Institute of Medicine in its seminal 2008 report: Retooling foran Aging America: Building the Healthcare Workforce. isminiseminar will provide clinicians with a comprehensive re-view of the evaluation and management of the older adultpresenting with the complaint of dizziness or imbalance. Onethird of individuals over the age of 65 years will suffer fromdizziness at some time, and the complaint accounts for one infourteen visits to the primary care physician. Disorders ofequilibrium result in significant diminution in quality of life,and are associated with falls, a major cause of morbidity in thisage group. The symptom of dizziness is challenging to primarycare practitioners who treat elderly adults, and is frequentlytreated with ill-advised vestibular suppression. This minisemi-nar will address both vestibular and non-vestibular causes ofdizziness in the elderly, with particular emphasis on historicalclues and physical examination. The specific geriatric chal-lenge of polypharmacy will be addressed, particularly as itrelates to disorders of balance. The following specific issueswill be discussed: 1) Benign paroxysmal positional vertigo isprevalent in the older patient; are outcomes different in theolder patient? How can we modify the Epley maneuver in the88 year-old kyphotic patient? 2) How do we perform a fall riskassessment and whose responsibility is it? 3) Whose respon-sibility is it to determine driving safety in the geriatric dizzypatient? 4) Can vestibular ablation be performed in the olderadult without trading vertigo for chronic disequilibrium? Canwe determine in advance which older adults will be able toachieve vestibular compensation? 5) Is imbalance and diffi-culty walking inevitable as people reach their 80s and 90s? Cananything be done to forestall this problem? Newer strategies investibular rehabilitation and prehabilitation to promote safeambulation and reduce fall risk will be discussed.EDUCATIONAL OBJECTIVES: 1) Diagnose the commoncauses of dizziness or imbalance in the older adult. 2) Knowspecific and non-specific treatment modalities for the variouscauses of imbalance in the elderly. 3) Counsel the elderlypatient and family members on quality of life issues related toimbalance.

Current Concepts in Microtia and Congenital

Aural AtresiaRobert Yellon, MD (moderator); Roland Eavey, MD;James Sidman, MD; Blake Papsin, MD, FRCSC,FRCS, FAAP

PROGRAM DESCRIPTION: Microtia and congenital auralatresia (CAA) are among the most challenging problems forotolaryngologists. In this miniseminar, the current evidencedescribing outcomes for management options for microtia andcongenital aural atresia (CAA) will be presented to assistsurgeons in making optimal decisions for each patient. Sur-geons with experience in the various types of reconstructionswill present options for reconstruction/rehabilitation in a de-bate-style format. The miniseminar will focus on the following

issues: 1) Microtia reconstruction has traditionally requiredmultiple staged surgeries with autologous rib graft harvest thatare technically difficult but excellent when successful. Alter-natives to for rib graft microtia reconstruction include glue-onprostheses, Medpore surgical implants, and BAHA fixturesused as anchors for prosthetic auricles. 2) For hearing rehabil-itation of CAA and severe congenital external auditory canalstenosis, options include aural atresiaplasty/canaloplasty ver-sus conventional hearing aids, bone conduction aids, orBAHA. 3) Current information concerning the genetics ofmicrotia/CAA and tissue engineering for cartilage productionfor auricle reconstruction will be presented. Current evidencein the literature will be presented along with the conclusions ofthe panelists regarding the surgical and non-surgical alterna-tives for patients with varying severities of microtia and CAA.As BAHA technology provides excellent hearing results forCAA and stable anchors for clip-on prosthetic ears, patientselection criteria for BAHA/prostheses versus microtia recon-struction/aural atresiaplasty must be adjusted to provide pa-tients with the best outcomes and minimal risk. However,surgical microtia and CAA reconstruction are still excellent forproperly selected patients.EDUCATIONAL OBJECTIVES: 1) Understand surgicalmanagement of microtia reconstruction and how BAHA al-tered selection criteria. 2) Understand management of congen-ital aural atresia and how BAHA altered selection criteria.3) Understand the genetics of microtia/CAA and tissue engi-neering techniques for cartilage production.

Determining the Source of Vertigo: BPPV

versus Other CausesGerard Gianoli, MD (moderator); Michael Teixido,MD; Michael Hoffer, MD; Mans Magnusson, MD,PhD; F Owen Black, MD

PROGRAM DESCRIPTION: This seminar presents a discus-sion of emerging techniques for the objective assessment of360-degree evaluation of all three semicircular canal pairs,relative to gravity vertical, as well as for differentiating non-particle (BPPV) induced positional vertigo. Seminar presenterswill discuss current physical principals and theorems and makeextensive use of video recordings of procedures and resultantnystagmus, as well as state-of-the-art 3-D modeling and ani-mations. While most knowledgeable clinicians today performcanalith repositioning, this miniseminar delves into the under-lying pathophysiology and anatomy as well as detection anddifferentiation of nystagmus patterns for all canals, variants ofBPPV and also non-particle positional vertigo. We will discussthe significance of the emerging peer-reviewed literature thatsuggests that BPPV variants and non-particle positional vertigoare more common than has been thought. Presenters will alsodiscuss their own experience regarding the usefulness of acomputerized, multi-axial system for facilitating managementof the entire spectrum of vertigo. Therefore, this course will

P32 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010

debate the need to see position-related vertigo more broadlythan posterior canalithiasis or cupulolithiasis. This course hasvalue for any otolaryngologist who evaluates dizzy patients inunderstanding a nystagmus-based approach to position-relatedvertigo rather than a rote maneuver approach. Nystagmus vid-eos and procedure replays will be used as the basis for discus-sion and exchange of ideas.EDUCATIONAL OBJECTIVES: 1) Understand underlyingpathophysiology and anatomy for nystagmus-based approachto position-related vertigo, both particle and non-particle.2) Understand importance of assessing the entire 360 degreesof each semicircular canal in BPPV patients.

