Day 3 :
- Track 14- Surgical Approaches for Laryngology in Adults and Pediatrics
Track 15: ENT Infectious Diseases
Track 16: Head, Neck and Oral Oncology
Track 17: Tinnitus
Location: Al Dhiyafah 1-3
Aage R Moller
The University of Texas at Dallas
Dr Kumaresh ENT Clinic
Ann and Robert H Lurie Children’s Hospital
Time : 09:00-09:20
Dana M Thompson is the Division Head of Pediatric Otolaryngology at Ann & Robert H. Lurie Children’s Hospital of Chicago where she holds the The Lauren D. Holinger Chair in Pediatric Otolaryngology. She is alsoa Professor of Otolaryngology at Northwestern University Feinberg School of Medicine. She completed her residency in Otolaryngology, Head and Neck Surgery at the Mayo Clinic, followed by a research year and apprenticeship in laryngology and esophageal disorders. She completed her second fellowship in Pediatric Otolaryngology at Cincinnati Children’s Hospital under the direction of Dr. Robin Cotton. She has held previous appointments on the faculty at the Mayo Clinic and Cincinnati Children’s Hospital. She has a unique hybrid of expertise in the surgical treatment and management of airway, voice, and swallowing disorders for infants, children, and adults and is the Director of the Multidisciplinary Aerodigestive Program at Lurie Children’s Hospital. Her other clinical interests include surgical management of supraglottic collapse, subglottic stenosis and tracheal stenosis, Infant Apnea, Airway and Extraesophageal Manifestations of GERD, Aerodigestive Manifestations of Eosinophilic Esophagitis, Oropharyngeal Swallowing, Airway Protection, Neurolaryngology, and Laryngomalacia. She was the 2006 recipient of the Harris Mosher Award for excellence in clinical research by the American Laryngological, Rhinological, and Otological Society (TRIO) for her work on Laryngomalacia.
Laryngomalacia is the most common cause of infant stridor and is categorized based on symptom presentation as mild, moderate or severe. In those with mild disease, symptoms usually resolve by 18 months of age. Up to 40% of infants will have feeding complications that improve with acid suppression treatment and management of refl ux disease. Up to 20% will have severe obstruction and require surgical intervention. Others will have symptoms that persist or present beyond infancy. Th ese variants of laryngomalacia include persistent, late onset, neurologic variant and exercise induced laryngomalacia. Th is presentation will review our clinical and research experience with over 500 patients to review the spectrum of clinical presentation and how medical co-morbidities predict disease severity and infl uence outcomes from treatment and management strategies. Representative clinical cases will be presented. Surgical techniques that include supraglottoplasty and epiglottopexy will be presented. Data supporting abnormal sensorimotor integration between peripheral and central vagal nerve function in disease etiology will be discussed.
Apollo Gleneagles Hospitals
Time : 09:20-09:40
Shantanu Panja is a renowned ENT-Head & Neck surgeon at Apollo Gleneagles Hospitals, Kolkata with special interest is Laryngology, Head and Neck Oncology, Laser, Robotics and Skull base surgery. He presented his clinical research on Endoscopic Optic Nerve Decompression at the Annual Conference of AAO-HNS at Boston, 2010 and was conferred an International Fellowship at the University of Pennsylvania. He was also an invited speaker at the German ENT congress in 2013. He has won several awards in his career, including the Best Paper at the National conference of AOI in 2008 and Best Video in the 2011 State AOI conference.
Transoral Laser surgery has been the standard of management for upper aerodigestive tract lesions. It is an extremely versatile tool for both benign and malignant conditions and can be used for troubleshooting various complicated situations. We present our collective experience of managing more than 300 varied cases in upper aerodigestive tract. We also present a few unusual complex cases which were managed successfully with laser. Th e gradual evolution and future of transoral surgery and creating the road-map for managing complicated cases are being highlighted.
University of Belgrade, Serbia
Time : 09:40-10:00
Zivorad Nikolic graduated both from Medical and Dental Schools at the University of Belgrade, Serbia, Yugoslavia. He has fi nished his Postgraduate surgical specialty training and Master of Science in 1993 at the Department for Maxillofacial Surgery, Faculty of Dental Medicine, University of Belgrade. During his education he had specialty training with emphasis on Plastic and Reconstructive surgery of Head and Neck as well as Craniofacial Surgery at Oxfords Radcliffe Infi rmary, Great Britain. During the years 2000-2002 he spent 18 months working at Newcastle General Hospital and London’s Central Middlesex Hospital working as a part of the team for Head and Neck Surgery performing various types of Microsurgical reconstructions after tumour removal, which he continued to perform back at Department for Maxillofacial Surgery in Belgrade until now. After he received his PhD title in 2006 he was appointed as Associate Professor at Faculty of Dental Medicine, University of Belgrade.
