May 26, 2003
PAPER SESSION - ROOM 3
OTOLOGY
15:40-15:50
How doe the mass of a middle ear PORP prosthesis affect its acoustic function - Bance M, Morris D, vanWijhe R, Narine A
Objectives:
To determine how the mass of a PORP prosthesis affects the transmission of vibrations from the eardrum to the footplate.
Methods:
A fresh cadavaric middle ear model was used, which has. properties similar to the living ear. After incus removal, a Goldenberg PORP prosthesis was placed between the eardrum and the stapes head. This was mass loaded with small, medium and large weights on its stem. Stapes footplate vibrations to standardized external canal sound inputs were recorded with a laser Doppler vibrometer. This experiment was performed in 7 temporal bones.
Results:
The effects of mass loading are relatively small for the small and medium weights. The larger weight added new resonant peaks and troughs at unpredictable frequencies.
Conclusions:
Overall, mass does not have a large effect on PORP functioning. This has implications for PORP design and selection by surgeons. Large masses can cause resonances that might affect sound clarity.
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15:50-16:00
The Effect of Adhesion to the Promontory on the Acoustic Functioning of Partial Ossicular Replacement Prostheses in the Cadaveric Human Ear- Morris D, Bance M, Van Wijhe R
Background:
Adhesion formation following ossiculoplasty surgery has been implicated as a cause for the progressive deterioration of an initially good post-operative hearing result. Scar tissue between the PORP and adjacent middle ear structures is a common finding at revision surgery.
Objectives:
This study aims to investigate the effects of simulated scarring on the acoustic transmission characteristics of a PORP in the fresh cadaveric human temporal bone.
Methods:
Cortical mastoidectomy and extended posterior tympanotomy permitted access to reflective markers placed on the stapes footplate. A sound stimulus at 80-95 decibels was presented to the closed external ear canal and displacements were measured with the Laser Doppler Vibrometer. PORP's were placed in 8 cadaveric specimens and after baseline measurements the shaft of the prosthesis was cemented to the adjacent promontory using dental cement. Serial measurements were made from the stapes footplate as the adhesive was allowed to harden, a process which we have taken to simulate the gradual fixation of a prosthesis by scarring in the live patient.
Results:
There was a consistent reduction in stapes footplate displacement as the cement hardened.
Conclusion: Adhesion of a PORP to the promontory produces a consistent reduction in acoustic transfer in the fresh human cadaveric model.
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16:00-16:10
Systemic Gentamicin Ototoxicity-Dosing Regimes, Risk Factors and Medical-Legal Concerns- Narayanan P, Kisilevsky V, Rutka J
Objectives:
To compare and contrast documented ototoxicity from single daily dose Gentamicin therapy(SSD) versus multiple daily dose (MDD) regimes.
Methods:
Thirty-two patients with systemic Gentamicin ototoxicity were reviewed. Retrospective analysis of the patient's charts focused on the indications for systemic Gentamicin therapy, risk factors for the development of ototoxicity and the variations in vestibular and hearing impairment related to the different treatment regimes
Results:
Systemic Gentamicin ototoxicity appeared primarily vestibular and occurred in both SSD and MDD regimes.The most common indication for systemic Gentamicin therapy was for the treatment of osteomyelitis. The most risk factors for the development of ototoxicity were prolonged treatment course (greater than 14 days) and concominant renal impairment/failure.
Conclusions:
Systemic Gentamicin ototoxicity can occur regardless of the dosing regimen employed. Although there are theoretical pharmacoeconomic advantages in out patient Gentamicin therapy, it is our experience that prolonged treatment courses should be avoided whenever possible. Patients and health care providers should be aware of the signs/symptoms of ototoxicity as part of the informed consent for this drug. The development of ototoxicity not infrequently results in a medical legal suit.
Key Words: Aminoglycosides, Gentamicin, ototoxicity, single daily dosage, multiple daily dosage, medical legal
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16:20-16:30
Long-Term Comparaison of Two Transtympanic Gentamicine Instillation's Protocols for Intractable Ménière's Disease - Fradet N, Nguyen N, Denis P, Jacques D, Renee D
The aim of this long term prospective study is to compare the efficacy and the morbidity of two different protocols using intratympanic gentamicine instillation for disabling Ménière' s disease. The first group of 22 patients received a fixed protocol of 3 injections per day during 4 days ( total of 12 ) as used by Dr Nedzelski ( Toronto ). The second regimen , used on 24 patients , consisted of one injection per day, twice a week.If symptoms persisted, the treatment was repeated. Treatment effectiveness was based on the Amerian Academy of Otolaryngology-Head and Neck Surgery 1995 Guidelines. Complete results of long term follow-up will be presented and discussed subsequently.
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16:30-16:40
Music perception by post-lingually deafened adult cochlear implant recipients- Stadelmann L, Ostroff J, Shipp D, Ng A, Chen J, Nedzelski J
Many post-lingually deafened adult cochlear implant recipients characterize the sound of music after implantation as unpleasant or difficult to follow. This may be due to a referential memory for the way that music sounded prior to the onset of profound hearing loss that is used to compare music delivered through the implant, which is not engineered optimally to transmit music.
Seven post-linguistically deafened adult cochlear implant recipients participated in this study. Musical background and experience were asessed with the use of a questionnaire. Participants were asked to listen to two types of music in the clinic: 1) familiar pieces - those heard prior to receiving a cochlear implant, 2) unfamiliar pieces – music released after receiving the implant. Participants were asked to rate each piece with respect to several aspects. Results demonstrate a clear preference by all participants for the familiar pieces of music rather than the “new” unfamiliar pieces.
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16:40-16:50
Expectant Management of Solitary Acoustic Neuromas - Nedzelski J, Grebenyuk J, Rowed D
The senior author has during the course of his career seen and managed 931 patients with unilateral acoustic neuromas. Of these, 263 individuals with unilateral tumors had at outset decided for a variety of reasons to have this entity managed expectantly (no treatment apart from regular monitoring).
The objectives of this study which is retrospective in nature, were: a) to determine the outcome in this patient cohort with respect to tumor growth, b) monitor changes in hearing over time, c) specify reasons for intervention (surgical or irradiation) in those patients who required treatment and d) try to determine whether there have been changes in the treatment paradigm over time.
1019 charts were individually reviewed so as to obtain a comprehensive overview of all patients seen with cerebellopontine angle tumors (meningiomas, neurofibromatosis type 2).
28% (263/961) of patients initially decided to adopt an expectant approach to their tumors. 26 individuals have had a follow up of less than one year. The mean follow up of the remaining 193 was 4.29 years. Of these 68 were followed for a minimum of 5 years. 20% (51/263) of this patient population required treatment.
