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Objectives To determine the prevalence and specific modalities of complementary and alternative medicine (CAM) by professional voice users (PVUs) for vocal ailments and to examine the PVU's health care utilization. Methods A Canadian national cross-sectional survey was conducted. Surveys were distributed electronically to members of the Alliance of Canadian Cinema, Television, and Radio Artists; the National Association of Teachers of Singing; the Canadian Actors Equity Association; and the Department of Vocal Performance at Western University. Participants were asked about the products/therapies they use to improve vocal health. Frequency of use, health care utilization, and general influencers in treatment choice were also collected. Results Two hundred eighty-eight participants completed the survey. 86% of participants claimed to have taken at least one form of CAM when experiencing voice loss or a negative voice change. Of the respondents, 18% claimed to use products/therapies for vocal health routinely in the absence of vocal ailments. The most common CAMs used were hot drinks with honey and/or lemon, lozenges, and inhaling steam. When vocally ill, PVUs were significantly more likely to use CAMs than any other treatment method. Voice teachers and medical doctors most commonly influenced the choice of the treatment. Conclusion This study illustrated the substantial prevalence of CAMs in the PVU community. Understanding the utilization of CAMs can help clinicians navigate treatment strategies for this patient population., (Copyright © 2021. Published by Elsevier Inc.)

Objective: To describe the successes and challenges associated with developing an otolaryngology-head and neck surgery (OHNS) medical education app and website., Design: From 2010 to 2018, OHNS faculty across Canada contributed to the development of a smartphone app, LearnENT. LearnENT 1.0, was initially launched in 2012 using the Apple iOS 6 platform. The app utilized a novel user interface and interactive features to help learners develop approaches to OHNS clinical problems, review relevant anatomy, history, and physical examination skills. However, the release of iOS 7 necessitated a redesign and relaunch of LearnENT which occurred from 2015 to 2018 to produce the final version of the app, LearnENT 2.0. Through the relaunching process, the LearnENT team redesigned the app's interface, produced a web version of the app, and created a new content management system., Setting: OHNS departments across Canada., Participants: OHNS faculty members, residents, and medical students., Results: Through this approach, a sustainable, widely accessible, open access OHNS e-Learning resource was developed. Since the relaunch, the LearnENT app has 2728 user accounts and has been widely used across the globe with users in 36 countries outside of North America. LearnENT is currently the official learning app of the Canadian Society of OHNS, has been featured on several different medical education platforms and incorporated into medical school curricula at various institutions., Conclusions: The authors successfully created a novel e-Learning resource with the goal of improving OHNS medical education both nationally and internationally., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Patients with resected oral cavity squamous cell carcinoma (OCSCC) are often treated with adjuvant radiation (RT) ± concomitant chemotherapy based on pathological findings. Standard RT volumes include all surgically dissected areas, including the tumour bed and dissected neck. RT has significant acute and long-term toxicities including odynophagia, dysphagia, dermatitis and fibrosis. The goal of this study is to assess the rate of regional failure with omission of radiation to the surgically dissected pathologically node negative (pN0) hemi-neck(s) compared to historical control, and to compare oncologic outcomes, toxicity, and quality of life (QoL) profiles between standard RT volumes and omission of RT to the pN0 neck., Methods: This is a multicentre phase II study randomizing 90 patients with T1-4 N0-2 OCSCC with at least one pN0 hemi-neck in a 1:2 ratio between standard RT volumes and omission of RT to the pN0 hemi-neck(s). Patients will be stratified based on overall nodal status (nodal involvement vs. no nodal involvement) and use of concurrent chemotherapy. The primary endpoint is regional failure in the pN0 hemi-neck(s); we hypothesize that a 2-year regional recurrence of 20% or less will be achieved. Secondary endpoints include overall and progression-free survival, local recurrence, rate of salvage therapy, toxicity and QoL., Discussion: This study will provide an assessment of omission of RT to the dissected pN0 hemi-neck(s) on oncologic outcomes, QoL and toxicity. Results will inform the design of future definitive phase III trials., Trial Registration: Clinicaltrials.gov identifier: NCT03997643 . Date of registration: June 25, 2019, Current version: 2.0 on July 11 2020.

