bluuebunny/crossref_metadata_2025 huggingface dataset:
Moisture Asymmetry and MJO Eastward Propagation in an Aquaplanet General Circulation Model*
Authors: Hsu Pang-Chi , Li Tim , Murakami Hiroyuki
Published: September 2014

The role of zonal moisture asymmetry in the eastward propagation of the Madden–Julian oscillation (MJO) is investigated through a set of aquaplanet atmospheric general circulation model (AGCM) experiments with a zonally symmetric sea surface temperature distribution. In the control experiment, the model produces eastward-propagating MJO-like perturbations with a dominant period of 30–90 days. The model MJO exhibits a clear zonal asymmetry in the lower-tropospheric specific humidity field, with a positive (negative) anomaly appearing to the east (west) of the MJO convection. A diagnosis of the lower-tropospheric moisture budget indicates that the asymmetry primarily arises from vertical moisture advection associated with boundary layer convergence, while horizontal moisture advection has the opposite effect.

In a sensitivity experiment, the lower-tropospheric specific humidity field is relaxed toward a zonal-mean basic state derived from the control simulation. In this case, the model’s mean state remains the same, but its intraseasonal mode becomes quasi-stationary. The numerical model experiments clearly demonstrate the importance of the zonal moisture asymmetry in MJO eastward propagation.
Analysis of Vortex Dynamics of Lateral Circulation in a Straight Tidal Estuary*
Authors: Li Ming , Cheng Peng , Chant Robert , Valle-Levinson Arnoldo , Arnott Kim
Published: September 2014

The dynamics associated with lateral circulation in a tidally driven estuarine channel is analyzed on the basis of streamwise vorticity. Without rotational effects, differential advection and diffusive boundary mixing produce two counterrotating vortices (in the cross-channel section) whose strength and sense of circulation may change during a tidal cycle. The streamwise vorticity equation is determined by a balance between baroclinic forcing and turbulent diffusion, which explains the flood–ebb asymmetry of the lateral circulation. Analysis of the lateral salinity gradient shows that differential advection is the main driver of lateral flows, but boundary mixing can also be an important contributor in stratified estuaries. The strength of lateral circulation decreases with increasing stratification. With rotational effects, the lateral Ekman forcing in the bottom boundary layer drives a one-cell lateral circulation that switches its sense of rotation over the tidal cycle. The vorticity budget analysis reveals a three-way balance among the tilting of planetary vorticity by the vertical shear in the along-channel current, baroclinic forcing, and turbulent diffusion. The structure and magnitude of the lateral circulation change with the width of the estuary, expressed nondimensionally as the Kelvin number Ke. This lateral circulation features two counterrotating vortices in narrow estuaries, one vortex filling up the entire cross section in estuaries of intermediate widths and one vortex confined to the left side (looking into the estuary) in wide estuaries. The magnitude of the streamwise vorticity increases rapidly with Ke, reaches a maximum at , and decreases slightly in wide estuaries subject to strong rotational control.
Why Scanning Instruments Are a Necessity for Constraining Temperature and Humidity Fields in the Lower Atmosphere
Authors: Themens David , Fabry Frédéric
Published: September 2014

The ability of different ground-based measurement strategies for constraining thermodynamic variables in the troposphere, particularly at the mesoscale, is investigated. First, a preliminary assessment of the capability of pure-vertical sounders for constraining temperature and water vapor fields in clear-sky conditions to current accuracy requirements is presented. Using analyses over one month from the Rapid Refresh model as input to an optimal estimation technique, it is shown that the horizontal density of a network of nonexisting, ideal vertical profiling instruments must be greater than 30 km in order to achieve accuracies of 0.5 g kg−1 for water vapor and 0.5 K for temperature. Then, an assessment of a scanning microwave radiometer’s capability for retrieving water vapor and temperature fields in a cloud-free environment over two- and three-dimensional mesoscale domains is also presented. The information content of an elevation and azimuthal scanning microwave radiometer is assessed using the same optimal estimation framework. Even though, in any specific pointing direction, the scanning radiometer does not provide much information, it is capable of providing considerably more constraints on thermodynamic fields, particularly water vapor, than a near-perfect vertical sounder. These constraints on water vapor are largely located within 80 km of the radiometer and between 1000- and 7000-m altitude, while temperature constraints are limited to within 35 km of the instrument at altitudes between the ground and 1500 m. The findings suggest that measurements from scanning radiometers will be needed to properly constrain the temperature and especially moisture fields to accuracies needed for mesoscale forecasting.
The Convective Evolution and Rapid Intensification of Hurricane Earl (2010)
Authors: Stevenson Stephanie N. , Corbosiero Kristen L. , Molinari John
Published: September 2014

The relationship between an inner-core (r < 100 km) lightning outbreak and the subsequent rapid intensification (RI) of Hurricane Earl (2010) is examined using lightning strikes recorded by the World Wide Lightning Location Network (WWLLN) and in situ observations from various aircraft missions. Moderate (8.4 m s−1) northeasterly deep-layer (850–200 hPa) vertical wind shear, caused by outflow from Hurricane Danielle, existed over Earl at the beginning of a prolonged period of RI. Over 70% of the lightning strikes within a 500-km radius occurred downshear, with a preference toward downshear right in the outer rainbands, in agreement with previous studies.