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May 27, 2003
PAPER SESSION - ROOM 1
OTOLOGY
15:40-15:50
A clinical test for Dynamic Visual Acuity (DVA): effects of head motion velocity - Dannenbaum E, Hakim-Zadeh R, Paquet N, Feldman A
A clinical method for evaluating osclipsia is the Dynamic Visual Acuity (DVA) test, yet the specific head velocity for testing is not standardized. The objective of this study was to compare DVA score at different velocities of passive head movement. Subjects (23 healthy, 6 post-acoustic-neuroma resection and 2 unilateral-vestibular hypofunction) were seated and their DVA was tested using Snellen and E- chart at five frequencies (0, 0.5, 1, 1.5, and 2 Hz) of passive head oscillations in the horizontal and vertical directions. The 40-degree range of head displacement was controlled. Each frequency was repeated 3 times. The results show: (1) DVA in healthy subjects did not vary when the head was moved at 0.5, 1, and 1.5 Hz (Snellen 95.6 %, E-chart 100%). At 2Hz, some showed a positive score of –2 (Snellen 17.4 %, E-chart 0%). (2) All patients, except one, had normal DVA when tested at 0.5 Hz , but the score was positive when tested at 1 Hz and higher (i.e. at 6/8 patients had postive scores (higher than -1) when tested 1.5 Hz in the horizontal direction). (3) The E-chart was associated with less DVA score variability (60% of similarity among the 3 trials at 1.5 Hz) as compared to the Snellen chart (40% of similarity at 1.5 Hz) In conclusion it is recommended that DVA be tested at 1.5 Hz with the E-chart.
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15:50-16:00
Normal Subjects vs Compensated Vestibularly Deficient Patients: Can the Slow-Phase of Nystagmus classify these Groups? - Katsarkas A, Smith H, Chan W, Galiana H
The slow-phase of vestibular nystagmus (SPV) is considered a reflection of the function of the vestibulo-ocular reflex (VOR). The SPV is treated as a continuous eye movement and the fast-phase interruptions are ignored. This method often cannot distinguish between healthy subjects and compensated patients because the eye movement is not continuous and the VOR is a non-linear system. Our transient analysis method incorporates the effects of the fast-phase end position on the next slow-phase segment. We analyzed data from unilateral vestibular deficient compensated patients and normal subjects. In contrast to prior techniques, the transient method can distinguish between normal subjects and compensated patients. The new method allows for robust detection of vestibular abnormalities even after compensation, and can be used for the analysis of any ocular nystagmus, including OKN, pursuit, saccades…etc. Data from normal subjects and compensated patients will be presented and will illustrate the clinical importance of this approach.
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16:00-16:10
Intentional Chemical Ablation using commercially available Gentamicin ear drops in Meniere's Disease versus inadvertent topical Gentamicin Ototoxicity; What's the Difference? - Kisilevsky V, Rutka J
Objectives:To compare the effects of Gentamicin ear drops on vestibular and cochlear function in patients treated for Meniere's disease and those identified with inadvertent topical Gentamicin-induced ototoxicity.
Methods:Patients with unilateral Meniere's disease underwent intratympanic Gentamicin ablation therapy using commercially available Gentamicin-containing ear drops.
Treatment outcome was assessed according to the 1995 AAO-HNS CHE Guidelines for the reporting in
Meniere's disease. A parallel cohort of patients with inadvertent topical Gentamicin-induced ototoxicity were also reviewed.The prevalence of post toxicity vestibular and hearing loss, the time difference etc. between the start of treatment to the appearance of ototoxicity was also studied in both patient groups.
Results: Thirty-seven (37) patients ( total 39 ears) underwent intentional Gentamicin ablation for Meniere's disease and 27 patients( total 34 ears) were identified with inadvertent topical Gentamicin ototoxicity.The significant differences were observed in the prevalenceof post treatment hearing loss between two patients groups.Symptoms and signs of ototoxicity were observed after 10 days on average in patients treated for Meniere's disease compared to 20 days on average in cases of inadvertent ototoxicity.
Conclusions: Commercially available topical Gentamicin preparations used in the treatment of Meniere's disease are more likely to result in hearing loss than in cases of inadvertent ototoxicity.
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16:20-16:30
High Resolution Strategy in Adults Utilizing the Clarion CII and HiRes 90K Devices - Al-Rowaished A, Schramm D, Seguin C
The Clarion CII Bionic Ear and HiRes 90K implants have the capacity to stimulate the cochlear nerve at rates much greater than conventional cochlear implants. This offers the potential advantage of increasing speech perception ability. Since the introduction of the Bionic Ear Implant in Ottawa in February 2001, forty adults have been implanted with the CII or HiRes 90K device.
Adults have had the option to participate in a high stimulation rate study. Fourteen adults have completed the clinical trial. For a period of three months, they were fit with their choice of one of the conventional strategies available with the Clarion device (SAS, CIS and MPS) and then were crossed over to the investigational High Resolution strategy for another three months. Up to one year follow-up is available for these patients.
Five patients to date have been implanted with the HiRes 90K device.
Results of our patients with the High Resolution strategy are presented.
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16:30-16:40
Closure of near total ear drum perforations using a modified House Technique - Blokmanis A, Archibald J
Objectives: To show a simple way of obtaining closure of near total ear drum perforations using a modified House Technique developed by the senior author.
Method: In the last twenty five years the senior author has been using a modified House technique to close total or near total ear drum perforations. The charts of patients who had undergone this surgery in the past had been kept so that eventually a retrospective outcome analysis could be performed. There were fourty two patients and forty eight ears. Pre and post surgery audiograms were reviewd and where possible the patients were contacted and interviewed to determine the long term results of the surgery. There were a number of patients who had failed previous surgical attrempts. The only exclusion criteria were patients who had had mastoid surgery and had ear drum perforations.
Result: The patients were all adults. The success rate of closure of these perforations was 98%. Most patients also had an improvement in their hearing.
Conclusions: The modified House technique is a simple technique that can produce good result in large ear drum perforations or when other techniques have failed.
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16:50-17:00
A comparison of behavioural and ASSR thresholds in normal hearing and hearing impaired adults - Brown DK
Screening for hearing in the neonatal period will lead to early identification of hearing loss. Early identification will lead to diagnosing hearing loss in infants less than 6 months. This can only be accomplished using physiological measures. The current tools for estimating audiometric thresholds, namely otoacoustic emissions (OAE) and auditory brainstem response (ABR), are not without problems. This has lead to the investigation of a new technique, Auditory Steady-State Response (ASSR). ASSRs are an objective brainstem measurement that are relatively easy to obtain and can be recorded from people of all ages while either awake or asleep. We investigated this new technique to determine auditory thresholds in adults. We will describe this new technique and present our data which compares the auditory thresholds obtained with behavioural audiometry to those obtained with the ASSR technique in a group of normal hearing and hearing impaired adults.
