Grace Medical Bojrab ALTO

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Grace Medical ALTO System

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Endoscopic Transcanal Transpromontorial Removal of an Intracochlear Schwannoma and Traditional Cochlear Implantation

Vestibular schwannomas (acoustic neuromas) develop due to mutations in Schwann cells that cause uncontrolled cell division. As a result, a tumor forms. As these tumors grow, they can compress the cochlear nerve causing unilateral hearing loss and tinnitus. Vestibular schwannomas may cause imbalance and occasionally vertigo. Intralabyrinthine schwannomas account for about 10% of vestibular schwannomas in centers that specialize in temporal bone imaging. Intracochlear schwannomas are the most common type of intralabyrinthine schwannomas. In this video, we describe an endoscopic transcanal transpromontorial approach to intracochlear schwannoma removal. This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH. Video editing was performed by Austin Miller, OMS-II, Ohio University Heritage College of Osteopathic Medicine.

Middle Fossa Transventricular and Subtemporal Approach for Meningioma Resection

Contributors: Micheala Lee This is a demonstration of using the transventricular and subtemporal corridors for resecting a large middle fossa, tentorial meningioma. The video details the microsurgical technique for detaching the tumor from the tentorial incisura, working near critical structures such as the oculomotor nerve, trochlear nerve, and posterior communiating artery. It also includes precise demonstration of how to separate the massive tumor from the feeding arterial supply stemming from the posterior cerebral artery. DOI: https://doi.org/10.17797/nbtj2jdx6l

Microvascular Decompression for Trigeminal Neuralgia (combined venous & arterial)

Contributors: Fadi Sweiss Microvascular decompression is the most effective surgical procedure for treating trigeminal neuralgia in patients with classic symptoms. Here we present a patient who had a "duo crush" from both a vein, as well as a loop of the superior cerebellar artery. The key maneuvers to create space between the compressive element and the nerve, in order to secure the teflon "cushion," are highlighted. DOI: https://doi.org/10.17797/qgthi9k07c

Translabyrinthine Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

Contributors: Bruce E. Mickey and J. Walter Kutz This video highlights key steps to the translabyrinthine approach for vestibular schwannoma resection. It emphases identification of the facial nerve and the benefit of facial nerve monitoring in lateral skull base surgery. DOI#: https://doi.org/10.17797/4w83z6uxam

Microtia Reconstruction: Stage 1

Stage 1 Microtia Repair using rib cartilage and modifications to the Nagata method of auricular formation. DOI#: http://dx.doi.org/10.17797/cquv22l7p3

Bilateral Cryptotia Repair

Contributors: Shira Koss 6 year old boy suffering from bullying at school as a result of bilateral cryptotia, a very unusual congenital ear anomaly in which the superior helix is buried under temporal skin. DOI#: http://dx.doi.org/10.17797/le4g6c5rk5

Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome

Contributors: Amy M. Moore, and Brandon Isaacson CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This video describes a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess.

Microtia Reconstruction Stage 2

This is the second stage of Microtia Reconstruction, the first stage was depicted in a prior video. The ear is elevated and lateralized to take its 3-dimensional form, and this is accomplished with use of an anteriorly based mastoid fascial flap as well as costal cartilage graft and full thickness skin graft. Editor Recruited By: Michael Golinko, MD

Tympanoplasty with tragal cartilage graft, postauricular approach

Tympanoplasty with tragal cartilage graft, postauricular approach Blake Hollowoa, Michael Kubala, Gresham Richter. Introduction Tympanic membrane (TM) perforations arise from multiple conditions including acute otitis media, barotrauma, chronic eustachian tube dysfunction, or as a complication of pressure equalization (PE) tube insertion. Most perforations heal spontaneously or with conservative measures such as ototopical drops and dry ear precautions. Perforations that do not heal can lead to conductive hearing loss, chronic infection, or cholesteatoma. A 6-year-old patient with a persistent TM perforation presented with otalgia and otorrhea. A tympanoplasty with a tragal cartilage graft was performed to repair the patient’s TM perforation. Methods The patient was intubated and the operation carried out under general anesthesia. Facial electrodes were inserted for facial nerve monitoring. The patient was prepped and draped in sterile fashion. The external canal was suctioned and irrigated. A tragal incision was then made to harvest a 1 cm piece of cartilage for the TM graft. The tragal incision was closed with monocryl suture. A postauricular incision was made in the natural skin crease to expose the posterior canal. Canal incisions were made to enter the external canal. A tympanomeatal flap was elevated until the middle ear was entered. The previously harvested tragal cartilage graft was inserted medial to the native TM perforation. Gel-Foam was inserted medial to the graft for support. Tragal perichondrium was inserted lateral to the tragal cartilage graft. Gel-Foam was then inserted lateral to the graft for support. The periosteum and postauricular incision were closed with vicryl suture. The external canal was inspected, then antibiotic ointment and an ear wick was inserted. The patient was dressed using a Glasscock dressing. Results The patient was discharged the same day and seen in clinic two weeks from his surgery. The incisions were healing well with no indications of infection or wound dehiscence. His pain was resolved and an appointment for formal audiology was scheduled for a 3-month follow-up visit. Conclusion Tympanoplasty with a tragal cartilage graft using a postauricular approach is a successful method to surgically correct persistent tympanic membrane perforations.

