Abstract
Clinical Practice Guideline: Ménière’s Disease
Gregory J. Basura, MD, PhD (Moderator); Seth R. Schwartz, MD, MPH; Meredith E. Adams, MD; Matthew L. Bush, MD, PhD
Session Description: Ménière’s disease (MD) is a clinical syndrome affecting approximately 50 to 200/100,000 adults and is most common between the ages of 40 and 70 years. This session will discuss the clinical practice guideline (CPG), which has the primary purpose of improving the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, this guideline uses the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical), while reducing unindicated diagnostic testing and/or imaging. The CPG is intended for all health care providers (eg, emergency medicine, primary care, otolaryngology, neurology, audiology, physical/vestibular therapy) who are likely to encounter, treat, and/or monitor patients with suspected MD. The target patient for the CPG is ≥18 years with suspected diagnosis of definite or probable MD presenting with fluctuating episodic vertigo lasting 20 minutes to hours.
Outcome Objectives: (1) Discuss how to improve the quality of the diagnostic workup and treatment outcomes of MD. (2) Recognize improvements in quality-of-care outcomes for MD patients. (3) Identify existing variations in practice and quality improvement opportunities to improve care.
Complex Dizziness for the General Otolaryngologist
James Naples, MD (Moderator); Soha N. Ghossaini, MD; Erika A. Woodson, MD; Syed F. Ahsan, MD
Session Description: Dizziness is one of the most common presenting complaints to a general otolaryngology practice, and most ear, nose, and throat specialists (ENTs) feel comfortable handling straightforward etiologies. This session will review more complex causes of dizziness and will assist the general ENT in recognizing and assessing these conditions. This session will cover symptoms and examination findings associated with vestibular migraine, persistent postural-perceptual dizziness, and the many guises of superior semicircular canal dehiscence. Appropriate use of testing and management of these conditions will also be discussed. An audience-response system will be used to allow participants to check their workups and assessments against the panel of experts.
Outcome Objectives: (1) Differentiate the clinical presentations of vertiginous migraine versus Ménière’s disease. (2) Recognize that chronic postural perceptive dizziness is a major diagnostic consideration in the individual with chronic vertigo. (3) Identify superior semicircular canal dehiscence using clinical judgment and appropriate diagnostic testing.
Controversy in Approaches for Superior Canal Dehiscence
Christopher A. Schutt, MD (Moderator); John P. Carey, MD; Seilesh Babu, MD; Marc L. Bennett, MD; Dennis I. Bojrab, MD; Larry B. Lundy, MD
Session Description: Superior canal dehiscence (SCD) is a rare but increasingly recognized pathology. Although the pathophysiology of SCD has been elucidated, the best method of treatment for canal dehiscence is still controversial. This session aims to foster dialogue, discussing the benefits and drawbacks of different surgical approaches used to improve symptomatic canal dehiscence.
Outcome Objectives: (1) Recognize key technical aspects and potential pitfalls of different approaches used to repair SCD. (2) Analyze the benefits and drawbacks of each surgical approach used to treat SCD. (3) Outline an individualized treatment plan based on patient and disease characteristics.
Endoscopic Ear Surgery in Clinical Practice
Daniel J. Lee, MD (Moderator); Alicia M. Quesnel, MD; Michael S. Cohen, MD; Muaaz Tarabichi, MD
Session Description: This session will introduce otolaryngologists to the principles of endoscopic ear surgery (EES). The target audience includes surgeons-in-training as well as established surgeons who wish to augment their existing surgical armamentarium with endoscopic techniques. Topics will include essential equipment, operating room layout, ergonomics, patient selection, safety, surgical techniques, pediatric and adult EES outcomes, common pitfalls, and barriers to entry. Extensive use of case videos will demonstrate how endoscopic techniques can augment, and in some cases replace, traditional microscopic approaches. Participants should leave this course with a greater understanding of how EES can be incorporated into an otologic surgical practice.
