Jane Lea
University of British Columbia, Otolaryngology, Faculty Member
Endoscopic ear surgery in Canada survey. (DOC 25Â kb)
Checklist 1: Task-specific evaluation of mastoidectomy [22]. Checklist 2: Global evaluation of mastoidectomy [22]. (ZIP 10Â kb)
a cross-sectional study
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The pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown, but labyrinthine artery infarction has been proposed. The objective of this study was to perform a systematic review and conduct a... more
The pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown, but labyrinthine artery infarction has been proposed. The objective of this study was to perform a systematic review and conduct a meta‐analysis assessing the risk of developing stroke and myocardial infarction after presentation with ISSNHL.
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Background Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are... more
Background Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. Methods A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. Results Direct evidence indicates that CO2 laser ablation, the ...
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Objective School hearing screening is a public health intervention that can improve care for children who experience hearing loss that is not detected on or develops after newborn screening. However, implementation of school hearing... more
Objective School hearing screening is a public health intervention that can improve care for children who experience hearing loss that is not detected on or develops after newborn screening. However, implementation of school hearing screening is sporadic and supported by mixed evidence to its economic benefit. This scoping review provides a summary of all published cost-effectiveness studies regarding school hearing screening programs globally. At the time of this review, there were no previously published reviews of a similar nature. Data Sources A structured search was applied to 4 databases: PubMed (Medline), Embase, CINAHL, and Cochrane Library. Review Methods The database search was carried out by 2 independent researchers, and results were reported in accordance with the PRISMA-ScR checklist and the JBI methodology for scoping reviews. Studies that included a cost analysis of screening programs for school-aged children in the school environment were eligible for inclusion. Stu...
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OBJECTIVE To evaluate the efficacy of cognitive and/or behavioral therapies in improving health-related quality of life (HRQOL), depression, and anxiety associated with tinnitus. DATA SOURCES EMBASE, MEDLINE, PubMed, PsycINFO, and the... more
OBJECTIVE To evaluate the efficacy of cognitive and/or behavioral therapies in improving health-related quality of life (HRQOL), depression, and anxiety associated with tinnitus. DATA SOURCES EMBASE, MEDLINE, PubMed, PsycINFO, and the Cochrane Registry were used to identify English studies from database inception until February 2018. STUDY SELECTION Randomized controlled trials (RCTs) comparing cognitive and/or behavioral therapies to one another or to waitlist controls for the treatment of tinnitus were included. DATA EXTRACTION Quality and risk were assessed using GRADE and Cochrane's Risk of Bias tool respectively. DATA SYNTHESIS Pairwise meta-analysis (12 RCTs: 1,144 patients) compared psychological interventions to waitlist controls. Outcomes were measured using standardized mean differences (SMDs) and 95% confidence intervals (CI). I and subgroup analyses were used to assess heterogeneity. Network meta-analysis (NMA) (19 RCTS: 1,543 patients) compared psychological therapies head-to-head. Treatment effects were presented by network diagrams, interval plots, and ranking diagrams indicating SMDs with 95% CI. Direct and indirect results were further assessed by inconsistency plots. CONCLUSIONS Results are consistent with previously published guidelines indicating that CBT is an effective therapy for tinnitus. While guided self-administered forms of CBT had larger effect sizes (SMD: 3.44; 95% CI: -0.022, 7.09; I: 99%) on tinnitus HRQOL, only face-to-face CBT was shown to make statistically significant improvements (SMD: 0.75; 95% CI: 0.53, 0.97; I: 0%). Guided self-administered CBT had the highest likelihood of being ranked first in improving tinnitus HRQOL (75%), depression (83%), and anxiety (87%), though statistically insignificant. This NMA is the first of its kind in this therapeutic area and provides new insights on the effects of different forms of cognitive and/or behavioral therapies for tinnitus.
