bluuebunny/crossref_metadata_2025 huggingface dataset:
General Otolaryngology
Authors: Osguthorpe J. David , Wax Mark K.
Published: September 2011

Program Description

The Academic Bowl pits four of the top otolaryngology residency programs in the country (Loyola University Medical Center; University of Mississippi Medical Center; Tulane University School of Medicine; and University of Texas Southwest) in a clinically oriented test of knowledge. While the programs compete, the audience can participate with the residents through the audience response system. Audience members can also earn CME/CE credit and review for MOC.

Educational Objectives

1) Test knowledge of current diagnosis and management of diseases of the head and neck. 2) Identify areas meriting further study before the Maintenance of Certification or Board Certification examinations. 3) Gain familiarity with the question format utilized by Annual Inservice and American Board of Otolaryngology exams.
Avoiding Disaster at the Skull Base: Case Studies in 3D
Authors: Snyderman Carl H. , Friedman Rick A. , Fernandez‐Miranda Juan M.
Published: September 2011

Program Description

Disaster awaits unprepared surgeons at the skull base. Multiple routine surgeries in otolaryngology are in close proximity to the skull base. Potential risks of endoscopic sinus surgery include cerebrospinal fluid leak, loss of olfaction, penetrating brain injury, visual loss, hemorrhage from the internal carotid artery, and loss of trigeminal sensory and motor function. Potential risks of temporal bone and lateral approaches include vascular injuries of the sigmoid sinus, jugular bulb, and internal carotid artery; injury to cranial nerves 7‐12; cerebrospinal fluid leak, intra‐ and extradural hemorrhage; and brain trauma. A thorough understanding of skull base anatomy is essential for avoiding such complications during routine surgical procedures. In this miniseminar, case studies will be used to demonstrate potential risks of standard surgical procedures relative to the skull base. Important anatomical landmarks and relationships will be presented in 3D using cadaveric dissections and intraoperative photographs. Strategies to avoid skull base complications will be discussed with an emphasis on everyday surgical procedures.

Educational Objectives

1) Understand key anatomical relationships at the skull base. 2) Relate skull base anatomy to anterior and lateral skull base approaches. 3) Apply anatomical knowledge to avoid surgical complications.
Challenging Cough Cases: A New Frontier in Otolaryngology
Authors: Altman Kenneth W. , Krouse John H. , Johns Michael M. E. , Carroll Linda M. , Murry Thomas
Published: September 2011

Program Description

Both acute and chronic cough are responsible for a significant portion of all ambulatory medical visits annually (about 3%), over‐the‐counter self‐medication expenses in excess of $3.6 billion in the United States, and impaired quality of life. According to 2007 data, there were more than 27 million visits to all physicians for cough, but that same year otolaryngologists saw a total of only 17 million visits for all diagnoses. This suggests a large unmet need for otolaryngologists to participate in the care of these patients. The diagnosis of cough can be simple or profoundly challenging, and it may be a sentinel indicator of severe underlying disease. The list of diseases that may induce cough is growing, along with an appreciation of their interrelations. For example, the Unified Airway concept supports our long‐held observation that the upper and lower airway diseases are closely related. There is also a spectrum of overlapping asthmatic, non‐asthmatic, and suppurative pulmonary disease. Gastroesophageal reflux (both distal and proximal LaryngoPharyngeal Reflux), along with neurologic reflexes and aspiration are similarly important. And the complex interplay of neurologic reflexes for cough in the brainstem may result in paradoxical vocal fold motion and disordered breathing. Otolaryngologists are playing an increasingly important role in the multidisciplinary evaluation of these challenging patients, and mastering many procedures associated with cough patients. The spectrum of medical specialists also includes pulmonology and chest physicians, allergy and immunology, gastroenterology, neurology, cardiology, infectious disease, speech and swallowing pathologists, as well as psychiatry. This miniseminar will involve the use of case presentations, panel discussion and audience participation to emphasize evidence‐based practice and “state‐of‐the‐art.” Controversial areas will include the inter‐relatedness of the disease, the role of speech therapy in disordered breathing, and the importance of early diagnosis in value‐based healthcare.

Educational Objectives

1) Learn the spectrum of common and uncommon causes of chronic cough. 2) Understand evidence‐based treatment guidelines in the evaluation and treatment of these patients. 3) Be prepared to participate in interdisciplinary discussion of these patients at their home institution.
Cochrane Reviews and Evidence‐Based Healthcare
Authors: Rosenfeld Richard M. , Burton Martin J. , Rhee John S. , Shin Jennifer J.
Published: September 2011

