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Stapedectomy with the Robinson cup-piston prosthesis
Otolaryngology Head and Neck Surgery Volume 112 Number 5
instruction Courses-- Wednesday
the use of the palpebral spring, silicone polymer prosthesis, canthoplasties, bandage lenses, Lacriserts, and combinations of topical agents.
COURSE 4732- I One-period course ($20)
Room NOCC-95 3:45-4:45
Implantable Hearing Aid: A New Otologic Frontier NAOAKI YANAGIHARA, MD Ehime, Japan
Educational objectives: To understand the state-of-the-art of implantable hearing aid, especially the device using a piezoelectric ossicular driver, and to understand future prospect of totally and partially implantable hearing aid. The function of a conventional heating aid depends on the acoustic input and acoustic output system. The system in itself involves such defects as sound distortion, acoustic feedback, wearing discomfort and cosmetic appearance. This is why only a small percentage of candidates for a hearing aid become hearing aid users. Development of an implantable hearing aid functioning as a part of an ear would be desirable. Recent technologic advances have rekindled interest in research on implantable heating aids. Basically, there are two principles used in the construction of implantable hearing aids: (1) piezoelectric and (2) electromagnetic. The devices can be implanted totally or partially. This course is designed to describe designs and indications, and discuss the advantage and disadvantages of implantable hearing aids. Emphasis is placed on the partially implantable one using a piezoelectric ceramic ossicular vibrator. The implant operation with its results is demonstrated by video. Future goals and horizons of the research and development of this technology will be considered.
P 191
brane reconstruction; (2) the use of cartilage for the reconstruction of atelectatic ears or recurrent perforations; (3) the posterior canal wall down procedure used in cholesteatoma surgery, including concomitant cartilage reconstruction of the posterior wall in sufficiently aerated ears; (4) the use of bioactive ionomer cement materials for ossicular reconstruction; and (5) the reconstruction of the ossicular chain during the first session of surgery. These principles and techniques can be applied to every middle ear pathology and result in good control of the disease process as well as excellent hearing results. The didactic session will also include a videotape resentation, the latter of which can be obtained by request.
COURSE 4734-1 One-period course ($20)
Room NOCC-97 3:45-4:45
Congenital Malformations of the Temporal Bone ANTONIO DELACRUZ, MD Los Angeles, Calif.
This course presents the developmental anatomy of the temporal bone as it relates to everyday otologic problems. Subjects to be emphasized are congenital stapes fixation/ malformation, facial nerve anomalies, malleus fixation, incus deformities, persistent stapedial artery, aberrant carotid artery, congenital aural atresia, and Mondini's and other cochlear malformations. It will highlight with slides and videotapes the management of the unanticipated encounter of the above malformations in the course of routine stapes or tympanomastoid surgery.
COURSE 4735-1 One-period course ($20)
Room NOCC-98 3:45-4:45
Stapedectomy with the Robinson Cup-Piston Prosthesis COURSE 4733- I One-period course ($20)
Room NOCC-96 3:45-4:45
MENDELLROBINSON,MD Providence, R.I.
Middle Ear Reconstructive Surgery DIRK HOEHMANN, MD, PhD,JOHN L. DORNHOFFER,MD, and JAN HELMS, MD W•rzburg, Germany, and Little Rock, Ark.
Educational objectives: To make a rational decision about which kind of middle ear pathology deserves the most straightforward approach for reconstructive attempts and to understand the principles of middle ear reconstructive surgery developed as a synthesis in the Departments of Otolaryngology at the University of Tiibingen and Wiirzburg. This course will present the principles of middle ear reconstructive surgery. These principles represent a synthesis of the techniques in middle ear surgery that have been developed at the Departments of Otolaryngology at the Universities of Ttibingen and Wtirzburg. Basic principles include (1) the use of perichondrium for tympanic mem-
Educational objectives: To understand the evolution and principles of the cup-piston stapes prosthesis and with videotape, join the surgeon and observe a complete stapedectomy procedure (narrated during the surgery). This course analyzes more than 30 years of use of the Robinson stainless steel stapes cup-piston prosthesis in stapedectomy surgery for otosclerosis. More than 200,000 stapedectomies have been performed with this technique since 1961. A rationale for the design and use of the prosthesis will be discussed, and the surgical technique will be demonstrated by color slides and a videotape. Definitive principles of stapedial footplate surgery will be included. The short-term and long-term hearing results and complications and comparison with other techniques will be presented. For the "occasional" otologic surgeon this technique has been recognized as being most suitable for providing
P192
Otolaryngology Head and Neck Surgery May 1995
Instruction Courses-- Wednesday
excellent short-term and long-term successful hearing resuits in otosclerosis surgery.
