The 2010 American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF) & OTO EXPO took place Sept. 26 to 29 in Boston and attracted over 9,000 participants from around the world, with the OTO EXPO featuring more than 300 companies with products and services. The conference focused on advances in otolaryngology, and included instruction courses, mini-seminars, scientific oral presentations, honorary guest lectures, and numerous scientific posters.
Several studies presented at the conference focused on applications of robotic surgery in otolaryngology. Ronald Kuppersmith, M.D., of the Baylor College of Medicine in Houston, moderated a mini-seminar that focused on potential advantages and disadvantages associated with thyroid surgery using the da Vinci surgical robot system, and discussed the surgical technique. The seminar also discussed patient selection and future applications of robotic surgery.
"Robotic surgery presented at these meetings is making advances in different areas, including sinus surgery and cancer surgery of the head and neck, and shows great promise in the future," said Jordan Josephson, M.D., director of the New York Nasal and Sinus Center and attending physician at the Manhattan Eye, Ear, and Throat Hospital.
In other research, Claudio Vicini, M.D., of the University of Pavia in Italy, and colleagues found that transoral robotic surgery (TORS) is safe and effective in treating patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The researchers retrospectively evaluated 40 adult patients with severe OSAHS, who were surgically treated with the da Vinci robotic surgical system during the previous 18 months.
"OSAHS TORS proved to be a feasible, safe, and effective surgical approach to OSAHS," the authors write.
Other surgical approaches have proven to be feasible, safe, and effective in head and neck surgery. In one study, researchers in Brazil found that the Miccoli technique is safe and feasible, with only a single incision required and surgical time equal to or even lower than that of conventional thyroidectomy, and apparently less postoperative pain. The investigators performed 700 minimally invasive video-assisted thyroidectomies using Miccoli's technique for benign and malignant thyroid nodules.
"The greatest difficulty for the introduction of the method is the change in the operating room preparation and commitment of the team to a new way to perform surgeries. The limitations of the method are those concerning the volume of the gland and nodules and the presence of thyroiditis, especially in the first cases," the authors write.
During a mini-seminar, a panel of experts discussed advances in the understanding of sinus disorders and novel surgical techniques. The panel discussed challenging cases and provided practicing otolaryngologists with surgical techniques to be applied to clinical practice. The experts provided information on surgical approaches for complicated allergic/inflammatory disorders, infectious problems, complicated nasal polyposis, encephaloceles, and skull-base tumors.
While surgical advances have improved outcomes of patients with chronic rhinosinusitis, surgical treatment does not always cure the condition, and many patients may opt for medical management. Currently, no guidelines, consensus, or recognized standards guide medical management of chronic rhinosinusitis, and some patients fail to respond to conventional management. In one mini-seminar, a panel of experts discussed the use of systemic and topical antibiotics, systemic and topical antifungals, systemic and topical immunomodulators, and systemic pharmacotherapy and immunotherapy for the treatment of chronic rhinosinusitis.
"Topical therapy with antibiotics and antifungals to treat sinus disease represents a great advance in the treatment of sinus sufferers. Topical antibiotic and antifungal therapy saves the patient the risks of internal therapy, and the latest studies support the efficacy of such therapy, which is now being more accepted worldwide. Sublingual therapy for allergies is now mainstream in Europe and around the world as a replacement for allergy shots, although this is still only practiced by [a] few physicians in the United States," Josephson said.
In another mini-seminar, otolaryngologists discussed advances in cochlear implant technology for the treatment of sensorineural hearing loss. The seminar provided an overview for the practicing otolaryngologist of currently approved U.S. Food and Drug Administration devices and touched on implantable hearing devices in development, discussing cochlear implants, implantable bone conductors, and devices for sensorineural hearing loss. In addition, the seminar reviewed electrical acoustical stimulation and provided a comparison of two bone conduction implant systems.
In one study evaluating the prevalence of hearing preservation following cochlear implantation (CI), Matthew Carlson, M.D., and colleagues found that acoustic hearing preservation following conventional long electrode CI is unpredictable but should be maintained as a realistic goal. The researchers retrospectively reviewed data on 292 implant patients who underwent CI with a newer generation implant model (Nucleus N24 Contour series or later, Advanced Bionics HR90K, and Med El Sonata) between 2004 and 2009.
The data revealed that hearing preservation occurred in 61 percent of patients, and 39 percent experienced no measurable hearing after CI. The researchers also found that post-implant monosyllabic word recognition was significantly associated with degree of hearing preservation.
"Preserved acoustic hearing potentially allows for combined electroacoustic stimulation in a select group of patients. Perhaps more germane to the conventional length CI recipient, minimally-traumatic electrode insertion may preserve delicate intracochlear neural structures allowing for improved speech perception in the electric-only condition," the authors write.
Several presentations focused on growing concerns involving insurance coverage and reimbursement associated with otolaryngology management and surgery, especially in the face of health care reform. While significant research is helping physicians provide more quality care to patients, many practicing otolaryngologists are concerned with the lack of insurance coverage and reimbursement.
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