Program Description

This miniseminar, taught by leadership from the AAO‐HNS and the Cochrane Collaboration, will empower attendees to use Cochrane reviews of interventions as a platform for evidence‐based healthcare. Cochrane Reviews are systematic reviews of primary healthcare research on prevention, treatment, rehabilitation, and diagnostic test accuracy. Each review addresses a clearly formulated question; for example: Do perioperative antibiotics improve recovery after tonsillectomy? All the existing primary research on a topic that meets certain criteria is searched for and collated, and then assessed using stringent guidelines, to judge the level of evidence for, or against, a specific intervention. Evidence‐based healthcare is the conscientious use of current best evidence, derived ideally from systematic review, in making decisions about the care of individual patients or the delivery of health services. Recognizing the increasing role of evidence‐based health care in otolaryngology, the AAO‐HNS has partnered with the Cochrane ENT Disorders Group since 2006. This miniseminar is one product of that partnership, along with other efforts to enhance the AAO‐HNS journal, annual meeting, research agenda, and quality initiatives. Attendees will learn of these efforts including ways to obtain Academy‐sponsored travel grants to the annual meeting of the Cochrane Collaboration. Time is allotted at the end of the session for audience questions to the expert panel.

Educational Objectives

1) Appreciate how systematic review of interventions facilitates evidence‐based healthcare. 2) Understand why Cochrane reviews are important to otolaryngologists and their patients. 3) Learn how to read a systematic review, interpret results, and apply findings to patient care.
Corticosteroid Use in Otolarynogology: What Does the Recent Evidence Tell Us?
Authors: Parnes Lorne S. , Stewart Michael G. , Hartnick Christopher J. , Piccirillo Jay F.
Published: September 2011

Program Description

Both oral and topical corticosteroids are used frequently in the practice of otolaryngology. Their use is often based on historical evidence rather than clinical research. First, we will overview corticosteroids’ mechanisms of action and their adverse effects. We will then present a brief overview on evidence‐based medicine and grade the evidence to help the audience understand how the studies which we are discussing fit into the overall scheme of “best evidence.” We will then present short case examples in each of the subspecialty areas of otology/neurotology, rhinology, laryngology/head and neck surgery, and pediatric otolaryngology. We will poll the audience if, and how, they might use corticosteroids in these case examples. We will then have clinician scientists who have expertise in each of these areas review the recent evidence in the literature to see if there is any scientific support for their use. Where possible, we will reference clinical practice guidelines. Representative acute cases might include Bell’s palsy, sudden deafness, nasal polyposis, acute laryngotracheobronchitis, and deep neck space infections. We will then re‐poll the audience for any changes of opinions. We will also discuss the general perioperative use of corticosteroids in ear surgery, sinus surgery, laryngeal surgery, and tonsillectomy. We feel that this mini‐seminar will be of great importance to the general otolaryngologist, providing them with the knowledge of when and when not to use corticosteroids in both their office and surgical practices.

Educational Objectives

1) Learn the evidence behind using corticosteroids in various otolaryngological disorders. 2) Understand the different oral and topical corticosteroid regimes. 3) Learn the proper use of corticosteroids in several common disorders.
Device Complications: What Does the Surgeon Do?
Authors: Park Albert H. , D’Eredita Riccardo , Smith Gina A. Maisto
Published: September 2011

Program Description

Medical device failures are commonly associated with surgical complications. In late 1997, the US FDA (Food and Drug Administration) reported that it receives approximately 100,000 medical device reports a year, and the agency considers this number just the tip of the medical device problem iceberg. Any surgeon is very likely to experience this complication in his or her operative career. The Pediatric Otolaryngology and the Medical Devices and Drugs Committee decided to organize a miniseminar to provide guidelines to surgeons experiencing this complication and for surgeons wishing to be informed to device failures. The symposium will be divided into two major parts. In the first part, clinical cases associated with medical device failures will be presented. The impact of one of these cases based on a national survey of pediatric otolaryngologists will be highlighted. The second part will then include the medicolegal ramifications, disclosure to patients and families, and resources available for the surgeon to report and receive updates on device failures.

Educational Objectives

1) Learn the role of the surgeon in disclosing device complications to patients and national reporting agencies. 2) Learn the medicolegal ramifications of a device failure to the surgeon. 3) Learn how an otolaryngologist can keep him or herself informed of device recalls or complications.
Failure on the Newborn Infant Hearing Screen: What’s Next?
Authors: Buchman Craig A. , Greinwald John H. , Papsin Blake C. , Roush Patricia A. , Niparko John K.
Published: September 2011

Program Description

Hearing screening for newborn infants has become commonplace. The Joint Commission on Infant Hearing (JCIH) in its position statements has created goals and guidelines for managing these children in a timely manner. The early hearing detection and intervention (EHDI) process is designed to maximize linguistic and communicative competence and literacy development for children who are deaf or hard of hearing. Without appropriate opportunities to learn language, these children will fall behind their hearing peers in language, cognition, and social‐emotional development. Such delays may result in lower educational and employment levels in adulthood. Early diagnosis and treatment of hearing impaired infants in the first year of life has been shown to avoid the detrimental effects of delayed action. Despite this fact and a high screening rate among programs (>95%), almost half of those infants who do not pass the initial screening fail to have appropriate and timely follow‐up including audiological and medical assessment by an individual with training in pediatric hearing disorders. Rather, families are often times reassured or misinformed by well‐intentioned professionals about this process and the consequences of delayed intervention. This miniseminar will provide the fundamental framework for obtaining timely and accurate audiological and medical diagnosis and hearing instrument fitting (hearing aids or cochlear implants). Recognized professionals in the field will cover topics such as electrophysiological hearing testing, practical application and results of amplification, medical assessment including radiological and genetic evaluation, and the criteria and results of cochlear implantation. Issues relevant to delayed diagnosis and intervention such as organizational structure, awareness, funding, and necessary political activity will be addressed.