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17:00-17:10
Performance Results with the Otologics Middle Ear Transducer (MET) Implantable Hearing Device - Fredrickson J, Niparko J, Slattery W, Neely JG
Objectives:
To assess performance of the Otologics MET Implantable Hearing Device compared to two pre-operative hearing aid baselines.
Methods:
Aided soundfield and speech performance of 40 subjects were measured across three amplification modes: 1) subject's optimally-fit hearing aid, 2) JUMP-1 digital hearing aid, and 3) postoperatively with the Button Audio Processor, the external component of the MET Implantable Hearing Device.
Results:
Better aided soundfield and speech performances were obtained with the Button Audio Processor compared to subject's optimally fit hearing aid. Comparable soundfield thresholds were obtained with the Button Audio Processor and JUMP-1 with a trend for improved speech performance with the Button Audio Processor. Sound quality questionnaires revealed a preference for the Button Audio Processor over both hearing aid technologies.
Conclusions:
The MET Implantable Hearing Device is a viable treatment option for patients with moderate to severe sensorineural hearing loss for a variety of quantitative and qualitative reasons.
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May 27, 2003 - AM
PAPER SESSION - ROOM 2
HEAD & NECK
08:30-08:40
Sexual Dysfunction and Quality of Life Following Treatment For Laryngeal Cancer - Taylor M, Yoo J, Agrawal S
The treatment of laryngeal cancer has significant implications for patients. Quality of life issues have emerged as an important variable in determining treatment and measuring success. Despite the fact that several studies have been performed with regards to quality of life following treatment for laryngeal cancer, no study has focused on sexual function in this cohort of patients. The purpose of this study was to assess overall sexual function, desire, and erectile function in laryngeal cancer patients. Other factors that may affect sexual function such as depression, body image perception, and marital relations were assessed. The UCLA Prostate Index was administered by means of a mailed questionnaire to 67 male patients who agreed to participate in the study. 32 patients were treated with a total laryngectomy while 35 patients received external beam radiation. All were free of disease. Erectile dysfunction was 79% in the study group. There was no difference between the laryngectomy and radiation groups. A difference in Body Image Perception was found to be statistically significant(p=0.04)between the two cohorts. There was no difference in the incidence of depression or problems with marital relations. This study proves that sexual dysfunction is prevalent in this cohort of patients and should be addressed by either the attending physician or paramedical staff.
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08:40-08:50
Radiotherapy for T1 and T2 Laryngeal Cancer: The Dalhousie University Experience - Tibbo J, Taylor SM, Trites J, Corsten G
A total of 373 cases of laryngeal cancer were reported in Nova Scotia during 1990-2001. All patients diagnosed were identified through The Nova Scotia Cancer Registry and subsequent information was obtained from QEII hospital records. Cases were classified by T-stage (T1=137, T2=90, T3=89, T4=57 cases) and affected structures (glottic= 233, supraglottic= 136, subglottic= 4 cases). T1 and T2 cancers of both the glottis (T1 =104, T2= 38 cases) and supraglottis (T1=4, T2=31) were reviewed. 95.2% (139/146) of T1/T2 glottic cancers were first treated with radiotherapy. 71.1% (74/104) and 63.3% (24/38) of T1 and T2 glottic cancers, respectively, were controlled by radiation with an average follow-up of 37 months. Of those T1 and T2 glottic cancers unsuccessfully treated by radiotherapy, 20 of 24 (83%) had total laryngectomies and were free of disease after 48 months. 75% of T1 (3/4) and 74% (23/31) of T2 supraglottic laryngeal cancers were successfully controlled by radiotherapy. Salvage surgery was attempted in 6 of the supraglottic cases unsuccessfully treated by radiotherapy, however, all patients died of disease. The results of our retrospective review justify considering primary surgery in early laryngeal cancer.
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08:50-09:00
Coping with head and neck cancer: results of a feasibility study - Archer J, Allison P, Edgar L, Nicolau B, Black M, Hier M
Objectives: 1) To test the feasibility of providing a psycho-educational, coping strategies intervention for people with head and neck (H&N) cancer; and 2) To collect preliminary outcomes data in preparation for a test of effectiveness of the intervention.
Methodology: Subjects diagnosed with a H&N malignancy were invited to participate. Those agreeing were offered one of three formats: i) small group; ii) one-to-one; or iii) home alone. Process and outcomes data (quality of life [QOL] measured by the EORTC QLQ-C30) were collected during and following the intervention. Analyses were perormed using non-parametric tests because of the small sample size and non-normal distribution of the data.
Results: Of 128 people invited to participate, 66 agreed, 59 completed the intervention and outcomes data are available on 49. Of the 59 completing the intervention, 3 had the group, 33 the one-to-one and 23 the home format. More men took the home format (p=0.015) and those with lower education (p=0.02) and early stage disease (p=0.045) were more likely to drop-out of the study. Of the 49 subjects with outcomes data, pre-post-intervention analyses QOL data suggested a significant improvement in social functioning (p=0.04), global QOL (p=0.007) fatigue (p=0.023) and sleep disturbance (p=0.015), plus a tendancy towards improved physical functioning (p=0.061).
Conclusions:These data suggest that the intervention is feasible and may improve elements of QOL in H&N cancer patients.
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09:10-09:20
The Unknown Primary: How Elusive is it? - Zakhary K, Amar Y, Black M, Hier M
Objectives: The first objective was to determine the percentage of head and neck occult squamous cell carcinomas (OSCCA) which are identified prior to definitive treatment. The second was to identify the modality which most often leads to localization of the OSSCA.
Methods: A 9-year retrospective review of 225 patients with squamous cell carcinoma presenting to a head and neck oncology practice.
Results: Eighteen patients with OSSCA were identified. The site of the primary was identified in eight (44%) of these patients. Seven of the 8 OSSCA were localized to the ipsilateral tonsil. The remaining OSCCA was found in the base of tongue. The modality which allowed localization of the OSSCA in seven of these patients was panendoscopy with biopsies. Computed tomography demonstrated the primary in the eighth patient.
Conclusions: Panendoscopy with biopsies is the modality with the highest yield in terms of localization providing the clinician with the primary site in close to fifty percent of patients.
