Yvonne Chan

Background Understanding mistreatment within medicine is an important first step in creating and maintaining a safe and inclusive work environment. The objective of this study was to quantify the prevalence of perceived workplace mistreatment amongst otolaryngology—head and neck surgery (OHNS) faculty and trainees in Canada. Methods This national cross-sectional survey was administered to practicing otolaryngologists and residents training in an otolaryngology program in Canada during the 2020–2021 academic year. The prevalence and sources of mistreatment (intimidation, harassment, and discrimination) were ascertained. The availability, awareness, and rate of utilization of institutional resources to address mistreatment were also studied. Results The survey was administered to 519 individuals and had an overall response rate of 39.1% (189/519). The respondents included faculty (n = 107; 56.6%) and trainees (n = 82; 43.4%). Mistreatment (intimidation, harassment, or discrimination) ...

An intriguing aspect of human eNOS gene expression is its relative restriction to the vascular endothelium. Functional expression studies have demonstrated that the cooperative interaction of Ets family members, Spl and Sp3 variants, MAZ, and W I are important in the transcriptional activation of the eNOS promoter. eNOS promoterfluciferase reporter constructs lack cell-specificity in transient uansfection assays in non-endothelid cells known not to express native eNOS mRNA. These results suggested that there exist cell-specific mechanisms that repress native eNOS gene expression in non-expressing cells. We propose that DNA methylation may play a role in this cell-specific expression of eNOS. Methylation-sensitive isoschizorner mapping revealed that the methylation status of the 5'-flanking region of the human eNOS gene differed between eNOS-expressing and non-expressin q human cell types. The methylation status of functionally-important regions of the human eNOS core promoter (-...

Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines...

Background Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were complete...

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature repor...

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology – Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions...

Background Acute bacterial rhinosinusitis (ABRS) is a highly prevalent disease that is treated by a variety of specialties, including but not limited to, family physicians, emergency physicians, otolaryngology—head and neck surgeons, infectious disease specialists, and allergy and immunologists. Unfortunately, despite high-quality guidelines, variable and substandard care continues to be demonstrated in the treatment of ABRS. Objective This study aimed to develop ABRS-specific quality indicators (QIs) to evaluate the diagnosis and management that reduces symptoms, improves quality of life, and prevents complications. Methods A guideline-based approach, proposed by Kötter et al., was used to develop QIs for ABRS. Candidate indicators (CIs) were extracted from 4 guiding documents and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliabilit...

The Choosing Wisely Canada campaign is an initiative that aims to involve physicians and patients in collaborative decision making to avoid unnecessary tests and treatments. The Rhinology Subspecialty Group of the Canadian Society of Otolaryngology – Head & Neck Surgery developed a list of five evidence-based recommendations for the management of acute rhinosinusitis and nasal fractures: (1) don’t prescribe antibiotics to patients with acute sinusitis who do not meet the diagnostic criteria for acute bacterial rhinosinusitis; (2) don’t order a CT scan for uncomplicated acute rhinosinusitis; (3) don’t order plain film sinus x-rays; (4) don’t swab the nasal cavity as part of the work up for rhinosinusitis; and (5) don’t order a plain film x-ray in the evaluation of nasal fractures.

Chronic rhinosinusitis (CRS) has been identified as a high-priority disease category for quality improvement. To this end, this study aimed to develop CRS-specific quality indicators (QIs) to evaluate diagnosis and management that relieves patient discomfort, improves quality of life, and prevents complications. A guideline-based approach, proposed in 2012 by Kötter et al. was used to develop QIs for CRS. Candidate indicators (CIs) were extracted from 3 practice guidelines and 1 international consensus statement on the diagnosis and management of CRS. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology. Thirty-nine CIs were identified ...

The frontal recess is the drainage pathway that connects the frontal sinus to the anterior ethmoid sinus. Mechanical obstruction is the primary cause of chronic frontal sinusitis with or without a secondary inflammatory process. Eosinophilic inflammation is one of the underlying causes for chronic rhinosinusitis. OBJECTIVES/HYPHOTHESIS: To evaluate long-term frontal sinus patency after endoscopic frontal sinusotomy in chronic rhinosinusitis patients and to assess the effect of eosinophilic inflammation on frontal sinus patency. Retrospective chart review. Symptom assessment and archived endoscopic photographs were prospectively collected on patients who underwent frontal sinusotomy between 7-1-1999 and 12-31-2000. Subjective symptom improvements were evaluated using the SNOT-20 = 20-item Sino-Nasal Outcome Test. Objective findings of endoscopic frontal sinus patency were documented by archived digital photography. A total of 161 patients with 294 frontal sinuses who underwent endoscopic frontal sinus surgery in the 18 months had an average follow-up of 45.9 months. The patient population was divided into two groups: 58 patients had eosinophilic CRS (ECRS), and 103 patients had CRS without eosinophils (non-ECRS). The mean follow-up for patients with ECRS is 61.6 months and 37.0 months for non-ECRS patients. The non-ECRS patients had a documented endoscopic frontal sinus patency of 90%, and the ECRS patients had an endoscopic frontal sinus patency of 85%. The overall frontal ostium patency rate for all patients was 88.0%. Long-term endoscopic confirmation of frontal ostium patency demonstrates that endoscopic frontal sinusotomy can yield high quality, durable results. There was no significant difference in patency results between ECRS and non-ECRS patients. Laryngoscope, 2009.

