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MONDAY, JUNE 20, 2005
WORKSHOP - Room 1
CHAIR: Daniel, S., MONTREAL, QC
PANEL: Ludemann, J., Lapointe, A., Giguere, C.M., Tewfik, T.L., Moxham, P.
13:30-14:00
"Challenging and Interesting Cases in Pediatric Otolaryngology"
This pediatric panel will be discussing interesting and challenging cases in pediatric otolaryngology. The moderators SJ Daniel and J Ludemann will be presenting the cases to the expert panel for their opinion on the management of these cases. Audience interaction is encouraged. Cases presented include: neonatal choanal atresia, nasopharyngeal angiofibroma, atypical mycobacterial adenitis, sinus mucormycosis, and lymphatic malformation. The management and controversies surrounding each entity will be addressed by the panellists.
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MONDAY, JUNE 20, 2005
WORKSHOP - Room 1
CHAIR: Adamson, P., TORONTO, ON
15:40-16:45
Management of the Crooked Nose
The crooked nose can be one of the most challenging deformities in rhinoplasty. This course reviews the major anatomic components contributing to this condition: The nasal septum; Tip; Bony nasal bridge; Cartilaginous dorsal middle third; Skin-soft tissue envelope. Various techniques that are used to correct these deformities, including sculpting, cartilage incision and excision, suturing, grafting and soft tissue will be discussed. The course is illustrated with video clips of many of the maneuvers described. Patient results and illustrations to document the efficacy of these techniques are shown. Time permitting, an interactive patient workshop will be presented. Time will be allotted for questions and answers.
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MONDAY JUNE 20, 2005
WORKSHOP - Room 1
CHAIR: Javer, A., VANCOUVER, BC
PANEL: Desrosiers, D., Wright, E., Witterick, I., Sindwani, R.
16:50-17:50
Allergic Fungal Rhinosinusitis: What Have We Learned So Far? / Frontal Sinus Surgery: Current Techniques, Pearls and Pitfalls
Objectives: 1) Review the history of AFRS. 2) Review the diagnostic criteria and their evolution. 3) Review the recent literature on current thoughts for the diagnosis and treatment protocols for AFRS. Are there multiple diseases with a common presentation? 4) Present the prospective multicenter Canadian study (sanctioned by the CSO Rhinology group) data on the presence of AFRS in Canada and regional variations, if any. 5) Using case presentations, demonstrate the difficulty in management of AFRS. At the end of this workshop, the participants should have a good understanding of the: 1) Historical perspective of Allergic Fungal Rhinosinusitis. 2) Pathophysiology of AFRS. 3) Current flow-chart for the diagnostic criteria for AFRS and associated co-conditions (EFRS, EMRS, etc). 4) Difficulty with diagnosis of AFRS and the importance of modified criteria. 5) Most current surgical and postoperative medical management protocols for AFRS. 6) Presence and incidence of AFRS at different centers across Canada.
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MONDAY, JUNE 20, 2005
WORKSHOP - Room 2
CHAIR: Kozak, K., VANCOUVER, BC
15:40-16:40
History of Deafness
Objectives: Deafness is a condition cared for by otolaryngologists since the specialty's inception. Historically and to this day, there have been two polarized camps (oralism versus sign language) as to how patients should be treated and educated. Why does this polarization exist? Where did oralism originate historically? Where and when did sign language become formalized? Why are there different types of sign language? What role did Alexander Graham Bell play in the history of oralism? Are the two groups as far apart today as in the past? These questions as well as many others will be covered in this interesting and informative workshop on the history of deafness.
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MONDAY, JUNE 20, 2005
WORKSHOP - Room 2
CHAIR: Leclerc, J., STE-FOY, QC
14:15-15:10
Basic Photoshop Knowledge for Effective Presentations
Objectives: Introduce Photoshop to beginners so that they can import, modify and use images adequately and efficiently in their future presentations. Methods: Powerpoint presentation. Content: 1. General characteristics of powerful illustrations. Some images do speak by themselves. They capture our attention and seem to stay forever in our minds. What are the underlying principles that create very effective visuals. 2. Most commonly used formats. Some formats are used in high quality images and use very little compression. Other formats are lighter in terms of size and can be sent much easier on the Web. A review of the most commonly used formats with their pros and cons will be presented. 3. How to import images - getting images into Photoshop. The final presentation may require images coming from many different sources including journals, books, pictures from a personal collection or from the Web. There are many ways to acquire these images and these will be explained and illustrated. 4. Changing image size and resolution. For each situation, different sizes and resolutions may be required. The steps to proceed to a change of size and/or resolution will be presented. 5. Editing and retouching. To be useful, many images need to be adapted, coloured or simplified. Many interesting tools are available to correct or modify an interesting picture or drawing. 6.Transferring. The last step is to send the corrected material to Powerpoint.
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TUESDAY, JUNE 21, 2005
Room 3
PAPER SESSION - HEAD AND NECK SURGERY
15:40 - 15:50
Killing Time: Waiting Times to Diagnosis and Treatment of Head and Neck Cancer-- A Comparative Study
– Goldstein, D.P., Irish, J.C., Jeremic, G., Werger, J., TORONTO, ON
Introduction: It is speculated that the majority of waiting time delays for treatment of head and neck cancer are independent of the health care resources available to the tertiary care centre. Objective: To describe the entire waiting time spectrum for patients with newly diagnosed head and neck cancer. Methods: A point of entry interview was performed on 50 consecutive head and neck cancer patients to determine specific time points: patient delay with symptoms, primary care physician delay in diagnosis and treatment, primary specialist delay for diagnosis and treatment, and treatment delay at a regional cancer centre. Patient interviewing, health care providers corroboration, and basic statistical analysis and interpretation were employed for a sample size of fifty patients without interventions. Significance: To cross-reference the data to a similar study done in 1995 by the same authors utilizing the same methodology, and analyze where to focus education to diminish waiting time.
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15:50 - 16:00
Extracranial Head and Neck Schwannomas: The McGill Experience
– Anand, S.M., Al-Qahtani, K., Black, M.J., Hier, M.P., Kost, K.M., Zeitouni, A.G., MONTREAL, QC
Objectives: Extracranial schwannomas (ECS) of the head and neck are uncommon tumors of peripheral nerve sheath origin. Methods: We reviewed our experience with ECS over the last 12 years with respect to presentation, management and outcome. Results: Thirty-five cases of ECS at three centers were identified from 1992 to 2004 (16 women, 19 men). The mean age at diagnosis was 50.5 years (range 19 – 87 years). Sites of ECS distribution included 7 facial, 6 vagus, 5 sympathetic chain, 5 brachial plexus, 5 cervical plexus, 2 hypoglossal, 2 jugular foramen, 2 trigeminal, and 1 lingual nerve. The most predominant symptoms were a painful mass, and facial nerve or vocal cord paresis. Wide surgical excision was performed in 32 of 35 patients (91%). Median follow-up is 64 months. Post-operative sequelae included vocal cord paralysis, Horner’s syndrome, and facial nerve paralysis for which cable nerve grafting largely achieved partial re-animation. Recurrence occurred in 4 patients. Three were re-operated and one irradiated. They have remained tumour free since. Conclusion: ECS are rare nerve sheath tumors often presenting in late stages at multiple sites in the head and neck. In our experience, surgical excision is the treatment of choice bearing in mind a potential for CN paralysis or sympathetic chain injury.
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16:00 - 16:10
Sarcoma of the Head and Neck. An Analysis of a 30 Year Experience in the Tom Baker Cancer Centre, Alberta Cancer Board, Calgary
– Huber, G.F., Matthews. T.W., Dort, J.C., CALGARY, AB
Background: Soft tissue sarcomas of the head and neck region are rare entities, constituting 1% of all head and neck tumors. Only a limited number, mostly on institution based experience, has been published. Material and Methods: We performed an analysis of patients with head and neck soft tissue sarcomas identified from our Cancer Clinic between 1974 and 2001. Exclusion criteria included chondrosarcomas, osteogenic sarcomas, pediatric rhabdomyosarcomas and sarcomas of the neuronal axis, given the known different behavior and treatment. Analysis: Potential prognostic factors including age, gender, tumor size, histology, grade, and adjuvant treatment were evaluated. A descriptive analysis and the overall survival was calculated by the Kaplan-Meier method. The cases were broken down into 10 year intervals and the provincial case incidence was calculated using the average Alberta population in that 10 year interval. The average of the 3 calculated incidences were used to determine the incidence over the entire time period. Treatment modalities used in each time period were analyzed to note any major changes. Finally a thorough comparison with the current literature and recommendations was conducted.
