Department Continues to GrowOtology and Pediatric Otolaryngology Add Faculty Members

The program has expanded again with commensurate increases in outpatient visits, surgical volumes, and academic productivity. For the first time, we now have two otologists in the department with the addition of Sarah Mowry. Sarah was the student body president and a Phi Beta Kappa graduate of Earlham College, and vice president of AOA at Tulane Medical School. She completed her residency at UCLA and a two-year otology/neurotology fellowship at the University of Iowa. She has co-authored 17 publications including four book chapters.

George Harris joins an already busy pediatric otolaryngology program. He graduated with distinction from the University of Illinois and attended Loyola University School of Medicine. He completed his residency at the University of Iowa, which included a two-year NIH-T32 funded research fellowship, and did his pediatric fellowship at the Medical University of South Carolina.

Both of these new faculty members have hit the ground running and are rapidly growing their practices while engaging in cutting edge research. Read more about the department’s busy tenth year inside.

The OTO ObserverThe Newsletter of the Department of Otolaryngology

Volume 10, Issue 1 Winter 2012

Inside this Issue

Faculty HighlightsMessage from the ChairHonors Consultant of the Year

Clinical HighlightsSnoring in ChildrenClival Chordoma

Faculty SpotlightDepartmental Faculty and Areas of Interest

Research SpotlightResearch Program ExpandsDean’s Summer Research Fellowships

Staff HighlightsBarb Carter’s New RoleMeet our New Staff

Publications

Resident/Fellow HighlightsOvercoming BoundariesNew Fellowships Offered_________________________

Associate Editor: Donna M. Black

Sarah E. Mowry, MD

George F. Harris, IV, MD

Phone Numbers and Web Site Address Appointments: (706) 721-4400 Academic Office: (706) 721-6100 Fax: (706) 721-0112

To learn more about recent events in the department, visit:georgiahealth.edu/otolaryngology

Faculty Highlights Winter 2012 Message from the Chair

This 10th year as a department marks our transformation to a large, fully-staffed program. We now have “bench-strength” in every major area, with two otologists, two pediatric otolaryngologists, two laryngologists, four sinus/plastics/general otolaryngologists and four head and neck surgeons. Major

areas are also complemented by our five fellowships. We have enjoyed a corresponding tripling of our clinical and academic volumes over the past five years. We are poised now to help our enterprise grow to new heights.

David J. Terris, M.D., F.A.C.S.Porubsky Professor and Chairman

Honors Michael Groves was selected to participate in the Georgia Physician’s Leadership Academy sponsored by the Medical Association of Georgia.

Brian McKinnon was promoted to Associate Professor at GHSU, was a guest speaker at the Osler Institute, the Caribbean Association of Otolaryngologists, Michigan State University, and the University of Tennessee Health Sciences Center. He was also awarded $12,000 in intramural funding.

Greg Postma was visiting professor at McGill University in Montreal, Canada and guest speaker for the Malaysian International Congress, the European Laryngological Society and the British Academic Conference of Otolaryngology.

David Terris was appointed to the ACGME ResidencyReview Committee for Otolaryngology. He also received the AAO-HNS Distinguished Service award and was visiting professor at Memorial Sloan-Kettering Cancer Center, Loyola University, the University of Connecticut and the University of Pisa in Italy. He was a guest speaker for the Malaysian International Congress, the NC/SC Societies of Otolaryngology, and Albert Einstein Hospital in Sao Paulo, Brazil.

Paul Weinberger received an Exemplary Teaching Award, and was awarded an intramural grant from the Institute for Regenerative and Reparative Medicine.

Consultant of the YearDarko Pucar was the unanimous selection for the Department of Otolaryngology Consultant of the Year in 2012. Hailing most recently from Memorial Sloan Kettering, Dr. Pucar has done

Five Fellowships AvailableEndocrine Surgery (contact Dr. David Terris: dterris@georgiahealth.edu)

Rhinology/Sinus Surgery (contact Dr. Stil Kountakis: skountakis@georgiahealth.edu)Laryngology (contact Dr. Gregory Postma: gpostma@georgiahealth.edu)

Facial Plastic Surgery (contact Dr. Achih Chen: achen@georgiahealth.edu)Head and Neck Oncologic Surgery (contact Dr. Arturo Solares: csolares@georgiahealth.edu)

a tremendous job of providing outstanding nuclear medicine services. In particular, his expert insight on both PET-CT scans and sestamibi scans has ensured the highest quality care for our head and neck and endocrine patients.

help confirm the diagnosis of OSA. At GHSU, a child is monitored overnight by a sleep medicine specialist.

