Day 1 :
Director Johns Hopkins voice Center USA
Time : 9:30-9:10
Dr. Lee Akst is head of the Johns Hopkins Voice Center and is Director of the Division of Laryngology at the Johns Hopkins University Department of Otolaryngology-Head and Neck Surgery. The focus of his clinical practice is on management of voice disorders, with focus on office-based treatments and operative management of epithelial diseases such as vocal cord leukoplakia, papilloma, and early glottis cancer. He has lectured extensively on phonosurgical techniques, treatment of laryngeal leukoplakia, laryngopharyngeal reflux, and globus pharyngeus. He has been working with engineers at Johns Hopkins on novel robotic platforms to bringing robotic surgery into the endolarynx to aid microlaryngeal operative precision. Dr. Akst received his undergraduate and medical degrees from Yale University, did his Otolaryngology residency at the Cleveland Clinic, and completed his laryngology fellowship at Massachusetts General Hospital.
This presentation will comprehensively review evaluation and management of laryngeal leukoplakia. Though white vocal fold lesions are common, management remains challenging; doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia through scar. I will present a framework for management of leukoplakia which balances oncologic with functional outcomes with the goal of achieving disease control without creating scar. State-of-the-art advances in care of leukoplakia will be emphasized and surgical techniques discussed will include role of infusion, use of the KTP laser and microflap resection of diseased epithelium. Advanced use of the KTP laser for office treatment of laryngeal dysplasia, an important part of my own practice and something which is only available in a limited number of centers worldwide will be discussed as well, to include appropriate anesthesia techniques for office-based procedures. Epidemiology of leukoplakia, rates of progression to malignancy and role of office-based biopsy will be reviewed. Though focus will be on KTP laser strategies as these represent cutting edge approached to management of this disease, I will also discuss cold instrument and CO2 laser techniques so that the audience, regardless of the tools available to them in their own practices, will be able to transition techniques learned in this presentation to care of their own patients. Approaches to anterior commissure involvement, bilateral disease and multiply recurrent dysplasia will be discussed through case presentations which should increase audience interest.
Professor Johns Hopkins Hospital USA
Keynote: Static and dynamic application of Multi‐Planar Reconstructed (MPR) and 3D CT images to improve image guidance for FESS, based on lamellae landmarks
Time : 10:00-10:30
1984: One of the pioneers in introducing 3D imaging in Neuroradiology.
1985: Replaced X-ray poly-tomography with CT for the evaluation of the nasal cavity and paranasal sinuses. Established the CT evaluation parameters, and described the imaging anatomy and pathology of this morphologic area.
1989: Introduced IGS in the USA using a mechanical sensor technology.
1991: First to use optical sensors in IGS and applied in FESS and Neurosurgical procedures.
1992: Advised the emergent VTI team in the application of electromagnetic sensors for IG-FESS procedures.
To date have authored/co-authored over 150 publications.
Author of 7 patents.
Author of 5 textbooks.
Serves as a reviewer for several journals.
Member of several national and international societies.
Associate Professor Duke University United States
Time : 10:30-11:00
Coblation technology has been used in adult and pediatric adenotonsillectomy since it was introduced in 2001. Since then this device has been used in numerous head and neck procedures including nasal polypectomy, epistaxis management, lingual tonsillectomy, removal or debulking of lymphovascular or venous malformations, removal of suprastomal granulation tissue and laryngeal surgery. Coblation technology uses plasma generation that dissolves hydrogen bonds in tissue, resulting in volume reduction and lower thermal spread to surrounding structures than electrocautery techniques. Literature review of techniques and indications will be supplemented with specific case presentations.
