Abstract
AAO-HNSF Clinical Consensus Statement: Sinus Ostial Dilation
Jay Piccirillo, MD (moderator); Spencer Payne, MD; Richard M. Rosenfeld, MD, MPH
Session Description: Over the past 1 to 2 years, sinus ostial dilation has fallen under increased scrutiny by both payers and providers. This miniseminar provides an overview of the newly developed American Academy of Otolaryngology—Head and Neck Surgery Foundation Clinical Consensus Statement: Sinus Ostial Dilation. The statements in this document reflect the expert opinion of a well-versed panel on the use of sinus ostial dilation and will discuss the current evidence.
Outcome Objectives: (1) Review the utilization criteria identified in the clinical consensus statement for sinus ostial dilation. (2) Identify current areas of consensus on technique and instrumentation for sinus ostial dilation. (3) Recognize where experts agree, and disagree, regarding indications for sinus ostial dilation and identify areas of expert consensus regarding the role of imaging in sinus ostial dilation.
Advanced Endoscopic Skull Base Reconstruction
Marc Rosen, MD (moderator); Ricardo L. Carrau, MD; Vijay Anand, MD, MBBS; Roy R. Casiano, MD
Session Description: Technological progress and clinical research efforts have allowed otolaryngologists and their neurosurgeon colleagues to expand the indications for minimally invasive endoscopic approaches to the anterior skull base. This progress is partially secondary to improved reconstructive techniques developed over time at large-volume endoscopic skull base surgery programs. The techniques and rationale behind them can vary significantly between centers and surgeons. The purpose of our miniseminar is to help the attendee understand how to reconstruct a variety of anterior skull base defects created following transsphenoidal pituitary surgery as well as extended endonasal approaches for resection of a variety of benign and malignant skull base pathologies. Our panelists will discuss their personal experiences with synthetic and autologous dural reconstruction, pedicle and free mucosal grafts, as well as adjunctive materials and devices such as tissue sealant, balloons, nasal stents, and packing. Management of intraoperative and postoperative complications, including cerebrospinal fluid leak (CSF), will also be discussed.
Outcome Objectives: (1) Recognize and understand the anatomic limitations of current endoscopic approaches to the anterior skull base for resection of benign and malignant lesions. (2) Compare, contrast, and choose between methods for dural, structural, and mucosal reconstruction of the postablative skull base and sinonasal cavity. (3) Identify and manage common complications following skull base reconstruction, including CSF leak and lesion recurrence.
Allergy: It’s Not Just the Nose!
Christopher D. Brook, MD (moderator); Michael P. Platt, MD, MS; Maria Veling, MD; Pieter Noordzij, MD; Charles Syms, MD
Session Description: This new miniseminar will provide up-to-date and evidence-based information about the effect of allergy on the ear, oral cavity, paranasal sinuses, pharynx, and larynx. The role of allergy in diseases such as Eustachian tube dysfunction, chronic otitis media, Ménière’s disease, obstructive sleep apnea, chronic cough, laryngitis, sinusitis, and oral allergy syndrome will be discussed by experts in each individual field. The pathophysiology, clinical features, and treatment options will be reviewed. The learner will leave the course with a more comprehensive understanding of the impact and manifestations of allergic disease throughout the head and neck.
Outcome Objectives: (1) Discuss the role of allergic disease in the pathophysiology of the sinuses, ears, oral cavity, obstructive sleep apnea, pharynx, and larynx. (2) Describe the role of allergy testing in head and neck diseases other than allergic rhinitis. (3) Identify the role of allergy treatment in the management of diseases of the head and neck other than allergic rhinitis.
Ask the Experts: An Endoscopic Potpourri
David W. Kennedy, MD (moderator); Peter J. Wormald, MD, PhD, MBBS; James Palmer, MD; Elina Toskala, MD, PhD, MBA; Peter Hwang, MD; Eugenia Vining, MD
Session Description: Open forum for interactive discussion of the management options and the decision rationale involved in difficult sinus and skull base cases and complicated treatment situations. A case presentation format is used with case presentations from each of the panelists. Questions regarding differential diagnosis, evaluation, imaging, and treatment are posed to the audience in multiple-choice format. The responses provided by the audience-response system are then discussed and expanded upon by the panelists in an interactive discussion. In general, cases are selected that might be encountered by either a general otolaryngologist or a subspecialty rhinologist, but cases selected have important decision and management dilemmas. Particular emphasis is placed on the decision-making process. Audience responses are discussed, and the rationale behind each panelist recommendation will be carefully elucidated. Discussion from the floor is also encouraged.
Outcome Objectives: (1) Evaluate the surgical decision-making process in chronic sinus disease. (2) Conduct imaging modalities and improve quality of interpretation for both computed tomography and magnetic resonance imaging images. (3) Explain the management of difficult-to-treat chronic rhinosinusitis.
