- Email: [email protected]
State-of-the-art dysphagia evaluation and treatment
plications will be followed by a panel discussion. The panel will discuss cases that highlight the benefits of this technique within the otolaryngologist-head and neck surgeon’s armamentarium for the treatment of salivary gland swelling. EDUCATIONAL OBJECTIVES: 1) To understand the indications for salivary endoscopy. 2) To understand the risks and benefits of the procedure. 3) To be able to appreciate the best uses of imaging modalities for these patients including ultrasound, MRI, and CT.
Sinus surgery: State-of-the-art update Brent Senior, MD (moderator); Peter H Hwang, MD; Stilianos Kountakis, MD, PhD; Rodney J. Schlosser, MD; Adam Mikial Zanation, MD PROGRAM DESCRIPTION: Endoscopic surgery of the sinuses has undergone significant changes in the last few years with regard to both technology and technique. In this interactive presentation sponsored by the American Rhinologic Society, speakers will focus on several of the most significant advances including endoscopic frontal surgery, endoscopic maxillary and ethmoid surgery, endoscopic management of CSF leaks and encephaloceles and endoscopic surgery of benign and malignant sinonasal and skull base tumors. Presenters will focus on the latest concepts and controversial areas with broad discussion of pros and cons. Audience participation with questions and debate will be encouraged. EDUCATIONAL OBJECTIVES: 1) To discuss recent advances endoscopic surgery of the frontal, maxillary, and ethmoid sinuses. 2) To review recent advances in endoscopic surgery in the management of CSF leaks and encephaloceles. 3) To discuss recent advances in endoscopic surgery for benign and malignant tumors of the nose, sinuses, and skull base.
Standing on shoulders of dummies: Simulation education 2009 Ellen S. Deutsch, MD (moderator); Seth Dailey, MD; Ara Darzi, FMedSci; Nikolas Blevins, MD; Marvin Peter Fried, MD; Kelly M Malloy, MD PROGRAM DESCRIPTION: We have the momentous opportunity to use simulation and other innovative educational processes to maximize learning while minimizing patient risk. Medical education is changing rapidly, and we can take advantage of a confluence of several important influences and opportunities to enhance our support for learning, improve our safety processes, minimize the direct risk to patients, and decrease our own malpractice risk. Simulation can be used to master new skills and new technologies, and refresh old skills, while minimizing risk to real patients. Simulation can be used to rehearse the management of uncommon but potentially catastrophic events. Moreover, simulation allows us to practice at our convenience using interactive, engaging learning processes. Learn about the variety of strategies and technologies being developed and used to accomplish these
P27 objectives, including simple and sophisticated task trainers with physical realism, virtual models with tactile or electronic feedback, animal or cadaveric models, real people acting as patients, and elegant, life-sized, interactive manikins, as well as immersive learning environments which combine these elements. Simulation has applications in otologic, laryngologic, and sinus procedural skills; as well as for safety, communication, and group interaction (crew resource) processes. Simulation has relevance for students, residents and practicing physicians. EDUCATIONAL OBJECTIVES: 1) Understand the applications of varied simulation strategies in activated, adult education. 2) Understand current simulation capabilities to facilitate learning sinus, otologic and airway procedures; enhance patient safety and crew-resource management; and influence the maintenance of certification. 3) Debate controversies surrounding simulation applications for procedural credentialing.
State-of-the-art dysphagia evaluation and treatment Katherine Kendall, MD (moderator); Rebecca J Leonard, MS, PhD; Dinesh K. Chhetri, MD; Gregory Postma, MD PROGRAM DESCRIPTION: Dysphagia is a significant health issue in the United States, with swallowing problems estimated to occur in 7% of the general population annually. Furthermore, dysphagia is more common in older individuals, and as the baby boomer generation ages, the incidence of dysphagia is likely to increase. Dysphagia may lead to aspiration and, in fact, the number of deaths due to aspiration pneumonia annually in the United States is greater than the number of deaths due the all types of head and neck cancer combined. Aspiration is the number one cause of death in nursing homes and 10% of all communityacquired pneumonias are thought to be due to aspiration. Beyond the risk of aspiration, chronic swallowing problems compromise nutritional status, the ability to take medications and undermine quality of life as a result of emotional repercussions such as loss of self-esteem and social isolation. Otolaryngologists are likely to see more patients in their practice with swallowing complaints. They are often called upon to coordinate an evaluation involving multiple specialties. As a result, they must be well versed in the evaluation and treatment of patients with dysphagia. This symposium will present an overview of the state of the art in the evaluation of patients with dysphagia, using current technology for ancillary testing. Normal swallowing physiology and the key elements required for successful swallowing will be presented. This short review will form the foundation for a discussion of effective history taking in patients with dysphagia and highlight components of the physical examination that give important clues to the etiology of swallowing difficulties. The indications, limitations and advantages of currently available ancillary testing will be covered including videofluoroscopic-swallowing studies, functional endoscopic evaluation of swallowing with or without sensory testing, manometry, and trans-nasal esophagoscopy. Empha-
MINISEM.
