POLIQUIN XOMED MEDTRONIC RESIDENTS COMPETITION
ROOM 1, TELUS CONVENTION CENTRE
09:00 - 09:10
Lateral Neck X-ray vs. Direct Video Rhinoscopy in Asssing Adenoid Size - *Mlynarek, Alex, Mark Tewfik, John Manoukian, Melvin Schloss, Ted Tewfik, Jeanne Choi-Rosen, MONTREAL
Objective: To evaluate the usefulness of adynamic lateral neck x-rays and dynamic video rhinoscopy in assessing adenoid hypertrophy, and the severity of associated clinical symptoms.
Methods: Children with suspected adenoid hypertrophy underwent standard lateral soft-tissue neck x-rays: the adenoid/nasopharyngeal (A/N) ratio, airway/soft palate ratio, as well as adenoid thickness, were assessed by a radiologist. The percentage of airway closure was assessed by direct fibreoptic rhinoscopy in ENT clinic. The severity of symptoms was assessed by parents using a standardized questionnaire.
Results: Statistical analysis using Spearman’s correlation coefficients was performed on 28 patients. There was a weak, but significant, correlation between percentage of airway occlusion assessed by fibreoptic rhinoscopy and total symptom score (r=.382, p<0.05), as well as a weak correlation that approaches significance between airway occlusion assessed by rhinoscopy and A/N Ratio determined by lateral neck x-ray (r=.362, p=0.058). There was no correlation between any of the measurements taken by lateral soft-tissue neck x-ray and total symptom score.
Conclusion: Dynamic video rhinoscopy is more accurate at assessing adenoid hypertrophy, and percentage of airway occlusion as estimated by video rhinoscopy is better correlated to severity of symptoms than are values obtained from lateral neck x-rays.
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9.15 – 9.25
Pediatric Laryngeal Paralysis : A New Proposed Surgical Therapy - *Brian Rotenberg, Sam Daniel, Mohamed Abdolel,
Vito Forte, TORONTO
Objectives:
The cricothyroid muscle (CTM) has a separate innervation from that of intrinsic laryngeal muscles, and therefore its action may contribute to airflow resistance in children with a laryngeal paralysis (LP) secondary to recurrent laryngeal nerve (RLN) palsy. We proposed removal of the CTM as a means of indirectly widening the paralysed neonatal glottis.
Methods:
A prospective study was conducted using a piglet animal model to both simulate LP and evaluate the proposed treatment’s outcome. LP was induced via bilateral RLN sectioning in seven piglets. The CTMs were then removed. Animals acted as their own controls. Outcome measures consisted of serial inspiratory and expiratory airflow resistance measurements taken 1) with no intervention (NI), 2) after RLN sectioning and 3) after CTM removal. Several animals were awakened to asses their clinical responses to the interventions. The paired Student t-test was used for statistical analysis.
Results:
Inspiratory airflow resistance was significantly increased by RLN sectioning (p=0.0062) and then significantly decreased after subsequent CTM removal (p=0.0005). Clinical responses to the interventions mirrored the measured findings.
Conclusion:
Removal of the CTM significantly decreases inspiratory airway resistance in piglets with induced LP. This proposed surgical therapy for pediatric bilateral LP warrants further investigation.
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9.30 – 9.40
Early Operative Intervention Versus Conventional Treatment in Epistaxis : A Randomized Prospective Trial - *Ali Moshaver, Jeffrey Harris, Richard Liu, Chris Diamond, Hadi Seikaly, EDMONTON
Objective: Intranasal endoscopic sphenopalatine artery ligation (ESAL) has recently been described and promoted as an effective and cost saving method of recurrent epistaxis treatment. To date there are no studies that compare ESAL to conventional epistaxis treatment. This prospective randomized trial was designed to evaluate ESAL in the treatment of recurrent epistaxis.
Study design: Randomized prospective clinical trial
Methods: This study was approved by the University of Alberta IRB. Patients were recruited through the emergency room after they had failed conservative treatment. Patients were randomly assigned to surgical or non-surgical treatment. The length of hospital stay, rates of recurrence, cost of treatment, and patient satisfaction were compared.
Results: The surgical (ESAL) group had a statistically significant shorter hospital stay, fewer recurrences, higher patient satisfaction and a cost savings of $7800 per patient.
Conclusion: ESAL is an excellent and cost effective method in treating recurrent epistaxis.
