bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenging Problems in Clinical Otology
Authors: Micco Alan G. , Leonetti John P. , Derebery Jennifer , Haynes David S. , Angeli Simon L.
Published: September 2011

Program Description

Approximately 35% of office visits in a general otolaryngologic practice are otologic in nature. Simple diagnosis such as cerumen impaction, presbycusis, or acute otitis media are very straight forward and rather easily treated. Other ear‐related issues can be more challenging and may require additional office time and resources to manage. This miniseminar will discuss the otologic evaluation and management of progressive SNHL, pulsatile tinnitus, referred otalgia, unilateral middle ear effusion, and osteoradionecrosis of the EAC. While the presentation of these issues may appear benign, they may represent a more serious underlying illness. Emphasis will be placed on a detailed differential diagnosis, and appropriate testing that should be considered by the general otolaryngologist. Audience participation will be encouraged through case presentations.

Educational Objectives

1) Recognize common patient presenting complaints that can be harbingers of a more serious problem. 2) Understand the basic workup that should be performed prior to referring the patient to a subspecialist. 3) Understand the essential treatment protocol that should be instituted prior to a referral.
Health Care for All? Economics, Politics, and Delivery Systems
Authors: Kokoska Mimi S. , Trimmer Joy L. , Eisenberg Lee D. , Stack Brendan C. , Burton Martin J. , Taylor Mark
Published: September 2011

Program Description

Discussions regarding health care (HC) legislation, reform, and costs continue to be in the public conscience. The media in large part have presented little facts and the enacted health care law has been met with mixed responses from the public, HC sector, and politicians. A central philosophical and public health question is should everyone have covered HC? The panel will suppose the answer is yes and present evidence for what systems could succeed in the US. This program presents facts from national and worldwide experiences that have been essentially absent in media discussion forums. It will also provide participants with an analysis of the political environment surrounding the HC debate in the US. The potential implications of a universal health HC system versus a nationalized HC system on otolaryngologists in private and academic practices will be discussed. Health information technology (HIT) beyond the electronic health record is just beginning to become widely implemented. There is evidence of rapid shifts in how HIT and exchanges will change the current models of clinical practice with socioeconomic implications. The various ways HIT has been and will be used to improve quality of care, shift revenues, and impact access to information will be presented. This set of presenters collectively has experience in a wide breadth of health care systems including private, academic, US government, as well as the Canadian and United Kingdom HC systems. They will provide their perspectives on the current challenges and successes associated with their systems. In conclusion, the panelists will have a moderated question and answer session covering questions such as, what is the preferred model for delivering health care for all in the US and how would you fund it? What is the scope of practice considerations in Canada, UK and US? The audience will also be able to provide and view their answers using the interactive audience response system.

Educational Objectives

1) Understand various government healthcare systems, politics of healthcare, and the impact on otolaryngologists. 2) Understand the current and future status of health information technology and exchanges beyond medical records. 3) Learn about global models of health care delivery from panelists with experience in varied healthcare systems.
Emerging Technologies in Implantable Auditory Prostheses
Authors: Fishman Andrew J. , Richter Claus‐Peter , Roland J. Thomas , Svirsky Mario A. , Rubinstein Jay T. , Micco Alan G.
Published: September 2011

Program Description

Current prosthetic auditory implants have achieved a high level of success, however, it would be fair to say that performance gains over the past decade have reached a stable plateau. The latest phase of development has centered primarily on increasing stimulus resolution, preserving residual auditory ultrastructure and function, and implanting higher order neural pathways. To serve these objectives, electrodes have been designed to more closely approximate the spiral ganglion and be inserted virtually atraumatically. Implantation of the higher order pathways has already been performed with combinations of penetrating needles or electrode paddles at the brainstem. Prototypes even exist for stimulation as high up as the auditory cortex. We are now also witnessing the development of highly focused fiberoptic delivery systems for infrared laser energy as the stimulus source. A panel of surgeons and scientists, all of whom have been involved in both clinical and basic science of auditory implants, will debate the strategies being developed to foster the next leap in performance gains. The seminar will begin with a candid appraisal of the successes of currently marketed achievements including modiolar hugging electrodes, hearing preservation hybrid implants, compressed and split arrays for severely malformed and obstructed cochleae, and bilateral implantation. Minimally invasive surgical techniques will be examined with the questions posed: What truly constitutes a minimally invasive procedure? What technical features need to be retained in order to maintain necessary safeguards and precautions? The variable successes of auditory brainstem implantation will be reviewed with an eye toward future improvement. The panelists will then present their collective experience with emerging technologies aiming to push the envelope of performance higher into the future. The constant gains in microprocessor speeds will offer opportunities for development of novel processing strategies including current steering. The emerging concept of integrated drug delivery systems will require a careful re‐exploration of the well‐known design problems of hermeticity, durability, and ultrastructural trauma induction. Changes in stimulus energy source (eg, infrared laser) will undoubtedly require radical changes in device designs and coding strategies. It is the hope of the organizers that this miniseminar will benefit both the attendees and the panelists through the process of evaluative debate and exploration of new ideas.