Background: Considerable evidence now indicates that individuals living in underprivileged neighbourhoods have higher rates of mortality and morbidity independent of individual-level characteristics. This study explored the impact of geographical marginalization on smoking cessation in a population of individuals with a diagnosis of head and neck cancer. The aims of this study were twofold: (1) assess the prevalence of smoking cessation in those with a previous diagnosis of head and neck cancer, (2) analyze the determinants of smoking alongside area-based measures of socioeconomic status., Methods: This was a cross-sectional study. We administered a self-reported nicotine dependence package to participants between the ages of 20-90 with a previous mucosal head and neck cancer diagnosis and with a history of tobacco use. Using the Canadian Marginalization (CAN-Marg) Index tool based on 2006 Canada Census data we compared the degree of marginalization to the smoking status. For those individuals who were currently smoking, nicotine dependence and readiness to quit were assessed. A summative score of marginalization was compared to smoking status of individuals., Results: The results from this study indicate that the summative level of marginalization developed from the combined factors of residential instability, material deprivation, ethnic concentration and dependency may be important factors in smoking cessation., Conclusions: This analysis of determinants of smoking alongside area-based measures of socioeconomic status may implicate the need for targeted population-based smoking cessation interventions.

Objective: To create and assess a novel high-fidelity peritonsillar abscess simulation task trainer with junior otolaryngology-head and neck surgery residents., Study Design: Prospective cohort study., Setting: Third annual Emergencies in Otolaryngology Head & Neck Surgery Bootcamp course at the Canadian Surgical Technologies & Advanced Robotics in London, Canada., Subjects and Methods: Fresh cadaveric material was obtained consisting of a head and neck. Abscess pockets were simulated with a finger of a latex glove containing vanilla pudding to represent pus, tied off with a silk suture. These abscess pockets were inserted into the peritonsillar space from the transected neck inferiorly, passing medial to the great vessels into the parapharyngeal space. Faculty members evaluated the models to test content validity. The primary outcome measure was a postbootcamp survey evaluation assessing specific domains: learning objectives, effectiveness of faculty, and the quality and realism of models., Results: When working with this model, learners were able to locate, visualize, and manipulate the abscess. The materials and positioning of the pockets created high-fidelity models that were realistic in appearance and haptics feedback., Conclusions: A novel high-fidelity task trainer has been successfully developed to teach the technique of peritonsillar abscess incision and drainage. This task trainer is currently the highest-fidelity model reported in the literature. This model allows learners to practice a high-stakes emergency skill in a controlled environment, affording the opportunity to practice localization, visualization, and drainage of the abscess with a high level of realism., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

The objective of this study was to determine the 30-day incidence of ischemic stroke following neck dissection compared to matched patients undergoing non-head and neck surgeries.A surgical dissection of the neck is a common procedure performed for many types of cancer. Whether such dissections increase the risk of ischemic stroke is uncertain.A retrospective cohort study using data from linked administrative and registry databases (1995-2012) in the province of Ontario, Canada was performed. Patients were matched 1-to-1 on age, sex, date of surgery, and comorbidities to patients undergoing non-head and neck surgeries. The primary outcome was ischemic stroke assessed in hospitalized patients using validated database codes.A total of 14,837 patients underwent surgical neck dissection. The 30-day incidence of ischemic stroke following the dissection was 0.7%. This incidence decreased in recent years (1.1% in 1995 to 2000; 0.8% in 2001 to 2006; 0.3% in 2007 to 2012; P for trend <0.0001). The 30-day incidence of ischemic stroke in patients undergoing neck dissection is similar to matched patients undergoing thoracic surgery (0.5%, P = 0.26) and colectomy (0.5%, P = 0.1). Factors independently associated with a higher risk of stroke in 30 days following neck dissection surgery were of age ≥75 years (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.53), and a history of diabetes (OR 1.60, 95% CI 1.02-2.49), hypertension (OR 2.64, 95% CI 1.64-4.25), or prior stroke (OR 4.06, 95% CI 2.29-7.18).Less than 1% of patients undergoing surgical neck dissection will experience an ischemic stroke in the following 30 days. This incidence of stroke is similar to thoracic surgery and colectomy.

