Browsing by Author "Monteiro, Eric"

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    Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study
    (2023-04-24) Thamboo, Andrew V.; Lee, Melissa; Bhutani, Mohit; Chan, Charles; Chan, Yvonne; Chapman, Ken R.; Chin, Christopher J.; Connors, Lori; Dorscheid, Del; Ellis, Anne K.; Gall, Richard M.; Godbout, Krystelle; Janjua, Arif; Javer, Amin; Kilty, Shaun; Kim, Harold; Kirkpatrick, Gordon; Lee, John M.; Leigh, Richard; Lemiere, Catherine; Monteiro, Eric; Neighbour, Helen; Keith, Paul K.; Philteos, George; Quirt, Jaclyn; Rotenberg, Brian; Ruiz, Juan C.; Scott, John R.; Sommer, Doron D.; Sowerby, Leigh; Tewfik, Marc; Waserman, Susan; Witterick, Ian; Wright, Erin D.; Yamashita, Cory; Desrosiers, Martin
    Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ( $$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract
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    Head and Neck Surgical Oncology Choosing Wisely Campaign: imaging for patients with hoarseness, fine needle aspiration for neck mass, and ultrasound for odynophagia
    (2018-01-08) Eskander, Antoine; Monteiro, Eric; O’Connell, Dan; Taylor, S. Mark
    Abstract Choosing Wisely Canada, is a campaign designed to raise awareness regarding inappropriate or unnecessary tests and treatments. The Canadian Society of Otolaryngology - Head & Neck Surgery and the Canadian Association of Head and Neck Surgical Oncologists developed a Choosing Wisely Canada list to help promote high quality care for patients presenting with disorders of the head and neck: (1) Don’t order imaging - computer tomography (CT) or magnetic resonance imaging (MRI) - as the initial investigation for patients presenting with a chief complaint of hoarseness, (2) Don’t perform an open biopsy or excision of a neck mass without having first considered a fine needle aspiration (FNA) biopsy and, (3) Don’t order neck ultrasound to investigate odynophagia (discomfort or pain with swallowing) or globus sensation.