Head and Neck Grows to SixTwo more fellowship-trained head and neck surgeons are joining the department allowing further differentiation and specialization of the surgical services we provide.

J. Kenneth Byrd, M.D., a native of Lexington, SC, completed fellowships in advanced head and neck oncologic surgery and skull base surgery at Pittsburgh. He has excelled at every step of his academic career, graduating Phi Beta Kappa from USC and AOA from medical school before undertaking his residency at MUSC. His research focus will be on comprehensive outcomes assessment in head and neck cancer, andwill require an upgrade of our existing tumor registry. Clinically, his efforts will center on all aspects of ablative head and neck surgery.

Jessica Peck, M.D. pursued microvascular training with Mark Wax at OHSU following her residency at Tripler Army Medical Center, where she received numerous teaching awards. She will provide comprehensive reconstructive capability within the department. She has a research interest in quality of life as it relates to free tissue transfer in the head and neck.

The OTO ObserverThe Newsletter of the Department of Otolaryngology

Volume 12, Issue 1 Spring 2014

Inside this Issue

Faculty HighlightsMessage from the ChairHonors Endocrine Books

Program SpotlightsPediatric OtolaryngologyEndocrine SurgeryOtology-Neurotology

ResearchDean’s Summer Research FellowsSelected Publications

Resident & Alumni NewsHail and Farewell

Staff HighlightsConsultant of the YearWelcome New StaffEmployee of the Month

_______________________

Associate Editor: Donna M. Black Phone Numbers and Web Site Address

Appointments: (706) 721-4400 AcademicOffice: (706)721-6100 Fax: (706) 721-0112

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

Jessica J. Peck, MD

J. Kenneth Byrd, MD

Spring in Augusta means beautiful azaleas, Mediterranean weather, and another exciting Master’s tournament with Georgia graduate Bubba Watson the victor. This year it also heralds the soon-to-be-named third chair of Otolaryngology at GRU.

The timing for the transition couldn’t be better as we continue our steady expansion in faculty members,

surgical volumes and all other productivity-based metrics (including a quadrupling of the wRVU’s since becoming a department in 2002). Our stable crew of senior faculty provides mentorship and opportunities for our residents, fellows and junior faculty. The future is very promising.

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

Faculty Highlights Spring 2014 Message from the Chair

Faculty Honors Achih Chen became the second member of our faculty to be featured on The Doctor’s show. He showcased his “total face rejuvenation”.

Michael Groves received the MCG Exemplary Teaching Award for Graduate Medical Education.

Sarah Mowry successfully passed the American Board of Otolaryngology Neurotology Subspecialty Examination.

Gregory Postma was an invited speaker for the Advanced Practices in Voice and Dysphagia conference in Las Vegas, the University of Arizona’s

ENT in the Desert conference, and the European Laryngologic Society in Antalya, Turkey. He was visiting professor at Mother Teresa Medical Center in Skopje, Macedonia.

David Terris was a guest speaker for the Saudi Arabian Otolaryngology Society and the Chinese Thyroid Association. He was an oral examiner for the American Board of Otolaryngology, was elected to the Board of Directors of the GA Chapter of AACE, and was appointed to the ATA Clinical Affairs Committee and the Editorial Board of VideoEndocrinology.

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

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

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

Endocrine Book Total Reaches Four

Drs. David Terris and Will Duke teamed up to produce the Thyroid Center’s third and fourth books devoted to endocrine surgery. Following a comprehensive thyroid and parathyroid text published in 2009 and a textbook on preventing complicationsinendocrinesurgeryreleasedlastyear,thefirst-ever full-size book entirely devoted to parathyroid surgery has just hit the bookstands (and Amazon). A book on minimally invasive thyroid and parathyroid surgery co-edited with former fellow Michael Singer was also recently published.

Massive JNA, No Skin Incisions - George Harris

A15-year-oldmalepresentedwithafive-monthhistoryofleft-sidednasalobstruction, epistaxis, and facial swelling. On presentation, there was obvious left-sided facial fullness (Fig 1).

An MRI was consistent with a large juvenile nasopharyngealangiofibroma(JNA)occupyingtheinfratemporal fossa, orbital apex, and contralateral nasal cavity (Fig 2). A multidisciplinary team consisting of Drs. George Harris (pediatric otolaryngology), Arturo Solares (skull base surgery) and Scott Rahimi (neurosurgery) completed a combination procedure consisting of preoperative embolization, intranasal debulking, and endoscopic removal of the tumor (Fig 3). This was completed

without any external incisions, to the great satisfaction of the family. Postoperative imaging revealed complete tumor resection, and serial examinations have revealed no evidence of recurrence.

