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Management of patients with incurable head and neck cancer
Otolaryngology Head and Neck Surgery
Volume 112 Number 5
COURSE 4709-1
One-period course ($20)
InstructionCourses-- Wednesday
Room NOCC-55 3:45-4:45
Management of Patients with Incurable Head and Neck Cancer THOMAS M. KIDDER,MD
Milwaukee, Wis.
Educational objectives: To understand the rationale and need for the head and neck surgeon to provide continuing and terminal care for patients dying of incurable head and neck malignancy and to effectively and confidently relieve pain and manage other distressing symptoms afflicting patients with incurable head and neck cancer.
This course presents for the otolaryngologist--head and neck surgeon a brief, pragmatic approach to caring for patients with incurable, end-stage cancer of the head and neck. Despite the poor overall survival rate, management of symptoms caused by incurable disease receives scant attention in the otolaryngology literature and in most residency and fellowship training programs. Too often when the incurable patient most needs the support of the head and neck surgeon, responsibility for alleviating pain and other distressing symptoms of terminal malignancy is abdicated and transferred to another physician or to a pain specialist or clinic. Emphasis is placed on practical, readily available methods for controlling chronic malignant pain. Useful information will be presented regarding analgesics of choice, mechanisms of action of opioids, controlling side effects, and utilizing adjuvant drugs and newer techniques for pain control. Nonpain symptoms such as nausea, constipation, and hypercalcemia will be discussed. Misconceptions about addiction and physical dependence, which pose major bartiers to effective pain control, will be addressed. A printed course summary and a handbook of cancer pain management will be provided to course attenders.
COURSE 4710-1
One-period course ($20)
Room NOCC-56 3:45-4:45
Lasers in Otology--Which One and Why? DAVID M. VERNICK, MD, S. GEORGE LESINSKI,MD, and JACK M. KARTUSH,MD
Boston, Mass., Cincinnati, Ohio, and Farmington Hills,Mich.
Educational objectives: To evaluate the advantages and disadvantages of all presently available lasers f o r ear surgery and to determine which laser would best fit individual needs.
The first report of a laser being used in an otologic procedure was in 1979 by Escudero, who used an argon laser to assist in a tympanoplasty. Since that time numerous uses of lasers have been reported in stapedectomy, chronic ear surgery, tympanic and vestibular neurectomy, acoustic neuroma resection, to name a few. Argon lasers received
P 185
FDA approval for otologic use in 1982. Since that time the KTP/532 and the carbon dioxide milliwatt lasers have been added to the list of otologicaUy useful lasers. Presently at least four commercially available lasers meet otologic needs. Each laser system has its own unique features that merit its consideration for use. Each laser also has its unique drawbacks, which make it less than ideal. Which laser is the best? Which laser should one buy? Which laser or lasers should one use? Does it make any difference which one is used? Why should one even consider using a laser in otologic surgery? This course will bring together three faculty members who have had extensive experience with the different otologic lasers for a discussion of the pros and cons of each system. The discussion will focus mainly on stapes surgery, but will include other applications as well. Laser physics, laboratory data, and current clinical studies will be discussed. Facts on all sides will be presented and discussed so that each participant can make a decision as to the efficacy of each laser system in otologic surgery.
COURSE 4712-1
One-period course ($20)
Room NOCC-61 3:45-4:45
Prosthetic Voice and Pulmonary Rehabilitation FRANSJ.M. HILGERS,MD, PhD, and R. THEOGREGOR, MB, PhD
Amsterdam, The Netherlands
Educational objectives: To understand the prospects of postlaryngectomy prosthetic voice and pulmonary rehabilitation with an indwelling voice prosthesis system, related appliances and HME and to comprehend the possibilities o f prosthetic voice rehabilitation after various pharyngeal and~or esophageal reconstructions.
Consistently high success rates with prosthetic voice rehabilitation have been reported in the last 14 years. A higher number of patients than ever before achieve a useful voice, making prosthetic voice rehabilitation the method of choice. Two types of voice prosthesis can be distinguished, i.e. non-indwelling and indwelling devices. The former devices can be removed and replaced by the patient, the latter stay in place permanently and have to be removed and replaced by a qualified health care provider at the end of the device life, which is mostly determined by incompetence of the valve and leakage. On the bases of our experience with surgical and prosthetic voice rehabilitation since 1979 in the Netherlands Cancer Institute, we have developed a preference for indwelling devices, by which the patients dexterity plays a less prominent role in achieving a reliable voice. In 1988, we developed an indwelling, low-resistance silicon voice prosthesis, Provox. This has been successfully used in our institute for the last six years in all laryngectomized patients. Primary insertion at the time of total laryngectomy, making stenting of the TE-fistula superfluous, is preferred, although secondary application is also easily accomplished. The clinical results, which can
Volume 112 Number 5
COURSE 4709-1
One-period course ($20)
InstructionCourses-- Wednesday
Room NOCC-55 3:45-4:45
Management of Patients with Incurable Head and Neck Cancer THOMAS M. KIDDER,MD
Milwaukee, Wis.