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16:20 - 16:30
Cost Analysis Comparing Two Treatments For Maxillary Rehabilitation
– Rieger, J.M., Nordstrom, D., Seikaly, H., Zakariasen, K., Wolfaardt, J., EDMONTON, AB
Objectives: The cost of implementing advanced digital technologies, such as rapid prototyping, in maxillary reconstruction has not previously been described. The purpose of this study is to establish the cost of using advanced digital technologies in maxillary reconstruction and to compare this to the costs associated with traditional techniques of maxillary rehabilitation. Methods: Six patients undergoing maxillary reconstruction with a fibular flap followed by an implant-supported partial denture placement, 6 patients with implant-supported obturators, and 9 patients with soft tissue supported obturators were included as subjects. Costs related to primary and reconstructive surgery, anesthesia, hospital stay, functional assessment, prosthodontic treatment, dental lab fees & materials, radiological procedures, implant components & surgery, advanced technology access, and hyperbaric oxygen treatment were totaled and averaged for each patient. Results: Differences in costs existed between all 3 groups. Conclusions: From time of initial consult to insertion of definitive prosthesis, the lowest-cost treatment option for cancer of the maxilla is a non-implant supported intraoral maxillary obturator. However, this result does not consider the costs of a lifetime recall schedule. In addition, it does not consider functional outcome and patient satisfaction. These issues are currently being explored.
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16:30 - 16:40
Is Suction Drainage An Effective Means of Preventing Hematoma in Thyroid Surgery: A Meta-Analysis
- Corsten, M.J., Johnson, S., Alherabi, A., OTTAWA, ON
Objectives: To evaluate the efficacy of suction drainage in preventing post-operative hematoma formation in thyroid surgery. Methods: We conducted a meta-analysis, using only randomized controlled trials in which the incidence of post-thyroidectomy hematoma was compared directly in patients with and without suction drains (8 studies since 1980, total N=944). The odds ratio (OR) with respective confidence intervals (CI) using fixed effects model was reported. We used an OR < 1.0 as being in favor of treatment (i.e. the use of suction drains). Results: In our meta-analysis there was no statistically significant difference between the rates of post thyroidectomy hematoma whether or not suction drains were used when the results were combined using a fixed effects model (OR 1.04, 95% CI 0.56 to 1.93) with p=0.90. In this comparison a fixed effects model was used rather than a random effects model because there was no statistically significant heterogeneity (chi-square 6.26, P= 0.28). Conclusions: We conclude that the use of suction drains in thyroid surgery to prevent post-operative hematoma is not evidence based.
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16:40 - 16:50
The Effect of Continued Smoking on the Incidence of 2nd Primaries and Recurrence in Patients Treated for Head and Neck Squamous Cell Carcinoma
- Chau, J., Seikaly, H., Harris, J.R., Calhoun, K,H., EDMONTON, AB
Purpose: To assess the effect of continued smoking on the incidence of 2nd primaries, recurrence, and survival in patients treated for head and neck squamous cell carcinoma. Design: Prospective cohort. Methods: 127 patients were enrolled in the study. Patients filled out an exhaustive smoking and alcohol questionnaire on presentation. Abbreviated questionnaires were filled at each follow-up period. All patient data was collected prospectively by a dedicated research nurse. All patients had a minimum of 5 years follow up. Results: 122 patients completed the study. 36% had stopped smoking at the first follow-up visit. Continued smoking was associated with increased incidence of recurrence, second primaries and decreased survival. Conclusions: Smoking cessation is difficult in head and neck cancer patients. Continued smoking is associated with decrease survival due to recurrence and 2nd primaries.
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17:00 - 17:10
Outcome Measures In The Delay of Post-operative Radiotherapy in Head & Neck Cancer Patients: A Retrospective Review
– Alherabi, A., Preston, M., Yammine, N., Odell, P., Eapean, L., Corsten, M., OTTAWA, ON
BACKGROUND: In the field of Head & Neck cancer treatment there is an assumption that a six week delay of post operative radiotherapy is the optimum time to balance recovery from radiation effect in the operative field and oncological control. OBJECTIVE: In this retrospective review we examined the effect of the delay in post operative radiotherapy to the outcome of patients and correlated that information to the site, stage, and pathology of the disease. METHODS: Our cohort was created from the Ottawa regional cancer centre medical record database to include all head & neck cancer patients 1990-2001 who received up front surgery followed by post operative radiotherapy and met our inclusion criteria. RESULTS: 172 patients were included. Mean age at time of surgery was 59.2 years. Thirty-seven patients were stage I disease (21.5%), 35 patients were stage II (20.3%), 24 patients were stage III (14%), and 72 patients were stage IV (41.9%). Eighty-nine patients had cancer of the oral cavity (51.74%), 30 patients had oropharyngeal cancer (17.44%), 16 patients had hypopharyngeal cancer (9.3%), and 34 patients had laryngeal cancer (19.77%).
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17:10 - 17:20
Le lambeau temporo-pariétal: une nouvelle application dans la reconstruction de la fosse moyenne
– Lacroix, Y., Denis, P., Gaeten, F., QUEBEC, QC
Objectif: Évaluer l'utilisation du lambeau temporo-pariétal dans le traitement des pathologies oto-neurochirurgicales comportant une communication entre la fosse moyenne et la mastoïde.Méthode: Révision de la littérature sur le lambeau temporo-pariétal, description de la technique chirurgicale et étude de 9 cas pour lesquels ce lambeau a été utilisé à l'Hôpital de l'Enfant-Jésus de Québec entre 1997 et 2004. Quatre cas de méningo-encéphalocèle, 4 cas de fistule de liquide céphalo-rachidien et 1 cas de granulome de cholestérol ont été révisés.Résultats: Aucune récidive de la pathologie initiale n'a été décelée sur un suivi moyende 27 mois. Présence de complications mineures (1 souffrance distale du cuir chevelu sans nécrose, 1 ecchymose du cuir chevelu, 1 hématome du site donneur drainé et 1 persistance de fistule de liquide céphalo-rachidien corrigée per-hospitalisation par l'utilisation d'un drain lombaire). Absence de complications majeures.Conclusion: Le lambeau temporo-pariétal constitue un excellent outil thérapeutique pour les pathologies oto-neurochirurgicales comportant une communication entre la fosse moyenne et la mastoïde, sans complication majeure reliée à la reconstruction ni récidive de la pathologie initiale.
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17:20 - 17:30
Treatment Variation and Treatment Outcome for Patients with Cancer of the Hypopharynx Across Ontario - A Preliminary Report
– Hall, S.F., Groome, P.A., Irish, J.C., TORONTO, ON
We have identified wide variation in the treatment practices between the Cancer Care Ontario treatment centers for patients with squamous cell carcinoma of the hypopharynx. This variation is consistent with a literature that has little evidence for and no agreement on the most effective treatment for these patients. We will present some preliminary results of a CIHR funded study based on the 950 cases across Ontario between Jan 1990 and Jan 2000. We will present a comparison of the case mix, treatments and outcomes by treatment center based on combined information from the Ontario Cancer Registry, CIHI and chart review.
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17:30 - 17:40
Comparison of Stage, Outcome and Pathological Characteristics in Young and Older Patients with Oral Tongue Cancer
– Brousseau VJ, Al-Qahtani K, Paczesny D, Domanowski G, Kost KM
Objectives: To compare the stage, outcome and pathological characteristics of young (<40 years at diagnosis) and older (>40 at diagnosis) patients with squamous cell cancer (SCCA) of the oral tongue. Methods: Retrospective review of patients diagnosed with SCCA of the oral tongue in the last 5 years. Pathological samples were reviewed by a single head and neck pathologist looking for koilocytosis, a finding indicating the presence of HPV. Data extracted included: age at diagnosis, risk factors, tumor stage, grade, presence of koilocytosis, and outcome. Results: There were 18 young (average age 33) and 67 older (average age 66) patients. Young patients had a lower prevalence of smoking and alcohol consumption than older patients (33% vs 61%, 22% vs 48% respectively). Young patients presented at the following stages: I 28%, II 22%, III 28%, IV 22%. Older patients presented at the following stages: I 25%, II 30%, III 16%, IV 28%. Three (17%) young and 4 (6%) of older patients succumbed to their tongue cancer. Koilocytosis was found in 39% of young and 36% of older patients. Conclusion: There does not appear to be difference in stage presentation or presence of koilocytosis between the two populations. Younger patients have a lower prevalence of smoking and drinking than the older patients. The young appear to have a slightly worse prognosis than the older patients in this sample. The presence of koilocytosis is not associated with a worse prognosis.
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MONDAY, JUNE 20, 2005
WORKSHOP - Room 3
CHAIR: Freeman, J., TORONTO, ON
PANEL: Black, M., Lampe, H., Gullane, P., Kerr, P., Gilbert, R.
13:30-15:10
Head and Neck Oncological Surgical Techniques - An Interactive Video Workshop
Objectives: To teach modern techniques of head and neck oncological surgery by way of video presentation of cases with expert panel and audience interaction. Methods: 4 video surgical techniques will be presented, each by an expert. The surgical cases will be as follows: 1. thyroidectomy, 2. conservation neck dissection, 3. parotidectomy, 4. laryngectomy. The video will be run and stopped at strategic times for audience and expert panel commentary/criticism. Results: This teaching tool will impart useful graphic information given by Canadian experts from across the country. Both trainee and practitioner will glean basic techniques and useful "tricks" for utilization during the course of a variety of oncological procedures. Conclusions: Video surgical presentations will be used to deliver state of the art surgical techniques for a varieity of procedures through an interactive workshop. Minimum of 2 hours are requested.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 1
CHAIR: Crysdale, W., TORONTO, ON
08:30 - 09:10
External Septoplasty in Children - How I Do It
External free graft septoplasty in children is completed for symtomatic anterior deviation of the nasal septum. To the present date, the author has completed such 251 procedures during the past 19 years. This procedure is controversial as it is felt by many that subsequent nasal growth is impacted. The author has completed 2 studies with the help of a surgical anthropologist that document that this has not been the case. It is crucial that the free cartilage graft fit the defect created and be properly fixed in position.The author will show how this is done.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 1
CHAIR: Martino, R., TORONTO
PANEL: Irish, J., Gilbert, R.