Aim: Contemporary reconstructions of the head and neck defects after tumour resection, comprises free vascularised tissue transfer that became a gold standard in last few decades. Th e aim of this study was to review our clinical results and experience, with use of free microvascular flaps and compare them with recently published series.
Methods: 97 patients underwent microsurgical reconstruction aft er the tumour ablation in the region of head and neck. Flap viability was monitored intra operatively by the Auckland test and postoperatively by the clinical observation and mini- Doppler test.
Results: The overall success rate was 85.1%. Th e complications that appeared were: Three complete flap necrosis and six late flap ischemic necroses, in the period from 10th to 14th postoperative day, one necrosis due to a venous thrombosis and three partial fl ap necrosis occurred.
Conclusion: Free flap reconstruction of the head and neck is a surgical technique that provides the reconstruction of complex and extensive defects that could not be performed by using local or regional flaps.
Farah Aga graduated from King’s College London as a dentist in 2008. Since then, she has completed a Postgraduate certificate in Implant Dentistry and is currently studying Medicine at Bart’s & The London. She is a member of the Joint Dental Faculty of the Royal College of Surgeons of England. She is intent on pursuing a career in Oral & Maxillofacial Surgery. She has numerous publications in the fi eld of OMFS.
The purpose of this talk is to discuss HPV as a risk factor for oropharyngeal cancer, its mechanism of carcinogenesis, detection and therapeutics. Th ere will also be a discussion on current vaccination protocols for HPV.
Dr. Anand ENT Speciality Centre
Time : 10:40-11:00
R Anand is the Director and Head of ENT in Dr. Anand ENT Specialty Centre, an academic training institute, Coimbatore, India. He graduated from Madurai Medical College, Madurai, Tamil Nadu, India. He worked as Resident under Dr. Mohan Kameswaran, a world renowned ENT Surgeon from Chennai, India. He is a member of various associations’ like European Politzer Society of Otology, World Sleep Association, Cochlear Implant group of India, Founder Member of Indian Academy of Otorhinolargyngology Head & Neck surgery, Indian Association of Surgeons for Sleep Apnoea. He has presented several papers in India and international conferences and conducts Cadaver hands on workshops in regular intervals. He also conducted Rhinology and Otology live surgery workshops.
In India the incidence of laryngeal cancer is high because of smoking and increased consumption of alcohol. In laryngeal cancer true vocal cords are the commonest site. Th e treatment for early vocal cord carcinoma depends upon the staging. In early vocal cord cancer the treatment modality will be surgery or radiotherapy, or may be combined. In early glottic cancer intra oral surgeries like striping of vocal cord margin in very early period is acceptable. Lot of powered instruments are useful in these surgeries like micro debrider, CO2 & diode laser and the conventional cold knife. It is a case study, 6 cases were selected the criteria being involvement of one side vocal cord without fi xation of vocal cord. All cases were followed postoperatively for a period of 6 months to one year to assess the pain, comfort, voice quality and recurrence of the lesion. Coblation is an innovation in ENT. It is a very useful tool for intra oral & intra laryngeal cancer excision. It has a lot of advantages over all other methods. Few are listed below: • Trans oral route; less pain, no bleeding (Ability to control over bleeding) • No complication; laryngeal odema is less • Tracheostomy is not required • Healing is good; less hospital stay • Low risk of airway fi re, complete excision is possible • Risk of scarring and stenosis is less • Minimally invasive and less thermal penetration as compared to the laser • Advanced tip design provides easier access to the anterior commissure and removal of sessile (fl at) lesions • Optimal surgeon visibility; short learning curve • Easy OR set up & cost eff ective; safer to use than laser • Integrated suction and coagulation Conclusion: Coblation technique is a recent advance in ENT and we can use it safely in early laryngeal cancer without any complications.
Seoul National University
Time : 11:00-11:20
Hong-Gyun Wu is currently Professor and Chairman of Department of Radiation Oncology, Seoul National University College of Medicine. He completed his graduation in 1990 and PhD in Medicine in 2001 both from Seoul National University College of Medicine.
Introduction: Epidermal Growth Factor (EGF) stimulates target cells by binding to Epidermal Growth Factor Receptor (EGFR) and EGF-EGFR interaction regulates the expression level of a variety of transcription factors through multiple signaling pathways. Th ese pathways are sometimes involved in cancer initiation, promotion, and/or progression. Now many kinds of EGFR inhibitors are developed and used in the clinic. But we noticed EGF-induced cancer cell death in several EGFRoverexpressing cancer cell lines while EGF-induced proliferation of normal fi broblast cell lines. I would like to introduce some possible clinical application of EGF in the management of head and neck cancer based on our experimental data.