Outcome Objectives: (1) Describe the equipment, ergonomics, and patient selection necessary for getting started with EES. (2) Select cases and techniques for EES with a view to optimizing outcomes and minimizing complications. (3) Discuss outcomes following transcanal EES in both pediatric and adult patients.
Endoscopic Ear Surgery: Tips and Pearls
Joao-Flavio Nogueira Junior, MD (Moderator); Daniele Marchioni, MD; Alejandro Rivas, MD; Brandon Isaacson, MD; Daniel Lee, MD; Muaaz Tarabichi, MD; Manuela Fina, MD
Session Description: Endoscopic ear surgery (EES) is becoming very popular worldwide. Transcanal endoscopic-assisted procedures and combined endoscopic and microscopic surgeries have been proven to be safe and effective to manage ear diseases in a minimally invasive way, preserving important anatomic structures, and allowing functional approaches to well-known conditions. Moreover, endoscopes have provided a better view and understanding of traditional middle ear anatomy and physiology, allowing new landmarks, novel concepts of tissue preservation, ventilation routes, and management of other conditions within the middle ear and beyond. In this session, the panelists will present the latest trends on EES, discussing advantages, disadvantages, indications, results, and possible complications.
Outcome Objectives: (1) Review the endoscopic anatomy of the middle ear, discussing the important endoscopic anatomic landmarks. (2) Identify actual indications and limitations, including new transcanal approaches to the lateral skull base. (3) Describe and demonstrate stepwise endoscopic middle ear approaches for several diseases of this area.
Hearing Loss in Older Adults: A Public Health Imperative
Richard K. Gurgel, MD (Moderator); Carrie L. Nieman, MD, MPH; Natasha Pollak, MD, MS; Aaron C. Moberly, MD
Session Description: Hearing loss is one of the most highly prevalent sensory deficits among older adults; two-thirds of adults 70 years and older have a clinically significant hearing loss. Increasing evidence suggests that hearing loss may no longer be a benign process of aging. Age-related hearing loss has been independently associated with negative outcomes in almost every domain of aging, including accelerated cognitive decline and incident dementia. A 2017 commissioned Lancet report estimates that hearing loss is the largest potentially modifiable risk factor for dementia. However, few older adults use hearing aids, and disparities in hearing health care exist based on race/ethnicity and socioeconomic status. Recent national efforts through the National Academies of Science, Engineering, and Medicine and legislation allowing for over-the-counter hearing aids have brought renewed calls for innovative, affordable, and accessible hearing care as a national public health imperative. This session will address what is currently known about the association between hearing loss and dementia. The panelists will review hearing and aural rehabilitation issues unique to aging populations, as well as innovative approaches to hearing health care that adapt to the changing national landscape. The information presented in this session will equip clinicians with the latest advances to treat older adults with hearing loss.
Outcome Objectives: (1) Examine what is known about the association of hearing loss and dementia in older adults. (2) Recognize resources available to best manage older adults with hearing loss. (3) Implement strategies to best provide hearing care to older adults in their practice.
Over-the-Counter Hearing Care: Current and Future Innovations to Help You and Your Patients
Seilesh Babu, MD (Moderator); Nicholas Reed; Carrie L. Nieman, MD, MPH
Session Description: Hearing loss affects two-thirds of adults over the age of 70 years. Recent high-profile, national efforts and legislation have brought sweeping changes to how adults will access hearing care in the coming years. This session will review the latest in Food and Drug Administration regulations related to hearing evaluation and care and their anticipated effects on patients and providers. In preparation for the 2020 debut of over-the counter (OTC) hearing aids, the panelists will provide a primer on how to advise patients on the latest devices and how to incorporate OTC devices into otolaryngology practice. The panelists will also cover counseling and considerations for optimal usability of hearing technology from the perspective of older adults and an update on the technologic innovations and delivery of OTC products. Finally, the panelists will discuss potential complementary policy changes that may be needed to support the hearing care needs of all older adults. Overall, the session will provide clinicians the information they need to know on the rapidly evolving landscape of hearing care and how to best serve older adults with hearing loss.
