Dalhousie University



Fellowship in otology, neurotology &
skull base surgery


Mission statement of fellowship: To produce well rounded inquiring academic neurotologists, who are clinically and research capable and will advance the boundaries of knowledge in the specialty of neurotology.

Summary of fellowship:
This fellowship consists of 60% clinical and 40% research components. The clinical component will encompass the whole of otology and neurotology, including middle ear disease and surgery, hearing reconstruction, skull base surgery, cochlear implants, implantable hearing devices, vestibular disorders and medical hearing disorders, in both adults and children. The research component will consist of research in middle ear mechanics, vestibular testing, gait testing, hearing handicap measures, as well as clinical research. Please note, that although we have a large skull base volume, including a large NF2 population, our philosophy of management is increasingly conservative management and stereotactic radiosurgery. We perform only about 5-10 skull base surgeries now specifically for acoustic neuroma per year. The Fellowship will equip the Fellow, however, to look at the full range of management options for skull base tumors. Our current volumes of Cochlear Implants and BAHAs are approx 25/year. We expect the Fellow to work harmoniously with the residents.

Eligible Candidates:
Medical degree from accredited university. Must have completed at least 3 years of an approved residency program in Otolaryngology. Must have demonstrated evidence of academic interest in Neurotology by publications, presentations and references from research or clinical faculty at sponsoring universities.  

Duration of fellowhip:
1 year, extendable to 2 years  
Supervisors and resource personnel:

Primary supervisor
: Dr. Manohar Bance Professor, Otology, Neurotology and Lateral Skull Base Surgery, Division of Otolaryngology, Dept. of Surgery, Dalhousie University Cross Appointments: School of Communication Disorders, Division of Neurosurgery, Faculty of Biomedical Engineering, Dept. of Anatomy and Cell Biology Director of the Dalhousie Middle Ear Mechanics Laboratory Director of research, Division of Otolaryngology

Secondary supervisor:
Dr. David P. Morris Assistant Professor, Otology, Neurotology and Lateral Skull Base Surgery, Division of Otolaryngology, Dept. of Surgery, Dalhousie University Otology, Neurotology Balance testing personnel at QEII HSC Access to specialized equipment: Posturography system, rotation chair (2Hz), evoked potentials Temporal Bone Dissection Laboratory located at QEII HSC Access to cadaveric temporal bones and drilling stations for anatomical research  

Clinical Component of Fellowship
Vestibular Disorders The objectives of this component are to develop a standardized approach to dizzy patients that will make the Fellow comfortable, efficient and accurate in the diagnosis of vestibular disorders. The fellow will participate in the Balance Clinics, which are run regularly. This clinic has a standardized approach to vertigo and balance disorders, with a data collection sheet, standard history and physical examination tools, and database of patients for research and audit. This is a teaching clinic to allow for discussion and teaching. We have access to rotation chair, posturography, gait analysis and other vestibular testing tools. The fellow will be expected to spend 1 week of their fellowship in hands-on training in doing electronystagmography, rotation chair testing and posturography testing. The fellow will be involved in surgery for vestibular disorders such as Gentimicin ablation, vestibular nerve sections, labyrinthectomies, posterior canal occlusions, middle fossa approach to superior canal resurfacing and endolymphatic sac decompressions Middle Ear The bulk of the clinical volume consists of middle ear pathology. Many, if not most, are tertiary referrals and revision cases. The fellow will participate in the evaluation of patients with middle ear disease in clinics. He/she will gain experience in the clinical evaluation, radiologic interpretation of CTs and MRIs of the temporal bone, and audiometric evaluation of these patients. Surgically, the fellow will be involved in complex middle ear surgeries such as ossiculoplasty, stapes surgery and some revision mastoidectomies. Less involved cases will involve the resident staff, and the fellow may act as a teaching resource for them. The principles and practice acquired in the middle ear mechanics laboratory will be applied in the operating room. Skull Base The fellow will be a part of the Lateral Skull Base clinic, directed by Dr.’s Bance and Metha. Other participants are from Neurosurgery. This clinic sees pooled patients with lateral skull base tumors or pathology. Management is arrived at in a consensus fashion by discussion of each case. This is a teaching clinic. All patients are entered into a skull base database. Surgically, the fellow will be involved in all transtemporal surgical approaches to the brainstem and cerebellopontine angle, and in the intracranial surgery of acoustic neuromas. He/She may be involved in the supervision of residents in the earlier parts of these procedures. Cochlear Implant The fellow will be involved in the multidisciplinary team assessment clinics for cochlear implants in both adults and children. He/She will partake in the decision making process. He/She will be expected to attend several programming sessions for cochlear implant recipients. Surgically, the fellow will be involved in the insertion of cochlear implants, and will share this surgical opportunity with the residents.

Bone Anchored Hearing Aids (BAHA)
The fellow will be involved in the selection, surgery and follow-up of BAHA patients, both adult and pediatric. The fellow will be expected to attend the audiologic assessment with “bite bar” trials, and the teaching sessions on care and use of the BAHA Medical Otology The fellow will participate in general otologic clinics and be involved in the assessment and management of a wide variety of general otologic problems including noise induced hearing loss, ototoxicity, congenital hearing loss, otalgia, eustachian tube problems, the draining ear and others. Hearing Rehabilitation The fellow will be expected to attend sessions in hearing rehabilitation counseling with the audiology staff at QEII HSC. In the clinic setting, the fellow will be involved in discussions on hearing rehabilitation strategies Tinnitus The fellow will be expected to attend several tinnitus evaluation and treatment clinics through the year with Mark Gulliver, an audiologist at QEII HSC with a focused interest in this area. Temporal Bone Laboratory The fellow will have an opportunity to practice surgical drilling and skull base approaches on cadaveric temporal bones in the temporal bone drilling station located at QEII HSC Research Component of Fellowship Fourty percent of the fellows time would be devoted to research. This is structured as about 2 days a week protected time. Middle Ear Mechanics Laboratory This will be a mandatory component of the fellowship research experience. Projects here will focus on hearing reconstruction issues in the middle ear. Audiologic Projects Projects focusing on auditory evoked potentials and sound-field hearing handicaps will be performed in conjuction with faculty in the School of Communication Disorders. Audiology M.Sc. students will be involved in many of these projects. Clinical Databases Databases are kept in the Lateral Skull Base Clinic, the Balance Clinic, as well as a Meniere’s Disease Database. A surgical database of all middle ear reconstructions is also kept. These will form the basis of retrospective reviews and audits. Clinical Projects Many clinical projects are available for investigation (see appendix 1). Many of these are focused clinical projects that could be performed within a 3-6 month time frame. Didactic Teaching Component The Fellow in involved in teaching the core otology resident teaching program, with the assistance of Dr. Bance and Morris. This is a great learning opportunity for the Fellow, Other teaching opportunities are: Teaching during clinics and OR Attend divisional rounds Formal coursework Presentation experience Would be expected to present at least two papers at meetings Publication experience Would be expected to publish at least 2 research and 2 clinical papers during year Overall Approach   The Fellow is treated as a semi-staff role, and there is usually a very friendly and informal relationship between the Fellow and supervisors. We expect the Fellow to challenge us, and to “flower” as an otologist during his/her time here.

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Dalhousie University Faculty of Medicine