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The Choosing Wisely Canada Campaign aims to raise awareness amongst physicians and patients regarding unnecessary tests and treatment. The otology/neurotology subspecialty group within the Canadian Society of Otolaryngology – Head & Neck... more
The Choosing Wisely Canada Campaign aims to raise awareness amongst physicians and patients regarding unnecessary tests and treatment. The otology/neurotology subspecialty group within the Canadian Society of Otolaryngology – Head & Neck Society developed a list of five common otologic presentations to help physicians deliver high quality effective care: (1) Don’t order specialized audiometric and vestibular testing to screen for peripheral vestibular disease, (2) Don’t perform computed tomography or blood work in the evaluation of sudden sensorineural hearing loss, (3) Don’t perform auditory brain responses (ABR) in patients with asymmetrical hearing loss, (4) Don’t prescribe oral antibiotics as first line treatment for patients with painless otorrhea associated with tympanic membrane perforation or tympanostomy tube, and (5) Don’t perform particle repositioning maneuvers without a clinical diagnosis of posterior canal benign paroxysmal positional vertigo.
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The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown. However, an increasing number of observational studies report intralabyrinthine signal alterations in patients with ISSNHL using... more
The underlying pathophysiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unknown. However, an increasing number of observational studies report intralabyrinthine signal alterations in patients with ISSNHL using three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging (MRI). These findings warrant a meta‐analysis.
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Patients with vestibular schwannomas (VS) are faced with complex management decisions. Watchful waiting, surgical resection, and radiation are all viable options with associated risks and benefits. We sought to determine if patients with... more
Patients with vestibular schwannomas (VS) are faced with complex management decisions. Watchful waiting, surgical resection, and radiation are all viable options with associated risks and benefits. We sought to determine if patients with VS experience decisional conflict when deciding between surgery or non-surgical management, and factors influencing the degree of decisional conflict. A prospective cohort study in two tertiary ambulatory skull-base clinics was performed. Patients with newly diagnosed or newly growing vestibular schwannomas were recruited. Patients were given a demographic form and the decisional conflict scale (DCS), a validated measure to assess the degree of uncertainty when making medical decisions. The degree of shared decision making (SDM) experienced by the patient and physician were assessed via the SDM-Q-10 and SDM-Q-Doc questionnaires, respectively. Non-parametric statistics were used. Questionnaires and demographic information were correlated with DCS usi...
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There is a prevailing opinion that spinning sensations signify a peripheral vestibular pathology while non-spinning sensations are not of vestibular origin. 1) Characterize the subjective sensations reported by patients during caloric... more
There is a prevailing opinion that spinning sensations signify a peripheral vestibular pathology while non-spinning sensations are not of vestibular origin. 1) Characterize the subjective sensations reported by patients during caloric testing. 2) Assess if the sensation was correlated with the peak slow phase velocity (SPV). Retrospective chart review at a Canadian adult tertiary-quaternary care balance centre for patients undergoing diagnostic caloric testing between December 2014 and September 2015. Of 163 patients included, 122 had normal calorics and 41 demonstrated unilateral weakness. Spinning/rotatory movements were the most commonly reported sensations (55-70%). No sensation was reported among 10-20% of patients. Other non-rotatory sensations were reported 20-25% of the time. Both lack of sensation and other sensations were more likely to be correlated with SPVs that were significantly lower than those associated with spinning/rotating sensations. However, 18% of patients wi...
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To review three patients with concurrent otosclerosis and superior canal dehiscence identified before operative intervention and provide a practical diagnostic approach to this clinical scenario. Retrospective patient series.... more
To review three patients with concurrent otosclerosis and superior canal dehiscence identified before operative intervention and provide a practical diagnostic approach to this clinical scenario. Retrospective patient series. Tertiary/quaternary referral center. Individuals with confirmed diagnoses of concurrent otosclerosis and superior semicircular canal dehiscence syndrome. Detailed history and physical examinations were performed on these patients, as well as detailed audiovestibular testing and computed tomography imaging. Establishing a clear diagnosis of concurrent otosclerosis and superior semicircular canal dehiscence syndrome using a thorough diagnostic approach. Three patients presented with conductive hearing loss and normal tympanic membranes. When history and physical examination yielded suspicious third window symptoms/signs, more detailed audiovestibular testing and computed tomography scan imaging were performed. All three patients were ultimately identified to have...
