Ep. 76 Medical Missions in ENT: Spotlight on Project Ear with Dr. Edward Dodson

11/08/22 • 48 min

In this episode of BackTable ENT, Dr. Varun Varadarajan interviews Dr. Edward Dodson, President of Project Ear and a neurotologist at the Ohio State University Wexner Medical Center, about his humanitarian efforts in the Dominican Republic.

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SHOW NOTES

Dr. Dodson was first introduced to Project Ear when he joined his mentor and Project Ear founder, Dr. Paul Lambert, on a mission trip to Dominican Republic in 1995 to perform ear surgeries. Although they could only operate on 12 patients, seeing hundreds of patients waiting in line for medical care was eye-opening for him.

Dr. Dodson then shares about preparations needed for the Project Ear medical mission trips. He emphasizes the importance of their local neurotologist liaison, Dr. Roberto Batista, who helped Project Ear by performing preoperative and postoperative care for patients in exchange for equipment. In the first years of the organization, the doctors had to learn which supplies to bring and how to store them as well as how to organize staff and supplies in order to pass through customs. Dr. Dodson notes that he used to sterilize wasted equipment from American ORs during their first trips. Later, Project Ear was able to partner with Ohio State University and could give credit to residents who participated on the trips and negotiate time for employees to travel. Because the mission hospital they worked with allowed trainees, he was allowed to take senior level American residents to the Dominican Republic. Furthermore, Dr. Dodson also sought out to teach DR residents independently at another hospital and brought them new medical equipment. This initiative led DR residents to be granted permission to participate in Project Ear surgeries as well as rotate at Ohio State. Currently, multiple ENT subspecialties, besides neurotology, and audiology are now represented within Project Ear.

Next, Dr. Dodson speaks about Dominican Republic-related topics. He explains that the most common ear conditions he sees are chronic draining ears, perforation, cholesteatomas, congenital atresia, stapedectomy, and otosclerosis. When the COVID-19 pandemic hit, he and his Project Ear colleagues started teaching via Zoom through giving lectures and Grand Rounds talks to Dominican Republic residents. Dr. Dodson and Dr. Varadarajan also reflect on the open-mindedness and creativity required to operate in a resource-limited environment. Dr. Dodson also explains about how he navigated relationships with local ENT doctors in the area.

Finally, he shares advice and resources for doctors looking to start their own medical mission trips. He emphasizes the importance of understanding the time it takes to plan and lead a trip as well as determining that your medical services are actually wanted in the country.

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RESOURCES

Project Ear

https://projectear.org/

Coalition for Global Hearing Health

https://coalitionforglobalhearinghealth.org/

AAO-HNSF Humanitarian Efforts List

https://www.entnet.org/get-involved/humanitarian-efforts/

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/nUekSE

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SHOW NOTES

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RESOURCES

Project Ear

https://projectear.org/

Coalition for Global Hearing Health

https://coalitionforglobalhearinghealth.org/

AAO-HNSF Humanitarian Efforts List

https://www.entnet.org/get-involved/humanitarian-efforts/

Previous Episode

Ep. 75 Technology and 3D Imaging for Endoscopic Skull Base Surgery in Children with Dr. Cristobal Langdon

In this episode of BackTable ENT, Dr. Gopi Shah discusses 3D imaging and other surgical technology with Dr. Cristobal Langdon, an academic and private practice rhinologist and skull base surgeon working at Hospital Sant Joan de Déu Barcelona.

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SHOW NOTES

First, Dr. Langdon speaks about common conditions he treats as a skull base surgeon, such as Rathke cleft cysts and craniopharyngiomas. Most of his referrals come from neurosurgeons and opthamologists once the decision to take a transnasal approach over an open approach is made.

Next, he talks about pre-operative preparations. During his initial patient visit, he scopes his patients with a flexible scope and tries to record every scope procedure for educational and planning purposes. Every patient receives an MRI, and a CT scan is usually already obtained. Dr. Langdon does not prescribe any antibiotics or corticosteroids before surgery. Then, he discusses how he uses 3D models for surgical planning. For him, 3D models are useful in deciding between different surgical approaches and practicing difficult surgeries. He requests that his models are made true to size by biomedical engineers. He also tells his engineering team which structures need to be constructed (i.e.-nerves, carotid arteries, etc.). Then, Dr. Shah and Dr. Langdon discuss the implications of virtual reality for surgical education.

