Thanks to a generous travel award from the British Rhinological Society and Medtronic, I was able to attend the 2009 American Rhinological Society Annual Meeting, held in the opulent Manchester Grand Hyatt Hotel in San Diego.
This excellent meeting included a round table discussion, a keynote speaker, a number of lectures as summarized below, and trainee research presentations.
The meeting started with a presentation by Professor Brent Senior (University of North Carolina) entitled 'Point of Service in Rhinology’, which addressed the impact of in-office CT scanning. This is a novel and emerging aspect of practice in the USA, with a company having recently brought to market a scanner that would easily fit into many consulting rooms. Unpublished research was presented which reported high patient satisfaction with the rapid and efficient service this provides, and improved levels of compliance with medical treatment in cases of radiologically confirmed rhinosinusitis. Such scans entail minimal radiation exposure, and are cost-effective compared to potentially unnecessary course of antibiotics, which have risks of their own. A code of practice was recommended to ensure probity, with guidelines for scanning referrals being broadly similar to those used in the UK.
Professor Stankiewicz of Loyola University, Illinois, the current President of the ARS, also stressed the importance of probity and ethical practice. He spoke on the importance of the professional relationship between clinicians and industry in rhinology. Fortunately no significant ethical conflicts have been highlighted since the birth of sinus surgery in the mid-1980s, and sponsorship from pharmaceutical and equipment companies has provided many research and educational opportunities to clinicians that would not have otherwise been possible.
Professor Roy Casiano (Miami, Florida) delivered a lecture on tips and tricks in skull base surgery. He explained how his technique for repairing skull base defects has developed over the years, with current practice favouring the acellular allograft AlloDermÆ over mucosal flaps in most cases.
The honour of giving the 5th Annual David W Kennedy lecture was given awarded to Professor PJ Wormald of Flinders University, Adelaide. His lecture, entitled ‘The Frontal Sinus’, emphasised the importance of understanding triplanar CT imaging to help identify all of the air cells contributing to the frontal sinus drainage pathway. He subsequently gave an additional lecture explaining technical tips for the Endoscopic Modified Lothrop Procedure.
The panel discussion focussed on the management of refractory sinusitis, and encompassed medical and surgical considerations. The panelists were Dr Jan Gosepath (Germany), Michael Chandler MD (New York), Martin Desrosiers MD (Montreal, Canada), and Amber Luong (Houston, Texas). They debated the management of difficult case examples, with their contributions highlighting areas of controversy.
Interspersed with these guest lectures were batches of short papers presented by trainees. A poster presentation offered further insights into the latest rhinological research within the USA and beyond.
Attendance at the meeting provided a great opportunity to catch up on the latest research and management expertise from some of the world’s pioneers of the specialty, and to meet with them informally during breaks in the programme.
The long journey was made especially worthwhile, as I was also able to attend the AAO-HNS conference, which began the following day at the San Diego Conference Centre. A generous bursary covering travel and conference registration expenses was provided by the British Rhinological Society and Medtronic. UK trainees are invited to apply for this award by writing to the secretary and president of the BRS, explaining why they consider themselves worthy recipients. Preference will be given to applicants presenting research at the meeting. The next Annual ARS meeting will be held in Boston, Massachusetts on Saturday September 25th 2010.
As the result of an informal meeting with Professor Peter Hwang at the ARS, I travelled north after the AAO meeting to visit the Department of Otolaryngology at Stanford University. Rhinology patients have surgery in the new Ambulatory Care Center on the Stanford campus. An attending (consultant) rhinologist occasionally supervises two lists running simultaneously in adjacent theatres, and image-guidance is used for most endoscopic cases. The Department of Otolaryngology is based in its own building across the road, where outpatients are seen, and the surgical team and their support staff have their offices. There is a temporal bone laboratory with 12 drilling stations, and impressive office space for junior medical staff to facilitate clinical administration and research.
Being on the university campus contributes greatly to a lively academic atmosphere, with research into virtual-reality temporal bone simulators benefiting from close proximity to the Departments of Computer Science and Robotic Engineering, for example. The ENT trainees (residents) I met were notably focused at extracting the maximum from their 4-year training programs, where the emphasis is firmly on clinical knowledge, with an exam every year, and clinical experience. Logbooks are kept in paper format, and each case is illustrated with intra-operative and radiological images, and notes of clinical or technical interest.
Stanford offer a one year Rhinology Fellowship, for which competition within the USA is, unsurprisingly, intense. Ambitious UK trainees should note, however, that occasionally US centres including Stanford will accept International Medical Graduates to the Fellowship program. Such applicants must have passed the US Medical Licensing Exams, equivalent to medical school finals, to be considered.
My visit to Stanford was a fascinating addition to the trip, and increased the value of attending the conference immeasurably. |