Educational Objectives

1) Understand the significance of a failure result on the newborn infant hearing screening examination. 2) Learn the fundamental, multidisciplinary evaluation, and management paradigm for infants that fail the newborn screen. 3) Understand the cause and consequences of inappropriate or delayed intervention in hearing impaired children.
Economic Aspects of Head and Neck Oncologic Surgery: Implications for the Head and Neck Surgeon Now and in the Future
Authors: Jalisi Scharukh , Koch Wayne M. , Burkey Brian B. , Couch Marion E.
Published: September 2011

Program Description

Although head and neck oncologic surgery (HNOS) is time consuming, requires an effective team, and needs allotment of precious resources, financial compensation for the surgeon is relatively low so that financial inducements for a surgeon to do HNOS are diminishing. However, HNOS can generate significant revenue for a hospital. This miniseminar provides information about costs, revenue, profit/ loss analysis of many aspects of HNOS. Parameters pertaining to HNOS that will be defined and discussed include the following: relative value units (RVU’s) contribution margins, case mix index, allocated expenses, opportunity costs, comparative profitability of various different treatment modalities, and the impact of diminishing reimbursements. In addition we will explain the ways that an otolaryngology department can utilize hospital financial data to justify the commitment of the varied resources that are needed to do major HNOS cases and to safely take care of the patients following surgery. In addition, we will discuss the mandate from the Residency Review Committee that requires residency programs to provide experience for residents with HNOS index cases. We will discuss how to prepare financial data, economic projections, and a business plan in a way that is both comprehensible to hospital financial planners and sufficiently compelling to warrant the commitment of resources that is likely to enable a HNOS program to become vibrant and grow. Examples of successful efforts to garner hospital resources for HNOS will be provided. Risk management will be considered in an analysis of safety issues inherent in doing HNOS and providing postoperative care for patients with advanced disease. We will discuss the need to report outcome data to such external data repositories and agencies such as University Healthsystems Consortium (UHC), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and the US Department of Health and Human Services. Finally, we will discuss how imminent health care reform measures are likely to impact financial aspects of doing HNOS within the next few years including Accountable Care organizations and Health Innovation Zones.

Educational Objectives

1) Understand how to obtain and interpret hospital financial data that is pertinent for HNOS. 2) Discuss how imminent health care reform measures may impact financial aspects of doing HNOS. 3) Understand the constraints for academic success for a head and neck oncologic surgeon.
Global Health 2011: Our Academy Around the World
Authors: Randolph Gregory W. , Thomas J. Regan , Bebear Jean‐Pierre , Carcamo Carla M. , Grandison Barbara , Gomez Juan‐Manuel Garcia , Ibekwe Titus , Lund Valerie J. , Profant Milan , Sichel Jean‐Yves , Tong Michael , Uzun Cem
Published: September 2011

Program Description

This international symposium will showcase Academy relationships and activities in seven regions of the world. President J. Regan Thomas, MD, will describe his vision for enhanced international collaboration. Academy Regional Advisors who are on the International Steering Committee will introduce our eminent and wide‐ranging visiting speakers.

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.
Landmark Randomized Clinical Trials in Otolaryngology
Authors: Brietzke Scott E. , Weinberger Debra G. , Davis Greg , Schwartz Seth R.
Published: September 2011

Program Description

The randomized clinical trial (RCT) represents the pinnacle of the evidence‐based medicine (EBM) hierarchy. Although they are far from perfect in actual execution, RCTs do offer the highest quality evidence available and are deserving of careful review to determine the validity of the results and to consider how they may be used to improve clinical care. While not as common as would be desired, many RCTs have been published in the field of otolaryngology over the years. The purpose of this miniseminar is to succinctly, but thoroughly review some of the key RCTs that have been published in the realm of otolaryngology in the past 10 to 20 years to inform the audience of the results and how they could positively influence the evidence basis of their practice. In addition, the key elements of an RCT that make it Level 1 evidence and thus less prone to the problems of error and bias will be reviewed. A four member panel composed of a pediatric otolaryngologist, a rhinologist, a neuro‐otologist, and a sleep surgeon will present the miniseminar. The key RCTs that have been published in various areas of otolaryngology including otitis media, tonsillitis, hearing loss, rhinosinusitis, and sleep apnea will be reviewed in brief detail. The strengths and weaknesses of each trial and the potential impact of the results on clinical practice will be discussed. Interactive audience participation technology will be used to reinforce the presented material and stimulate audience interest. The attendee of this miniseminar should walk away having learned about some tangible, key published level 1 evidence which could lead to substantive changes in their clinical practice.