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9.45 – 10.00
The Role of Allergy, Adenoids and Eustachian Tube in the Pathogenesis of Otitis Media with Effusion in Atopic Children -
* Lily Nguyen, John Manoukian, Steve Sobol, Melvin Schloss, MONTREAL
Background: Otitis media with effusion (OME) occurs in the setting of Eustachian tube (ET) dysfunction. Previous studies have demonstrated a predominance of Th2 mediators in the middle ear effusions (MEE) of atopic children, suggesting that allergy plays a role in the pathogenesis of OME. Given that the middle ear is contiguous with the upper airway, the ET and adenoids may also be involved in the pathophysiology of the allergic OME.
Objective: We hypothesize that atopic children have cellular and cytokine profiles in the MEE and in the adenoids that is different from non-atopic patients.
Methods: Twenty-six patients undergoing with ventilation tube placement for OME and adenoidectomy for adenoid hypertrophy were recruited. The atopic status was determined for each patient using standard skin testing. The cellular and cytokine profile of the MEE and the adenoid and torus tubaris tissue biopsies were obtained using immunocytochemistry, in-situ hybridization and real-time PCR.
Results: Preliminary results indicate that, within the atopic patient, there is a similar cellular and cytokine profile within the three regions sampled, with a predominant expression of Th2 cytokines and an increased infiltration of activated T-cells. These findings were not present in the non-atopic patient.
Conclusion: These findings confirm the concept of the united airway where the allergic process is continuous from the adenoids to the middle ear.
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10.15 – 10.30
The Use of intratympanic Dexamethasone in Meniere’s Disease - *Joshua Hornig, Richard Liu, EDMONTON
OBJECTIVE : To determine the efficacy of intratympanic dexamethasone infiltration in treating the symptoms of Meniere’s disease.
STUDY DESIGN : Prospective case series.
METHODS : Eight consecutive patients with intractable Meniere’s disease underwent a series of four intratympanic treatments with 10 mg/mL dexamethasone. Hearing results were assessed pre- and post-treatment by standard audiograms. Alleviation of vertigo in each case was evaluated by ratings on a disability scale and functional level scale before and after treatment. Similarly, a tinnitus handicap inventory was used to determine any change in this symptom.
RESULTS : 7 of 8 patients experienced significant improvement in vertigo according to ratings on the disability and functional level scales. Two patients required a second series of injections after experiencing recurrence of vertigo. Hearing was not worsened in any of the patients after treatment. Tinnitus remained unchanged in all eight patients.
CONCLUSIONS : Intratympanic dexamethasone is a safe alternative for the treatment of Meniere’s disease. Vertigo was improved in the majority of patients, although recurrences did occur. Hearing and tinnitus were unaffected.
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11.05 – 11.15
Outcome and Quality of Life Assessment After Type 1 Thyroplasty - *AbdulRahman, AL-Riwaished, Paul Odell, Pam Maser, OTTAWA
OBJECTIVES : To report the outcome and complications as well as the quality of life assessment after type 1 thyroplasty for unilateral vocal fold paralysis
METHODS : A retrospective study of twenty two patients who underwent type 1 thyroplasty for unilateral vocal fold paralysis, between 1995 – 2002, was conducted. Many of these patients had preoperative and postoperative evaluation by speech pathology. Those patients were followed during that period to assess their quality of life improvement as well as to evaluate them for outcome and complications.
RESULTS: Most patients showed a considerable improvement of their glottic insufficiency symptoms both subjectively and objectively with low rate of complications.
CONCLUSION : Type 1 thyroplasty remains a safe procedure with few major complications. Patient’s perception of glottic insufficiency caused by unilateral vocal fold paralysis improved significantly after type 1 thyroplasty.
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11.20 – 11.30
Functional, Quality of Life, and Facial Aesthetics Assessment of Different Approaches to the Parapharyngeal Space - *Aimee Mabini, Patrick Gullane, Jonathon Irish, Ralph Gilbert, Dale Brown, TORONTO
Objective : To examine the impact of surgical resections in the parapharyngeal space on facial esthetics, quality of life (AOL), and function. This study will compare the outcomes of two different surgical approaches, specifically, transcervical and midline mandibulotomy.
Design :Cross-sectional cohort descriptive study. A large tertiary-referral, academic otolaryngology department. Fifty long-term postoperative patients for the treatment of parapharyngeal space tumours.
Methods: (1)Observer-rated and patient-rated assessment of facial disfigurement using a disfigurement scale and analoque-scale questionnaire, respectively. (2) Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) as a measure of general quality of life. (3) The University of Washington Quality of Life questionnaire (UWQOL) to address issues unique to head and neck cancer patients. (4) House-Brackmann facial nerve grading system and measurement of trismus for assessing functional outcome.
Results: No significant difference was found between the two groups on the disfigurement and quality of life scales. Patients who underwent a transcervical approach were more likely to have facial nerve injury compared to patients who had a midline mandibulotomy approach.