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09:20-09:30
Transfusion Risk in Head and Cancer Resection - Chau J, Rashiq S, Seikaly H
Objective:
To find preoperative factors which predict the need for blood transfusion in Head and Neck cancer patients
Methods:
The cohort of patients undergoing head and neck surgery between Oct. 1996 and Oct. 2002 were studied retrospectively. Demographic and clinical information was obtained from hospital and blood bank computerized databases and supplemented where necessary by manual review of hospital records. The outcome variable was the number of units of allogeneic and autologous blood transfused perioperatively. Univariate analysis and logistic regression modeling were performed for each of the variables of interest to determine whether or not an association existed with transfusion.
Results:
900 patients met the criteria for inclusion in the Study. Analysis showed positive associations between transfusion risk and increasing age, female gender, preexisting anemia, low body weight, short stature and surgical procedure.
Conclusion:
Patients meeting any of these criteria are candidates for specific measures to reduce transfusion need.
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09:30-09:40
Parathyroid Hormone Level as a Predictor of Hypocalcemia Post Total Thyroidectomy - Lam A, Kerr PD
The potential for hypocalcemia is a major impediment to early discharge after total thyroidectomy. To date, nobody has described a very useful way to predict the development of this complication. As a result, many patients undergo laborious serial calcium measurements and are kept in hospital for monitoring. Commencing calcium replacement based on symptoms or after noting a significant drop in serum calcium often further delays discharge. The alternative approach of empirically starting high dose supplemental calcium places many patients on medication unnecessarily, and does not allow for an individualized monitoring protocol that is based on risk.
The ideal test for predicting hypocalcemia would be accurate, simple, inexpensive, and would yield a result immediately. Thus, it would facilitate early discharge in those at low risk, and prompt early initiation of calcium therapy and more careful monitoring in those who were at risk of developing hypocalcemia. Predicting hypocalcemia from early changes in the postoperative calcium level has been less accurate, less timely, and more cumbersome than desired. Therefore, this technique is far from ideal, and has not been routinely employed. Postoperative parathyroid hormone (PTH) levels have traditionally been too expensive and the results too delayed to be considered useful. However, recent advances in PTH determination have reduced the cost and time required to run the assay. We report a novel approach for predicting hypocalcemia using a single PTH level drawn early in the postoperative period.
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May 27, 2003 - PM
PAPER SESSION - ROOM 3
HEAD & NECK
15:40-15:50
Total laryngopharyngectomy reconstruction with a U-shaped radial forearm free flap - Alsoairy M, Harris J, Seikaly H
Objectives: To evaluate the outcome of pharyngoesophageal reconstruction aftertotal laryngopharyngectomy using radial forearm free flap.
Design of study: Retrospective review in the setting of a tertiary academic centre (U of A Hospital).
Patients and methods: Ten patients underwent total laryngopharyngectomy with radial forearm free flap reconstruction. The flap was sutured to remnant pharynx and esophagus superiorly and inferiorly respectively and to the prevertebral fascia on the sides making a U-shaped canal instead of the tubed flap.
Results: All the flaps survived. Oral intake resumed within 8-10 days. One patient developed a fistula. Distal narrowing occurred in two patients requiring dilatation.
Conclusion: The advantages of using the U-shaped RFFF reconstruction after total laryngopharyngectomy include high flap reliability, reduced leak and stricture rates compared to the tubed flap reconstruction.
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15:50-16:00
Reconstruction of the Orbit Following Maxillectomy - Gilbert R, Neligan P, Gullane P, Irish J, Brown D, Hall F
Objectives: Reconstruction of the orbit following radical maxillectomy which includes a resection of the orbital floor is a major reconstructive challenge. The purpose of this paper is to review an experience and describe a single institutional approach to reconstruction of the orbit post maxillectomy.
Methods: A retrospective review of all patients undergoing orbital floor reconstruction post maxillectomy. Outcome measures including reconstructive technique, local and general complications, functional and aesthetic result, need for revision procedures.
Results: A variety of techniques have been used including temporalis muscle flaps, free tissue transfer with or without bone and non-vascularized bone covered by free tissue transfer and or local vascularized tissue. The use of non-vascularized bone covered by vascularized tissue produced the best ultimate result. A majority of patients had poor aesthetic outcomes related to the lack of a understanding of the need to reconstruct not just the floor of the orbit but also the anterosuperior wall of the maxilla.
Conclusion: The best approach to orbit reconstruction is yet to be defined, currently the authors support the use of non-vascularized bone supported by either local or free tissue transfer for achieving the best results in this difficult group of patients.
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16:00-16:10
Epstein-Barr Virus (EBV) DNA Measured in Nasopharyngeal Brushings in Patients with Nasopharyngeal Carcinoma (NPC) - Makitie A, Reis P, Irish J, Zhang T, Chin S, Kamel-Reid S, Siu L
Objective: We measured the amount of tumor-derived EBV DNA in the nasal brushings of NPC patients to determine correlation with tumor load and response to treatment.
Materials and Methods: Baseline measurements of EBV from nasopharyngeal brushings were obtained from 19 patients with locally advanced or metastatic NPC prior to treatment. A follow-up sample was available from 5 patients post treatment. Real-time quantitative PCR system using SYBR Green I fluorescent dye was used to detect EBV DNA copy number.
Results: Nasopharyngeal brush biopsies showed a high copy number of EBV DNA in most of samples. The highest copy number detected was 145,369,44 copies/mL in one sample. In the post-treatment follow-up samples the copy number was significantly lower.
Conclusions: We have demonstrated that EBV DNA can be detected in the brush biopsies from NPC patients using Real-time Quantitative PCR. The potential of this technique as an NPC tumor marker for post-treatment follow-up is currently being validated.
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16:20-16:30
The role of neck dissection in a protocol of hyperfractionated accelerated radiotherapy with integrated neck surgery (“HARDWINS”) - Thuot F, Waldron J, O'Sullivan B, Gullane P, Brown D, Freeman J, Witterick I, Gilbert R, Irish J
Organ preservation has become the mainstay of head and neck cancer therapy resulting in improving the quality of life in survivors of head and neck cancers without compromising survival. In an attempt to continue to maximize organ preservation, the development of new strategies have employed concomitant chemo-radiotherapy and novel radiation fractionation schedules. The aim of this study is to evaluate the role of elective neck dissection integrated with hyperfractionated accelerated radiotherapy (64 Gy in 40 fractions over 4 weeks). The “HARDWINS” protocol employs sequential reduction of high dose irradiated volume to include only the primary tumour and delivers an adjuvant dose to other lymph nodes regions. This strategy requires surgery in a subset for regional disease control. 110 patients with stage III and IV squamous cell carcinoma of the larynx, oropharynx and hypopharynx were included in a phase II prospective study at the Toronto Princess Margaret Hospital. Patients were treated with 3 different four week hyperfractionated accelerated regiments to the primary tumor area using the shrinking field technique. A mandatory neck dissection was done for nodal masses > 3 cm eight weeks after the completion of radiation therapy. The present report focuses on a subset of 34 patients in this protocol whom had a neck dissection integrated in their treatment.