Educational Objectives

1) Understand the concept of the hierarchy of evidence and the key features of the RCT. 2) Learn about key RCTs that have been published in otolaryngology over the past 10 to 20 years. 3) Apply the findings of key RCTs to improve the evidence basis of one’s practice.
Misdiagnosis of Aging
Authors: Kost Karen M. , Malloy Kelly Michele , Calhoun Karen H. , Sataloff Robert T. , McKinnon Brian J.
Published: September 2011

Program Description

This miniseminar will illustrate the potential “misdiagnoses” of aging and highlight management of common geriatric symptoms. The presentation format will emphasize key points through illustrative cases. Audience participation will be encouraged through the use of interactive keypads. The population demographics of North America are changing rapidly, with an increasing number of elderly individuals. In otolaryngology, age‐related changes in hearing, vestibular function, smell, and phonation are recognized, as are changes in the soft tissues of the head and neck. Some of these changes are compounded by co‐morbidities in other organ systems. It is tempting to dismiss a geriatric patient’s complaints as part of “normal aging.” In doing so there is a risk of missing the same correctable pathology we see in younger patients. The presentation in elderly patients may be subtle and/or atypical, resulting in failure to order appropriate diagnostic tests. Symptoms commonly misdiagnosed as “normal” aging include dizziness, dysphonia, and rhinorrhea. Such assumptions may “blind” the otolaryngologist to treatable etiologies, such as benign positional vertigo, polypharmacy, or allergic rhinitis. The consequences of these potential misdiagnoses directly impact both the level of functioning and quality of life of the geriatric patient. Complaints should be attributed to aging only through exclusion or positive evidence. When this is the case, it is important to recognize that many of the symptoms may nonetheless be managed successfully. Presbyphonia may improve significantly with voice therapy and possibly vocal fold augmentation. Hearing loss frequently is amenable to rehabilitation with an appropriate hearing aid. Multiple symptoms are the rule rather than the exception, and treatment results in a more highly functioning patient with an improved quality of life. In some cases intervention may mean the difference between an autonomous individual and one who is dependent or living in a home.

Educational Objectives

1) Describe the problem of misdiagnosis. 2) Identify frequent misdiagnoses and recognize the subtle and atypical presentations of disorders in elderly patients. 3) Identify treatable complaints attributable to “normal” aging.
Outcomes Research: Past, Present, and Future
Authors: Stewart Michael G. , Piccirillo Jay F. , Gliklich Richard E. , Smith Timothy L. , Yueh Bevan , Rosenfeld Richard M. , Chen Amy Y.
Published: September 2011

Program Description

“Outcomes research” in medicine is now about 23 years old, and in otolaryngology almost 20 years old. In this miniseminar, some of the otolaryngologists who were involved in outcomes research from its inception will discuss the history, progress, and future opportunities for outcomes research, both in otolaryngology‐head and neck surgery, as well as medicine at large. We will also discuss needed next steps—and barriers—to gather the appropriate data to answer important questions for the future. Outcomes assessment will also become increasingly important at the licensure and regulatory level, and we will address those issues as well. The miniseminar will be organized as follows. First, a couple of speakers will give brief presentations on the history, current status, and potential future impacts of outcomes research in otolaryngology. We will discuss outcomes tool development, diseases studied, and the results from several large outcomes‐based studies. Next, there will be a panel discussion moderated by Dr Stewart which will cover the following topics: Which outcomes assessment tools are currently used in clinical practice? Which outcomes instruments should we be using in practice? In which diseases have the findings from outcomes research changed clinical practice? What other diseases/areas are most in need of outcomes assessment, and also the related question of where might outcomes assessment actually change practice significantly? What have we learned about co‐morbidity and severity staging? The panel will also discuss the role of outcomes assessment in Maintenance of Certification from the perspective of a state licensing board, and the American Board of Otolaryngology. One of the panelists has experience designing outcomes databases for other organizations, and he will relate his unique experience in this area. In addition, we will discuss the role of the Academy, the Board, and other central organizations in outcomes measurements, as well as how to select the best outcome tool, and how to create a database for outcomes assessment. Finally we will discuss the future of outcomes research. Are we teaching our residents and fellows the principles of outcomes assessment? Are we training enough faculty and non‐faculty otolaryngologists on how to do good outcomes research? What opportunities do new training grants offer? What is the funding status for outcomes research overall, and in otolaryngology? What is the potential future of outcomes research in otolaryngology? We will also take questions from the audience.