A conventional approach to image-guided surgery relies on positional tracking relative to preoperative images. We investigated the performance of intraoperative cone-beam computed tomography (CBCT) on a mobile C-arm for real-time guidance of head and neck surgery. Objectives were as follows: (1) to quantify improvements in surgical performance achieved with intraoperative CBCT and (2) to investigate specific, challenging surgical tasks for which CBCT is essential for total target ablation and critical structure avoidance. Surgical performance was evaluated using a phantom model in which a simulated skull base lesion was excised with and without intraoperative CBCT guidance. Performance was quantified by means of statistical decision theory analysis for conservative and radical excision tasks, yielding measures of sensitivity and specificity for each surgical task. Cadaveric specimens were employed to demonstrate the efficacy of CBCT guidance in sinus and skull base surgery. Performa...

Tinnitus is the perception of sound with the absence of acoustic stimulus. It affects approximately 10% of the population. This is a symptom with a broad differential diagnosis. In some cases, tinnitus impacts significantly on patients' activities of daily living. Understanding how to differentiate between subjective and objective tinnitus is essential to the evaluation and management of these patients. The various causes of each type of tinnitus will be discussed. This review presents a general approach to tinnitus in order to facilitate timely diagnosis and management of this complex symptom.

To determine patients' smoking status after the diagnosis and treatment of squamous cell carcinoma of the head and neck (SCCHN) and to identify factors associated with smoking cessation. Cross-sectional survey study conducted over a 2-year period. Head and neck surgery clinic of an academic tertiary care hospital. Two hundred thirteen consecutive patients diagnosed with SCCHN were interviewed to ascertain patients' smoking status and the incidence of smoking cessation. Information on demographics, tobacco and alcohol history, disease characteristics, and treatment modality was also collected. The rate of smoking cessation was evaluated, in which smoking cessation is defined as the use of no cigarettes at least 1 month prior to the interview. Possible predictors of smoking cessation were evaluated. One hundred twenty-five patients were found to be smoking at the time of diagnosis. Among these patients, 53.6% stopped smoking after diagnosis or during treatment. In the univariate analyses, tumour site (p = .01), concurrent alcohol use (p = .03), and number of attempts to quit pre- (p = .03) and postdiagnosis (p = .001) were found to be highly predictive of patient smoking cessation. Multivariable modelling showed that gender, tumour site, and number of attempts to quit smoking were significantly and independently related to smoking cessation. Although smoking cessation would be presumed to be high after cancer diagnosis, this study has identified patient subgroups in which postdiagnosis smoking cessation intervention programs need to be made more effective.

This review is timely and relevant because rhinosinusitis is a disease process that is heterogeneous in its clinical and pathologic manifestations. Therefore, no one causative factor has been identified that fully accounts for all rhinosinusitis. The purpose of this review is to provide a succinct update of rhinosinusitis classification, pathophysiology, and management given the new movement toward evidence-based guidelines. The term rhinosinusitis reflects the concurrent inflammatory and infectious processes that affect the nasal passages and the contiguous paranasal sinuses. The most recent classification scheme is intended primarily to guide clinical research and divides rhinosinusitis into four categories: acute bacterial rhinosinusitis, chronic sinusitis with nasal polyposis, chronic rhinosinusitis with nasal polyposis, and allergic fungal rhinosinusitis. The goals of treatment include reduction of mucosal edema, reestablishment of sinus ventilation, and eradication of infecting pathogens. Multiple therapies are available for the management of chronic rhinosinusitis, including antibiotics, hypertonic and isotonic saline irrigations or sprays, topical and systemic glucocorticords, antileukotriene agents, and endoscopic sinus surgery. Rhinosinusitis is a common medical problem that interferes with patient quality of life and loss of work productivity. Because of the heterogeneity that underlies its pathology, no one treatment regimen exists for the management of rhinosinusitis.

Dizziness is one of the most common complaints among patients presenting to primary care physicians, neurologists, and otolaryngologists. This symptom is nonspecific and includes a broad differential diagnosis. The current review aims to present a general overview of the approach to dizziness as well as to discuss the more common causes in detail. The term dizziness encompasses a large spectrum of symptomatology. Understanding how to differentiate between vestibular disorders and other types of dizziness is the key to the evaluation and management of dizzy patients. The distinction between central and peripheral vertigo will be emphasized and the various causes of each type of vertigo will be presented. Dizziness is a common medical condition that impacts significantly on patients' activities of daily living. This review outlines the clinical approach to dizziness to facilitate timely diagnosis and management of this complex symptom.