Then, the doctors discuss the use of technology in the operating room. Dr. Langdon does not often use image guidance. He sometimes uses neurosurgical guidance, but warns against becoming dependent on technology and not learning patient anatomy well. He thinks image-guided instruments are nice, but not necessary to have. Like Dr. Shah, he uses intrathecal fluorescein to look for CSF leaks. Then, the doctors also discuss the pros and cons of different types of flaps and packing.

Finally, Dr. Langdon speaks about his postoperative saline regimen. He recommends that all his pediatric patients use at least 100 mL for each side every 12 hours. Dr. Shah likes to show the patient and their families educational videos of sinus rinses before surgery so they are prepared postoperatively. Both doctors concede that synechiae (scar tissue) may form in kids, but they rarely take pediatric patients back to the OR for debridement.

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RESOURCES

Dr. Langdon’s Youtube

https://www.youtube.com/c/BarcelonaRhinologySchool

Next Episode

Ep. 77 In-Office Procedures for Chronic Rhinitis with Dr. Stan McClurg

In this episode, Dr. Stan McClurg, a private practice rhinologist at Ascentist Healthcare in Kansas City, shares his approach to diagnosis and treatment of chronic rhinitis patients using the in-office RhinAer procedure.

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Aerin Medical

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SHOW NOTES

First, Dr. McClurg talks us through his patient base. When he initially started as a rhinologist, he would get referrals for patients with persistent rhinitis after a procedure. Before in-office procedures for chronic rhinitis were developed, he recommended ipratropium bromide spray to patients and referred them for allergy testing. However, his recent patient referrals have been for isolated chronic rhinitis (defined by consistent rhinorrhea for more than 4 weeks) with no other ENT problems. With these patients, he performs allergy skin testing to make sure the diagnosis is not really allergic rhinitis that can be treated with desensitization therapy. He also uses a rigid nasal endoscope to check the patient’s nose for colored purulence and polyps, two clues that can point to a diagnosis other than chronic rhinitis. When he scopes his patient, he does not use a decongestant spray and uses a small endoscope to avoid patient discomfort. If he believes that a patient has chronic rhinitis, he will perform a ipratropium bromide challenge; he asks patients to use the spray for 1 month. If their symptoms are mitigated by the spray, then he is more optimistic that an in-office procedure will mitigate the chronic rhinitis. If the patient fails the trial, the secretions are probably coming from a source other than the nose, and the diagnosis is unlikely to be chronic rhinitis.

Next, Dr. McClurg speaks about different in-office treatments for chronic rhinitis. He first explains his experience with ClariFix, a procedure that uses cryoablation to freeze the posterior nasal nerve. He has found that 40% of his patients experience the known side effect of post-treatment headache. Additionally, some of them may have crusting in the sphenopalatine region that causes post-nasal drip. Since then, he has switched to using the RhinAer system, which delivers radioablation through a stylus to treat the posterior nasal nerve more aggressively. It also has the capability of treating the inferior turbinate. Dr. McClurg notes that patients with normal nasal anatomy and a good ipratropium bromide response are the best candidates for this procedure. 80% of his patients see a favorable result after surgery.

He then describes his RhinAer in-office procedure. He does these procedures in exam rooms in order to help with flow of his day and make his patients more comfortable. He only uses lidocaine to anesthetize the patient, as he has found that epinephrine causes tachycardia and anxiety. The procedure, including anesthesia time, takes him about 10 minutes. However, he adds that he has performed this procedure in the OR as an adjunct procedure after a septoplasty or a rhinoplasty.

Finally, he describes his recommendations for postoperative care. He encourages his patients to do daily saline rinses. He notes it takes about 6-8 weeks for the RhinAer procedure to show a good response. During this time, he recommends that patients use ipratropium bromide concurrently in order to obtain an optimal response.