The location of inner-core strikes in Earl differed markedly from previous studies. The inner-core lightning activity precessed from left of shear to upshear, an extremely rare event, beginning just prior to the onset of RI. Diagnosis of the vortex tilt midway through the lightning precession showed this convection was occurring downtilt in the upshear-left quadrant; however, limited observations could not confirm if the vortex tilt was precessing with the lightning. Elevated values of low-level relative humidity and CAPE were also found upshear and supported the inner-core convection, which was found to occur within the radius of maximum wind (RMW). Previous studies have shown that convection located inside the RMW promotes intensification. It is hypothesized that intensification may have occurred in part because the vertical wind shear acted to reduce the upshear tilt, and the occurrence of convection inside the RMW helped to enhance the warm core.
Forecasting a Large Number of Tropical Cyclone Intensities around Japan Using a High-Resolution Atmosphere–Ocean Coupled Model
Authors: Ito Kosuke , Kuroda Tohru , Saito Kazuo , Wada Akiyoshi
Published: September 2014

This work quantifies the benefits of using a high-resolution atmosphere–ocean coupled model in tropical cyclone (TC) intensity forecasts in the vicinity of Japan. To do so, a large number of high-resolution calculations were performed by running the Japan Meteorological Agency (JMA) nonhydrostatic atmospheric mesoscale model (AMSM) and atmosphere–ocean coupled mesoscale model (CMSM). A total of 281 3-day forecasts were compiled for 34 TCs from April 2009 to September 2012 for each model. The performance of these models is compared with the JMA global atmospheric spectral model (GSM) that is used for the operational TC intensity guidance. The TC intensities are better predicted by CMSM than the other models. The improvement rates in CMSM relative to GSM and AMSM generally increase with increasing forecast time (FT). CMSM is better than GSM and AMSM by 27.4% and 21.3% at FT = 48 h in terms of minimum sea level pressure, respectively. Regarding the maximum wind speed, CMSM is better than GSM and AMSM by 12.8% and 19.5% at FT = 48 h, respectively. This is due to smaller initial intensity errors and sea surface cooling consistent with in situ observations that suppress erroneous TC intensification. Thus, a high-resolution coupled model is promising for TC intensity prediction in the area surrounding Japan, where most of the TCs are in a decay stage. In contrast, coupling to the upper-ocean model yields only a negligible difference in the TC track forecast skill on average.
Creating Cultural Consumers
Authors: Kisida Brian , Greene Jay P. , Bowen Daniel H.
Published: August 2014

The theories of cultural reproduction and cultural mobility have largely shaped the study of the effects of cultural capital on academic outcomes. Missing in this debate has been a rigorous examination of how children actually acquire cultural capital when it is not provided by their families. Drawing on data from a large-scale experimental study of schools participating in an art museum’s educational program, we show that students’ exposure to a cultural institution has the effect of creating ‘‘cultural consumers’’ motivated to acquire new cultural capital. We find that the experience has the strongest impact on students from more disadvantaged backgrounds. As such, our analysis reveals important aspects about the nature of cultural capital acquisition. To the extent that the evidence supporting cultural mobility is accurate, it may be because disadvantaged children can be activated to acquire cultural capital, thus compensating for family background characteristics and changing their habitus.
Treating Every Needle in the Haystack
Authors: Singh Sanjeev , Suresh Swetha , McClave Stephen A. , Cave Matt
Published: September 2014

Neurologic complications are not uncommon following bariatric surgery. Hyperammonemic encephalopathy (HAE) due to an acquired or unmasked urea cycle deficit is among the rarest of these. Pediatric nutrition support specialists are familiar with recognizing urea cycle deficits, but adult specialists may not be. Here we present a case of a patient initially misdiagnosed with cirrhosis who presented with recurrent HAE 4 years after Roux‐en‐Y gastric bypass. She was diagnosed with a proximal urea cycle deficit and severe protein calorie malnutrition. The patient recovered with specialized nutrition and medical support targeting this condition. A literature review indicates multiple fatalities from this condition, indicating the importance of early diagnosis and appropriate nutrition support.
Board of Governors’ Hot Topic 2014: Will Fee for Service Survive?
Authors: Parikh Sanjay R. , Kennedy David W. , Waguespack Richard W. , Denneny James C. , Setzen Michael
Published: September 2014

Program Description:

On the hinge of health care reform, the Board of Governors’ (BOG's) 2014 hot topic is: will fee for service survive? Expert panelists, consisting of American Academy of Otolaryngology—Head and Neck Surgery presidents, BOG chairs, and physician payment and policy workgroup members, will discuss if fee for service will be superseded by payments based on work relative value units, quality measures, hospital employment, and bundled payments. Presentations will be made on current and past payment structures, bundled payments, quality metrics, and the sustainability of private practice. Time for interaction between the audience and panelists will be ensured through a final round table discussion.