Evidence-Based Otologic SurgerySimon Angeli, MD (moderator); Cliff Megerian, MD;Lawrence Lustig, MD; David Friedland, MD, PhD;Alan Micco, MD

PROGRAM DESCRIPTION: The interest in Evidence-Based Medicine (EBM) has recently grown out of the need forvalid clinical information, and increasing pressure by the pub-lic and policy makers on clinicians to justify recommendationsabout health care. EBM is a discipline with specific conceptsand tools intended to aid in making decisions about the care ofindividual patients. The practice of EBM depends on the use ofthe best available evidence. Although EBM has been wellestablished in medicine, its practice in the surgical specialties isnot as widespread. One of the problems of the practice of EBMin the surgical specialties is that less than half of all surgeriesare amenable to study by an unbiased design such as a ran-domized clinical trial. To solve a specific clinical problem, theclinician is often confronted with the overwhelming task ofreconciling conflicting and widely diverse information. Fortu-nately, strategies for tracking down and appraising clinicalevidence have been developed and made available to the busyclinician. Similarly, the level of clinical studies in specialtypublications is expected to rise with increasing demands forbetter quality research by both the medical community and thepublic. This course will discuss the definition, significance, andpractice of EBM as it relates to otologic surgery. We willreview the steps of the practice of EBM: 1) formulating rele-vant questions; 2) tracking down the best evidence; 3) apprais-ing the evidence for its validity and importance; and 4) inte-grating the appraisal with our clinical expertise, patientsvalues, and circumstances. To illustrate the practice of evi-dence-based otology and using the best available evidence, thefollowing questions will be discussed by the experts: Introduc-tion: Practicing Evidence-Based Medicine. 1) Intratympanicgentamicin for vertigo of Meniere’s disease; 2) Combinedsteroid therapy and sudden sensorineural hearing loss; 3) Sur-gery for acute traumatic facial paralysis; 4) Is surgery everindicated for malignant external otitis? 5) Is a second-looktympanomastoidectomy for cholesteatoma always indicated?

EDUCATIONAL OBJECTIVES: 1) Develop an understand-ing of basic concepts of evidence-based medicine (EBM).2) Learn skills for the appraisal of studies about surgical ther-apies for common otologic disorders. 3) Review surgical ther-apies for Meniere’s disease, sudden hearing loss, cholestea-toma, facial paralysis, malignant external otitis.

Tinnitus Cutting Edge Treatment OptionsMichael Hoffer, MD (moderator); Carey Balaban,PhD; Abraham Shulman, MD; Jeff Carroll, PhD;Tobias Kleinjung, MD

PROGRAM DESCRIPTION: The diagnosis and treatment oftinnitus are extremely challenging. Due to the nature of thedisorder there has been a significant increase in the number oftherapeutic options available over the last several years. This islargely due to a continued search for more effective options forpatients who suffer from this disorder and from the inability tofind one therapy that works in the majority of cases. The lackof such a standard therapy is understandable given the varietyof etiologies of tinnitus but at the same time can be veryconfusing to those who see patients with this disorder. In thisfirst installation of a five year program on tinnitus we willbegin by discussing some unifying theories on the etiology oftinnitus and how we might best design treatment options. Wewill spend the majority of the time looking at the newesttreatment options including new drug therapies and new soundand counseling therapies as well as examining the state of theart in transmagnetic stimulation and transcranial stimulation.We have assembled a panel of United States and Internationalexperts in these areas with the goal that each participant canreturn to their practice with useful tools in managing patientswith tinnitus. The seminar will involve mini-presentations fromeach panelist followed by a directed question and answer period.EDUCATIONAL OBJECTIVES: 1) Understand some com-mon tinnitus pathophysiologies. 2) Understand the newesttreatment options for tinnitus. 3) Implement new treatments fortinnitus in their practice.

Treating COM Conductive Hearing Loss: What

Should We Do?Ravi Samy, MD (moderator); Nikolas Blevins, MD;Eric Kraus, MD, MS; Lorne Parnes, MD; BrianWesterberg, MD, MHSc

PROGRAM DESCRIPTION: Conductive hearing loss can bedue to a variety of conditions, but it most commonly occurs inchronic otitis media with or without cholesteatoma and/or itssurgical treatment. Ossiculoplasty has been the mainstay forsurgical correction of conductive hearing loss. Unfortunately,numerous factors including disease recurrence and/or persis-tent Eustachian tube dysfunction create significant variabilityin results and affect the long-term stability of reconstruction.Even in experienced hands, ossicular reconstruction can betechnically demanding. The use of autologous tissue (i.e., bone

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