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Interview with Stephen Cass MD, Otology-Neurotology, University of Colorado

Stephen Cass, MD

September 9, 2002
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TOPIC: Upcoming Conference on Evaluation and Management of Dizziness

AO/Beck: Hi Dr. Cass. Thanks for joining me today.

Cass: Hi Dr. Beck. Nice to be here.

AO/Beck: Before we get to the topic at hand, can you please review a little of your professional background for me?

Cass: Sure. I graduated from Wayne State University Medical School in Detroit in 1983, and then I did my residency in ENT also at Wayne State. Following that I did my fellowship in otology and neurotology at the Michigan Ear Institute with Drs. McGee, Graham and Kartush.

AO/Beck: That must have been an extraordinary fellowship.

Cass: Yes it was. That was a wonderful and exciting time in otology and neurotology and I was studying and learning from some of the best otologists in the world. My fellowship lasted from 1988 through 1990. After that I went to the University of Pittsburgh and I was there until 1999, and then I moved to the University of Colorado.

AO/Beck: What is your position at the University of Colorado and can you tell me your particular areas of interest within otology and neurotology?

Cass: I am currently an associate professor in the Department of Otolaryngology and my primary interests are in vestibular disorders, cranial base surgery and cochlear implants.

AO/Beck: And along those lines, I read you're organizing an exciting and comprehensive conference on vestibular issues in October?

Cass: Yes, that's correct. The conference is October 11th and 12th. We're going to hold the conference in Chicago and it's called Evaluation and Management of Dizziness: Leading Clinicians Discuss and Defend Best Practices. This course will be a little different because it will essentially be focused on best practices for the evaluation and management of the dizzy patient.

AO/Beck: Can you please tell me who will be presenting at the conference and what topics they'll be addressing, and who the primary audience is for this conference?

Cass: Sure. The primary audience is ENTs, neurologists, audiologists, physical therapists and physicians in other specialties, really anyone faced with the task of evaluating and managing patients with dizziness and vertigo. We've tried to assemble representation from all the specialties that work with dizzy patients.

We have a family physician, Dr Philip Sloane, from the University of North Carolina and he'll review patient demographics, how he manages patients with dizziness and how and when he decides to refer. Then we have two neurotologists, Dr. Steven Rauch from Harvard will be discussing how to make the diagnosis, what tests to order and how these tests support or refute a particular diagnosis. We have Dr. Lorne Parnes from the University of Western Canada and he will discuss how he treats patients with unknown or untreatable diseases. We also have two neurologists, Dr. Hain from Northwestern University and Dr. Solomon from the University of Pennslyvania who will discuss evaluation and treatment from the neurologic point of view. We have an audiologist, who I think you're familiar with, Dr. Neil Shepard, from the University of Pennsylvania. Dr. Shepard will address basic and sophisticated tests and what information can be gleaned from each, why to order one versus the other and related matters. We have a physical therapist, Susan Whitney, who will be addressing protocols and outcomes related to physical therapy for the dizzy patient. We have Dr. Rolf Jacob, a psychiatrist from the University of Pittsburgh. Dr. Jacob will address how essential it is to understand the interaction between dizziness and psychiatric disorders and how to better understand and manage the psychological issues the dizzy patient is dealing with. Dr. Jacob is an expert in panic disorders and agoraphobia and he'll also address how these problems interact with dizziness. Also, we'll have a medical practice manager, Karen Zupko to address billing, coding and reimbursement issues.

AO/Beck: OK, you've convinced me. This does sound like a comprehensive meeting. Are you going to have panel discussions too, or will this be podium presentation format?

Cass: Both. As you know, in otology and neurotology there are many opinions and schools of thoughts, and of course in audiology and in neurology -- there are also some rather strong opinions about what to do and when to do it too! Sometimes science leads the way, and sometimes the real world day-to-day practice pattern leads the way. This conference will be a little different because we'll be probing and looking for reasons, and the person presenting will really need to defend their evaluation and management protocol to the panel, and of course to the conference participants too. In other words, one of the goals of this conference is to explore the techniques to see what works best - and why. We want the presenters to tell us the best way to do things, and then defend why they do it!

AO/Beck: Very good. Can you mention any specific issues which might be addressed by the panel?

Cass: The panel will have autonomy and they can move about through subjects as they choose, and as the audience desires. I am very interested in the real nuts and bolts issues of managing dizzy patients. So, I might offer up discussion on issues such as; do you order an MRI on the dizzy patient? And if so, when, based on what? Of course, Meniere's Disease is always a topic for discussion, such as how to diagnose and treat it. We will discuss standard treatments such as endolymphatic sac surgery and its application to the dizzy patient, and we'll probably also discuss direct inner ear medical treatment for vestibular disorders, such as chemical labyrinthectomy, which has become a popular and successful office-based procedure.

We all have things we feel comfortable with, but there is always more to learn. For example migraine-related dizziness is commonly overlooked and under treated. We will discuss how to perform the Epley-type maneuvers for BPPV and how to use vestibular-rehabilitation experts and psychiatrists to help your patients.

Another very important issue is referral criteria. In other words, some physicians hold on to these patients as long as they can, and others find it much more efficient to just refer the patient to a balance specialist as soon as possible. So we'll be exploring the best and most efficient ways to handle referrals, and I think this will really be useful for the professionals in the trenches.

AO/Beck: Thanks Dr. Cass. I appreciate the update on this conference. Is there a website address that the readers can go to in order to obtain more information?

Cass: Yes, they can hyperlink to the news release from an earlier announcement in June, /audiology/newroot/News/displaynews.asp?id=579
Or they can hyperlink directly into the ICS website, www.icsmedical.com.

AO/Beck: Thanks very much. The conference really sounds terrific and I am certain it will be a success.

Cass: Thank you too. I really enjoy the news and information from Audiology Online.

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Stephen Cass, MD

Otology-Neurotology, University of Colorado



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