09:10 - 10:00
Evidence Based Medicine in Otolaryngology: Separating the Wheat from the Chaff
In the era of Evidenced-Based Medicine (EBM), it is essential that clinicians keep abreast of the latest literature. EBM is a method of basing clinical decisions on more than experience, intuition, or personal choices but also on hard, documented, scientific information from well-designed research. In order to practice EBM, clinicians are required to: a) conduct critical appraisals of individual articles: and, b) access systematic reviews on specific topics. This workshop will teach the methods of critical appraisal using examples from the otolaryngology literature. Not all articles are methodologically correct but participants will learn how to separate the 'wheat from the chaff’. In addition, several high quality otolaryngology electronic databases of systematic reviews will be reviewed. Participants will be shown how to utilize these databases to facilitate on-going clinical decision-making. There will be a review of the methodologies involved in developing an evidence-base guideline using one otolaryngological topic as an example. Workshop Objectives: 1) To discuss the features and value of Evidenced-Based Practice in reference to the practice of Otolaryngology. 2) To review the process of systematic reviews and provide a list of resources for available systematic reviews relating to otolaryngology. 3) To demonstrate the benefit of Clinical Practice Guidelines in decision making using an example from otolaryngology.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 1
CHAIR: Younger, R., VANCOUVER, BC
PANEL: Strecker, H., Dmytryshyn, R., Kibblewhite, D., Brownrigg, P.
13:30 - 15:10
Botox for Dummies / The Extreme Nasal Deviation Makeover / An Apprentice Guide to the Wide Nasal Tip
Non-invasive esthetic surgery has been revolutionized by Botox in the new millenium. Botox injections are the most frequently performed procedure for cosmetic enhancement in North America. Panelists will discuss their current indications for the usage of Botox, with specific mixing protocols and injections techniques outlined to allow head and neck surgeons a better understanding of the benefits and limitations of this much talked about treatment modality.
Extreme septal and external deviation of the nose remains a daunting challenge for both novice and experienced nasal surgeons. Five specific regions of potential extreme nasal deviation will be addressed, namely the columella, nasal septum, lower lateral cartilages, upper lateral cartilage and nasal bones. Case presentations on these anatomic specific areas will be made outlining surgical approaches and techniques that have stood the test of time allowing for stable, long term realigned nose results. Panel discussions, that follow the anatomical analysis, will ratify what works for the extreme nasal deviation makeover.
Management of the wide nasal tip is a multifaceted rhinoplasty problem with varied approaches and technical variations, all aligned to bring the nose into better esthetic balance. The pros and cons of endonasal versus external approaches will highlight case presentations, followed by in depth discussions, outlining the panellists current philosophy with regards to mastering the wide nasal tip.
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TUESDAY, JUNE 21, 2005
Room 1
PAPER SESSION - GENERAL
15:40 - 15:50
Complications of tracheostomies performed in the Intensive Care Unit vs. the Operating Room
– Yousuf, K., Cheung, R.L., Freeman, J., TORONTO, ON
Background: Surgical tracheostomy has become a procedure often performed in critically-ill patients. According to a literature review, the complications and morbidity associated with this surgical intervention have not been compared in the settings of the Intensive Care Unit (ICU) versus the Operating Room (OR). The aim of this retrospective study is to determine whether or not a significant difference in complications between the two settings exists. Methods: A retrospective chart analysis for 50 patients who had undergone a tracheostomy (25 in the ICU, 25 in the OR) at Mt. Sinai Hospital in Toronto, Ontario between the years of 2001-2003 was conducted. The course while going through the treatment, and follow-up was documented. Immediate (bleeding, pneumothorax, difficult cannulation) and delayed (pneumonia, anemia, wound infection, sepsis) complications were noted. Differences between complications in the two groups were measured with statistical analysis. Results: No statistically significant difference in the immediate or delayed complication rates between the two sets of patients exists based on initial analysis. Conclusion: The study shows that there isn’t a significant difference in rates of immediate or delayed complications in patients who have had a tracheostomy in the setting of the ICU versus the OR.
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15:50 - 16:00
A Multimodal Multidisciplinary Surgical Approach for the Treatment of Pituitary Tumours
– Zeitouni, A.G., Leblanc, R., Soualmi, L., MONTREAL, QC
Objectives: The surgical management of pituitary tumours is being impacted by the development of two key technologies: image guidance and endoscopy. This study seeks to assess the impact of these technologies. Methods: Retrospective review of patients seen at the Skull Base Clinic of the McGill University Health Centre and operated in a multidisciplinary context. Results: Seventy-five patients were reviewed. Neuronavigation was used in all cases. We review our experience using a multimodal approach combining endoscopic and microscope techniques along with a unique, high capability image guidance system. Both endoscopy and the microscope have a role. Endoscopy permits identifying surrounding structures in the lateral wall of the sphenoid, next to the tumour, and "around corners". The microscope continues to play a key role. It facilitates a bimanual technique, stable magnification and a 3 D view. These technologies are complementary. Cases illustrating these points will be presented. Conclusion: the multidisciplinary, multimodal approach developed permits maximizing of the benefits of these new technologies.
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16:00 - 16:10
Perceptual Evaluation of Smoker’s Voices: Can Smokers be Distinguished from Non-smokers Based on Voice Alone?
– Kost, K.M., Brown, E.D., Al-Eisa, M., MONTREAL, QC
Introduction: Smoking is known to lower the frequency of the voice based on objective acoustic analysis (Sorensen & Horrii 1982). It is our hypothesis that medical experts will be able to reliably distinguish the voice of a smoker from that of a non-smoker from a recording alone. To our knowledge, no study in the English literature has assessed the perceptual evaluation of smokers' voices. Objectives: To determine whether smoking-induced voice changes can be reliably detected from a recording alone, and to determine whether medical expert versus non-expert recognition ability differs. Methods: The voices of 40 smokers with over twenty pack-year histories and 40 age- and sex-matched non-smokers will be digitally recorded using a phonetically balanced paragraph. The recordings were assessed by medical experts and non-experts blinded to the gender, smoking status and appearance of the patients. Results: Recordings of the 40 smokers and 40 non-smokers were assessed by medical experts and non experts, who were asked to determine the gender and smoking status of the patients. Accoustical analysis was also performed on the recordings by a speech-language pathologist.Conclusions: This study provides better understanding of the degree to which smoking alters the voice. Evidence that smoking causes noticeable vocal change may be used as a potential tool to discourage smoking. Further studies are necessary to determine the dose relationship between pack-years and vocal change.
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16:10 - 16:20
Sentinel Lymph Node Biopsy in Squamous Cell Carcinoma of the Head and Neck:
Where We Stand Now, and Where We are Going
– Côté, V., Payne, R.J., Kost, K.M., Hier, M., MONTREAL, QC
Background and objectives : This review was performed to evaluate the existing literature on SLNB for early stage oral and oropharyngeal head and neck squamous cell carcinoma (HNSCC) in clinically negative (N0) necks.
Methods : A Medline search identified 43 pertinent published trials and reviews in the English language from 1990 to 2004.
Results : Recent studies consistently show high sensivities >93% for T1 and T2 HNSCC. SLNB has the potential to replace neck dissection in those patients. Data on T3 and T4 tumors is not as promising, although research is currently underway to determine the true metastasis detection rate. Appropriate technique is crucial for the complete detection of the sentinel nodes. For HNSCC sentinel lymphadenectomy, many studies have advocated the use of a colloid tracer and gamma probe detector, as well as the harvesting of a total of 3 nodes as a good standard technique.
Conclusion : American multi-centre trials are currently underway gathering crucial data on this technique. It is very likely that SLNB will become indicated for T1 and T2 oral cavity squamous cell carcinoma with N0 necks, and possible that the indication will extend to all early stage HNSCC. However, more research will be necessary for advanced head and neck cancers.
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16:30 - 16:40
Percutaneous Tracheotomy in 500 Cases: What's The Verdict?