Materials & Methods: Two EGFR-over expressing cancer cell lines (AMC-HN3 and A431) and normal fi broblast were cultured with 0.01-1000 nM of recombinant human EGF (rhEGF), and clonogenic assay was performed. Aft er culturing serum-starved cells with 10 nMrhEGF, the expression patterns of two apoptosis-associated proteins (cleaved caspase-3 and cleaved PARP) and PI3K/Akt/mTOR signaling pathway were measured using immunoblotting. Balb/c-nu mice, which were inoculated with A431 (human squamous cell carcinoma) cells at right hind legs were divided into fi ve groups: I (no treatment), II (EGF for 6 days), III (EGF for 20 days), IV (radiotherapy (RT)), and V (RT plus concomitant EGF). EGF was administered intraperitoneally (5 mg/kg) once a day, and RT dose was 30 Gy in 6 fractions. Hematoxylin and eosin (H&E) staining sections of tumor, liver, lung, and kidney tissues were investigated. Immunohistochemistry staining of caspase-3 was performed in tumor tissues.
Results: In the clonogenic assay, the number of colonies was decreased in a dose-dependent manner in cancer cell lines, whereas rhEGF treatment increased the number of colonies in normal fibroblast. Th e expression of cleaved caspase-3 and cleaved PARP was signifi cantly induced in the cancer cell lines, whereas there was no expression in normal fi broblast. As for PI3K/Akt/mTOR signaling pathway, rhEGF treatment paradoxically suppressed the expression of PI3K, Akt, phospho-Akt, and mTOR in a time-dependent manner. EGF for 6 days decreased tumor volume since day 13, but it approached to the level of the control group on day 23 (P=0.550). Th e duration of tumor shrinkage was prolonged more in group V (RT + EGF), and the slope of tumor re-growth phase was steeper in group IV (RT) (P=0.034). EGF for 20 days decreased tumor volume until the end of follow-up (P<0.001).In the immunohistochemistry of caspase-3, mice treated with RT plus EGF showed stronger staining intensity than the RT group. Th ere were no abnormal histologic fi ndings in H&E staining of the normal organs.
Conclusions: EGF treatment induced cell death in the two EGFR-overexpressing cancer cell lines, and the mode of cell death was apoptosis. And, the cell death might be associated with the paradoxical suppression of PI3K/Akt/mTOR signaling pathway. According to animal studies, we suggest EGF-induced anti-tumor eff ect in the xenograft mouse models with A431 cells. Th e concomitant use of EGF resulted in tumor growth delay more, and it shows the potential as a radiosensitizer in the design of fractionated irradiation.
University of Santo Tomas Hospital
Title: Primitive Neuroectodermal Tumor (PNET) presenting as recurrent intranasal obstruction in an adult
Time : 11:20-11:40
Helena Michelle N Casipit completed her Pre medicine, Medicine, Post Graduate Internship at the University of Santo Tomas Hospital, Manila Philippines. She is currently a third year resident of Otorhinolaryngology Head and Neck Surgery, also at the University of Santo Tomas Hospital, Manila Philippines.
Background: Nasal obstruction is a common manifestation of diseases with nasal involvement such as: Allergic rhinitis, vasomotor rhinitis and rhinosinusitus. Th is article will report an unusual case of Primitive Neuroectodermal Tumor (PNET) in the sinonasal area in an adult, presenting as recurrent nasal obstruction.
Study Design: Case report
Setting: Tertiary hospital
Population: 65 year old female, with recurrent nasal obstruction.
Results: A 65 year old female presenting with recurrent nasal obstruction was treated conservatively as a case of Chronic Rhinosinusitis. However, further work up lead to a diagnosis of Primitive Neuroectodermal Tumor (PNET) in the Sinonasal area. PNET is an aggressive, locally invasive disease commonly presenting as loco regional pain in the lower limb of pediatric population. Various combinations of chemotherapy salvage surgery and radiation is currently the recommended treatment option.
Conclusion: Primitive Neuroectodermal Tumor (PNET) is a highly malignant tumor, primarily seen in the long bones and soft tissues of the pediatric population. At this moment, due to paucity of literature, there is still much to learn regarding the optimum management and long-term prognosis of PNET of the head and neck region in adults.
