, and despise all teachers but themselves.

It is with this background that, when I first encountered Dr. Jim Snow's 1983 text Controversy in Otolaryngology, I readily began to employ it as a source of reference on a regular basis. By choosing controversial areas of clinical practice, and offering the opinion of accomplished practitioners, I was able, as a student of our specialty, to foment and shape a management algorithm predicated upon distinguished experience and knowledge, tempered by the commentaries contained therein.

Because I valued the original text and found it to be unique amongst the many publications in our field, it seemed that a review and update would provide the contemporary practitioner with a valuable and portable source of information. Much to my delight, Dr. Snow and a number of my colleagues endorsed the project. Moreover, Jim has graciously written a broad-perspective introduction reflecting his unique experience as practitioner and former NIH Director. Not surprisingly, some of the "controversial topics" have been laid to rest and a general acceptance regarding management strategy has been adopted; however, several others remain fertile ground for difference of opinion, and as newer methodologies and management strategies have come into practice, new controversial issues have arisen.

Contributors to this text were chosen based upon their recognized clinical expertise, knowledge, and communicative skills. Each was charged with the task of addressing a given topic from a broad-perspective overview, establishing for the reader how a certain opinion was reached, citing relevant literature and experience, and providing a clearly articulated management algorithm that would enable the reader, in a relatively short period of time, to have a clear sense as to what particular viewpoint is being expressed and advocated, and why.

Ultimately, the goal of the book is to provide the contemporary practitioner with a focused discussion that allows for a critical comparison of what an individual practitioner is presently doing that parallels or disagrees with the approach advocated by an experienced colleague.

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