Figure 2: Massive tonsillar hypertrophy

Surgery is the primary treatment for OSA in children. Tonsillectomy with adenoidectomy is the first-line surgical option, and surgery is often curative. GHSU provides all of the necessary tools to evaluate and treat complex pediatric sleep medicine. Doctors George F. Harris and C. Anthony Hughes, pediatric ENT specialists at Georgia Health Sciences University, are available to answer any questions you may have. If you have a patient you believe may benefit from a multidisciplinary sleep evaluation, please call 706-721-6387.

Winter 2012 Clinical HighlightsSnoring in Children George Harris, IV, MD – Pediatric Otolaryngology

When does snoring become a medical problem in children? This answer may be more complicated than previously thought.

Enlargement of the adenoids, which lie behind the nasal cavity at the top of the throat (Figure 1), and tonsils, which lie behind the tongue and along the wall of the pharynx (Figure 2) is the most

common cause of obstructive sleep apnea (OSA) in children. Sleep apnea is quite common, present in up to 5% of the school-aged population. Snoring is the most common symptom. Another is witnessed apneas. The presence of daytime symptoms such as tiredness and falling asleep in school should alert clinicians to consider OSA. Recent research indicates that there may even be behavior, attention, and school performance issues which can be attributed to OSA. Childhood obesity is on the rise and is another factor which worsens OSA, and makes treatment more challenging. A sleep study (also known as a polysomnogram) can be performed to

Figure 1: Adenoid hypertrophy

They Grow Them Big in Georgia C. Arturo Solares, MD – Skull Base Surgery

A) Sagittal MRI showing intradural tumor extension; B) Intraoperative picture showing dural defect after tumor resection.

The GHSU Skull Base Surgery team recently performed a completely endonasal endoscopic removal of a very large clival chordoma with intradural extension in a 38 year old woman who

presented with progressive vision loss. The defect was reconstructed with abdominal fat to obliterate the dead space and a nasoseptal flap. The patient recovered without neurologic sequelae and will receive post-operative proton beam radiotherapy.

Cavity after initial tumor debulking and identification of bilateral internal carotid arteries (Arrows).

Faculty Spotlight Winter 2012 Departmental Faculty and Areas of Interest

Jimmy Brown, DDS, MD Achih H. Chen, MD Scott S. DeRossi, DMD Michael W. Groves, MD Sleep/Head and Neck Surgery Facial Plastic Surgery Oral Medicine General Otolaryngology

George F. Harris, IV, MD C. Anthony Hughes, MD Lana L. Jackson, MD Stil Kountakis, MD, PhD Pediatric Otolaryngology Pediatric Otolaryngology Head and Neck Surgery Rhinology and Sinus Surgery

Brian J. McKinnon, MD, MBA Sarah E. Mowry, MD Edward Porubsky, MD Gregory N. Postma, MD Otology/Neurotology Otology/Neurotology General Otolaryngology Laryngology

C. Arturo Solares, MD David J. Terris, MD John R. Vender, MD Paul M. Weinberger, MD Skull Base Surgery Endocrine Surgery Neurosurgery Laryngology

Barb Carter Transitions into New Role It was with mixed emotions that we learned of Barb Carter’s desire to step down from management back into patient care. We are sad to lose her tremendous leadership and thoughtful management style, but equally pleased that she has chosen to stay within our department as our new Head and Neck Cancer Nurse Navigator. This of course was a very smooth and easy transition for Barb, to the delight of Arturo Solares, Lana Jackson, and the rest of the head and neck team. Congratulations are certainly in order!

Winter 2012 Research SpotlightDepartmental Research Program Continues to MatureNumerous advancements are being made in the area of stem-cell mediated tracheal transplantation, including a grant from the newly formed Institute of Regenerative Medicine. We formed a partnership with the U.S. Department of Energy’s Savannah River Nuclear Laboratories (SNRL) to serve as a research conduit for GHSU researchers interested in working with nanotechnology and “esoteric materials” inventions arising from SNRL labs. We will test the applications of a novel nanoparticle (porous-walled ceramic microspheres) as a drug delivery device in various head and neck applications. The arrangement was cemented by a $40,000 grant to Dr. Paul Weinberger, Assistant Professor and Director of the Otolaryngology Department research activities.