Educational Objectives

1) Learn the history of outcomes research in medicine and in otolaryngology. 2) Understand the results from outcomes studies in otolaryngology and their impact on patient care. 3) Be able to select outcomes tools for research, practice assessment, and maintenance of certification.
Professionalism Tune‐up: New Standards for Otolaryngology, 2011
Authors: Stachler Robert J. , Zacharek Mark A. , Medina Jesus E. , Calhoun Karen H. , McCammon Susan D.
Published: September 2011

Program Description

This miniseminar will be a general review of professionalism and its importance for practitioners, residents, students, and nurses. It is vitally important and practical for clinicians to have a regular review of appropriate etiquette and behavior at meetings and in interactions with others, students, bosses, and pharmaceutical companies. This miniseminar will equip the attendee with tools for lifelong learning. Speaker and Topic: Jesus Medina, MD: Professionalism in 2011, Definition of professionalism: 20 min. Karen Calhoun, MD: Professionalism in the work place: 15 min. Mark Zacharek, MD: Professionalism in a Residency Program: Core Curriculum: 15 min. Robert J. Stachler, MD: Academic Professionalism, Proper Meeting Etiquette: 15 min. Susan McCammon, MD: Appropriate Vendor, Drug Representative, Pharmaceutical Relationships: 15 min. Question and Answers: 10 min.

Educational Objectives

1) Define professionalism: in the work place, in an academic environment, and at home. 2) Identify appropriate styles of behavior to be effective role models for residents, students, and colleagues. 3) Demonstrate proper etiquette at social functions and meetings to be an effective leader in your field. 4) Define appropriate relationships with vendors, drug representatives, and pharmaceutical companies. 5) Review appropriate behavioral constructs and skills in core curricula during residency training for lifelong learning and reassessment during your career. 6) To learn how to play appropriately in the sandbox.
Head and Neck Surgery
Authors: Marchal Francis , Eisele David W. , Pua Kin‐Choo , Cernea Claudio R. , Arndal Helge , Morton Randall P. , Faure Frederic
Published: September 2011

Program Description

This miniseminar on sialendoscopy will provide the audience with the latest developments of sialendoscopy, starting from the basics to advanced cases of sialadenitis. A complete description of the actual indications, how best to investigate those patients, how to treat them—under local or general anesthesia, and how to avoid complications will be detailed. All treatment modalities will be explained and videos shown, with the picture in picture system, allowing easy comprehension of both operative and endoscopic field. Results from around 100 centers linked to the European Sialendoscopy Training Center (ESTC) will be presented, allowing the participants to have objective evidence of the success of this technique.

Educational Objectives

1) Understand the role of sialendoscopy as a new treatment modality, not only for salivary stones, but also for juvenile recurrent parotitis, adult recurrent parotitis, radio‐iodine‐induced parotitis, or other inflammatory conditions leading to ductal strictures. 2) Appreciate the paradigm shift that is occurring in the whole world for using interventional sialendoscopy instead of removing salivary glands. 3) Consider the results of multicentric studies analyzing the benefits of the technique but also its limitations.
EHR/EMR and “Meaningful Use”: Efficient Strategies to Comply with Current and Future Mandates
Authors: Lee K. J. , Ermini Edward B. , Eisenberg Lee D. , Das Subinoy , Nielsen David R.
Published: September 2011

Program Description

This miniseminar will analyze and help academic as well as private practice doctors to comply with the current and future criteria of “Meaningful Use” efficiently without interrupting the “patient‐doctor encounter.” Features of electronic health record that will help the doctor and the staff as well as pitfalls will be discussed. Time will be allocated for Q&A.

Educational Objectives

1) Understand “Meaningful Use” criteria. 2) Be able to select and use an EHR/EMR to receive “stimulus money.” 3) Understand Pay for Performance.
HPV‐Associated Oropharyngeal Cancer Tumor Board
Authors: Nussenbaum Brian , Weinstein Gregory S. , Girod Douglas A. , Bradford Carol R. , Hinni Michael L. , Colevas Dimitri , Yom Sue
Published: September 2011

Program Description

The incidence of Human Papilloma Virus (HPV)–related oropharyngeal cancer is increasing at a near‐epidemic proportion. As such, otolaryngologists are diagnosing and treating greater numbers of patients, especially younger patients, with this distinct disease. There have been significant strides in our knowledge about the pathophysiology of this disease. Yet despite our increased knowledge, there are still several unanswered questions about the ideal management. The educational objective of this miniseminar is to provide otolaryngologists with up‐to‐date clinically relevant information about making treatment decisions for patients with oropharyngeal cancer. This will be done using a case‐based format in the style of a multidisciplinary tumor board with incorporating audience participation. The cases discussed will incorporate basic concepts and controversial topics within the discussion. These topics will include 1) initial management with surgical techniques versus non‐surgical modalities, 2) incorporating biomarkers (HPV, p16, others) and patient‐related factors into initial treatment decision making, 3) optimal management of the neck, 4) management of patients with persistent/recurrent primary site disease after completion of initial therapy, and 5) management of patients with an unknown primary site when the neck metastasis is HPV positive. Panel members will provide support for their responses based on the best evidence‐based medicine available. Standard available therapies, currently available and upcoming clinical trials, and future research directions will be emphasized. At the conclusion of this miniseminar, the participant will be able to describe the current “state‐of‐the‐art” for evaluation and management of oropharynx cancer and discuss the underlying principles for how treatment decisions are made.