Nadir Ahmad, MD, FACS, is the Division Head, Otolaryngology-Head & Neck Surgery and Associate Professor of Surgery at the Cooper University Hospital/Medical School in Camden, NJ, USA. He is also the Director of the Head & Neck Cancer Program at the MD Anderson at Cooper Cancer Center in Camden, NJ, USA. He completed fellowship training in Head & Neck Surgical Oncology, Microvascular Reconstructive Surgery, and Skull Base Surgery at Vanderbilt University Medical Center under the mentorship of Dr. James Netterville, Dr. Brian Burkey, and Dr. Robert Sinard. He was previously an Assistant Professor in the Department of Otolaryngology- Head & Neck Surgery at the Virginia Commonwealth University/Medical College of Virginia. He has done surgical mission work in Nigeria and has been a Visiting Surgeon/ Professor at Civil Hospital/Dow Medical College and Indus Hospital, both in Karachi, Pakistan.
Carotid body tumors (CBT) are paragangliomas arising from the carotid body, a chemoreceptor located at the carotid bifurcation. These tumors are predominantly benign and slow-growing. Most CBT are sporadic but an understanding of the anatomy/physiology of paragangliomas, and potential familial inheritance, bilaterality, and association with other paragangliomas is paramount to the optimum evaluation and management of these tumors. Surgical resection with curative intent continues to be the treatment of choice, with minimum morbidity associated with proper preoperative planning and surgical technique. Observation and radiation therapy continue to be acceptable alternatives in select patients. It is imperative to understand the complications of CBT surgery, such as regional cranial nerve injury, fi rst bite syndrome, and baroreceptor refl ex failure, to properly counsel patients preoperatively, and manage these potential complications in the postoperative setting.
Radiation damage to the head and neck after radiotherapy is known to be associated with high T stage, the type of surgical intervention, the use of, the dose and the site of radiotherapy. Th ere may be a reduction in damage using intensity modulated radiotherapy with but damage can be increased by concurrent use of chemotherapy. Radiation damage to muscles and many other tissues occurs by a process of fi brosis. Th is restricts the action of the muscles and in the heads and neck is exhibited in a number of ways. Consequently a high proportion of patients receiving radiotherapy for head and neck cancer report some degree of dysphagia and trismus. Between 32 to 83% of patients receiving radiotherapy for head and neck cancer report some degree of dysphagia. Between 3-90% of post radiotherapy patients suff er from trismus. Depending on the severity, the limited mouth opening and loss of masticatory function can cause diffi culties with daily activities such as eating, chewing, swallowing, breathing, and speaking. It can lead to further problems such as severe pain, weight loss, and poor oral hygiene. Th e resultant limited access to the oral cavity can also make it impossible to clinically diagnose recurrence at this site. In terms of radiotherapy damage to the head and neck perhaps the most obvious but least common is osteoradionecrosis of the jaws and other bones. It is now well recognized that osteoradionecrosis is a consequence of fi brotic change in bone. Th e reported incidence of this varies but has been put at between 2-22%. Th e severity of this condition and its consequent eff ect on the patient is extremely variable, with a spectrum ranging from entirely asymptomatic to causing severe pain, disfi gurement and functional impairment of the jaws. All these fibrotic conditions can result in anxiety and depression and a signifi cant impairment in quality of life. Th ere are a number of genotypes may be indicative of susceptibility to fibrotic radiation damage, potentially giving a method of prediction to how the normal tissues individuals will respond to radiotherapy. This certainly includes a polymorphism in the transforming factor beta promoter gene, which has been shown to be predictive of osteoradionecrosis and trismus. Genome wide association studies may be used in the future and this constitutes an ongoing research project, to enable identifi cation of other genotypes. The aim is to be able to identify those patients who are most at risk of radiation damage, and modify treatment accordingly.
Dr Sulaiman Al Habib Medical Group
Kingdom of Saudi Arabia
Time : 12:20-12:40
Aikaterini Fragkou is an accredited ENT & HNS Consultant, with more than 10 years of clinical experience. PhD holder, with a strong academic background on evidence based medicine she shows a strong interest in otology, rhinology and voice pathology. She has a strong presence in many reputed medical journals. She is actually serving as a Consultant ENT & HNS in Dr. Sulaiman Al Habib Medical Group, Kingdom of Saudi Arabia, and is in strong collaboration with the ENT dept. of the National University of Athens, Greece.
Purpose: Tinnitus is very common among the patients that will knock on the door of your clinic, and, although it is very common among the hearing impaired population, specifi c treatment for tinnitus is not provided in most clinics. In this presentation we will try to provide a simplifi ed and methodic treatment plan that can be adopted and implemented in most ENT clinics. Method: In order to establish a tinnitus clinic, the tinnitus specialist should set an overall plan regarding the type and degree of tinnitus management. A multilevel assessment of the tinnitus is set, and it comprises of measurement of tinnitus and of the reaction a patient has to the tinnitus, including the use of questionnaires. Management typically involves counseling and therapy. In order to manage tinnitus, we take into consideration diff erent areas, such as thoughts and emotions, hearing and communication, sleep and concentration. Conclusions: Otolaryngologists are trained, other than to provide therapy, also to provide counseling to treat tinnitus patients. Our aim is to establish a treatment of 3 stages directed to the different patient categories, such as bothered, concerned, or distressed. Most cases should also include and follow up, whereas the more severe ones should also be referred to other specialties.
