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The difficult airway
Miniseminars
The difficult airway C Blake Simpson, MD (moderator); Eric Mair, MD; Albert Merati, MD; William Clark, MD, DDS; Gregory Postma, MD; Stacey Allen PROGRAM DESCRIPTION: Otolaryngologists are often called on to manage patients with difficult airways and this can be one of the more challenging and stressful aspects of our field. Multiple approaches can used depending on the expertise and training of the physician, and a unified and widely accepted airway algorithm has not been adopted by our specialty. New devices have been developed that extend the range of options available to the physician. The purpose of this miniseminar is to highlight standard approaches for airway management, as well as new and innovative devices and techniques that may be used to secure a difficult airway. The focus of the program will be on individual case management (both adult and pediatric), using a multidisciplinary panel to discuss varying approaches in airway management. The purpose is not to provide correct management strategies in each case, but to instead demonstrate the wide range of options available to the physician. EDUCATIONAL OBJECTIVES: 1) Learn a variety of approaches in the management of the difficult airway in both adult and pediatric patients. 2) Understand the rationale behind each approach and the ideal setting in which to use these techniques. 3) Be able to use a collaborative approach with the anesthesia team when approaching challenging airway cases.
Thyroid nodule FNA update: When to do it, when not, and how David L Steward, MD (moderator); David Terris, MD; Gregory Randolph, MD; Ralph Tufano, MD; Lisa Orloff, MD PROGRAM DESCRIPTION: In 2008, the National Cancer Institute published its review and conclusions from the State of the Science Conference on Thyroid Fine Needle Aspiration (FNA) which resulted in new recommendations regarding the management of thyroid nodules. Specific attention was given to diagnostic terminology and morphologic criteria for follicular thyroid lesions subdividing the atypical, suspicious, indeterminate, or follicular lesion findings into tiered categories based upon expected risk of malignancy (atypia of undetermined significance 5-10%, suspicious for neoplasm 20-30%, and suspicious for malignancy 5075%). Other committees addressed indications for FNA, training and credentialing, technique, ancillary studies, and post FNA management. Further, the American Thyroid Association has revised guidelines for thyroid nodule management with specific recommendations for which nodules should undergo FNA based upon size and sonographic criteria. This miniseminar will present these updates and changing paradigms in thyroid nodule management with a panel of experts in the field. Particular attention will be given to which nodules to observe, when and how to biopsy, and when to operate. Knowledge of these new consensus recommendations is critically important for otolaryngologists to provide state of the art care for their patients and to enable informed discussion with colleagues in endocrinology, pathology, and radiology. EDUCATIONAL OBJECTIVES: 1) Learn the new NCI diagnostic terminology for thyroid cytology reporting. 2) Understand which thyroid nodules should not undergo fine needle biopsy and which may be observed. 3) Learn the correct technique for thyroid fine needle biopsy.
Topical therapies in chronic sinonasal disease Richard Harvey (moderator); Peter J Wormald, MD, FRACS, FRCS, FSC (SA); Alexander Chiu, MD; Alkis J Psaltis, MBBS(Hons), PhD; Rodney J Schlosser, MD PROGRAM DESCRIPTION: There has been an explosion in the understanding of the mechanisms of chronic sinonasal inflammation. Multiple approaches to control and modify the inflammatory reaction in chronic rhinosinusitis have led to many new agents being introduced topically to the nose. This miniseminar aims to provide an evidence-based approach to the science behind topical management of sinonasal disease. Current research into irrigation dynamics and delivery device will be discussed. There are a range of products available to deliver solutions topically to nose. The scientific basis behind high and low volume along with negative and positive pressure delivery is presented. The general therapeutic goal of topical management often lies between, poten-
MINISEM.
tion. More recent innovations have been in the areas of electrosurgery, balloon dilatation, CT scanning (in-office, intraoperative), and paranasal sinus biomaterials. Further advances in powered instrumentation and image guidance have also continued to expand the boundaries of endoscopic sinus surgery. There are no currently established guidelines regarding when each of the available technologic innovations should be applied, although there is increasing clinical experience and evidence based data regarding how these modalities may expand the scope of rhinologic practice. This panel will present clinical and scientific data regarding the safety and efficacy of recent technologic innovations in the management of CRS. The potential roles for each of these modalities in both the operative and outpatient settings will be discussed. An evidence based algorithm for the application of each innovation will be presented. The panelists consist of experienced academic rhinologists and sinus surgeons who represent six academic tertiary centers. The panelist also lead in funded research for innovations to optimize the management of both basic and complicated sinonasal pathologies. EDUCATIONAL OBJECTIVES: 1) Recognize the variety of technological tools available in the management of patients with chronic rhinosinusitis (CRS). 2) Develop a rational algorithm for the application of these modalities in both the outpatient and operative setting. 3) Discuss the currently available clinical and scientific evidence for the safety, efficacy, risks and benefits of selected technologic innovations.