Background: Radiation therapy treatment planning has advanced over the past 2 decades, with increased emphasis on 3-dimensional imaging for target and organ-at-risk (OAR) delineation. Recent studies suggest a need for improved resident instruction in this area. We developed and evaluated an intensive national educational course ("boot camp") designed to provide dedicated instruction in site-specific anatomy, radiology, and contouring using a multidisciplinary (MDT) approach., Methods: The anatomy and radiology contouring (ARC) boot camp was modeled after prior single-institution pilot studies and a needs-assessment survey. The boot camp incorporated joint lectures from radiation oncologists, anatomists, radiologists, and surgeons, with hands-on contouring instruction and small group interactive seminars using cadaveric prosections and correlative axial radiographs. Outcomes were evaluated using pretesting and posttesting, including anatomy/radiology multiple-choice questions (MCQ), timed contouring sessions (evaluated relative to a gold standard using Dice similarity metrics), and qualitative questions on satisfaction and perceived effectiveness. Analyses of pretest versus posttest scores were performed using nonparametric paired testing., Results: Twenty-nine radiation oncology residents from 10 Canadian universities participated. As part of their current training, 29%, 75%, and 21% receive anatomy, radiology, and contouring instruction, respectively. On posttest scores, the MCQ knowledge scores improved significantly (pretest mean 60% vs posttest mean 80%, P<.001). Across all contoured structures, there was a 0.20 median improvement in students' average Dice score (P<.001). For individual structures, significant Dice improvements occurred in 10 structures. Residents self-reported an improved ability to contour OARs and interpret radiographs in all anatomic sites, 92% of students found the MDT format effective for their learning, and 93% found the boot camp more effective than educational sessions at their own institutions. All of the residents (100%) would recommend this course to others., Conclusions: The ARC boot camp is an effective intervention for improving radiation oncology residents' knowledge and understanding of anatomy and radiology in addition to enhancing their confidence and accuracy in contouring., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives/hypothesis: A 1-day intensive course (bootcamp) was developed, to teach junior otolaryngology-head and neck surgery (OTO-HNS) residents emergency procedural skills, clinical reasoning, and communication skills. This learning paradigm utilized a number of novel task trainers, panel discussions, and emergency simulations. The study objective was to assess the educational value of this bootcamp., Study Design: Prospective cohort survey., Methods: Residents were recruited from regional teaching centers within a 2000-km radius of the simulation center. Preceptors fluent in English and in French were in attendance. Pre-bootcamp outcome measures included the Kolb Learning Style Inventory and a self-administered survey measuring confidence levels in performing specific OTO-HNS tasks. Post-bootcamp outcome measures included a survey evaluating the bootcamp experience and a structured follow-up telephone interview., Results: Twenty-eight residents participated in the bootcamp from across the United States and Canada. When asked if they felt that "overall, the educational day was an effective learning process," the average score was 4.75/5.0. The vast majority of participants (92.9%) felt they would recommend the bootcamp to a future junior resident. Kolb learning styles that prefer active experimentation (acting, initiating, and deciding) were more common than those that utilize reflective observation (imagining, analyzing, reflecting), which favors a hands-on model of learning., Conclusion: This first Canadian OTO-HNS bootcamp demonstrated the feasibility and effectiveness of conducting a centralized bootcamp for regional training centers spanning multiple states/provinces and languages. Future bootcamps will be held annually and will ideally continue the natural evolution of surgical, hands-on training., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To assess the oncological and functional outcomes of T1b squamous cell carcinoma (SCC) of the glottic larynx treated with laser in comparison with radiation., Design: A Canadian multicenter cohort study., Setting: Three tertiary referral centers for head and neck cancer- Dalhousie University in Halifax, Nova Scotia, Western University in London, Ontario and the University of Manitoba, Winnipeg., Methods: Patients with T1b glottic SCC who underwent transoral laser resection or radiation as the primary modality of treatment., Outcome Measures: Oncological outcomes were evaluated using local control, laryngeal preservation, disease free survival and disease specific survival. Voice outcomes were assessed using the Voice Handicap Index-10 (VHI-10)., Results: 63 patients met study criteria. 21 were treated with laser and 42 with radiation. Oncologic outcomes at 2 years for laser and radiation demonstrated local control of 95% and 85.9%; laryngeal preservation of 100% and 85.9%; disease free survival of 88.7% and 85.9% and overall survival of 94.1% and 94.8% respectively. VHI-10 data was available for 23/63 patients. During the last follow up visit VHI-10 ranged from 0 to 11 (median 6) in the laser group and 0 to 34 (median 7) in the radiation group., Conclusion: T1b SCC of the glottis can be effectively treated with transoral laser microsurgery with oncological outcomes that are at least equivalent to radiation. For patients with VHI scores, voice quality was similar between the two groups. To our knowledge this is the first study directly comparing the oncologic and voice outcomes with laser and radiation for the treatment of glottic cancer involving the anterior commissure.

Due to significant differences in healthcare structure between the United States and Canada, there are unique barriers to adopting new medical technology in Canada. In this article, we describe our experience developing a transoral robotic surgery (TORS) program at Western University. Specifically, we outline the steps that were necessary to obtain institutional and multidisciplinary team approval, financial support, as well as surgeon and allied healthcare personnel training. This experience can potentially be used as a roadmap for other Canadian institutions pursuing a TORS program.

