bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysphagia: From Science to Clinical Practice
Authors: Amin Milan R. , Belafsky Peter C. , McCulloch Timothy M. , Langmore Susan E.
Published: August 2013

Program Description:

This miniseminar will focus on advances in the field of dysphagia. Dysphagia is an extremely common problem that has a profound effect on the lives of patients who suffer from it. However, there is little consensus on how to evaluate and treat patients with this problem, largely because of the lack of data‐driven protocols. This miniseminar is designed to update the audience on recent basic science, translational, and clinical research in the field of dysphagia. It is anticipated that the talks will stimulate participants to think critically about how best to manage their patients with dysphagia.

Educational Objectives:

1) Evaluate the impact of dysphagia and dysphagia‐related disorders. 2) Analyze new research related to dysphagia and how it impacts management of the patient with dysphagia. 3) Explore options for treating patients with dysphagia.
Endoscopic vs Open Treatment of Laryngotracheal Stenosis
Authors: Khosla Sid , Rutter Michael J. , de Alarcon Alessandro , Sandhu Guri , Halum Stacey L. , Hillel Alexander T.
Published: August 2013

Program Description:

A significant challenge in the surgical management of laryngotracheal stenosis is when to choose an open repair over an endoscopic approach. This clinical decision‐making process is made more difficult by the fact that there is significant controversy about this topic, and thus there is no general consensus. This miniseminar will focus on the surgical details of different endoscopic and open procedures. On the panel, there will be both surgeons who favor endoscopic approaches and those who frequently do both. Discussion will be further enhanced by the use of multiple case presentations and interactive audience participation.

Educational Objectives:

1) Recite the details of multiple endoscopic approaches, including the use of balloons, lasers, stents, application of mitomycin C, and injection of steroids for both children and adults. 2) Describe how co‐morbidities, patient age, patient preferences, airway surgical history, and nature (eg, length, location, firmness) modify the decision of when to choose an open versus endoscopic approach. 3) Recognize when to choose a cricotracheal resection versus a laryngotracheal resection and the details of both procedures.
Globus: The Perennial Complaint
Authors: Tan Melin , Mirza Natasha , Franco Ramon A. , Weissbrod Philip A.
Published: August 2013

Program Description:

Globus pharyngeus is a sensory abnormality of the throat affecting 4‐6% of the population. To date, the etiology of globus still remains poorly elucidated although many theories have evolved. There is no consensus regarding the diagnosis and management for these patients. This miniseminar is intended to concisely: 1) Review all of the key elements of evaluation, examination, diagnosis, and management of patients with globus; 2) Evaluate all possible etiologies for globus sensation; 3) Summarize the literature supporting or refuting all diagnostic modalities for patients with globus; 4) Discuss a practical management algorithm for treatment of patients with globus.

Educational Objectives:

1) Acquire practical tools for assessment and diagnosis of patients with globus. 2) Consider all potentially beneficial diagnostic options of patients with globus. 3) Survey current clinical practice methods for management of patients with globus.
Practical Approach to Swallowing Problems
Authors: Lintzenich Catherine R. , Amin Milan R. , Postma Gregory N. , Merati Albert L.
Published: August 2013

Program Description:

This miniseminar will present a practical approach to the evaluation of swallowing problems, one of the most common problems seen in otolaryngology practices. A combination of didactic teaching and case presentations will be used to illustrate appropriate workup of swallowing problems, including history, examination, and diagnostic tests. The use of swallowing evaluations, such as fluoroscopy, endoscopy, and manometry, will be discussed. Non‐surgical and surgical approaches to managing swallowing problems, along with risks and benefits, will be presented.

Educational Objectives:

1) Identify a practical algorithm for the evaluation of swallowing problems. 2) Discuss the benefits of diagnostic tests for swallowing problems, including fluoroscopy, endoscopy, and manometry. 3) Apply the appropriate approach to non‐surgical and surgical therapeutics for swallowing problems.
Reflux: Pathophysiology to Management
Authors: Blumin Joel H. , Johnston Nikki , Jobe Blair A. , Merati Albert L.
Published: August 2013

Program Description:

This miniseminar will highlight advances in science and management of extra esophageal reflux. For decades, management of reflux has focused on acid suppression, often with variable patient outcome. Advances in understanding the mechanism of extra esophageal reflux have demonstrated the importance of all reflux events, from acid to alkaline. This miniseminar will feature thought provoking perspectives from leaders in translational and clinical research. Pathophysiology, surgical, and medical management of extra esophageal reflux will be highlighted.

Educational Objectives:

1) Evaluate the impact of reflux mediated injury to the epithelia of the upper aerodigestive tract. 2) Recognize that management of reflux is more than acid suppression. Appreciate the role of surgical management of extraesophageal symptoms. 3) Identify shifts in management of reflux mediated laryngitis.
Voice: From Cells to Song
Authors: Sulica Lucian , Rosen Clark A. , Simpson C. Blake , Thibeault Susan
Published: August 2013

Program Description:

This miniseminar will feature thought provoking perspectives from leaders in translational and clinical research. An exploration of the pathophysiology of vocal fold scar and present cell biology treatment methods will be presented. This will include recent advances for vocal fold lamina propria rehabilitation. A discussion will be presented regarding evidence for vocal fold paralysis treatment of laryngeal framework surgery versus laryngeal re‐innervation. This discussion will highlight the areas of indications and results. Advanced voice procedures to optimize voice outcomes will be presented, including laser application for a variety of voice disorders and vocal fold augmentation approaches and materials.