Conclusions: Overall, there was no significant difference in morbidity between the two groups.
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11.35 – 11.45
High Resolution X-ray CT Scanning of the Human Stapes Footplate - *Abdulrahman Hagr, Robert Funnell, Anthony Zeitouni, Jamie Rappaprt, MONTREAL
Objectives:
The mechanical behaviour of the footplate and its annular ligament depends critically on their shape and orientation in the oval window, but their accurate measurements have been difficult to make due to their small size. Our aims are to visualize the footplate at high resolution and understand its dynamics.
Methods:
The human cadaver stapes footplate was dissected and very high resolution CT scans, with voxel sizes as small as 6 µm were performed. Locally developed software was used to reconstruct the images.
Results:
The data permit us to explore minor details in the shape and orientation of the footplate. The potential of finite-element modelling of the footplate and annular ligament will be demonstrated.
Conclusions’:
The results obtained lead to further insight into the functional morphology of the footplate and annular ligament. The implications for disease processes near the footplate (such as otosclerosis) and for prosthesis design will be discussed.
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11.50 – 12.00
Systematic Review of Intratympanic Gentamicin in the Treatment of Meniere’s Disease - *Chris Diamond, Joshua Hornig, Richard Liu, EDMONTON
Background
Intratympanic gentamicin has been hypothesized to effectively treat Meniere's disease, although a summary of best available evidence on the effectiveness of this treatment has not been conducted.
Objectives
Perform a systematic review of the best available evidence for intratympanic gentamicin in the treatment of patients with Meniere's disease.
Methods
Comprehensive electronic searches were conducted on the databases of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. All generated titles were reviewed and potentially relevent articles assessed for inclusion. The best available evidence on outcomes following intratympanic gentamicin treatment was considered. No studies used appropriate comparison groups in the analysis. All outcome measures conformed to American Academy of Otolaryngology Head and Neck Surgery Criteria for Evaluation of Therapy for Meniere's Disease.
Results
Pooled results on improvement of vertigo, tinnitus, and change in hearing will be presented.
Conclusions
Intratympanic gentamicin treatment appears to be safe and relatively effective for the control of the symptoms of Meniere's disease. However, the current best level of evidence for this intervention is descriptive case series with unstandardized protocols and likely biased results. There is a significant need for a prospective randomized clinical trial of intratympanic gentamicin in the treatment of Meniere's disease.
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12.05 – 12.15
Postoperative Parathyroid Hormone Level as a Predictor of Post-Thyroidectomy Hypocalcemia - *Richard Payne, Michael Hier, Martin Black, Michael Tamilia, MONTREAL
Objectives: To evaluate levels of parathyroid hormone after total thyroidectomy surgery in order to ascertain its ability at predicting hypocalcemia.
Methods: This is a prospective study in which parathyroid hormone level is tested in patients who have undergone total thyroidectomy. Levels are measured postoperatively at 12 and 20 hours. Corrected calcium is also measured at 6, 12 and 20 hours as per the preexisting protocol.
Results: The study began in October of 2002 and preliminary data suggests that PTH is an accurate predictor of the tendency of the serum calcium. It is estimated that by March 2003 the number of patients enrolled in the study will surpass 100. The data will be interpreted for statistical significance.
Conclusions: If the data proves that PTH alone or in conjunction with corrected calcium values can predict the calcium trend; then patients will spend less time in the hospital after total thyroidectomy surgery.
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13.30 – 13.40
A Randomized Control Study of Consent Presentation in Otology : Effects on Recall of Adding Written Take Home Sheet to Verbal Presentation - *Tim Brown, Manohar Bance, Emad Massoud, HALIFAX
ABSTRACT - TBA
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13.45 – 13.55
A Magnetoecephalogram Study of Native Deaf Signing Children : Relationships Between Visual Communications and Auditory Neural Networks - *Vincent Lincent, Sam Daniel, Blake Papsin, Robert Harrison, TORONTO
Language processing in hearing non-signing individuals is prominently left-sided and this has been confirmed with neuroimaging studies such as PET and fMRI. The same imaging modalities have also recently demonstrated similar cortical activation of left-sided language centers in native deaf signing individuals. Furthermore, these native deaf signing individuals, unlike hearing non-signing individuals also strongly activated right sided cortical centers responsible mainly for visual-spatial function. We performed magnetoencephalography (MEG) studies with magnetic resonance imaging for anatomical correlation on five native deaf signing children as well as five hearing non-signing control subjects. Participants were asked to view a series of video clips in which short sequences of signing were shown. We will be demonstrating all of the cortical regions of activation, signal intensities, and temporal relationships between the activated cortical regions. These results will be used to postulate on the auditory neural networks in native deaf signing children.
