Problem Solving in Otologic Surgery: When to Image,When to Operate: A Guide to Making the Right Intraoperative Decisions

Program Description: Every time the ear surgeon operates, a significant number of events occur and are anticipated. Many of these are routine and predictable. However, sometimes the unexpected occurs, which can be during the preoperative assessment, during surgery, or after surgery. Treatment outcomes are dependent on the surgeon’s handling of unexpected findings or occurrences as well as the decisions made regarding what is best for the patient. This miniseminar presents cases of 4 common otologic diagnoses where the surgeon was faced with unanticipated situations that challenged his diagnostic and surgical skills; where every decision made affected the final outcome. The disease entities presented are Meniere’s disease, otosclerosis, chronic otitis media with cholesteatoma, and chronic otitis media without cholesteatoma. In each case presented, the panelist will discuss his decisions regarding whether or not to image the patient, whether or not to recommend surgery, what was found intraoperatively, and what was encountered that required difficult but necessary intraoperative decisions. The panelists are all expert otologic surgeons with many years of experience in handling complicated otologic problems. The emphasis of the miniseminar is not to present unusual cases, but instead is to present common problems where unexpected findings significantly challenged the surgeon and complicated the case. In Meniere’s disease, various approaches in evaluation and treatment are used by otolaryngologists. It is anticipated that after this miniseminar the attendee will have a better understanding of how to approach Meniere’s disease systematically and be able to anticipate potential problems. Otosclerosis may seem straight forward, but a myriad of anatomical variations exist that may confuse the surgeon. In addition, other entities may mimic otosclerosis. This miniseminar should help the attendee more accurately prepare for otosclerosis surgery and its potential variations. Chronic otitis media with and without cholesteatoma is a continuum of disease that can challenge all ear surgeons. By presenting ways to evaluate these diseases with awareness of possibly encountering unanticipated findings, this miniseminar should help the attendee feel more comfortable handling chronic otitis media and its many presentations. The emphasis of this miniseminar is for both general otolaryngologists and otologists to become aware of and be able to diagnose and treat the unpredictable challenges that are so often seen in common otologic conditions and how to make the correct intraoperative decisions.

Educational Objectives: 1) Understand that common otologic diseases may present unanticipated challenges during diagnosis and treatment. 2) Learn how to anticipate diagnostic dilemmas and be able to make appropriate treatment recommendations. 3) Learn how to recognize unusual surgical presentations and how to make the right intraoperative decision.