Educational Objectives:

(1) Describe the history of fee for service and how it has changed in the past 10 years. (2) Relate the impact of health care reform on current and future payment systems. (3) Recognize the challenges private practice will have with new reimbursement models.
Facial Plastic Surgery Maintenance of Certification Review Course
Authors: Jordan James R. , Fedok Fred G. , Jarchow Andrea , McCarn Kate E. , Chi John J.
Published: September 2014

Program Description:

This 3‐hour course sponsored by the American Academy of Otolaryngology—Head and Neck Surgery Foundation Facial Plastic and Reconstructive Surgery Education Committee will provide a concise review of facial plastic surgery topics that will provide attendees a starting point in preparing for the recertification examination (maintenance of certification [MOC] part III). Faculty will use a combination of didactic and case‐based formats to cover essential content areas including facial trauma, aging face, facial defect repair, and surgical management of chronic facial paralysis. The course will also fulfill the MOC part II requirements by providing continuing medical education credit.

Educational Objectives:

(1) Demonstrate increased understanding of key topics in facial plastic surgery. (2) Guide further study on these topics in facial plastic surgery. (3) Access available resources in facial plastic surgery that will assist in test preparation.
Facial Trauma, Concussions, and Return to Play: What Otolaryngologists Need to Know
Authors: Kellman Robert M. , Tatum Sherard A. , Jeyakumar Anita S. , Tollefson Travis T. , Doerr Timothy D. , Brickman Todd M.
Published: September 2014

Program Description:

Concussions and return to play are public health concerns that are gaining coverage as incidence and public awareness increases. Otolaryngologists play an increasing role in the diagnosis of facial trauma and concussions. Not only does the public and health community look to head and neck surgeons for facial trauma treatment, but there is also increasing need for otolaryngologists to play a role in helping concussed athletes return to play. This miniseminar will present the relationship of facial trauma to concussions, review guidelines for diagnosing concussions, review guidelines for returning athletes to play, and review how otolaryngologists fit into the treatment algorithm.

Educational Objectives:

(1) Consider the relationship between facial trauma and concussions. (2) Cite the criteria for diagnosing concussions and returning athletes back to play. (3) Determine the role the otolaryngologist plays in helping the athlete return to play.
Academic Bowl
Authors: Wax Mark K. , Malekzadeh Sonya
Published: September 2014

Program Description:

The academic bowl has been an annual interactive resident competition at the American Academy of Otolaryngology—Head and Neck Surgery Foundation annual meeting for the past 8 years. Four teams from across the country are selected based on strict academic criteria. These programs send 3 residents to represent them in an interactive question‐and‐answer format. The educational committees of the foundation develop questions. They are presented to the teams and the audience. Each team responds, and the audience is given a chance to pit their knowledge against the residents’. The resident team with the best score at the end of the competition wins a prize.

Educational Objectives:

(1) Attendees will be able to see what the current level of knowledge is in various subspecialties of otolaryngology. (2) Attendees will be able to compare their knowledge base to residents across a wide range of topics. (3) Attendees will be able to determine areas of weakness in their knowledge base as compared with residents.
Challenging Cough Cases: A Protocolized Approach
Authors: Altman Kenneth W. , Krouse John H. , Luong Amber U. , Lane Andrew P. , Carroll Thomas L. , Rosen Clark A.
Published: September 2014

Program Description:

Chronic cough is an increasingly important public health concern, accounts for a large number of ambulatory care visits, and often involves a protracted clinical course. Otolaryngologists play a critical role in the care of these patients because of our interdisciplinary approach to the aerodigestive tract and our mastery of many procedures used to evaluate and treat related conditions. This miniseminar will present challenging cases with panel discussion and audience participation to emphasize evidence‐based practice and the “state‐of‐the‐art” for patients with chronic cough. Controversial areas will include prioritization, the use of evidence‐based protocols, and the importance of early diagnosis in value‐based health care.

Educational Objectives:

(1) Describe evidence‐based treatment guidelines in the evaluation and treatment of chronic cough. (2) Use the spectrum of common and uncommon causes of chronic cough with an appreciation of the underlying physiology. (3) Evaluate these complex patients, perform objective testing when indicated, and prescribe appropriate pharmacotherapy for patients with chronic cough.
Global Health 2014: Our Academy around the World
Authors: Saunders James E. , Al‐Hagr Abdulrahman A. , Saim Dato Lokman , Betka Jan , Letort Jose J. , Ferreras Freddy A. , Howard David J.
Published: September 2014

Program Description:

This international symposium will focus on the Academy's international relations and activities in a variety of key regions around the globe. President Richard W. Waguespack, MD, will welcome the audience, and president‐elect Gayle Woodson, MD, will describe her vision for enhanced international collaboration. The American Academy of Otolaryngology—Head and Neck Surgery Foundation Regional Advisors for the Europe, Middle East, Pacific Rim, and Turkey/Greece/the Balkans will introduce eminent speakers to describe the state of otolaryngology in these regions and subject areas, including socioeconomic and workforce issues.