Miniseminars
P28
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
sis will be placed on effective interpretation of test results. Finally, treatment recommendations will be discussed including dietary modifications, swallowing therapy, surgical treatments and nonoral feeding. At the conclusion of the seminar, the symposium attendees should understand how to incorporate history, physical examination and ancillary testing to determine the etiology of swallowing complaints, to make diagnosis-based treatment recommendations and to optimize patient nutrition and social functioning while preventing aspiration. EDUCATIONAL OBJECTIVES: 1) Understand the physiology of normal swallowing and learn the key components of a dysphagia history and physical examination. 2) Be familiar with current swallowing testing modalities, understanding the benefits and limitations of each and interpreting the results of tests with respect to the pathophysiology of swallowing complaints. 3) Make treatment recommendations optimizing patient outcomes.
State-of-the-art endoscopic management of larynx and pharynx cancer James Burns, MD (moderator); Gregory Weinstein, MD; Steven Marc Zeitels, MD; Bruce H Haughey, MBChB, FRACS 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. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and update the attendees on state-of-the-art procedural innovations. 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. Based on the panels vast clinical experience, suggestions for future direction and application of these technologies in larynx and pharynx cancer will be presented. This miniseminar will be presented in a didactic format with case examples to highlight specific treatment strategies within the upper aerodigestive tract. Interaction between the panelists and attendees is welcomed and encouraged. EDUCATIONAL OBJECTIVES: 1) Understand outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Understand the emerging role of robotics in the endoscopic surgical management of larynx and pharynx cancer. 3) Understand concepts of photoangiolysis in treatment of aerodigestive tract malignancy.
Successful treatment of snoring and obstructive sleep apnea Michael Friedman, MD (moderator); B Tucker Woodson, MD; Kenny P Pang, FAMS, FRCS PROGRAM DESCRIPTION: Media, attention, physician education, and continued research on the long-term sequelae of obstructive sleep apnea/hypopnea syndrome (OSAHS) have created a huge increase in the number of patients seeking treatment. At the same time, disillusionment with the results of classic surgery such as UPPP and genioglossal advancement may have made many otolaryngologists avoid treatment. As the demand for treatment increases, surgery for OSAHS will become an increasingly significant component of every ENT practice. The purpose of this course is 1) To review new techniques and new clinical research, 2) to present a staging system that helps identify appropriate treatment with reasonable success rates, 3) to identify a large percentage of OSAHS patients with mild to moderate disease that could benefit from minimally invasive techniques. Various techniques will be presented. 1) Tongue base coblation allows for controlled resection of midline tongue base tissue with minimally invasive technology, offering advantages over radiofrequency reduction such as tissue removal vs reduction and better control of the amount of tissue removed. 2) Lateral pharyngoplasty, a modified UPP with improved results. 3) Minimally invasive nasal valve repair will be reviewed. Complications, avoided complications, and potential complications will be discussed by the panelists. Audience discussion is encouraged and ample time will be allotted for a question and answer section. EDUCATIONAL OBJECTIVES: 1) Learn an algorithm for successful treatment of snoring and obstructive sleep apnea. 2) Understand one approach for proper identification and treatment of each anatomic area. 3) Learn perioperative management, complications, and pearls based on faculty experience. 4) Identify patients who can be helped with multilevel minimally invasive techniques rather than classic surgery.
