EDUCATIONAL OBJECTIVES: 1) Know recent changes in American Thyroid Association guidelines on management of thyroid nodules and cancer. 2) Be familiar with contemporary work-up and evaluation of thyroid nodules. 3) Be knowledge- able in the surgical management of thyroid cancer and princi- ples of cancer surveillance. Laryngology/Bronchoesophagology Beyond the Larynx: Management of Adult Airway Stenosis Nicole Maronian, MD (moderator); Joel Blumin, MD; Sid Khosla, MD; Dinesh Chhetri, MD PROGRAM DESCRIPTION: Although pediatric subglottic stenosis and repair are a common topic, adult laryngotracheal injury and repair remain less well understood. The incidence of tracheal damage in the adult from intubation and tracheostomy is not insignificant and management is not without complexi- ties. Significant advances have occurred in the available op- tions for the work-up and treatment of adult laryngotracheal stenosis. Yet treatment of these problems, especially subglottal stenosis, remains challenging for multiple reasons. First, the identification of the problem is often delayed, impacting deci- sions about management options. Autoimmune and inflamma- tory diseases can affect the larynx and trachea, but both diag- nosis and treatment of these systemic conditions is often less than optimal. In addition, many of these patients have signif- icant co-morbidities, including diabetes, heart disease, obesity and COPD. Further, both the existence of the stenosis and its treatment can significantly affect voice and swallowing, in- creasing potential complications and difficulty in pre-operative patient counseling. Finally, because many of the innovative treatment options for these conditions are relatively new, there is no general consensus on treatment algorithms. The focus of this miniseminar is to have a multidisciplinary panel discuss optimal management from the acute injury to chronic narrow- ing as well as perspectives on prevention. Discussion regarding work-up will include fiberoptic evaluation of the larynx, tra- chea, and esophagus, radiological imaging, and consultation with other services. The panelists will also describe the me- chanics of airway damage and healing responses. A variety of surgical options will also be presented, including the use of laser, balloon dilation, steroid injection, mitomycin C applica- tion, as well as endoscopic techniques versus open surgical repair. Complications of these techniques and management of concurrent voice and swallowing problems will be central to the discussion. EDUCATIONAL OBJECTIVES: 1) Understand the risk fac- tors and etiology for laryngeal/tracheal damage. 2) Learn the options for early and endoscopic repair. 3) Be able to discuss the options for open repair of severe glottic/tracheal injuries. Challenges and Opportunities in the Management of Dysphagia Katherine Kendall, MD (moderator); John Sinacori, MD; Ozelm Tulunay-Ugur, MD PROGRAM DESCRIPTION: This miniseminar, co-endorsed by the Airway and Swallowing and Geriatric Committees of the AAO-HNS, is part of four thematically grouped minisemi- nars on challenges and opportunities in geriatric otolaryngol- ogy. The aim is to arm otolaryngologists with competencies needed to care for this growing segment of the population. Collectively, these miniseminars will raise awareness of the critical importance of geriatrics in otolaryngology and help fulfill the charge outlined by the Institute of Medicine in its seminal 2008 report: Retooling for an Aging America: Build- ing the Healthcare Workforce. This miniseminar will address the comprehensive evaluation and treatment of the older adult with dysphagia, a significant problem in this age group. There are approximately 78.2 million baby-boomers in the United States who in 2006 started turning 60 years old at a rate of 330 every hour. Fifteen percent of the community-dwelling elders experience dysphagia. This number increases to 50-60% in nursing homes and 10-30% in general medical wards. Dyspha- gia among the elder population not only reduces the quality of life, but also significantly increases morbidity and mortality. Management of dysphagia in the older adult, an already com- plex process, is further confounded by the presence of comor- bidities, polypharmacy, and ethical end of life decisions. Pa- tients with dementia pose a particular challenge; hence a discussion of this entity and its implications will be integrated into the presentation. The benefits of a team approach in evaluation and management of the older adult with dysphagia will be emphasized, and strategies for assembling a dysphagia team will be introduced with discussion of the role of the otolaryngologist. Significant differences exist between swal- lowing function in the geriatric and non-geriatric populations, confounding diagnostic evaluation. This will be explored in detail so that participants will leave with a basic algorithm that can be applied in their daily practice. Advances and new techniques in medical and surgical management aimed to en- sure safe feeding in this challenging population will also be addressed. Key Points: 1) Swallowing difficulties are often under-appreciated in older adults. 2) Otolaryngologists need to be vigilant in recognizing dysphagia in this group. 3) Changes in swallowing physiology accompany the aging process and impact both evaluation and management strategies. 4) The otolaryngologist must be familiar with a number of strategies for the diagnosis and treatment of dysphagia in this population. 5) Dementia is a common comorbidity, impacting diagnosis, management, and outcome. EDUCATIONAL OBJECTIVES: 1) Define risk factors, dif- ferential diagnosis, and appropriate testing in evaluation of older dysphagia patients. 2) Understand how dementia affects swallowing and ethical issues posed by affected patients. P30 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010