Kumaresh Krishnamoorthy after completing his residency in 1999 pursued advanced clinical fellowship training in the US in both -Head and Neck Surgery and Otology & Neurotology. He is one of the few in India to have a dual fellowship degree. He is an honorary faculty at Bangalore Medical College, India and he started the Cochlear Implant program which was the fi rst in a tertiary teaching Government hospital in Karnataka. He instructs in hands-on workshops on head and neck and Otology courses. He has authored text book chapters and has contributed articles in peer reviewed journals. He is actively involved with cutting edge research in the areas of his specialization. Microbial Robotics (formerly Bacterial Robotics), a life science fi rm developing microscopic BactoBots™ recently appointed him, as its Director, Clinical Surgery – India, for its soon-to-be-formed medical device subsidiary.
Tinnitus is an auditory phenomenon where sound is perceived in the absence of an external stimulus. Th is symptom aff ects 1 in 5 people. Th e majority of suff erers have subjective tinnitus and not objective tinnitus (where others can also hear the sound). Tinnitus can be unilateral or bilateral. Th e most common cause is hearing loss. Tinnitus can be benefi cial when it is used as a warning sign in patients who are prone to noise induced hearing loss (e.g., those working in industries without protection of their hearing). Th e management should be directed towards the underlying cause and includes a detailed case history, head and neck examination, measurement of auditory function with a hearing test, and identifi cation of associated symptoms. Though eventually many people become habituated to tinnitus, it can negatively impact the quality of life. In a small percentage of all aff ected people, the tinnitus can be severe enough to cause depression and anxiety. In recent years, cochlear implantation is being increasingly used to reduce tinnitus in eligible candidates, especially those with either associate unilateral or bilateral severe to profound hearing loss.
The Tinnitus Clinic Inc
Title: Acoustic coordinated reset neuromodulation in a real life patient populations with Chronic tonal Tinnitus
Time : 13:40-14:00
Mark Williams is a UK based audiologist with a specialist interest in the provision adult rehabilitation programmes for tinnitus and hyperacusis. He has previously led a team of audiologists for the NHS and has been a clinical tutor / examiner for MSc and BSc Audiology students at University College London (UCL. He is a registered as a Hearing Aid Dispenser and Audiologist with the Health Professions Council (HPC) and the Registration Council for Clinical Physiologists (RCCP). He originally completed a BSc Hons. in Molecular Biology, MSc in Audiological Science and Post-Graduation Diploma in Audiology from University College London.
Primary tinnitus has a severe negative infl uence on the quality of life of a signifi cant portion of the general population. Acoustic coordinated reset neuromodulation is designed to induce a long-lasting reduction of tinnitus symptoms. To test acoustic coordinated reset neuromodulation as a treatment for chronic, tonal tinnitus under real–life conditions, an outpatient study RESET REAL LIFE was commissioned. Herein we present the results of this study. In a prospective, open-label, nonrandomized, non-controlled multi-center clinical study with 200 chronic tinnitus patients, tinnitus questionnaire TBF-12 and Global Clinical Improvement-Impression scale (CGI-I7) are used to study the safety and effi cacy of acoustic coordinated reset neuromodulation. 189 patients completed the last 12 month visit, 11 patients dropped out. An additional observational study was also carried out with 66 subjects treated in an independent UK based clinic. For this work the THQ questionnaire and VAS scales, for tinnitus loudness and annoyance, were recorded over a 22-26 treatment period. Acoustic coordinated reset neuromodulation caused a statistically and clinically signifi cant decrease in TBF-12, THQ and VAS scores which was also reflected in the CGI-I7 aft er 12 months of therapy under real-life conditions. There were no persistent adverse events reported that were related to the therapy.
Wilhelmina Mulders completed her PhD in 1997 at the University of Nijmegen in The Netherlands and has since then worked at The University of Western Australia. She has published more than 45 papers in international peer-reviewed journals with the majority as first author.