Educational Objectives

1) Understand the current status and future direction of hybrid “hearing preservation” cochlear implantation. 2) Understand the newest device and coding strategies including infrared laser optical based devices. 3) Be familiar with the current systems under development including vestibular prostheses, DACS and ABI.
The Use of Implants in the Management of Tinnitus
Authors: Hoffer Michael E. , Seidman Michael D. , Rubinstein Jay T. , Van de Heyning Paul , Shulman Abraham
Published: September 2011

Program Description

Tinnitus is one of the most common health problems in the United States and recent figures show that tinnitus is increasing in frequency. As otolaryngologists we are the primary specialty responsible for the diagnosis and management of tinnitus. Despite a great deal of work in this area definitive treatment options for tinnitus are lacking in many cases. Recognizing the importance of this issue the AAO‐HNSF and the Martha Entenmann Tinnitus Foundation have endowed a series of miniseminars to address tinnitus. This year’s panel will once again be comprised of national and international experts who will discuss advances in tinnitus treatment using implantable devices. The panel will discuss the use of cochlear implants, implantable hearing aids, and other, more novel, implantable devices. In particular the presenters will focus on the physiologic basis for tinnitus response to electrical or mechanical stimulation, cases series and outcomes, and patient selection for various treatments. The panel will finish by discussing several cases and will provide time for audience questions.

Educational Objectives

1) Better understand treatment options for tinnitus. 2) Better understand the principals that support the use of electrical stimulation in tinnitus. 3) Provide a more clear understanding of the impact of cochlear implants on tinnitus.
Tympanoplasty: Best Method of Grafting, Medial, Lateral, Medio‐Lateral, or Cartilage
Authors: Jung Timothy T. K. , Brackmann Derald E. , Chole Richard A. , Dornhoffer John L. , McKenna Michael J.
Published: September 2011

Program Description

Although there are well‐established surgical techniques for tympanoplasty to repair chronic tympanic membrane perforation, surgical methods remain varied, often based more on local traditions than on scientific research. Successful tympanoplasty continues to pose a significant challenge to the otolaryngologist. The goal of this miniseminar is to present the best surgical technique of this common procedure. Toward these ends, we have assembled a panel of respected and experienced otologists from the East coast, Midwest, South, and West coast of the US. Following a brief introduction, each panelist will present his preferred surgical technique of tympanoplasty for tympanic membrane perforation that works best whether media, lateral, medio‐lateral, or cartilage graft method. The remaining time will be devoted to case presentations to discuss on best graft method for particular cases. This miniseminar will provide information that should improve the ability of each participant to perform successful tympanoplasty for chronic tympanic membrane perforation in different clinical situations.

Educational Objectives

1) Learn best grafting method in tympanoplasty for reconstruction of chronic tympanic membrane perforation. 2) Understand to use different method grafting depending on the location of tympanic membrane perforation. 3) Be able to perform better tympanoplasty in different clinical situations.
Pediatric Otolaryngology
Authors: White David R. , Buchman Craig A. , Choo Daniel , Preciado Diego A. , Froehlich Patrick
Published: September 2011

Program Description

The management of cholesteatoma has been a topic frequently filled with controversy regarding surgical technique and different methods of hearing restoration. Cholesteatoma management has always presented the otolaryngologist with a unique set of challenges, especially in the pediatric population. Challenges in management include access to various areas of the middle ear and surrounding structures, identification of recurrence, and restoration of hearing loss caused by the disease. Within the past decade, novel techniques such as removal/replacement of the canal wall, diffusion weighted MRI for diagnosis of recurrence, and advances in understanding of cholesteatoma biology have resulted in evolving clinical algorithms used to treat this difficult disease. This miniseminar will be organized as a panel discussing current care and novel management of pediatric cholesteatoma. The multi‐institutional panel will include experts in cholesteatoma biology, resective surgery for cholesteatoma, hearing restoration, and imaging of cholesteatoma. Each panelist will focus on novel and/or controversial aspects of cholesteatoma management. The miniseminar will use an audience response system to allow interaction between the panel and the audience during the presentations.

Educational Objectives

1) Identify current theories regarding etiology of pediatric cholesteatoma and biologic factors determining behavior of cholesteatoma. 2) Understand current options for primary and hearing restorative surgery for pediatric cholesteatoma. 3) Learn about current options for identification of recurrent pediatric cholesteatoma.
Biofilms in Otolaryngology: What Does This Mean to the Clinician?
Authors: Derkay Craig S. , Post James C. , Han Joseph , Darrow David H.
Published: September 2011

Program Description

Virtually all microbes live in biofilm communities. Within these communities, the microbes assume differing specialized roles which confer survival advantages on the community. These communities cause chronic and device‐associated infections. The role of biofilms in the persistence of chronic, mucosal‐based ENT‐related infections was first recognized in otitis media. Within the field of pediatric otolaryngology, biofilms have now been shown to play a role in many infections, including: recurrent acute otitis media, otitis media with effusion, cholesteatoma, chronic tonsillitis, chronic rhinosinusitis, and infections of tracheostomies, endotracheal tubes, tympanostomy tubes, and cochlear implants. The recognition that chronic ear, nose, and throat bacterial infections are biofilm‐related has been the impetus for the development of new technologies for the study of biofilms and their prevention and treatment. Understanding that chronic bacterial infections are biofilm‐related is fundamental to developing rationale strategies for treatment and prevention.