Draping Technique for Major Ear Surgery during Pandemic!!!

Covid -19 Pandemic has changed the way we provide our healthcare services to our patients. ENT / Otolaryngology is one of the high risk speciality for contracting Covid infection. We as professionals has to take maximum precautions not only to protect our patients but also all our healthcare staff working with us in to minimise the risk of contracting the virus ((Krajewska). Unfortunately our patients do need appropriate necessary treatment for their otological problems during this pandemic. Drilling mastoid bone will generate significant aerosol during the procedure, putting everyone in the operating theatre at risk (Prof P Rae). Though every patient who undergoes any surgical procedure should have Covid test, self isolate and free from Covid symptoms. There is risk of contracting Covid infection from asymptomatic patient or staff. We should try and take every step to minimise the risk of contracting Covid infection either from Covid positive / negative Or symptomatic / asymptomatic patient or staff. There are few techniques been tried by our colleagues around the world to minimise aerosol during major ear surgery. We tried to use of the technique proposed by our colleagues in UK ( W. Hellier), as it was too cumbersome during the procedure, we propose the modified technique to drape the surgical site during major ear surgery to reduce the aerosol.

Total Facial Nerve Decompression via Combined Middle Fossa-Transmastoid Approach

This video demonstrates total facial nerve decompression via combined Middle Fossa-Transmastoid approach. Gavriel D. Kohlberg, MD,1 Noga Lipschitz, MD,1 Charles B. Poff, BS,2 MD, Ravi N. Samy, MD, FACS1,3 1 Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2 College of Medicine, Medical University of South Carolina, Charleston, SC, USA 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

Lateral Graft Tympanoplasty

Title: Lateral Graft Tympanoplasty Description: A lateral graft tympanoplasty is performed to demonstrate the utility of this technically challenging approach. The technical pearls that contribute to the high success rate of this graft are highlighted. Learning Points: The lateral graft tympanoplasty was popularized by Sheehy in the 1960s. Although technically more demanding than underlay graft techniques, the lateral graft is an essential method for Otologists to have in their armamentarium. The lateral graft is especially useful in cases of total perforation or anterior marginal perforation as well as revision tympanoplasty. Potential disadvantages of this technique include graft lateralization and anterior blunting as well as keratin pearl formation. When performed by an experienced surgeon, the results of lateral grafting are excellent. The technical considerations that promote successful lateral grafting are highlighted in this video.

Middle Fossa Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

This video demonstrates the operative setup and surgical steps of a middle fossa approach for the resection of vestibular schwannoma (acoustic neuroma). Authors: Cameron C. Wick, MD (cameron.wick@wustl.edu) 1 Samuel L. Barnett, MD (sam.barnett@utsouthwestern.edu) 2 J. Walter Kutz Jr., MD (walter.kutz@utsouthwestern.edu) 3 Brandon Isaacson, MD (brandon.isaacson@utsouthwestern.edu) 3 1 - Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 2 - Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 3- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX

Use of CO2 Flexible Fiber Laser in Lyses of Middle Ear Adhesions

This video demonstrates the use of CO2 flexible fiber laser for the lyses of middle ear adhesions in a patient s/p canal wall down mastoidectomy.

Endoscopic Ossiculoplasty (TORP) with Prolapsed Facial Nerve

This video illustrates an endoscopic ossiculoplasty using a total ossicular replacement prosthesis (TORP) in a patient with a mixed hearing loss and a large conductive component. The video highlights the middle ear anatomy including a dehiscent and prolapsed facial nerve partially obstructing the oval window. Technical pearls for the ossiculoplasty are also highlighted. Cameron C. Wick, MD Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA cameron.wick@wustl.edu J. Walter Kutz Jr., MD Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA walter.kutz@utsouthwestern.edu

Congenital Cholesteatoma - Endaural Approach Tympanoplasty

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Endoscopic Stapedotomy

Endoscopic ear surgery is an emerging technique championed for its improved visualization within the middle ear space. Stapes surgery presents a unique endoscopic challenge in that it offers a different type of depth perception compared to the binocular microscopic view. This video highlights the surgical steps for an endoscopic stapedotomy using a CO2 laser and Eclipse nitinol piston. The stapes footplate and stapedotomy are well visualized with the endoscope. Just like in endoscopic sinus surgery, depth perception is achieved through muscle-memory and camera movement. Author: Cameron C. Wick, MD Institution: Department of Otolaryngology - Head and Neck, Washington University School of Medicine in St. Louis, St. Louis, MO, USA Email: cameron.wick@wustl.edu

A Guide to Temporal Bone Dissection: Cortical Mastoidectomy & Facial Recess Approach (Part 1 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Description This video covers the key steps of a cortical mastoidectomy and facial recess approach during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. The first part of this video demonstrates a basic cortical mastoidectomy and focuses on fundamental principles including the preservation of the tegmen and sigmoid plate, adequate posterior canal wall thinning, continual saucerization, adequate removal of air cells, and early identification of the lateral semicircular canal and incus. The second part of the video discusses the facial recess approach and enlightens the viewer on the boundaries of the facial recess, the course of the mastoid segment of the facial nerve, and the location of the round window. Key surgical landmarks demonstrated in the course of this video include: zygomatic root, temporal line, posterior meatal wall, Henle’s spine, mastoid tip, tegmen mastoideum, sigmoid sinus, Koerner’s septum, lateral semicircular canal, incus, incus buttress, chorda tympani nerve, mastoid segment of the facial nerve, facial recess, round window niche, and round window.