Balloon Sinuplasty: Indications, Technique, and Evidence
Waleed M. Abuzeid, MD (moderator); Michael Setzen, MD; Satish Govindaraj, MD; Devyani Lal, MD
Session Description: The role of balloon sinuplasty in the surgical care of patients with chronic rhinosinusitis continues to evolve based on increasing clinical experience and research. This miniseminar will explore modern concepts related to balloon sinuplasty in both the operative and office setting. A framework for defining the benefits, technique, and limitations of the procedure will be reviewed. An evidence-based discussion of the procedural indications and outcomes will be based on a review of the scientific literature and the experience of the panelists. A practical approach to successfully performing the procedure will be presented including surgical pearls and pitfalls.
Outcome Objectives: (1) Understand the indications, outcomes, and contra-indications for balloon sinuplasty in operating room and office setting in both adult and pediatric patients. (2) Comprehend practical aspects to performing the procedure successfully in various clinical settings. (3) Discuss the primary findings, conclusions, and limitations of the scientific literature related to balloon sinuplasty.
Chronic Sinusitis: What to Do When Everything Fails
Edward D. McCoul, MD, MPH (moderator); Roy R. Casiano, MD; Peter Hwang, MD; Abtin Tabaee, MD
Session Description: Chronic rhinosinusitis (CRS) may be refractory to standard medical and surgical treatment, with persistent, poorly controlled symptoms and objective inflammatory findings. These patients represent a diagnostic and treatment challenge given the complexity of the underlying disease and the limitations in available management options. In this miniseminar, leaders in the field will present a practical framework for clinical evaluation and treatment of refractory CRS. Panelists will discuss the various pathophysiologic factors that may exist in patients with refractory CRS as they relate to clinical management. Available treatment options and supporting best evidence will be presented, including systemic and topical pharmacotherapy, in-office procedures, and specific options for revision sinus surgery. Cases will be discussed that highlight emerging concepts in evaluation and management of refractory CRS.
Outcome Objectives: (1) Recognize the various pathophysiologic processes that may contribute to refractory CRS. (2) Describe the available medical and surgical treatment options for patients with CRS that persists despite previous medical and surgical treatment. (3) Implement appropriate treatment of patients with refractory CRS based on current best evidence.
Difficult Nasal Polyps: Allergic Fungal Sinusitis and Aspirin-Exacerbated Respiratory Disease Success Strategies
James Palmer, MD (moderator); Nithin D. Adappa, MD; John Bosso, MD
Session Description: Chronic sinusitis with nasal polyposis has a detrimental impact on quality of life and may exacerbate coexisting conditions such as asthma. This miniseminar will outline the latest theories on disease pathogenesis as well as promote rational medical and surgical strategies for severe nasal polyposis management, specifically the 2 toughest areas of nasal polyposis to treat: allergic fungal sinusitis (AFS) and aspirin-exacerbated respiratory disease (AERD). Treatments designed to decrease reliance on systemic steroids including surgical methods and complementary medical therapeutics such as topical steroid irrigations, macrolides, and antileukotrienes will be discussed. A panel of experts will provide the latest innovations in medical and surgical treatments through a case-based approach of difficult patients and strategies for success illustrating these advancements.
Outcome Objectives: (1) Describe current pathogenesis theories of nasal polyposis in AFS and AERD. (2) Recognize the latest medical and surgical treatments for nasal polyposis in AFS and AERD. (3) Initiate additional therapeutic measures for successful long-term treatment of nasal polyposis in AFS and AERD.
Endotypes in Chronic Sinusitis: Treatment Implications
Pete Batra, MD (moderator); Bobby A. Tajudeen, MD; Nithin D. Adappa, MD; Martin Citardi, MD
Session Description: Recent innovations in research and expansion of knowledge have resulted in improved classification of chronic rhinosinusitis (CRS) into multiple endotypes. This has led to the introduction of new evidence-based diagnostic and management algorithms. The purpose of this miniseminar is to provide otolaryngologists with the most up-to-date information about subclassification of CRS and how each endotype leads to a unique repertoire of medical and surgical strategies for optimal treatment. Detailed management steps for specific endotypes, including acetylsalicylic acid (ASA)–sensitive triad, allergic fungal sinusitis, and cystic fibrosis subtypes will be discussed. The role of structured pathology reporting to identify CRS endotypes and therapeutic implications will also be outlined. Relevant cases will be reviewed in the context of these presentations to illustrate these emerging principles.