Dean’s Office Awards Seven Student GrantsEach year a number of GHSU students are awarded prestigious Dean’s Summer Research Fellowships, designed to encourage participation in cutting-edge basic and clinical research. This year seven students received funding to do research in the Department of Otolaryngology (the most of any department on campus): Aaron Cunningham (assigned to mentor Paul Weinberger), Thomas Ergen (Gregory Postma), Hunter Faircloth (Paul Weinberger), Andrew Heffernan (David Terris), Matthew Jones (Paul Weinberger), James Webster (Brian McKinnon), and Jennifer White (David Terris).

Staff Highlights

Barbara CarterCancer Nurse

NavigatorMeet Our New StaffBecause of our tremendous growth, we have added much needed additional staff. We have been fortunate to recruit outstanding personnel to support our multiple missions of patient care, research and education. We are pleased to welcome several outstanding individuals to our team:

Victoria Hollimon Laura Meyer Peggy Barmore Rachel Cawley OR Scheduler Research Coordinator Practice Site Coordinator Residency Coordinator

Selected Publications Winter 2012 Mallur P, Morrison M, Rosen C, Postma GN, Amin MR. Safety and efficacy of carboxymethyl cellulose in the treatment of glottic insufficiency. Laryngoscope 122:322-326, 2012.

Jana T, McKinnon BJ. Pathology quiz case: Eccrine hidrocystoma of the external auditory canal. Arch Otolaryngol Head Neck Surg 138(8):779, 2012.

Halum SL, Ting JY, Plowman EK, Belafsky PC, Harbarger CF, Postma GN, Pitman MJ, LaMonica D, Moscatello A, Khosla S, Cauley CE, Maronian NC, Melki S, Wick C, Sinacori JT, White Z, Younes A, Ekbom DC, Sardesai MG, Merati AL. A multi-institutional analysis of tracheotomy complications. Laryngoscope 122:38-45, 2012.

Postma GN, Amin MR. Extraesophageal reflux is still NOT the same disorder as gastroesophageal reflux. Letter to the Editor. Otolaryngol Head Neck Surg 146(4):684, 2012.

Bush CM, Prosser JD, Morrison MP, Sandhu G, Wenger KH, Pashley DH, Birchall MA, Postma GN, Weinberger PM. Knotless barbed suture for tracheal resection anastomosis. Laryngoscope 122:1062-1066, 2012.

O’Rourke AK, Weinberger PM, Postma GN. Killian-Jamieson diverticulum. ENT J 91(5):196, 2012.

Rosen CA, Gartner-Schmidt J, Hathaway B, Simpson CB, Postma GN, Courey M, Sataloff RT. A nomenclature paradigm for benign midmembranous vocal fold lesions. Laryngoscope 122:1335-1341, 2012.

Ogbureke K, Weinberger P, Looney SW, Fisher LW. Expressions of matrix metalloproteinase-9 (MMP-9), dentin sialophosphoprotein (DSPP), and osteopontin (OPN) at histologically negative surgical margins may predict recurrence of oral squamous cell carcinoma. Oncotarget 3(3):286-98, 2012.

Jana T, Khabbaz E, Bush CM, Prosser JD, Birchall MA, Nichols CA, Postma GN, Weinberger PM. The body as a living bioreactor: A feasibility study of pedicle flaps for tracheal transplantation. Eur Arch Oto-Rhino-Laryngol (In press).

Terris DJ, Singer MC. Qualitative and quantitative differences between two robotic thyroidectomy techniques. Otolaryngol Head Neck Surg 147(1):20-5, 2012.

Carty SE, Doherty G, Inabnet WB, Pasieka JL, Randolph G, Shaha AR, Terris DJ, Tufano R, Tuttle RM. American Thyroid Association statement on the essential elements of interdisciplinary communication of perioperative information for patients undergoing thyroid cancer surgery. Thyroid 22(4):395-9, 2012.