Educational Objectives:

1) Describe the cellular biology of vocal fold scar and approaches of regenerative medicine as treatment options. 2) Interpret the known and unknown aspects of vocal fold paralysis treatment with laryngeal framework surgery in contrast to laryngeal re‐innervation. 3) Apply the most modern, advanced voice surgical methods, including laser and vocal fold injection approaches.
Advances in the Objective Diagnosis of Ménière's Disease
Authors: Hornibrook Jeremy , Gibson William P. R. , Manzari Leonardo , Nakashima Tsutomu
Published: August 2013

Program Description:

Ménière's disease is currently diagnosed by the AAO‐HNS Equilibrium Committee Guidelines (1995), which are used worldwide. In the guidelines a “Certain” diagnosis requires histopathological confirmation of endolymphatic hydrops, with no provision for any in vivo test which might confirm that. This seminar will present one well established test (tone burst electrocochleography) and two newer techniques (vestibular evoked myogenic potential [VEMPs] and magnetic resonance imaging [MRI] inner ear imaging with intratympanic gadolinium) for demonstrating hydrops, and their basis for advancing knowledge of the pathophysiology of Ménière's disease. Practical examples of the AAO‐HNS guidelines underdiagnosing Ménière's disease and its use in distinguishing Ménière's disease from vestibular migraine are presented.

Educational Objectives:

1) Relate the basis and validity of tone burst electrocochleography as a sensitive and specific test for hydrops and its methodology as a simple office test. 2) Demonstrate that during a Ménière's attack, the cervical VEMP amplitude is unchanged but the optical VEMP increases, implying a mechanical change in the membranous labyrinth as opposed to an ionic change. 3) Show that MRI inner ear imaging can visually demonstrate hydrops in the cochlea and vestibule.
Practical Guide to MOC: Who, What, When, Why, and How
Authors: Teng Marita S. , Malekzadeh Sonya , Miller Robert H. , Choi Sukgi S. , Lin Derrick T. , Weber Randal S. , Smith Shane
Published: August 2013

Program Description:

This miniseminar is designed to assist American Board of Otolaryngology (ABOto) diplomates in understanding the process of Maintenance of Certification (MOC). Panelists will include representatives from the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) and ABO to, as well as recent examinees of Part III MOC. Discussion will include the purpose, layout, and timeline of MOC, as well as practical tips for completing the requirements and passing the Part III examination. The panelists will also review what educational resources are available for continuation of lifelong learning, maintenance of certification, and recertification. The miniseminar will conclude with an interactive question and answer session.

Educational Objectives:

1) Recognize MOC as a 10‐year cycle and understand the specific requirements for each of the four components of MOC. 2) Identify common concerns, anxieties, and misconceptions of Part III MOC. 3) List AAO‐HNS educational resources designed for lifelong learning, maintenance of certification, and recertification.
Hearing Loss 2013: Expanded Technology, Expanded Criteria
Authors: Coelho Daniel H. , Babu Seilesh , Papsin Blake C. , Buchman Craig A. , Roland J. Thomas
Published: August 2013

Program Description:

The purpose of this course is to educate our otolaryngology community about how best to provide the widest array of surgical technologies to the largest populations of patients with hearing loss. Traditionally, technologic advancement has driven the field forward, though recent attention has also focused on expanding eligibility criteria for existing technology. The format will be a panel of experts with proposed topics organized by patient population (rather than by technology), including patients with moderate to severe hearing loss and significant residual hearing, single sided‐deafness, tinnitus, children, age extremes, the multi‐handicapped, cochlear nerve deficiency, and others.

Educational Objectives:

1) Recognize the most current surgical technologies available to patients with hearing loss. 2) Articulate the rationale for expanding inclusion criteria for existing technologies to patients previously considered ineligible. 3) Evaluate how promising preliminary outcomes data support the continued expansion of both technology and criteria for patients with hearing loss.
The Martha Entenmann Tinnitus Research Center, Inc.: Abraham Shulman, MD; and Barbara Goldstein, PhD; International Tinnitus Miniseminar: New Concepts in Electrophysiology and Tinnitus
Authors: Hoffer Michael , Olivera Carlos , Prichep Leslie , Kleinjung Tobias , Shulman Abraham
Published: August 2013

Program Description:

A neurobiology for all clinical types of tinnitus is emerging, reflecting advances in the neuroscience of brain function and the cochleovestibular system. The electrophysiologic identification of brain functions activated in the presence of the tinnitus signal can provide a basis for translation to optimize tinnitus diagnosis and treatment. This miniseminar will focus on electrophysiology and tinnitus. Electrophysiologic markers of ear and brain function have been identified in subjective idiopathic tinnitus patients of all clinical types. This clinical experience has been reflective predominantly of site of lesion testing of cochleovestibular function. Tinnitus is an aberrant auditory percept. Advances in the neuroscience of brain imaging, sensory physiology, auditory physiology, brain function, and tinnitus have provided the otolaryngologist and all tinnitus professionals methods for objectification of the subjective tinnitus complaint. This miniseminar will initially review the past and present experience with electrophysiologic markers for tinnitus of cochleovestibular function. Second, the focus will be on presentation of two methods of objectification for the identification of electrophysiologic markers of tinnitus in brain as follows: 1) Quantitative electroencephalography (QEEG) and 2) low resolution electromagnetic tomography (Loreta). In this miniseminar, the fourth in a series examining tinnitus, each speaker will examine an electrophysiologic technique and then provide case discussions to examine the use of this technique in treatment selection.

