Title: Hypoglossal nerve stimulation to treat obstructive sleep apnea
Hypoglossal Nerve Stimulation is an emerging therapy for patients suffering with obstructive sleep apnea, (OSA). Continuous positive airway Pressure, (CPAP), is currently the “gold standard” therapy for OSA, however, a significant proportion of patients, up to 50%, cannot tolerate this therapy. There are numerous surgical options for patients, however, hypoglossal nerve stimulation has been demonstrated to be highly effective in the properly selected patient.
Erich P. Voigt is Associate Clinical Professor of Otolaryngology – Head and Neck Surgery and Director of General – Sleep Otolaryngology at NYU Langone Health in NYC. He is a magna cum laude graduate of SUNY – Health Science Center at Brooklyn (Downstate Medical Center). He trained at the combined residency program of Manhattan Eye, Ear and Throat Hospital, New York Weill Cornell University, Lenox Hill Hopsital and Memorial Sloan Kettering Cancer Center. He was Chief Resident at Columbia University Medical School. Voigt has been faculty in academic medicine for over 20 years treating countless patients with OSA. He has lectured internationally on numerous subjects including Snoring and Sleep Apnea. He is the host of the ENT Show on sirius Xm satellite radio. He is an active surgeon performing Hypoglossal nerve stimulation implantation.
Title: Vertigo: Eustachian tube function should be tested before vestibular function
Eustachian tube dysfunction (ETD) is defined by symptoms and signs of pressure dysregulation in the middle ear. Vertigo associated with ETD is caused in most (and perhaps all) instances by unilateral Eustachian tube obstruction or by more complete obstruction one side than the other. Vertigo due to unilateral ETD was first defined as “alternobaric vertigo” (or ‘vertigo altenobarica’), by Dr. Claes Lundgren who coined the term in 1965 to describe vertigo in deep-sea divers. The fundamental mechanism of ABV is asymmetrical middle ear pressures. This diagnosis can also be applied to cases at ground level, no matter how minute the difference in pressure is. Persistent ABV at ground level is associated with abnormal vestibular function test results. ABV should be differentiated from any condition conferring active risk of vertigo or severe disequilibrium. Vestibular organ dysfunction is caused by poorly regulated pressure in the middle ears. Vestibular organs are dependent variable organs. Every clinical test currently used to assess vestibular function should ideally be performed in a state where pressures in the middle ear cavities are well within normal range, and perfectly balanced between the ears. Taking these points into consideration, I would like to (1) propose that ABV be included in the ETD Consensus Statement as an official symptom of ETD, (2) reiterate that Eustachian tube function should be tested before vestibular function, and (3) call for case studies and research into cases of vertigo where Eustachian tube function was assessed before vestibular function.
Hee-Young Kim is an otolaryngologist and director of Kim Ear, Nose and Throat Clinic, Seoul, Republic of Korea. He received his Doctor of Medicine, and PhD in pathology from Chung-Ang University, South Korea. His area of academic interest is Eustachian tube disfunction and he has published on topics such as Vertigo: Eustachian tube function should be assessed before vestibular function, Eustachian tube catheterization, vertigo due to Eustachian tube obstruction in peer-reviewed journals. He was awarded the Albert Nelson Marquis Lifetime Achievement Award. Since 2016, he has served as the Editor-in-Chief of the Journal of Otolaryngology-ENT Research.
Title: Endoscopic approach to ear surgeries
Although it is three decades since the first use of operative endoscopy for the exploration of old mastoid cavities ,the endoscope is used infrequently in the day to day surgical management of ear disease around the world. The role of the endoscopes as defined by many prominent otologists has been so marginal that most surgeons have not felt compelled to master newer techniques and instrumentation for its use. In contrast he started using endoscopy in ear surgery just 2 years after his postgraduate completion during practice years in Saudi Arabia. It has replaced the microscope as the instrument of choice in middle ear surgery. The endoscope offers a new perspective on cholestaetoma management as it provides more anatomical as well as functional approaches and widens our understanding of its pathology. Additionally the wide view provided by the endoscope enables minimally invasive transcanal access to all areas within the tympanic cavity and facilitates the complete extirpation of disease without the need for a postauricular approach or incision. According to my clinical experience more and more cadaveric dissections are needed to provide hands-on training with endoscopic ear surgeries as the future sees scarless mastoidectomies. Hethink endoscopes can replace the microscopes as a tool in all ear surgeries including petrous apex.
Syed imdad Husain hashmi has completed his MS ENT at age of 27 years from Pravara institute of medical science, Ioni, Ahmednagar, India. He is the ENT Specialist registrar at Shifa Jeddah Polyclinic snice last 6.5 years. He is also Editorial Board member of IP Journal of Otorhinolaryngology and Allied Science.
Title: Radiofrequency ablation for thyroid nodules – A new trend in the treatment for benign and malignant nodules
Until recently, classic treatment for most thyroid nodules was restricted to partial or total thyroidectomy, radioiodine therapy, or suppressive levothyroxine therapy, all of which have potential drawbacks. On the other side of the spectrum stands observational follow-up, which despite avoiding procedural complications, may lead to compressive symptoms or cosmetic concerns. In this context, Radiofrequency Ablation (RFA) and other thermal therapies have emerged to fill in the gap of less invasive and yet similarly effective therapeutic options for neoplastic thyroid disease. In the past ten years, RFA, for many reasons, has been progressively more employed in the treatment of thyroid nodules than other thermal treatments. This minimally invasive technique is largely beneficial in the face of patients who reject or are unsuitable for surgery due to clinical or cosmetic reasons. Many publications have already established RFA’s efficacy on large benign nodules or papillary microcarcinomas, confirming its role as a feasible alternative to thyroidectomy or radioiodine therapy. Moreover, complications such as thyroidectomy or radioiodine-induced hypothyroidism are significantly milder or less common in patients submitted to RFA. This presentation aims to update the recent trends in this innovative and disruptive technique concerning the treatment of benign and malignant thyroid nodules.
Erivelto Volpi is a head and neck surgeon specialized in thyroid and parathyroid diseases. He had his general surgery and head and neck surgery training at Hospital das Clinicas of the University of Sao Paulo, where he worked for 26 years until he retired in 2018. Since 2015 he works at the Oncology Center at Oswaldo Cruz German Hospital, one of Brazil's top ten private hospitals. He was one of the founders of the Brazilian Society of Endocrine Surgery and served for eight years at the Executive Committee of Latin American Thyroid Society. Currently, he is an Associate Editor of Clinical Thyroidology (a Journal of the American Thyroid Association).