Mission Statement

The Canadian Society of Otolaryngology-Head & Neck Surgery is dedicated to improving patient care through the support of education, the advancement of research, sponsorship of advocacy, promotion of the specialty, outreach to under serviced populations, and the maintenance of high professional and ethical standards.

The means of accomplishing this mission include the holding of an annual scientific meeting, facilitation of collaborative scholarship, the publication of a scientific journal, and the promotion of education at all levels.


 

Continuing Professional Development

The Canadian Society of Otolaryngology-Head & Neck Surgery recognizes its leadership role in continuing professional development for otolaryngologists practicing in Canada.  It acknowledges that professional development extends beyond the traditional continuing medical education focused primary on updating medical knowledge and it intends to offer learning opportunities that extend beyond the limits of traditional teams.  The Society will accomplish this through ongoing assessments of professional needs and is committed to the development of CPD activities which will address such needs.

 


Positions, Statements and Guideline Links

 

Bethesda Position FNA

Position statement of the Endocrine Surgery Group of the Canadian Society of Otolaryngology-Head and Neck Surgery for the reporting of thyroid fine needle aspirates:

Endorsement of The Bethesda System for Reporting Thyroid Cytopathology

Manon Auger1, Marc Pusztaszeri1, Derin Caglar1, Olga Gologan2, Jérémie Berdugo2, Richard J. Payne3,4, Véronique-Isabelle Forest3, Alex Mlynarek3, Michael P. Hier3, Marco Mascarella4, Shamir Chandarana5, Robert Hart5, Paul Kerr6, Marie-Jo Olivier7, Anastasios Maniakas7, Danielle Beaudoin8, Paule Dupuis9, Vance Tsai10, Jamie Tibbo11, Pierre-Hugues Fortier12, Eitan Prisman13, Kristian MacDonald14, Kristen Mead15, Matthew Rigby16, Tim Wallace17, Martin Bullock18, Fadi Brimo1, Yonca Kanber1, Rania Ywakim19

  1. Department of Pathology, McGill University
  2. Département de Pathologie, Université de Montréal
  3. Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital
  4. Department of Otolaryngology – Head and Neck Surgery – McGill University Health Centre
  5. Section of Otolaryngology – Head and Neck Surgery – University of Calgary
  6. Department of Otolaryngology – Head and Neck Surgery – University Manitoba
  7. Département de Chirurgie – Division Otorhinolaryngologie Chirurgie Cervico-Faciale – Université de Montréal
  8. Département Otorhinolaryngologie Chirurgie Cervico-Faciale – Université Laval
  9. Département de Chirurgie – Division Otorhinolaryngologie Chirurgie Cervico-Faciale – Hôpital Pierre-Boucher
  10. Department of Surgery – Division of Otolaryngology – Head and Neck Surgery – Abbotsford Hospital and Regional Cancer Centre British Columbia
  11. Department of Surgery – Division of Otolaryngology – Head and Neck Surgery – Memorial University of Newfoundland
  12. Département de Chirurgie – Service Oto-rhino-laryngologie et Chirurgie Cervico-Faciale – Université de Sherbrooke
  13. Department of Surgery – Division of Otolaryngology – Head and Neck Surgery – University of British Columbia
  14. Department of Otolaryngology – Queen Elizabeth Hospital – Charlottetown, Prince Edward Island
  15. Department of Pathology – Queen Elizabeth Hospital – Charlottetown, Prince Edward Island
  16. Department of Surgery – Division of Otolaryngology – Head and Neck Surgery – Dalhousie University
  17. Department of Surgery – Division of Otolaryngology – Head and Neck Surgery – Cumberland Regional Health Care Center, New Brunswick
  18. Department of Pathology – Dalhousie University
  19. Department of Surgery – Division of Otolaryngology – Head and Neck Surgery – Lakeshore General Hospital, Quebec

 

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), the second edition of which was published in 2018, has been widely implemented worldwide, including in Canada; it is also endorsed by the American Thyroid Association. By the current position statement, the Endocrine Surgery Group of Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) confirms that it endorses TBSRTC, which should be used for reporting the diagnostic findings of thyroid fine needle aspirates (FNAs) in Canada.  The current position statement, along with the one from the Canadian Society of Cytopathology, can be used as a tool to encourage the use of TBSRTC by pathologists not yet adhering to it.1

TBSRTC was created to provide a uniform, tiered reporting system with standardization of cytologic diagnostic criteria and terminology, which should ultimately translate into improved patient diagnosis and care.  The second edition of TBSRTC (TBSRTC II) was adjusted to reflect new evidence-based data since publication of its first edition in 2010, including a) the incorporation of the Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP), requiring a more conservative approach to the cytologic diagnosis of Papillary Thyroid Carcinoma (PTC), b) revised Risk of Malignancy (ROM) for each diagnostic categories, and c) updated American Thyroid Association management guidelines for thyroid nodule and cancer.