P29
The difficult airway C Blake Simpson, MD (moderator); Eric Mair, MD; Albert Merati, MD; William Clark, MD, DDS; Gregory Postma, MD; Stacey Allen PROGRAM DESCRIPTION: Otolaryngologists are often called on to manage patients with difficult airways and this can be one of the more challenging and stressful aspects of our field. Multiple approaches can used depending on the expertise and training of the physician, and a unified and widely accepted airway algorithm has not been adopted by our specialty. New devices have been developed that extend the range of options available to the physician. The purpose of this miniseminar is to highlight standard approaches for airway management, as well as new and innovative devices and techniques that may be used to secure a difficult airway. The focus of the program will be on individual case management (both adult and pediatric), using a multidisciplinary panel to discuss varying approaches in airway management. The purpose is not to provide correct management strategies in each case, but to instead demonstrate the wide range of options available to the physician. EDUCATIONAL OBJECTIVES: 1) Learn a variety of approaches in the management of the difficult airway in both adult and pediatric patients. 2) Understand the rationale behind each approach and the ideal setting in which to use these techniques. 3) Be able to use a collaborative approach with the anesthesia team when approaching challenging airway cases.
Thyroid nodule FNA update: When to do it, when not, and how David L Steward, MD (moderator); David Terris, MD; Gregory Randolph, MD; Ralph Tufano, MD; Lisa Orloff, MD PROGRAM DESCRIPTION: In 2008, the National Cancer Institute published its review and conclusions from the State of the Science Conference on Thyroid Fine Needle Aspiration (FNA) which resulted in new recommendations regarding the management of thyroid nodules. Specific attention was given to diagnostic terminology and morphologic criteria for follicular thyroid lesions subdividing the atypical, suspicious, indeterminate, or follicular lesion findings into tiered categories based upon expected risk of malignancy (atypia of undetermined significance 5-10%, suspicious for neoplasm 20-30%, and suspicious for malignancy 5075%). Other committees addressed indications for FNA, training and credentialing, technique, ancillary studies, and post FNA management. Further, the American Thyroid Association has revised guidelines for thyroid nodule management with specific recommendations for which nodules should undergo FNA based upon size and sonographic criteria. This miniseminar will present these updates and changing paradigms in thyroid nodule management with a panel of experts in the field. Particular attention will be given to which nodules to observe, when and how to biopsy, and when to operate. Knowledge of these new consensus recommendations is critically important for otolaryngologists to provide state of the art care for their patients and to enable informed discussion with colleagues in endocrinology, pathology, and radiology. EDUCATIONAL OBJECTIVES: 1) Learn the new NCI diagnostic terminology for thyroid cytology reporting. 2) Understand which thyroid nodules should not undergo fine needle biopsy and which may be observed. 3) Learn the correct technique for thyroid fine needle biopsy.
Topical therapies in chronic sinonasal disease Richard Harvey (moderator); Peter J Wormald, MD, FRACS, FRCS, FSC (SA); Alexander Chiu, MD; Alkis J Psaltis, MBBS(Hons), PhD; Rodney J Schlosser, MD PROGRAM DESCRIPTION: There has been an explosion in the understanding of the mechanisms of chronic sinonasal inflammation. Multiple approaches to control and modify the inflammatory reaction in chronic rhinosinusitis have led to many new agents being introduced topically to the nose. This miniseminar aims to provide an evidence-based approach to the science behind topical management of sinonasal disease. Current research into irrigation dynamics and delivery device will be discussed. There are a range of products available to deliver solutions topically to nose. The scientific basis behind high and low volume along with negative and positive pressure delivery is presented. The general therapeutic goal of topical management often lies between, poten-
MINISEM.
tion. More recent innovations have been in the areas of electrosurgery, balloon dilatation, CT scanning (in-office, intraoperative), and paranasal sinus biomaterials. Further advances in powered instrumentation and image guidance have also continued to expand the boundaries of endoscopic sinus surgery. There are no currently established guidelines regarding when each of the available technologic innovations should be applied, although there is increasing clinical experience and evidence based data regarding how these modalities may expand the scope of rhinologic practice. This panel will present clinical and scientific data regarding the safety and efficacy of recent technologic innovations in the management of CRS. The potential roles for each of these modalities in both the operative and outpatient settings will be discussed. An evidence based algorithm for the application of each innovation will be presented. The panelists consist of experienced academic rhinologists and sinus surgeons who represent six academic tertiary centers. The panelist also lead in funded research for innovations to optimize the management of both basic and complicated sinonasal pathologies. EDUCATIONAL OBJECTIVES: 1) Recognize the variety of technological tools available in the management of patients with chronic rhinosinusitis (CRS). 2) Develop a rational algorithm for the application of these modalities in both the outpatient and operative setting. 3) Discuss the currently available clinical and scientific evidence for the safety, efficacy, risks and benefits of selected technologic innovations.
P29