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Noise-induced hearing loss is one of the most common forms of sensorineural hearing loss, is a major health problem, is largely preventable and is probably more widespread than revealed by conventional pure tone threshold testing.... more
Noise-induced hearing loss is one of the most common forms of sensorineural hearing loss, is a major health problem, is largely preventable and is probably more widespread than revealed by conventional pure tone threshold testing. Noise-induced damage to the cochlea is traditionally considered to be associated with symmetrical mild to moderate hearing loss with associated tinnitus; however, there is a significant number of patients with asymmetrical thresholds and, depending on the exposure, severe to profound hearing loss as well. Recent epidemiology and animal studies have provided further insight into the pathophysiology, clinical findings, social and economic impacts of noise-induced hearing loss. Furthermore, it is recently shown that acoustic trauma is associated with vestibular dysfunction, with associated dizziness that is not always measurable with current techniques. Deliberation of the prevalence, treatment and prevention of noise-induced hearing loss is important and tim...
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Mental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills. The objectives of... more
Mental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills. The objectives of this study were, 1) To develop and evaluate a mental practice protocol for mastoidectomy 2) To assess the immediate impact of mental practice on a mastoidectomy surgical task among senior Otolaryngology─Head & Neck Surgery (OHNS) residents. Three expert surgeons were interviewed using verbal protocol analysis to develop a mastoidectomy mental practice script. Twelve senior Residents from Canadian training programs were randomized into two groups. All Residents were video-recorded performing a baseline mastoidectomy in a temporal bone lab. The intervention group received mental practice training, while the control group undertook self-directed textbook study. All subjects were then video-recorded performing a second mastoidectomy. Changes in pre- and p...
Research Interests: Otolaryngology, Medicine, Humans, Female, Male, and 11 moreMental processes, Graduate medical education, British Columbia, Adult, Otolaryngology - Head and Neck Surgery, Clinical Competence, Video Recording, Otolaryngology Head and Neck Surgery, internship and residency, Interviews as topic, and Mastoid
Endoscopic ear surgery is an emerging technique with recent literature highlighting advantages over the traditional microscopic approach. This study aims to characterize the current status of endoscopic ear surgery in Canada and better... more
Endoscopic ear surgery is an emerging technique with recent literature highlighting advantages over the traditional microscopic approach. This study aims to characterize the current status of endoscopic ear surgery in Canada and better understand the beliefs and concerns of the otolaryngology - head & neck surgery community regarding this technique. A cross-sectional survey study of Canadian otolaryngologists was performed. Members of the Canadian Society of Otolaryngology were contacted though an online survey carried out in 2015. The majority of participants in this study (70 %) used an endoscope in their practice, with a large proportion utilizing the endoscope for cholesteatoma or tympanoplasty surgery. To date, 38 Canadian otolaryngologists (70 % of respondents) have used an endoscope for at least 1 surgical case, but only 6 (11 %) have performed more than 50 endoscopic cases. Of the otolaryngologists who use endoscopes regularly, the majority still use the microscope as their ...
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Abstract With rising global interest in minimally invasive surgical approaches and the cumulative advances in technology, there is a growing population of otolaryngologists incorporating endoscopic ear surgery into clinical practice and... more
Abstract With rising global interest in minimally invasive surgical approaches and the cumulative advances in technology, there is a growing population of otolaryngologists incorporating endoscopic ear surgery into clinical practice and residency training. To date, limited data are available on the learning curve and training process involved in this technique. While the endoscopic approach to the ear has several advantages, it carries also unique challenges and risks that one should be aware of as they impact endoscopic skill acquisition. The current practices in endoscopic ear surgery training involve sharing of technical pearls and a graded step-by-step approach to endoscopic skill development through clinical practice and hands-on courses. In the academic environment, the endoscopic approach carries several advantages for the trainees—through improvement in teaching and the relative ease of the technique as compared to the traditional microscopic approach.
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Objective To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head... more
Objective To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head trauma. Data Sources Systematic review of the literature was performed using Medline, EMBASE, and Cochrane databases. English and French articles meeting inclusion criteria and published between 1946 and October 2014 were included. Review Methods Data were independently extracted from the articles by 2 reviewers using data collection forms developed a priori. Inclusion and exclusion criteria were decided a priori. Studies were included if they reported on at least 1 case of posttraumatic BPPV (t-BPPV), reported on outcomes of all patients with t-BPPV, had a clearly defined inception point, and provided a clear diagnosis of BPPV (defined a priori by reviewers). Results A total of 3017 titles, 362 abstracts, and 67 articles were reviewed, from which 16 ar...