A Guide to Temporal Bone Dissection: Endolymphatic Sac Dissection (Part 2 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video shows the key steps in the dissection of the endolymphatic sac during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part one of our video series and demonstrates fundamentals of endolymphatic surgery including the location and appearance of the endolymphatic sac, and its relationship to the labyrinth. Key surgical landmarks demonstrated in the course of this video include: sigmoid sinus, mastoid segment of the facial nerve, retrofacial air cells, endolymphatic sac, lateral and posterior semicircular canal, and Donaldson’s line

A Guide to Temporal Bone Dissection: Lateral Temporal Bone Resection (Part 3 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video covers the key steps of a lateral temporal bone resection during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part two of our video series. This approach allows for the en bloc removal of the external auditory canal and demonstrates fundamental steps of the procedure including: the propagation of a superior trough between the tegmen and the superior aspect of the external auditory canal, the extension of the facial recess inferiorly with sacrifice of the chorda tympani, and the drilling of the hypotympanic bone towards the glenoid. At the completion of the demonstration, the viewer is afforded a labelled view of the medial wall of the mesotympanum, as well as the medial aspect of the external auditory canal with an intact tympanic membrane. Key surgical landmarks demonstrated in the course of this video include: tegmen, zygomatic root, malleus, incus, stapes, glenoid, eustachian tube, mastoid segment of the facial nerve, chorda tympani nerve, facial recess, hypotympanic space, annular bone, tensor tympani tendon, cochlear promontory, pyramidal process, round window, and lateral semicircular canal.

A Guide to Temporal Bone Dissection: Labyrinthectomy (Part 4 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates the key steps of a labyrinthectomy during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part three of our video series and demonstrates fundamental steps involved in a labyrinthectomy including: the identification of the three-dimensional (3D) orientation of the semicircular canals, the location of the common crus, the relationship between the second genu of the facial nerve and the posterior semicircular canal, the relationship of the vestibule to the endolymphatic sac, the course of the subarcuate artery, and the relationship of the labyrinth to the internal auditory canal. Key surgical landmarks demonstrated in the course of this video include: posterior semicircular canal, superior semicircular canal, lateral semicircular canal, common crus, external genu of facial nerve, tympanic segment of the facial nerve, tegmen, vestibule, endolymphatic sac, endolymphatic duct, subarcuate artery.

A Guide to Temporal Bone Dissection: Internal Auditory Canal Dissection (Part 5 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates key steps in the dissection of the internal auditory canal during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part four of our video series and demonstrates fundamental steps involved in the dissection of the internal auditory canal including: establishing an inferior trough and identification of the cochlear aqueduct, establishing a superior trough and identification of the labyrinthine segment of the facial nerve, and blue-lining the internal auditory canal from porous to fundus. Key surgical landmarks demonstrated in the course of this video include: internal auditory canal, cochlear aqueduct, meatal segment of the facial nerve, labyrinthine segment of the facial nerve, 1st genu of the facial nerve, tympanic segment of the facial nerve, 2nd genu of the facial nerve, mastoid segment of the facial nerve.

A Guide to Temporal Bone Dissection: Infratemporal Approach (Part 6 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates key steps in the infratemporal approach during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part five of our video series and demonstrates fundamental steps of the procedure including: decompression and mobilization of the facial nerve, dissection of the cochlear scalae, skeletonization of the carotid artery, and entry into the jugular bulb. We demonstrate the wide opening of the jugular bulb to facilitate visualization of the medial wall of the jugular bulb, which subsequently aids in the dissection of the pars nervosa. Key surgical landmarks demonstrated in the course of this video include: sigmoid sinus, jugular bulb, mastoid segment of the facial nerve, cochlear scalae, internal carotid artery, pars nervosa

Endoscopic Stapedotomy (2:55)

Stapedotomy is used to treat conductive hearing loss caused by a fixed stapes footplate. The procedure is traditionally performed via a surgical microscope. In recent years an endoscopic approach has been increasingly utilized due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for stapedotomy via an endoscopic approach.   This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.   Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Endoscopic Tympanoplasty with Tragal Cartilage Graft in a Pediatric Patient (3:54)

Tympanoplasty is used to repair persistent perforations of the tympanic membrane. The procedure has traditionally been performed via a surgical microscope. In recent years an endoscopic approach has been increasingly used due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for endoscopic tympanoplasty using a tragal cartilage graft in a pediatric patient.   This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.   Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Surgical management of keratosis obturans

Keratosis obturans is a condition of the external auditory canal (EAC) characterised by formation and accumulation of desquamated keratin resulting in varying symptoms. Clinically presents as otalgia, conductive hearing loss and recurrent infection. Typically seen in younger age group and can occur bilaterally. Extension to adjacent structures can occur and result in further complications. The proposed theory is that there is a defect in epithelial in migration resulting in widening / osteitis of external canal bone. Condition was first described by Toynbee in 1850, and named by Wreden in 1874. Pipergerdes in 1980 distinguished keratosis obturans as separate disease from external auditory canal cholesteatoma. Ever since various treatment regime has been recommended but none of them have been curative. Michael M Paparella was first to propose surgical treatment in 1966 and he then modified the surgical technique in 1981. Because the defect is in epithelial migration, canaloplasty with or without graft, without obliterating the bony canal defect will not restore epithelial migration. Hence, M. M Paparella’s surgical technique was NOT popularized. Mr Basavaraj proposes novel technique which not only clears the diseased bone but obliterates the bony defect, and grafts the ear canal to bring it back to normal shape and size to encourage normal epithelial migration.

Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach

Authors: Gavriel D. Kohlberg, MD - University of Cincinnati Noga Lipschitz, MD - University of Cincinnati Charlie Poff, BS - Medical University of South Carolina Ravi N. Samy, MD, FACS - University of Cincinnati

Successful Placement of Transcutaneous Bone Anchored Hearing Aid in a Pediatric Patient

The Osia System is a transcutaneous bone anchored hearing aid which can be used for the correction of both conductive and sensorineural hearing loss. This video depicts the implantation of the Osia in a pediatric patient with a history of right-sided microtia.

Endoscopic Repair of a Jugular Diverticulum

We present a case of a patient with a jugular diverticulum causing persistent pulsatile tinnitus which was successfully treated with a CO2 laser endoscopic procedure. To our knowledge this is the first instance of a dehiscent jugular diverticulum being successfully treated in this manner. We believe this procedure is advantageous when compared to other treatment modalities because it is 1) minimally invasive 2) there is decreased pain and recovery time compared to other surgical approaches and 3) the risk of serious post-op infection such as meningitis is theoretically much lower when compared to posterior auricular approaches that must expose the dura of the brain to reach the jugular diverticulum.

Myringotomy and Tympanostomy Tube (Ear Tube) Placement

This video demonstrates the required instruments, appropriate set-up, relevant anatomy, and procedural steps for ear tube placement. Sarah Maurrasse, MD; Erik Waldman, MD Yale School of Medicine, Yale New Haven Children's Hospital

Endoscopic Assisted Aural Atresia Repair

Congenital aural atresia (CAA) is a birth defect that describes both aplasia and hypoplasia or stenosis of the external auditory canal (EAC). CAA can be associated with microtia (malformation of the pinna), middle ear and occasionally inner ear malformations. Surgical correction of CAA is a very challenging operation and requires a thorough knowledge of the surgical anatomy of the facial nerve, middle and inner ears. Traditional post-auricular approach or transcanal approach with the help of a microscope usually provides adequate images needed for the procedure. Endosocpic ear surgery provides the advantage of visualization beyond the view provided by the microscope, further refinement of the surgical approach, precise assessment of the ossicular chain mobility and placement of ossicular chain prosthesis if necessary.

Transotic Approach for Cochlear Schwannoma

This video shows a transotic approach for a cochlear schwannoma in a 59-year-old female who presented with sudden sensorineural hearing loss in her left three years prior. She was found to have subsequent growth of her tumor on imaging and elected to undergo surgery. The transotic approach is a valuable approach within the armamentarium of a skull base team and differs from the transcochlear approach in the handling of the facial nerve. Techniques for ear canal overclosure, eustachian tube packing and mastoid obliteration are also highlighted.

Use of CO2 laser in preparation for cochlear implant via round window

Use of CO2 laser in preparation for cochlear implant via round window

ENDOSCOPIC CARTILAGE MYRINGOPLASTY

This video demonstrates the use of the endoscope in cartilage myringoplasty. DOI# http://dx.doi.org/10.17797/gz02921q1s

Selective Stapedial tendon and Tensor Tympani tenotomy for the treatment of Middle Ear Myoclonus in a pediatric patient

Objective tinnitus is a rare phenomenon whereby a patient perceives sound in the absence of external auditory stimuli, that is also observed by the examiner. Unlike subjective tinnitus which is thought to be somatosensory and usually difficult to cure, objective tinnitus is more likely to have an identifiable cause amenable to treatment. The differential for objective tinnitus includes aberrant vascular anatomy affecting the temporal bone, patulous eustachian tube function, and abnormal myoclonic activity of the palatal or middle ear muscles.1 We present a 16-year-old female who presented for evaluation of objective tinnitus. On physical examination, an intermittent rhythmic clicking was identified. Visualization of both the tympanic membrane and palate during active audible tinnitus was observed and found to be normal. A hearing test was performed demonstrating normal hearing and speech thresholds as well as normal tympanogram. Acoustic reflex testing demonstrated absent decay in both ears and spontaneous discharge for the right ear in response to both high and very low stimulus indicating abnormal stapedial and tensor tympani function. MRA demonstrated normal vascular anatomy and MRI was obtained demonstrating normal anatomy without lesions of the brainstem, cochleovestibular nerves, or ear or mastoid pathology. The patients was subsequently diagnosed with isolated middle ear myocolonus (MEM). Treatment options including medical versus surgical therapy were discussed as has previously been described. The patient ultimately elected for surgical tenotomy of the stapedial and tensor tympani tendons. Using endoscopic technique, a middle ear exploration was performed. Canal injection was performed with standard tympanomeatal flap elevation was assisted with epinephrine pledgets. The Annular ligament was identified and the middle ear was entered. Additional dissections was performed superiorly, and the chorda tympani nerve was identified and preserved. The stapedial tendon was visualized emanating from the pyramidal eminence to the posterior crus of the stapes. Balluci scissors were used to sharply incise the tendon and the remaining ends were reflected using a Rosen needle to prevent re-anastamosis. Additional dissection along the malleus was performed to gain access to the tensor tympani tendon. A 30 degree angled endoscope was utilized to visualize the tensor tympani tendon extending forward from the cochleariform process to the neck of the malleus. The angled 6400 Beaver blade was used to sharply incise the tendon, requiring multiple passess due to the thickness of the tendon. The sharply incised ends of both tendons were clearly visualized. The tympanomeatal flap was re draped and secured with gel foam packing. The patient was seen in follow up three weeks post operatively with a well healed ear drum, resolution of her objective tinnitus, normal hearing, and absent stapedial reflexes. The patient and mother were happy. Endoscopic stapedial and tensor tympani tenotomy is a feasible technique for isolated MEM in the pediatric population.