Objectives: There is no standardized curriculum for laryngology within otolaryngology residency programs despite the fact that laryngology is a significant portion of the Royal College of Physicians and Surgeons of Canada examination. Our objective was to evaluate trainee perceptions of laryngology within otolaryngology residency programs., Design: Cross-sectional survey., Setting: Canadian otolaryngology residency programs., Methods: A Web-based, anonymous survey was conducted among otolaryngology residents. The survey was based on Royal College learning objectives for laryngology. The survey was administered using Dillman's Total Design Method and distributed in English and French., Results: Sixty-four of 150 (42.6%) residents responded to the survey (55.6% male; mean age 29.3 years). About half of the respondents agreed or strongly agreed that the amount of didactic and clinical laryngology instruction was adequate. About 41.0% agreed or strongly agreed that the amount of operative laryngology instruction was adequate. Cited areas for improvement included injection laryngoplasty, botulinum toxin injection, medialization thyroplasty, care of the professional voice, phonosurgery, and videostroboscopy. Areas of strength included flexible nasopharyngoscopy, laryngeal anatomy, hoarseness, stridor, laryngopharyngeal reflux disease, and vocal cord paralysis. Overall, 40.7% felt somewhat comfortable providing laryngology care. The presence of a laryngology fellowship at the training program, respondent interest in pursuing a fellowship, completion of a laryngology elective, and previous laryngology research did not affect the residency experience. Senior residents are more comfortable with providing laryngology care than juniors., Conclusions: Several areas of strengths and areas for improvement in laryngology appear to exist within otolaryngology residency programs as perceived by current trainees.

Objective: To compare the laryngeal preservation rates and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT)., Design: Multicenter, retrospective consecutive cohort of stage 1 and 2 glottic carcinoma treated with TLM or RT., Setting: Three Canadian academic cancer centres., Methods and Main Outcome Measures: The patients were those of the regional cancer registries associated with each of the participating universities between 2002 and 2010. The primary oncologic end point was organ preservation. The primary functional outcome measure was the Voice Handicap Index (VHI-10)., Results: A total of 234 patients were treated for early glottic cancer (143 TLM, 91 RT). At 2 years, the laryngeal preservation rate for stage 1 disease was 100% TLM and 92% RT (p < .004); for stage 2 disease, it was 100% TLM and 88% RT (p  =  not significant). There was only one laryngectomy in the TLM group over 5 years posttreatment. There were functional data on 132 patients (83 TLM, 49 RT). Median VHI-10 scores were inferior for laser patients at all three time intervals (6, 12, and 24-48 months posttreament) despite a stage bias in favour of TLM (range of median VHI score over time intervals: TLM  =  9.5-12, RT  =  3.5-8; p  =  .01-.08). However, theses scores represent mild disability in both groups., Conclusions: TLM patients have poorer voice quality than RT patients. However, the advantages of TLM in most patients outweigh the degree of voice handicap. Organ preservation rates for TLM were better than or equal to those of RT for both stage 1 and 2 glottic cancer.

Objectives: Otolaryngologic problems are common in primary care but are underrepresented in undergraduate medical education (UME). A significant portion of the total structured teaching received by physicians in primary care specialties is spent in UME, but teaching of otolaryngology in UME is limited and not standardized across Canadian medical schools. This study assessed the content and structure of otolaryngology UME at Canadian undergraduate medical programs and postgraduate primary care programs and surveyed community otolaryngologists to identify important clinical topics for inclusion in an otolaryngology curriculum., Methods: A survey was created based on previously validated and published curriculum needs assessment instruments for medical education. Surveys were distributed to (1) undergraduate directors of otolaryngology, (2) postgraduate program directors of family and emergency medicine at English-language medical schools, and (3) community otolaryngologists in Canada., Results: There is large variation in the quantity of otolaryngology teaching in UME. Knowledge of otolaryngology is formally evaluated at half of the responding programs, although skills in otolaryngology are rarely tested. Clerkship rotations are not uniformly offered, and the length of these placements is limited. Opportunities in postgraduate training for formal education in otolaryngology are rare. Several important topics that are not uniformly taught include sudden sensorineural hearing loss, sleep apnea, and nasal trauma. Important skills that are not uniformly taught include treatment of benign paroxysmal positional vertigo and epistaxis., Conclusions: There is limited time for teaching otolaryngology in UME; therefore, it is essential to emphasize teaching key topics and skills, which are highlighted in the results of this study.