Educational Objectives:

1) Understand the neurobiology of tinnitus. 2) Understand the availability of the use of electrophysiologic outcomes to provide objectivity for the subjective tinnitus complaint. 3) Recognize how established methodologies of recording electrophysiology of the ear and brain can be applied to the tinnitus patient.
Neurotologic Emergencies: What the General Otolaryngologist Needs to Know
Authors: Chandrasekhar Sujana S. , Hashisaki George T. , Lustig Lawrence R. , Brodie Hilary , Arriaga Moises A.
Published: August 2013

Program Description:

This miniseminar, presented on behalf of the American Neurotology Society, is designed to provide the practicing general otolaryngologist with immediately useful clinical pearls in the evaluation and management of patients presenting with neurotologic emergencies. Five expert neurotologists will present the current state of the art in the following areas: temporal bone fracture, acute mastoiditis, meningitis, idiopathic facial nerve palsy, and sudden hearing loss. These patients often present the clinician with challenges, including how to assess, when and what to test, and what treatment options to offer, as well as what the expected outcomes are. ARQ and Q&A will be emphasized.

Educational Objectives:

1) Describe what to do with a patient with temporal bone fracture, including anticipation and management of hearing loss, cerebrospinal fluid (CSF) leak, and other complications. 2) Manage the patient with sudden cranial nerve palsy, including facial nerve paralysis or sensorineural hearing loss, including medical and surgical management. 3) Apply the current best practices for the management of meningitis and acute mastoiditis, including acute medical management and workup for otogenic causes.
Otogenic Pain and Aural Fullness: Mystery Diagnosis
Authors: Micco Alan G. , Megerian Cliff , Toh Elizabeth H. , Angeli Simon I.
Published: August 2013

Program Description:

Otogenic pain and aural fullness can be some of the more frustrating chief complaints to work up and address. Many patients with this complaint are frustrated with a lack of diagnosis and treatment. This leads to multiple visits in search of the answer to their affliction. In this miniseminar, a panel of experts will discuss an appropriate evaluation and workup for these issues. Discussions will highlight appropriate examinations, testing, and imaging, as well as a thorough discussion of the differential diagnoses. Also, recommendations for treatment will be discussed. Case presentations will highlight proper workup and management of these confusing cases.

Educational Objectives:

1) Recite likely etiologies of aural fullness and otogenic pain. 2) Recognize potentially serious etiologies of these symptoms. 3) Use appropriate workup and treatment of these symptoms and their causes.
Clinical Pearls in Pediatric Otolaryngology: A Video Forum
Authors: Parikh Sanjay R. , Roy Soham , Derkay Craig S. , Hartnick Christopher J. , White David R. , Kazahaya Ken , Rutter Michael J. , Goudy Steven L. , Zdanski Carlton
Published: August 2013

Program Description:

This video‐based forum will provide audience members with state of the art concepts in pediatric otolaryngology. The speakers consist of: Carlton Zdanski: Transoral Robotic Surgery in Children: Indications and Results; Christopher Hartnick: Bevacizumab (Avastin) injection for pediatric RRP; Craig Derkay: Modifications of the Seldinger technique to secure the difficult pediatric airway; David White: Endoscopic division of the sternocleidomastoid muscle for treatment of torticollis; Ken Kazahaya: Endoscopic assisted otologic surgery; Michael Rutter: Tracheotomy tube fenestration; Sanjay Parikh: Diagnosis of sleep induced laryngomalacia; Soham Roy: Radiofrequency ablation of pediatric oral cavity lesions; Steven Goudy: Video‐assisted pharyngeal surgery.

Educational Objectives:

1) Consider contemporary airway management ideas for tracheotomy tubes, recurrent papillomatosis, and laryngomalacia. 2) Describe novel endoscopic laryngopharyngeal techniques with robotics, radiofrequency, and video‐assistance. 3) Implement novel endoscopic otologic and neck techniques.
Management and Treatment of Pediatric Rhinosinusitis
Authors: Chun Robert H. , Skinner Margaret L. , Sulman Cecille G. , Wei Julie L.
Published: August 2013

Program Description:

Pediatric chronic rhinosinusitis (PCR) without cystic fibrosis remains one of the most common complaints presenting to otolaryngologists. However, there is no standardized protocol in the work‐up, diagnosis, imaging, and treatment of this disease process. This seminar will focus on diagnostic testing, including when to image and what allergy or immunology tests to order; pre‐operative medical treatment options, including irrigations and diet modification; and review of best evidence for surgical management of PCR, including balloon dilation. We will also discuss the management of complications of acute pediatric rhinosinusitis and discuss our data about long‐term impacts of surgical intervention.