The following is a short summary of the diagnostic terminology of TBSRTC; explanations of the diagnostic criteria, and illustrations can be found in TBSRTC atlas.2

Each thyroid FNA report should include one of six diagnostic categories: (I) Nondiagnostic or Unsatisfactory, (II) Benign; (III) Atypia of Undetermined Significance (AUS) or Follicular Lesion of Undetermined Significance (FLUS); (IV) Follicular neoplasm or Suspicious for follicular neoplasm; (V) Suspicious for malignancy; and (VI) Malignant.  Of note, although the numerical diagnostic categories (i.e. I to VI) can be listed in the cytologic report, they cannot be used as “stand alone”. Also, although, there is a choice of two different names for categories I, III and IV, a laboratory should adopt only one wording for each category in order to minimize confusion.

For most categories, providing subcategorization (see Table I) is encouraged as it can provide clinically relevant information that can better guide management; however, this is optional. Additional comments, listing of ROM and suggested clinical management are also optional, left to the discretion of the (cyto)pathologist, depending on local practices. (see Table II)

Although the second edition of TBSRTC is the version that should be used at the time of publication of the current position statement, it is anticipated that a third edition with further modifications will be published in the future, and that practice should be adapted accordingly.

 

References

  1. https://cytopathology.ca/wp-content/uploads/2019/07/Bethesda-system-memo.pdf

2.Ali SZ, Cibas ES.  The Bethesda System for reporting thyroid cytopathology: definitions, criteria and explanatory notes.  2nd ed. New York, NY: Springer 2018, 236p.

Table I: Classification with subclassifications suggested for each of the diagnostic categories

I. Nondiagnostic or Unsatisfactory

Cyst fluid only

Virtually acellular specimen

Other (obscuring blood, air drying artefact, etc)

II. Benign

Benign follicular nodule (includes nodular hyperplasia, colloid nodule, etc)

Lymphocytic thyroiditis

Granulomatous thyroiditis

Other

III. Atypia of Undetermined Significance (AUS) or Follicular Lesion of Undetermined Significance (FLUS)

AUS with architectural atypia

AUS with nuclear (cytological) atypia

AUS with architectural and nuclear (cytological) atypia

AUS Hürthle cell type

AUS, other

IV. Follicular neoplasm or Suspicious for follicular neoplasm

Specify if oncocytic (Hürthle cell) type (i.e. Hürthle cell neoplasm)

V. Suspicious for malignancy

Suspicious for papillary thyroid carcinoma

Suspicious for medullary thyroid carcinoma

Suspicious for metastatic carcinoma

Suspicious for lymphoma

Other

VI. Malignant

Papillary thyroid carcinoma

Medullary thyroid carcinoma

Anaplastic thyroid carcinoma

Metastatic malignancy

Lymphoma

Other

 

HPV Prevention Statement

Our Ongoing and Neglected HPV Cancer Challenge

Vaccination, Screening and Early Detection will Eliminate HPV-associated Cancers (2021)

 

View document here.

 

HPV Vaccination for Males

 

Position Statement HPV Vaccination for Males (2020)

 

At the most recent business meeting of the Society in Winnipeg, the following position statement related to HPV vaccination for males was ratified by the general assembly:

 

“Recognizing that human papillomavirus (HPV) is the most common sexually transmitted infection in men and women and that males suffer from the consequences of being infected with HPV, the CSOHNS calls on the Canadian Government to fund HPV vaccination programs for boys and men.”

 

View background document

Vaping Use by Youth

This position paper was approved by the CSOHNS Council, November 8, 2020

Statement on Vaping Use Among Youth

There has been an alarming increase in current electronic cigarette (e-cigarette) use among youth.1 The previously observed decline in youth tobacco use has reversed with the latest statistic, and now e-cigarettes have become the most commonly used tobacco product by teens.1 This is a cause for concern given the alarming rise in vaping-linked lung illnesses and deaths recently noted.2 With the US Food and Drug Administration referring to youth vaping as an ‘epidemic’, governments are considering outright banning flavored e-cigarette products, it is critical that we also consider reforms to address access to e-cigarettes, to prevent the downstream negative effects of tobacco on our youth’s health.