- Kost, K., MONTREAL, QC
Objectives: To evaluate the safety and feasibility of endoscopic percutaneous dilatational tracheotomy (PDT) using the multiple and single dilator techniques in adult, intubated intensive care unit (ICU) patients. Methods: Prospective evaluation of PDT in 500 consecutive cases from 1990 to 2003. Parameters recorded included: age, sex, diagnosis, American Society of Anesthesia (ASA) Class, Body Mass Index (BMI), number of days intubated, and hematological indices. Endoscopic PDT was carried out using multiple dilators in the first 191 cases, and a single dilator in the remaining 309 patients. Pre-operative, intraoperative and postoperative data were recorded in all cases. Results: The total complication rate was 9.2% (13.6% in th multiple dilator group and 6.5% in the single dilator group), with over half of these considered minor. The absence of serious complications such as pneumothorax and pneumomediastinum are attributed to the use of bronchoscopy. There was a statistically significant relationship between experience and the likelihood of complications in the multiple dilator group (p<.0001) with a higher rate of complications in the first 30 patients (40%) compared with 8,7% in the remaining 161 patients. Patients with a BMI >30 experienced a significantly higher (p<.05) number of complications compared to those with a BMI <30. Conclusions: Endoscopic PDT is at least as safe as surgical tracheotomy in the ICU setting.
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16:40 - 16:50
Uvulopalatopharyngoplasty in unselected patients with obstructive sleep apnea syndrome
- Lui, B., Werger, J., SCARBOROUGH, ON
Objectives: To evaluate the efficacy of uvulopalatopharngoplasty (UPPP) in unselected patients with obstructive sleep apnea syndrome (OSAS). Study Design: A retrospective study on 27 patients who completed UPPP for the treatment of OSAS. Materials and Methods: Forty-nine patients with OSAS underwent UPPP treatment. Twenty-seven patients obtained postoperative polysomnography and clinical follow up. Postoperative complications and polysomnographic findings were reviewed. Results: Patients experienced significant reductions in mean AHI (p=0.006) and mean incidence of oxygen de-saturations below 90% (p=0.014). Furthermore, there was a significant increase in the mean minimum oxygen saturation level (p=0.039). Postoperative complications in these patients included minor bleeding, temporary velopalatal insufficiency and temporary dysphonia. Conclusions: Overall, these results indicate that UPPP provides a significant benefit for most unselected patients in the management of OSAS with respect to clinical and polysomnographic findings.
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16:50 - 17:00
Analysis of Non-Traumatic Facial Nerve Paralysis Patients: The Sunnybrook Experience
– Mabini, A.J., Nedzelski, J.M., TORONTO, ON
Objective: To evaluate the incidence, clinical presentation and outcomes of patients diagnosed with Bell’s Palsy and Ramsay Hunt Syndrome in the Facial Nerve Clinic. Method: A retrospective chart review. Results: From 2001 to 2004, 20 patients were diagnosed with Bell’s Palsy and 4 patients with Ramsay Hunt Syndrome. The majority of patients affected were female. 33% of patients had an initial complete lower motor neuron paralysis. 70% of patients were treated with either steroids, antivirals, antibiotics or a combination. Complete facial nerve recovery was found in 25% of Bell’s Palsy patients and 75% of Ramsay Hunt Syndrome. Conclusion: The incidence of Ramsay Hunt Syndrome is 16% at our institution. Facial nerve recovery from Bell’s Palsy is lower than previously reported. However, the outcome of Ramsay Hunt Syndrome is better than published reports, with a 75% rate of complete facial nerve recovery and no residual vestibulocohlear dysfunction.
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17:10 - 17:20
The Sunnybrook Experience: A Review of Deep Vein Thrombosis and Pulmonary Embolism in Otolaryngology
– Lee, J., Alexander, A., Higgins, K., TORONTO, ON
Objective: To review deep vein thrombosis (DVT) and pulmonary embolism (PE) as a post-operative complication in the Department of Otolaryngology at a single academic hospital. Methods: This was a retrospective chart review of all surgical patients in the Department of Otolaryngology at The Sunnybrook and Women’s College Hospital from 1989-2004. Patients who suffered either a DVT or PE as a post-operative complication were identified. Results: 16 patients were identified in our study. The average age of the patient at surgery was 59.2 years. There were 7 females and 9 males. The average length of surgery was 8.2 hours. 12 patients (75%) underwent a Head & Neck surgical procedure, 3 patients (18.7%) had an Otology/Neurotology procedure, while 1 patient (6.2%) had a General Otolaryngology procedure. 12 patients (75%) developed a DVT, 7 patients developed a PE (43.7%), while 3 patients (18.7%) developed both. Our analysis with respect to DVT and PE risk factors, clinical presentation, diagnosis, prophylaxis, and treatment will be discussed. Conclusion: Venous thromboembolism is a potential cause of significant morbidity and mortality in the Otolaryngology patient population.
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17:20 - 17:30
Otoplasty Outcomes: Continued Evaluation
– Cushing SL, Crysdale WS
Objectives: Aesthetic deformities resulting in a prominent ear are extremely common and are addressed through otoplasty. A number of techniques exist currently and it therefore remains imperative that surgeons invest in the assessment of their long term results. It is with this in mind that we have reviewed our immediate and long-term results using a standard protocol based on the Frankfort horizontal line. Methods: A database of patients undergoing otoplasty by a single surgeon at the Hospital for Sick Children in Toronto since 1988 (138 patients) has been maintained. Furnas and/or Mustarde techniques were employed in all patients. Pre- and post-operative measurements at 4 points based on the Frankfort horizontal line were recorded. All patients presently less than 18 years of age (58 patients) have been asked to return for follow-up measurements and to complete a patient satisfaction survey. A similar follow-up review was conducted in 1993.
Results: The average immediate medialization achieved was 6.1mm at the superior point, 12.3mm at the superior line, 11.8mm at the Frankfort horizontal line and 8.5mm at the conchal line. Follow-up measurements are currently underway.
Conclusion: Preliminary data suggests that with time a substantial amount of the correction achieved through otoplasty is lost, but that ear to ear symmetry is maintained. It is anticipated that despite some loss of medialization, patients and families remain satisfied with the overall results.
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17:30 - 17:40
Rounding of the Inferior Rectus Muscle as an Indication of an Orbital Floor Fracture with Periorbital Disruption
– Banerjee, A., Moore, C., Matic, D., Tse, R., LONDON, ON
Objectives: To determine if rounding of the inferior rectus muscle (IRM) on coronal CT scan is a reliable indicator of orbital floor fracture with periorbital disruption.
Methods: Coronal CT scans of 5 fresh cadaveric heads (10 orbits) will be performed. CT scans will then be repeated after creation of orbital floor fractures, first without disruption of the periorbita and then after disruption of the periorbita. The shape of the IRM will be determined on these CT scans.
Results: Preliminary data shows that rounding of the IRM is seen only with orbital floor fractures with periorbital disruption and not seen on either the prefracture CT scans or on the post-fracture CT scan without periorbital disruption.
Conclusion: We expect to show that rounding of the IRM is a reliable indicator of orbital floor fracture with periorbital disruption. This CT finding may therefore represent another indication for surgical repair of orbital floor fractures.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 2
CHAIR: Marshall, A., TORONTO, ON
PANEL: Chen, J., TORONTO, ON
08:30 - 09:15
Minimizing Risks and Complications in Otological Study
This workshop will focus on technical tips and avoiding the pitfalls of surgery in otology. Areas to be covered will include the following: 1. Pre-operative assessment and planning of surgical technique. 2. Preparation in the operating room. 3. Limitations of exposure in surgical techniques. 4. Minimizing the risk of iatrogenic trauma from drilling. 5. The use of the laser in stapes surgery. 6. Special situations: i. Facial recess approach; ii. The sclerotic mastoid; iii. Mucosal disease of the footplate; iv. Fistula management; v. Ossiculoplasty.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 2
CHAIR: Westerberg, B., VANCOUVER, BC
09:15 - 10:00
Medical Legal Otology
Otolaryngologists are often requested to supply medical legal reports on patients involved in litigation. The presenter regularly performs independent medical evaluations and completes medical legal reports on patients involved in litigation. Objectives: This workshop will review: 1. The obligations of the Otolaryngologist in supplying medical legal reports to lawyers when requested; 2. A format for written reports allowing increased clarity and efficiency of report writing; 3. A systematic approach to an independent medical evaluation of a patient involved in litigation, using dizziness after head injury as an example.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 2
CHAIR: Kost, K., MONTREAL, QC
PANEL: Eibling, D., Rosen, C., Black, M.
13:30 - 15:10
Care of the Professional Voice
Objectives: 1. Understand the special needs of the professional voice user. 2. Identify pathological conditions affecting the professional voice user. 3. Appreciate the use of videostrobolaryngoscopy. 4. Understand the medical and surgical management options. Methods: Use of video clips and interactive audience participation to elicit videostrobolaryngoscopic findings, and review potential management options. Abstract: The term ‘vocal entertainers’ includes singers, teachers, sales persons, and politicians, all of whom rely on their voice for their livelihood. Management of voice abnormalities in this group generates considerable anxiety for the otolaryngologist. Dysphonia may be obvious, but is often perceptually subtle and may be noted only by the professional him or herself. Seemingly minor voice complaints may alarm the vocal user who fears dramatic negative implications for health and career. Videostroboscopy is a sophisticated diagnostic tool allows recognition of subtle abnormalities easily missed with flexible laryngoscopy alone. Accurate diagnosis, and appropriate management are critical in achieving a positive outcome in the professional voice user.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 2
CHAIR: Seikaly, H., EDMONTON, AB
PANEL: Harris, J., Rieger, J., Ansari, K., Jha,N., Wolfaardt, J.