Educational Objectives:

1) Apply the indications for CT imaging, the role of allergy and immunology testing, and the potential impact of non‐surgical interventions in managing PCR. 2) Evaluate the evidence related to surgical treatment of PCR, including biopsy for primary ciliary dyskinesia, adenoidectomy, functional endoscopic sinus surgery, and balloon dilation. 3) Recognize the acute and long‐term complications seen in pediatric rhinosinusitis and the short‐term and long‐term management of this disease.
Ask the Experts: An Endoscopic Potpourri
Authors: Kennedy David W. , Palmer James N. , Ferguson Berrylin J. , Hwang Peter H. , Stankiewicz James A. , Zinreich S. James
Published: August 2013

Program Description:

Rhinologic diagnostic and treatment problems commonly create dilemmas in practice. This miniseminar provides for interactive discussion of the management options and the decision rationale involved in difficult sinus diagnostic and treatment situations. A case presentation format is used with case presentations from each of the panelists, emphasizing questions with regard to differential diagnosis, evaluation, imagining, and treatment. Cases are representative of those encountered by either a general otolaryngologist or a subspecialty rhinologist, but have critical decision points for discussion. The session focuses on the decision making process, frontal sinus disease, revision surgery, and fungal sinusitis, as well as common tumors.

Educational Objectives:

1) Review the surgical decision making process in chronic sinus disease. 2) Implement different imaging modalities and improved quality of interpretation for both CT and MRI images. 3) Improve the management of difficult to treat chronic rhinosinusitis.
Evidence‐Based Post‐operative Management of Chronic Rhinosinusitis
Authors: Lee Jivianne T. , Han Joseph , Hwang Peter H. , Stringer Scott P.
Published: August 2013

Program Description:

Endoscopic sinus surgery (ESS) without adequate post‐operative care can lead to unsatisfactory results. Judicious post‐operative management of chronic rhinosinusitis (CRS) is essential to optimize surgical outcomes. Recent years have witnessed significant expansion and innovation with respect to post‐op interventions. The purpose of this miniseminar is to evaluate and discuss the extensive complement of post‐op therapies currently available for CRS from an evidence‐based perspective. A panel of academic leading rhinologists will be conducting this miniseminar using a multimedia case‐based format with audience interactive questions. Clinical cases illustrating implementation of various post‐op regimens will be presented in addition to review of relevant evidence.

Educational Objectives:

1) Evaluate current post‐op therapies for CRS and appraise their roles in maximizing surgical outcomes. 2) Assess the use of biomaterials, novel adjuvant therapies, and recent innovations in pharmaceutical delivery post‐ESS. 3) Discuss the relevant evidence and proper application of each therapeutic modality in the post‐operative setting.
Innovative Immunomodulatory Therapies in Chronic Sinusitis
Authors: Chandra Rakesh K. , Batra Pete S. , Chiu Alexander G. , Han Joseph , Holbrook Eric H. , Sindwani Raj
Published: August 2013

Program Description:

The purpose of the miniseminar is to systematically review the available immunomodulatory therapies in the management strategy of CRS. The panelists will present clinical scenarios to illustrate potential use of these innovative treatments. The existing literature will also be appraised to elucidate the strength of the existing evidence base. The panel consists of experienced academic rhinologists representing six academic tertiary care centers with extensive experience in treating recalcitrant CRS patients. Audience participation will be encouraged through use of the audience response system. Real‐time texting of questions to the moderator will be used to maximize interaction between the audience and panelists.

Educational Objectives:

1) Discuss potential immunomodulatory targets for systemic and topical therapy in chronic rhinosinusitis based on current knowledge of the disease pathophysiology. 2) Apply innovative medical therapies in a case‐based approach, including topical/oral steroids, topical/systemic antimicrobials, leukotriene modifiers, aspirin desensitization, monoclonal antibodies, and immunotherapy. 3) Appraise the available literature on these treatment modalities to elucidate the strength of the present evidence base.
Office‐Based Procedures and Surgery in Rhinology
Authors: Benninger Michael S. , Hwang Peter H. , Han Joseph , Atkins James S. , Krespi Yosef P.
Published: August 2013

Program Description:

Office based rhinologic surgical procedures have increased, driven by expansion of procedure technology applicable to the office and improved endoscopic visualization. These procedures are minimally invasive and afford the ability for office management of relatively simple surgical disease and also more complex, chronic disorders, such as chronic rhinosinusitis with polyps. This miniseminar will describe the technology and techniques of office rhinologic procedures. These include injections, laser surgery, polypectomy, turbinectomy, and the use of balloons. The seminar will identify optimal methods of anesthesia, creating a safe and efficient procedure setting, compliance, and legal and coding aspects of establishing office rhinology procedures.

Educational Objectives:

1) Describe the role of office based nasal and sinus procedures/surgery in the context of patient safety, cost containment, and clinical efficiency. 2) Incorporate processes and procedures that will allow for efficient and safe implementation of office based nasal and sinus procedures/surgery. 3) Analyze the socio‐economic issues related to office based rhinologic procedures and surgery, including medico‐legal issues and billing and reimbursement methods.
Topical Therapies in Chronic Sinonasal Disease
Authors: Harvey Richard J. , Chiu Alexander G. , Schlosser Rodney J. , Cohen Noam A. , Psaltis Alkis , Wormald Peter J.
Published: August 2013

Program Description:

This miniseminar provides an evidence‐based approach to the science behind topical management of sinonasal disease and parallels our greater understanding of the mechanisms in chronic sino‐nasal inflammation. The scientific basis behind delivery systems is presented. Cochrane reviews on topical steroids and antifungals have produced surprising evidence, and current recommendations by treatment guidelines such as EPOS 2012 will be debated. The miniseminar is presented by rhinologists actively involved in the development of topical therapies both clinically and in research. There is direct clinical application of current research and available products to the management of chronic sinonasal disease in general otolaryngology practice.

