2014年『第118屆美國耳鼻喉頭頸外科醫學會年會』出席演講心得

郭錦龍醫師

2013年參加在"加拿大"溫哥華舉行的第117屆"美國"耳鼻喉頭頸外科醫學會年會。

所有講者上台接受台下聽眾的發問。

「美國耳鼻喉頭頸外科醫學會American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)」是世界上最大的耳鼻喉科醫學會，積極致力於耳鼻喉科醫師的臨床進修教育，與論文研究的推廣，定期每年集合全球耳鼻喉科醫師與相關醫療人員盛大舉辦研討會議。繼去年參加舉辦在加拿大溫哥華(可見兩國真的是兄弟國)的第117屆美國耳鼻喉頭頸外科醫學會年會後，本人再次參加今年第118屆年會，大會在美國佛羅里達州奧蘭多舉辦，地點是橙縣會議中心(Orange County Convention Center)。

大會手冊，整本內容可以在大會網站免費下載。

Orange County Convention Center會場的階梯很氣派!

為了保險起見，發表前一天就要把檔案上傳。

拿著大會手冊看看哪一場演講比較有趣。

在美國主辦單位的精心規劃之下，全球耳鼻喉科醫師們均歡欣的參與盛會。本次共計有來自全世界超過5500位耳鼻喉科醫師或專家與會參加。本人在台北榮總耳鼻喉部部主任蕭安穗主任以及鼻科主任許志宏主任的協助及指導之下，以「兒童後天性膽脂瘤之修正版CAO分期系統 A Revised CAO Staging Classification for Predicting Prognosis of Acquired Cholesteatoma in Children」及「頭部創傷後嗅覺受損病人之嗅覺改善及惡化Olfactory improvement and decline in patients with post-traumatic olfactory dysfunction」的臨床報告投稿，經審查後獲邀口頭論文發表殊榮。此外，本次會議之議程安排有多元化且內容豐富的議程，對於耳鼻喉科醫師而言是非常難得的學習機會。本次會議除了發表口頭專題醫學論文，同時與他國學者進行學術交流，充分吸取醫學新知，對本職學能之精進獲益甚大。

上台發表前最後的預演。

第一場口頭發表在8點半。

2014年參加在美國奧蘭多舉辦的美國耳鼻喉頭頸外科醫學會年會，第一篇口頭論文發表。旁邊有兩位座長，在我旁邊的那位臉長的很臭，好像欠他錢沒還似的!

第二場口頭發表在10點半。沒錯! 都在同一天，很拼吧!

第二篇口頭論文發表，這次來了位美女座長，氣氛好多了!

美國耳鼻喉頭頸外科醫學會年會有個特點，就是甚麼都貴，光是註冊費就要895美元(台幣約25850元)，這還是早鳥價，如果晚點註冊，費用高達1495美元(台幣44850)。此外，美國耳鼻喉頭頸外科醫學會年會每天的行程只有半天，下午全部是要交錢的訓練課程，一小時要70美元(2100元台幣)，如果是實作課程一小時更要90美元(2700元台幣)。不過這也沒辦法，誰叫人家是世界第一大國，你要來朝聖，就得有所付出。

參加兩屆的美國耳鼻喉頭頸外科醫學會年會，吸收到許多醫學新知，更拓展自身的視野，也深深感受全球耳鼻喉科學的進步。不過今年飛到奧蘭多一共飛了16個小時，轉機等了8小時，加起來要24小時才能飛到奧蘭多，真的蠻辛苦的，我想以後應該不會再想來奧蘭多了吧!

以下是我這兩年口頭論文發表的三篇論文。

第一篇

Long-term Safety of Tympanomastoid Obliteration for Children with Suppurative Cholesteatomatous Ears

Chin-Lung Kuo, An-Suey Shiao, Chiang-Feng Lien, Wen-Huei Liao

Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

Objective: To analyze long-term prognosis and safety in children with suppurative cholesteatomatous ears following tympanomastoidectomy with cartilage obliteration.

Method: During a 30-year period (1982 - 2012), the medical records of children (≤18 years) with cholesteatomas after primary tympanomastoidectomies with cartilage obliteration were analyzed. The recidivism rates were calculated using Kaplan-Meier survival analysis. Potential predictors of recidivism were entered into a Cox’s regression model as covariates for multivariate analysis. These factors were sex, tympanomastoid obliteration, eardrum perforation, ossicular destruction, facial nerve dehiscence, history of ventilation tube insertion, craniofacial abnormality, surgical technique, and extent of disease.