Outcome Objectives: (1) Explain recent changes in federal regulations around hearing health care delivery for age-related hearing loss. (2) Analyze key components of assessing OTC hearing devices and technology for older adults with hearing loss. (3) Compare newly available OTC hearing devices to aid patients with decision making around their hearing care.
Over-the-Counter Hearing Care: The Realities and Opportunities From Practice To Patients American Neurotology Society (ANS) Subspeciality
Carrie Nieman, MD, MPH (Moderator); Kevin Franck, PhD, MBA; James Denneny, MD; Barbara Kelley
Session Description: Hearing loss (HL) is increasingly recognized as a public health issue with pervasive impact during the aging process and consequences on population health. The extremely low and stagnant utilization of hearing aids in the face of the growing burden of hearing disability and associated comorbidities in our population is attributed to lack of affordability of these devices using traditional bundled models of payment. Furthermore as one of the most expensive financial outlays for most families, individuals often delay intervention until disability and its secondary effects are well entrenched. Efforts initiated by the White House and U.S. Congress have led to the Over-the-Counter Hearing Aid Act of 2017 which mandated the establishment of an over the counter (OTC) hearing aid category for adults with perceived mild to moderate HL. This act presents both an opportunity for improved access to hearing intervention for populations in need of these services, and a threat to traditional financial models that have governed hearing aid practice and industry sales. The goals of this panel are to give a broad perspective on this issue from various professional/stakeholder groups, including otolaryngology, audiology, and patients. The wider availability of hearing amplification devices to consumers is welcomed by many, but there are considerations that warrant a thoughtful approach to availability of OTC devices to the public. This panel presentation features the perspectives of national leaders in otolaryngology, audiology, and patient advocates who are currently shaping the future of OTC hearing solutions.
Outcome Objectives: (1) Recognize how the OTC Hearing Aid Act of 2017 is being operationalized now within otolaryngology and audiology practice and how it will likely evolve in the future. (2) Examine alternative practice models that are sustainable and embrace a new opportunity for expanded access to hearing intervention from the perspective of clinicians and patients. (3) Consider greater engagement in population health through partnership with patients, audiology and primary care in mitigating negative effects associated with hearing loss.
The Spectrum of Implantable Hearing Devices: Indications and Outcomes
Samuel P. Gubbels, MD (Moderator); Bruce J. Gantz, MD; Oliver F. Adunka, MD; Jack A. Shohet, MD
Session Description: The number of Food and Drug Administration (FDA)–approved implantable hearing devices (IHD) available has increased in the past 2 decades. In addition, the indications for common IHD, such as cochlear implants, continue to evolve and expand over time. As such, understanding the spectrum of IHD options and their respective indications can be challenging to otolaryngologists and neurotologists alike. Given recent findings of the connection between cognitive decline, hearing loss, and hearing rehabilitation, it is critical that providers seeing patients with hearing loss have a strong working knowledge of all aspects of hearing aids and IHD so that they can optimally counsel and treat patients. This session will review the IHD options currently available in the United States and discuss in detail the indications for each. These include cochlear implants, bone-conducting hearing aids, and implantable middle ear devices, among others. In addition, the panelists will review a variety of common patient presentations and their approach for selection of the most appropriate IHD for each. Details regarding the surgical procedures, complications, insurance considerations, and outcomes for each type of IHD will be reviewed to provide a complete framework for attendees to draw on when counseling patients. This session assumes little prior understanding of IHD and will be tailored to a broad audience encompassing trainees, advanced practice providers, practicing otolaryngologists, and neurotologists. The panelists were very well received in their first year of presentation and look forward to the opportunity to present the topic once again, having now incorporated feedback from last year’s session and expanded the breadth and depth of the topics covered by the panel of experts.