Educational Objectives

1) Appreciate the current state of understanding regarding biofilms in middle ear effusions and recurrent acute otitis media. 2) Understand the contributions that biofilms make toward chronic infections of the tonsils and adenoids. 3) Understand the near and long‐term possibilities in treatment and prevention of pediatric otolaryngology infections associated with biofilms.
From Bench to Bedside: Updates in Pediatric Obstructive Sleep Apnea
Authors: Ishman Stacey L. , Bhattacharjee Rakesh , Garetz Susan L.
Published: September 2011

Program Description

Pediatric obstructive sleep apnea (OSA) has been identified in 2% to 4% of children in the United States. While adenotonsillectomy is widely regarded as the primary therapy for pediatric OSA, evidence suggests that anatomy alone is not enough to explain the presence of OSA. With this in mind, evaluation of other factors contributing to OSA has revealed that inflammation, and specifically leukotrienes, may contribute to airway obstruction and that medical treatment of airway inflammation may be effective to treat sleep disordered breathing (SDB). In addition, the evidence regarding accurate diagnosis of sleep‐disordered breathing in children is still subject to debate. While sleep studies are unquestionably the gold standard for diagnosis, the use of criteria adapted from adult studies has led to come controversy regarding the correct parameters to use for diagnosis. Additional investigations have found that respiratory patterns in children differ from those in adults and standard sleep study parameters may not be very specific or sensitive. Therefore, flow‐based respiratory measures have been developed to help determine which children would benefit from treatment and measure response to treatment after surgery. While accurate measurement of SDB is essential, quantification of the consequences of OSA and SDB is also important and the relationship between neurobehavioral measures and SDB has been explored. Understanding the role of inflammation and the potential for flow‐based respiratory measures is critical in advancing the treatment of pediatric OSA. In addition, a better understanding of the relationship between neurocognitive and behavioral measures and SDB is fundamental to developing rationale strategies for treatment.

Educational Objectives

1) Appreciate the current state of understanding regarding inflammation and biomarkers in pediatric obstructive sleep apnea. 2) Understand how the measurement of airflow in children can best reflect sleep‐disordered breathing. 3) Understand the relationship between neurocognition and sleep disordered breathing in children and changes seen with treatment.
Genetics in Otolaryngology: Translational Research
Authors: Lesperance Marci , Gruber Stephen B. , Runge‐Samuelson Christina L.
Published: September 2011

Program Description

Recent years have seen great advances in our understanding of the molecular genetic basis of many clinical disorders. Building on the success of the Human Genome Project, new technologies are in development to identify disease‐causing mutations through genetic testing. However, there is a knowledge gap among otolaryngologists regarding which patients should undergo genetics evaluation and how genetic testing should be utilized in the care of patients. The three participants are clinician‐scientists who investigate the genetic factors underlying human disease, and also apply their understanding of genetics to the care of patients. This panel will discuss the state of the art in genetic testing in otolaryngology as well as translation of recent research which will soon be clinically available. Dr Gruber will address cancer genetics, applying his work in cancer in general to head and neck tumors; Dr Runge will discuss the evaluation of auditory neuropathy beyond routine clinical measures and also genetic testing as an example of genetic hearing loss. Dr Lesperance will discuss approaches to genetic evaluation of the pediatric patient, for children with rare genetic disorders, multiple congenital anomalies, and for Mendelian disorders. The emphasis will be on providing the practicing otolaryngologist with the tools to counsel and evaluate their patients with potential genetic disorders.

Educational Objectives

1) Describe relationships between genotype and phenotype in auditory neuropathy spectrum disorder. 2) List the most common methods of genetic testing and the risks and benefits of each. 3) Understand the role of the geneticist in evaluating patients with otolaryngologic disorders.
Hot Topics in Otolaryngology: 2011
Authors: Abramson Peter , King Raymond , Koriwchak Michael J. , Geller Lawrence , Love Rick G.
Published: September 2011