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14.00 – 14.10
Functional Outcomes after Primary Mandibular Resection and Reconstruction With the Fibular Osteocutaneous Free Flap - * Maharaj Mitra, Jana Reiger, Jeffery Harris, John Wolfaardt, Hadi Seikaly, EDMONTON
Objective:To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as swallowing data in patients reconstructed with fibular osteocutaneous free flaps for mandibular resections.
Methods: Acoustical, aeromechanical, perceptual speech data, and swallowing data were gathered at three evaluation times (pre-operatively, pre-radiation therapy, and post-radiation therapy) for patients treated for oral cancer via mandibular resection and reconstruction with a fibular osteocutaneous free flap. The degree of involvement of the tongue, FOM, mandible, and reconstructive techniques were entered as between group factors in the analysis.
Results: 22 patients were included in the study. All patients were able to resume a normal diet. There were no significant differences in speech intelligibility between the patient groups based on degree of FOM or mandible resected. There was speech intelligibility difference between the patient groups based on degree of tongue resected.
Conclusions:Fibular osteocutaneous free flaps are a good functional reconstructive option after mandibulectomy for oral cancer
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14.15 – 14.25
The Effects of Recombinant BMP-7 in Distraction Osteoneogenesis of the Rabbit Mandible - *Kristina Zakhary, Lucy Lesard, Reggie Hamdy, Dimitri Moutakis, MONTREAL
ABSTRACT TBA
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14.30 – 14.45
Sodium Thiosulphate as a Chemoprotective Agent for Cis-platin Toxicity - *Norbert Viallet, Brian Blakely, Asher Begleiter,
Marsha Leith, WINNIPEG
Objectives : To study the effect of Cis-platin (CDDP) on FADU human squamous cell carcinoma cells. To study if Sodium Thiosulfate(STS), an agent protective against CDDP ototoxicity, effects the tumorcidal activity of CDDP.
Method : FADU tumor cells were grown in culture. Cells were exposed to varying concentrations of CDDP with and without concomitant STS. MTT assays were then performed to determine the effect of treatment on FADU cell growth.
Results : Dose response curves were generated for the FADU cells exposed to CDDP with and without concomitant STS. Concomitant STS was found to inhibit the tumorcidal activity of CDDP in vitro.
Conclusions : Simultaneous administration of STS to in vitro culture of FADU tumor cells leads to inhibition of CDDP’s tumorcidal activity.
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15.10 – 15.20
Prospective Study of Peri-operative Fluid Management in Free Flap Surgery of the Head and Neck. - *Jason Franklin, John Yoo, Thomas Matthews, Douglas Ross, Howard Lampe, LONDON
ABSTRACT TBA
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15.30 – 15.40
Use of Reovirus as Irrigation Solution for Squamous Cell Cancer Contaminated Wounds in a SCID Mouse Model - *James Brooks, Hadi Seikaly, Ron Moore, Thomas Lim, EDMONTON
ABSTRACT TBA
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15.45 – 15.55
Functional Outcomes After Primary Tongue Cancer Resection and Reconstruction With the Radial Forearm Free Flap - *Trina Uwierar, Hadi Seikaly, Jana Riger, EDMONTON
Objective: To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as swallowing data in patients reconstructed with fibular osteocutaneous free flaps for mandibular resections.
Methods: Acoustical, aeromechanical, perceptual speech data, and swallowing data were gathered at three evaluation times (pre-operatively, pre-radiation therapy, and post-radiation therapy) for patients treated for oral cancer via mandibular resection and reconstruction with a fibular osteocutaneous free flap. The degree of involvement of the tongue, FOM, mandible, and reconstructive techniques were entered as between group factors in the analysis.
Results: 22 patients were included in the study. All patients were able to resume a normal diet. There were no significant differences in speech intelligibility between the patient groups based on degree of FOM or mandible resected. There was speech intelligibility difference between the patient groups based on degree of tongue resected.
Conclusions: Fibular osteocutaneous free flaps are a good functional reconstructive option after mandibulectomy for oral cancer
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16.00 – 16.10
Colorimetric Evaluation of Facial Skin and Free Flap Donor Sites in Various Ethnic Populations - *Kenny Ngo, Ralph Gilbert, Peter Neligan, David Goldstein, TORONTO
ABSTRACT TBA
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16.15 – 16.25
A Comparison Microvascular End to End versus Side to Side Venous Anastomosis in the Rat Groin Free Flap Model - *Khalid Ansari, Jeff Harris, Hadi Seikaly, EDMONTON
ABSTRACT TBA
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