It is generally accepted that trauma to the cochlea is the most common trigger for tinnitus. Th e altered input from the cochlea is thought to lead to plasticity in the central auditory system eventually resulting in abnormal patterns of activity in the cortex translating into the perceptual phenomenon that is tinnitus. At that stage, tinnitus is commonly thought to be generated by the brain and independent of cochlear output. However, using an animal model, we have found evidence to suggest the contrary. In our model we use acoustic trauma to induce hearing loss and increased spontaneous activity (hyperactivity) in central auditory structures, which may be involved in the generation of tinnitus. We demonstrated that for some time aft er trauma, central hyperactivity is due to hyperexcitability and is still dependent on cochlear drive. At later time-points the central hyperactivity becomes generated intrinsically. Our data could explain the mechanism by which furosemide, a loop diuretic known to suppress the spontaneous activity of the auditory nerve, can reduce tinnitus in some patients. It could also be a mechanism by which some forms of cochlear electrical stimulation may aff ect tinnitus perception. Experiments in our animal model will be discussed showing the eff ects of such treatments on central hyperactivity and tinnitus. Th e results show support for the notion that there may be a therapeutic window for recent onset tinnitus for drug or other treatments that target peripheral spontaneous activity.
University of Texas at Dallas
Time : 14:20-14:40
Sven Vanneste is an Associate Professor in auditory and integrative neuroscience with research focus on understanding the common pathophysiological mechanisms clustering groups of pathologies, such as thalamocortical dysrhythmias (pain, tinnitus, depression) or obsessive compulsive spectrum disorder (addiction, OCD, eating disorders) by translating knowledge obtained from one disease to other diseases with similar underlying mechanisms, and to develop novel invasive and non-invasive neuromodulation treatments based on it.
Non-pulsatile tinnitus is an auditory phantom percept characterized as a tone, or a noise-like sound such as a hissing or buzzing sound or polyphonic, in the absence of any objective physical sound source. Although advances have been made in symptomatic pharmacological and non-pharmacological treatments, these treatments are unable to eliminate the tinnitus sensation in most patients. One of the major breakthroughs in neuroscience was the recognition of neuroplasticity, i.e. the fact that the brain is capable of changing its activity, connectivity, structure and function as an adaptation to a changing environment. Neuromodulation has subsequently been developed to induce neuroplastic changes by the application of local electrical, magnetic, or other stimuli in an attempt to treat maladaptive brain-related pathologies. I will discuss novel approaches using non-invasive and invasive neuromodulation that have emerged as an interesting and promising modality in the investigation of novel approaches for tinnitus relief.
Mohammad Yousef Al Johani is an Assistant Consultant at the Department of Otorhinolaryngology Head and Neck Surgery at King Abdulaziz Medical City in Jeddah, Kingdom of Saudi Arabia. He obtained his MBBS at King Abdulaziz University in Jeddah, in 2005. He completed his Residency in the Western Region Program of the Saudi Board of Otolaryngology Head and Neck Surgery in Dec 2014.
Ectopic thyroid tissue is an uncommon abnormality. Most reported cases were in midline or near midline without thyroid gland in its normal position. Few cases were reported as lateral ectopic thyroid tissue without normally located thyroid tissue BUT Lateral ectopic thyroid tissue with normally functioning and positioning thyroid gland is extremely rare. We present a 60 years old female patient complaining of 5 months history of left submandibular mass. NO risk factors of malignancy. It was diagnosed as a case of submandibular lymph node or minor salivary gland tumor. CT SCAN with contrast showed well defi ned rounded lobulated mass immediately inferior and not continuous to left submandibular gland. Excisional biopsy was done. Histopathology report came as a benign thyroid tissue with lymphocytic thyroiditis background. Th is is a rare case of left sequestered submandibular thyroid nodule. Lateral thyroid ectopias refl ect difficulties in diagnosis and management.
University of Zurich
Time : 15:20-15:40
Martin Meyer has completed his PhD at the age of 32 years from Max Planck Institute of Cognitive and Brain Sciences Leipzig. He used to work as Post doc at the Universities of Edinburgh and Zurich. He is Assistant Professor for “neuroplasticity and learning in the healthy aging brain” at University of Zurich and Co-director of the “International Aging and Plasticity Imaging Centre”. He has published more than 80 papers in reputed journals. His present research focuses on neuroplasticity of tinnitus, functional neuroanatomy of the perisylvian region and neurocognition of speech perception and hearing loss.
