David D Pothier

UHN: Toronto General Hospital · Otolaryngology, Head and Neck Surgery

Objective: To review insights gained from a 21-year experience with gentamicin-induced vestibulotoxicity including differences in vestibulotoxicity between single daily dosing (SDD) and multiple daily dosing (MDD) regimens. Study design: Retrospective case series. Setting: Tertiary care center. Patients: Patients with gentamicin vestibulotox...

Objectives: The traditional medical care model of "assess and refer" requires revamping to address the multifaceted needs of patients with chronic dizziness and imbalance by adopting an interdisciplinary approach to care that integrates nursing and psychiatry (INaP). We aim to present a novel interdisciplinary approach that incorporates INaP in th...

Objectives/hypothesis: The traditional medical care model of "assess and refer" in a sequential fashion fails to recognize the complexities that arise due to overlapping physical and psychiatric comorbidities experienced by patients with chronic dizziness or imbalance, thus resulting in inadequate treatment outcomes. We aimed to evaluate the impac...

Introduction: To determine the impact of a head-referenced cochlear implant (CI) stimulation system, BalanCI, on balance and postural control in children with bilateral cochleovestibular loss (BCVL) who use bilateral CI. Methods: Prospective, blinded case-control study. Balance and postural control testing occurred in two settings: (1) quiet cli...

Background: An analysis of the scope of practice of recent Otolaryngology - Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgi...

IMPORTANCE Catastrophizing is a maladaptive thought process that involves irrational fear and worry about anticipated or actual symptoms. Although clinically relevant, the role of catastrophizing in patients with chronic dizziness or imbalance has not yet been explored to our knowledge. OBJECTIVES To validate a measure of dizziness catastrophizing...

Purpose: To report long-term (>4 years) toxicity and quality of life (QoL) among patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT) in a nonendemic center. Methods and materials: A cross-sectional cohort study enrolled patients with NPC who were disease-free and ≥4 years after IMRT ± chemothera...

Assault and violence at the workplace although uncommon are occupational health and safety hazards. Although there is no paucity of literature on cochleovestibular dysfunction after head injuries, there is little published on cochleovestibular dysfunction as a consequence of assault at the workplace. This article is protected by copyright. All righ...

Although the use of topical gentamicin has declined systemic gentamicin remains an important antimicrobial agent in the management of infections caused by multidrug-resistant gram-negative bacteria. Nephrotoxicity and Ototoxicity from systemic gentamicin is well documented despite normal gentamicin levels (peak and trough) and normal renal function...

Impaired insight into illness (IMP-INS) is common among individuals with schizophrenia spectrum disorders (SSD), contributing to medication nonadherence and poor clinical outcomes. Caloric vestibular simulation (CVS) is typically used to assess peripheral vestibular system function. Left cold CVS is also a transiently effective treatment for IMP-IN...

Background: Oscillopsia can result from dysfunction involving the vestibuloocular reflex (VOR). Few studies have detailed the full spectrum of clinical characteristics and laboratory findings of this disabling condition. Objectives: To review causes and clinical characteristics of oscillopsia. Methods: Retrospective review of clinical records of a...

Objectives: To evaluate the biological behaviour of tumour remnants intentionally left in the surgical bed following the incomplete excision of vestibular schwannomas [VS] and to review the relation between extent of resection and preservation of facial nerve function. Methods: A retrospective chart review of 450 patients that underwent surgery...

Objective: To determine the incidence of olfactory dysfunction in workers following head injury in the work place, to define its relationship to the site, severity of injury and direction of force. The demographics of head injured workers were also assessed to determine if those with olfactory loss were more likely to have sustained a cochleovesti...

To evaluate the evidence and trends in published literature on the treatment of Ménière's syndrome or disease (MS/D) by comparing studies published in the last two decades. A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders groups trials...

Background: Gentamicin is used for the treatment of resistant gram-negative bacterial infections. Studies comparing single-daily dosing (SDD) to multiple-daily dosing (MDD) show similar efficacy and less nephrotoxicity. Less is known about the effects of different dosing regimens on the development of ototoxicity. Among patients referred to our Mul...

