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Recent Submissions
Treatment of Sudden Sensorineural Hearing Loss: A Narrative Review
(2024) Johnston, Cara; Rahman, Fariha; de Champlain, Katie; Chau, Justin
Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency characterized as a loss of 30 dB HL or greater across at least three consecutive audiometric frequencies within a 72-hour period. SSNHL can negatively impact a patient’s quality of life. Treatment of SSNHL often involves the use of systemic oral and/or intratympanic corticosteroids. Hyperbaric oxygen therapy (HBOT) has been utilized as an adjunct to steroid treatment. Other treatment modalities including antivirals, diuretics, antihistamines, prostaglandins, and vasodilators have been trialed without significant success. As it stands, practice guidelines may differ between clinicians and there is a need to review current management practices.
Objective: To synthesize existing research on the treatment of SSNHL and identify gaps and discrepancies in treatment recommendations.
Methods: A review of literature from the following databases was conducted: Web of Science, Pubmed, and National Library of Medicine. Articles that cover the current treatment models for SSNHL and clinical trials that analyze the effects of various treatment parameters were included.
Results: First-line therapies including the prompt initiation of corticosteroid therapy have been identified as potentially efficacious. Consistently, therapies including HBOT with steroid therapy showed slight gain in hearing in comparison to groups who did not receive HBOT. There is limited use of other treatments. Large variation exists when looking at treatment duration, initiation, dosage of steroids, pressure inside HBOT chamber, and uses in salvage therapy.
Conclusion: Oral steroid, intratympanic steroid, and hyperbaric oxygen therapy dominate as treatment in sudden sensorineural hearing loss. However, optimal treatment parameters remain unclear, highlighting a need for increased research in this area.
Hidradenitis Suppurativa Chart Review: Biologic Drugs Used in Comorbid Conditions
(2024) Rochelle Tonkin; Jennifer Wytsma; Sonia Czyz; Susan Poelman; Lauren Lam
Background: Biologics are becoming more commonly used as treatment for hidradenitis suppurativa (HS). Given the increased prevalence of comorbid conditions in those with HS, there exists an opportunity to treat both HS and existing comorbidities with a single biologic agent.
Objective: To evaluate which biologic medications HS patients are on, the burden of
comorbid conditions in those patients, and whether changes in prescribing habits for HS and comorbid conditions are necessary.
Method: A chart review of HS patients treated with biologic medications over the past 3 years at a private community clinic in Calgary, Alberta, Canada was performed. Data collection included patient age/gender demographics, name of the biologic medication(s), comorbid condition(s), and duration of therapy for those patients treated. Diagnoses were classified and grouped according to currently published HS comorbid conditions.
Results: Preliminary results have demonstrated that of the 81 patients who met the
inclusion criteria, the two biologics most often prescribed were Adalimumab (n=66, 82%) and Secukinumab (n=14, 17%). The most prevalent comorbid conditions were
depression/anxiety (n=39, 48%), type II diabetes (n=33, 40.7%), obesity (n=26, 32.1%), psoriasis (n=9, 11%), inflammatory bowel disease (n=7, 9%), and inflammatory arthritis (n=6, 7%). Other comorbidities identified included asthma (n=13, 16%) and sleep apnea (n=9, 11%).
Discussion: Given that certain biologics are also able to treat other inflammatory
conditions, such as IBD, psoriasis, and rheumatoid arthritis, and the high prevalence of these conditions in patients with HS, it may be more efficient for prescribers to coordinate with other specialties to treat both HS and comorbid conditions with a single biologic agent.
Cardiometabolic Screening in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis
(2024) Evanchuk, Jenna; Brünger, Griffin; James, Kristin; McClurg, Caitlin; Vine, Donna; Yamamoto, Jennifer M.; Benham, Jamie L.