Professor Bangabandhu Sheikh Mujib Medical University (BSMMU)
Keynote: Role of bilateral selective neck dissection in surgical management of advance laryngeal carcinoma with N0 neck
Time : 11:50-12:20
Belayat Hossain Siddiquee is a Pioneer Head Neck Surgeon in Bangladesh. He started career as Head Neck Surgeons in 1992 after obtaining Fellowship in ORLHNS from Bangladesh . He is first person posted as Professor of Head-Neck Surgery in the University Hospital of the country. He is Founder chief of HNS Division,BSMMU, Founder president, Bangladesh Society of HN Surgeons, Governing Council Member, Asian Society Head-Neck Oncology (ASHNO), Councilor, IFHNOS, Country Coordinator, World Head-Neck Cancer Day and Editorial Board Member, Springer journal “Oral Cancer”. He is working to improve skill of HN Surgeon’s of his country to global level, make facilities for HN Surgery accessible to common people.
Advance laryngeal carcinoma with N0 neck is a condition where controversies about surgical management are still present. Clearance of the echelon groups of cervical lymph nodes in clinically and radiologically negative neck during surgery for laryngeal primary has got a positive impact on prognosis. We have treated 114 such cases over thirteen years (2001-2013). Fifty five (55) were glottic and 59 supraglottic carcinoma. Surgery was done both in primary and irradiated cases: Primary modality in 53 cases (Glottic-23 and Supraglottic-30) and 61 irradiated cases (Glottic-32 and Supraglottic-29). Two types of surgery offered were (1) Total Laryngectomy, (2) Total Laryngectomy+Bilateral Selective Neck Dissection of Level-II, III, IV lymph nodes (Bil.SND). Total laryngectomy was done in 41 cases (Glottic-20 and Supraglottic-21), Total Laryngectomy+Bil.SND in 73 cases (Glottic-35 and Supraglottic-38). Postoperative adjuvant radiotherapy was given according to demand of the postoperative histopathology. 97.37% (111 patients) were followed up for >2 years, 74.35% (85 cases) >3 years and 45.61% (52 cases) for >5 years. Recurrence detected in 15 cases of Glottic carcinoma, Laryngectomy group-11 (55%) and Laryngectomy+Bil.SND-04 cases (11.43%; p=0.001). In supraglottic carcinoma recurrence found in 20 cases, Laryngectomy group-11 (52.38%) and Laryngectomy+Bil.SND-09 cases (23, 68%; p=0.026). Most of the recurrence (68.18%) occurs in the neck if not addressed properly during surgery. Prophylactic Bilateral SND in advance carcinoma of the larynx with N0 neck has significant influence in reducing recurrence.
Department of Plastic & Reconstructive Surgery, Rambam Healthcare Campus, Haifa, Israel
Time : 11:20-11:50
Doubts are commonly cast over the safety of the single-stage augmentation mastopexy procedure. Currently, the literature is sparse. Applying the “Lejour” technique for augmentation mastopexy has provided excellent aesthetic results and significantly reduced complications. Hereby presented is this easy to learn reproducible technique, allowing one to perform both procedures together safely. To the best of our knowledge, this is the first description written in the English literature.
- Tissue Expansion
Researcher of the Scientific Research Institute for Pediatric Surgery at the Pirogov Russian National Research Medical University
Title: Application of skin stretching technique for closure of large surface skin defects in children
Time : 14:30-14:50
Maria Shcherbakova has completed First Moscow National Medical University and postgraduate education from Pirogov Russian National Research Medical University. She is the doctor in the Speransky Children's Hospital, researcher of the Scientific Research Institute for Pediatric Surgery at the Pirogov Russian National Research Medical University. She specialised in a plastic and reconstructive surgery of children with postburn trauma.
- Anesthesia and Pain Relief in ENT Surgery
Harvard Medical School, USA
Time : 16:20-16:40
Dr. Sassan Sabouri, an instructor at Harvard Medical School, is a graduate from medical school in Shahid Beheshti Medical University (SBMU) in Tehran, Iran. First, he finished his anesthesiology residency in SBMU. He has gained his major experience by practicing anesthesia in different cities across Iran for 10 years. In 2006, he started his residency in General Surgery in Temple University in Johnstown PA and then Anesthesiology Residency in New York State University at Buffalo NY, where he became one of the chief residents. After graduation from residency he became one of the staff at the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital (MGH), MA. His clinical innovations are primarily focused on regional anesthesia. Collaboratively, he started General Surgery Regional Service in MGH in May 2012. He has had multiple abstracts and presentations in the USA as well as internationally in Iran and India.
