Day 3 :
- Anesthesia in Ear, Nose and Throat Surgery
Cincinnati Children's Hospital Medical Center, USA.
Dr. John Greinwald is a tenured professor of Otolaryngology and Pediatrics with over 20 years of experience with a focus on the genetic causes and treatment of deafness. Dr. Greinwald co-founded the Ear and Hearing Center at Cincinnati Children’s Hospital Medical Center. He has pioneered the establishment of diagnostic evaluation algorithms for children with sensorineural hearing loss and developed a next generation sequencing platform to determine the genetic causes of hearing loss in children.
He has 81 peer review articles published with the majority related to hearing loss. His research interests concentrate on identifying novel causes of genetic diseases, mitigating barriers to genetic counseling in underserved populations, developing innovative methods of providing complex genetic information to patients and physicians and helped pioneer minimal access cochlear implant surgery. Clinically, he is the Medical Director of the Cochlear Implant Team and faculty in the Auditory Genetics Laboratory of the Ear and Hearing Center.
Dr. Greinwald received his undergraduate B.S. degree from Wofford College and his M.D. degree from the Medical University of South Carolina. His Otolaryngology training was at the Naval Medical Center Portsmouth Virginia and his pediatric otolaryngology fellowship at the University of Iowa. He is board certified in Otolaryngology Head and Neck Surgery
Objective: To determine the diagnostic utility of various tests and treatment option for pediatric patients presenting with a unilateral sensorineural hearing loss (SNHL)
Study Design: Retrospective chart review, uncontrolled case series
Setting: Tertiary academic center; Pediatric Hospital
Subjects: Pediatric patients (<18 years old) evaluated for unilateral SNHL
Methods: Upon IRB approval patients with single sided SNHL were identified using an internal database. Audiologic data, genetic testing, imaging results and pertinent clinical information were analyzed to determine the most efficacious method of evaluating these patients.
Results: 407 patients were identified with average age (SD) of 87.4 months (53.9). 233 patients were males (53%). 37 patients had high frequency (HF) SNHL alone, 51 patients with normal HF PTA (abnormal low frequency PTA) and 319 with a flat audiometric configuration. Hearing loss was more common on the left side and in males. More than 50% of patients had mild to moderate SNHL. GJB2 was a rarely seen (0.7%), while mutations in the SLC26A4 gene were seen in 18% of patients. Enlarged vestibular aqueduct (EVA) was found in 17% of patients. In patients with unilateral EVA, 19% had contralateral ear involvement. Overall, 19% of patients developed bilateral hearing loss. Treatments varied from observation, traditional hearing aids, CROS hearing aids and cochlear implantation. Seven patients with single sided deafness were implanted. All patients continue wearing their implants and getting appropriate aided benefit with speech reception thresholds at 30dB or better with a minimum of 2 years of follow up.
Conclusion: USNHL is a relatively common problem affecting children. In our population, progression occurred relatively frequently. Temporal bone anomalies such as EVA, were common. Cochlear nerve deficiencies are also demonstrated in our study and are best demonstrated on MRI. Pendred syndrome and DFNB1 are rare. Based on our data, an algorithm for children with USNHL shows that imaging should be the primary diagnostic study. Magnetic resonance imaging may be the best imaging modality due to its ability to diagnose deficient cochlear nerves in addition to common temporal bone anomalies. Treatment should be individualized based on the medical needs of the child. Cochlear implantation is now an option for patients with single sided deafness.
Louisiana State University, USA.
Dr. Knowles completed a Pathology residency from 1991-1996 then completed a cytopathology fellowship from 1996-1997. He was in private practice from 1997 to 2015 but has recently transitioned from 18 years in private practice in pathology and returned to the medical center practice of pathology at Louisiana State Health Science Center in Shreveport LA. His responsibilities include teaching medical students and pathology residents, and pathology to internal medicine residents. His subspecialty sign-out responsibilities include cytopathology, gastrointestinal pathology and head and neck pathology. The faculty at LSU are engaged in numerous research activities covering many areas of clinical and academic medicine. The article presented at this meeting combines gastroenterology pathology; head and neck pathology with implications for developmental pediatrics, OB-Gyn, anesthesia and embryology.
Oral foregut duplication cysts are extremely rare lesions with approximately 57 cases reported. They are congenital cysts, located in the anterior or ventral tongue, and occur predominantly in males. They are lined by one or more types of epithelia which is limited to gastric, intestinal or respiratory epithelium. The differential diagnosis includes lymphangioma, hemangioma, ranula, epidermoid cyst, teratoma and less likely a malignant process. They are congenital and if present at birth or early infancy, and they can cause difficulties in feeding, swallowing, speech, and airway obstruction. If discovered in utero and suspected to be large enough, they may also cause respiratory distress and optimal patient care would dictate that ENT be present at delivery. Even a small lesion if left untreated may cause speech difficulties in toddlers so definitive treatment is required.