Educational Objectives:

1) Define the therapeutic goals of topical therapies and understand the influence of device and surgical state on topical delivery. 2) Review current evidence based guidelines on topical therapies in CRS and learn about the science behind novel topical agents. 3) Identify the inflammatory conditions under which to apply these new topical therapies.
Creating a Comprehensive Sleep Center in an Otolaryngology Practice
Authors: Friedman Michael , Yaremchuk Kathleen L. , Jacobwitz Ofer , Davidson Terence M.
Published: August 2013

Program Description:

With increased demand of patients seeking treatment for obstructive sleep apnea/hypopnea syndrome (OSAHS), diagnosis of OSAHS will become an increasingly significant component of every ENT practice. Surgical treatment will remain an option for selected patients Explain options for attended and unattended polysomnography. Review new techniques and clinical research on OSAHS. Review CPT coding and reimbursement expectations for diagnostic studies, non‐invasive and minimally invasive procedures. Identify patients with mild/moderate disease (continuous positive airway pressure intolerant) who could benefit from minimally‐invasive and non‐invasive techniques. Present non‐invasive treatment options that can be incorporated into an ENT practice.

Educational Objectives:

1) Incorporate sleep testing into ENT practice, implement coding/reimbursement for diagnostic and treatment, and apply an algorithm for successful treatment of snoring and OSA. 2) Properly identify and treat each anatomic site and identify patients who can be helped by multilevel minimally‐invasive techniques rather than classic surgery. 3) Incorporate custom‐made mandibular advancement devices into an ENT/OSAHS practice and share our experience with Provent therapy.
Current Concepts and Pitfalls in the Management of Obstructive Sleep Apnea
Authors: Pang Kenny P. , Rotenberg Brian , Woodson B. Tucker
Published: August 2013

Program Description:

There are many different ways and surgical techniques available to treat OSA, causing a lot of confusion and disparity in managing these OSA patients. There is a need to standardize diagnosis, treatment, and prognosis. Concepts will be discussed and pitfalls will be highlighted. This miniseminar will address these latest current concepts in airway evaluation, clinical diagnosis, polysomnographic diagnosis, and various surgical management (from nose, palate, and tongue surgery). The miniseminar will also highlight the pitfalls that should be avoided in the management of OSA.

Educational Objectives:

1) Recognize the basic concepts of airway evaluation and diagnosis and surgical management of OSA. 2) Confidently diagnose, evaluate, and treat patients with OSA.
Palate Surgery in Obstructive Sleep Apnea: How to Choose among the Options
Authors: Kezirian Eric J. , Weaver Edward M. , Rotenberg Brian , Pang Kenny P. , Cahali Michel B. , Friedman Michael , Woodson B. Tucker
Published: August 2013

Program Description:

Palate surgery is the primary surgical approach for treatment of OSA. Although uvulopalatopharyngoplasty (UPPP) was described 30 years ago, the past 10‐15 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, palate stiffening, modified expansion sphincter pharyngoplasty, relocation pharyngoplasty, lateral pharyngoplasty, Z‐palatoplasty, and palatal advancement. 2) Differentiate between the various palatoplasty techniques for different types of patients.
Pediatric Obstructive Sleep Apnea Syndrome: Guidelines, Evidence, and Nuance
Authors: Maturo Stephen C. , Brietzke Scott E. , Ishman Stacey L. , Mitchell Ron B.
Published: August 2013

Program Description:

Pediatric obstructive sleep apnea syndrome (OSAS) is one of the most common referrals for otolaryngologists. Over the past three years, clinical practice guidelines have been published by the AAO‐HNS, American Academy of Pediatrics, and American Academy of Sleep Medicine regarding the diagnosis and management of OSAS. This presentation will begin with a comparison of these guidelines and the evidence used to reach the recommendations. Panelists, through case examples and examination of current literature, will then discuss nuanced issues of pediatric OSA to include short‐ and long‐term perioperative management, obese children with sleep apnea, and subtleties of formal polysomnography in children.

Educational Objectives:

1) Compare similarities and differences in the practice guidelines by the various subspecialties involved in the management of children with OSAS and the evidence used to make these recommendations. 2) Evaluate the evidence supporting current perioperative management strategies in children undergoing surgical treatment for OSAS. 3) Improve management of OSAS in obese children and the growing evidence that suggests these children carry increased perioperative risk.
Reducing Surgical Risk: Perioperative Management of Obstructive Sleep Apnea
Authors: Soose Ryan J. , Coutras Steven W. , Ishman Stacey L. , Rotenberg Brian , Stierer Tracey L.
Published: August 2013

Program Description:

OSA is common in surgical populations. Recent studies suggest higher risk of respiratory failure, reintubation, ICU transfer, and longer length of stay in OSA patients. This miniseminar will examine these risks from medical, surgical, and anesthesia perspectives, including an overview of the pathophysiology of this increased risk. Sleep‐certified specialists will discuss anesthesia and patient factors contributing to perioperative risk, measures to reduce this risk, and considerations unique to the pediatric population. Finally, the miniseminar will provide practical information for developing a system‐wide preoperative screening protocol and implementing clinical pathways to evaluate and manage OSA patients in the perioperative period.