Objectives/HypothesisAn analysis of the frequency and intensity of postoperative aftercare required for modified radical mastoidectomy (MRM) and patterns of healing in the postoperative period. Study DesignA retrospective review of all primary modified radical mastoidectomies carried out for cholesteatoma under the care of the senior author between...

Program Description The goals of cholesteatoma surgery are the complete removal of disease while minimizing the risk of recurrence. A secondary goal is to optimize postoperative hearing. This miniseminar features distinguished experts in the field who will present well-established methods of cholesteatoma surgery. Important topics, such as intact-c...

Background The potential efficacy of antifungal agents (e.g. Mycostatin) in treating acute attacks of Ménière's disease was first suggested in 1983 but few data have been published. Oral Mycostatin has been used as second-line medical treatment for intractable Ménière's disease at our institution for many years. Objective This preliminary cohort s...

The round window region is a critical area of the middle ear; the aim of this paper is to describe its anatomy from an endoscopic perspective, emphasizing some structures, the knowledge of which could have important implications during surgery, as well as to evaluate what involvement cholesteatoma may have with these structures. Retrospective revie...

A prototype system for intraoperative cone beam computed tomography (CBCT) imaging has been developed and augmented with real time optical tracking of a surgical drill. We hypothesize that this system provides sufficient accuracy for guidance of temporal bone surgery. Basic research. Measurements of drill localization accuracy using CBCT imaging we...

Objective Conventional computed tomography (CT) imaging is the standard imaging technique for temporal bone diseases, whereas cone-beam CT (CBCT) imaging is a very fast imaging tool with a significant less radiation dose compared with conventional CT. We hypothesize that a system for intraoperative cone-beam CT provides comparable image quality to...

Program Description Endoscopic ear surgery (EES) is a current hot topic in our specialty; however, it is not entirely correct to introduce EES as “new.” Although not new, it is clear that during the past few years, endoscopes have proven to be safe and effective instruments to manage ear diseases in a minimally invasive way, preserving important an...

A detailed and comprehensive discussion of transcanal endoscopic management of cholesteatoma is presented. After a presentation of the anatomy of the area, the rationale, advantages and limitations, technique, and long-term results of each technique are presented. A case presentation follows each technique. Techniques presented are: endoscopic tran...

The endoscope allows for better inspection for cholesteatoma in cases with chronic otitis media, better access to selective epitympanic poor ventilation and secondary selective chronic otitis media, better visualization of anterior poor ventilation of the mesotympanum (reestablishing adequate ventilation to the mesotympanum), better visualization a...

The otolaryngologist will find in this article a direct and frank discussion and useful advice for how to get started performing solely endoscopic ear surgery for abnormalities of the middle ear. The author provides discussion and photos based on his experience with this procedure. Presented herein are selection of the endoscope, how to approach th...

Objectives Determine the effectiveness and side effect profile of antivirals in the treatment of idiopathic sudden sensorineural hearing loss (ISSHL). Methods We systematically searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5...

The Power Balance Silicone Wristband (Power Balance LLC, Laguna Niguel, CA) (power balance band; PBB) consists of a silicone wristband, incorporating two holograms, which is meant to confer improvements in balance on the wearer. Despite its popularity, the PBB has become somewhat controversial, with a number of articles being published in the news...

The Nintendo Wii Balance Board (WBB) is a low-cost, commercially available gaming device that shares many characteristics with a laboratory-grade forceplate. This study evaluates the WBB and explores its potential application as a low-cost posturography system. Custom software was written to interface with the WBB and measure the Modified Clinical...

(1) To assess hypersensitivity to bismuth iodoform paraffin paste impregnated ribbon gauze following its use in packing canal wall down mastoidectomy cavities; (2) to determine if isolation of the skin and mucosa from the pack, using thin Silastic sheeting and Cortisporin ointment, reduces hypersensitivity reactions, compared with a previous series...

The symptom of oscillopsia in patients with bilateral vestibular loss (BVL) can be reduced as dynamic visual acuity (DVA), the reduction in visual acuity during head movement, is improved by using real-time image stabilization, delivered by augmented reality eyewear. Tertiary multidisciplinary neurotology clinic. Prospective experimental study. Imm...