Technologic innovations in the management of CRS Rakesh Chandra, MD (moderator); Alexander Chiu, MD; Pete Batra, MD; Joseph Han, MD; Eric Holbrook, MD; Raj Sindwani, MD, FRCS PROGRAM DESCRIPTION: Management of chronic rhinosinusitis (CRS) has undergone continuous evolution through advances in technology. Many of these innovations have promoted minimally invasive management of complicated pathologies, including neoplastic disease. Such innovations have also facilitated treatment of uncomplicated sinus disease with subjective improvements in recovery. The current era in management of CRS was inspired by the proliferation of endoscopy, and the introduction of both the microdebrider and image guided surgical naviga-
Sinus surgery: State-of-the-art update Brent Senior, MD (moderator); Peter H Hwang, MD; Stilianos Kountakis, MD, PhD; Rodney J. Schlosser, MD; Adam Mikial Zanation, MD PROGRAM DESCRIPTION: Endoscopic surgery of the sinuses has undergone significant changes in the last few years with regard to both technology and technique. In this interactive presentation sponsored by the American Rhinologic Society, speakers will focus on several of the most significant advances including endoscopic frontal surgery, endoscopic maxillary and ethmoid surgery, endoscopic management of CSF leaks and encephaloceles and endoscopic surgery of benign and malignant sinonasal and skull base tumors. Presenters will focus on the latest concepts and controversial areas with broad discussion of pros and cons. Audience participation with questions and debate will be encouraged. EDUCATIONAL OBJECTIVES: 1) To discuss recent advances endoscopic surgery of the frontal, maxillary, and ethmoid sinuses. 2) To review recent advances in endoscopic surgery in the management of CSF leaks and encephaloceles. 3) To discuss recent advances in endoscopic surgery for benign and malignant tumors of the nose, sinuses, and skull base.
Standing on shoulders of dummies: Simulation education 2009 Ellen S. Deutsch, MD (moderator); Seth Dailey, MD; Ara Darzi, FMedSci; Nikolas Blevins, MD; Marvin Peter Fried, MD; Kelly M Malloy, MD PROGRAM DESCRIPTION: We have the momentous opportunity to use simulation and other innovative educational processes to maximize learning while minimizing patient risk. Medical education is changing rapidly, and we can take advantage of a confluence of several important influences and opportunities to enhance our support for learning, improve our safety processes, minimize the direct risk to patients, and decrease our own malpractice risk. Simulation can be used to master new skills and new technologies, and refresh old skills, while minimizing risk to real patients. Simulation can be used to rehearse the management of uncommon but potentially catastrophic events. Moreover, simulation allows us to practice at our convenience using interactive, engaging learning processes. Learn about the variety of strategies and technologies being developed and used to accomplish these
P27 objectives, including simple and sophisticated task trainers with physical realism, virtual models with tactile or electronic feedback, animal or cadaveric models, real people acting as patients, and elegant, life-sized, interactive manikins, as well as immersive learning environments which combine these elements. Simulation has applications in otologic, laryngologic, and sinus procedural skills; as well as for safety, communication, and group interaction (crew resource) processes. Simulation has relevance for students, residents and practicing physicians. EDUCATIONAL OBJECTIVES: 1) Understand the applications of varied simulation strategies in activated, adult education. 2) Understand current simulation capabilities to facilitate learning sinus, otologic and airway procedures; enhance patient safety and crew-resource management; and influence the maintenance of certification. 3) Debate controversies surrounding simulation applications for procedural credentialing.
State-of-the-art dysphagia evaluation and treatment Katherine Kendall, MD (moderator); Rebecca J Leonard, MS, PhD; Dinesh K. Chhetri, MD; Gregory Postma, MD PROGRAM DESCRIPTION: Dysphagia is a significant health issue in the United States, with swallowing problems estimated to occur in 7% of the general population annually. Furthermore, dysphagia is more common in older individuals, and as the baby boomer generation ages, the incidence of dysphagia is likely to increase. Dysphagia may lead to aspiration and, in fact, the number of deaths due to aspiration pneumonia annually in the United States is greater than the number of deaths due the all types of head and neck cancer combined. Aspiration is the number one cause of death in nursing homes and 10% of all communityacquired pneumonias are thought to be due to aspiration. Beyond the risk of aspiration, chronic swallowing problems compromise nutritional status, the ability to take medications and undermine quality of life as a result of emotional repercussions such as loss of self-esteem and social isolation. Otolaryngologists are likely to see more patients in their practice with swallowing complaints. They are often called upon to coordinate an evaluation involving multiple specialties. As a result, they must be well versed in the evaluation and treatment of patients with dysphagia. This symposium will present an overview of the state of the art in the evaluation of patients with dysphagia, using current technology for ancillary testing. Normal swallowing physiology and the key elements required for successful swallowing will be presented. This short review will form the foundation for a discussion of effective history taking in patients with dysphagia and highlight components of the physical examination that give important clues to the etiology of swallowing difficulties. The indications, limitations and advantages of currently available ancillary testing will be covered including videofluoroscopic-swallowing studies, functional endoscopic evaluation of swallowing with or without sensory testing, manometry, and trans-nasal esophagoscopy. Empha-
MINISEM.