Educational Objectives

1) Describe the current “state‐of‐the‐art” for evaluation and management of HPV‐associated oropharynx cancer. 2) Discuss the underlying principles for making treatment decisions for patients with oropharynx cancer. 3) Describe current standard treatment options, available clinical trials, and future research directions.
Managing the Neck in Papillary Thyroid Cancer: Exploring the Evidence
Authors: Terris David J. , Kraus Dennis H. , Orloff Lisa A. , Randolph Gregory W. , Chen Amy Y. , Tufano Ralph P. , Singer Michael C.
Published: September 2011

Program Description

A tremendous amount of debate has occurred since the 2006 and 2009 ATA guidelines made recommendation regarding the indications for central and lateral neck lymph node surgery in patients with well‐differentiated thyroid cancer. While consensus has yet to be reached, several pivotal issues have been defined and are the target of prospective randomized trials. The panelists will identify these key issues and answer the following questions: 1) What is the prevailing clinical approach in 2011? 2) What is the best evidence available that governs this approach? 3) What are the future opportunities for refining our understanding? Specific issues that will be explored include: 1) Lateral neck surgery ‐ when and how much? Which levels should be addressed? 2) Has there been a change in the epidemiology of well‐differentiated thyroid cancer? How has this impacted neck disease and survival? What is the appropriate threshold for nodal surgery after prior thyroidectomy? 3) What is the evidence for elective central neck dissection (pro and con)? 4) How do we best determine where the disease is located? What is the optimal way to define the extent of surgery? 5) Putting it all together, how do I approach the neck in a patient with early and advanced well‐differentiated thyroid cancer? This will be an interactive panel with plentiful discussion and questions from the audience and case‐based analysis. The panelists will move toward consensus when possible regarding each of these issues and help provide a framework for investigation and validation of proposed management algorithms.

Educational Objectives

1) Understand which levels should be addressed in undertaking lateral neck surgery for thyroid cancer. 2) Recognize changes in epidemiology of thyroid cancer and impact on neck disease and survival. 3) Become familiar with optimal determination of the location of disease and therefore extent of surgery.
State‐of‐the‐Art Endoscopic Management of Larynx and Pharynx Cancer
Authors: Burns James A. , Zeitels Steven M. , Haughey Bruce H. , Weinstein Gregory S.
Published: September 2011

Program Description

Transoral treatment of larynx and pharynx cancer has been done for over a century. Despite substantial technical innovations such as enhanced imaging, innovative laser technologies, and robotics guidance systems, radiotherapy and/or chemotherapy dominate the treatment strategy at many institutions. In part, this is due to limited familiarity with recent novel endoscopic surgical approaches. Outcomes data on transoral microsurgical management for advanced oropharynx and larynx cancer will be presented to illustrate the efficacy of surgical management of these diseases. Robotics and laser photoangiolysis of laryngeal cancer are two emerging technologies that can enhance endoscopic surgery. These novel and innovative treatment technologies can potentially be combined in the future to expand the indications for endoscopic surgery. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and update the attendees on state‐of‐the‐art procedural innovations.

Educational Objectives

1) Understand outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Understand the emerging role of robotics in endoscopic surgical management of larynx and pharynx cancer. 3) Understand concepts of photoangiolysis in treatment of aerodigestive tract malignancy.
Transoral Robotic Surgery: A New Paradigm in the Treatment of Head and Neck Cancer and Reconstructive Surgery
Authors: Lin Derrick T. , Genden Eric M. , Magnuson J. Scott , Selber Jesse
Published: September 2011

Program Description

Transoral robotic head and neck surgery (TORS) has quickly become an accepted alternative approach for treatment of tumors of the upper aerodigestive tract. Specifically, approaches to oropharyngeal tumors have traditionally been through a mandibulotomy or lingual release approach with its associated postoperative morbidity. Because of this potential morbidity and the proven efficacy of chemoradiotherapy, there has been a paradigm shift away from upfront surgical management. With the advent of TORS over the past few years, several reports have documented its safety and improved functional outcomes in the management not only of oropharyngeal tumors but also of hypopharyngeal and laryngeal cancers without sacrificing tumor control or overall survival. As the indications for TORS continue to expand, will there then be an evolving role for robotic‐assisted reconstructive surgery? And what are the indications for reconstructions after TORS? The miniseminar will be composed of four parts: First, the moderator will provide a short introduction. The second speaker will review the current literature and their experience with TORS. They will specifically discuss the current indications and functional results without reconstruction. The third speaker will discuss the rationale for robotic free flap reconstruction, its indications and potential improved function. The last speaker will discuss the current research on robotic assisted reconstruction and its future advantages and challenges ahead.