Following recently described small series of patients with the syndrome of cerebellar ataxia with bilateral vestibulopathy (CABV), the authors undertook a careful clinical and laboratory assessment of patients who presented to their unit with characteristics of this syndrome. Case note review. Tertiary, university-based, multidisciplinary neurootol...

Chlorhexidine is a common antiseptic used to prevent surgical infection. However, its exposure to the middle ear may lead to deafness. The mechanisms of the ototoxicity of chlorhexidine are reviewed. The importance of recognizing its toxicity cannot be overstated in preventing injury to patients undergoing ear surgery. A systematic literature searc...

To conduct a survey of the antiseptic preparations used for ear surgeries among otolaryngologists in Canada. An electronic survey was sent to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery via e-mail. Questions included the use of antiseptic, choice of preparation solution, duration of preparation, use of a barrier m...

There has been a reduction in the number of modified radical mastoidectomy and revision mastoidectomy surgeries per head of population in Ontario between 1987 and 2007, we believe that this represents a true reduction in prevalence of cholesteatoma. The increase of cases performed at the University Hospital Network, Toronto (UHN) may represent a sh...

To record with video-otoscopy the appearance of the tympanic membranes of a cross section of children aged 9 to 10 years. Cross-sectional study nested within an established longitudinal study of childhood development, the Avon Longitudinal Study of Parents and Children. South West England, U.K. Approximately 6908 of 7261 children with ages ranging...

Objective: 1) Develop an auditory biofeedback device based on the Apple iPod Touch. 2) Investigate the efficacy of auditory biofeedback for patients with bilateral vestibular loss (BVL) using posturography. Method: The “Vestio” vestibular prosthesis provides auditory biofeedback via a small head-mounted device that can be housed in a cap. It uses i...

Objective: 1) Develop real-time image stabilization using immersive augmented reality eyewear to counteract bobbing oscillopsia in patients with bilateral vestibular loss (BVL). 2) Measure change in dynamic visual acuity (DVA) in patients with BVL using the device. Method: Immersive virtual reality glasses used in combination with a compact digital...

Objective: 1) Report the largest series to date of patients with cerebellar ataxia with bilateral vestibulopathy (CABV). 2) Understand the unique balance problems in this disorder; we studied the eye movements crucial for gaze stabilization. Method: From over 16 years at a multidisciplinary neuro-otology clinic, 32 patients (mean age, 51.7 (SD = 19...

Thyroidectomy has few complications, as a result, many patients are concerned about the prominence of their scar. Performing thyroid surgery through excessively small incisions in order to maximise cosmesis may increase the likelihood of complications. This study investigates the relationship between conventional approach thyroidectomy scar length...

Tympanic membrane retractions are commonly managed by ENT surgeons. There is currently no consensus as to the indications, timing and options for management of this condition. To study the effectiveness of different surgical options in the management of tympanic membrane retractions. We searched the Cochrane Ear, Nose and Throat Disorders Group Tri...

The National Health Service Plan of 2000 proposed that patients should receive a copy of all correspondence regarding their care. There is concern that the readability of patients' letters may not be appropriate for many patients. This study determined readability scores for sequential letters written to general practitioners and copied to patients...

Background: Idiopathic sudden sensorineural hearing loss (ISSHL) is sudden hearing loss where clinical assessment fails to reveal a cause. The most widely used therapeutic agents for ISSHL are antivirals, steroids, hyperbaric oxygen, vasodilators and rheological/vasoactive substances. There is currently conflicting evidence for vasodilator and vas...

Information leaflets are commonly used in Speech and Language Therapy Departments. Despite widespread use, they can be of variable quality. To revise current departmental leaflets using the National Health Service (NHS) Toolkit for Producing Patient Information and to test the effect that this has on the readability scores of the text. Twenty exist...

POTHIER L. & POTHIER D.D. (2009) European Journal of Cancer Care Patient-orientated web sites on laryngectomy: is their information readable? The objective of the study was to determine levels of readability of commonly accessed websites containing patient information on laryngectomy. A Cross-sectional study of Internet websites was designed. The f...