Educational Objectives:

(1) Understand the myriad ways the Academy interacts with otolaryngology communities in different regions. (2) Appreciate the opportunities for collaboration in scientific exchange, research, fellowships, and observerships. (3) Learn the Academy's resources available to members, subscribers, meeting attendees, and Web visitors.
High‐Performance Operating Rooms: Beyond the Checklist
Authors: Venkatraman Giri , Eibling David E. , Roberson David W.
Published: September 2014

Program Description:

Despite adoption of checklists and timeouts in many operating rooms across the country, surgical errors continue to happen. Our program will address some of the myths associated with checklists, including that stand‐alone error prevention strategies such as checklists prevent wrong‐side surgeries or that checklists should be mandated and will prevent errors. We will then discuss how the checklist process needs to be augmented with specific surgeon‐as‐leader behaviors: effective team building, communication, and creating a safety focus. We will also discuss some of the challenges around developing and building these techniques and behaviors in our institutions.

Educational Objectives:

(1) At the end of this session, attendee surgeons will demonstrate improved leadership skills. (2) Upon completing this session, attendee surgeons will learn the skills necessary to establish a high‐functioning team.
The Pearls and Pitfalls of Grant Writing: Maximizing Your Funding
Authors: Schmalbach Cecelia E. , Rosenthal Eben L. , Couch Marion E. , Pynnonen Melissa A. , Liu Jeffrey C. , St. John Maie
Published: September 2014

Program Description:

Seeking an edge in the competitive grant world? This interactive miniseminar will provide a comprehensive review of key elements to a fundable grant. Practical tips on scientific writing, building a productive research team, and maximizing resources will be provided. An overview of basic statistics will help to maximize collaborative efforts with your statistician. Gain insight into the scoring process from an experienced National Institutes of Health reviewer who will highlight common pitfalls. Current 2014 funding mechanisms will also be provided. Residents and faculty new to the grant process, as well as researchers striving to improve their score, will benefit from this course.

Educational Objectives:

(1) Explain key components of a grant to include hypothesis, specific aims, timeline, statistics, budget, and institutional review board. (2) Describe the scoring mechanism, review process, and common pitfalls leading to an unfundable grant. (3) Recognize current grant mechanisms and funding opportunities, with emphasis of American Academy of Otolaryngology—Head and Neck Surgery Foundation CORE grants, K‐awards, and R‐01 funding.
Technology with a Twist: Tools and Techniques to Advance Patient Care and Inspire Innovation
Authors: Devaiah Anand K. , Batra Pete S. , Moe Kris S. , Artz Gregory J. , Wormald Peter J. , Holsinger Chris
Published: September 2014

Program Description:

There are significant technological advances occurring in different otolaryngology subspecialties. In addition, there are many opportunities for cross‐pollenization of ideas to envision novel ways to use these technologies. In this miniseminar, the participant will learn about novel technologies being applied in a selected number of technology‐heavy areas of otolaryngology. The panel and audience will engage in an interactive discussion about the different technologies and where else these could be employed or changed to solve other clinical problems. Topics include intraoperative computed tomography advances, vascular injury and control, frontiers in robotic surgery, computer‐assisted surgery, middle ear gels, 3‐dimensional printing, and biomaterials.

Educational Objectives:

(1) Discuss new technologies being applied in different fields within otolaryngology. (2) Review where these technologies have inherent strengths and limits in their current application. (3) Synthesize new and unique applications for these technologies in otolaryngology.
Beyond Stones: Other Indications for Sialendoscopy
Authors: Gillespie M. Boyd , Eisele David W. , Schaitkin Barry M. , Walvekar Rohan R. , Joshi Arjun S. , Hoffman Henry T.
Published: September 2014

Program Description:

Sialendoscopy is recognized as a first‐line option in the management of salivary stones. The role of sialendoscopy in nonstone disorders is less clear. This miniseminar focuses on the indications and applications of sialendoscopy for nonstone disorders including ductal scar and trauma, Sjogren disease, radioiodine sialadenitis, and recurrent juvenile parotitis. The moderator will present cases of nonstone disorders to a panel of experts in order to determine their use of sialendoscopy in the management of these disorders. The discussion will conclude with a brief overview of the current best evidence of the role of sialendoscopy in the management of nonstone disorders.

Educational Objectives:

(1) Recognize which nonstone salivary disorders may benefit from sialendoscopy. (2) Learn techniques for applying sialendoscopy to nonstone disorders. (3) Understand the outcomes and limitations of sialendoscopy in the management of nonstone disorders.
Clinic‐Based Decision Making for Head and Neck Endocrine Disease
Authors: Smith Russell B. , Tufano Ralph P. , Steward David L. , Shindo Maisie L. , Caruana Salvatore M. , Hunt Jason P.
Published: September 2014

Program Description:

Patients with thyroid and parathyroid disease are commonly encountered in a head and neck surgery practice. While the evaluation and management of many patients is relatively straightforward, others are significantly more complicated. The goal of this session is to discuss complex clinical scenarios encountered in the outpatient clinic. The cost‐effective use of diagnostic testing as well as the factors critical in treatment planning will be outlined. The entities reviewed will include fine‐needle aspiration for thyroid nodules, surveillance of patients with well‐differentiated thyroid cancer, and evaluation and decision for surgery in hyperparathyroidism.

