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Who Should (Not) Have Surgery for OSA?
Miniseminars
Vocal Fold Paresis Lucian Sulica, MD (moderator); Mark S Courey, MD; Gregory N Postma, MD; C Gaelyn Garrett, MD; Steven A Bielamowicz, MD; Albert L Merati, MD Vocal fold paresis is emerging as a significant cause of laryngeal dysfunction, including dysphonia, cough, and pain. Yet consensus regarding basic features of vocal fold paresis remains elusive. The objective of this miniseminar is to critically review existing knowledge and contemporary thinking regarding this challenging clinical entity. Panelists will provide succinct practice-oriented case-based presentations aimed at answering key questions regarding vocal fold paresis. These include: 1) How is vocal fold paresis defined and distinguished from paralysis? 2) How common is it? 3) What are its causes? 4) What are the clinical manifestations, including signs and symptoms? 5) What diagnostic techniques are most useful? 6) How are patients with vocal fold paresis best managed? The seminar will include time for audience questions and productive debate, aimed at highlighting areas of lack of consensus in this topic.
Walking the Line: Staying Clean in PhysicianIndustry Relationships Maurice Roth, MD (moderator); Udayan K Shah, MD; Gina Maisto Smith; Eric Mann, MD, PhD; Gavin Setzen, MD There is increasing impact felt by Academy members from direct-to-consumer marketing and consultative and advisory relationships sought by the bio-pharma and device industries. This course is intended for physicians considering or involved with industry relationships. Recommendations will be made which maximize patient benefit from new products, minimize legal risk, and optimize physician involvement and compensation. We aim in this one-hour medico-legal presentation to empower participants through awareness of regulatory and criminal risks for malfeasance and fraud, by didactic slide-based format using case law, current examples, sample contracts, and audience participation. Following this miniseminar, attendees should be better able to engage in productive, long-term collaborative relationships with corporations, while maintaining 1) improvements in pa-
tient care, 2) legality, 3) technical and clinical innovation, and 4) compensation for work done.
What to Do with the Patient that Fails Chemoradiation Mark K Wax, MD (moderator); Jonas T Johnson, MD; Donald T Weed, MD; Eric M Genden, MD Organ Preservation Protocols continue to become more prevalent in the practice and management of patients with head and neck cancer. Unfortunately, a significant number of patients will fail their Oregon Preservation Protocol and require surgical salvage. Many issues remain in the management of these complex patients. This miniseminar will be a case management format with presentation by the individuals of one or two cases demonstrating their perspective and then a short presentation by the presenter on the subject. Specific issues that will be discussed will include: 1) Can an unresectable tumor be converted to a resectable tumor? 2) What is the current status of investigations to detect recurrence, both in the local and regional site, as well as distant metastasis? 3) When should surgery be offered? 4) What strategies can be used to reduce postoperative complications in these patients. 5) Finally, in the truly inoperable patient what alternatives remain; re irradiate/ chemo/ phase 1 studies/ palliative care.
Who Should (Not) Have Surgery for OSA? Eric J Kezirian, MD, MPH (moderator); Allan I Pack, MB, ChB, PhD; Edward M Weaver, MD, MPH Treatment of any disorder is based on an understanding of its consequences and the risks and benefits of treatment. For sleep disordered breathing (SDB), the large majority of this evidence comes from young and middle-aged adults, for whom SDB is associated with excessive daytime somnolence, quality of life and performance deficits, motor vehicle crashes, substantial cardiovascular morbidity and mortality, and endocrine disturbances. However, two important special populations exist for whom this evidence may not be relevant: asymptomatic adults and the elderly. Although many individuals comprise these two subgroups, few studies have specifically considered the consequences of SDB and the risks and benefits of surgical or non-surgical treatment. For asymptomatic individuals, the goals of treatment are largely limited to the health-related effects of SDB. The first presentation will describe the benefits that have been demonstrated with treatment of asymptomatic individuals at various tiers of SDB severity. SDB is common among older adults, as it affects an estimated 51% of men and 39% of women aged 65-95 years. Importantly, SDB in older adults may represent a distinct entity; the risk factors for and consequences of sleep apnea in older adults differ from those observed in younger patients.
MINISEM.
stranded RNA molecules reduce expression of homologous genes. Notable for its exquisite sequence specificity, it is ideally applied to diseases caused by a gain-of-function mechanism of action. A second therapeutic possibility is to upregulate expression of the normal gene thereby diluting the dominant-negative phenotype. These approaches are possible using adeno-associated or adenoviral vectors to deliver specific constructs to specific cells in the inner ear. Types of deafness in which both of these approaches can be piloted include DFNA2 (KCNQ4), DFNA3 (GJB2) and DFNA5 (DFNA5).
P27
P28
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
The question of whether SDB has similar consequences in older and younger populations parallels similar controversies about the clinical importance of so-called “physiologic abnormalities” in the elderly in hypertension, hypercholesterolemia, and subclinical hypothyroidism. The second presentation will assess the evidence concerning the effects of SDB and the benefits of surgical and non-surgical treatment in older adults. Positive airway pressure therapy is the primary treatment for adults with moderate to severe obstructive sleep apnea. Indi-
viduals who do not tolerate this treatment modality can consider alternatives, including surgery. Individuals commonly will have incomplete adherence to positive airway pressure therapy, and the adjunctive role of surgical treatment in improving or worsening positive airway pressure therapy compliance remains unclear. The available evidence suggests that treatment of the nasal airway can improve compliance, whereas surgical treatment of the pharynx can produce a range of outcomes. The third presentation will include a comprehensive review of this literature.
For up-to-date information about times, room locations, and schedule of sessions, visit www.entnet.org/annual_meeting, or consult your onsite program.