Non-pulsatile tinnitus can be conceived as an auditory phantom percept of permanent high-pitched sound without any external sound source. While previous research and treatment focused on the inner ear, it is meanwhile widely accepted that tinnitus must not be considered as a sole dysfunction of the ear even though tinnitus is usually preceded and associated by minor to substantial hearing loss. It has rather been agreed that tinnitus emanates from a perplexing network that includes the ear and the auditory pathway, but primarily resides in the human brain. To date the general approach in tinnitus research suggests comparing data collected from individuals suff ering from subjective tinnitus (TI) with data of non-affected controls. However, recent research has shown that TI is not aff ected to the same extent. Hence, the undisputed heterogeneity of TI may account for all the previous failures in describing a consistent and comprehensive picture of the neural and psychological interactions that may underlie tinnitus. Th e talk presents data from human imaging studies that aimed at identifying plastic alterations in neuroanatomical and neurophysiological patterns in TI based on comprehensive psychopathological and behavioral measurements. Our data evidences the existence of two major factors, namely distress and duration, which diff erentially contribute to the pathophysiology of tinnitus. These two factors correspond to characteristic patterns of increased oscillatory activity in distinct frequency bands as well as systematic increase or decrease of cortical surface area and cortical thickness. Th is approach allows a better understanding of individual signature of tinnitus.
The University of Alabama at Birmingham
Time : 15:40-16:00
James A Bonner, MD, is the Merle M Salter Professor and Chairman, Department of Radiation Oncology, the University of Alabama at Birmingham School of Medicine (UAB), Birmingham, Alabama. Following residency and chief residency appointments in the Radiation Oncology Department at the University of Michigan, he joined the faculty at the Mayo Clinic, Rochester, Minnesota. He was a faculty member at the Mayo Clinic for 8 years prior to moving to the University of Alabama at Birmingham (UAB). While at the Mayo Clinic, the Mayo Fellows Association honored him Teacher of the Year in Radiation Oncology in 1994 and 1996, and was Co-Chair of the Lung Cancer Program of the Mayo-North Central Cancer Treatment Group (NCCTG) from 1994-1998. He is currently a Senior Advisor to the Cancer Center Director. He has had a long research interest in methods of enhancing radiosensitization such as combinations of chemotherapy or targeted therapy with radiotherapy. He has been the principal investigator of several clinical protocols and has published more than 125 manuscripts. He is a fellow of the American Society for Radiation Oncology (ASTRO). After serving in many University leadership roles, he was elected to be President of The University of Alabama Health Services Foundation (UAHSF).
Over twenty years ago, head and neck cancers were found to have high levels of Epidermal Growth Factor Receptor (EGFr) expression. Additionally, studies emerged that showed a correlation with increased levels of EGFr and decrease locoregional control and survival for patients with head and neck cancer who were treated with radiotherapy. In-vitro and in-vivo studies of human head and neck cancers demonstrated radiosensitization with the anti-EGFr monoclonal antibody cetuximab. Th erefore, it was hypothesized that the inhibition of EGFr may lead to improved loco-regional control and survival for this group of patients. An early Phase IB/IIA trial showed that the anti-EGFr antibody cetuximab could be safely combined with radiation for the treatment of unresectable loco-regionally advanced head and neck cancer. Th is initial regimen included curative radiation with weekly cetuximab. Also, this early study showed a promising complete response rate in 13 of the 15 evaluable patients on the trial. Th erefore, a Phase III trial was performed in order to compare this regimen of radiotherapy with weekly cetuximab (8 infusions) to radiotherapy alone for patients with loco-regionally advanced head and neck cancer. Th e 3 and 5 year survival results showed 10% absolute improvements in survival (cetuximab + RT: 46% vs. RT alone: 36% at 5 years). Importantly, the addition of cetuximab to radiotherapy did not increase the incidence of grade 3/4 mucositis or dysphagia. An evaluation of the time course of mucositis and dysphagia revealed that cetuximab did not alter the time to onset or time to resolution of grade 3/4 mucositis or dysphagia. Recently, Bonner, et al. have presented the importance of HPV status for the patients in this randomized trial (ESMO: 2014) and these results will be reviewed. Based on the promising results employing cetuximab and radiotherapy, numerous investigations have been performed to evaluate new combinations of cetuximab and chemoradiotherapy for patients with loco-regionally advanced head and neck cancer. Th ese studies will be reviewed. Also, other anti-EGFr agents are being studied in various combinations with chemotherapy or radiotherapy. Finally, investigations are being performed to study combinations of targeted agents that inhibit multiple critical aspects of EGFr signaling or more than one signaling pathway.
Shahid Sadoughi University of Medical Sciences
Title: Comparison the effect of peritonsillar infiltration of Tramadol and Parenteral Dexamethasone on Post tonsillectomy pain, nausea and vomiting in children
Time : 16:00-16:20
Zahra Sarafraz is a 29 years old resident in Otolaryngology Department of Shahid Sadoughi University of Medical Science. She has many articles and presentations in different countries and conferences such as ISCOMS, Esc-Berlin and AIMS. In 2014 she received best researcher award in her university.