COURSE 4736-1 One-period course ($20)
Room NOCC-99 3:45-4:45
Congenital Viral Induced Hearing Loss MELVIN STRAUSS,MD Cleveland, Ohio
Educational objectives: To understand the nature and mag-
nitude of congenital hearing loss with a specific understanding of viral causes of congenital hearing loss and to be knowledgeable of all aspects of congenital cytomegalovirus Iabyrinthitis including efforts at prevention and experimental studies. In this course, the nature and magnitude of the problem of congenital hearing loss is presented. Recommendations for auditory screening of the Joint Committee on Infant Hearing from 1981 and 1990 and the 1993 NIH Conference on Early Identification of Hearing Impairment in Infants and Young Children are reviewed. The TORCHES group of congenital infections is discussed with an emphasis on rubella, the first recognized, and the herpes virus group now known to be responsible for the majority of congenital viral-induced hearing losses. The pathophysiology and temporal bone histopathology of hematogenous, meningogenic, neurogenic, and otogenic routes of labyrinthine infection are presented. Discussed next are the specific clinical, audiologic, vestibular, and temporal bone histopathologic features of congenital viral labyrinthine infection with an emphasis on cytomegalovirus. Finally, experimental work and knowledge acquired in this area and the potential clinical importance are discussed. This includes the application of polymerase chain reaction methodology to temporal bone studies.
COURSE 4737- ! One-period course ($20)
Room NOCC-1 O0 3:45-4:45
Avoiding Complications of Sphenoethmoid Surgery ALAN SOGG, MD, and BRUCEJAFEK, MD Cleveland, Ohio, and Denver, Colo.
A complication arising from sphenoethmoid sinus surgery is a well recognized possibility. This course will discuss not only the common factors leading to complications such as inadequate exposure and bleeding, but also the less frequently considered possibilities such as a surgeon's choice of approach employed and anatomic distortion from various causes such as previous surgery. Our techniques for avoiding sphenoethrnoid surgical complications, regardless of the operative technique employed, are presented. The minimization of a complication, should it occur, is stressed. The surgical techniques of these
procedures and the treatment of specific complications are not emphasized, but technical points of necessity are presented. Included among the points emphasized are control of bleeding and obtaining good exposure so that the more common complications, such as orbital plate damage, and the much less common but possibly tragic ones, such as dural injury, can be avoided. Appropriate slides will be used, and sufficient time for questions and discussion will be provided. A Liability Committee report from the January 1978 Bulletin, entitled "Ethmoidectomy in Court," not only put emphasis on potential current legal problems in our specialty, but by its very content stressed the need for discussion for the avoidance of these problems.
COURSE 4738-1 One-period course ($20)
Room NOCC-101 3:45-4:45
Vestibular Rehabilitation: Diagnosis Based Strategies RICHARD E. GANS, PhD St. Petersburg, Fla.
Educational objectives: To understand the various strate-
gies used in designing therapy programs based on specific diagnosis and to learn how specific protocols improve vestibular and balance function. An emerging form of treatment for equilibrium disorders is vestibular rehabilitation and balance retraining. Otolaryngologists are increasingly being called on to extend their scope of practice to include this form of treatment to their armamentarium of medical and surgical management strategies. The purpose of this program is to introduce the otolaryngologist to a variety of diagnosis-based strategies in developing vestibular rehabilitation and balance retraining programs for their patients. The presentation will focus on rehabilitation strategies that are designed to be used with patients presenting specific electrophysiologic test results and clinical findings. Case studies will be used to illustrate the continuum of care after diagnosis, with an emphasis on outcome prediction.
COURSE 4739-1 One-period course ($20)
Room NOCC-102 3:45-4:45
The Latissimus Dorsi Flap in Head and Neck Reconstruction RANDAL C. PANIELLO,MD, and MATTHEWNAGORSKY, MD St. Louis, Mo., and Philadelphia, Pa.
Educational objectives: To understand the anatomy and
surgical technique involved in the latissiums dorsi family of donor sites for pedicled and free flap reconstructions and to understand the clinical indications for and the limitations of these flaps. The latissimus dorsi muscle and its overlying skin form a versatile donor site for head and neck reconstruction. The flap may be harvested as a pedicled or free flap, and may
instruction Courses-- Wednesday
the use of the palpebral spring, silicone polymer prosthesis, canthoplasties, bandage lenses, Lacriserts, and combinations of topical agents.
