Braz. j. . vol.81 número6

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BrazJOtorhinolaryngol.2015;81(6):579---580

www.bjorl.org

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

EDITORIAL

New

insights

in

otology

and

neuro-otology

夽

Novas

perspectivas

em

otologia

e

neurotologia

Researchandinnovationarecertainlythedriversbehindthe progressofmedicine.However,physiciansmustbecarefulin electingchangestoimplement.Thingsarenotalways bene-ficialsimplybecausetheyarenew.Oldconceptsmaystand uptotimeandbecomeclassics.InBrazil,mostofthetime we tend to acceptand start incorporatingnew ideas and conceptsfromabroad.Worse,wetendtodiscardold con-ceptsassoonaswecomeacrossnewones.Frequently,old ideasarestillvalidandcanhelpustogetherwiththenew ones;thus,itiswisetoselectnewideaswhilekeepingthe time-testedonesalive.

Subspecialization is certainly a concept that has con-tributed greatly to Otolaryngology. However, it must be built upon a solid general basis. The general understand-ing of head and neck medicine and surgery will make possible a permanent dialog among specialists. It is the commonground that will keepOtolaryngology profession-als togetherand communicatingwitheach other.Isolated micro-subspecialtieswillneverbestrongenough.

It followsthatourresidency programsmust beableto teachallaspectsofheadandneckmedicineandsurgery.A goodprogrammustnotallowresidentstobecome subspe-cializedduringtheirtraining;excellenceinsomefieldsisnot anacceptablesubstituteforgoodteachinginallaspectsof headandneckcare.

The excellenceof aresidencyprogram shouldbe mea-sured by its ability to teach the broad capacities of an otolaryngologist-headandnecksurgeon,justastheABORL descriptionofanotolaryngologist’scapabilitiesstates.

ThisisthewayitworksintheUnitedStates,andcertainly this philosophy has made Otolaryngology a long-standing, strong, and respected specialty. Are we following these guidelinesinBrazil?

How arewe toproduce thespecialists in thesubareas of our field? Some decades ago it was possible to teach

夽 _Please_cite_this_article_as:_de_Oliveira,_CACP._New_insights_in

otol-ogyandneuro-otology.BrazJOtorhinolaryngol.2015;81:579---80.

Otolaryngology-Headand Neck Surgeryin a four-year res-idencyprogram. This isnolonger possiblebecause ofthe enormousprogress thathastaken placeinhead andneck medicineandsurgery.TheResidencymustproducegeneral otolaryngologistswithbasic capabilitiesinallfieldsofour specialty.Subspecializationmustbepursuedinfellowships tobe embarked upon after the residency.Excellent resi-dency programsshould beable toteach the residentsall aspectsofotolaryngologyaswellasteachfellowsincertain subspecializedareas.

What does all this jazz has todo withnew insights in OtologyandNeuro-Otology?

The international Neurootology and Equilibriometric Society(NES)wassetupbymedicaldoctors,technical assis-tants, and engineers interestedin neuro-otologyduring a meetingintheHeadandNeckClinicoftheNeuro-otology DivisionoftheUniversityofWursburgonMay25,1974. Got-tfriedAust,ChristianBetow,andErikaClaussenfromBerlin; Claus-FrenzClaussenfromWursburg;ChristianHenningfrom Ulm;GunterHortman(electricalengineer);andPedro Estel-rrichandJuanManuelTatofromArgentina areamongthe founders.

Atthatinitial meeting,itwasestablishedthattheNES wouldbeconcernedwiththediagnosis ofneuro-otological malfunction or dysfunction, comprising the fields of the human ‘‘Exosensorium’’: equilibriometry (vertigo, dizzi-ness,etc.),audiometry(hearingdisorders,tinnitus,etc.), olfactometry (dysosmia, anosmia, etc.) and gustometry (dysgesia,ageusia).1