Introduction: Tonsillectomy is a common surgery performed in children. Post tonsillectomy pain is an important concern. The aim of this study is assessing the eff ect of peritonsillar infi ltration of tramadol and parenteral dexamethasone on post tonsillectomy pain, nausea and vomiting in children.
Material & Methods: A double-blind randomized clinical trial was performed on 90 patients aged 6-12 years who were admitted for elective tonsillectomy. Th e patients were randomly divided into 3 groups to receive dexamethasone, tramadol or placebo. All patients underwent the same method of anesthesia and surgical procedure. Three groups had no diff erence in age, sex, and duration of anesthesia and surgery. Post-Operative pain was evaluated using VAS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting and were also assessed during 24 hours after surgery.
Results: Pain was signifi cantly lower in tramadol group (P=0.005), longer time to the fi rst request for analgesic (P=0.001), shorter time to the beginning of liquid regimen (P=0.001), and lower change in hemodynamic parameters such as blood pressure (P=0.001) and heart rate (P=0.001) than other two groups. Dexamethasone group had signifi cantly lower nausea and vomiting (P=0.001).
Conclusion: Preoperative peritonsillar infi ltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption and time to recovery without signifi cant side eff ects.
Jeremy Turner, PhD, is a Research Professor in Otolaryngology and Pharmacology at SIU School of Medicine and an Associate Professor of Psychology at Illinois College. His research focuses on animal models of hearing loss and tinnitus. His research has been supported by the US National Institutes of Health (NIDCD and NIA), the Tinnitus Research Consortium, the US Department of Defense, and several pharmaceutical companies. Dr. Turner also co-founded a contract hearing research company, OtoScience Labs, which conducts noise and tinnitus research and consulting. He is a member of the Association for Research in Otolaryngology, Society for Neuroscience, and is on the Scientifi c Advisory Committee of the American Tinnitus Association.
One major obstacle in the development of our understanding of the pathophysiology, prevention, and treatment for tinnitus is the fact that tinnitus measurement in both animal models and human subjects has been notoriously difficult. Without an adequate measurement of tinnitus we cannot hope to adequately diagnose, track, and provide treatment for those suff ering. This talk will highlight some of the datafrom our lab and others on the measurement of tinnitus in animal models and humans using silent gap-based testing. The hypothesis of this work is that the fundamental deficit present in tinnitus is that the subjectcan no longer hear silence. By using silence as a test cue in an automated session, we hope to be able to provide objective and reliable measurement of tinnitus, and to ultimately provide a useful tool for researchers and clinicians. Th is talk will highlight the need for better measurements in tinnitus, summarize the contributions of the animal model work, and identify the challenges still ahead of us.
Osaka University Graduate School of Medicine
Title: TINNITUS AS PRESENTING SYMPTOM OF DURAL ARTERIOVENOUS FISTULAS – A DIAGNOSIS NOT TO BE MISSED
Time : 16:40-17:00
Zogopoulos Panagiotis is a resident of Neurosurgery at the General Hospital of Nikaia-Piraeus “Agios Panteleimon”, Athens, Greece. He has conducted a 6-month research on dural arteriovenous fistulas at the Neurosurgery Department of Osaka University Hospital in Japan. Several of his papers have been published in reputed peer-review journals and he has presented various researches in international conferences.
Tinnitus can be the presenting symptom of a cerebral dural arteriovenous fistula (DAVF), a vascular shunt often characterised by an aggressive course. Over the last 7 years (2008-2014) 32 patients with cerebral DAVFs presented at the Neurosurgery department of Osaka University hospital. In 15 of these patients (47%) tinnitus was the presenting symptom that led to clinical and radiographic exams establishing diagnosis. Particularly, eight men and seven women with mean age of 57,6 years (range: 38-80 years) complained about tinnitus. Mean duration of symptomatology until diagnosis and treatment was 10.3 months. All 15 patients underwent endovascular treatment with embolisation of the shunt with detachable coils and/or glue. The distribution of DAVFs according to shunt location was: transverse-sigmoid sinus (n=8), cavernous sinus (n=3), tentorial sinus (n=2), sphenoid wing (n=1) and anterior condylar confluence (n=1). Patients who had tinnitus for more than 6 months before treatment (n=5) had a significantly worse clinical outcome regarding persistent tinnitus (P=0.01) compared to patients with tinnitus of less than 6 months' onset (n=10), over a mean follow-up period of 3 years. Tinnitus may occur even when the DAVF is not in direct contact with the auditory nerve. Increased awareness of clinicians, and especially ENTs, regarding this underlying pathology, is essential in preventing significant morbidity and mortality and magnetic resonance angiography is highly recommended for these patients, early in the course of their disease so as to establish diagnosis and proceed to proper treatment.