COURSE 4732- I One-period course ($20)
Room NOCC-95 3:45-4:45
Implantable Hearing Aid: A New Otologic Frontier NAOAKI YANAGIHARA, MD Ehime, Japan
Educational objectives: To understand the state-of-the-art of implantable hearing aid, especially the device using a piezoelectric ossicular driver, and to understand future prospect of totally and partially implantable hearing aid. The function of a conventional heating aid depends on the acoustic input and acoustic output system. The system in itself involves such defects as sound distortion, acoustic feedback, wearing discomfort and cosmetic appearance. This is why only a small percentage of candidates for a hearing aid become hearing aid users. Development of an implantable hearing aid functioning as a part of an ear would be desirable. Recent technologic advances have rekindled interest in research on implantable heating aids. Basically, there are two principles used in the construction of implantable hearing aids: (1) piezoelectric and (2) electromagnetic. The devices can be implanted totally or partially. This course is designed to describe designs and indications, and discuss the advantage and disadvantages of implantable hearing aids. Emphasis is placed on the partially implantable one using a piezoelectric ceramic ossicular vibrator. The implant operation with its results is demonstrated by video. Future goals and horizons of the research and development of this technology will be considered.
P 191
brane reconstruction; (2) the use of cartilage for the reconstruction of atelectatic ears or recurrent perforations; (3) the posterior canal wall down procedure used in cholesteatoma surgery, including concomitant cartilage reconstruction of the posterior wall in sufficiently aerated ears; (4) the use of bioactive ionomer cement materials for ossicular reconstruction; and (5) the reconstruction of the ossicular chain during the first session of surgery. These principles and techniques can be applied to every middle ear pathology and result in good control of the disease process as well as excellent hearing results. The didactic session will also include a videotape resentation, the latter of which can be obtained by request.
COURSE 4734-1 One-period course ($20)
Room NOCC-97 3:45-4:45
Congenital Malformations of the Temporal Bone ANTONIO DELACRUZ, MD Los Angeles, Calif.
This course presents the developmental anatomy of the temporal bone as it relates to everyday otologic problems. Subjects to be emphasized are congenital stapes fixation/ malformation, facial nerve anomalies, malleus fixation, incus deformities, persistent stapedial artery, aberrant carotid artery, congenital aural atresia, and Mondini's and other cochlear malformations. It will highlight with slides and videotapes the management of the unanticipated encounter of the above malformations in the course of routine stapes or tympanomastoid surgery.
COURSE 4735-1 One-period course ($20)
Room NOCC-98 3:45-4:45
Stapedectomy with the Robinson Cup-Piston Prosthesis COURSE 4733- I One-period course ($20)
Room NOCC-96 3:45-4:45
MENDELLROBINSON,MD Providence, R.I.
Middle Ear Reconstructive Surgery DIRK HOEHMANN, MD, PhD,JOHN L. DORNHOFFER,MD, and JAN HELMS, MD W•rzburg, Germany, and Little Rock, Ark.
Educational objectives: To make a rational decision about which kind of middle ear pathology deserves the most straightforward approach for reconstructive attempts and to understand the principles of middle ear reconstructive surgery developed as a synthesis in the Departments of Otolaryngology at the University of Tiibingen and Wiirzburg. This course will present the principles of middle ear reconstructive surgery. These principles represent a synthesis of the techniques in middle ear surgery that have been developed at the Departments of Otolaryngology at the Universities of Ttibingen and Wtirzburg. Basic principles include (1) the use of perichondrium for tympanic mem-
Educational objectives: To understand the evolution and principles of the cup-piston stapes prosthesis and with videotape, join the surgeon and observe a complete stapedectomy procedure (narrated during the surgery). This course analyzes more than 30 years of use of the Robinson stainless steel stapes cup-piston prosthesis in stapedectomy surgery for otosclerosis. More than 200,000 stapedectomies have been performed with this technique since 1961. A rationale for the design and use of the prosthesis will be discussed, and the surgical technique will be demonstrated by color slides and a videotape. Definitive principles of stapedial footplate surgery will be included. The short-term and long-term hearing results and complications and comparison with other techniques will be presented. For the "occasional" otologic surgeon this technique has been recognized as being most suitable for providing
P192
Otolaryngology Head and Neck Surgery May 1995
Instruction Courses-- Wednesday
excellent short-term and long-term successful hearing resuits in otosclerosis surgery.