Educational Conference for Learning, Innovation, and Professional Scholarly Enhancement (ECLIPSE) abstract
Conference date: Dec 6, 2025
Cardiometabolic Screening in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis
Authors: Jenna Evanchuk, Griffin Brünger, Kristin James, Caitlin McClurg, Donna Vine, Jennifer M Yamamoto, Jamie L Benham
Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition, estimated to impact 10% of people with ovaries. An extensive body of evidence suggests an association between PCOS and an increased risk of cardiometabolic complications. The 2023 International PCOS Guidelines included recommendations for the screening of cardiometabolic risk factors and conditions in this patient population, but a synthesis of these practices in a clinical setting is lacking.
Objective: The primary objective of this systematic review was to determine the proportion of cardiometabolic screening conducted in patients with PCOS, and secondly to characterize the factors associated with screening measures.
Data Sources: MEDLINE and EMBASE were searched from inception to March 2024.
Study Selection: Title, abstract, and full text screening was completed by two independent reviewers (JE and GB, or JE and KJ). Independent data extraction was performed in duplicate using the predetermined protocol criteria. Any discrepancies were reconciled between reviewers until a unanimous decision was reached.
Analyses: Random effects and stratified meta-analysis were conducted to determine the pooled proportions and 95% confidence intervals (95% CI) of screening for cardiometabolic conditions (e.g. diabetes, dyslipidemia, hypertension, obesity) among people with PCOS. The Newcastle Ottawa Scale was used for quality assessment.
Results: 8280 studies were screened and 23 were included after full text review. The source of screening data were the medical records of patients with PCOS in 12 studies, whereas the remaining 11 studies surveyed the screening practices of providers caring for people with PCOS. After compiling data from the studies reporting on medical records, the pooled proportion of screening for diabetes was 52% (10 studies, 95% CI: 23-79%) and for dyslipidemia 40% (9 studies, 95% CI: 16-69%). The pooled proportion of hypertension screening was 99% (5 studies, 95% CI: 90-100%) and 89% (7 studies, 95% CI: 64-98%) for obesity, according to medical records. The pooled proportion of providers answering yes as to whether they would conduct diabetes or dyslipidemia screening for patients with PCOS was 79% (6 studies, 95% CI: 57-91%) and 60% (2 studies, 95% CI: 33-83%), respectively.
Conclusion: There was a discrepancy between a provider’s intention to perform screening for diabetes and dyslipidemia and performed screening as indicated by medical records. Further research is needed to determine if this discrepancy persists across diverse clinical practices and to identify the driving factors, including systemic, provider, or patient barriers.
Systematic Review Registration: PROSPERO, CRD42024503780
Alterations in mitochondrial function associated with cold temperature acclimation and life stage in Caloptilia fraxinella
(2024) Mast, Heather; Silva, Maise; Lemieux, Hélène
Background: Mitochondrial oxidative phosphorylation (OXPHOS) produces most of the energy needed for cellular function. OXPHOS utilizes the electron transfer system (ETS) to create a proton gradient to produce energy in the form of adenosine triphosphate (ATP). When facing temperature changes, animals respond by altering their metabolism, including their mitochondrial metabolism, to preserve their cellular functions.
Methods: This project utilized the technique of high-resolution respirometry to first look at modifications of the main OXPHOS pathways (NADH and Succinate pathways through the ETS’ complexes I and II, respectively), as well as the lesser-studied Proline dehydrogenase pathway (important for flight muscle) in the ash leaf cone roller moth, Caloptilia fraxinella Ely (Lepidoptera: Gracillariidae). Second, we looked at the influence of the developmental stage (pupae and adults) and cold temperature acclimation (5°C) on substrate utilization, since this insect overwinters at an immature stage then emerges in the spring to mate and die. We also studied the impact of a more extreme cold acclimation temperature (-10°C) on mitochondrial function in adults to accomplish this objective.