Ravi N. Samy, MD, FACS

University of Cincinnati

• Director, Cochlear Implant and Auditory Brainstem Implant Program
• Program Director, Neurotology Fellowship
• Associate Professor, Department of Otolaryngology

Dr. Ravi Samy was born in Madras (now Chennai), India. He emigrated to the United States in 1973, at the age of 4. The first city in the US in which he lived was Canton, OH. After spending a few years in Connecticut during his father’s psychiatry residency, he moved to Wichita Falls, TX. He spent most of his formative years in Texas and considers himself a Texan. After graduating high school as co-valedictorian, Dr. Samy matriculated at Duke University. He graduated magna cum laude with a BS in Zoology in 1991. He then stayed on at Duke University School of Medicine and graduated in 1995. From 1995-2000, Dr. Samy was an intern and then a resident at Stanford University School of Medicine, where he developed a love for otology, neurotology, and skull base surgery. From 2000-2002, he was a fellow in Neurotology at the University of Iowa. After graduating, he was an Assistant Professor from 2002-2005 at UT-Southwestern Medical Center in Dallas, TX. Although he never wanted to leave Texas again, he was enamored with a phenomenal academic opportunity in the Department of Otolaryngology at the University of Cincinnati/Cincinnati Children’s Medical Center. He has been there for almost 8 years. He became an Associate Professor last year. During his time here, he has created an ACGME accredited, two-year Neurotology fellowship, one of only approximately 15 in the country. Dr. Samy serves not only as Program Director for the Neurotology Fellowship but also as the Director of the Cochlear Implant and Auditory Brainstem Implant program. His research interests include cochlear and auditory brainstem implantation as well as acoustic neuromas, neurofibromatosis type 2, facial nerve tumors, and other diseases and disorders of the lateral skull base. Finally, he is interested in using novel techniques and technologies to eradicate tumors, such as the use of surgical robotic systems or synthetic biology in the form of bacterial robotics systems. He is collaborating with researchers in India, including one of his former fellows, to incorporate these technologies and to enhance global health and increase collaboration between UC and international institutions, thus benefiting both US citizens and those of other nations.

Dr. Samy’s website, CiSurgeon.org provides information about Cochlear Implants, including FAQ, Cochlear Implant Surgery, preparation and more.

Harold C. Pillsbury, III, MD, FACS

University of North Carolina at Chapel Hill

• Chair, University of North Carolina Department of Otolaryngology
• Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery

Harold C. Pillsbury, III, M.D., F.A.C.S., is the Chair of the UNC Department of Otolaryngology/Head and Neck Surgery, as well as the Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery.

A native of Baltimore, Maryland, Dr. Pillsbury earned his B.A. and M.D. degrees from George Washington University in Washington, DC (1970 and 1972, respectively). He completed his residency training in Otolaryngology/Head and Neck Surgery at the University of North Carolina School of Medicine in 1976. Following six years at the Yale University School of Medicine, he joined the UNC faculty in 1982 as an Associate Professor. He served as Chief of the Division of Otolaryngology/Head and Neck Surgery from 1983 to 2001.

Dr. Pillsbury has completed an eighteen year term on the American Board of Otolaryngology where he served as Exam Chair and President. He is also past President of the American Academy of Otolaryngology-Head and Neck Surgery, The American Laryngological Association, The Society of University Otolaryngologists, and the Triological Society. He is also past CME coordinator and Vice-President of the Southern Section Triological Society. He is the past President of the American Academy of Otolaryngic Allergy.

Dr. Pillsbury has written and/or contributed to over 270 publications and over 45 textbooks. He has also given over 326 presentations nationally and internationally. He has been the primary investigator or co-investigator on over 21 grants. His special field of interest is neurotology and, most especially, cochlear implantation.

Deanne King, M.D., Ph.D.

• Assistant Professor, University of Arkansas for Medical Sciences
• Director of Clinical Research, Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences

King has a Bachelor of Science in biochemistry from the Texas A&M University in College Station. She has an M.D./Ph.D. in molecular and cellular biology and pathobiology from the Medical University of South Carolina in Charleston. She completed an internship in general surgery and a surgery residency in otolaryngology-head and neck surgery, both at UAMS.