In recent years, there have been many advances using ultrasound to visualize the airway and related structures (1). Airway regional techniques are essentially used for providing airway anesthesia for awake direct laryngoscopy or fibro-optic intubation.
The three major neural supply to the airway are: Trigeminal, Glossopharyngeal and Vagus (Image). Blocking these individual nerves usually provide more profound anesthesia than simple local anesthetic (LA) topicalization and will reduce the total dose.
Objective of this presentation is to discuss some of the techniques of blocking the nerves of the airway and whether using ultrasound as a nerve localization method can be helpful.
Glossopharyngeal nerve innervates the oropharynx, soft palate, posterior portion of the tongue and the pharyngeal surface of the epiglottis. Block on this nerve will provide an anesthetize passage for endotracheal tube (ETT) as well as abolishes the gag reflex. This nerve can be anesthetized using either intraoral or extraoral approaches. USG for the extraoral has been described for patients with chronic pain (2). However it can be easily blocked as it crosses the palatoglossal arch.
Superior Laryngeal Nerve provides sensation to the base of the tongue, posterior surface of the epiglottis, aryepiglottic fold and the arytenoids. Block of this nerve has been used as a sole technique for intubation and can be done at the level of the thyrohyoid membrane inferior to the cornu of the hyoid bone. USG is useful especially when finding landmarks become difficult (3,4).
Recurrent Laryngeal Nerve, which provides sensory innervation to the vocal folds and the trachea, can be easily blocked by the transtracheal block. US has been useful in finding landmarks to perform this block (5). Block of this nerve can prevent coughing and bucking in reaction to presence of the ETT.
Nasal passage is anesthetized by blocking the palatine and ant. ethmoidal nerves.
- Head, Neck and Oral Oncology
Assistant Professor West Virginia University USA
Time : 13:50-14:10
Jeffson Chung is the Head and Neck Oncologic Surgeon with an appointment of Assistant Professor at West Virginia University, USA. He has research interests in head and neck cancer treatment outcomes, functional outcomes, technology in the ENT practice and telemedicine.
Statement of the Problem: The increasing incidence of HPV associated oropharyngeal cancer has sparked interest in minimally invasive transoral surgery as a primary treatment modality. However, proper surgical exposure and access to the tongue base is difficult to achieve. Many complex oral retraction systems have been developed in attempt to solve this problem but none work consistently or efficiently.
Methodology: This cadaveric study introduces the floor of mouth window: A simple adjunctive procedure done at the time of transoral resection and concurrent neck dissection that greatly improves surgical access to the tongue base while eliminating the need for oral retractors. It involves passing the oral tongue through the floor of mouth into the neck dissection field, thereby creating space for robotic or laser instruments to perform cancer resection. The floor of mouth is closed primarily in layers at the end of the procedure.
Findings: This study compares the tongue base exposure achievable with existing oral retractors to that achievable utilizing this novel technique. Our finding is that superior surgical exposure is attainable without retractors using the floor of mouth window.
Conclusion & Significance: We believe this technique may have a major impact on the management of oropharyngeal cancers because having a simple, reproducible method to access the tongue base will encourage greater adoption of transoral surgery as a treatment modality. It is a technique that can be helpful regardless of any future advances in robot or laser technology. Furthermore, this technique reduces the reliance on multiple complicated and expensive retraction systems. Finally, the improved exposure and visualization of the tongue base attainable by this new procedure may facilitate clear surgical margins and thus maximize the potential for cure, which is ultimately the objective of all head and neck surgeons.