16:50 - 17:50
Oropharyngeal Cancer Surgery and Reconstruction: The Forgotten Art
Educational objectives: 1. To understand the indications and contraindications of oropharyngeal cancer surgery; 2. To understand the approaches, resection methods and reconstructive principles of oropharyngeal cancer surgery; 3. To become familiar with the different reconstructive techniques for oropharyngeal defects. Workshop description: This workshop will discuss all treatment protocols of oropharyngeal cancer but the majority of time will be dedicated to surgical and reconstructive management. Functional resection and reconstructive techniques will be illustrated. Long-term functional and survival outcomes will be presented.
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TUESDAY, JUNE 21, 2005
WORKSHOP - Room 3
CHAIR: Irish, J., TORONTO, ON
PANEL: Rafferty, M., Taylor, M., Trites, J.
09:15 - 10:00
Sentinel Node Biopsies in Head and Neck Cancer: What's the Evidence
Sentinel node biopsies are being increasingly utilized in oncology with significant benefits in the management of breast cancer and melanoma patients. There is increasing utilization of this technique in head and neck cancer management including oral and cutaneous squamous cell carcinoma and in head and neck melanoma. While it has gained wide acceptance as the standard of care for head and neck melanoma, its exact role in the N0 neck of a squamous cell carcinoma is more controversial. Recent publications suggest that SNL has a role to play in the staging and management of the N0 neck in HNSCC. However the head and neck anatomy offers a unique technical challenges to the procedure. Specifically, the head and neck has a very rich and complex lymphatic supply, the primary tumours are often in a site not easily accessible for accurate injection and this may lead to more than one region of the mucosa being injected and thus giving rise to misleading sentinel nodes. This workshop will: 1) Describe the technique for sentinel node biopsy in melanoma and oral SCC; 2) Review two centres experiences with this technique and discuss troubleshooting and pitfalls; 3) Utilize evidence-based medical review to determine the technique efficacy and benefit in patients with head and neck melanoma, skin SCC and oral cancer.
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TUESDAY, JUNE 21, 2005
Room 3
PAPER SESSION - PEDIATRICS / RHINOLOGY
15:40 - 15:50
Pediatric tracheostomy: A 22 year review at British Columbia's Children's Hospital
– Chiu, S., Kozak, F.K., Ospina, J.C., Adderley, R., Sweeney, D., Westerberg, B.D., VANCOUVER, BC
Objective: To review the 22 year history of pediatric tracheostomy at B.C. Children's Hospital with regards to incidence and indications. Methods: A retrospective review of charts and an electronic data base for patients with tracheostomy for greater than two months between 1982 and 2003 were reviewed for indications, gender, age, duration of tracheostomy, complications and mortality. Results: One hundred and thirty-eight tracheostomies were performed with approximately the same rate of occurrence for each study year. Indications included, home ventilation (38%), hemagioma/lymphangioma (12%), craniofacial malformation (4%), subglotticstenosis (11%), other laryngeal pathology (16%), and other (19%) . Tracheostomy for ventilation markedly decreased in 1991 with the introduction of noninvasive ventilation (BiPap, nasal CPAP). Infectious indications for an acute tracheostomy have decreased in the second half of the study period. Conclusions: The frequency of tracheostomy at our institution has remained static but indications have changed over the past 15 years.
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15:50 - 16:00
Temporal bone findings on computed tomography imaging in Branchio-Oto-Renal Syndrome
– Propst, E.J., Papsin, B.C., Gordon, K.A., Blaser, S., TORONTO, ON
OBJECTIVE: To describe temporal bone findings using Computerized Tomography (CT) in individuals with Branchio-Oto-Renal Syndrome. STUDY DESIGN: Retrospective evaluation of CT findings in individuals with a clinical diagnosis of Branchio-Oto-Renal Syndrome. PATIENTS: Forty ears from twenty patients with a clinical diagnosis of Branchio-Oto-Renal Syndrome from 13 families. RESULTS: Computerized Tomography findings included a funnel-shaped internal acoustic meatus, hypoplastic cochlea, hypoplastic or absent modiolus, absent lamina cribrosa, enlarged and medially-deviated facial nerve canal, hypoplastic horizontal semicircular canal, dilated vestibular aqueduct, fused ossicles, dilated Eustachian tube and medially-deviated carotid artery. CONCLUSION: The association of findings on CT imaging can also strongly support the diagnosis of Branchio-Oto-Renal Syndrome. The distribution of these findings across affected individuals will be discussed.
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16:00 - 16:10
Comparative Study of "Acetaminophen-Morphine" versus "Rofecoxib-Morphine" for Post-Tonsillectomy Pain Control
– Carignan, M., Vallée, E., Dorion, D., Lafrenaye, S., BEAUVILLE, QC
Introduction: Although tonsillectomy is one of the most commonly performed paediatric surgery, postoperative pain remains a problem. Selective inhibitors of cyclooxygenase type 2, such as rofecoxib, do not interfere with platelets adhesion and would relieve pain without increasing bleeding complications. Objective: To evaluate the efficacy and safety of a combination of “rofecoxib-morphine” versus “acetaminophen-morphine” for post-tonsillectomy pain control. Methodology: Eighty children, 5 to 17 years old, took part in that prospective comparative study. The first 40 children were in the group “acetaminophen-morphine” (group A) and the others were in the group “rofecoxib-morphine” (group B). Parents were instructed as to the specific schedule medication should be used. Data such as pain scores, administrated doses of medication, side effects and general health status of the child were collected by phone calls on the first, third and seventh day after the surgery. Results: Pain scores for group A and group B are : Day 0 (arrival at home): 4,6 vs 2,5 ; Day 0 average : 4,7 vs 3,3; Day 1 : 3,6 vs 2,6 ; Day 3 : 2,3 vs 1,4 ; Day 7 : 1,4 vs 2,0. Children who received rofecoxib generally drank, ate and went back to their regular activities faster than children of group A. No side effects were reported with rofecoxib. Conclusion: Combination of rofecoxib and morphine is safe, provides good pain relief and helps children go back faster to their activities.
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16:10 16:20
Changing Patterns in Atypical Mycobacterial Adenitis in Quebec
- Vu, T.T.V., Daniel, S.J., Quach, C., MONTREAL, QC
Objective: Describe atypical mycobacterial adenitis (AMA) epidemiology, clinical presentation, diagnosis and treatment. Methods: Retrospective study in a tertiary pediatric hospital of children with AMA confirmed by microbiology, between January 1st 1990 and March 1st 2004. Results: 36 patients were identified (2,7 y.o.). From 1990 to 1999, 13 cases were diagnosed with AMA, compared to 23 from 2000 to 2004. The affected lymph nodes are located in the submandibular (17), cervical (12), parotid (3), pre-auricular (2), axillary (3) and mediastinal (3). 35 patients received a surgical intervention. Four received medical treatment prior to, or concomitant with surgery. With excisional biopsy (26) or functional neck dissection (1), 56% resolved, whereas 26% recurred and 19% persisted. All the patients operated by incision & drainage (6) or curettage (1) required another surgery, and one of them had a medical treatment. Two patients were treated with medications for mediastinal adenitis. Conclusion: The incidence of AMA has doubled in 2000-2004 compared to 1990-1999. The significance of this important raise in numbers is still unclear. The outcome in our series raises the hypothesis of a more aggressive strain in our province. A pan-Canadian prospective study is underway to clarify these issues.
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16:30 - 16:40
Return to Home, School and Sports After Electrosurgical Adenoidectomy: When Is It Safe?
– Ludemann, J.P., Moxham, J.P., VANCOUVER, BC
Objectives: To determine when it is safe for healthy children to return to home, school and sports after uncomplicated electrosurgical adenoidectomy (uEA). Methods: 1. Survey of Canadian Otolaryngologists (CO) regarding their EA complication rates and their opinions regarding best practice standards for patient care after EA. 2. Prospective pilot study of 50 children who were allowed to resume sports 3 days after uEA. Results: 1. 11 CO responded to the survey. The total estimated EA cases performed were 7832 over 10 years. 3 patients were known to have bled mildly, all within 2 days of EA; none required reoperation. 9 CO supported discharge home 2 hours after uEA, if other standard discharge criteria were met. 7 CO supported return to school the next day, if the child had returned to his/her usual state of health; however, 2 CO suggested 7-10 days at home. 4 CO supported return to sports 3 days after uEA. 2. 50 children (mean age 6.8 years, range 2-14 years) were allowed to resume sports 3 days after uEA. None bled or had other complications. Conclusions: Considerable variation exists in Canada in terms of current practice standards regarding return to home, school and sports after uEA. Survey data suggests that, after uEA, it is safe for healthy children to return home after 2 hours and to school the next day. Preliminary data suggests that it may be safe for children to resume sports 3 days after uEA; however this should be studied on a larger scale.