Educational objectives: To understand the rationale and need for the head and neck surgeon to provide continuing and terminal care for patients dying of incurable head and neck malignancy and to effectively and confidently relieve pain and manage other distressing symptoms afflicting patients with incurable head and neck cancer.
This course presents for the otolaryngologist--head and neck surgeon a brief, pragmatic approach to caring for patients with incurable, end-stage cancer of the head and neck. Despite the poor overall survival rate, management of symptoms caused by incurable disease receives scant attention in the otolaryngology literature and in most residency and fellowship training programs. Too often when the incurable patient most needs the support of the head and neck surgeon, responsibility for alleviating pain and other distressing symptoms of terminal malignancy is abdicated and transferred to another physician or to a pain specialist or clinic. Emphasis is placed on practical, readily available methods for controlling chronic malignant pain. Useful information will be presented regarding analgesics of choice, mechanisms of action of opioids, controlling side effects, and utilizing adjuvant drugs and newer techniques for pain control. Nonpain symptoms such as nausea, constipation, and hypercalcemia will be discussed. Misconceptions about addiction and physical dependence, which pose major bartiers to effective pain control, will be addressed. A printed course summary and a handbook of cancer pain management will be provided to course attenders.
COURSE 4710-1
One-period course ($20)
Room NOCC-56 3:45-4:45
Lasers in Otology--Which One and Why? DAVID M. VERNICK, MD, S. GEORGE LESINSKI,MD, and JACK M. KARTUSH,MD
Boston, Mass., Cincinnati, Ohio, and Farmington Hills,Mich.
Educational objectives: To evaluate the advantages and disadvantages of all presently available lasers f o r ear surgery and to determine which laser would best fit individual needs.
The first report of a laser being used in an otologic procedure was in 1979 by Escudero, who used an argon laser to assist in a tympanoplasty. Since that time numerous uses of lasers have been reported in stapedectomy, chronic ear surgery, tympanic and vestibular neurectomy, acoustic neuroma resection, to name a few. Argon lasers received
P 185
FDA approval for otologic use in 1982. Since that time the KTP/532 and the carbon dioxide milliwatt lasers have been added to the list of otologicaUy useful lasers. Presently at least four commercially available lasers meet otologic needs. Each laser system has its own unique features that merit its consideration for use. Each laser also has its unique drawbacks, which make it less than ideal. Which laser is the best? Which laser should one buy? Which laser or lasers should one use? Does it make any difference which one is used? Why should one even consider using a laser in otologic surgery? This course will bring together three faculty members who have had extensive experience with the different otologic lasers for a discussion of the pros and cons of each system. The discussion will focus mainly on stapes surgery, but will include other applications as well. Laser physics, laboratory data, and current clinical studies will be discussed. Facts on all sides will be presented and discussed so that each participant can make a decision as to the efficacy of each laser system in otologic surgery.
COURSE 4712-1
One-period course ($20)
Room NOCC-61 3:45-4:45
Prosthetic Voice and Pulmonary Rehabilitation FRANSJ.M. HILGERS,MD, PhD, and R. THEOGREGOR, MB, PhD
Amsterdam, The Netherlands
Educational objectives: To understand the prospects of postlaryngectomy prosthetic voice and pulmonary rehabilitation with an indwelling voice prosthesis system, related appliances and HME and to comprehend the possibilities o f prosthetic voice rehabilitation after various pharyngeal and~or esophageal reconstructions.
Consistently high success rates with prosthetic voice rehabilitation have been reported in the last 14 years. A higher number of patients than ever before achieve a useful voice, making prosthetic voice rehabilitation the method of choice. Two types of voice prosthesis can be distinguished, i.e. non-indwelling and indwelling devices. The former devices can be removed and replaced by the patient, the latter stay in place permanently and have to be removed and replaced by a qualified health care provider at the end of the device life, which is mostly determined by incompetence of the valve and leakage. On the bases of our experience with surgical and prosthetic voice rehabilitation since 1979 in the Netherlands Cancer Institute, we have developed a preference for indwelling devices, by which the patients dexterity plays a less prominent role in achieving a reliable voice. In 1988, we developed an indwelling, low-resistance silicon voice prosthesis, Provox. This has been successfully used in our institute for the last six years in all laryngectomized patients. Primary insertion at the time of total laryngectomy, making stenting of the TE-fistula superfluous, is preferred, although secondary application is also easily accomplished. The clinical results, which can