What is fascinating about oral foregut duplication cysts is the possible histogenesis. They are always comprised of one or more upper GI and/or respiratory tissues. This trapped primitive tissue, apparently removed from its normal milieu, still has the capability to differentiate into gastric, intestinal or respiratory tissue, singly or in combinations of epithelia as was this case. This suggests that the trapped cells are preprogrammed to differentiate along certain possible cell lines but are influenced by some unknown local or distant environmental factors.
University of Tennessee Health Science Center, USA.
Dr. Jerome Thompson is an ENT-otolaryngologist in Memphis, Tennessee and is affiliated with multiple hospitals in the area, including Baptist Memorial Hospital-Memphis and Memphis Veterans Affairs Medical Center. He received his medical degree from David Geffen School of Medicine at UCLA and has been in practice for more than 20 years. Dr. Thompson accepts several types of health insurance, listed below. He is one of 35 doctors at Baptist Memorial Hospital-Memphis and one of 5 at Memphis Veterans Affairs Medical Center who specialize in Otolaryngology.
Prior to the 1980s, births of fetuses with congenital abnormalities causing airway obstruction had mortality rates approaching 40%. Anoxic brain injury results if the airway is not secured within 5 minutes following termination of maternal-fetal circulation. The advent of the EXIT (ex utero intrapartum therapy) procedure allowed surgeons to operate on a partially delivered fetus, still connected to maternal circulation. This significantly extending the time allowed to secure the airway. It is particularly useful in cases of Congenital High Airway Obstruction Syndrome or CHAOS. Pediatric otolaryngologists have used the EXIT since 1994. It remains an infrequently performed operation, with even the largest academic pediatric hospitals averaging approximately only 5 procedures per year. It is now part of the armamentarium of pediatric and cardiovascular surgeons. In this article, we share our 9 most interesting experiences with the EXIT procedure, and what we have learned from each case.
Jordan University of Science and Technology, Jordan
Assistant professor at Jordan University of Science and Technology, Otolaryngologist at King Abdullah University Hospital. After finishing medical degree, joined residency program in otolaryngology. Got my fellowship degree in otology and skull base surgery from Italy.
After returning to Jordan joined teaching of medical students and ENT residents in JUST/KAUH. I am otolaryngologist mainly interested in otology. I am trained to do otologic surgeries mainly concentrating on cochlear implants and prosthetic ear implants. I have published a number of articles in highly ranked medical journals.
Microtia is a congenital malformation of variable severity of the external ear affecting external ear (with or without middle ear) components shape and position. This deformity affects 3 of every 10,000 live births. In 10% of cases could be bilateral.
Microtia may present within a spectrum of branchial arch defects (hemifacial microsomia, craniofacial microsomia) or may manifest as an independent malformation.
Hearing loss and cosmetic discomfort may affect child scholastic performance and leads to social withdrawal.
Reconstruction of shape and hearing acuity is a challenge even for experienced surgeons. The prosthetic ear is aesthetically pleasing, composed of natural looking anatomical contours, shape, and texture along with good color that blends with surrounding existing skin. Bone anchoring hearing aids (BAHA) is one of the most affective hearing solutions. Combining of the BAHA implant and prosthetic ear attached by titanium screws may give both functional and psychological relief for both child and parents. These outcomes can be optimized by the integration of digital technologies in the construction process. CT scan images in cases of uni or bilateral cases can be processed in special software to give a mirror image of the present contralateral ear or ideal position for implant insertion in bilateral cases. Giving clear idea about bone quality and best insertion site of vistafix prosthetic ear and BAHA implants.
Using specialized 3D printers can give us ideal shaped prosthetic ear which can be colored according to patient specific skin color providing a base for reproducible results regardless of operator.
This modality of treatment can give us pleasant safe solution for function and cosmetic appearance.
- Phoniatry and Obstructive sleep apnea(OSA)
ENT Department – Senigallia, Italy
Head of Sleep Apnea Center and Rhinology/Rhino-Allergology Center - Otolaryngology Dept. ASUR Marche – AV2 – Senigallia – Italy. International faculty member of the XXXV Pan-American Congress of Otorhinolaryngology 2016, Cuba. Past Director of the 1st International Conference on Rhinology and Rhino-Allergology / 5th Bulgarian Italian Rhinology Meeting, 2016 Senigallia (Italy). Committee Member and Chairman of the International Specialists Conference on Ear, Nose and Throat Disorders, November 2016 Alicante (Spain). In the past: University Professor at the UNIVPM – Ancona – Italy.