Program Description

The executive committee of the Board of Governors is proud to present its annual miniseminar. There are many topics that are at the forefront of the practice of otolaryngology. This miniseminar will present three topics that are exceptionally important at this time. Reimbursement for Emergency Department coverage, hospital/physician joint ventures, and an update on payments for EHR and meaningful use. Many hospitals are now reimbursing for emergency department (ED) coverage, many are not. Rick Love, MD, headed the BOG Legislative Committee task force on pay for ED call that resulted in the Academy position paper on this matter. He will give us recommendations on how to successfully merge the feeling of obligation to care for hospital emergency room patients in light of increasing overhead, liability, and decreasing physician reimbursement. Dr Love will shed light on how to be remunerated for hospital ED coverage and at the same time stay within OIG regulations. Lawrence Geller, vice president of consulting services for the group Medical Management Associates, is a sought after speaker and consultant on topics related to healthcare. As portions of the new healthcare law become implemented, hospital/physician joint ventures will be a common trend. Mr Geller will present on the implications of such alliances. The government has recommended that our country’s healthcare providers adopt electronic healthcare record keeping. There are multiple monetary incentives attached to meaningful use and 2011 is the first year slated for reimbursement. Michael Koriwchak, MD, an Atlanta‐based otolaryngologist is a noted lecturer and consultant on matters of EHR design, implementation, and “meaningful use.” He also has a popular blog dedicated to topics related to EHR and physician practices‐ “The Wired EMR Practice.” Dr Koriwchak will update attendees on the progress of the EHR initiatives, how you can you stay or get compliant, and whether the government is keeping their end of the bargain.

Educational Objectives

1) Learn the current opinion, regulations, and AAO‐HNS position regarding pay for emergency department coverage. 2) Understand accountable care organizations and the pros and cons of hospital/physician joint ventures. 3) Learn about implementation of an electronic health record strategy that qualifies for government reimbursement.
Safer Radiologic Imaging of Otolaryngologic Disease in Children
Authors: Tunkel David E. , Gorges Sandra , Wei Julie L. , de Jong Andrew L. , Skinner Margaret L.
Published: September 2011

Program Description

Radiation exposure from medical imaging has increased six‐fold over the past 30 years, and such imaging has been estimated to provide half of an individual’s radiation exposure. The risk of cancer development from such radiation exposure has been discussed recently in the medical literature and the lay press. These issues are most notable in children, with long life expectancy and the potential for multiple exposures to medical imaging in their future. This symposium will be a multi‐speaker symposium, and at the end of the various presentations, specific case scenarios will be presented with the opportunity to use the Audience Response System for audience participation for better understanding of current otolaryngology practice patterns related to imaging study selection in pediatric patients. The speakers will include a pediatric radiologist as well as 3 pediatric otolaryngologists, and presentations will include strategies on how to use reduced radiation doses for select imaging studies, review the current American College of Radiology Appropriateness Criteria for Otolaryngology related image study selection, appropriateness of using the MiniCAT image system in the office setting, as well as risks and benefits for each image modality for specific pediatric head and neck diseases.

Educational Objectives

1) Discuss current issues related to safety of radiologic imaging studies used most often in children. 2) Review specific case scenarios and discuss imaging options, relative risks, and benefits of each modality. 3) Enhance judicious use of imaging studies for given pathology, and counseling of parents about risks.
Rhinology/Allergy
Authors: Kennedy David W. , Palmer James N. , Zinreich S. James , Ferguson Berrylin J. , Stankiewicz James A. , Hwang Peter H.
Published: September 2011

Program Description

The miniseminar provides an open forum for interactive discussion of management options and the decision rationale involved in sinus and skull base cases of varying complexity. A case presentation format is utilized with case presentations from each of the panelists. Questions regarding differential diagnosis, evaluation, imaging, and treatment are posed to the audience in multiple choice format. The responses provided by the audience response system are then discussed and expanded upon by the panelists in an interactive discussion. In general, cases are selected that might be encountered by either a general otolaryngologist or a subspecialty rhinologist, but which have important decision and management dilemmas. Each panelist has been chosen because of their depth of knowledge in the field and because of the clarity of their presentations. Particular emphasis is placed on the decision making process and on frontal sinus disease, revision surgery, and fungal sinusitis, as well as the management of more common tumors. The rationale behind each recommendation will be carefully elucidated. Discussion from the floor is encouraged and the use of a touch pad audience response system creates audience participation as an integral aspect of the case discussions.

Educational Objectives

1) Improve knowledge of the surgical decision making process in chronic sinus disease. 2) Learn different imaging modalities and improve quality of interpretation for both CT and MRI images. 3) Improve understanding of the management of difficult to treat chronic rhinosinusitis.
Balloon Catheter Technology in Rhinology: Reviewing the Evidence
Authors: Batra Pete S. , Marple Bradley F. , Ryan Matthew W. , Sindwani Raj
Published: September 2011