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16:40 - 16:50
The Evolution of a Pediatric Cochlear Implant Program: The First 100 Cases
– Chiu, S., Kozak, F.K., Juck, K.J., Ospina, J.C., Hunter, R., Myer, D.M., Mitchell, J.T., Arnold, S.L., Trengrove, C.E., VANCOUVER, BC
Objective: To review the first 100 cases of cochlear implantation at B.C. Children's Hospital. Methods: A retrospective chart review of all patients who received a cochlear implant between 1988 and 2004 for age, gender, indications, complications, pre- and post- implant mode of communication, habilitation program, pre- and post- implant audiological data and family support system. Results: Implantation at BCCH was initially minimal, ranging from 2 to a maximum of 9 implants per year between 1988 and 2002. In 2003 government funding allowed formalization of a financially viable pediatric cochlear implant program for the province of British Columbia. Due to this substantial increase in funding, from April 2003 to March 2004, 27 implantations were performed. A decrease in age of implantation and age of diagnosis has been noted despite no formal Universal Newborn Hearing Screening Program in the province of B.C. Conclusions: Pediatric cochlear implantation in the province of British Columbia is now complemented by a full team of specialists in this area which includes audiology, psychology, social work, auditory-verbal therapy and otolaryngology.
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16:50 - 17:00
Tracheotomy in the First Year of Life, Analysis of a 20 Year Period
– Balys, R.L., Daniel, S., Manoukian, J.J., Abou-Jaoude, P., MONTREAL, QC
Introduction: Infant tracheotomy is associated with a high rate of morbidity. A previous study at our institution examined indications and complications of tracheotomy in infants less than 1 year of age from 1982 to1992. Since that time, we have noticed dramatic changes. Objectives: To review indications and complications of tracheotomies in infants less than 1 year of age from 1993 to 2003 and to compare these results with the preceding ten year period. Methods: A retrospective chart review of all tracheotomies performed in infants less than one year of age between 1993 and 2003 at the Montreal Children’s Hospital. Results: Nineteen patients were identified in this ten-year period with a minimum follow-up of 18 months. The indications for tracheotomy in this group have changed with much fewer tracheotomies now done for long term ventilation. This has resulted in a 57% decrease in the number of tracheotomies performed. Our apparent increased rate of complications, with eight life threatening events and one tracheotomy related mortality, is likely related to tracheotomies only being done on very sick infants. Conclusions: This paper confirms the need for vigilant surveillance of infants with a tracheotomy. The changing indications are resulting in fewer infant tracheotomies and an apparent increase in complications.
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17:10 - 17:20
Maxillary sinus tubes for refractory chronic sinusitis
– Witterick, I.J., Lavigne, F., TORONTO, ON
Objectives: To assess the effectiveness of maxillary sinus tubes for application of topical antibiotics and steroids in the management of refractory chronic sinusitis. Methods: This study analyzes 10 consecutive patients with refractory chronic maxillary sinusitis. All patients had previously undergone endoscopic ethmoidectomy and antrostomy. All patients had patent antrostomies, no evidence of anatomical obstruction, and had undergone multiple courses of antibiotics directed by cultures of maxillary secretions. In addition, all patients had been tried on topical nasal steroids, systemic steroids, saline rinses and had had one or more lavages of their maxillary sinuses. All patients underwent uni- or bilateral placement of maxillary sinus tubes as described by Lavigne with daily instillation of topical Tobramycin and a Ciprofloxacin/hydrocortisone combination. Outcomes were measured by endoscopic examination and the SNOT-16 questionnaire at 2 and 6 months. Results: Eight patients showed significant improvement by endoscopic examination and the SNOT-16 at 2 months. Two patients did not improve and continued to have symptoms requiring other medical therapies. The 6 month results will be available for the presentation. Conclusions: Topical application of antibiotics and corticosteroid delivered by a maxillary sinus tube has shown good short-term improvement in patients with refractory chronic sinusitis unresponsive to traditional medical and surgical therapies.
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17:20 - 17:30
Sinonasal Malignancies: An Endoscopic Approach
– Tsaparas, Y., Javer, AR., Genoway, K., VANCOUVER, BC
Objectives: To report our experience with endoscopic resection of sinonasal and anterior skull base malignancies. Methods: Eight patients who each underwent resection of a sinonasal malignancy either through an endoscopic approach alone (7 cases), or combined with an external approach (1 case) were followed prospectively. All patients except one were treated with curative intent. Demographic data, procedural details, adjuvant therapy, and outcomes are reported. Malignancies included squamous cell carcinoma (SSC) (3cases), hemangiopericytoma, adenoid cystic carcinoma, chondrosarcoma, esthesioneuroblastoma, and MALT lymphoma. Results: Mean follow-up time was 36 months (22-52 months). Five patients are alive with no evidence of disease. Two patients with SCC are dead of disease at 21 and 24 months, one of whom was treated palliatively following malignant transformation of an inverted papilloma. Four patients underwent post-operative radiotherapy. There were no surgical complications and morbidity was minimal. Conclusion: Endoscopic resection of sinonasal malignancy appears feasible in select cases.
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17:30 - 17:40
In-vitro Assay of Biofilm-forming Capacity in Chronic Sinusitis
– Desrosiers, M., Bendouah, Z., Abou-Hamad, W., Barbeau, J., MONTREAL, QC
Aims: Biofilm formation by bacteria is increasingly being recognized as an important factor in the persistence of chronic inflammatory ENT disorders such as chronic otitis media with effusion, and may be present in chronic sinusitis as well. We wish to determine whether biofilm-forming capacity is present in bacteria recovered from patients with chronic sinusitis. Setting: Prospective trial, academic tertiary practice. Method: Individuals undergoing endoscopic sinus surgery for severe chronic sinusitis or with persistence of disease after ESS have been cultured consecutively. Biofilm forming capacity will be assayed in-vitro by measuring of optical density of staining for biofilm formation as compared to postive and negative controls for P Aeruginosa, S Aureus, and coagulase-negative staphylococci. Results: 10 samples for each species are being assessed. Importance: We hope these results will enhance understanding of the pathogenesis and persistence of chronic sinus disease and offer a novel tool for better assessment of patients.
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WEDNESDAY, JUNE 22, 2005
Room 1
PAPER SESSION - HEAD & NECK / RHINOLOGY
08:30 - 08:40
The Effect of Radiation on Oral and Oropharyngeal Function - Krepelka, J., Seikaly, H., Rieger, J., Harris, J.R., Jha, N., Wolfaardt, J., EDMONTON, AB
Objective: To examines the effect of radiation therapy on oral and oropharyngeal function of patients that have undergone cancer treatment with particular emphasis on longitudinal comparison of the preoperative function to that in the post-operative and post-radiation therapy time periods. Design: Prospective cohort. Methods: Speech and swallowing data were gathered at three evaluation times (pre-operatively, pre-radiation therapy, and post-radiation therapy). Single words and sentences were recorded and analyzed for speech intelligibility. Modified barium swallows of liquid, pudding, and cookie consistencies were analyzed and graded for problems in the oral and oropharyngeal phases. Results: 103 patients were reviewed. There was no significant difference across any of the evaluation times for single word or sentence intelligibility. The swallowing data showed significant worsening of function after radiation treatment when compared to preoperative and postoperative periods. Conclusions: Oral and oropharyngeal swallowing function is significantly affected by radiation treatment.
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08:40 - 08:50
Does Routine Pre-operative Imaging of Parotid Tumors Affect Surgical Management Decision Making?
- Cheung, R., TORONTO, ON
Objective: Pre-operative radiologic investigations of parotid tumors are often routinely ordered. The goals of imaging studies are to accurately delineate local and regional extent of tumors. The objective of the study is to determine whether pre-operative imaging of parotid tumors would alter the surgical approach to the affected area. Method: A retrospective review of 177 patients with parotid tumors who were seen at the Mount Sinai Hospital in Toronto, Ontario from 2000 to 2002. One hundred and five patients underwent pre-op radiologic imaging prior to definitive surgery. Results: All of the 105 patients had their tumors removed by either a conventional parotid lobectomy, total parotidectomy with mobilization of facial nerve or external approach to the paraphayrngeal space despite the extent of the tumors. Imaging did not play a role in surgical decision making as the decision to what operation to be performed was made clinically. Conclusion: Unless there is clinical evidence suggestive of a large parotid tumor with involvement of the parapharyngeal space, imaging of patients with parotid tumors should not be part of the routine pre-operative investigation.
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08:50 - 09:00
The Correlation Between Tumour and Nodal Volume and Survival in Head and Neck Squamous Cell Carcinoma
– Anand, S.M., Daniel, S.J., Funnel, W.R.J., Levental, M., Hier, M.P., Black, M.J., Kost, K.M., Zeitouni, A.G., MONTREAL, QC
Recent technology has facilitated both tumour and nodal volume measurements but their significance as prognostic factors in the treatment of head and neck squamous cell cancer (HNSCC) still remains unclear. We have previously shown that the prognosis of patients with HNSCC N3 nodal disease does correlate with nodal surface area, however, we have yet to explore if there is a relationship between volume and survival from HNSCC disease. Objective: This study aims to assess the prognostic value of tumour and nodal volumes in HNSCC. Methods: A retrospective review of HNSCC patients with varied primary sites treated by surgery, radiotherapy and/or chemotherapy at the Jewish General Hospital and McGill University Health Centre hospitals from 1998-2003. Tumours and nodes are outlined semi-automatically in digitized CT scans, and volumes are computed based on surface triangulations of 3-D reconstructions using novel software developed by our team. Clinical outcomes assessed are post-treatment tumour and nodal control and survival from disease. Results: 3-D reconstructions and tumour and nodal volumes have been generated. Graphical renderings of the 3-D reconstructions and correlations between tumour and nodal volumes and survival will be shown. Conclusions: Such correlations may allow individualized patient management in HNSCC based on volume measurements from CT.