King said she enjoys helping researchers make connections.

“Research can sometimes be an isolating pursuit, but collaboration and idea-sharing is so important to the overall process,” King said. “I’m also looking forward to helping our students and residents. Otolaryngology-head and neck surgery is a highly competitive field. Having published research to your name early in your career is not only a valuable experience, but, increasingly, a necessity for medical students to successfully match into an otolaryngology residency.”

Faculty in the Department of Otolaryngology-Head and Neck Surgery are fellowship-trained in their specialty and cover all the sub-specialties in the field (otology, endocrine, head and neck, rhinology, laryngology, pediatric and vascular anomalies). The faculty consistently receive high scores on patient satisfaction, and six faculty are listed in “Best Doctors in America.” They practice at UAMS Medical Center, Arkansas Children’s Hospital and the Central Arkansas Veterans Health Care System.

Gerald B. Healy, M.D., FACS, FRCSI, FRCS

• Professor of Otolaryngology – Head and Neck Surgery, Harvard Medical School
• Past President, American College of Surgeons
• The Healy Chair in Otolaryngology (Emeritus)
• Otolaryngologist-in-Chief (Emeritus), Children’s Hospital, Boston
• Surgeon-in-chief (Emeritus), Children’s Hospital, Boston

Gerald B. Healy, M.D., was born in Boston, Massachusetts and received his undergraduate degree with honors from Boston College in 1963 and his M.D. degree from Boston University in 1967. He is the emeritus Surgeon-in-Chief and the emeritus Gerald B. Healy Chair in Otolaryngology at Children’s Hospital Boston. Dr. Healy is Professor of Otology and Laryngology at Harvard Medical School.

Dr. Healy is a member of numerous honorary societies, including the American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, the Triological Society, the American Laryngological Association, the American Society of Pediatric Otolaryngology and the American Society of Head and Neck Surgery. He has served as President of the Massachusetts Chapter of the American College of Surgeons, the American Society of Pediatric Otolaryngology, the American Bronchoesopagological Association, and the Triological Society (the leading academic society in the specialty of Otolaryngology-Head and Neck Surgery). He has served as Secretary and President of the American Laryngological Association. He is an Honorary Fellow of the Royal College of Surgeons of Ireland and the Royal College of Surgeons of England. He has served as a Chairman of the Board of Regents of the American College of Surgeons and is a past-President of the College. He was the first Otolaryngologist to be elected President. Presently Dr. Healy is a Senior Fellow at the Institute for Healthcare Improvement, Cambridge, Massachusetts.

In 1986, Dr. Healy was elected to the Board of Directors of the American Board of Otolaryngology and served as its Executive Vice-President until 2004. He has also served as a Director of the American Board of Emergency Medicine. He served as a member of the Board of Registration in Medicine in Massachusetts through 2014.

Dr. Healy served as a former Trustee of the Boston Children’s Hospital and Boystown in Omaha, Nebraska.

An active scholar and lecturer, Dr. Healy is the author of several books and book chapters and/or monographs, and is extensively published in peer-reviewed journals. He has been the principal investigator of NIH funded research addressing diseases affecting infants and children and has been cited for his pioneering work with laser surgery in children. In addition he has lectured in North America, Asia and Europe on health care reform, patient safety, the need to restructure medical education and international medical collaboration.

Overview of Keratosis Obturans

Attendees will learn more about Keratosis Obturans and common complications that arise during the procedure. Panelists will answer audience questions during the presentation.

Sreeshyla Basavaraj MBBS, DLO, FRCS (ORL)

Consultant ENT Surgeon
St. Mary's Hopsital, IOW

Dr. Basavaraj was accredited by the Specialist Advisory Committee in Otorhinolaryngology - Head & Neck Surgery and has been awarded his Certificate of Completion of Specialist Training by the Specialist Training Authority of the Surgical Royal Colleges in 2009. After completion of his higher surgical training in Ear Nose Throat & Head Neck surgery in Liverpool, he worked as a Locum Consultant at Queen Alexandra hospital, Portsmouth. He was trained in all sub-specialities of ENT Head and Neck surgery with a sub-speciality interest in Otology. He, along with his other two colleagues, provides 24/7 ENT service for the Island population.

Getting Started in Endoscopic Ear Surgery

Drs. Michael Cohen, Nirmal Patel, Christen Caloway, and Adrian James discuss the necessary equipment and relevant anatomy knowledge required for endoscopic ear surgeries. They will also demonstrate basic surgical techniques for you to watch and learn.

Endoscopic Tympanoplasty and Ossiculoplasty

Drs. Justin Golub, Samantha Anne, Steve Hoff, and Michael Kuo compare different methods of performing Tympanoplasty and demonstrate safe techniques for both. They will also review the outcomes and potential differences patients may face based on the type of surgery performed.

Endoscopic Management of Cholesteatoma

Drs. Sharon Cushing, Walter Kutz, Alex Saxby, and Dan Choo highlight the roles of the Endoscope within various procedures. They will show how to utilize Endoscopic and Microscopic techniques alongside one another.