Program Description

Balloon catheter technology was introduced to otolaryngology in 2005 for management of paranasal sinus inflammatory disease. Since its introduction, it has engendered considerable controversy with proponents for and against adoption of the technology. Over time, alternate balloon devices have been advocated for office‐based sinus ostia dilatation. Balloon technology has been promoted to be less invasive resulting in reduced pain and quicker recovery, generating significant press and interest by the lay public looking for new solutions for sinonasal problems. Thus, proper vetting of the balloon devices is essential to elucidate their proper role in the surgical paradigm for management of chronic rhinosinusitis. This miniseminar will objectively evaluate the currently available operative suite and office‐based balloon catheter technology. Rhinologists with considerable experience without commercial conflicts on balloons will assess the frank advantages and limitations of the current balloon devices. Evidence‐based review will be incorporated to assess the strengths and weaknesses of the existing peer‐review literature. The potential complications unique to balloon catheters will be reviewed. The concerns of radiation exposure from fluoroscopy will be discussed. Current coding dilemmas and socioeconomic issues will also be addressed. At the conclusion of the miniseminar, participants should have a better understanding of the potential strengths and weaknesses of the balloon catheter technology in the context of management of paranasal sinus disease. This information will also serve as the foundation for better evaluation of new technologies that are introduced to our specialty. The miniseminar will be presented in a multimedia powerpoint format with video demonstrations, when applicable. Audience participation will be encouraged to stimulate discussion through the course of the miniseminar.

Educational Objectives

1) Review currently available balloon catheter technologies and to explore implications on the FESS paradigm. 2) Critically appraise the existing peer‐review literature and address potential complications and radiation exposure. 3) Assess socioeconomic implications and CPT coding issues related to balloons.
Clinical Consensus Statement: Appropriate Use of Computed Tomography for Paranasal Sinus Disease
Authors: Setzen Gavin , Rhee John S. , Ferguson Berrylin J. , Han Joseph
Published: September 2011

Program Description

The miniseminar will consist of a lively panel discussion on the newly developed AAO‐HNS clinical consensus statement (CS) on the appropriate use of computed tomography (CT) for paranasal sinus disease. There is increasing scrutiny by government, health policy makers, and third‐party payers, regarding issues of radiation safety and appropriate utilization with CT imaging. Unlike clinical practice guidelines that could encompass other disciplines, CSs produced by the AAO‐HNS are focused on the specialty of otolaryngology‐head and neck surgery. Because clinical evidence is lacking, the terms “evidence‐based,” and “guideline” should not be used in the context of CSs. Nonetheless, the development panel has conducted a systematic review to ensure that the best available evidence is identified to support decisions, even if this evidence is limited to case series or previously published consensus documents.

Educational Objectives

1) Learn about the systematic review that was conducted to identify the best available evidence to support decisions on the appropriate use computed tomography (CT) for paranasal sinus disease. 2) Understand when it is most appropriate to use CT for paranasal sinus disease.
Complications in FESS: Doing Right When Things Go Wrong
Authors: Getz Anne E. , Hwang Peter H. , Goyal Parul , Wormald Peter J. , Stankiewicz James A. , Kennedy David W.
Published: September 2011

Program Description

Functional Endoscopic Sinus Surgery (FESS) is one of the most frequently performed procedures in otorhinolaryngology and is thus responsible for a significant incidence of complications. Thorough knowledge of the paranasal sinuses and their surrounding structures and adequate surgical experience are keys to preventing surgical complications. Special considerations in hemostasis help optimize visualization and increase safety. Meticulous preoperative review of the patient’s imaging studies is critical in successfully identifying the patient’s unique anatomic and surgical issues, thereby facilitating avoidance of complications. Maxillofacial CT is an absolute requirement prior to surgery, and systematic review of danger areas is critical. These will be reviewed and discussed in detail. Despite these preparatory measures, both minor and major complications may still occur. The surgeon must therefore possess the skill set to deal with these complications in order to consider him‐ or herself a safe surgeon. Specific complications including cerebrospinal fluid leak, neurovascular injuries, and orbital complications will be discussed in a case presentation format. Algorithms on how to address such scenarios will be presented. Finally, the medicolegal aspects of surgical complications will be considered including documentation and discussion with the patient and their families.

Educational Objectives

1) Learn strategies to avoid complications during FESS. 2) Understand management (both surgical and medicolegal) of FESS‐related complications.
Evidence‐Based Approach to Treating Chronic Rhinosinusitis
Authors: Davis Greg E. , Smith Timothy L. , Marple Bradley F. , Orlandi Richard R.
Published: September 2011

Program Description

The treatment of chronic rhinosinusitis (CRS) requires extensive skill in surgical and medical management strategies. Innovations in this field are constantly evolving. Not uncommonly, payers are hesitant to compensate for technology that is innovated and has not yet stood the test of time. The presentations will provide specific citations for the clinician to effectively communicate with payers, patients, and hospital administrators. The purpose of this miniseminar is to provide a state‐of the‐art summary of the best scientific evidence available to help clinicians treat patients with CRS. This miniseminar will present the highest level of evidence‐based medicine available for: 1) endoscopic sinus surgery, 2) balloon sinuplasty, 3) image‐guided sinus surgery, and 4) medical management of CRS. By focusing on strong, well‐performed clinical studies, the attendee will learn the research studies that directly impact the surgical and medical treatment of CRS. The miniseminar will conclude with applying this evidence‐based research to clinical cases to solidify the applicability and understanding of the research presented.