COURSE 4736-1 One-period course ($20)
Room NOCC-99 3:45-4:45
Congenital Viral Induced Hearing Loss MELVIN STRAUSS,MD Cleveland, Ohio
Educational objectives: To understand the nature and mag-
nitude of congenital hearing loss with a specific understanding of viral causes of congenital hearing loss and to be knowledgeable of all aspects of congenital cytomegalovirus Iabyrinthitis including efforts at prevention and experimental studies. In this course, the nature and magnitude of the problem of congenital hearing loss is presented. Recommendations for auditory screening of the Joint Committee on Infant Hearing from 1981 and 1990 and the 1993 NIH Conference on Early Identification of Hearing Impairment in Infants and Young Children are reviewed. The TORCHES group of congenital infections is discussed with an emphasis on rubella, the first recognized, and the herpes virus group now known to be responsible for the majority of congenital viral-induced hearing losses. The pathophysiology and temporal bone histopathology of hematogenous, meningogenic, neurogenic, and otogenic routes of labyrinthine infection are presented. Discussed next are the specific clinical, audiologic, vestibular, and temporal bone histopathologic features of congenital viral labyrinthine infection with an emphasis on cytomegalovirus. Finally, experimental work and knowledge acquired in this area and the potential clinical importance are discussed. This includes the application of polymerase chain reaction methodology to temporal bone studies.
COURSE 4737- ! One-period course ($20)
Room NOCC-1 O0 3:45-4:45
Avoiding Complications of Sphenoethmoid Surgery ALAN SOGG, MD, and BRUCEJAFEK, MD Cleveland, Ohio, and Denver, Colo.
A complication arising from sphenoethmoid sinus surgery is a well recognized possibility. This course will discuss not only the common factors leading to complications such as inadequate exposure and bleeding, but also the less frequently considered possibilities such as a surgeon's choice of approach employed and anatomic distortion from various causes such as previous surgery. Our techniques for avoiding sphenoethrnoid surgical complications, regardless of the operative technique employed, are presented. The minimization of a complication, should it occur, is stressed. The surgical techniques of these
procedures and the treatment of specific complications are not emphasized, but technical points of necessity are presented. Included among the points emphasized are control of bleeding and obtaining good exposure so that the more common complications, such as orbital plate damage, and the much less common but possibly tragic ones, such as dural injury, can be avoided. Appropriate slides will be used, and sufficient time for questions and discussion will be provided. A Liability Committee report from the January 1978 Bulletin, entitled "Ethmoidectomy in Court," not only put emphasis on potential current legal problems in our specialty, but by its very content stressed the need for discussion for the avoidance of these problems.
COURSE 4738-1 One-period course ($20)
Room NOCC-101 3:45-4:45
Vestibular Rehabilitation: Diagnosis Based Strategies RICHARD E. GANS, PhD St. Petersburg, Fla.
Educational objectives: To understand the various strate-
gies used in designing therapy programs based on specific diagnosis and to learn how specific protocols improve vestibular and balance function. An emerging form of treatment for equilibrium disorders is vestibular rehabilitation and balance retraining. Otolaryngologists are increasingly being called on to extend their scope of practice to include this form of treatment to their armamentarium of medical and surgical management strategies. The purpose of this program is to introduce the otolaryngologist to a variety of diagnosis-based strategies in developing vestibular rehabilitation and balance retraining programs for their patients. The presentation will focus on rehabilitation strategies that are designed to be used with patients presenting specific electrophysiologic test results and clinical findings. Case studies will be used to illustrate the continuum of care after diagnosis, with an emphasis on outcome prediction.
COURSE 4739-1 One-period course ($20)
Room NOCC-102 3:45-4:45
The Latissimus Dorsi Flap in Head and Neck Reconstruction RANDAL C. PANIELLO,MD, and MATTHEWNAGORSKY, MD St. Louis, Mo., and Philadelphia, Pa.
Educational objectives: To understand the anatomy and
surgical technique involved in the latissiums dorsi family of donor sites for pedicled and free flap reconstructions and to understand the clinical indications for and the limitations of these flaps. The latissimus dorsi muscle and its overlying skin form a versatile donor site for head and neck reconstruction. The flap may be harvested as a pedicled or free flap, and may