- Hearing Impairment- Causes and Treatment
Huseyin Isildak is an Otologist/Neurotologist in Penn State Hershey Medical Center. He also serves as the Director of Otology/Neurotology and Cochlear Implant Program in the center since 2013. He has his expertise in in hearing and balance disorders. His research interests are Meniere disease and implantable hearing implants. Besides being an Ear and Skull Base Surgeon, he is strongly interested in conducting to research and teaching. He has over 40 peer-reviewed scientific publications and a number of book chapters. He is currently in the Editorial Boards of prestigious journals such as Operative Techniques in Otolaryngology-Head and Neck Surgery and BMC cancer.
Objective: To evaluate current trends in managing Meniere's disease (MD) by both general otolaryngologists and otologists/neurotologists and discuss treatment modalities.
Study Design: Cross-sectional study.
Setting: Survey of physicians.
Subjects & Methods: An electronic questionnaire was disseminated to all members of AAO-HNS.
Results: Eight hundred and sixty (860) members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Thirty-nine percent (39%) of respondents believe that diet and life style changes are effective in controlling symptoms in more than 50% of their MD patients. Overall, 72.8% of respondents used hydrochlorothiazide/triamterene (HCTZ/TAT) often or always with neurotologists using HCTZ/TAT more often than generalists (P<0.001). Half of neurotologists used IT steroids often or always, compared to only 10% of generalists (P<0.001). Endolymphatic sac procedures are the most common surgeries and are used more often by neurotologists than by generalists (P<0.001). The Medtronic Meniett device is used more by neurotologists (P<0.001) but it is not commonly used overall (69.2% never use).
Conclusion: Many options are available for the treatment of MD. Neurotologists tend to use a wider variety of medications in their treatment protocols than generalists. Neurotologists tend to perform surgical interventions more frequently than generalists. Our evidence shows significant heterogeneity for treatment of Meniere's disease among otolaryngologists. A guideline that outlines appropriate therapeutic options, dosing and treatment escalation is warranted.
Consultation oto-neurologie Clinique ORL CHU GRENOBLE, France
Title: The skull vibration induced nystagmus test (SVINT): Clinical benefit in unilateral vestibular lesions and anterior canal dehiscence diagnosis
Time : 13:30-13:50
MD.PhD In the ENT Department CHU Michallon,Grenoble- and living in Briançon and Meylan – France
Vocationnal training: Resident in 1974; Senior Registrar ENT – CHU Michallon Grenoble in 1978
Thesis–Doctorate in Medecine : 1980 : Kanamycin transplacentar ototoxic effect in rats.
Degree in cervical and facial surgery 1997
DU (Diplome Universitaire) of vestibulometry and vestibular Rehabilitation : 1995
Master thesis. DEA (Diplome d’etude approfondie) STAPS (Physiology, Biomécanic and Psychobiology of the Physical activities) : 2001
University PhD thesis. 18 Sept 2014 (Nancy): The Skull Vibration Induced Nystagmus Test (Dumas Test)
Scientific societies : Fellow of the French ENT and cervico-facial pathology society (S.F.ORL); the Audiology French society; the international otoneurology society (SIO); the international vestibular rehabilitation society (SIRV).
Member of the Laboratory Development, Adaptation and Disadvantage (EA 3450
DevAH) – University of Lorraine
Co-director of PhD Thesis about “SVINT a potential screening tool in children” Solara Sinno (Beyrouth Lebanon) on preparation for 2018.
Professioinnal activity: In charge of Vestibulometry Consultation in the ENT department in Grenoble Hospital- CHU Michallon
From 1977, 131 papers were published in indexed reviews or presented as oral présentations in different international congresses or Posters.