Educational Objectives

1) Recognize the state‐of‐the‐art evidence‐based research for the management of CRS. 2) Apply evidence‐based clinical research to improve medical and surgical treatment of CRS. 3) Understand evidence behind recent advances in the treatment of CRS including image‐guidance and balloon sinuplasty.
Improving Outcomes in FESS: Tips from Revision Surgeons
Authors: Palmer James N. , Schlosser Rodney J. , Wormald Peter J. , Stamm Aldo E. C.
Published: September 2011

Program Description

Functional Endoscopic Sinus Surgery (FESS) is a well‐established technique for treatment of patients with Chronic Rhinosinusitis. Applied in properly selected patients, FESS is associated with an 80% to 90% success rate. However, the remainder 10% to 20% of patients often have recurrence of disease and require subsequent surgery. This seminar will use a case‐based approach to evaluate and discuss the common problems and difficulties that are seen by the revision surgeon. In the process of dissecting surgical situations that require revision, the panelists will discuss strategies to avoid recurrent disease and maximize the success of primary FESS. The panelists will be able to draw from years of revision FESS experience, as well as multiple publications. All clinical cases will be accompanied by endoscopic pictures and videos, as well as a complete complement of appropriate radiologic images. Special highlights of the seminar will include an emphasis on frontal and sphenoid sinus disease, as well as methods of perioperative medical treatment to achieve long term surgical success and improvement of outcomes.

Educational Objectives

1) Identify common areas of post‐operative sinus disease. 2) Learn surgical techniques that avoid the need for revision surgery, and revision surgery strategies. 3) Have a greater understanding of peri‐operative medical treatments to improve surgical outcomes.
The Nose Inside and Out
Authors: Setzen Michael , Becker Daniel , Toffel Paul H. , Pearlman Steven J. , Kridel Russell W. H. , Davis Richard E.
Published: September 2011

Program Description

This unique seminar will bring together leaders from both the American Rhinologic Society (ARS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). We will be examining both functional and aesthetic considerations in nasal surgery from workup to revision surgery. When it comes to nasal surgery, all aspects of anatomy and physiology should be considered, especially when functional and aesthetic surgery is combined. A thorough evaluation is important prior to cosmetic rhinoplasty, with or without septoplasty, including an evaluation of the septum, ostiomeatal complex and inferior turbinates, often using fiber optic endoscopy. The indications for CT scanning will be discussed in patients with sinus disease prior to rhinoplasty. Functional endoscopic sinus surgery can be performed at the same time as rhinoplasty precluding the need for a second surgical procedure. Benefits and contraindications for a combined approach will be presented. Prevention and surgical treatment of nasal septal perforations will be presented since nasal septal perforations most commonly occur following nasal surgery or cocaine abuse. Preventative measures to reduce iatrogenic occurrences will be discussed as well as surgical techniques to repair septal perforations of various sizes. “Functionally safe cosmetic rhinoplasty” will address potential functional pitfalls from cosmetic rhinoplasty. The speaker will target reduced cross‐sectional area of the internal nasal valve following many standard rhinoplasty techniques. Methods for cosmetic rhinoplasty that preserve and/or enhance nasal valve function will be presented. Revision rhinoplasty is reported in 5% to 15% of patients. Based on a recent study, “Functional and aesthetic concerns of patients seeking revision rhinoplasty,” the most common complaints that patients present with, from the patients’ point of view, will be presented. This will be accompanied by a summary of these problems with tips on how to prevent them from occurring in the first place. Case presentations will highlight the above.

Educational Objectives

1) Understand the importance of a detailed workup prior to nasal surgery and rhinoplasty. 2) Understand that functional endoscopic sinus surgery can be performed concurrently with cosmetic rhinoplasty. 3) Perform safe septorhinoplasty while maintaining function; prevent sepal perforations; learn why patients seek revision surgery.
Sleep Medicine
Authors: Friedman Michael , Davidson Terence M. , Lipsey Marty R.
Published: September 2011

Program Description

Media coverage, physician education, and continued research on the long‐term sequelae of obstructive sleep apnea/hypopnea syndrome (OSAHS) have created a huge increase in the number of patients seeking treatment. At the same time, disillusionment with the results of classic surgery such as UPPP and genioglossal advancement has deterred many otolaryngologists from attempting to treat this condition. As the demand for treatment increases, diagnosis of OSAHS will become an increasingly significant component of every ENT practice and surgical treatment will remain an option for selected patients. The purpose of this course is to 1) Explain options for attached and unattached PSG or portable system, 2) Review new techniques and new clinical research on OSAHS, 3) Present a clinical staging system that helps identify appropriate treatment and predict the success for individual patients, 4) Identify patients with mild to moderate disease and those who are CPAP intolerant who could benefit from minimally‐invasive and non‐invasive techniques, 5) Present non‐invasive treatment options that can be incorporated into an ENT practice. In addition to classical OSAHS treatment, the course will review a variety of polysomnogram systems and the strengths and weakness of each system. Our experience with Provent, a non‐CPAP, non‐invasive treatment option, will also be discussed in addition to thermoplastic mandibular advancement devices. Simplified systems to setup a joint venture with dental specialists for custom‐made devices will also be presented. Presenters will discuss the economics of establishing a comprehensive sleep apnea center. We will detail startup strategies and costs for establishing a multidisciplinary sleep apnea team and center. In addition, coding and reimbursement procedures will be explained to maximize revenue production. Audience discussion will be encouraged and ample time will be allotted for a question and answer session.