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16:30-16:40
Recurrent Pleomorphic Adenoma of the Parotid Gland: A Fifteen Year Experience - Maxwell L, Hall F, Freeman J
This is a retrospective analysis of thirty five patients treated for first recurrence of pleomorphic adenoma of the parotid gland from 1982 to 1997. All patients were treated surgically; no patients received radiotherapy for benign disease. We experienced a locoregional control rate of 77%. Our malignant transformation rate was 5.7%. Our results suggest that in carefully selected patients, local excision of recurrent disease is sufficient in controlling further recurrence.
KEYWORDS – pleomorphic adenoma, parotid gland, tumor recurrence, locoregional control.
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16:40-16:50
Marginal Mandibulectomy: A good oncological operation? - Thuot F, Irish J, Brown D, Gilbert R, Gullane P
Marginal mandibulectomy is a conservative ablative procedure for head and neck malignancies close to or minimally invading the bony cortex. Its objective is to reduce operative and long-term morbidity by maintaining bone continuity without compromising oncologic results. Since it's first description in 1953 by Greer et al., it has been the subject of controversy regarding the assessment of bone involvement, selection of patients and oncologic results. A retrospective review of 50 patients treated by this technique at the Toronto General Hospital/Princess Margaret Hospital between 1995 and 2000 was conducted. Data pertaining to preoperative evaluation, type of resection, method of reconstruction, pathologic status of invasion and tumor-free margins was investigated. Outcome factors analyzed include short and long term complications, esthetic and functional results as well as incidence and patterns of loco-regional failure. We will present these results and discuss them with an up to date of current literature.
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17:00-17:10
Outcomes in elderly patients with head and neck cancer - Franklin J, Lee J, Yoo J
Objective: To assess the outcomes of head and neck cancer patients over 80 years of age as compared to younger patients.
Methods: Utilizing a database at the London Regional Cancer Centre consecutive patients diagnosed with head and neck cancer over the age of 80 were entered into the study. Data with respect to site and stage of cancer as well as medical co-morbidity was collected. A group of patients between the ages of 70 and 80 matched for co-morbidities were analyzed. Data was collected prospectively. The groups were then compared for their ability to undergo complete therapy as initially recommended, complications of treatment, local control, disease free survival and overall survival. Patients were followed for 2 years from the time of diagnosis.
Results: Age had a significant effect on patient’s ability to undergo and complete curative treatment and therefore resulted in poor local control, disease free survival and overall survival.
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17:10-17:20
CT Volumetric Analysis as a Predictor of Local Control in Laryngeal Cancers Treated with Conventional Radiotherapy - Hamilton S, Matthews T, Venkatesan V, Lewis C, Assis L
Background: There is controversy regarding the appropriate management of T2 and T3 laryngeal cancers, with some investigators finding little correlation between the current TMN staging system and tumour control following radiotherapy.
Objective: To establish the utility of CT-determined tumour volume as a predictor of local control of moderately advanced (T2/T3) squamous cell carcinoma of the larynx.
Methods: A retrospective chart review and CT volumetric analysis were performed on patients who had been treated for T2/T3 laryngeal SCC with conventional radiotherapy alone at the London Regional Cancer Center between 1995-2000. Patient demographics, tumour characteristics, radiotherapy methods and tumour stage were analyzed and related to local failure with univariate and multivariate analyses.
Results: There were 47 patients with laryngeal carcinoma included in the analysis, of which 30 were glottic and 17 were supraglottic. Tumour size ranged from 0.15 cm3 to 16.64 cm3, and was found to be significantly correlated with local control. Multivariate analysis revealed that local control was also significantly influenced by patient age at diagnosis and overall stage. The local failure rate in this group of patients was 40% (19/47).
Conclusions: Pretreatment CT tumour volume is a significant predictor of local outcome following radiotherapy in this population. Potential application and future areas of study will be discussed.
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May 27, 2003 - AM
PAPER SESSION - ROOM 3
PEDIATRIC OTOLARYNGOLOGY
08:30-08:40
Acquired Subglottic Cysts in Preterm Infants - Johnson L, Rutter M, Shott S, Cotton R
Objectives: Acquired subglottic cysts are a recognised complication of intubation in preterm infants. Our experience is reviewed to determine the demographics and outcomes of therapy.
Methods: A case series of 9 patients evaluated at a tertiary care paediatric institution over a two-year period is presented.
Results: A total of 9 patients evaluated for symptoms of airway distress were found to have subglottic cysts. All had a history of prematurity with intubation in the perinatal period. All but one became symptomatic many months following intubation. Diagnosis, by microlaryngoscopy and bronchoscopy, usually revealed multiple large cysts. Treatment consisted of cyst marsupialisation by Bugbee electrocautery or CO2 laser. A total of 20 procedures were performed. 4 patients required a single procedure.
Conclusion: Subglottic cysts are associated with intubation in premature patients, but are independent of the duration of intubation, and usually develop over many months. Serial Bugbee electrocautery is an effective intervention in most of patients.
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08:40-08:50
INTRAPARTUM MANAGEMENT OF SEVERE FETAL AIRWAY OBSTRUCTION - Preciado D, Rutter M, Willging J, Cotton R
OBJECTIVES: Review our experience with the planned intrapartum management of fetuses with known severe airway obstruction.
METHODS: Retrospective review of prenatal presentations, intrapartum airway procurement methods, outcomes, and complications.
RESULTS: All cases (11) at our tertiary airway referral institution (1995-2002) were reviewed. Obstruction was secondary to giant cervicofacial lymphangiomas (5), teratomas (2), epignathis (1), epulis (1), conjoined fetus (1), and tracheal foreign body (1). Elective cesarean delivery of the entire fetus was performed while maintaining fetal-placental circulation as long as possible. We found it necessary to deliver the entire fetus in order to improve airway exposure and decrease maternal hemorrhage. The airway was secured effectively in all cases.
CONCLUSIONS: While full cesarean delivery of the fetus significantly reduces fetal-placental circulation times in comparison to the formal EXIT (ex-utero intrapartum treatment) procedure, airway access is improved, maternal complications may be decreased, and high airway procurement success is still safely achieved.