The frontal recess is the drainage pathway that connects the frontal sinus to the anterior ethmoid sinus. Mechanical obstruction is the primary cause of chronic frontal sinusitis with or without a secondary inflammatory process. Eosinophilic inflammation is one of the underlying causes for chronic rhinosinusitis. OBJECTIVES/HYPHOTHESIS: To evaluate long-term frontal sinus patency after endoscopic frontal sinusotomy in chronic rhinosinusitis patients and to assess the effect of eosinophilic inflammation on frontal sinus patency. Retrospective chart review. Symptom assessment and archived endoscopic photographs were prospectively collected on patients who underwent frontal sinusotomy between 7-1-1999 and 12-31-2000. Subjective symptom improvements were evaluated using the SNOT-20 = 20-item Sino-Nasal Outcome Test. Objective findings of endoscopic frontal sinus patency were documented by archived digital photography. A total of 161 patients with 294 frontal sinuses who underwent endoscopic frontal sinus surgery in the 18 months had an average follow-up of 45.9 months. The patient population was divided into two groups: 58 patients had eosinophilic CRS (ECRS), and 103 patients had CRS without eosinophils (non-ECRS). The mean follow-up for patients with ECRS is 61.6 months and 37.0 months for non-ECRS patients. The non-ECRS patients had a documented endoscopic frontal sinus patency of 90%, and the ECRS patients had an endoscopic frontal sinus patency of 85%. The overall frontal ostium patency rate for all patients was 88.0%. Long-term endoscopic confirmation of frontal ostium patency demonstrates that endoscopic frontal sinusotomy can yield high quality, durable results. There was no significant difference in patency results between ECRS and non-ECRS patients. Laryngoscope, 2009.

To describe our preclinical experience with Cone Beam CT (CBCT) in image-guided surgery of the temporal bone. A mobile isocentric C-arm (PowerMobil, Siemens Medical Systems, Erlangen, Germany) modified to include a flat-panel detector (Varian Imaging Products, Palo Alto, CA) and a motorized orbit was developed to acquire multiple projections in rotation about a subject. Initial experiments imaging steel wire in air were used to investigate the system's spatial resolution in 3D image reconstruction. Subsequently temporal bone dissection was performed on five cadaver heads using the modified C-arm as an image guidance system. We obtained a spatial resolution of 0.85 mm. The image acquisition time was 120 seconds and the radiation dose approximately one-tenth of a conventional CT scan. CBCT provided submillimeter accuracy at high speed with low radiation dosage to offer utility as an intraoperative imaging system. CBCT offers technology that approximates "near-real-time" image guidance. C-4.

This study compared two methods of hand function assessment, the Michigan Hand Outcomes Questionnaire (MHQ) and the Test d'Evaluation des Membres Supérieurs des Personnes Agées (TEMPA) in 20 patients discharged from a regional adult burn center (1995-1999). Spearman's rank correlation coefficient analysis was used to compare the MHQ and TEMPA scores, with P <.05 considered significant. The MHQ revealed that 68% of patients reported hand function deterioration, mainly with the nondominant hand (65%). Activities of daily living (76%) and work (59%) were the most affected. According to the MHQ, patient satisfaction correlated with work performance (r =.66, P =.002), aesthetics (r =.64, P =.003), pain (r =.59, P =.008), and activities of daily living (r =.54, P =.017). The MHQ indicated more hand function deterioration than the TEMPA. There was a significant correlation between the MHQ and TEMPA total scores (r =.68, P =.001). This study supports using the MHQ to determine which patients would benefit from the more resource-consuming TEMPA.

A cone-beam CT (CBCT) imaging system based on a mobile C-arm (Siemens PowerMobil) incorporating a high-performance flat-panel detector (Varian PaxScan) has been developed in our laboratory. We hypothesize that intraoperative C-arm CBCT provides image quality and guidance performance sufficient to assist surgical approach to the frontal recess. A preclinical prospective study was conducted using six cadaver heads to assess the performance characteristics and the potential clinical utility of this imaging system. The mobile C-arm was employed for intraoperative CBCT guidance of the endoscopic approach to twelve frontal recesses. The imaging system is capable of sub-mm 3D spatial resolution with bone and soft-tissue visibility and a field of view sufficient for guidance of head and neck surgery. The system can generate intraoperative, volumetric CT images rapidly with an acceptably low radiation exposure to the patient and with image quality sufficient for most surgical tasks. Moreover, the system is portable and compatible with the surgical setup, providing excellent access to the patient. Finally, the accuracy of the system is not bound to a registration process. The ability to create updated images as surgery progresses introduces the concept of 'near-real-time' CT guidance for head and neck surgery. We found that the use of CBCT increased surgical confidence in accessing the frontal recess, resolved ambiguities with anatomical variations, and provided valuable teaching information to surgeons in training in both preoperative planning and correlation between tri-planar CT scans and intraoperative endoscopic findings.