Dionigi G, Alesina PF, Barczynski M, Boni L, Chiang FY, Kim HY, Materazzi G, Randolph GW, Terris DJ, Wu CW. Recurrent laryngeal nerve injury in video-assisted thyroidectomy: lessons learned from neuromonitoring. Surg Endosc 26(9):2601-8, 2012.

Aziz S, Singer MC, Terris DJ, Rizvi AA. Double parathyroid adenoma successfully managed by localization studies, intraoperative PTH monitoring, and minimally invasive surgery. Endocr Pract 11:1-9, 2012.

Singer MC, Terris DJ. Cost-effective by any definition. Otolaryngol Head Neck Surg 147(1):181, 2012.

Fisher M, Terris DJ. Parathyroid surgery and sestamibi-negative patients. ENT & Audiology News 21(4):60-61, 2012.

Friedman M, Samuelson C, Hamilton C, Fisher M, Kelley K, Joseph N, Wang P, Lin H. Effect of continuous positive airway pressure on C-reactive protein levels in sleep apnea: A meta-analysis. Otolaryngol Head Neck Surg 147(3):423-33, 2012.

Friedman M, Hamilton C, Samuelson C, Kelley K, Taylor R, Darling R, Taylor D, Fisher M, Maley A. The value of routine pH monitoring in the diagnosis and treatment of laryngopharyngeal reflux. Otolaryngol Head Neck Surg 146(6):952-8, 2012.

Comer BT, Kincaid NW, Kountakis SE. The association between supraorbital ethmoid air cells and orbital proptosis in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol (In press).

Soler ZM, Oyer SL, Kern RC, Senior BA, Kountakis SE, Marple BF, Smith TL. Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: an evidenced-based review with recommendations. Int Forum Allergy Rhinol (In press).

Winter 2012 Resident/Fellow Highlights Overcoming International and Anatomical Boundaries Carrie Bush, MD – Chief Resident, Otolaryngology

Otolaryngology residents at GHSU enjoyed the rare opportunity to cross dural boundaries at the annual Skull Base Symposium. Of equal interest, they were able to share this opportunity with participants from South America, who made the trip to Augusta, GA for the occasion. Under the guidance of Drs. Arturo Solares and Ricardo Carrau the group was able to transcend a Babel-like experience, and work through an English/Spanish milieu to better understand the anatomy of the skull base.

Residents had been working under the leadership of Dr. Solares to help advance the newly established skull base laboratory at GHSU. This has provided residents the invaluable ability to learn rhinologic and skull base procedures in a safe, relaxed environment. The recent Skull Base Symposium allowed greater practice of these new skills while working with colleagues from 9 different countries. Throughout the course, drilling was kept at a maximum level. One of the pearls taken from the symposium: “pedal to the metal” is not so different from “pedal al metal.”

Mariah Pate (PGY-1) perfects her nasal endoscopy skills while assisting David Jang (Rhinology Fellow).

Participants in the 2012 Skull Base Symposium

New Fellowships OfferedIn addition to our three well-established fellowships in Endocrine Surgery, Rhinology, and Laryngology, the department recently began offering fellowships in Facial Plastic and Reconstructive Surgery and Head and Neck Oncologic Surgery. Our first Facial Plastic surgery fellow is a former resident, Adam Becker (’08). We anticipate our first Head and Neck Oncologic Surgery fellow for July 2013. Interested individuals are encouraged to reach out to Arturo Solares, Director of the Skull Base Center.

To share your news with the other alumni, please send updates to Donna Black atdonnab@georgiahealth.edu or call 706-721-6100.

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The OTO Observer

Newsletter

1079 10/12

Temporal Bone Dissection andOtology Update

_______________

February 8-9, 2013Augusta, Georgia

Distinguished Guest Faculty

John Emmett, MDShea Ear Clinic

Memphis, Tennessee

Program Chairs

Sarah E. Mowry, MDAssistant Professor

Georgia Health Sciences University

George F. Harris, MDAssistant Professor

Georgia Health Sciences University

Register early. Participation in the Lab is limited.

11th Annual Porubsky Symposium

__________

June 14-15, 2013Augusta, Georgia

Distinguished Guest Faculty

Michael J. Rutter, MDCincinnati Children’s Hospital Medical Center

Cincinnati, Ohio

Program Chairs

Lana L. Jackson, MDAssistant Professor

Georgia Health Sciences University

David J. Terris, MDProfessor and Chairman

Georgia Health Sciences University