Educational Objectives:

(1) Describe the appropriate use of fine‐needle aspiration biopsy with a focus on implementing the use of molecular markers into the diagnostic evaluation. (2) Explain the indications for adjuvant radioactive iodine therapy in patients with low‐, intermediate‐, and high‐risk well‐differentiated thyroid cancer. (3) Implement a cost‐effective approach to preoperative imaging in a patient with primary and recurrent hyperparathyroidism.
The Human Papillomavirus Discussion: The Latest Data and How to Counsel Patients
Authors: Smith Richard V. , Khariwala Samir S. , Malloy Kelly M. , Moore Michael G. , Gosselin Benoit J.
Published: September 2014

Program Description:

Human papillomavirus (HPV)–related oropharyngeal cancer is now recognized as a clinically distinct entity, and data describing the nature of the epidemic, optimal treatment strategies, and survival outcomes are rapidly developing. Our patients are asking pertinent questions about HPV transmission, the role of vaccination, and monitoring recommendations. This miniseminar will update practitioners on the accuracy of testing, how to counsel patients and families regarding the nature of HPV infection (risk and transmissibility), vaccination, the management of benign lesions, and surveillance. This panel will appeal broadly to trainees, general otolaryngologists, and head and neck surgical oncologists.

Educational Objectives:

(1) Advise patients and partners regarding HPV infection and transmission. (2) List the Centers for Disease Control and Prevention recommendations for HPV vaccination. (3) Develop a surveillance plan for patients with HPV and their families.
Surgery with Optical Imaging: Fluorescence‐Guided and Molecular Navigation
Authors: Nguyen Quyen T. , Rosenthal Eben L. , Vahrmeijer Alex L.
Published: September 2014

Program Description:

The next breakthrough in surgery will be intraoperative visualization of key normal structures and diseased tissue in real time using biological targeting compounds. Agents for visualizing blood flow are currently available to evaluate flap perfusion or vessel dynamics and sentinel node detection. Both antibody‐based agents and small molecules with high‐affinity target binding linked to fluorophores can be detected with high sensitivity using currently available cameras. Agents are being developed for imaging nerves. There are active clinical trials to image cancer cells to ensure complete resection. This miniseminar will provide an overview of agents that are currently available and in development.

Educational Objectives:

(1) Describe the utility of optical imaging in head and neck surgery. (2) Implement currently available optical imaging agents in surgical practice. (3) Analyze validity of new agents and instruments that will be coming to the market for surgical optical imaging.
Thyroid Surgical Care 2014: Ultrasound, Fine‐Needle Aspiration, Molecular Testing, and the American Thyroid Association Guidelines
Authors: Witt Robert L. , Randolph Gregory W. , Steward David L. , Pribitkin Edmund A. , Ferris Robert L.
Published: September 2014

Program Description:

Evaluation of thyroid nodules with surgeon‐performed ultrasound and fine‐needle aspiration (FNA), armed with molecular testing, is rapidly transforming thyroid surgery. Didactic presentations and case studies including American Thyroid Association (ATA) guidelines will provide participants with risk stratification using ultrasound and pearls for surgeon‐performed FNA. Molecular Classifiers have a 95% negative predictive value for indeterminate nodules reducing unnecessary diagnostic lobectomies. Molecular alteration testing from FNA with panels including BRAF is 100% specific for papillary thyroid cancer and has evolved into next‐generation sequencing from the cancer genome atlas (TCGA). Combined mutation marker analysis has improved prognostic information. Personalized thyroid cancer surgical management is approaching.

Educational Objectives:

(1) Explain that Molecular Classifier testing for cytologically indeterminate nodules may reduce the number of unnecessary diagnostic thyroid lobectomies. (2) Recognize next‐generation sequencing and the cancer genome atlas for cytologically indeterminate nodules will improve the diagnosis of thyroid cancer. (3) Interpret ATA guidelines for ultrasound, FNA, molecular testing, and prognostication.
Patient Satisfaction Charm School: Understanding and Improving Scores in Otolaryngology
Authors: Boss Emily F. , Stachler Robert J. , Kokoska Mimi S. , Rowe‐Gorosh Marla
Published: September 2014

Program Description:

Patient satisfaction is an emerging theme in modern health care, and there are myriad federal‐, state‐, institutional‐, and practice‐level initiatives that emphasize systematic measurement and public reporting of patient satisfaction scores. Moreover, patient satisfaction scores are increasingly weighted in reimbursement formulas and pay‐for‐performance initiatives. This course will introduce the significance of patient satisfaction in otolaryngology, review nuts and bolts of patient satisfaction measurement and reporting, and offer effective and simple techniques for providers to better communicate with patients and improve satisfaction scores, even within the time constraints of modern practice.

Educational Objectives:

(1) Recognize patient satisfaction as a quality indicator and learn initiatives surrounding measurement, reporting, and benchmarking of patient satisfaction scores. (2) Explain how patient satisfaction scores affect the bottom line (correlate with productivity, market share, and reimbursement. (3) Practice techniques for communication with patients that will result in greater patient engagement and increased satisfaction scores.
Cough: Contemporary Challenges
Authors: Stachler Robert J. , Bock Jonathan M. , Cohen Seth M. , Altman Kenneth W.
Published: September 2014

Program Description:

The purpose of this miniseminar is to present the contemporary management of cough. This miniseminar will thoroughly cover the most common etiologies of cough and its current management. A description of the sensory receptors, hyperexcitability related to neuropathy (including postviral), pharmacologic suppression of hyperexcitability, and management of pertussis (whooping cough) will be presented. If time allows, a few difficult cases will be presented that highlight the current management strategies.