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Mental practice (MP) is ‘the symbolic, covert, mental rehearsal of a task in the absence of actual, physical rehearsal’. 1 When a musician thinks through a passage or an athlete prepares for competition by visualising their performance,... more
Mental practice (MP) is ‘the symbolic, covert, mental rehearsal of a task in the absence of actual, physical rehearsal’. 1 When a musician thinks through a passage or an athlete prepares for competition by visualising their performance, they are engaging in MP. It is a specifi c form of mental preparation, separate from positive imagery, selfeffi cacy statements, motivational strategies or attentionfocusing. MP has been studied extensively in sports and psychology literature, and is an integral part of the formal training of many individuals who perform complex motor skills at high levels. Although many surgeons and surgical trainees undoubtedly use forms of MP to prepare for cases, it has only recently been investigated as a formal teaching tool, and to our knowledge is not incorporated into most residency programme curricula. MP, as described in the surgical literature, typically involves a period of relaxation exercises followed by an expert educator reciting a mental imagery script outlining a stepbystep operative approach, with emphasis on visual, haptic and cognitive cues. 2 In practice, once a certain level of competency is obtained, it could be performed independently. Based on our experiences as learners and teachers we believe that MP offers a number of potential benefi ts for surgeons at all levels of training.
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Objective To assess for the presence of human herpesvirus (HHV) using immunohistochemical and polymerase chain reaction (PCR) assay in surgically excised vestibular schwannoma (VS) samples. Study Design Cross-sectional study. Setting A... more
Objective To assess for the presence of human herpesvirus (HHV) using immunohistochemical and polymerase chain reaction (PCR) assay in surgically excised vestibular schwannoma (VS) samples. Study Design Cross-sectional study. Setting A retrospective laboratory-based study of tumors from patients with vestibular schwannoma. Subjects and Methods Tissue microarrays (TMAs) representing sporadic and NF2-associated VS from 121 patients, as well as appropriate positive and negative controls, were studied. TMA sections were immunostained using antibodies directed against HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, and HHV-8. PCR was used for the detection of all 8 known human herpesviruses. Results There was no detectable HHV (HHV-1, HHV-2, HHV-3, HHV-4, HHV-5, HHV-8) by immunohistochemistry in any of the 121 cases of sporadic and NF2 cases analyzed. These data were further validated by DNA sequence analyses using PCR in a subset of the VS samples, all of which were found to be negative for all HHV....
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Research Interests: Medicine, Dexamethasone, Humans, Chronic Disease, Microbial genetic and drug resistance, and 9 moreStaphylococcus aureus, Pseudomonas aeruginosa, Pseudomonas Aeruginosa, Otolaryngology - Head and Neck Surgery, Ciprofloxacin, N-Acetylcysteine, Otolaryngology Head and Neck Surgery, In Vitro Techniques, and acetylcysteine
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A 65-year-old man gave a 3-year history of brief spells of spinning vertigo brought on by rolling over in bed or bending down. Dix-Hallpike testing with either ear down provoked almost immediate paroxysms of downbeat-nystagmus and vertigo... more
A 65-year-old man gave a 3-year history of brief spells of spinning vertigo brought on by rolling over in bed or bending down. Dix-Hallpike testing with either ear down provoked almost immediate paroxysms of downbeat-nystagmus and vertigo lasting between 5 and 10 seconds (See Supplemental DigitalContentVideosAandB,http://links.lww.com/MAO/A190, http://links.lww.com/MAO/A191, which demonstrate downbeat nystamgus with no latency in the right and left DixHallpike positions, respectively; Fig. 1C). His examination was otherwise normal, with no spontaneous or gaze-evoked nystagmus, normal saccadic and pursuit eye movements, FIG. 1. Brain MRI with contrast (A and B) and video nystagmography. A, Coronal T1-weighted imaging illustrating the left cerebellarhemangioblastoma (arrow). B, Edema within the cerebellum and brainstem on axial T2-image (arrow).C, Videonystagmography, illustrating paroxysmal downbeat nystagmus lasting 5 to 10 seconds on Dix-Hallpike testing.