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09:10 - 09:20
Different Methods of Surgical Reconstruction of Soft Palate Defects: An Assessment of Functional Outcome
– Seikaly, H., Ansari, K., Rieger, J., Harris, J.R., Jha, N., Wolfaardt, J.
Objective: To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes of different methods of soft palate reconstructionDesign: Prospective cohort. Methods: Patients with an expected soft palate defect of 50% or greater were included in the study. All the defects were reconstructed with a radial forearm free flap and one of two modifications were used: 1) Posterior wall/flap adhesion (AD) or 2) Complete closure of the adynamic portion of the soft palate (SPIR). Acoustical, aeromechanical and perceptual speech data were collected at three evaluation times (pre-operatively, pre-radiation, and post-radiation) Results: There were significant differences in the aeromechanical measurements and speech intelligibility between the two patient groups. Patients with AD reconstructions had significantly higher nasalance values and larger velopharyngeal orifice (VPO) areas than individuals who had SPIR. All patients resumed a normal oral diet. Conclusions: The SPIR method of soft palate reconstruction provides better restoration of aeromechanical, acoustical, and perceptual speech outcomes.
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09:20 - 09:30
Completion Thyroidectomy: An Analysis of Indication, Cmplication Rate and Cost Effectiveness in 250 Matched Cases
– Rafferty, M., Brown, D., Gullane, P., Rotstein, L., Irish, J.C., Gilbert, R., TORONTO, ON
Objectives: To review our institutions' experience with completion thyroidectomy for well differentiated carcinoma and to establish its safety and cost effectiveness when compared to a total thyroidectomy. Methods: Review of our institutions head and neck oncology data base revealed 250 completion thyroidectomies performed over a twelve year period by the four senior authors. These cases were compared with an equal sized cohort of patients, matched for age,sex and year of procedure whom underwent total thyroidectomies. Analysis was conducted on complication rates, management of the parathyroid gland intraoperatively and the cost analysis of both procedures. Cost analysis was based on operating duration and number of total days the patient spent in hospital. Results: The complication rates in the two groups were similar. Hypocalcaemia was temporary in 9% of cases and permenant in 2% of patients. Injury to the recurrent laryngeal nerve was temporary in 3% of cases and permenant in 1%. Post operative haemorrhage and wound infection were seen in 0.5% of all cases. Conclusions: These results suggest that the policy of initial partial thyroidectomy is an acceptable and safe procedure although the total length of stay and resource utilization is higher in the completion thyroidectomy group.
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09:30 - 09:40
A Comparison of Drain versus No-drain Thyroidectomy: Randomized Prospective Clinical Trial
– Mechor, B.D.M., Harris, J.R., Seikaly, H., EDMONTON, AB
Objective: A randomized clinical trial to compare the use of drain versus no drain for thyroidectomy surgery. Outcomes including length of hospital stay, postoperative complications and surgical time will be assessed. Methods: After obtaining ethics approval, patients will be randomized to either the use of drain or no drain by a blinded observer at the completion of the thyroidectomy. 2cc of Tisseel will be used in all surgical wounds. Surgical time will be noted. Parameters (hospital stay, complications) will be measured until discharge from hospital. Results: Our preliminary data suggest that hospital stay is significantly less for patients without surgical drains. No significant difference in terms of postoperative complications or surgical time has been identified. Conclusion: We conclude that there is no increase in the number of postoperative complications or surgical time in the absence of a drain following thyroidectomy and there is a decrease in the length of surgical stay.
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09:50 - 10:00
Could We Avoid the Adrenaline Rush During Endoscopic Nasal Surgery? A Pilot Randomized Controlled Trial
– Witterick, I.J., Cohen-Kerem, R., Brown, S., TORONTO, ON
Hypothesis: Adrenalin administered topically during endoscopic sinus surgery in concentration of 1:1000 may be sufficient to facilitate appropriate endoscopic sinus surgery visualization while reducing the risk for ominous side effects associated with intra-mucosal injection. Objectives: To study the pharmacokinetics of adrenalin administration to the nasal mucosa via injection and topical administration during endoscopic sinus surgery under general anesthesia. To assess the effectiveness and safety of adrenalin administered topically versus adrenalin administered by injection to the nasal mucosa. Methods: Thirty patients undergoing endoscopic sinus surgery will undergo double blind randomization into two groups. In the first group, adrenalin 1:100000 will be applied by injection (including 1% Xylocaine) to the nasal mucosa in addition to topical cotton pledgets soaked in adrenalin 1:1000. In the second group adrenaline will be applied to cotton pledgets only in concentration of 1:1000 while injections of the nasal mucosa will include saline. Monitoring of the patient’s heart rate, blood pressure, arrhythmias and catecholamine blood levels through the procedure will be the outcome measures. Results: to be discussed.
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10:00 - 10:10
Use of Anteriorly-based Pericranial Flap in Frontal Sinus Obliteration
– Moshaver, A., Harris, J.R., Seikaly, H., EDMONTON, AB
Objective: In an era of endoscopic sinus surgery, frontal sinus obliteration continues to remain an important treatment option in chronic frontal sinus disease. Numerous avascular obliterative materials including fat, muscle, cancellous bone, and hydroxyapatite have been used in this procedure. In this paper, we describe a vascularized anteriorly-based pericranial flap to obliterate frontal sinus. Study design: Retrospective chart review of patients referred to tertiary care hospital between 1996-2003. Methods: Records of the patients who underwent this procedure were reviewed. Demographics, indications, immediate and late complications were recorded. Phone questionnaire was used to assess patient satisfaction with the outcome. Results: A total of 12 patients underwent frontal sinus obliteration using this technique. Mean follow-up was 40 months. None of the patients developed recurrent frontal sinusitis. All of the patients were pleased with the outcome. Conclusion: Pericranial flap is a highly vascularized flap that is easily harvested and is an effective and viable modality for obliterating frontal sinus.
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10:10 - 10:20
Fungal Cultures in AFS Patients: Finding a Feasible Protocol for the Canadian Laboratory
– Gervais, M., Javer, A.R., Romney, M., Zemcov, J., VANCOUVER, BC
Objective : No uniform consensus exists on how to grow fungi from sinus aspirates in the Canadian setting. The success rate for fungal cultures is poor (10-20%) even with endoscopically obvious allergic mucin. In allergic fungal sinusitis (AFS) patients, a positive fungal culture is an important major diagnostic criterion. Method : Twenty AFS patients are currently being enrolled in a prospective study. Ten mls of mucin is collected from each patient and divided in half. A modified Mayo protocol is used for one half while the current local lab protocol is used for the other half. Results : Data will be analysed to : 1) compare the yield using current protocols with the Mayo technique, 2) compare the difference in cost, 3) come up with the cheapest yet most effective technique. Conclusion : Our aim is to propose a feasible standardized protocol for culturing fungi from sinus aspirates in the Canadian laboratory setting.
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10:20 - 10:30
Nasal Septal Perforation Repair Using an Inferior Turbinate Flap
– Kilty, S.J., Brownrigg, P., Safar, A., OTTAWA, ON
Nasal septal perforation repair presents a challenging problem to the reconstructive surgeon. Numerous surgical techniques for the repair of this nasal defect have been described. Although the literature describes great success using the advancement of local mucoperichondrial flaps, it is often difficult to reproduce these results, especially for the closure of larger defects. We describe both our technique and results using a pedicled inferior turbinate flap for the closure of a nasal septal perforation in more than 20 patients.
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WEDNESDAY, JUNE 22, 2005
Room 2
PAPER SESSION - OTOLOGY
08:30 - 08:40
Intraoperative Imaging of the Temporal Bone Using a Mobile C-arm For High-resolution Cone-beam CT: Pre-clinical Investigation and Demonstration of 3D Image Quality
– Rafferty, M., Siewerdsen, J.H., Chan, Y., Jaffray, D.A., Irish, J.C., TORONTO, ON
Objectives: A mobile C-arm for intraoperative cone-beam computed tomography (CT) was investigated as a tool for guidance of temporal bone surgery. Imaging and guidance performance was evaluated in relation to three specific surgical tasks that required exquisite visualization of 3D anatomy. Methods: A mobile isocentric C-arm was developed in our laboratory to provide fully 3D cone-beam CT imaging capability with spatial resolution exceeding that of conventional CT. System performance was investigated in guiding temporal bone surgery across 5 cadavers. High-resolution cone-beam CT images were acquired intraoperatively, visualized using 3D imaging software, and used in the guidance of three surgical tasks; mastoidectomy with skeletonisation of cleft boundaries; Posterior tympanotomy and cochleostomy; and skeletonisation of the facial nerve. Results: Intraoperative cone-beam CT provided excellent visualization of complex temporal bone anatomy, offering a valuable tool for surgical guidance and avoidance of critical structures. Spatial resolution was nearly isotropic, with ~0.5 mm resolution in 3D. Conclusions: Intraoperative cone-beam CT on a mobile C-arm offers an attractive modality for the real time guidance of temporal bone surgery. High-resolution 3D imaging offered exquisite visualization of complex anatomy and improved surgical confidence and performance in critical structure avoidance and has particular utility in abnormal anatomy or diseased states.