Future Directions for Endoscopic Ear Surgery

Drs. Joao Flavio Nogueira, Yi-Chun Carol Liu, and Arun Iyer look ahead to the future of Endoscopic Ear Surgery. They will discuss instrumentation and procedures currently in use and hypothesize where each might be headed and how it may come to be used down the road.

Congenital Hearing Loss: Management and Workup

Drs. Daniela Carvalho, Natalie London, Albert Park, Catherine Birman, and Sophie Achard discuss the diagnosis and treatment of Sensorineural Hearing Loss (SNHL), provide an update on therapy provided for Conductive Hearing Loss (CHL), and review the many recent advances with Cochlear Implants (CI) for children.

Cochlear Implant Surgery: Controversies and Complications

Drs. Natalie London, Kenneth Lee, Yisgav Shapira, and Sunil Dutt highlight the controversies in current Cochlear Implant (CI) guidelines, discuss common complications with CI and device selection process.

Challenges with Cochlear Implants: Approach and Selection

Drs. Sharon Cushing, Cameron Wick, and James G. Naples dissect the steps necessary to achieve surgical efficiency and demonstrate how to incorporate that safely into their teaching.

Single Sided Deafness

Drs. Kenneth Lee, Meg Dillon, Byung Yoon Choi, and Brendan O’Connell provide a holistic overview of Single Sided Deafness (SSD), review the Cochlear Implant (CI) options possible, and discuss the bone conducting treatment options, both surgical and non-surgical.

Dr. Derald Brackmann

Join us in the journey of the legend as he gives us insights into his life and his achievements. Join us to be inspired by one of the best surgeons in the world.

Dr. Brackmann will be joined by Dr. Ravi N. Samy, Chief of Otology/Neurotology at the University of Cincinnati , along with Dr. James G. Naples, Otologist/Neurotologist of Harvard Medical School, Beth Israel Deaconess.

Current Techniques, Pearls and Strategies for Cochlear Implantation

In the second installation of CSurgeries’ series in otology, join this interactive webinar with Dr. Sharon Cushing, paediatric otolaryngologist at The Hospital for Sick Children in Toronto, Canada, and an Associate Professor and Clinician Investigator in the Department of Otolaryngology Head and Neck Surgery at the University of Toronto, Dr. Samantha Anne, faculty member and otolaryngologist at the Cleveland Clinic, and Dr. Rodrigo C. Silva, Director, Ear and Hearing Center, Texas Children’s Hospital and Associate Professor, Baylor College of Medicine. This panel of experts will discuss how Cochlear implantation (CI) has evolved into the standard of care for the rehabilitation of children with significant hearing loss. These faculty members will discuss videos showcasing the most current techniques for CI in children, as well as pearls and strategies to avoid complications.

Treatment of Chronic Atelectatic Middle Ear with Endoscopic Placement of Cartilage Shield T-tube

Join this interactive webinar with Drs. Ravi N. Samy (University of Cincinnati Medical Center) James G. Naples (Beth Isreal Deaconess / Harvard Medical), and Yi-Chun Carol Liu (Baylor).

These faculty members in otology/neurotology will feature a video on the treatment of chronic atelectatic middle ear with endoscopic placement of cartilage shield T-tube while providing their commentary on the approach and sharing best practices for success.

The Future of Otology/Neurotology Surgery and Education in the Post-COVID Era

Join this interactive webinar with Drs. Ravi N. Samy (Cincinnati), Per Caye-Thomasen (Denmark), Sampath Rao (India), Alex Karkas (France), and James G. Naples (Boston). These faculty members in otology/neurotology will discuss their thoughts on the future of otologic surgery after the pandemic.

The panel will discuss topics such as decision-making, the state of elective surgery, telemedicine, and many others.
This webinar is the third installation of a series on surgery in the COVID 19 era, brought to you by CSurgeries. To access the previous recordings please go to: www.csurgeries.com

This webinar is sponsored by Grace Medical (http://www.gracemedical.com/)

CSurgeries: An International Perspective With Dr. Juliana Bonilla-Velez

Dr. Juliana Bonilla-Velez

PGY 4 – Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences
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Tell me a little bit about yourself.

My name is Juliana Bonilla-Velez, and I’m a 4th year resident at the University of Arkansas for Medical Sciences. I’m originally from Colombia, and that’s where I did my medical training. I was very fortunate to work with Dr. Rocco at Mass Eye & Ear Institute as a postdoctoral research fellow on oropharyngeal cancer, and then I came to do my residency training at UAMS. Here, I was also very fortunate to be able to work with Dr. Richter – who is not only one of the founders but an avid promoter of CSurgeries.

He introduced me to CSurgeries very early on in my training. It really is an amazing tool, especially for residents to be able to easily visualize all the things that you are reading!  At times, it can be difficult to put all the aspects of a surgery together (especially if you haven’t seen that type of surgery before) or to learn how different people [surgeons] do things. There are so many different techniques for each type of surgery, so I feel like it’s a great avenue that enriches resident education.

Dr. Bonilla-Velez, I understand you published with CSurgeries in June 2016.  What can you tell me about your experience? Was it easy? Difficult?

It was my first experience making a video, so that was a little challenging. I was working together with a medical student and we made a really good team.  She worked a bit more on the media aspect of helping to put the video together, but then we were able to work together and incorporate some of the more technical aspects of the surgery, and important steps and findings to highlight.