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08:50-09:00
Connexin mutation testing of children with non-syndromic, autosomal recessive hearing loss - Thomas M, Tewfik T
Objective: The etiology of hearing loss is heterogeneous and falls into the two broad categories of genetic and environmental. In the genetic subgroup, 70% are non- syndromic hearing loss. Fifty percent of non-syndromic sensori-neural deafness is due to a mutation in the connexin 26 gene. Our goal is to review the detection rate of a connexin mutation in a multi-ethnic Canadian population.
Methods: A prospective review of patients with non-syndromic hearing loss seen over 2 years. All had connexin 26 mutation testing.
Results: Nine of the 17 patients had connexin 26 mutations.
Conclusions: The majority of our patients with connexin 26 mutations had moderate-profound hearing loss. Testing for connexin mutations should be standard care since it accounts for a large proportion of individuals with non-syndromic hearing loss. Reasons for testing include ruling out a syndromic cause, predicting moderate-profound hearing loss and the need for language intervention, cochlear implants, and genetic counselling.
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09:10-09:20
The effect of age on amplitude of the Auditory Steady State Response in young infants - Muir PJ, Brown DK, John MS
The Auditory Steady-State Response (ASSR) is a neural potential that follows the envelope of a complex sound. Amplitude and/or frequency modulated tonal stimuli can be presented monaurally or binaurally and the resulting activity is recorded from the scalp. The response is displayed in the frequency domain as the amplitude spectrum. Statistical methods are used to determine the presence of a response. Since multiple stimuli with better frequency-specificity can be presented, this technique holds great promise for more efficient testing, especially in the paediatric population. If ASSR is to be used as a clinical tool in the identification and evaluation of infant hearing, we must be able to use this technique with very young infants. Therefore, this study investigated the effect of age on ASSR amplitude in infants from term born (38 to 42 weeks gestational age) to two months of age. We will discuss the results and their implications for the use of ASSR with infants.
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09:20-09:30
Retropharyngeal Abscess in children: A Ten year experience - Al-Sabah BH, Bin Salleen HM, Hagr AA, Tewfik TL
Retropharyngeal abscess is the disease of early childhood with disastrous sequelae. Retrospective chart review in Montréal children hospital was done for retropharyngeal abscess from 1990 until 2001. We looked for age, sex, symptoms, bacteriology, method of diagnosis, treatment and complication. An extensive review of current literature will be presented.
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09:30-09:40
Long-term outcomes for children with submucous cleft palate that have velopharyngeal insufficiency - Husein M, Chang E, Cable B, Karnell M, Canady J
Objective: To review the long-term outcomes on children with submucous cleft palate that also have velopharyngeal insufficiency(VPI)
Methods: A retrospective chart review was carried out at a tertiary care academic center of all patients that had VPI with a submucous cleft palate. The University of Iowa Cleft Palate registry parameters encompassing nasality(hyper/hypo), nasal emissions, articulation, intelligibility and velopharyngeal competency were compared pre-operatively and post-operatively.
Results: Preliminary results demonstrate a long-term, stable improvement in children that underwent palatal surgery for VPI.
Conclusion: Long-term positive outcomes in the treatment of velopharyngeal insufficiency in the submucous cleft population were demonstrated with a combined approach of speech therapy and palatal surgery.
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May 28, 2003 - AM
PAPER SESSION - ROOM 1
RHINOLOGY
08:30-08:40
Selective irrigation of the sinuses in the management of chronic rhinosinusitis refractory to medical therapy - Lavigne FG, Tulic MK, Gagnon J, Hamid Q
Although endoscopic sinus surgery has been widely used for the treatment of chronic rhinosinusitis, some patients fail to derive clinical benefit from this procedure. As such, we have evaluated the efficacy of a treatment regiment consisting of selective irrigation of sinus diseased mucosa with topical antibiotics and steroids in conjunction with oral antibiotics and steroids. Twenty patients suffering from chronic rhinosinusitis and resistant to medical treatment (mean duration 3.4 yrs) underwent intubations of the affected maxillary and/or ethmoid sinuses for irrigation for duration of 21 to 30 days. A CT scan of the paranasal sinus was taken both pre- and post- treatment and staged according to the Lund-MacKay system. Clinical symptoms were scored for rhinorrhea, facial pain, nasal congestion and smell prior to treatment and at the end of follow-up.The clinical experience with the technique of intubation and irrigation was well tolerated by all patients.
We found an improvement in all symptom scores including rhinorrhea, nasal congestion, smell (n=20, P<0.001) and facial pain (n=20, P<0.01). Similar improvements were seen with on the CT scans with reduced staging from 14.6 ± 1.1 to 5.6 ± 1.1 (P< 0.001). Only three patients did not respond to SIS and they needed further surgery.These results suggest that sinus irrigation may be a reasonable and effective alternative to ethmoidectomy with drainage procedures and may become the treatment of choice for some patiens with CRS.
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08:40-08:50
Sphenoid Fungal Sinusitis: The St. Paul's Sinus Center Experience - Javer AR, Morley R
Objectives: Sphenoid fungal sinusitis can range from a benign non-invasive, asymptomatic fungal ball to an aggressively invasive sphenoid sinusitis resulting in blindness and orbital apex involvement usually resulting in death. Our experience with a range of different types of sphenoid fungal infections and their treatment is presented.
Methods: A thirty month retrospective review of all invasive and noninvasive sphenoid fungal infections was carried out. One invasive sphenoid fungal infection with orbital apex syndrome causing blindness was identified. Four other noninvasive sphenoid fungal infections were also identified.
Results: Treatment methods included a transnasal sphenoidotomy for the noninvasive sphenoid fungal infections, to repeated transethmoidal sphenoid debridements with optic nerve decompression for the invasive fungal infection.
Conclusion: Aggressive surgical and medical management is essential for invasive sphenoid fungal sinusitis if survival is to be expected. For the non-invasive sphenoid fungal infections a simple transnasal sphenoidotomy will result in a cure.
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08:50-09:00
The effect of middle meatus stenting after endoscopic sinus surgery - Witterick IJ, Tatwani T, Bravo M
Objective: To evaluate the efficacy of Silastic and Merogel stents when used as a spacer in the middle meatus after endoscopic sinus surgery.
Study Design: Prospective pilot study, involving 30 patients undergoing nearly identical endoscopic sinus procedures of both nasal cavities at Saint Joseph’s Health Center in Toronto. Measurements of the middle meatus will be performed at the time of surgery and at two and eight weeks post-operatively. Patients will receive a stent in one side randomly assigned but not the other.