Educational Objectives:

1) Explain the specific surgical and anesthesia risks in patients with OSA and the pathophysiology of the increased risk. 2) Review preoperative, intraoperative, and postoperative strategies that can be employed to reduce complications in patients with OSA. 3) Compare available preoperative screening questionnaires and discuss the development of clinical pathways to screen for and manage OSA patients in the perioperative period.
Coding and Precertification Strategies for Nasal Surgery
Authors: Rhee John S. , Tollefson Travis T. , Ward Preston D. , Patel Krishna G.
Published: August 2013

Program Description:

In the setting of decreased reimbursements and increased insurance denials, wading through the world of current procedural terminology (CPT) coding for nasal surgery can be challenging. This interactive miniseminar will discuss appropriate coding for nasal surgeries, clarifying the differences between rhinoplasty, vestibular stenosis repair, septoplasty, and turbinate surgery, and discuss indications for precertification. Individual speakers, well versed in the world of nasal surgery, will share strategies in documentation, patient counseling, and navigating appeals. The main goal of the miniseminar is to provide an algorithm for proper and accurate coding and helpful strategies to support these coding choices.

Educational Objectives:

1) Maximize coding for nasal surgeries involving functional rhinoplasty, septoplasty, and treatment of inferior turbinates. 2) Recognize clinical indications that impact coverage of rhinoplasty by insurance companies. 3) Improve efficiency when interacting with insurance companies in the management of rhinoplasty coding.
Comparison of Tolerance and Cost‐Effectiveness of Two Nasal Anesthesia Techniques for Trans‐nasal Flexible Laryngoscopy (TFL)
Authors: Young VyVy N. , Rosen Clark A. , Smith Libby J.
Published: August 2013

Objectives:

1) Compare tolerance of aerosolized spray vs. syringe administration of topical anesthesia for TFL. 2) Analyze cost‐effectiveness of both techniques.

Methods:

Prospective, blinded, randomized trial. 108 patients underwent TFL over a 3‐month period. Patients were randomized to receive equivalent dose of 1:1 neosynephrine/4% plain lidocaine mixture via either aerosolized spray (“spray”) or application with 1‐cc syringe (“syringe”). Patients and physicians independently rated comfort of TFL on a 5‐point scale (1=not at all comfortable to 5=very comfortable). Data was collected on patient and endoscopist experience with TFL as well as reasons for poor tolerance of laryngoscopy. Cost analyses of disposable spray tips and syringes were calculated.

Results:

Both patients and physicians reported very high tolerance of TFL. There was no difference in patient tolerance between spray‐ vs. syringe‐administered anesthesia (P = 0.89). Poor tolerance of laryngoscopy was reported in 6.5% with comparable distribution between anesthetic methods (P = 0.93). There was no impact of patient prior experience with TFL (P = 0.280), and there was no difference between anesthetic methods for TFL performed by the resident, fellow, or attending. The difference between costs of the disposable spray tip vs. syringe was $1.30 per unit.

Conclusions:

Use of a 1‐cc syringe is an effective method to provide topical nasal anesthesia for TFL and saves $1.30 per unit compared to disposable spray tips. In our practice, transition to syringe‐administered nasal anesthesia is projected to save $1,300 per 1,000 patients, or an anticipated $3,000 per year, with continued excellent patient tolerance of TFL.
The Two‐Week Wait Head and Neck Clinic: Do We Know What Our Patients Think?
Authors: Glore Raad J. , Kundra Amrit , Conboy Peter J. , Moir Andrew , Alun‐Jones Tom
Published: August 2013

Objectives:

Explore patients’ views on hospital communication when patients are referred to the two‐week wait head and neck clinic (2WWHNC).

Methods:

A prospective qualitative study in the form of questionnaire handed to new patients attending the 2WWHNC. The study ran for six weeks (October ‐ November 2011) and included 104 patients.

Results:

25.9% of patients said the hospital information letter provoked anxiety. 29.8% of patients said they were not informed by their general practitioners (GPs) that they would require further specialist assessment and investigations.

Conclusions:

A significant minority of patients were unaware they were attending the 2WWHNC to investigate the possibility of an underlying head and neck cancer. Although patients recognized that hospital communication was informative, perhaps reconsideration of the wording of the information letter as well as providing clearer information by the GPs may help to reduce the level of anxiety.
Incidence and Survival Trends of Sinonasal Adenocarcinoma from 1973 to 2009
Authors: Patel Neal , Patel Shail M. , Sanghvi Saurin , Patel Nicolas R. , Baredes Soly , Eloy Jean A.
Published: August 2013

Objectives:

Study the incidence and survival of patients with sinonasal adenocarcinoma (SNA) between 1973 and 2009 using the Surveillance, Epidemiology, and End Result (SEER) database.

Methods:

A retrospective cohort study using the United States National Cancer Institute's SEER registry was analyzed to study the incidence and survival for SNA from 1973‐2009. Analysis was conducted based on race and gender.

Results:

In total, 885 cases of SNA were reported. Males accounted for 50.17%, while females accounted for 49.83%, amounting to a 1.01:1.00 male to female ratio. Analysis of incidence trends revealed a statistically significant decline in incidence of overall population, females, blacks, and “others” (P < 0.05). Overall 20‐year survival for SNA over the past 30 years was 30.25%. Survival data were additionally analyzed by gender revealing females to have a slightly better survival than males (P > 0.05). When survival was stratified by race, “others” had the best survival, followed by whites and blacks, respectively, although this was not statistically significant.