Almost all e-cigarettes contain nicotine, which if exposed to the still developing adolescent brain (until the age of 25), is associated with a lifetime risk of addiction, and in some cases, increased impulsivity and mood disorders.3 Furthermore, studies from both Canada and the US suggest that e-cigarettes are a gateway to other tobacco products. According to a cohort study assessing youths aged 12 to 15 years, using e-cigarettes as one’s first tobacco product was associated with more than 4 times the odds of ever cigarette use and nearly 3 times the odds of current cigarette use over 2 years of follow-up. E-cigarette use represents a catalyst for cigarette initiation among youth, raising concerns for renormalizing smoking behaviors and undermining the decades of progress previously made in reducing smoking among youths.4 Reports published by the World Health Organization and the US National Cancer Institute indicate that websites dedicated to retailing e-cigarettes ‘contain themes that may appeal to young people, including images or claims of modernity, enhanced social status or social activity, romance, and the use of e-cigarettes by celebrities’.5

While 18 is the minimal legal age (MLA) for purchasing e-cigarette products in Alberta, other provinces in Canada have set this limit at 19 years.3 The concept of increasing MLA is a topical one- in the US, Senate where a bill was introduced this May to increase the federal age for purchasing tobacco products, including e-cigarettes, to 21.6 The majority of underage users rely on social sources to obtain tobacco. Raising the MLA to 21 will mean that those who can legally obtain e-cigarettes are less likely to be in the same social networks as high school students.7 Increasing the MLA will also prevent/delay the initiation of tobacco, most impacting those aged 15 to 17 years.8 This would carry long-term health benefits as well, as demonstrated by a 75-year dynamic simulation model of the 2003 US population, that suggests that increasing the MLA would result in a large drop in youth smoking prevalence and consequently adult smoking age.9 Another option is to ban flavored e-cigarettes to reverse this epidemic of youth e-cigarette use. Health experts have long said that e-liquid favors like cotton candy and gummy bear, attract teenagers, and that these flavors are often why youth are interested in starting using e-cigarette products initially

Based on these facts we would suggest that the Canadian Society of Otolaryngology Head and Neck Surgery support increasing the MLA to 21 in Canada, and the banning of flavored e-cigarettes. The use of products containing nicotine poses an undeniable threat to our youth, and this position is a step in the right direction in curbing the dangerous rise in e-cigarette use we are observing in our children.

 Respectfully submitted by

Priya Sivarajah

Hadi Seikaly

 

References:

  1. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students- United States, 2011-2018. MMWR Morb Mortal Wkly Rep 2018; 67:1276-1277.
  2. Outbreak of Severe Pulmonary Disease Linked with E-cigarette Product Use. Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#what-we-know
  3. Canada, Health. “Government of Canada.” ca, Government of Canada, 21 Sept. 2011, www.canada.ca/en/health-canada/services/health-concerns/tobacco/legislation/tobacco-product-labelling/smoking-mortality.html.
  4. S. Department of Health and Human Services (USDHHS). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.
  5. Berry KM, Fetterman JL, Benjamin EJ, et al. Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Netw Open.Published online February 01, 20192(2):e187794. doi:10.1001/jamanetworkopen.2018.7794
  6. CMA Response: Health Canada Consultation on the Impact of Vaping Products Advertising on Youth and Non-Users of Tobacco Products. Published online March 22, 2019. Retrieved June 16, 2019, from https://policybase.cma.ca/documents/Briefpdf/BR2019-07.pdf
  7. Public Health Law Center. Retrieved June 16, 2019, from https://publichealthlawcenter.org/resources/us-e-cigarette-regulations-50-state-review
  8. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Retrieved June 16, 2019, from http://www.nationalacademies.org/hmd/~/media/Files/Report Files/2015/TobaccoMinAge/tobacco_minimum_age_report_brief.pdf
  9. Ahmad, S., & Billimek, J. (2007). Limiting youth access to tobacco: Comparing the long-term health impacts of increasing cigarette excise taxes and raising the legal smoking age to 21 in the United States. Health Policy,80(3), 378-391. doi:10.1016/j.healthpol.2006.04.001

 

Guidelines on Same Day Thyroid Surgery

 

Same Day Thyroid Surgery Guidelines (2015)

 

These guidelines were developed by the Canadian Society of Otolaryngology – Head and Neck Surgery Endocrine Group. At the 2015 Annual Meeting in Winnipeg, Manitoba a consensus was achieved and the guidelines were adopted.

 

Preamble:
Same day thyroid surgery is becoming increasingly more common in North America. The Canadian Society of Otolaryngology – Head and Neck Surgery Endocrine Group determined that it was important to develop a guideline to assist thyroid surgeons performing same day thyroid surgery. The process involved reviewing guidelines developed by other groups (For example: American Thyroid Association Statement on Outpatient Thyroidectomy, 2013), discussion via telephone, correspondence via Email, and a discussion at the 2015 Annual Meeting of the Canadian Society of Otolaryngology – Head and Neck Surgery Endocrine Group in Winnipeg, Manitoba where a consensus was reached.

 

Disclaimer:
These guidelines were developed to assist thyroid surgeons with decision making. They are not intended to replace or supersede the surgeon’s judgment.

 

Organization:
The guidelines are organized into four categories: Patient Factors, Social Situation, Final Check, and Protocol.

