CORONADO, CALIF.—Otolaryngologists from across the nation and abroad gathered at an oceanside resort here January 22-24 for the 2015 Triological Society Combined Sections Meeting to share surgical techniques and approaches to treatment and to debate current medical issues that affect the specialty.
Explore this issue:March 2015
By the final day of sessions, a total of 512 attendees from the U.S., Canada, and Europe had registered for the meeting at the Hotel del Coronado in the island town of Coronado, across a bridge from San Diego.
“We have some residents from our university presenting here, so it’s nice to be able to support them,” said Paul Imbery, MD, a resident in the otolaryngology program at State University of New York-Upstate. He and some fellow residents were also participating in the meeting’s Resident Bowl, a “quiz show” featuring otolaryngology residents from institutions around the country.
In his presidential address, Derald Brackmann, MD, clinical professor of otolaryngology-head and neck surgery and neurosurgery at the University of Southern California School of Medicine in Los Angeles and an otolaryngologist at the House Ear Clinic, said the Triological Society presidency was the “epitome” of the many presidencies he’s held, including the American Academy of Otolaryngology-Head and Neck Surgery and the American Neurotology Society, in part because the organization is a relatively small group. “I think having a thesis and doing that extra thing to become a member of the Triologic is special,” he added.
In his introduction of Dr. Brackmann, Ralph Metson, MD, the society’s Eastern section vice president, recalled when he was a resident rotating through Los Angeles Children’s Hospital, where Dr. Brackmann left an impression. “He brought his own equipment, did his own dictation, and boy, was he a fabulous teacher,” Dr. Metson said. “He’s the go-to guy for people who need advice about difficult otoneurologic cases. His clinical judgment is just impeccable. The advice he gives is always delivered with the utmost humility.”
A Historical Look at Glomus Tumors and Neurotology
Here are some highlights from Dr. Brackmann’s talk, which focused on the evolution of the treatment of glomus tumors in the skull base.
- Treating gliomas used to be fairly straightforward: “You saw a glomus tumor, you operated on it. There was really no other alternative.”
- The most problematic of the glomus tumors are those that involve the carotid artery and intracranial tumors. “The major issue became the lower cranial nerves and that became a very serious issue.” In some larger tumors, “it’s virtually impossible to save the lower cranial nerves,” he said.
- The morbidity associated with such tumors could have devastating effects—“These people were miserable and often times remained miserable throughout their lives,” in part because they were never able to achieve ease of swallowing.
- With radiosurgery, tumor control became an option. “What can we do to improve the quality of life for these patients?”
- Tumor control options include observation, microsurgical resection, radiation therapy, or a combination of surgery and radiation.
- Treatment choices, he said, should be made on a case-by-case basis, factoring in the age of the patient, health status, location and size of the tumor, status of the lower cranial nerve, and the patient’s wishes.
- Observation might be the best choice in elderly patients with small tumors in which the residual is not showing growth.
- MRI should be performed three to six months after surgery, with yearly follow-ups after that.
- Microsurgical resection is an option when total resection of the tumor is achievable with preservation of function, when the function of the lower cranial nerves has been compromised, and if the patient’s health allows it.
- Radiation therapy should be considered as a primary treatment or as a combination treatment with microsurgery.
- “Most patients are now being treated with radiosurgery. There are some risks to that. If you have a tumor that’s near the cochlea, there’s a great risk to the hearing. The cochlea can only tolerate about 5 Gy of radiation, and if the tumor is up into the middle ear, there’s no way that you can radiate that tumor without producing hearing loss. That’s something to consider.”
- Combining surgery and radiotherapy is best in situations in which you can take out the tumor in the middle ear and in the jugular bulb outside of the lower cranial nerves—that can save the hearing, remove the cause of tinnitus, and lead to tumor control.