Results: Among a total of 150 cholesteatomatous ears in 146 children, there were 95 discharging ears (63%) in 94 children. Among the 95 discharging ears, tympanomastoidectomy was performed with cartilage obliteration (CO group) in 77 ears (81%) and without cartilage obliteration (WO group) in 18 ears (19%). The mean follow-up period was 11.6 ± 8.1 years. Recidivism was observed in 16 ears in the CO group (12 recurrent and 4 residual) and 4 in the WO group (2 recurrent and 2 residual). The 10-year cumulative recidivism rates were comparable between CO and WO groups (19% vs. 25%, p=0.762, log-rank). Multivariate analysis indicated that tympanomastoid obliteration was not a negative predictor of recidivism (p=0.760), while surgical technique (canal wall up vs. down; hazard ratio=5.86, p=0.011) was a significant predictor. Major long-term complications were not observed.

Conclusion: This study provides long-term evidence supporting the safety, feasibility and effectiveness of tympanomastoid cartilage obliteration for children with suppurative cholesteatomatous ears.

 這篇論文後續投稿到耳鼻喉科權威雜誌Audiology and Neurotology，很幸運地被接受，預計2014年10月正式刊登。

第二篇

A Revised CAO Staging Classification for Predicting Prognosis of Acquired Cholesteatoma in Children

Chin-Lung Kuo, An-Suey Shiao and Chiang-Feng Lien

Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC

Objective: Dr. Lien described a CAO (Cholesteatoma extent, Atelectasis degree and Ossicle involvement) staging system for cholesteatoma in 1984. Due to an accumulated 30 years clinical data, we propose a revised and simplified model of stratification. The study aimed to investigate the prognosis of pediatric acquired cholesteatoma based on the revised staging system.

Method: Between1982 and 2012, 132 ears in 128 children (≤18 years) with acquired cholesteatomas after primary surgery were included. Each case was scored as to cholesteatoma extent, history of grommet insertion, age, ossicular destruction and otorrhea. The total score classifies patients as stage I (5 to 6 points), stage II (7 to 9 points) or stage III (10 to 12 points). The staging system was applied to the first half cohort (66 ears), to the second half cohort (66 ears) and to the entire cohort (132 ears). Differences between stages were compared using Kaplan-Meier cumulative recidivism curves.

Results: The mean follow-up period was 12 years. The 15-year cumulative recidivism rate was 19.6% overall, 0% in stage I, 10.4% in stage II and 30.6% in stage III. The cumulative recidivism curves were well stratified by stage, with differences reaching statistical significance in the second half and entire cohorts (p=0.048 and 0.026, respectively).

Conclusion: The revised staging classification may adequately stratify patients regarding prognosis. Although the simplified staging system may be useful in identifying children at risk for recidivism and in counseling patients, further external validation on an independent data set is warranted before broad application could be recommended.

第三篇

Olfactory improvement and decline in patients with post-traumatic olfactory dysfunction

Chin-Lung Kuo, La-Yuan Fan, An-Suey Shiao and Chih-Hung Shu

Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC

Objectives: To identify the prognosis in patients with post-traumatic olfactory dysfunction.

Methods: From 2007 to 2013, patients with post-traumatic olfactory dysfunction were enrolled. TDI score of Sniffin´Sticks test, a sum of olfactory threshold, discrimination and identification, was ≤15 for anosmia, ≥30 for normosmia, and in between for hyposmia. Olfactory improvement/decline was defined as an increase/decrease in TDI score ≥6 points. Cumulative incidence of olfactory improvement and decline was calculated with Kaplan-Meier Method. Variables with a potential impact on olfactory changes were entered into Cox regression analyses. The correlation between the TDI scores of first and last visit was evaluated.

Results: We included 80 patients with an average 9.4-month follow-up (1-52 months). The 12-month cumulative rate of olfactory improvement and decline was 8.4% and 11.8%, respectively. Anosmia was found in 71.2% of the patients, hyposmia in 27.5%, and normosmia in 1.2% at first visit; whereas anosmia in 72.5%, hyposmia in 23.8%, and normosmia in 3.8% at last visit (Fisher's exact, p=0.583). Multivariate analyses revealed no associations between clinical predictors and olfactory changes (all p>0.05). A positive correlation between the TDI scores of first and last visit (Spearman test, Rho=0.532, P<0.001) confirmed the absence of significant changes in olfaction.

Conclusion: Patients with post-traumatic olfactory dysfunction was associated with either a lower risk for decline in olfaction and a low chance of improvement. Although most patients maintained a status of stable disease, anosmia accounting for the majority of patients may reflect a poor prognosis in olfactory recovery for the population with head trauma.