Results: Our results demonstrate no differences in substrate utilization between males and females and no change in proline metabolism with cold acclimation in adults. Adults depend on the NADH pathway less than pupae, and this pathway’s contribution to overall respiration is higher when animals are acclimated to 5°C compared to 20°C. Contrarily, adults utilize the Succinate pathway more than pupae, but this pathway is not altered by temperature in adults. Pupae use the Succinate pathway more at 5°C compared to 20°C. Interestingly in adults, this difference between the pathways reverses at even colder (-10°C) temperatures; adults decrease the contribution of the NADH pathway but increase the contribution of the Succinate pathway after acclimation at -10°C when compared to 20°C.
Conclusion: The NADH pathway is more efficient in producing energy and is more involved in activating signaling pathways which could result in better responses to cold temperature in adults. It is possible that pupae have not developed this mechanism to adapt to colder temperatures since they do not typically survive the winter months. Together, these results elucidate some biochemical changes that C. fraxinella uses to withstand various temperatures at different life stages.
Abstract: Defining and Mapping Temporal Bone Surgery Competencies in Otolaryngology–Head and Neck Surgery Residency: A Canadian Nationwide Survey
(2024) Hammal,Jessica; Aleinati Fatemeh, Mohammad; Lui, Justin T.
Background: Temporal bone surgery is an essential component of Otolaryngology–Head and Neck Surgery (OHNS) training, encompassing a variety of complex procedures that require advanced skills and anatomical knowledge. However, training and competency levels vary significantly across Canadian OHNS residency programs, partly due to ambiguities in the Royal College of Physicians and Surgeons of Canada (RCPSC) Competence By Design (CBD) expectations for temporal bone surgery. This study aimed to identify essential temporal bone surgical procedures for OHNS residency training, establish the required competency level for each procedure, and determine an appropriate timeline for achieving these competencies.
Methods: A cross-sectional, nationwide survey was conducted targeting Canadian general otolaryngologists and otology/neurotology subspecialists. A survey was developed to evaluate key temporal bone procedures in terms of relevance to residency training, expected competency level, and the expected timeline to achieve this. Program administrators from OHNS residency programs across Canada were contacted to facilitate survey dissemination. Responses were analyzed using a threshold of 60% to establish consensus.
Results: In total, 21 responses were received, of which 57% were otology/neurotology subspecialists and 43% were general otolaryngologists. Over half of respondents had more than 10 years of experience in their field. Consensus was achieved in the expectation of independently performing tympanoplasty (95.2%) and canal wall up mastoidectomy (81.0%). Consensus was also achieved in the expectation to partially perform stapedectomy/stapedotomy (66.7%), as well as achieve an understanding of posterior tympanotomy (61.9%), middle cranial fossa skull base approach (76.2%), translabyrinthine skull base approach (61.9%), suboccipital skull base approach (61.9%), superior canal dehiscence surgery (61.9%), and anterior petrosectomy (61.9%). Consensus was not achieved for canalplasty, ossiculoplasty, canal wall down mastoidectomy, and posterior petrosectomy. When responses were grouped by respondent specialty, general otolaryngologists had higher expectations than otologists/neurotologists in tympanoplasty (100% vs 91.67% for expectation to perform) and CWU mastoidectomy (88.89% vs 75% for expectation to perform), although this did not meet statistical significance. Trends in other competencies were more variable with no consistent pattern of differences between groups.
Discussion: This study provides the first published consensus among Canadian OHNS providers regarding key temporal bone procedures in residency training. Both tympanoplasty and canal wall up mastoidectomy were identified as procedures expected to be independently performed by residents. Variable expectations for other procedures reflect ongoing uncertainty about the extent of temporal bone surgical training suitable for OHNS residency in Canada. Furthermore, there is some divergence in views depending on scope of practice, which can further contribute to variable training expectations.
Conclusion: This study is the first to establish a consensus on temporal bone surgical competencies in Canadian OHNS residency training. Establishing clear expectations for procedural competency is critical for ensuring consistency in residency training. We hope that these findings will help shape the RCPSC OHNS residency curriculum for temporal bone surgery.