Educational Objectives:

(1) Explain the multiple etiologies for cough and its management. (2) Examine the complex relationship between the cough receptors and the larynx. (3) Illustrate pertussis resurgence and contemporary management.
It's Not Always Reflux: What Are We Missing?
Authors: Pitman Michael J. , Bock Jonathan M. , Cohen Seth M. , Courey Mark S.
Published: September 2014

Program Description:

Laryngopharyngeal reflux (LPR) is commonly diagnosed in patients seen by otolaryngologists. Prescribing of proton pump inhibitors (PPIs) increased 5‐fold from 1990 to 2001 and accounts for 10% of costs in evaluation and management of patients with voice disorders. In response, 46.5% of general otolaryngologists feel they are overdiagnosing LPR. Considering this, what diagnoses are otolaryngologists missing due to the reflexive diagnosis of LPR? The goal of this program is to present a clear clinical approach to the diagnosis and treatment of patients complaining of LPR‐like symptoms and suggest alternative diagnoses and treatments as well as an approach to patients unresponsive to PPI therapy.

Educational Objectives:

(1) Diagnose efficiently and effectively treat a patient who has LPR‐like symptoms but is unresponsive to PPI management. (2) Describe the unified airway concept and how it alters the diagnostic and therapeutic approach to patients with LPR‐like symptoms. (3) Implement treatment for postviral vagal neuropathy and irritable larynx syndrome.
Management of Bilateral Vocal Fold Immobility
Authors: Khosla Sid , Hillel Alexander T. , de Alarcon Alessandro , Halum Stacey L. , Sulica Lucian , Woodson Gayle E.
Published: September 2014

Program Description:

This miniseminar will address workup and surgical treatment of acute and chronic bilateral vocal fold immobility due to neurological and mechanical injury. Diagnostic challenges will be discussed including how to determine the cause of immobility and whether to use electromyography. Options for acute treatment will include observation, tracheotomy, the use of botulism toxin, and endoscopic lateralization. We will explore how to choose endoscopic versus open procedures for chronic disease and analyze how the choice of procedure depends on the age of the patient and the cause of immobility. There will be an emphasis on case studies and audience participation.

Educational Objectives:

(1) Differentiate between neurological and mechanical causes of bilateral vocal fold immobility. (2) Consider the advantages and disadvantages of all endoscopic and open procedures for bilateral immobility due to a neurological cause. (3) Consider the advantages and disadvantages of all endoscopic and open procedures for bilateral immobility due to cricoarytenoid joint fixation or glottal stenosis.
Vocal Fold Leukoplakia: Controversies in Evaluation and Treatment
Authors: Akst Lee M. , Altman Kenneth W. , Burns James A. , Califano Joseph , Quon Harry , Remacle Marc J.
Published: September 2014

Program Description:

This miniseminar comprehensively reviews evaluation and management of laryngeal leukoplakia. Although white vocal fold lesions are common, management remains challenging. Doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia. Within a framework balancing oncologic with functional outcomes, and using case‐based presentations, this miniseminar highlights challenges, controversies, and emerging paradigms in laryngeal leukoplakia care. Perspectives from laryngology, head and neck oncology, and radiation oncology will discuss innovations such as narrow‐band imaging, optical coherence tomography, potassium titanyl phosphate (KTP) and CO2 laser, chemotherapy, radiotherapy, and photodynamic therapy as they apply to current and future state‐of‐the‐art management.

Educational Objectives:

(1) Understand the risk of progression of laryngeal leukoplakia to carcinoma and need to balance oncologic efficacy with functional outcomes in leukoplakia care. (2) Review current and emerging techniques for accurate diagnosis, staging, and surveillance of laryngeal leukoplakia. (3) Discuss treatment alternatives for laryngeal leukoplakia, emphasizing surgical techniques of KTP, CO2, and cold‐instrument phonosurgery and including potential roles of radiotherapy, photodynamic therapy, and chemotherapy.
Current and Developing Management of Single‐Sided Deafness
Authors: Wazen Jack J. , Soli Sigfrid D. , Young Nancy M. , Goddard John C. , Gantz Bruce J. , Roland J. Thomas
Published: September 2014

Program Description:

The single‐sided deafness (SSD) handicap has been underestimated. The purpose of this miniseminar is to present the latest research on the benefits of binaural hearing (Sig Soli, PhD), and the impact of SSD on childhood development and school performance (Nancy Young, MD). The different rehabilitation methods available will be presented, including osseointegrated bone conduction technologies (Jack J. Wazen, MD) and nonsurgical options (John Goddard, MD). Future trends and clinical research on the use of cochlear implants in SSD will be presented (Bruce Gantz, MD, and Tom Roland, MD). Open discussion, questions, and audience participation will follow the presentations.