Fifteen patients will receive silastic and the rest will receive the Merogel stent. Outcome measures include patient self report about the amount of bleeding, discharge and pain. In addition a second otolaryngologist familiar with endoscopic sinus surgery who will be blinded about the location of the stents will asses the middle meatus for healing synechia and measurement of the middle meatus.
Results: The final results will be presented comparing the stented and unstented sides.
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09:10-09:20
Image-guided transnasal endoscopic approach to the pterygopalatine fossa and lateral sphenoid sinus - Hussain AE, Desrosiers MY
Introduction: Lesions of the pterygopalatine fossa (PPF) and or/ the lateral sphenoid sinus is difficult to access and have traditionally been managed through open approaches.
Objective: We describe an endoscopic approach to PPF lesions, using clinical examples.
Method: We present six cases of lesions involving the PPF and or/ the lateral sphenoid sinus. The endoscopic approach involves a wide maxillary antrostomy and sphenoidotomy to expose the posterior wall of the maxillary sinus, followed by a meticulous opening of the posterior wall of the maxillary sinus, providing a good access to the PPF. Image-guided surgery enhances appreciation of the spatial relationships of the anatomy and execution of the surgery.
Results: All patients had satisfactory exposure. There were no complications. One patient continued to have a persistence of a pre-existing V2 dysthesia.
Conclusion: The transnasal endoscopic technique represents a safe and effective approach to lesions of this hitherto difficult to access area.
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09:20-09:30
Microbiology of Persistent Sinus Infections after Endoscopic Sinus Surgery - Bravo MC, Witterick IJ, Mazzulli T
We reviewed patients who were symptomatic and had endoscopic evidence of persistent maxillary or frontal sinusitis even after patent middle meatal antrostomies were achieved with the standard Messerklinger approach. None had obvious anatomic obstructions of sinus drainage, and repeat surgery was not deemed to be beneficial. All patients had visible collections of purulent discharge in the maxillary antrum or drainage through the frontal recess, which were collected using sterile washes delivered through an endoscopically guided cannula. Our initial results include Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeurginosa, Enterobacter aerogenes and Escherichia coli. The latter three species of bacteria are not typical of those associated with chronic rhinosinusitis. These culture and sensitivity results helped to guide antimicrobial therapy. The final microbiology, antibiotic resistance patterns, treatments and outcomes will be discussed.
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09:30-09:40
Endoscopic Electrosurgical Management Of Posterior Epistaxis: A Shifting Paradigm - Durr DG
Objectives: To describe our current endoscopic electrosurgical management of posterior epistaxis
Background: The recent literature has embraced the use of electrosurgery, sphenopalatine artery clipping and endoscopy in posterior epistaxis, with several published papers on the subject. With the advent of endoscopy the surgical treatment of posterior epistaxis has shifted from internal maxillary artery ligation to endoscopic sphenopalatine artery ligation/clipping/cautery.
Methods: Twelve patients with severe posterior epistaxis treated in 2 community hospitals with one or more the following methods: endoscopic selective sphenopalatine branch cauterization, endoscopic sphenopalatine artery cautery, and endoscopic posterior nasal cauterization.
Results: All 12 patients had no recurrence of the posterior epistaxis with good outcomes and reduced hospital stay.
Conclusion: A gradual trend is occuring form posterior nasal packing to the more liberal endoscopic management of posterior epistaxis. Endoscopic electrosurgery provides a precise and effective approach.
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09:50-10:00
Endoscope assisted Image guided approach to the pituitary gland: a cadaveric study - Durr DG, Mohr G
Objectives: To establish initial phase transition from microscopic to endoscopic transsphenoidal approach to the pituitary gland using cadaveric dissection.
Background: Microscopic transsphenoidal surgery is the current standard technique. Endoscopic transsphenoidal approach to the pituitary gland is getting wider acceptance with the increasing familiarity in endoscopy. Associated image-guided surgery using an electromagnetric field tracking system allows a precise approach, increasing surgical safety and efficacy.
Methods: Three cadaveric anatomic head dissections performed with the use of endoscopy and image guidance to approach the pituitary gland and the posterior sphenoid wall.
Results: Image guided endoscopic approach the pituitary gland is an exciting approach that provides advantages (minimally invasive, direct, wider angle) and disadvantages (endoscopic learning curve, surgery with one hand).
Conclusions: Progressive conversion to endoscopic transsphenoidal approach or endoscopically assisted to the pituitary gland is a natural trend, as endoscopic surgery is becoming more available for minimally invasive purposes.
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10:00-10:10
Randomized, controlled, study of biocompatible nasal packing on outcomes of surgical treatment of rhinosinusitis with polyposis - Franklin JH, Wright ED
Objective: To demonstrate the effect of biocompatible dressing on post-operative discomfort and mucosal healing following sinus surgery.
Study Design: Prospective, randomized, controlled, blinded study.
Methods: Patients 18 to 80 undergoing sinus surgery were enrolled in the study. Each patient’s ethmoid cavities were randomized to receive either merogel® or the standard merocel sinus packs. Patients therefore served as their own control. Pre-operative CT scan and intra-operative endoscopic photographs were utililized for staging within the Lund-Mackay system. The procedure was performed as indicated by extent of disease. The remaining merogel was removed at 2 weeks by endoscopic suctioning in the clinic. Patients completed questionnaires regarding sinus symptoms and discomfort. Post-operative endoscopic photographs were graded by an independent blinded rhinosinologist. Length of follow-up was 3 months.
Results: There were no significant adverse events in either group. Patients comfort was superior in the merogel cavity. The biocompatible dressing had no adverse effect on wound healing.
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10:10-10:20
Thermal and Infrared Imaging of the Maxillary Sinuses - Gall RM, Attas M, Mansfield C, Sowa M, Posthumus T
Sinusitis affects tens of millions of North Americans every year. In many cases, misdiagnosis results in the inappropriate use of antibiotics. As well, incorrect or inadequate treatment may result in chronic infection, requiring specialized imaging techniques to support a diagnosis. This study investigates alternative imaging techniques that could be used to evaluate the sinuses non-invasively. Two modalities based on infrared light, thermal and near infrared spectroscopic imaging, are being assessed to devise a robust and objective means of diagnosing maxillary sinusitis. In this study a the thermal camera is used to take a passive "heat image", detecting possible localized increases in surface temperature that may occur due to sinus inflammation or infection. The infrared spectroscopic camera records inflammation-related changes in tissue hemodynamics and hydration using reflected infrared light.
Progress to date is discussed.