In fact, the recording of the procedure was not difficult at all. It did not interfere with the clinical aspect of what we were doing. The surgery went great, and recording did not obstruct it, make it slower or impose any impediment to the completion of the surgery. At the same time, it was very insightful to be able to review all of it and to put it together in a format that would be easy to teach others what was going on. Not only was it a great experience…it was fun!

It’s very interesting that as a resident you were able to partner with a medical student to take over the technical aspect of video recording and editing while you were able to oversee and supervise the surgical content. Having recently partnered with the International Association of Student Surgical Societies, it confirms that we’re going in the right direction. 

Absolutely. Even as a medical student, I was very involved in research and publication. I was actually one of the founders of the International Journal of Medical Students which was an amazing experience, but also gave me a better understanding of the other side of making science. From a medical student’s perspective, it is such an enriching and fulfilling experience to be able to participate in all of these avenues for publishing – participate in research projects, writing manuscripts or making videos – just learning how to think in that way, getting your feet wet and learning all of these skills are so important for the rest of your career as a physician, especially now with evidence-based medicine.

How has publishing with CSurgeries contributed to education as a surgical resident?

As an author, it was very interesting to be able to go through the process of putting the video together, thinking through all the technical aspects of what we were doing and summarizing it in a short format that would be easy to show others.

As a viewer and user of CSurgeries, it allows you to be able to see different techniques for different types of surgeries. Perhaps the Attending at your institution is doing the procedure one way, but seeing how others are doing it in other places certainly enriches your education. In preparation for surgery, CSurgeries publications allow you to see what the steps are, so you can get a more visual understanding of what it is you are going to be doing and what you’re reading in the books. In surgery, even more so than other specialties, this is critical. Learning in 2D in one thing.  Being able to see in 3D what it is you’re actually going to be seeing in surgery is quite another. For that reason, CSurgeries is definitely a very valuable tool – especially for people in training.

As a user of CSurgeries, is there a particular CSurgeries publication you recommend (either within or outside of your specialty) you recommend for our members to view and why?

As a 4th year resident, at least in my program, we haven’t started our otology rotation, so I feel like I struggle a little bit more trying to imagine and put together all the otologic surgeries. I haven’t been exposed to them nor have I seen them before. For that reason, one video that was very useful to me that I really enjoyed was Right Stapedotomy that was published by Dr. Babu at the Michigan Ear Institute. Just seeing the video, especially with the ear (it’s such intricate anatomy) was extremely useful. Having access to such a high-quality video that walks you through the surgery, seeing all the steps clearly, was really great.

Of course, there are going to be personal circumstances for which you would find a video more educational than others- depending on what your institution does or your prior experiences. One of the really neat things about CSurgeries is that there’s so much variety- not only within otolaryngology, but among all the other specialties. It’s got something for everyone.

You mentioned you are also a founder of the International Journal of Medical Students. What can you tell me about the IJMS?

Our vision was to create a space that would be made by medical students for medical students to promote research and to provide an avenue for publication that would include all specialties. We aim to speak to medical students who are in a unique part of their training. Not only do we offer a window for them to show their publications, but we are able to help get them to that high-quality level of having a paper that is amenable for publication.

It was also a very exciting to build a team of people that would be able to represent all  – not only from around the globe but also those in different stages of their training. We have mentors who have guided us from the beginning, taught us to put all these pieces together and to provide not only an avenue but a service for medical students worldwide where they can publish their work and learn. Especially nowadays where medicine is guided by the paradigm of Evidence-Based Medicine, it’s critical for physicians to be able not only to do research but to understand the research that is published. It serves to train both the authors and the students who are learning to be the editors about all the different aspects of the publication process.  It’s been a really very rewarding experience knowing we’ve been able to contribute to medical students’ education worldwide.

How is publishing with CSurgeries different from publishing with IJMS? How are they similar?

It’s different in the sense that the CSurgeries is a video peer-reviewed journal. It’s very visually perfect for the surgical field because it takes you through the novel of each surgery by  showing what the key structures are and the key steps you need to be doing. It’s very educational, especially for people in training. In terms of similarities, both aim to educate physicians, students and other surgeons. IJMS provides an avenue for written publication of research along with the more traditional strategies while CSurgeries provides an avenue for video publication. Both share a common mission of education.

What advice do you have for international medical graduates looking to pursue surgical residency in the United States?

It’s certainly a very difficult task, but at the same time, it can be immensely rewarding. You have to be very passionate about what you want to do, what you want to accomplish, and what you want for your life. If your goals are clear and you can translate all that passion into hard work and dedication to your specialty, that goes a long way. It’s certainly hard but not impossible. I’d highly encourage you to push through the difficulties if you feel that’s your life mission. Don’t give up on your dreams.

What would you be doing if you were not a surgeon?

Oh gosh! There is nothing else I would rather be doing! I wish I could have a parallel life to be able to do all the things I want to do, but all at the same time. But certainly the life I would not give up is being a future pediatric otolaryngologist and be able to continue to participate in academics, in research and education, and in clinical practice and leadership.  I look forward to playing a part in furthering the field

Watch Dr. Juliana Bonilla-Velez’s video Excision of Thyroglossal Duct Cyst and her Facebook Live, You’ve Matched, What’s Next?