Conclusions:

The overall incidence of SNA has significantly declined over the past 30 years. The highest decrease in incidence was observed in “others,” when compared to whites and blacks. Moreover, while the female incidence significantly declined, the male incidence rate has stayed stable over the past 30 years. Overall long‐term survival has increased over the last 30 years. No significant difference in survival was noted for gender and race.
Incidence and Treatment Trends in Young Patients with Oropharyngeal Cancer: The SEER Analysis
Authors: Gayar Omar , Ghanem Tamer A.H. , Hall Francis T. , Cote Michele , Ruterbusch Julie , Elshaikh Mohamed , Siddiqui Farzan
Published: August 2013

Objectives:

1) Assess the incidence of oropharyngeal squamous cell carcinoma (OPCa) in patients <45 years. 2) Assess treatments and outcomes.

Methods:

The SEER 9 database was queried (1973‐2009) for OPCa patients <45 years of age.

Results:

There were 1603 patients who met the study criteria. The incidence in patients between 36‐45 years increased from 0.79 to 1.39 (per 100,000). In the same time period, there was an increase in rate from 0.20 to 0.42 in whites and a decrease in rate in black patients from 0.67 to 0.32. Surgery was performed alone in 220 (13.72%) and in combination with radiation therapy in 734 (45.79%). Five‐year survival for the study cohort is 54%. Compared to white patients, black patients had worse survival (P < 0.0001). Patients who had surgery as part of their treatment, either alone (localized stage patients) or in combination with radiation had the highest 5‐year survival, followed by radiation.

Conclusions:

There was an increase in OPCa in patients within the last 4 decades, particularly in the 36‐44 age range. Interestingly, the incidence increased in whites and decreased in blacks. It is important to note that the majority of these patients were treated with surgery, either alone or with radiotherapy. The rising incidence within recent decades is thought to be related to HPV transmission and changes in sexual practices.
An Innovative Computerized Control System in Transoral Laser Surgery of the Larynx
Authors: Guastini Luca , De Matos Leonardo , Caldwell Darwin , Peretti Giorgio
Published: August 2013

Objectives:

1) Describe a new computerized system in transoral laser surgery of the larynx based on a tablet stylus interface. The mechanical joystick interface currently used is the major limiting factor for surgical precision, quality, and safety, requiring extensive surgeon practice. 2) Analyze the statistical reduction of absolute and root‐mean‐square error (RMS error) with the stylus interface in path‐follow trials.

Methods:

A new robotic system for transoral laser surgery has been created to improve the surgeon's control. It offers a more ergonomic, intuitive, and programmable laser control device: a touch interface with dynamic intraoperative planning capabilities. The system is based on a large‐range laser scanner fully controlled by a stylus on a tactile sensor. It aims the laser in real‐time over the whole surgical field and allows path memorization, providing accurate repetitions of surgeon‐defined laser paths. This enables pre‐execution surgical action tracking and unmatched control for long cuts. Paths of any shape and length are dynamically planned too with the plain stylus device.

Results:

Trials on ex‐vivo pig larynges and artificial targets performed by experienced and non‐experienced surgeons demonstrate a drop of 80% in max absolute error and about 50% in RMS error with the stylus interface in path‐follow trials. Dynamic planning has also demonstrated its benefits. No error was observed in trials, getting only. 03 mm mean RMS error under a 40× microscope magnification.

Conclusions:

Trials so far have assessed the new system as highly intuitive and effective. It improves surgical precision, quality, and safety.
Laryngeal Squamous Cell Carcinoma in 4256 Women: A Population‐Based Analysis of Gender's Prognostic Implications
Authors: Fritsch Smith Valerie A.
Published: August 2013

Objectives:

1) Describe a large series of female patients with laryngeal squamous cell carcinoma (SCC). 2) Determine if there are gender‐related differences in clinicopathologic factors, outcomes, and prognostic indicators.

Methods:

All cases of laryngeal SCC diagnosed between the years 2000‐2008 were extracted from the Surveillance Epidemiology and End Results database. Clinicopathologic data, disease‐specific survival (DSS), and prognostic factors were compared between genders using chi‐square, Kaplan‐Meier, and multivariable regression analysis.

Results:

Of 21,666 patients, 4,256 (19.6%) were female. Supraglottic tumors were predominant in females (61%) (vs. 64% glottic tumors in males; P < 0.001); and females with supraglottic SCC were less likely to present with locally‐advanced disease or nodal metastases (P < 0.001). Overall, female gender was independently associated with improved DSS (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.74‐0.89, P < 0.001). Further analysis stratified by age subgroups revealed that the favorable prognostic implications associated with female gender were limited to patients diagnosed at age<70y (P < 0.005). In this group, females carried a 27‐32% lower risk of SCC‐specific mortality on multivariable analysis (P < 0.005). Notably, the protective effective of female gender was lost after age at diagnosis exceeded 70y (P > 0.25). Prognostic factors were mostly similar within each gender subgroup; however, the negative prognostic implications of age were significantly greater in females. In fact, the risk of laryngeal SCC‐specific death nearly tripled per annum in females (2.9% vs. 1.6% in males, P < 0.01).