Outcome Objectives: (1) Describe pathophysiology and classification schema of endotypes in CRS. (2) Review the latest medical and surgical treatment strategies for CRS based on endotypes, with special focus of ASA-sensitive triad, allergic fungal sinusitis, and cystic fibrosis. (3) Define the role of structured histopathology profiling to better characterize and manage CRS endotypes.
Food Allergy 2017: State of the Science
William Reisacher, MD (moderator); Cecelia Damask, DO; Maria Veling, MD
Session Description: Food allergies are difficult for the patient to understand and challenging for the clinician to treat. The Centers for Disease Control and Prevention (CDC) has recently reported that the prevalence of reported food allergies increased 18% over the past 10 years in children under 18 years. This miniseminar includes 3 didactic lectures, an audience-interactive section, and questions and answers. The lectures will focus on why food allergies develop, by taking a critical look at the latest scientific evidence available in the literature, the role of oral tolerance in human evolution and the relationship of failure to achieve oral tolerance on the health of the individual, relevant immunology, nonimmunologic food reactions versus immunologic reactions, both immunoglobulin E (IgE)–mediated and non–IgE-mediated food allergy, current methods of diagnosing food allergies, and cutting-edge strategies such as component-resolved testing skin and in vitro methods versus double-blind placebo-controlled food challenges. Comprehensive treatment options for food allergies will also be discussed.
Outcome Objectives: (1) Evaluate the scientific basis of IgE- and non–IgE-mediated food allergy. (2) Describe and compare the most recent diagnostic strategies for food allergy. (3) Recognize the currently available treatments for food allergy as well as future directions.
Nonallergic Rhinitis: Update 2017
John H. Krouse, MD, PhD, MBA (moderator); Stephanie Joe, MD; Amber Luong, MD, PhD; William Reisacher, MD; Elina Toskala, MD, PhD, MBA
Session Description: Patients with nonallergic rhinitis (NAR) remain a clinical challenge for otolaryngologists. These patients have often failed a thorough allergy workup and are classified with NAR. Our panel of practicing rhinologists and otolaryngic allergists will discuss recent research into both the diagnosis and treatment of NAR and will further expand on novel methods for managing these patients. Through short lectures, panel discussions, and case presentations, we will provide examples of clinical approaches to patients with NAR that will assist the practicing clinician in the successful diagnosis and treatment of these individuals.
Outcome Objectives: (1) Delineate the pathophysiologies of various phenotypes of NAR. (2) Discuss the diagnostic challenges in approaching the patient with symptoms and signs of NAR. (3) Identify various traditional and novel treatment options for patients diagnosed with NAR.
Novel Therapeutic Modalities for Recalcitrant Sinusitis
Jivianne Lee, MD (moderator); Joseph Han, MD; Scott Stringer, MD
Session Description: Management of chronic rhinosinusitis (CRS) recalcitrant to standard medical and surgical intervention remains a challenge. However, recent years have witnessed significant expansion and innovation in our treatment armamentarium for such refractory disease. The purpose of this miniseminar is to describe the diverse spectrum of therapies currently available for recalcitrant CRS, with an emphasis on novel therapeutic modalities. New surgical approaches and technologic advances for treatment of refractory CRS will be delineated. Emerging systemic biologics with immunomodulatory capabilities will also be addressed. The efficacy of topical anti-infective and anti-inflammatory agents will also be discussed in addition to a review of the relevant evidence. This miniseminar will be conducted by a panel of academic leading rhinologists using a multimedia, interactive case-based format.
Outcome Objectives: (1) Describe new surgical approaches and recent technologic innovations for management of recalcitrant CRS. (2) Discuss novel medical therapies including nascent systemic biotherapeutics, immunomodulators, and topical additives to assess their potential role in the treatment of refractory CRS. (3) Evaluate the relevant evidence, outcomes, and proper application of each therapeutic modality in patients with recalcitrant CRS.
Successful Endoscopic Sinus Surgery: Technical Pearls
Devyani Lal, MD (moderator); Roy R. Casiano, MD; Peter Hwang, MD; Rick Chandra, MD; Brent A. Senior, MD
Session Description: While many patients have biologically refractory sinonasal disease, technical errors can also compromise results from endoscopic sinus surgery (ESS). Middle meatal adhesions, lateralized middle turbinate, missed maxillary ostium, residual and scarred ethmoid cells, sphenoid ostium stenosis, and frontal recess scarring can worsen outcome and require revision surgery. Our session will discuss technical causes of ESS failure and how to avoid or address these. Our panel of experienced rhinologists will share critical pearls on executing ESS on all the sinuses. We will also discuss modifications in selection and execution of surgical procedures for biologically recalcitrant disease such as sinonasal polyposis.
Outcome Objectives: (1) Recognize technical errors that can compromise success from ESS. (2) Implement surgical techniques that can optimize success from ESS. (3) Identify methods to avoid and manage complications.