Interest in Pediatric Otolaryngology IntensifiesThere has been a wave of interest in pediatric otolaryngology in Augusta, starting with one of last year’s chief residents (Drew Prosser, see story above) and blossoming to include our upcoming graduate (Claude Harbarger) and our two rising chief residents (Brian Ho and Jessica Van Beek-King) pictured here with the pediatric otolaryngology team, who helped inspire this interest. Claude will pursue his fellowship training at UAB in Birmingham, Brian recently matched at Cincinnati Children’s Hospital and Jessica recently matched at the University of Chicago.

Figure 3: Surgical specimens

Figure 1: Left facial fullness as a result of massive JNA

Figure 2: MRI of mass

Left to Right: C. Anthony Hughes, Jessica Van Beek-King, George Harris, Brian Ho, Brian Shirley, Claude Harbarger

Andrea and Drew Prosser, both graduates at the top of the 2008 MCG medical school class, are returning to Augusta after Drew completeshisfinalyearoftheworld-renowned,two-yearfellowshipinpediatric otolaryngology at Cincinnati Children’s Hospital. Both Andrea (in Ophthalmology) and Drew (in Otolaryngology) excelled in residency here as well, and are looking forward to returning home with their two children, Wynn (3 years) and Graham (8 months). Drew will bring with him world-class surgical techniques in airway reconstructive surgery, otologic procedures, and surgical treatment of benign and malignant pediatric head and neck masses. His expertise will further strengthen the Department’s expanding clinical and educational programs, while his research will focus on outcomes of pediatric airway reconstruction,

pediatric sleep apnea and advanced surgical treatment of congenital neck masses.

Spring 2014 Program Spotlight: Pediatric Otolaryngology

Prossers to Return Home

Drew Prosser, MD, will join GRU Pediatric

Otolaryngology

Andrea Prosser, MD, Ophthalmologist

We have a long history of providing comprehensive endocrine courses for surgeons and endocrinologists around the country. This year we also took on the responsibility of educating the public. Two months after our successful eleventh consecutive cadaver-based thyroid/parathyroid symposium (featuring Greg Randolph, Janice Pasieka and several other experts), we hosted our fourth public symposium at the Augusta Marriott. This interactive experience featured lectures by Drs. Will Duke and Ted Chin on the state-of-the-

art evaluation and surgical techniques used to manage nodular thyroid disease, and allowed members of the community to interact directly with physicians to learn more information about this common condition.

Ultrasound Screening a HitWe have conducted free thyroid screening in our department in the past, but this year we packed up our portable ultrasound and took our show on the road. Dr. Will Duke performed thyroid screening at the Plant Vogtle nuclear facility, which included neck ultrasound (see photograph). Fifteen of the nearly 100 individuals screened required follow-up assessment. We anticipate providing this service on an ongoing basis in the future.

Substernal Goiter Makes for Easy DeliveryOften the presence of a substernal goiter can pose surgical challenges. In this patient who was referred for management of hyperparathyroidism,

however, the serendipitous finding(onin-officeultrasound) of a large substernal goiter ipsilateral to the parathyroid adenoma (see sestamibi image, Figure 1) eventually made the parathyroid surgery easier. Upon delivery of the goiter (Figure 2), the parathyroid adenoma could be seen attached to the anterior surface of the thyroid. She had a prompt drop in the intraoperative parathyroid hormone level (Figure 3).

Figure 3: Intraoperative rapid PTH confirms biochemical cure

Figure 2: Large substernal goiterwith adenoma attached

Program Spotlight: Endocrine Surgery Spring 2014

Educating Physicians and Patients

Dr. Will Duke delivers thyroid nodule lecture

Dr. Will Duke performs ultrasound

Figure 1: Sestamibi scan showing parathyroid adenoma and goiter

Weathering the StormThe Eleventh Otology Update and Temporal Bone Symposium will go down in the annals of our robust CME programs as perhaps the most interesting and creative. We suffered through the epic Ice Storm of 2014 that struck Augusta at precisely the scheduled time oftheTemporalBoneCourse.Theflightsofthefeaturedguest speaker were of course cancelled. Nevertheless, through the magic of Skype, Dr. Bruce Gantz was able to deliver his lectures in living color from the comfort of hisofficeinIowa.Thosethatbravedtheinclementconditionsandmadethejourneyenjoyedthelecturesandlaboratory time.