Educational Objectives

1) Learn how to incorporate sleep testing into an ENT practice. 2) Learn an algorithm for successful treatment of snoring and obstructive sleep apnea. 3) Understand the approach for proper identification and treatment of each anatomic site. 4) Identify patients who can be helped by multilevel minimally invasive techniques rather than classic surgery. 5) Learn how and when to incorporate custom‐made mandibular advancement devices into an ENT/OSAHS practice.
Current Concepts in Tongue Surgery for OSA
Authors: Woodson B. Tucker , Rotenberg Brian , Pang Kenny P.
Published: September 2011

Program Description

To describe the various tongue base surgical techniques that are available for patients with OSA. Why we do them, who we do them for, and when? Tongue base obstruction has been known to be one of the levels of obstruction in OSA. Surgical treatment of the palate alone has been shown to be ineffective in patients with high Mallampati grades, Friedman Stage II & III, and tongue base collapse seen on dynamic nasopharyngoscopy. Severity of OSA is currently known to correlate with degree of tongue base and lateral pharyngeal wall collapse. Patients with severe OSA are more likely to have tongue base obstruction. Airway evaluation is vital in the management and assessment of patients with OSA. The indications for tongue base surgery is pivotal in the decision making process. All the indications based on the clinical examination would be explored and discussed. Various tongue base surgical techniques are discussed, ranging from radiofrequency of the tongue base, genioglossus advancement, hyoid suspension, laser midline glossectomy, tongue suspension, coblator channeling techniques, and robotic tongue base surgery. The surgical steps are illustrated, success rates are presented, and complications are discussed.

Educational Objectives

1) Apply the appropriate airway evaluation. 2) Choose the correct procedure. 3) Understand the technique behind each procedure.
International Healthcare and Women: The Roles and Challenges of Women in Sustainable Humanitarian Outreach
Authors: Malekzadeh Sonya , Woodson Gayle E. , Randolph Gregory W. , Nazon Marie‐Maud , Cordes Susan R. , Chandrasekhar Sujana S.
Published: September 2011

Program Description

Humanitarian aid offers human, technological, and financial resources to vulnerable people throughout the world. As health care providers, we strive to provide not only quality medical care, but to establish sustainable programs through our global outreach endeavors. Equipped with the proper resources, women have the power to help whole families and entire communities. Women are at the heart of many community‐based efforts to improve basic education, prevent the spread of disease, and increase access to medical care. This miniseminar focuses on the role of women in the international community as otolaryngologists, educators, community leaders, and patients. Panelists will discuss the challenges, both locally and abroad, facing women in promoting and administering outreach in developing nations. The importance of empowering women around the world by providing support through resources and education will be explored. Successful outreach missions and partnership programs will be presented to highlight the significance of establishing lasting access to health care through education. Panelists will relate their experiences from disparate areas of the world: the Middle East, Haiti, Africa, India, and Central America. Introduction by AAO‐HNS President J. Regan Thomas, MD. Sonya Malekzadeh, MD, and Gregory W. Randolph, MD, will moderate the session which will include four panelists.

Educational Objectives

1) Comprehend the challenges of women physicians providing sustainable humanitarian aid. 2) Appreciate what it means to be a woman patient in a developing country. 3) Understand the relationship between a US program and a developing country educational program.
An Audit of Clinical Coding in ENT Operations
Authors: Arshad Faisal Ahmed , Mirza Showkat
Published: September 2011

Objective

Payment by results was introduced to the UK National Health Service in 2004. Specific payment tariff for ENT departments is determined by clinical code of the patient’s episode. Our aim was to review clinical coding in our department and assess scope for improving accuracy of coding and income tariffs.

Method

We retrospectively reviewed coding of operations over a 4‐month period. A database was obtained including primary operation code and payment tariff. Using a system that grouped operation codes according to anatomic site, we analyzed each case to see if actual code attributed to the procedure could be improved.

Results

Over the 4‐month period there were 930 operations; 866 (93%) were correctly coded with an optimal tariff, 19 (2%) were incorrectly coded giving an excessive total tariff of £24,840, and 45 (5%) were incorrectly coded losing a tariff of £37,381. Therefore, over the 4‐month period, £12,541 was lost due to suboptimal coding.

Conclusion

A system that groups ENT operation codes according to anatomic regions and procedure types efficiently aids the accuracy and optimization of income tariffs. It may be employed during the clinical coding process as a quality assurance tool.
Detection of SCCA Using Optical Spectroscopy: Site Comparison
Authors: Lee Walter , Afshari Hamid , Ramanujam Nimmi , Beumer Halton W. , Vishwanth Karthik , Puscas Liana
Published: September 2011

Objective

Compare diffuse reflectance spectroscopy signature differences between malignant and nonmalignant mucosal tissue based on primary site of origin (ie, larynx, oropharynx, oral cavity).