To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. A prospective cohort study and qualitative systematic review. Multi-cancer networks in the South West of England, Hampshire and...

The extent of surgical training given to undergraduates is variable and the decisions taken on the adequacy of the amount to be delivered are often made using little evidence. Therefore, these decisions are vulnerable to bias. Arbitrary coherence is a recently recognized behavior that can be induced by influencing subjects to anchor their answers t...

In August 2008 a compulsory annual fee of £125 was imposed on surgical trainees to support the ongoing costs of the Joint Committee on Surgical Training (JCST). This included the costs of running the Intercollegiate Surgical Curriculum Programme (ISCP) and contributing towards the Orthopaedic Competence Assessment Programme (OCAP). Fees are to be p...

Aims and Methods The internet is an important source of mental health information. Given variable literacy levels in the general public, patient information websites need to be easily readable to prevent misunderstanding and consequent misinformation about mental health problems being propagated. the aim was to ascertain the readability of websites...

Objectives It is difficult to reliably diagnose the early stages of retraction on a purely clinical basis. This is of particular importance where a diagnosis needs to be made in a setting, such as in primary care or a clinical dataset, where tympanometry is not always available. Although a split light reflex is sometimes used clinically, it has not...

To measure the thermal properties of operative endoscopes used in otorhinolaryngological practice. A series of endoscopes of varying diameters and angulations were attached to a light source and temperature measurements taken of their shaft and tip; a measurement was also taken 5 mm in front of the endoscope tip. Temperature changes took place rapi...

Informed consent is crucial in most research but written consent is not without its drawbacks. Written consent serves to protect the researcher more than it serves to protect the participant and this can present a barrier to their relationship. In certain circumstances it can undermine the trust important in research. For ‘simple’ studies, where tr...

Objectives. To investigate the feasibility and effectiveness of endoscopic dewaxing1 in primary care as a replacement for syringing or irrigation of the external auditory meatus. Method. Case control pilot study. Seven practice nurses from General Practices in the Wiltshire area completed a training course in the technique of endoscopic dewaxing. A...

Examination of the upper aerodigestive tract is an important part of ENT practice. The use of both flexible and rigid nasendoscopes is the most common way of achieving this in the out-patient setting. However, these procedures can cause pain or discomfort for the patient, and topical preparations have been used in an attempt to reduce this. The var...

General Practitioners (GPs) are required to diagnose a number of common ear pathologies on a regular basis. In particular, otitis media with effusion (OME) can be well managed in primary care if a reliable diagnosis can be made. We set out to assess the confidence and ability of GPs to diagnose otopathology, as well as the access that they had to t...

Background: The aetiology of the autistic spectrum disorders (ASD) is largely unknown. Objectives: To assess whether signs and symptoms related to common health problems in childhood are associated with ASD. Methods: The Avon Longitudinal Study of Parents and Children (ALSPAC; n=14000) started in early pregnancy. Data collected on the child dur...

To report an unrecognised complication of fibre-optic nasendoscopy, and its management. A protective, transparent nasendoscopy sheath is often used to reduce nasendoscope 'downtime' and to prevent cross infection, with minimal effect on the obtained image quality. We report the case of a subcutaneous tracheostomy procedure during which, without und...

Impacted wax accounts for a considerable proportion of cancelled appointments in the audiology department. Current practice usually involves the patient being referred back to their General Practitioner (GP) for wax removal. Endoscopic dewaxing is a technique that can be used to remove wax under direct vision. Having been trained in the technique,...

We read with interest the recent work by Back et al¹ designing and evaluating the efficacy of Oncotalk, a new residential communication skills workshop. Indeed, discussing bad news remains a challenging area in everyday practice, since few of today's residents and fellows have received any formal communication skills training.² Although the article...

Sending patients a copy of the letters that are produced for their referring general practitioners (GPs) from an out-patient consultation is a policy of the UK Department of Health. Little research has been done to establish how patients attending out-patient departments feel about this practice and the effect this may have on the department itself...