I have recently learned about the last global survey on access and use of web information systems via internet and intranet. Only in Brazil, there are nearly 40 million people that use this information traffic means, being considered the third country in internet access in the world.

What seemed to be impossible has gained form an irrevocable aspect. In little time, each citizen that has access to every-day Western civil rights will have a point of communication with all other people, in the same conditions and from anywhere in the world.

This is a philosophically instigating situation. We share the same environment and the same means of living, respect ethical, moral and cultural rules that are quite similar and we are practically interconnected by a network of information that is similar to a neural network. Moreover, we realize that once information is sent from the exterior, a company, family or subject will be able to connect and transmit it to other sites of the company, home or office through the intranet. The global village is getting closer to a single and integral biological system.

What maintains and represents this integrity is our capability to choose information from the environment and the global web, broadcasted by the system of receptors installed in our sensorial devices. Just to review, we have the visual system, with 2nd, 3rd, 4th and 6th cranial nerves, olfactory system with 1st cranial nerve, auditory and vestibular system with the 8th nerve, the gustative system with the 5th nerve, and finally, the sensorial system of the "internal" environment, with special signaling, characteristic receptors and peculiar intracellular messengers.

We can soon realize that most of our communication with the external environment, or in other words, our social health, is contained within the interests of Otorhinolaryngology. Now it is on us to know whether the specialist is committed with the expansion of knowledge on the topics and how much we have contributed to improving the communication conditions of subjects.

Taking into account the topic of communication, we can adopt two very interesting pathways, being that the first one concerns our capability to communicate with the outside world, which is temperature, tact, vision, hearing, olfaction, taste, muscle movement, voice and speech. These systems should be connected so that we can form the so-called "interior representation" of the external world. For it to happen, we should have learned and been trained in the logics of information sharing that has minimum coherence with which exists in the body horizon. This is when the second pathway comes into place, obviously indissoluble from the first one, that is the internal sensorial system. The interconnection and exchange of information between each system is made in an individual way, cell by cell, and can be made based on different types of signaling. There are endocrine signs that use molecules named hormones to take orders and information to target-cells in far away sites from where they are synthesized by endocrine organs. There is paracrine signaling, in which the signaling molecules released by a cell affect only the target-cell that is closely related to it. There is also the autocrine signaling, in which cells respond to substances released by themselves.

Each signaling method makes use of molecules that bind to surface receptors or cytosol or even the nucleus of the cell it is going to work with. Receptors may be of different types and today we know that we know very little about the magnitude of human functional control. Moreover, inside the cells we have the so-called messengers such as AMPc, GMPc, IP3, etc that modulate and transfer information to different intracellular organelles. Therefore, the internal communication system can be so or more complex than the external system. Regardless, they are quite similar.

It is by means of integrity and good internal communication that we can have appropriate answers to stimuli and external situations that ensure our survival.

We can use a medical term that has been attracting growing respect, the holistic understanding of subjects, which considers the human body as an inseparable unit and associated with the meaning it has to total health, in which we consider that it is not enough to have active vital functions that reach good quality of life. Thus, we conclude that the reach of interrelation needs of a subject to another, such as cells from the same organism, is essential for us physician that have as the main activity the support to biological balance.

In the case of Otorhinolaryngology, we have awaken to more responsibilities in an attempt to provide better surviving conditions to human beings. The decrease in nasosinusal and otological diseases and the increase in knowledge about functional voice, hearing and sleep makes the specialists start to work in matters that they did not use to address. It is the first pathway that is more acknowledged and mastered by Otorhinolaryngologists. However, if we observe the number of publications related to internal environment and cell communication systems in the topics of interest of hearing, speech, olfaction, and taste, we can see that we have failed in presenting doubts and solutions to possible bottlenecks presented in signaling and exchange of intracellular information. In the end of the day, it means little knowledge on target-cells, signalers, receptors, messengers and cell responses for each of the sectors comprised by the cranial nerves under our arena of responsibility. It reduces our ability to provide the needs to development of active drugs in the region, limits the recognition of active genes, and prevents the use of strategies that guide feeding habits for the resolution of ENT affections.

Currently, molecular biology has already provided data about the many different activities and its players, such as cations, proteins and hormones in cells of inner ear, larynx, nose and mouth. But there is a lot to do and the task is very late if compared to other areas of medicine.

I am under the impression that medicine will be differently when doubts related to cell function control are better known. Maybe it is an excellent opportunity for Otorhinolaryngology to definitely leap from the underground to the penthouse of health-related reasoning. Each one of us has to give some thought to it. Our journal is responsible for stimulating our curiosity. Otorhinolaryngologists are responsible for performing their role as physicians that have a holistic perspective of human beings.

Henrique Olival Costa