Method

Panendoscopy with biopsy patients were eligible. Diffuse reflectance spectroscopy (DRS) data were obtained from the tumor site and corresponding normal tissue. Biomarker specific optical absorption data were extracted for malignant and non‐malignant tissues. Specific differences in malignant and non‐malignant tissues were examined based on primary site.

Results

Patients with mucosal squamous cell carcinoma of the head and neck were enrolled in the study. Overall, our data confirm prior findings that statistically significant differences in oxygen saturation (SO2%) (P <. 01) and mean tissue scattering coefficient (MTSC) (P <. 01) exist when comparing malignant and nonmalignant tissue. When stratified by anatomical site, SO2% is more indicative of malignancy than MTSC in the larynx. SO2% and MTSC are equally reflective of malignancy in the pharynx. MTSC is more indicative than SO2% for malignancy in tongue lesions.

Conclusion

DRS continues to be valid in detecting significant differences between malignant and non‐malignant lesions of the head and neck. DRS biomarkers of SO2% and MTSC data differ in importance according to primary site. This research will improve the ability to detect and monitor malignant mucosal lesions.
Effects of a New PPARgamma Agonist on Tongue Carcinoma Cells
Authors: Koshkareva Yekaterina A. , Daly John
Published: September 2011

Objective

To investigate the effects of GW1929, a new specific PPARgamma agonist, on head and neck squamous carcinoma cell proliferation, apoptosis, and invasion.

Method

Human well‐differentiated tongue SCC15 cells were treated with 5, 10, 20 micromolar GW1929, and 1% DMSO in 2% FBS Media (control). Tetrazolilum salt WST‐1 assay was used to assess proliferation. Cell cycle was analyzed with FACS. Caspase3 was measured with Caspase‐Glo3/7 luminescent. RT‐PCR measured metalloproteinase‐9 and tissue inhibitor of metalloproteinase‐1 mRNA to assess anti‐invasive effects.

Results

GW1929 inhibited tumor cell proliferation. At 24, 48, and 72 hours, treatment with 5, 10, and 20 micromolar GW1929 inhibited SCC15 proliferation by 12% to 23%, 17% to 31%, 27% to 45% in a dose‐dependent manner. FACS analysis showed that GW1929 prevented cells from entering S‐phase of cell cycle. Confirming significant cellular apoptosis, levels of caspase 3 were 154%, 163%, 185% of control after a 24‐hour treatment with 5, 10, 20 micromolar GW1929. GW1929 decreased expression of markers of extracellular matrix invasion in a dose‐dependent manner. At 24 hours, levels of MMP‐9 mRNA were decreased up to 2 fold, and levels of TIMP‐1 mRNA were increased up to 2 fold.

Conclusion

GW1929 is a potential antiproliferative agent, as evidenced by its pro‐apoptotic, anti‐proliferative, and anti‐invasive effect on squamous carcinoma of the tongue.
EGF‐SubA Is Cytotoxic to Laryngeal SCC Cells
Authors: Jaiswal Vibha , Behrendt Anna , Backer Joseph , Boyd Mark T. , Aslam Mohammed , Jones Terence
Published: September 2011

Objective

1) Examine the effect and mechanism of action of EGF‐SubA on laryngeal (LSCC) cells. EGF‐SubA is a novel cytotoxic drug that promotes cleavage of GRP‐78, a key component of the unfolded protein response. 2) Examine the interaction of EGF‐SubA with clinically relevant modalities: cisplatin and gamma radiation in LSCC cells.

Method

In vitro cytotoxicity was determined for a panel of 7 LSCC lines of varying p53 status using MTT assays. For studies of EGF‐SubA combined with cisplatin or gamma radiation, apoptosis was also determined by flow cytometry. Clonogenic assays were used to determine the effect of combining EGF‐SubA with gamma radiation.

Results

EGF‐SubA is cytotoxic to LSCC (laryngeal squamous cell carcinoma) cells at picoMolar concentrations, regardless of p53 status in lines derived from primary tumor sites and from metastases. The cytotoxic effects of EGF‐SubA are not rapid and do not depend upon apoptosis. EGF‐SubA acted as a radiosensitizing agent when used in combination with gamma radiation producing a 30% reduction in the surviving fraction at 2Gy. Furthermore, EGF‐SubA evoked at least an additive cytotoxic effect when used in combination with cisplatin. Flow cytometry demonstrated that in contrast to EGF‐SubA alone, both combined treatments induced apoptosis.

Conclusion

In vitro EGF‐SubA is highly cytotoxic to LSCC cells at picoMolar concentrations, and while the mechanism of cell death of EGF‐SubA alone is unclear, combinations of EGF‐SubA with genotoxic agents potently induce apoptosis.