Contribution to 2 Annual Reports of the French ENT and cervico-facial surgery Society: “Balance troubles and Vertigo” (Report 1997). “Electrophysiology in ENT” (Report 2008)
My five last years peer reviewed publications are focussed on the topic of effects of vibrations on the vestibular apparatus, the optimization of the skull vibration induced nystagmus test (SVINT); its clinical implications and the chemical labyrinthectomy in disabling Menière’s disease. My recent domain of interest is Hydrops detected by MRI in Menière’sdisease and recurrent vertigo in collaboration with A. Attye Neuroradiologist in Grenoble
Background & Aim: Vibrations applied to skull produce a vibration induced nystagmus (VIN) in unilateral vestibular lesions (UVL). These responses described for the first time by Lücke in 1976 were confirmed and extended by Hamann, et al. and our group in Grenoble in 1999. A VIN induced by cervical vibrations has also been described but involves different somatosensory inputs and centers. Moreover, bone conducted vibrations stimulate utricle (oVEMP) or sacculus (cVEMP) and muscular cervical stimulations influence posture. Our purpose was to clarify this initial design, the actual inner ear target of this test restricted to bone conduction stimulation (which we term the Skull Vibration Induced Nystagmus Test (SVINT)), to find out optimal stimulation locations and frequencies, to show possible clinical interest of the VIN primarily in unilateral lesions (UVL) and superior canal dehiscence (SCD). In animals, Curthoys demonstrated at 100 Hz a stimulation of both canalar and otolithic structures (type I inner ear cells) and at 500 Hz a specific stimulation of otolithic irregular fibers.
Material & Methods: 19500 patients with total or partial peripheral unilateral lesions (TUVL/PUVL) or superior semicircular canal dehiscence (SCD) were studied with the Synapsys 3F vibrator (30, 60, 100 Hz) and the (10-800 Hz) Bruel & Kjaer Vibrator applied on vertex and each mastoids, and recorded under VNG 2D or 3D. The results were compared with those in 95 normal subjects and 34 brainstem lesions.
Results: The test is positive when it generates a VIN beating toward the same direction whatever the skull location, sustained, repeatable, starting with the stimulation and stopping with it. Optimal frequency is 100 Hz in patients with normally encased labyrinth; the best location is the mastoid in UVL except in SCD (higher responses are obtained on vertex). Both labyrinths are concomitantly stimulated and VIN is the result of the stimulation of the intact side in TUVL. In PUVL, a VIN beating toward the intact side is usually obtained but in SCD, VIN beats toward the lesion side (bone conduction facilitation) and is observed at higher frequencies. The VIN slow phase velocity (SPV) is correlated in TUVL with the total caloric efficiency on the healthy ear. No responses are observed in bilateral symmetrical lesions. VIN is permanent in TUVL. Sensitivity is 98% in TUVL and specificity 94% in normal subjects. In PUVL, sensitivity is 75% and VIN beats toward the intact side in 91% of cases. No significant alteration of the vestibulo-spinal reflex analyzed with posturography was observed in chronic compensated UVL. SVINT is more sensitive to reveal peripheral than central diseases.
Conclusion: SVINT is a global vestibular test at 100 Hz and acts as a vestibular Weber test. It explores the vestibulo-ocular reflex and complements the CaT, the HST and the HIT in the vestibule multi-frequency analysis. In clinical practice, it can substitute the water caloric test in case of middle or external ear pathologies. SVINT is useful to detect instantaneously as a bedside first line examination test, a vestibular asymmetry. It usually reveals a lesional nystagmus in common UVL peripheral patients and an excitatory VIN in SCD. It is more sensitive to reveal peripheral than central diseases. The VIN is not modified by the vestibular compensation mechanisms and involves type I inner ear sensory cells.
Associate Professor Texas Tech University Health Sciences Center (TTUHSC) USA
Title: Use of ultrasound biofeedback in speech intervention for children with hearing loss and cleft palate
Time : 14:10-14:30
Sue Ann S Lee is an Associate Professor in the Department of Speech, Language & Hearing Sciences at Texas Tech University Health Sciences Center. She has earned her Master’s degree from The Ohio State University and her PhD in Speech Pathology at the University of Texas at Austin. Her research interest lies in speech characteristics in children with and without speech sound disorders and bilingualism. Her recent research focuses on examining speech therapy efficacy using various technologies such as ultrasound and telepractice. She has received external grants from the National Institutes of Health, CH Foundation and the South Plains Foundation. Her work has been published in multiple high impact journals such as the Journal of Child Language and Journal of Speech, Language and Hearing Research. She currently serves as an Editorial Board Member for Clinical Archives of Communication Disorders and Journal of Communication Disorders and Assistive Technology.