Miniseminars
P28
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
sis will be placed on effective interpretation of test results. Finally, treatment recommendations will be discussed including dietary modifications, swallowing therapy, surgical treatments and nonoral feeding. At the conclusion of the seminar, the symposium attendees should understand how to incorporate history, physical examination and ancillary testing to determine the etiology of swallowing complaints, to make diagnosis-based treatment recommendations and to optimize patient nutrition and social functioning while preventing aspiration. EDUCATIONAL OBJECTIVES: 1) Understand the physiology of normal swallowing and learn the key components of a dysphagia history and physical examination. 2) Be familiar with current swallowing testing modalities, understanding the benefits and limitations of each and interpreting the results of tests with respect to the pathophysiology of swallowing complaints. 3) Make treatment recommendations optimizing patient outcomes.
State-of-the-art endoscopic management of larynx and pharynx cancer James Burns, MD (moderator); Gregory Weinstein, MD; Steven Marc Zeitels, MD; Bruce H Haughey, MBChB, FRACS 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. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and update the attendees on state-of-the-art procedural innovations. 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. Based on the panels vast clinical experience, suggestions for future direction and application of these technologies in larynx and pharynx cancer will be presented. This miniseminar will be presented in a didactic format with case examples to highlight specific treatment strategies within the upper aerodigestive tract. Interaction between the panelists and attendees is welcomed and encouraged. EDUCATIONAL OBJECTIVES: 1) Understand outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Understand the emerging role of robotics in the endoscopic surgical management of larynx and pharynx cancer. 3) Understand concepts of photoangiolysis in treatment of aerodigestive tract malignancy.
Successful treatment of snoring and obstructive sleep apnea Michael Friedman, MD (moderator); B Tucker Woodson, MD; Kenny P Pang, FAMS, FRCS PROGRAM DESCRIPTION: Media, attention, physician education, and continued research on the long-term sequelae of obstructive sleep apnea/hypopnea syndrome (OSAHS) have created a huge increase in the number of patients seeking treatment. At the same time, disillusionment with the results of classic surgery such as UPPP and genioglossal advancement may have made many otolaryngologists avoid treatment. As the demand for treatment increases, surgery for OSAHS will become an increasingly significant component of every ENT practice. The purpose of this course is 1) To review new techniques and new clinical research, 2) to present a staging system that helps identify appropriate treatment with reasonable success rates, 3) to identify a large percentage of OSAHS patients with mild to moderate disease that could benefit from minimally invasive techniques. Various techniques will be presented. 1) Tongue base coblation allows for controlled resection of midline tongue base tissue with minimally invasive technology, offering advantages over radiofrequency reduction such as tissue removal vs reduction and better control of the amount of tissue removed. 2) Lateral pharyngoplasty, a modified UPP with improved results. 3) Minimally invasive nasal valve repair will be reviewed. Complications, avoided complications, and potential complications will be discussed by the panelists. Audience discussion is encouraged and ample time will be allotted for a question and answer section. EDUCATIONAL OBJECTIVES: 1) Learn an algorithm for successful treatment of snoring and obstructive sleep apnea. 2) Understand one approach for proper identification and treatment of each anatomic area. 3) Learn perioperative management, complications, and pearls based on faculty experience. 4) Identify patients who can be helped with multilevel minimally invasive techniques rather than classic surgery.
Technologic innovations in the management of CRS Rakesh Chandra, MD (moderator); Alexander Chiu, MD; Pete Batra, MD; Joseph Han, MD; Eric Holbrook, MD; Raj Sindwani, MD, FRCS PROGRAM DESCRIPTION: Management of chronic rhinosinusitis (CRS) has undergone continuous evolution through advances in technology. Many of these innovations have promoted minimally invasive management of complicated pathologies, including neoplastic disease. Such innovations have also facilitated treatment of uncomplicated sinus disease with subjective improvements in recovery. The current era in management of CRS was inspired by the proliferation of endoscopy, and the introduction of both the microdebrider and image guided surgical naviga-