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08:40 - 08:50
Hearing Loss and Sjogrens Syndrome
– Anthony, R., Al-Alamadi, A.M., Taplin, M.A., Bookman, A., Slomovic, A., Caferry, B., McComb, J., Rutka, J.A., TORONTO, ON
Objective: Analyze whether there is an association with Sjogren's or sicca syndrome and hearing loss(sensorineural and conductive). Methods: Case control study reviewing 250 consecutive patients with Sjogren's or sicca syndrome attending the UHN Multidisciplinary Sjogren's clinic over a 10 year period. Outcome measures included pure tone audiometric thresholds compared to age and sex matched normative data and their respective audiometric configurations. Results: Results demonstrate no significant associated sensorineural hearing loss between Sjogren's and those with sicca syndrome compared to normative data. There are a greater number of patients with Sjogren's syndrome however with low frequency sensorineural hearing loss configurations than expected. Conclusions: Previous studies have been limited in concluding whether hearing loss (either sensorineural, conductive or mixed) exits by small sample size. Previous findings suggesting significant hearing loss in Sjogren's syndrome beyond normative age and sex matched data is not supported in this study. The finding low frequency sensorineural hearing loss in a subset of patients with Sjogren's syndrome is documented for the first time. We speculate that this type of loss might arise as a result of an autoimmune process and its possible association with endolymphatic hydrops.
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08:50 - 09:00
Auditory Brainstem Implants; The Toronto Experience
- Marshall, A.H., Rowed, D., Nedzelski, J. M., TORONTO, ON
Aim: To discuss the operative technique and results after 6 months of use of the first two auditory brainstem implants (ABI) performed in Canada.Method: At time of submission we have performed 2 ABI’s in Toronto using the Nucleus 24 device. Both of these NF2 patients had undergone previous tumour removal on the side of implantation. Both patients had residual tumour which was excised at the time of implantation. One patient had good facial nerve function pre-operatively, whilst the other had poor facial movement which had previously been augmented by a VII/XII graft.Results: We will discuss the technical issues at implantation in the previously violated field with residual tumour, including intra-operative video. We will also present the facial function post-operatively, and the results after 6 months use of the ABI’s.
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09:10 - 09:20
The Issue of Informed Consent in Otologic Surgery: Can We Improve on Patient’s Recall of Risk?
– Henry, E.L., Bance, M., Massoud, E., Brown, T.F., HALIFAX, NS
Objective: A previous study by us had shown that a simple text handout did not improve recall of surgical risks in ear surgery. The aim of this study was to determine if a more visual handout would increase risk recall. Study Design: A prospective, randomized trial was undertaken in a tertiary care setting. Methods: Patients undergoing otologic surgery were consented using an established checklist of surgical risks. Patients were randomized to a handout outlilning risk either with or without pictures. A telephone call made on average 19.7 days later evaluated risk recall. Results: 36 patients have been enrolled in the study. Fifteen patients received a handout with pictures and twenty-one without. The overall percentage of risks recalled by the picture group was 47.7% and without pictures was 46.4%. This difference was not statistically significant. The patients in the higher education group had a significantly better risk recall then the lower education group (60.5% vs. 37.3). Addition of pictures led to better recall of risks of infection and hearing loss. Conclusions: The addition of pictures to a handout did not alter overall patient recall of surgical risks of otologic surgery.
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09:20 - 09:30
Meniett Device: Its Effectiveness in Controlling the Symptoms of Endolymphatic Hydrops
– Lange, B.J., Li, X., Heinrich, F., CALGARY, AB
Introduction:The Meniett device is a portable machine which generates intermittent micropressure pulses to the inner ear through a tympanostomy tube. This overpressure treatment prevents the buildup of endolymphatic pressure, which is thought to cause the symptoms of endolymphatc hydrops. Objectives: The goal was to evaluate patient satisfaction of the Meniett device. Methods: The office records of the twenty one patients who had used the device for more than six months were reviewed retrospectively. Followup ranged from six months to two years with an average of eleven months. Results: Six of the twenty one patients did not have enough improvement in the frequency and severity of their vertiginous episodes to warrant continued use of the device. No patient noted significant improvement in hearing. Five patients noted improvement in aural pressure. Conclusion: The majority of patients noted an improvement in their vertigo episodes. Statistics will be discussed and the possible influence of comorbid factors, which may have influenced the results.
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09:30 - 09:40
The Endaural Incision in Stapes Surgery: How Much More Access is Created?
– Marshall, A.H., Chen, J.M., TORONTO, ON
Aim: To measure the increase in surgical access afforded by an endaural incision in stapes surgery. Method: We measured the diameter and volume of the ear canals of 11 patients undergoing stapedectomy. In each case, with the patient anaesthetised and in the operative position, a marker was used to indicate two perpendicular diameters (horizontal and vertical). These were measured with the skin stretched before and after an endaural incision was performed. The EAC volume was measured pre- and post-incision. Results: The mean vertical and horizontal diameters increased by 4mm (p=0.01) and 6mm (p<0.0001) respectively. The volume increased by 8mm3 (p<0.0001). Discussion: The endaural incision significantly increased the cross-sectional diameter and volume of access in stapes surgery. We believe this provides better illumination and access for the surgeon to perform the operation. We also believe it make teaching the procedure safer, enabling the supervising surgeon to operate simultaneously.
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09:50 - 10:00
Statistical Analysis of Cochlear Implant Reliability
– Schramm, D.R., Stinnett, S., OTTAWA, ON
Approximately 400 cochlear implant surgeries have been performed in Ottawa in the past 11 years. Occasionally a revision procedure has been necessary to replace a defective device. Recently the reliability of cochlear implants has come under scrutiny. Various manufacturers have used different methods of reporting device reliability. The purpose of this study was to investigate device reliability in our pediatric and adult population using a common standard to determine cochlear implant cumulative survival rates (International Organization for Standardization criterion 5841-2). The Ottawa Cochlear Implant Program database was analyzed to determine cochlear implant survival rates in accordance with ISO standards. Various generations of cochlear implants were evaluated. Following conventional methods, a cochlear implant was considered nonfunctional only if there was objective evidence of device failure on integrity testing. In addition, "soft failures" were also included in this analysis. When a soft failure occurs there is no objective evidence of device malfunction. However, there is significant improvement of speech recognition after reimplantation. Adult and pediatric cochlear implant survival rates were analyzed separately. Assessment of cochlear implant survival using a common standard permits objective comparison of device reliability between various manufacturers.
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10:00 - 10:10
Incus Interposition in Ossicular Reconstruction; 10 Years Experience
- Marshall, A.H., Chen, J.M., TORONTO, ON
Aim: To discuss the technique of partial and full incus interposition. Method: In partial incus interposition (PII), the root of the long process is fashioned into a seat for the stapes and the body’s superior aspect is notched for the handle of the malleus. In full incus interposition (FII), the short process is placed on the footplate of the stapes and the articular surface is placed under the neck of the malleus. A retrospective review of the senior authors experience over 10 years was performed. The pre- and post-operative air-bone gaps (ABG) and speech reception thresholds (SRT) were compared. Results: The mean ABG and SRT improvement in the PII group (n=29) was from 32dB to 16dB (p<0.05) and 47dB to 30dB (p<0.05) respectively. The mean ABG and SRT improvement in the FII group (n=11) was from 37dB to 21dB (p<0.05) and 49dB to 32dB (p<0.05). Discussion: The result for ABG closure and SRT improvement are comparable for both techniques. We will discuss which technical factors lead to the best results.
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09:50 - 10:00
Treatment of Sudden Sensorineural Hearing Loss: A Meta-Analysis and Systematic Review
- Conlin, A.E., Parnes, L.S., LONDON, ON
Objectives: To describe and compare the preoperative pattern of bone conduction threshold responses in patients with otosclerosis to those following laser assisted stapedotomy. Methods: One hundred and fifty patients underwent CO2 laser assisted stapedotomy between the years 1999-2003. Pre and postoperative audiograms were analyzed to evaluate bone conduction thresholds at 250, 500, 1000, 2000, 4000Hz with a view to changing bone conduction including the "Carhart" notch. Results: A significant variation in the morphology of the "Carhart" notch was noted with almost equal distribution between 500, 1000 and 2000 Hz. Overclosure was common with significant variation in the degree and frequencies involved. Conclusion: It appears that in our series the morphology of the "Carhart" notch is variable and is not exclusively at 2000 Hz as classically described. In addition, no specific pattern for overclosure was documented. The mechanism of this phenomenon is not completely understood and the discussion will focus on its theoretical causes.
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