 

I. Patient Factors

Same day surgery should be avoided in the following patients:

1. Serious medical conditions.

2. Suffering from moderate or severe obstructive sleep apnea.

3. Taking any blood thinning medications at the time of surgery (not including NSAIDs).

 

 

At the time of discharge the patient should meet the following:

 

1. Vital signs are stable.

2. There is no significant coughing or vomiting.

3. Pain is well controlled.

4. The incision site is not worrisome for hematoma.

5. Tolerates PO and is able to void.

 

II. Social Situation

 

1. The patient needs a responsible adult to drive them home from the hospital.

2. A responsible adult must stay with the patient overnight.

3. The patient must live within reasonable proximity of an appropriate hospital.

4. The patient must demonstrate that they understand the instructions and risks associated with
hematoma, hypocalcemia, and infection.

 

III. Final Check

 

1. The patient meets the hospital post-thyroidectomy hypocalcemia criteria for discharge.

2. The patient is examined at a minimum of 2 hours post-thyroidectomy.

3. The staff surgeon feels as if the patient can go home given the extent of surgery and perioperative
course in his/her judgment.

 

IV. Protocol

1. The patient and the responsible adult that will stay with them receive verbal and written instructions
regarding signs of hematoma as well as what to do.

2. The patient and the responsible adult that will stay with them receive verbal and written instructions
regarding signs of hypocalcemia as well as what to do.

3. The phone number of the hospital is provided with instructions of who to call if they have questions.

4. If uncertain about whether a hematoma is developing, call an ambulance and go directly to the
hospital.

Choosing Wisely Canada (Otolaryngology)
Position Statement on Early Hearing Detection and Intervention (EHDI): Canadian Infant Hearing Task Force (2016)

 

 

 

 

Every year in Canada, more than a thousand children are born with a permanent hearing loss. There is evidence that children who receive timely diagnosis and intervention (screening by 1 month, diagnosis by 3 months and intervention by 6 months of age) have better communication, literacy and cognition than children with delayed diagnoses. Reducing the age of diagnosis, paired with early support for communication development, results in improved outcomes for the child and family.

Early hearing detection and intervention programs have become a standard of care in many countries, where screening for hearing loss is made available to all newborn babies. This is not the case in Canada, where many provinces and territories do not have sufficient programs in place. Recent reviews by the Canadian Pediatric Society (CPS) and the Canadian Infant Hearing Task Force identified gaps in many provinces and territories in hearing screening and follow-up services which limit access to timely and appropriate detection and intervention. The CPS lists Canada’s lack of a nationwide program for early hearing detection and intervention as one of the top challenges facing Canada’s youth.

It is time for all Canadians to have access to a well-integrated and culturally sensitive early hearing detection and intervention program. This must include a comprehensive range of services including screening; surveillance for late-onset hearing loss in childhood; diagnosis and intervention; access to assistive technologies; and support for communication development. Anything less leaves our children at a significant disadvantage.

This position statement was developed by the Canadian Infant Hearing Task Force, a collaboration of the Canadian Academy of Audiology (CAA) and Speech-Language and Audiology Canada (SAC). For more information about the Canadian Infant Hearing Task Force, please visit www.infanthearingcanada.ca

This position statement has been endorsed by the Canadian Society of Otolaryngology-Head and Neck Surgery

Cochlear Implants in Children

Position On Cochlear Implants In Children

SINCE the majority of society is a “hearing” one;

SINCE optimal results are achieved by implantation at younger rather than older ages;

The Canadian Society of Otolaryngology – Head and Neck Surgery supports the use of cochlear implants in children.

IN THE PRESENCE of informed consent in the case of a child by the parents or legal guardian;

WHERE surgeons are available capable of performing the procedure safely;

WHERE proper aural rehabilitation is available.

Hearing Loss & Otolaryngological Disease in Developing Communities

 

Position On Hearing Loss And Otolaryngological Disease In Developing Communities

 

  • We recognize many areas in the world as disadvantaged from the standpoint of otolaryngology, hearing, and ear health care. This includes remote areas in Canada, particularly those in the North that, because of distance and isolation, are disadvantaged.

 

  • We recognize many populations in developing countries who do not have access to otolaryngologic care.

 

  • The Society supports its members in their endeavour to provide otolaryngologic care to both of the above populations or groups.

 

  • The Society supports the education of all health care workers involved in the provision of otolaryngologic, hearing, and ear health care to these populations, including physicians, audiologists, nurses, and technicians. This support is both to provide education in developing countries and for personnel from developing countries in Canada.

 

  • The Society supports its members providing such education both in developing areas and in our own home base.

 

  • The Society encourages Provincial Colleges of Physicians and Surgeons to modify requirements for training licensure for physicians from disadvantaged countries, particularly those seeking educational experience only.

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