Educational Objectives:

(1) Recognize the benefits of binaural hearing in children and adults and the potential deficits imposed by SSD. (2) Differentiate between surgical and nonsurgical options in the rehabilitation of SSD. (3) Use developing technologies and clinical research in the rehabilitation of SSD, including the use of cochlear implants.
Protect Your Practice, Protect Yourself, and Protect Your Family
Authors: Bhatt Nikhil J. , Abaza Mona M. , Kelley Kanwar S. , Khalid Ayesha N. , Church Steve , Matthes William , Lee K. J.
Published: September 2014

Program Description:

Physicians must confront significant financial issues over the course of their careers. These issues can be especially problematic for young physicians entering practice, although decisions around professional and personal finance must be made throughout one's career. Matters such as professional liability, asset protection, practice management, employment contracting, and retirement planning all must be addressed proactively and confidently for maximal financial benefit. This miniseminar will include presentations from physicians and financial professionals that highlight these important decisions and considerations for otolaryngologists. Representatives of Academy committees will participate in an interactive discussion around central topics of vital interest to practicing physicians.

Educational Objectives:

(1) Recognize the importance of building and protecting their practices. (2) Preserve their investment in their futures. (3) Examine employment contracts and retirement planning.
AAO‐HNSF: A Clinical Consensus Statement on Pediatric Recurrent and Chronic Rhinosinusitis
Authors: Brietzke Scott E. , Rosenfeld Richard M. , Shin Jennifer J.
Published: September 2014

Program Description:

This clinical consensus statement was developed by a multidisciplinary panel of experts to improve patient care and outcomes for pediatric patients with chronic and recurrent rhinosinusitis. Clinical statements were developed using the modified Delphi technique to optimize expert consensus. Clinical statements were developed to specifically address differences between and within medical disciplines regarding the diagnostic methods for pediatric rhinosinusitis and in both the medical and surgical therapeutic approaches for the management of pediatric rhinosinusitis. This miniseminar will review the key results of the panel's efforts as well as critically assess the available, supporting evidence.

Educational Objectives:

(1) Review the key clinical factors that distinguish acute and/or chronic rhinosinusitis from other common illnesses such as viral upper respiratory infection or allergic rhinitis. (2) Assess the most useful diagnostic measures to establish the diagnosis of rhinosinusitis in children. (3) Explore the stepwise recommended medical and surgical treatment approaches for pediatric rhinosinusitis.
The Role of Otolaryngologists in the Accountable Care Organization: Pros and Cons
Authors: Lee K. J. , Das Subinoy , Dillon Jane T. , Nielsen David R. , Setzen Gavin
Published: September 2014

Program Description:

There are many questions about the role of otolaryngologists in an Affordable Care Organization (ACO). Our team of experts from private practice to academia, from administration to technology, will engage the audience. We will incorporate content that focuses on patient care, quality improvement, and access. We will welcome questions and advice from the audience.

Educational Objectives:

(1) Make an informed decision whether to join or not to join an ACO. (2) Recognize the pros and cons to such a decision. (3) Manage the risk involved in this decision.
American Academy of Otolaryngology—Head and Neck Surgery Foundation Clinical Practice Guidelines: Allergic Rhinitis
Authors: Seidman Michael D. , Gurgel Richard K. , Lin Sandra Y. , Schwartz Seth R.
Published: September 2014

Program Description:

Allergic rhinitis is a worldwide health problem affecting 30 to 60 million people in the United States annually, including up to 30% of adults and as many as 40% of children. The multidisciplinary, AAO‐HNSF‐developed Clinical Practice Guideline: Allergic Rhinitis, will be presented. The evidence‐based recommendations are designed for clinicians involved in the diagnosis and management of patients with allergic rhinitis.

Educational Objectives:

(1) Properly diagnosis allergic rhinitis. (2) Differentiate between allergic and non‐allergic rhinitis. (3) Know when to perform allergy testing; and understand the role of immunotherapy (sublingual and subcutaneous).
Food Allergy 2014: State of the Science
Authors: Reisacher William R. , Calhoun Karen H. , Damask Cecelia , Veling Maria C.
Published: September 2014

Program Description:

This miniseminar includes 3 didactic lectures, an audience‐interactive section, and Q&A. The lectures will focus on why food allergies develop by taking a critical look at the latest scientific evidence available in the literature, the role of oral tolerance in human evolution, and the relationship of failure to achieve oral tolerance on the health of the individual, relevant immunology, nonimmunologic food reactions versus immunologic reactions, both IgE‐mediated and non–IgE‐mediated, current methods of diagnosing food allergies, cutting‐edge strategies such as component‐resolved testing, skin and in vitro methods versus double‐blind, placebo‐controlled food challenge. Treatment options for food allergy will also be discussed.

Educational Objectives:

(1) Evaluate the scientific basis of IgE‐ and non–IgE‐mediated food allergy. (2) Describe the manifestations of food allergy in the head and neck region. (3) Use the currently available treatments for food allergy as well as future directions.
Take the Media Plunge: Become an Expert, Enhance Your Practice, Engage Your Patients
Authors: Stern Wendy B. , Tylor Dale A. , Jameson Marni , Medalie Melissa
Published: September 2014

Program Description:

Unprecedented availability of health‐related information on the Internet, television, radio, and print has empowered our patients to play larger roles in medical decision making. Increasingly, to help educate a knowledge‐hungry public and to help build their practices, otolaryngologists must interact with journalists. Formal media training is often lacking in residency or fellowship, making this task seem daunting. This miniseminar reveals the multitude of media opportunities, including those on the Academy Web site, and how to best interact with journalists and the public. Speakers include renowned television and print health journalists and otolaryngologists with media experience. Audience participation is encouraged.