Speech-language pathologists frequently provide visual feedback during treatment to help clients visualize articulatory gestures and movements for various speech sounds. While traditional visual feedback approaches incorporate visual cues using mirrors, figures or diagrams, alternative methods of visual feedback are gaining more attention in current research. These alternative methods include the use of acoustic analysis, electropalatogaphy and ultrasound biofeedback. Several speech-language pathologists and researchers have begun to investigate the effectiveness of ultrasound in intervention for speech sound disorders. Current research, however, is limited in populations investigated (e.g., normal hearing, articulation disorders, CAS), error sounds targeted (e.g., primarily residual /r/) and participant age ranges (e.g., late elementary and adolescents) included. The objective of this study was to evaluate the efficacy of ultrasound biofeedback as a tool for speech intervention in young children with hearing loss and with cleft palate. Two female children with cochlear implants and two male children with cleft palate, whose age ranged from 4 year 10 months and 6 years 5 months, participated in two single subjects multiple baseline design studies. A GE Logic E ultrasound with an 8c transducer was used. 30-minute treatment sessions were conducted twice a week for 10 weeks. Various speech sounds were targeted. We found gains in production accuracy for target sounds that were previously resistant treatment in the children with hearing loss. Speech intervention for children with cleft palate is still in progress and will be fully completed by May 2017. Based on currently available results, ultrasound is indicated as a potentially effective tool for the treatment of speech error sounds in young children. The findings in this study were consistent with the findings of previous studies.
Associate Professor Department Chair and Graduate Program Director Department of Communication Sciences & Disorders University of Wisconsin-River Falls
Title: Transcranial magnetic stimulation reveals differences between spasmodic dysphonia and muscle tension dysphonia
Time : 14:50-15:10
Sharyl A Samargia is an Associate Professor and Speech-Language Pathologist. Her expertise is the study of neuroplasticity as it relates to functional motor recovery in individuals with neurologic disease or injury. She is interested in combining neuromodulation techniques and high intensity, task specific behavioral practice to facilitate true neural recovery and minimize maladaptive plasticity.
Statement of the Problem: Adductor spasmodic dysphonia (AdSD) is a form of focal dystonia resulting in a strained voice quality during speech tasks. The pathophysiology of AdSD is largely unknown and differential diagnosis is challenging due to the shared perceptual features with muscle tension dysphonia (MTD). Considering MTD does not have a neurologic-basis, comparison of cortical excitability, using transcranial magnetic stimulation (TMS), between MTD and AdSD offers a novel approach in differential diagnosis. A direct comparison of cortical excitability in AdSD and MTD has not previously been reported.
Methodology: 10 subjects with AdSD, 8 with MTD and 10 healthy controls received single and paired pulse transcranial magnetic stimulation (TMS) to the primary motor cortex contralateral to tested muscles, first dorsal interosseus (FDI) and masseter. We hypothesized cortical excitability in AdSD would be significantly different than in MTD and healthy and would correlate with perceptual severity in AdSD.
Findings: Cortical silent period (CSP) duration in masseter and FDI were significantly shorter in AdSD than MTD and healthy controls. Other measures failed to demonstrate differences.
Conclusion & Significance: There are differences in intracortical excitability between AdSD, MTD and healthy controls. Differences in intracortical inhibition in FDI and masseter suggest widespread dysfunction of the GABAB (Gamma-Amino-Butyric Acid Type B) mechanism may be a pathophysiologic feature of AdSD, similar to other forms of focal dystonia. Further exploration of the use of TMS to assist in the differential diagnosis of AdSD and MTD is warranted.