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May 28, 2003 - AM
PAPER SESSION - ROOM 2
GENERAL OTOLARYNGOLOGY / FACIAL PLASTICS
08:30-08:40
Combined Treatment of Microdermabrasion & Alpha Hydroxy Acid Micropeels for Facial Rejuvenation - Tan A, Tsang W, Cook R
Microdermabrasion is a technique that rejuvenates the aging skin. Despite its popularity in recent years, little has been published regarding patient satisfaction. Our previous study has demonstrated its safety, effectiveness, and level of patient satisfaction. We will now present the results of our follow-up study with the use of a new combined alpha hydroxyl acid (AHA) micropeels and microdermabrasion protocol.
Objectives: This study investigated patient satisfaction using microdermabrasion with AHA micropeels.
Methods: 60 patients receiving microdermabrasion were surveyed about their satisfaction. Half of the patients underwent the combined AHA / microdermabrasion protocol. The operator's assessment of the treatment results, the level of erythema and complications were recorded.
Results: The average satisfaction level was high on an 8.0 point scale for the patients who completed the treatments. Higher scores were achieved for patients receiving combined AHA micropeel / microdermabrasion treatments. The average erythema level remained low for both groups. Potential complications are reviewed.
Conclusion: Microdermabrasion is an effective non-invasive facial rejuvenation procedure with high level of patient satisfaction. The addition of AHA micropeels to the treatment protocol has increased the effectiveness and patient satisfaction rating.
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08:40-08:50
Management of Cough Patients in a Regional Voice Program - Andreassen M, Gilmurray B, Bosch J, Hulme W, Beveridge S
The Calgary Regional Voice Program receives over 400 new referrals a year. The majority are patients with a primary complant of dysphonia. However, an increasing proportion of our referrals are patients with speech-breathing disorders including chronic/laryngeal cough, vocal cord dysfunction and breath-holding. Last year, 40% of new referrals were patients with speech-breathing disorders, many having failed conventional asthma treatment.
Objective: - to share our approach to the assessment and management of cough patients
Methods: Overview of our interdisciplinary team (Otolaryngology, Pulmonology, Speech Language Pathology) and members' roles are provided. Team assessment techniques, and behavioural intervention carried out by the speech language pathologist is highlighted. Patient video samples pre-and post- treatment are shown for illustration.
Results: Clinical outcome measured as objective change in cough behaviour, as well as average number of visits and duration of intervention for a series of over 100 patients is presented.
Conclusion: Management of patients with chronic/laryngeal cough is a growing part of our clinical practice. A short course of behavioural intervention can be effective in treating this sometimes debilitating disorder.
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08:50-09:00
Percutaneous Tracheotomy in an Academic Teaching Centre - Chan Y, Black M, Korman M, Anderson J
Percutaneous tracheotomy (PT) provides an alternative approach to open surgical tracheotomy (ST). A number of advantages of PT have been described in the literature, including shorter procedure duration, fewer complications, elimination of the risks of patient transfer, reduction of operating room scheduling conflicts, and improvement of ICU utilization. These considerations are crucial in the delivery of optimal patient care given the current economic constraints of our health care system. This retrospective study will review the 8-year experience at our institution which includes over 150 cases performed using two different Ciaglia percutaneous tracheotomy systems. The current literature will be reviewed and a demonstration of the technique will be presented. Since patient selection is a key factor in avoiding complications, the specific selection criteria will be discussed. Patient demographic data, peri-operative and post-operative complications, as well as long-term follow-up will be reviewed as will be the clinical application of our findings.
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09:10-09:20
Midface Rejuvination: The Midface Suspension Technique - Ellis D, Brown D
Midface rejuvination is an important aspect of facial plastic surgery. Recently, a minimally invasive technique has been described to rejuvinate the midface. Midface suspension, a technique whereby percutaneous sutures are utilized to lift a ptotic cheek mound has been performed by our centre in 15 patients.
The technique will be reviewed and pre and post-treatment photodocumentation will be analyzed. Issues of post-operative recovery, morbidity and complications will be discussed.
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09:20-09:30
Trends in Management of Peritonsillar Abscesses - Tan A, Micomonaco D, KINGSTON
Peritonsillar abscess is one the most common deep head & neck infection. Controversies remain over the appropriate treatment regime and cost to the health care system. This study evaluates the management of peritonsillar abscesses by comparing the efficacy of needle aspiration (NA) vs. incision and drainage (ID).
Methods: A retrospective review of patients admitted to the Southeastern Ontario Health Care Center within the past 5 yrs (> 100 patients) with the diagnosis of peritonsillar abscess was conducted. Efficacy of NA and ID were measured based on time to discharge from the hospital. Diagnostic criteria, airway management, choice of antibiotics, supplemental surgical treatments and complications were studied. Criteria for outpatient management were reviewed.
Results: There is little or no difference in outcome between needle aspiration and incision and drainage. Similar findings are noted for the choices of antibiotics.
Conclusion: Needle aspiration is as effective as incision and drainage for the management of uncomplicated peritonsillar abscess. Patients appear to tolerate NA better than ID with less morbidity.
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09:30-09:40
Endoscopic Management of Zenker's Diverticuli - Janjua A, Black M, Fenton R
Endoscopic treatment of Zenker’s diverticuli offers an alternative approach to open surgical management. Its main advantages are a decrease in the associated morbidity, reduced anesthetic time, faster resumption of oral diet, and reduced hospital stay. These are important considerations as this disease entity mainly affects the frail and elderly.
This retrospective analysis will review our institution’s 20-year experience of more than 40 endoscopic cases performed by one surgeon. In addition, a video-endoscopic demonstration of this technique will be presented.
Patient demographics, peri-operative complication rates (including conversion rate to open procedures), and resultant functional outcomes will be evaluated. Comparison of these features with that of the established literature for the traditional open management will be performed. The clinical utility of this procedure is addressed based on this comparative analysis.
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09:40-09:50
Outcome and quality of life assessment after collagen augmentation of the vocal fold - Al-Rowaished A, Marsan J
OBJECTIVES : To report the short-term and long-term outcomes as well as the quality of life benefits of collagen augmentation of vocal fold for glottic insufficiency.
METHODS : A retrospective study of ten patients who underwent collagen augmentation of the vocal fold, between 1990 – 2002, was conducted. Those patients were followed during that period to assess their quality of life improvement as well as to evaluate the short-term and long-term outcomes
RESULTS: Most patients showed a favorable improvement of their glottic insufficiency symptoms without any complications. The duration of the benefit appears to persist in the long-term. For most patients the most important measure of success was the resultant voice.
CONCLUSION : Collagen injection is a valid option for improvement of phonation in patients presenting with glottic insufficiency. A successful injection may relieve breathiness, fatigue and stressful phonation and considerably improve volume . Results of treatment will depend on proper patients selection and technical precision of the injection site.
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