Sincethattime(1974), theNES hasheld annual meet-ingsthathavealternatedbetweenBadKissingen,Germany, andsomewhereabroadthefollowingyear.Forty-one meet-ingswereheldfrom1974to2014,andallcontinentshave hostedat least one of them.The format of the meetings hasbeenalwaysthesame:therearetwosectionsinevery Congress.Onedealswithneuro-otologyandtheotherwith tinnitus.TinnitushasbecomeanimportantpartoftheNES afterProfessorAbrahamShulmanfromNewYorkState Uni-versityjoinedtheSociety.Shulmanhasdedicatedhislifeto thestudy oftinnitusandhasproducedquitean admirable

http://dx.doi.org/10.1016/j.bjorl.2015.08.003

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580 EDITORIAL

bodyofconcepts andtheoriesabout thissymptom, which nowareacceptedasimportantcontributions.Themeetings arefilledbyscientificcontributionsfromthemembersofthe NESintheformatof15-minpresentationsthatarediscussed duringeachsectionofpaperpresentation.

The NES has embraced important contributions from Brazilian neuro-otologists during these years. Professors YotakaFukuda,Maurício,andFernandoGananc¸aofUNIFESP, andProfessorsMaudonetandMezzalirafromUnicamphave allcontributedtotheSociety;oneofthepastNESmeetings tookplaceinSãoPauloundertheChairmanshipofProfessor MaurícioGananc¸a(1987).

Because of my association with Professor Shulman, I becameinvolvedwiththeNEStostudytinnitus.Inthelast 18years,IhaveattendedseveralNESmeetingsandin1914 inPrague,IwaselectedVice Presidentof theSocietyand receivedthemissionoforganizingtheCongressinBrazilin 2015.

The idea was to organize the meeting in Brasília the samewayit hadbeen conductedin thepast. However,it becamecleartomethatameetingdealingexclusivelywith neuro-otologyheldinBrasíliawouldbeverydifficulttocarry outsuccessfully.Also,theformatoftheNESmeetingswas certainly not compatible with the Brazilian concept of a congress.

Whenoneisintrouble,helpmustbesought.SoIasked ProfessorFernandoGananc¸atoparticipateinthe organiza-tionofthemeeting.Heaccepted,andindeedwaswithme allthetimeuntilwefinished.WeaskedStelaMarisEvents toorganize theCongress. At thispoint, a fortunate thing happened:Professors SadySelaimen and Oswaldo Laércio CruzwereorganizingthefirstEarBraziltotakeplaceabout thesametimetheNESCongresswasscheduledtohappen. Fernandothenhadthethought:whydon’twecombineEar BrazilandtheNESCongressintoonemajorevent?Iagreed immediately,andfortunatelySadyandLaércioalsopromptly agreed.

Wedidnotrealizethatthiswasamajorinnovationinthe NES meetings. Soon we started to get feedback fromthe NES membership manifesting absolute disagreement with

our idea of combining their meeting with another event, makingtheNESapartnerinthescene.

Wetookafirmstandanddecidedtogoaheadwithour plan. We scheduled talksby Brazilian professors, we put togetherroundtablesmixingupotoneurologistsand otolo-gistsdiscussingcommonthemes,wemaintainedthesections forpresentationsofpapers,andwehopedforthebest.

Themeetingwasasuccess. Wehavereceived congrat-ulations from Professor Claussen, Professor Szirmai, and membersoftheNES.

Indeed, the meeting had a very high scientific level thankstotheexcellentpaperspresentedbyBrazilian grad-uate students and residents. Innovation here was clearly present,andblendingotolaryngologistswithdifferent sub-specialiststodiscusscommonproblems wasasteptoward maintaining a common basis for our specialty. The third day mixed up Ear Brazil and the NES Congress com-pletely in a common program. Indeed, the final round tablecombiningneuro-otologistsandotologicsurgeonswas enlightening.

Newinsightsinotologyandneuro-otologycertainlywere born during this memorable experience. A well-balanced mixofinnovationandgood,solidtraditioniscertainlythe wayforward.Ourpastissolid.Itcertainlywillenlightenour pathtothefuture.

Conflicts

of

interest

Theauthordeclaresnoconflictsofinterest.

Reference

1.Report on the Development of GNA-NES-SNE since 1974. In: AnnalsoftheXXXIXNESCongress.2012.

CarlosAugustoCostaPiresdeOliveira