Outcome Objectives: (1) Describe the FDA-approved IHD currently available and their mechanisms for hearing rehabilitation. (2) Summarize approved and experimental indications for each type of IHD currently on the US market. (3) Explain the surgical procedures, hearing outcomes, and potential complications of each IHD.
Temporal Bone Radiology: Basic to Advanced
Ashkan Monfared, MD (Moderator); Richard K. Gurgel, MD; Nikolas H. Blevins, MD; Howard W. Francis, MD; Elizabeth M. Toh, MD, MBA; Joni K. Doherty, MD, PhD; Samuel P. Gubbels, MD
Session Description: Through this interactive session, the audience is exposed to challenging temporal bone radiology cases and offered strategies to improve their interpretation. The first hour will focus on fundamentals of temporal bone imaging and the second hour on advanced case presentation. The emphasis is placed on subtle but pertinent findings on computed tomography and magnetic resonance imaging examinations and their importance in creating and narrowing a differential diagnoses. Panelists will present guidelines to aid in the efficient acquisition and interpretation of imaging for patients with common otologic symptoms such as vertigo, congenital hearing loss, pulsatile tinnitus, as well as rare and more challenging disorders such as skull-base, jugular foramen, and facial nerve tumors.
Outcome Objectives: (1) Identify fundamentals of temporal bone imaging. (2) Order appropriate radiographic tests and recognize the strengths and limitations of different imaging modalities. (3) Interpret key radiographic findings for common pathologic conditions of the temporal bone.
Vestibular Migraines: 2019 Management Update
Michael E. Hoffer, MD (Moderator); Courtney C. J. Voelker, MD, PhD; Joel A. Goebel, MD; Eric E. Smouha, MD; Hamed Sajjadi, MD; Edward I. Cho, MD
Session Description: Vestibular migraines have become increasingly recognized as one of the most common causes of dizziness. Despite increased attention to this disorder, a great deal of uncertainty remains with respect to the diagnosis and management of this entity. This session will focus on some of the most critical issues in vestibular migraines, including differential diagnosis, new diagnostic techniques, novel treatment strategies, and the relationship of this disorder to other common balance entities. Given the prevalence of this diagnosis and the impact of this disorder on patients, this session is extremely relevant to otolaryngology practice in 2019.
Outcome Objectives: (1) Improve understanding of the differential diagnosis of vestibular migraines. (2) Summarize new techniques used to diagnosis vestibular migraines. (3) Explain novel treatment modalities for vestibular migraines.
Vestibular Physical Therapy: Evidence-Based Clinical Case Presentations
Edward I. Cho, MD (Moderator); Jeffrey D. Sharon, MD; Habib Rizk, MD, MSc; Kim R. Gottshall, PhD
Session Description: Vestibular physical therapy is vital in the management of dizziness and balance disorders. The panelists will use a clinical case presentation format to discuss the current evidence regarding the efficacy of vestibular physical therapy in conditions such as benign paroxysmal positional vertigo (BPPV), peripheral vestibular hypofunction, Ménière’s disease, vestibular migraine, and central vestibular dysfunction. This topic is very relevant in light of an aging patient population with increasing balance disorders. Also, many otolaryngologists need to make informed decisions about incorporating vestibular physical therapy within their own practices. By the end of this panel presentation, otolaryngologists and other providers should have a better understanding of the evidence and indications for vestibular physical therapy.
Outcome Objectives: (1) Describe the evidence behind vestibular physical therapy for peripheral vestibular conditions such as BPPV and vestibular hypofunction. (2) Discuss the evidence behind vestibular physical therapy for central vestibular conditions such as vestibular migraine and mal de debarquement syndrome. (3) Summarize the benefits of a multidisciplinary approach to vestibular disorders and develop ideas about implementation.