Conclusions:

There are significant gender‐related clinicopathologic differences in laryngeal SCC. Females diagnosed at age<70y have significantly better DSS than males; and mortality risk is highly attributable to age in women.
Lean Six Sigma Applied to Ultrasound of the Head and Neck: Changing Patient Management
Authors: Matt Bruce H. , Butler Penny D. , Woodward‐Hagg Heather K. , Kokoska Mimi S.
Published: August 2013

Objectives:

1) Confirm the positive value stream of office‐based ultrasound using Lean Six Sigma. 2) Demonstrate how ultrasound reduces time to diagnosis, costs, patient inconvenience and travel, exposure to ionizing radiation, intravenous contrast, and laboratory tests.

Methods:

A retrospective review of adults with head and neck lesions between 2009‐2012 at a veterans administration hospital was conducted. Affiliated interventions: Ultrasound evaluation of head and neck lesions. Outcome Measurements: Type of diagnostic tests, time to diagnosis, radiation exposure, episodes of patient travel, and final diagnosis. Independent variables: Age and gender of patient. Preliminary analyses: Value stream mapping prior to and after implementing office‐based ultrasound confirmed the time from consult request to final diagnosis of a head and neck lesion was reduced from a range of 49‐146 days, requiring 17 steps, to a range of 7‐29 days, requiring 9 steps.

Results:

Office‐based ultrasound for evaluation of head and neck lesions reduced costs, time to diagnosis, risks and inconvenience to patients, radiation exposure, and unnecessary laboratory and patient complaints, while increasing staff satisfaction. In addition, office‐based ultrasound also changed the clinical management of specific patients.

Conclusions:

Lean Six Sigma is used to reduce waste and optimize quality and accuracy in manufacturing. This is the first known application of Lean Six Sigma to office‐based ultrasound in the evaluation of head and neck lesions. The value of office‐based ultrasound to patients, healthcare systems, and healthcare teams is unquestionable.
Biomimetic Scaffolds Loaded with Adipose‐Derived Stem Cells and BMP‐2 Induce Healing of Mandibular Defects
Authors: Lee Matthew K. , DeConde Adam , Aghaloo Tara , Lee Min , Tetradis Sotirios , St. John Maie
Published: August 2013

Objectives:

Investigate the efficacy of biomimetic scaffolds, alone and in combination with osteogenic signaling factors and adipose‐derived stem cells (ASCs), to heal a critical‐sized segmental mandibular defect in a rat model.

Study Design:

Prospective study using an animal model.

Methods:

Adipose‐derived stem cells were isolated and cultured from the inguinal fat of green fluorescent protein (GFP)‐transgenic Lewis rats. Using 3D printing, biomimetic PLGA scaffolds were fabricated and impregnated with ASCs and/or bone morphogenic protein (BMP‐2). Critical‐sized 5‐mm segmental mandibular defects were created in adult Lewis rats and implanted with 1) blank PLGA scaffolds, 2) PLGA scaffolds seeded with ASCs, 3) PLGA scaffolds with BMP, 4) PLGA scaffolds with BMP and ASCs. Animals were sacrificed at 12 weeks, and bone healing was evaluated using microCT analysis.

Results:

A total of 28 rats underwent creation of segmental mandibular defects with implantation of biomimetic scaffolds. MicroCT analysis demonstrated no bridging of the segmental bony defect in rats implanted with blank scaffolds (control). Rats implanted with scaffolds containing ASCs, BMP‐2, and ASCs in combination with BMP‐2 demonstrated healing of critical‐sized segmental mandibular defects, as determined by microCT analysis.

Conclusions:

ASCs and BMP‐2, alone and in combination, demonstrate the ability to heal critical sized mandibular defects in rats. This has implications for future translational research in oromandibular reconstruction.
Multiportal Robotic Access to the Anterior Cranial Fossa: An Engineering and Surgical Feasibility Study
Authors: Bly Randall A. , Su David , Lendvay Thomas , Friedman Diana , Hannaford Blake , Ferreira Manuel , Moe Kris S.
Published: August 2013

Objectives:

Use of robotic surgical technology in skull base surgery has been limited due to the need for 3 non‐disruptive surgical portals; adequate working space between the large robotic arms; and the steep approach angle to the skull base. The objectives were to determine the minimum space requirements between robotic arms, systematically analyze surgical approach portals in a computer model, and assess task performance capability of the derived approaches.

Methods:

A computer analysis on 10 computed tomography scans computed approach trajectory angles and distances to specified skull base target locations for multiportal surgical approaches. The optimal combinations of portals were tested using the da Vinci and Raven robotic systems to perform tasks, both in dry lab and cadaver settings.

Results:

Two robotic tools required an angle of at least 20 degrees between them to function effectively at the skull base targets. In the computer analysis, the angle between two transnasal robotic tools was 14.7, and combining with transorbital portals yielded angles much larger (up to 46.0 degrees). Additionally, the skull base trajectory angle was improved by greater than 28 degrees.

Conclusions:

Computer analysis and cadaver testing demonstrated that the optimal multiportal combination to access sella and parasellar target locations was using 1 transnasal and 2 transorbital portals. This technique addresses the 2 major challenges of 1) the narrow funnel effect generated from portals in close proximity and 2) the steep angle of approach to the skull base, reported in studies evaluating transoral, transcervical, transmaxillary, and transhyoid portals.