Educational Objectives

1) Understand the role of transoral robotic surgery in head and neck cancer. 2) Understand the current use of robotic reconstructive surgery. 3) Understand the indications and future potential for robotic‐assisted reconstructive surgery.
Update on Diagnosis and Management of Primary Hyperparathyroidism
Authors: Shindo Maisie L. , Orloff Lisa A. , Steward David L. , Stack Brendan C.
Published: September 2011

Program Description

The diagnosis and management of primary hyperparathyroidism is generally straightforward. Cases referred from endocrinologists for surgery will usually have the classic laboratory findings and the correct diagnosis. An adenoma will be localized by imaging in approximately 80% to 85% of these patients. As increasing referrals are being generated from primary care physicians rather than endocrinologists, surgeons will invariably see only partially worked up patients and diagnostic dilemmas. The first part of this panel, which is composed of expert endocrine surgeons with extensive experience in parathyroid surgery, will address some of the diagnostic challenges and their evaluation. The second portion of the panel will focus on treatment. Minimally invasive parathyroidectomy (MIP) has become the preferred surgical approach for treatment of primary hyperparathyroidism. Localization of an adenoma on preoperative imaging is the key to being able to perform a successful MIP. The panel will discuss pearls and pitfalls in the imaging of parathyroid adenomas, including the use of ultrasound, sestamibi parathyroid scan, and CT scans. Thirdly the panel will present state of the art minimally invasive parathyroidectomy techniques, such as radioguided surgery, lateral approach, performing MIP under local/sedation. Cases will also be presented on how to approach failed explorations.

Educational Objectives

1) Learn pearls and recognize pitfalls of challenging cases of hyperparathyroidism. 2) Understand the principles and techniques of minimally invasive parathyroidectomy. 3) Learn how to improve the yield of preoperative imaging for primary hyperparathyroidism.
Controversies in the Management of Pediatric Aspiration
Authors: Gerber Mark E. , Zur Karen B. , Messner Anna H. , Schroeder James W.
Published: September 2011

Program Description

This miniseminar is supported by the Airway and Swallowing Committee. It will be an open forum and interactive discussion on the management of dysphagia and aspiration in the pediatric population. The panelists will discuss diagnostic methods as well as medical and surgical treatment options. They will assist the attendee in understanding the pathophysiology and morbidity of chronic aspiration in children. A case presentation format will be used and the audience will be able to help determine the focus of the discussion. Attendees will have the opportunity to submit a case for presentation by emailing to aspirationaao@me.com prior to the meeting. Each case presented will have a set of questions developed regarding differential diagnosis, evaluation, and treatment for the audience to select prior to discussion by the panel. The audience response will be a springboard for more in‐depth discussions. Controversies that will be reviewed include the use of videofluoroscopic swallow studies vs fiber optic endoscopic evaluation of swallowing; sialorrhea management options, including botox, ductal ligation, and salivary gland excision, and surgical management options for persistent aspiration following maximal treatment for sialorrhea and GERD.

Educational Objectives

1) Understand diagnostic tests available for children with dysphagia and aspiration. 2) Formulate algorithm for investigation of children who present with symptoms of dysphagia and aspiration. 3) Understand treatment options for mild, moderate, and severe dysphagia and aspiration.
Cricopharyngeal Dysphagia: An Evidence‐Based Approach to Diagnosis and Management
Authors: Stachler Robert J. , Merati Albert L. , Amin Milan R. , Franco Ramon A. , Song Phillip
Published: September 2011

Program Description

For the past decade, the management of a cricopharyngeal dysphagia including a Zenker’s Diverticulum has predominantly been endoscopic. Recent literature has suggested that long‐term outcomes may not be as successful with the endoscopic technique as once believed. The purpose of this miniseminar is to thoroughly review the literature on this topic and present the most up to date, evidence‐based court room style debate on this topic. This 90‐min miniseminar will review: 1) the normal anatomy of the cricopharyngeus and the upper esophagus. 2) Methods of assessing this area, ie, radiographic, endoscopic, manometry, pH probe. 3) Medical management and its role in this disease process. 4) Surgical techniques: Open techniques: Diverticulectomy with stapled or hand‐sewn closure, diverticuloplasty, +/‐ cricopharyngeal myotomy. Closed (endoscopic) technique: diverticulotomy utilizing stapled, laser, bovie. 5) What is the appropriate management of the patient with a When to botox? When to dilate? What are the long‐term results of this management? This miniseminar will be interactive. At numerous times during the discussion questions will be asked of the audience to keep them involved and entertained. The open vs closed surgical debate will be a court‐room style debate with the Moderator acting as the judge or arbitrator. Each presenter will have 8 mins to define their side of the argument and to present the data. Four minutes will be allowed for cross examination or rebuttal, 2 mins for the closing argument if needed. The audience will give the verdict at the end. A series of questions will be asked of the jury (audience) at the end. Events/Schedule: Normal anatomy of the cricopharyngeus and its assessment: 10 min (Robert Stachler, MD). Medical and surgical management of cricopharyngeal dysfunction: 20 min (Milan Amin, MD). Introduction of the debate of surgical management: 7 mins (Milan Amin, MD). Presiding Arbitrator: Robert J. Stachler, MD. Courtroom: 30 mins total. Pro‐open diverticulectomy: Al Meroti, MD; Pro‐endoscopic diverticulectomy: Phil Song, MD, Ramon Franco, MD. Questions and Answers (Case presentation if time allows): 20 mins. Miniseminar Evaluation for the Audience: This should be an interactive presentation with questions for the audience to answer and an opportunity for the audience to give a verdict on which technique seems to have the best evidence. This is not a question of right or wrong. It is a question of best evidence. The jury will be prompted on this very point. Decisions are rendered based on the best evidence only.