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Whole-brain radiotherapy (WBRT) is a standard treatment recommendation for patients with brain metastases. The goal of treatment is symptom control, which in the short run can be often achieved by steroids. Patients with a short life... more
Whole-brain radiotherapy (WBRT) is a standard treatment recommendation for patients with brain metastases. The goal of treatment is symptom control, which in the short run can be often achieved by steroids. Patients with a short life expectancy may not derive benefit from the addition of radiation. The ability to identify this group would aid the decision of whether to recommend WBRT. Data on all patients referred for WBRT to palliative radiotherapy teams at two comprehensive cancer centres were prospectively collected over a 2-year period. The most frequent radiation dose and fractionation was 2000 cGy in 5 fractions over 1 week. Multivariate logistic regression analysis using forward stepwise selection process was used to develop a prediction model for early death (before 8 weeks). The variables considered were sex, performance status, primary disease, weight loss, age, time from primary diagnosis to brain metastases diagnosis, number of metastatic sites and Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) status. Two hundred and seventy-five patients with brain metastases were assessed. The median follow-up was 19 weeks, and estimated median overall survival was 5.3 months. Multivariate regression revealed Eastern Cooperative Oncology Group (ECOG) performance status and number of metastatic sites to be significant predictors of early death. The odds ratios were 2.38 (95% confidence interval [CI] 1.77-3.19) and 1.39 (95% CI 1.07-1.81), respectively. Sixty-eight per cent of patients could be correctly classified; however, 55% would have been incorrectly predicted to die early. Poor performance status and number of metastatic sites are useful predictors of early death. A regression model was highly predictive overall, but this was primarily due to a high negative predictive value of 86%. The ability to predict patients who would die early (positive predictive value) was only 45%. Thus, despite the understanding that we are over-treating a subset of patients, further research is required to identify patients who do not require radiotherapy.
Research Interests: Survival Analysis, Medicine, Multivariate Analysis, Prospective studies, Humans, and 15 moreFemale, Male, Clinical oncology, Life Expectancy, Clinical Sciences, Aged, Middle Aged, Adult, Photons, Survival Rate, Prognosis, Brain Metastases, Proportional Hazards Models, Logistic Models, and Brain Neoplasms
Research Interests: Endocrinology, Cancer, Medicine, Humans, Testosterone, and 15 moreSpermatogenesis, Iodine, Clinical, Male, tESTIS, Systematic review, Clinical Sciences, Pituitary Gland, Clinical Endocrinology, Review Literature As Topic, Luteinizing Hormone, Radioisotope, Follicle stimulating hormone, Paediatrics and reproductive medicine, and Macho
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Results After reviewing 334 abstracts and 59 full-text papers, seven papers were included. In longitudinal studies examining the effect of single primary RAI dose activities of ≤ 150 mCi, serum FSH and LH rose between months 2 and 6, with... more
Results After reviewing 334 abstracts and 59 full-text papers, seven papers were included. In longitudinal studies examining the effect of single primary RAI dose activities of ≤ 150 mCi, serum FSH and LH rose between months 2 and 6, with normalization by 18 months; serum ...
Research Interests: Endocrinology, Cancer, Medicine, Humans, Testosterone, and 15 moreSpermatogenesis, Iodine, Clinical, Male, tESTIS, Systematic review, Clinical Sciences, Pituitary Gland, Clinical Endocrinology, Review Literature As Topic, Luteinizing Hormone, Radioisotope, Follicle stimulating hormone, Paediatrics and reproductive medicine, and Macho
Results After reviewing 349 unique citations and 61 full-text papers, 16 papers including data from 3023 women or adolescents with DTC were included. All studies were observational, with no long-term randomized control trial data. The age... more
Results After reviewing 349 unique citations and 61 full-text papers, 16 papers including data from 3023 women or adolescents with DTC were included. All studies were observational, with no long-term randomized control trial data. The age at first RAI treatment varied from 8 to ...
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Eosinophilic angiocentric fibrosis (EAF) is a rare, benign condition of unknown etiology involving the sinonasal tract and the upper respiratory airways, and rarely, larynx, and orbit. We report four cases of EAF identified, in three... more
Eosinophilic angiocentric fibrosis (EAF) is a rare, benign condition of unknown etiology involving the sinonasal tract and the upper respiratory airways, and rarely, larynx, and orbit. We report four cases of EAF identified, in three women and one man, aged 31, 57, 27, and 51 ...