Spring 2014 Program Spotlight: Otology-Neurotology

Innovative Otologic ProcedureDr. Sarah Mowry recently performed the second Hybrid Cochlear implant in the United States outside of a clinical trial. The patient had experiencedsignificanthighfrequency hearing loss, but had residual low frequency hearing. She was struggling to participate in her normal activities. The Hybrid system was recently approved by the FDA for these patients and expands the possibility of hearing to a wider population with severe hearing loss.Onthepediatricside,Dr.Mowryalsoperformedthefirstendoscopic

middle ear surgery at the Children’s Hospital of Georgia. The patient had a cholesteatoma of the anterior portion of themiddleearthatwasdifficulttoaccessthroughtraditional approaches. It was removed successfully and the endoscopic approach allowed the child to have a minimally invasiveapproachtothisdifficult-to-accessarea.Thedrumwas completely healed and mobile at the child’s one-month follow-up visit.

Audiology Offers Latest Hearing Device GRU Audiology Associates now offers the SoundBite non-surgical bone conduction hearing device for appropriate candidates. Dr. Sarah King, Keith Axelson (hearing aid technologist) and Dwain Greene (front desk coordinator) continue to provide stellar audiologic services as the group looks to build on these strong foundations.

Dr. Mowry inserts the first Hybrid Cochlear implant in Georgia

Hybrid Cochlear implant receiver/stimulator

1. Preoperative image of a small very anteriorly located cholesteatoma 2. Postoperative view following complete removal of the cholesteatoma and repair of the anterior portion of the scutum and tympanic annulus with a small cartilage graft

Dr. Sarah King demonstrates features of thenew Soundbite hearing aid

Dr. Sarah Mowry speaks about recent advances in the diagnosis and treatment of Meniere’s Disease

Selected Publications Spring 2014 Dean’s Summer Research FellowsWe have established a long tradition of hosting medical students pursuing research-oriented careers, who have successfully competed for a Dean’s Summer Research scholarship. This year is no exception as six studentswillworkwithfiveofourfacultytodeveloptheirresearchskills.ThomasHolmeswillworkwithStilKountakis, Leslie Peard with Tony Hughes, Burton Dunlap and Sushma Reddy will work with Paul Weinberger, and Amanda Bradley and Brian Sullivan have teamed up with the endocrine unit (Drs. Terris and Duke).

Selected PublicationsHo B, Jang DW, Van Rompaey J, Figueroa R, Brown JJ, Carrau RL, Solares CA. Landmarks for endoscopic approach to the parapharyngeal internal carotid. Laryngoscope 2014 Jan 21 doi:10.1002/lary.24601.

Mason E, Gurrola J 2nd, Reyes C, Brown JJ, Figueroa R, Solares CA. Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach. Laryngoscope 2014 Jan 20 doi:10.1002/lary.24594.

Walker PC, Mowry SE, Hansen MR, Gantz BJ. Long-term results of canal wall reconstruction tympanomastoidectomy. Otol Neurotol 35(1):e24-30, 2014.

Mowry SE, Hansen MR. Resident participation in cadaveric temporal bone dissection correlates with improved performance on a standardized skill assessment instrument. Otol Neurotol 35(1):77-83, 2014.

Howell J, Segel J, Jajosky R, Savage NM, Fields B, Kota V, Mowry SE. Acute facial paralysis and otomastoiditis as presenting symptoms of myeloid sarcoma. Otol Neurotol (In press).

Jones MC, Rueggeberg FA, Faircloth HA, Cunningham AJ, Bush CM, Prosser JD, Waller JL, Postma GN, WeinbergerPM.Definingthebiomechanicalpropertiesof the rabbit trachea. Laryngoscope. 2014 Apr 29. doi:10.1002/lary.24739.

Van Rompaey J, Bush C, Khabbaz E, Vender J, Panizza B, Solares CA. What is the best route to the Meckel Cave? Anatomical comparison between the endoscopic endonasal approach and a lateral approach. J Neurol Surg B Skull Base 74(6):331-6, 2013.

Van Rompaey J, Bush C, Solares CA. Anatomic analysis specificfortheendoscopicapproachtotheinferior,medial and lateral orbit. Orbit 33(2):115-23, 2014.

White LC, Singer MC, Terris DJ. Robotic facelift thyroidectomy. Op Techn Otolaryngol Head Neck Surg 24(21):120-25, 2013.

Mehra S, Tuttle RM, Terris DJ, et al. Improving the quality of thyroid cancer care: How does the thyroid cancer care collaborative cross the Institute of Medicine’s quality chasm? Thyroid 24(4):615-24, 2014.