Vocal Fold Paresis Lucian Sulica, MD (moderator); Mark S Courey, MD; Gregory N Postma, MD; C Gaelyn Garrett, MD; Steven A Bielamowicz, MD; Albert L Merati, MD Vocal fold paresis is emerging as a significant cause of laryngeal dysfunction, including dysphonia, cough, and pain. Yet consensus regarding basic features of vocal fold paresis remains elusive. The objective of this miniseminar is to critically review existing knowledge and contemporary thinking regarding this challenging clinical entity. Panelists will provide succinct practice-oriented case-based presentations aimed at answering key questions regarding vocal fold paresis. These include: 1) How is vocal fold paresis defined and distinguished from paralysis? 2) How common is it? 3) What are its causes? 4) What are the clinical manifestations, including signs and symptoms? 5) What diagnostic techniques are most useful? 6) How are patients with vocal fold paresis best managed? The seminar will include time for audience questions and productive debate, aimed at highlighting areas of lack of consensus in this topic.
Walking the Line: Staying Clean in PhysicianIndustry Relationships Maurice Roth, MD (moderator); Udayan K Shah, MD; Gina Maisto Smith; Eric Mann, MD, PhD; Gavin Setzen, MD There is increasing impact felt by Academy members from direct-to-consumer marketing and consultative and advisory relationships sought by the bio-pharma and device industries. This course is intended for physicians considering or involved with industry relationships. Recommendations will be made which maximize patient benefit from new products, minimize legal risk, and optimize physician involvement and compensation. We aim in this one-hour medico-legal presentation to empower participants through awareness of regulatory and criminal risks for malfeasance and fraud, by didactic slide-based format using case law, current examples, sample contracts, and audience participation. Following this miniseminar, attendees should be better able to engage in productive, long-term collaborative relationships with corporations, while maintaining 1) improvements in pa-
tient care, 2) legality, 3) technical and clinical innovation, and 4) compensation for work done.
What to Do with the Patient that Fails Chemoradiation Mark K Wax, MD (moderator); Jonas T Johnson, MD; Donald T Weed, MD; Eric M Genden, MD Organ Preservation Protocols continue to become more prevalent in the practice and management of patients with head and neck cancer. Unfortunately, a significant number of patients will fail their Oregon Preservation Protocol and require surgical salvage. Many issues remain in the management of these complex patients. This miniseminar will be a case management format with presentation by the individuals of one or two cases demonstrating their perspective and then a short presentation by the presenter on the subject. Specific issues that will be discussed will include: 1) Can an unresectable tumor be converted to a resectable tumor? 2) What is the current status of investigations to detect recurrence, both in the local and regional site, as well as distant metastasis? 3) When should surgery be offered? 4) What strategies can be used to reduce postoperative complications in these patients. 5) Finally, in the truly inoperable patient what alternatives remain; re irradiate/ chemo/ phase 1 studies/ palliative care.
Who Should (Not) Have Surgery for OSA? Eric J Kezirian, MD, MPH (moderator); Allan I Pack, MB, ChB, PhD; Edward M Weaver, MD, MPH Treatment of any disorder is based on an understanding of its consequences and the risks and benefits of treatment. For sleep disordered breathing (SDB), the large majority of this evidence comes from young and middle-aged adults, for whom SDB is associated with excessive daytime somnolence, quality of life and performance deficits, motor vehicle crashes, substantial cardiovascular morbidity and mortality, and endocrine disturbances. However, two important special populations exist for whom this evidence may not be relevant: asymptomatic adults and the elderly. Although many individuals comprise these two subgroups, few studies have specifically considered the consequences of SDB and the risks and benefits of surgical or non-surgical treatment. For asymptomatic individuals, the goals of treatment are largely limited to the health-related effects of SDB. The first presentation will describe the benefits that have been demonstrated with treatment of asymptomatic individuals at various tiers of SDB severity. SDB is common among older adults, as it affects an estimated 51% of men and 39% of women aged 65-95 years. Importantly, SDB in older adults may represent a distinct entity; the risk factors for and consequences of sleep apnea in older adults differ from those observed in younger patients.
MINISEM.
stranded RNA molecules reduce expression of homologous genes. Notable for its exquisite sequence specificity, it is ideally applied to diseases caused by a gain-of-function mechanism of action. A second therapeutic possibility is to upregulate expression of the normal gene thereby diluting the dominant-negative phenotype. These approaches are possible using adeno-associated or adenoviral vectors to deliver specific constructs to specific cells in the inner ear. Types of deafness in which both of these approaches can be piloted include DFNA2 (KCNQ4), DFNA3 (GJB2) and DFNA5 (DFNA5).
P27
P28
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
The question of whether SDB has similar consequences in older and younger populations parallels similar controversies about the clinical importance of so-called “physiologic abnormalities” in the elderly in hypertension, hypercholesterolemia, and subclinical hypothyroidism. The second presentation will assess the evidence concerning the effects of SDB and the benefits of surgical and non-surgical treatment in older adults. Positive airway pressure therapy is the primary treatment for adults with moderate to severe obstructive sleep apnea. Indi-
viduals who do not tolerate this treatment modality can consider alternatives, including surgery. Individuals commonly will have incomplete adherence to positive airway pressure therapy, and the adjunctive role of surgical treatment in improving or worsening positive airway pressure therapy compliance remains unclear. The available evidence suggests that treatment of the nasal airway can improve compliance, whereas surgical treatment of the pharynx can produce a range of outcomes. The third presentation will include a comprehensive review of this literature.
For up-to-date information about times, room locations, and schedule of sessions, visit www.entnet.org/annual_meeting, or consult your onsite program.