Educational Objectives:

(1) Improve their communication with journalists. (2) Recognize the opportunities within and outside the Academy for print, television, radio, and online media exposure. (3) Increase involvement with the media to enhance your practice and educate your patients.
Postop Care after Endoscopic Sinus Surgery: Packing, Spacers, or Nothing
Authors: Citardi Martin J. , Han Joseph , Marple Bradley F. , Orlandi Richard R. , Wormald Peter J.
Published: September 2014

Program Description:

Since the introduction of endoscopic sinus surgery, surgeons have debated the merits of middle meatus packing. Many surgeons favor a middle meatal spacer, rather than packing, since the former implies an intentional design for better wound healing. Recently, the emphasis has been upon dissolvable or fragmentable materials that may exert positive effects upon wound healing, and a dissolvable stent that provides drug delivery has also been introduced. In addition, some surgeons do not use any materials whatsoever in the middle meatus after surgery. This miniseminar will feature evidence‐based reviews of the published trials, as well as practical knowledge from experienced surgeons.

Educational Objectives:

(1) Comprehend the principles of biomaterials selection for placement in the nose and paranasal sinuses. (2) Review principles of postoperative care with an emphasis on integration into the global surgical strategy. (3) Compare various middle meatal spacers, including chitosan, esterified hyaluronic acid, steroid‐releasing implant, and synthetic fragmental foam sponge.
Tackling Problematic Chronic Rhinosinusitis: Technical Pearls on Optimizing Outcomes from Endoscopic Sinus Surgery
Authors: Lal Devyani , Casiano Roy R. , Chandra Rakesh K. , Hwang Peter H. , Senior Brent A. , Stankiewicz James A.
Published: September 2014

Program Description:

Failure of adequate response to endoscopic sinus surgery (ESS) is a frequent cause of frustration to chronic rhinosinusitis patients and their surgeons. Technical execution of ESS may be a factor in some common findings at revision ESS (middle meatal adhesions, lateralized middle turbinate, missed maxillary ostium, residual uncinate process, residual anterior and posterior ethmoid cells, sphenoid ostium stenosis, and frontal recess scarring). Using real‐life demonstrative cases, our expert panel will share practical and key technical pearls on optimizing results from ESS. These include simple modifications in surgical techniques, selection of procedure appropriate to disease, and incorporation of state‐of‐the‐art technology (endoscopes, instrumentation, navigation, etc).

Educational Objectives:

(1) Recognize technical causes of failure of satisfactory response from ESS. (2) Implement changes in surgical techniques to optimize technical execution of ESS. (3) Learn to use technology and instrumentation to improve execution and completeness of ESS.
Controversies in Management of the Nasal Airway and Sleep Disorders
Authors: Woodson B. Tucker , Rotenberg Brian , Soose Ryan J. , Friedman Michael , Ishman Stacey L.
Published: September 2014

Program Description:

Surgical and medical management of the nasal airway has traditionally not been considered primary indication for sleep disorders’ treatment. Controversy exists over nasal surgery as primary treatment of snoring and sleep apnea. Algorithms to manage sleep‐disordered breathing often ignore or dismiss the nasal airway. This miniseminar addresses the following controversies: (1) Is the nasal airway an important contributor to sleep disorders? (2) Does nasal surgery affect sleep? (3) Does nasal treatment affect the use of continuous positive airway pressure? and (4) What is the role and documented effect of nasal surgery sleep apnea treatment in adults and children?

Educational Objectives:

(1) Justify using appropriate evidence‐based outcome metrics of medical and surgical treatment of the nose for specific sleep‐related breathing disorders. (2) Compare medical outcomes of sleep apnea treatment with and without treatment of nasal obstruction. (3) Describe potential differences and obstacles in treating nasal obstruction using traditional definitions versus treating it as a spectrum of sleep disordered breathing.
Palate Surgery in Obstructive Sleep Apnea: How to Choose among the Options
Authors: Kezirian Eric J. , Weaver Edward M. , Li Hsueh‐Yu , Woodson B. Tucker , Friedman Michael , Cahali Michel B. , Pang Kenny P.
Published: September 2014

Program Description:

Palate surgery is the primary surgical approach for treatment of obstructive sleep apnea. Although uvulopalatopharyngoplasty (UPPP) was described 30 years ago, the past 10 to 15 years have witnessed the development of alternative palatoplasty techniques. This miniseminar draws from leading surgeons who have developed these procedures and/or performed clinical trials related to them. Findings from published studies will enable attendees to learn more about selection from among the procedures for their patients.

Educational Objectives:

(1) Interpret evidence regarding the range of palatoplasty techniques: UPPP, modified expansion sphincter pharyngoplasty (aka functional expansion pharyngoplasty), relocation pharyngoplasty, lateral pharyngoplasty, Z‐palatoplasty, and palatal advancement. (2) Identify the key patient characteristics to guide the selection among palate surgery techniques.