Urken ML, Milas M, Terris DJ, et al. A review of the management of recurrent and persistent metastatic lymph nodes in well differentiated thyroid cancer: A multifactorial decision making guide created for the Thyroid Cancer Care Collaborative. Head Neck 2014 Jan 17 doi: 10.1002/hed.23615.

Duke WS, White JR, Waller JL, Terris DJ. Endoscopic thyroidectomy is safe in patients with a high body mass index. Thyroid 2014 Mar 31 [Epub ahead of print].

Duke WS, Terris DJ. Alternative approaches to the thyroid gland. Endocrinol Metab Clin North Am (In press).

Duke WS, Terris DJ. Robotic thyroidectomy: Facelift approach. Curr Surg Rep (In press).

Duke WS, Chaung K, Terris DJ. Thyroid cancer: contemporary surgical techniques. Otolaryngol Clin North Am (In press).

Arthur ME, Odo N, Parker W, Weinberger PM, Patel VS. CASE 0-2013: Supracarinal tracheal tear after atraumatic endotracheal intubation: Anesthetic considerations for surgical repair. J Cardiothorac Vasc Anesth. 2014 Jan 16 pii:S1053-0770(13)00491-6. doi:10.1053/j.jvca.2013.08.014.

Weinstein J, Akbani R, Bondaruk R, Weinberger PM, et al (TGCA Consortium). Comprehensive molecular characterization of urothelial bladder carcinoma. Nature 507:315-322, 2014.

Weinberger PM. Bioreactor for tubular organs. Georgia Regents University. Provisional Patent #61/794,938(USA).FullUSpatentpending,filedMarch 2014.

Spring 2014 Resident and Alumni Update Hail

Joshua YelvertonVA CommonwealthRhinology Fellow

Christopher JohnsonNaval Med Ctr San

DiegoLaryngology Fellow

Steven BomeliUniv of PittsburghEndocrine Surgery

Fellow

Colin FullerTexas A&M

PGY-1

Christopher LetoUniv of Kansas

PGY-1

Farewell

Jose G. Gurrola, II will join the faculty at University of Virginia

Rebecca J. Howell will join the faculty

at University of Cincinnati

Katrina Chaung will enter private

practice in Dallas, TX

Hachem Jammal will enter private practice in Saudi

Arabia

Claude Harbarger will do a pediatric

otolaryngology fellowship at UAB

Consultants of the YearWe are pleased to announce that the Immunopathology Team was the unanimous selection for the Department of Otolaryngology Consultant of the Year for 2014. They consistently provide exceptional point-of-care intraoperative PTH assay support, and went beyond all expectations during the February ice storm.

Welcome New StaffIt just keeps getting better. One of the hardest jobs in our department is that of the surgery scheduler. It requires a tremendous amount of energy, organizational skills, and patient compassion. We are fortunate to have recruited an individual who embodies each of these characteristics. Ashley Silas is already having a major impact. She successfully implemented iRequest,reformattedandfine-tunedtheschedulestructure, and is working hard to improve the experience of our many surgical patients, including renovatingtheschedulingoffice.Ourpatientsareingreat hands.

Ashley Silas

Left to Right – Renee Arthur, Marion Winter,Connie Johnson, Joyce Oliver, Kathy Graham

Employee of the MonthDwain Greene was voted by his co-workers as APAS Desk Operations Specialist employee of the month for June. His attributes on the survey included: “Dwain is always willing to help, goes above and beyond for the patients. He helps other clinics when has not been asked to help and he has a great attitude. He’s friendly, loyal, honest and has a positive personality”. Dwainreceivedacertificateandagiftpacketthankinghimforgoingtheextramile.

Dwain Greene

Spring 2014 Staff Highlights

Dwain Greene Dwain Greene

Department of Otolaryngology1120 15th StreetAugusta, Georgia 30912-4060

Non-ProfitOrg.U.S. POSTAGE

PAIDAugusta, GA

Permit No. 210

The OTO Observer

Newsletter

1079 5/14

Airway o, South CarolinaProgram Co-Chairs

Gregory N. Postma, MDProfessor

Georgia Regents University

Paul M. Weinberger, MDAssistant Professor

Georgia Regents University

Airway on the Island_______________

August 2015

Kiawah Island, South Carolina

Program Co-Chairs

Sarah E. Mowry, MDAssistant Professor

Georgia Regents University

C. Arturo Solares, MDAssociate Professor

Georgia Regents University

Register early. Participation in the Lab is limited.

Skull Base and TemporalBone Dissection and

Otology Update_______________February 5-7, 2015Augusta, Georgia