International faculty member of the VI Bulgarian Italian Meeting of Rhinology. Dr. Bucci attended medical school at Catholic University (UCSC) in Rome, and completed his residency in Otolaryngology-Head and Neck Surgery at UCSC - Gemelli Hospital in Rome. Reserve Medical Officer of the Italian Navy. Consultant in Otolaryngology from 2002. PhD (Rhinology and Rhino-Allergology) in 2006 at UCSC - Rome. Fellowship in Otolaryngology in Spain (University Hospital, Cadiz). Fellowship trained in Facial Plastic Surgery (AMC) and OSAS (Sint Lucas Andreas Hospital) in Amsterdam, The Netherlands, in Facial Plastic Surgery (Calixto Garcia University Hospital), La Habana, Cuba. Research focused on Rhinology/RhinoAllergology, Sleep Apnea/OSAS, and dysphagia/swallowing disorders. Teaching, management and audit experienced. His other main interest is in humanitarian and international outreach. He is Vice-president of the ONLUS association: “ANATRA.it” (National Association of Tracheotomised patients). Member of the ERS (European Rhinologic Society).
Obstructive sleep apnea (OSA) is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. Airway obstruction in OSA may occur at many levels. Surgical procedures are inherently directed at specific regions of the upper airway. Traditionally, upper airway examination is performed while the patient is awake. Nasofibrolaryngoscopy under induced sleep is a promising alternative for identifying sites of upper airway obstruction in patients with OSA. The purpose of this study was to systematically review the evidence regarding the usefulness of Drug Induced Sleep Endoscopy (DISE) compared with that of traditional awake examination for surgical decision-making in patients with OSAS. This review emphasizes the direct impact of DISE compared with that of awake examination on surgical decision-making in OSA patients.
Materials and methods. We performed a systematic review of studies using DISE to identify obstruction sites and patterns of obstruction in patients with OSA. Only studies with a primary objective of evaluating the usefulness of DISE for surgical decision-making and the importance of identifying multilevel obstruction were selected. Then a retrospective chart review of OSAS patients who underwent DISE at our Centre for Diagnosis and Treatment of Respiratory Sleep Disorders, as part of their surgical evaluation, were reviewed. According to others authors we found that palatal obstruction was the most frequently observed site of obstruction, followed by tongue base obstruction, laryngeal obstruction and hypopharyngeal obstruction.
Conclusion. Although consensus has been reached on several aspects of the DISE procedure some topics remain open to future research. DISE is an additional method to reveal obstruction sites that have not been detected in awake patients. DISE is mandatory in the diagnostic work-up of OSA and is a valid addition when surgery is considered. Anyway, larger detailed analyses are needed to determine the importance of each site and degree of obstruction seen on DISE.
- poster presentations
Gwangju Veterans Hospital, South Korea.
Objective: 1) To categorize and analyze applicant responses to a supplemental question used during the applicant selection process. 2) To assess the incidence of leadership training as an element in applicant response over three match cycles
Study Design: Qualitative retrospective review of applicant responses to a supplemental question during the 2012, 2013, and 2014 match cycles. Setting: Academic otolaryngology residency training program.
Subjects and Methods: Responses to a supplemental question were analyzed and specific elements were categorized. Frequency of each reason was assessed by match cycle and gender. Chi square test was performed on proportion of responses containing leadership related elements by year and gender. Statistical significance was defined as p-value <0.05.
Results: Of the 592 responses that were analyzed, 394 were males and 194 were females. 3 applicants' gender could not be identified with available ERAS data. The most often cited reasons for applying were research opportunities (69%), education and training (57%), leadership program (48%), comprehensiveness of subspecialties (36%), reputation (25%), and location (17%). There was a statistically significant difference in the proportion of leadership program in each of the three years (p≤0.01).
Conclusions: We describe the use of a supplemental application question during the residency match cycle designed to help select applicants for interview that would best “fit” with our program focused on leadership. We hope this will stimulate consideration of how to improve the “fit” of applicants to otolaryngology residency programs.
Kuwait University, Kuwait
Academic position: Assistance Professor of Audiology in the Department of Hearing and Speech Sciences, Health Science Center (HSC), Faculty of the Allied Health Sciences, Kuwait university. Audiology Program Coordinator.Degree Holding: B.Sc. Audiology, M.Sc. Clinical Audiology, Ph.D. Academic Doctorates of Audiology Member of Audiology Society of Australia (MASA) Certificate of Clinical-Competence (CCC-A) -Audiology Clinical work: Pediatric Audiology Consultant
Research interest: Pediatric Audiology, Educational Audiology, auditory physiology and electrophysiology (objective measures in infant and young children) , Hearing in children with cancer, Cochlear Implantation in Auditory Neuropathy Spectrum Disorder, Clinical Audiology, Cortical auditory evoked potential in infants and young children, hearing screening (newborn and school aged children) and cochlear implant in pediatric population.
Objective: Voice onset time (VOT) is an important parameter of speech that denotes the time interval between consonant onset and the onset of low frequency periodicity generated. In this study we examined the temporal encoding of voice onset time in the cortical auditory evoked response (CAEP) of young children.
Methods: Scalp recoded CAEP were measured in 18 children aged from 5-8 participated (n=18). The N2 latency was evoked using differences in voice-onset-times (VOTs) using stop consonant-vowel syllables /ga/-/ka/.
Results: A significant and systematic shift in the N2 latency was observed for differences in VOT.
Conclusions: Our results demonstrate that temporal encoding of VOT exists in the developing cortical evoked response.