Educational Objectives

1) Appreciate the newest techniques available to manage cricopharyngeal dysphagia. 2) Evaluate and treat cricopharyngeal dysphagia. 3) Become facile with the medical management currently available to treat CP dysphagia.
Reducing Complications from Tracheotomy
Authors: Merati Albert L. , Halum Stacey L. , Postma Gregory N. , Arora Asit
Published: September 2011

Program Description

While tracheotomies are regularly performed by otolaryngologists nationwide and abroad, technique and perioperative management vary widely between surgeons. Recently, the Academy Airway and Swallowing Committee performed a multi‐institutional study reviewing the technique, management, and outcomes from a large series of consecutive tracheotomies. We have used our study, as well as national and international databases to construct tracheotomy evidence‐based guidelines for the otolaryngologist. We will discuss incorporation of tracheostomy care teams for the merging of quality care, medical economics, and patient safety. Guidelines will be presented in an interactive format (surveying the audience on their current practices) with the goal of optimizing intraoperative patient safety and minimizing early and late postoperative complications.

Educational Objectives

1) Understand the management factors associated with tracheotomy complications. 2) Understand how tracheostomy care teams can optimize patient management. 3) Information will be presented in an interactive format with audience participation.
The Otolaryngologist’s Role in Management of Aspiration: A Practical Review
Authors: Khosla Sid , Merati Albert L. , Pitman Michael J. , Kelchner Lisa , Postma Gregory N.
Published: September 2011

Program Description

Aspiration pneumonia is a major problem in the geriatric population, in patients who are hospitalized long term, and for people with head and neck cancer. It is the second most common type of nosocomial infection, resulting in massive mortality and morbidity; in the elderly, the mortality rates range from 20% to 50%, with a rate as high as 80% in some studies. The health care costs associated with aspiration pneumonia are staggering. While aspiration pneumonia is often due to oropharyngeal or laryngeal disorders, the role of the otolaryngologist in diagnosing and managing aspiration can vary significantly; this purely clinical miniseminar will focus on how the general otolaryngologist can maximally contribute to the care of patients with aspiration. The panelists will discuss the following: 1) The practical value of multiple diagnostic modalities will be reviewed, including fiberoptic laryngoscopy, transnasal esophagoscopy (TNE), modified barium swallow and other radiological imaging, functional endoscopic evaluation of swallowing (FEES), sensory testing, pH and impedance probes, and high resolution manometry; 2) in‐office evaluation for surgical decision making; 3) when to perform a tracheotomy or refer for a gastrostomy tube; 4) nonsurgical treatment including swallowing therapy, stents, salivary control, injection of botulism toxin, and electrical stimulation; 5) surgical treatment including laryngeal framework surgery, cricopharyngeal myotomy, laryngeal suspension, laryngeal closure procedures, and sensory reinnervation. Illustrative cases will also be presented to highlight common dilemmas and challenges.

Educational Objectives

1) Describe how in‐office evaluation and procedures are useful for decision making in medical and surgical treatment. 2) Understand the value of different diagnostic modalities. 3) Describe medical and surgical treatments for aspiration.
Otology/Neurotology
Authors: Lalwani Anil K. , Buchman Craig A. , El‐Kashlan Hussam K. , Lustig Lawrence R. , McGrew Benjamin M. , Megerian Cliff A.
Published: September 2011

Program Description

The temporal bone is the home to and neighbor of a variety of critical neural and vascular structures that are at risk for injury during otologic surgery involving the middle ear and mastoid cavity. Their injury can have devastating consequences including hearing loss, facial nerve injury, central nervous system injury, or stroke. The challenge to the otologic surgeon is to eradicate disease, to preserve structure and function, and to avoid injury. Being prepared to handle expected and unexpected situations is the key to success for otologic or any other surgery. In this miniseminar, a panel of experts will specifically review: 1) How to avoid cholesteatoma recurrence; 2) strategies to prevent facial nerve injury; 3) what to do when the brain is injured; 4) avoiding and managing vascular injury; 5) what to do when the unexpected occurs during routine stapes surgery. The goal of the panel is to provide the tools necessary to become a more effective otologic surgeon and guidance for how to handle a variety of potential complications that may be encountered during routine ear surgery.

Educational Objectives

1) Understand surgical principles and techniques to avoid FN, vascular, and CNS injury during otologic surgery. 2) Understand strategies to effect total removal of cholesteatoma and minimize its recurrence. 3) Understand the state‐of‐the‐art approaches to minimizing and addressing complications of stapes surgery.