The OTO ObserverThe Newsletter of the Department of Otolaryngology

Medical College of Georgia

Inside This Issue

Message from the ChairPhone Numbers and Web Site

Address

Faculty HighlightsHonors5 Faculty Named Best Doctors® 2 New Textbooks Edited ByDepartmental Faculty

MCG Center for Voice andSwallowing DisordersNew Center Opens

Staff HighlightsBedell and Howard RecruitedBrace Elected

CMEGrand Rounds ScheduleTNE SymposiumMinimally InvasiveThyroid/Parathyroid Symposium

Clinical Spotlight Transnasal Esophagoscopy

ResearchPresentationsPublications

Resident & Alumni NewsPictures from the ArchivesGiving Opportunities

MESSAGE FROM THE CHAIR

As winter approaches in Augusta, a number ofsignificant programmatic changes are beingimplemented. Our successful recruitment of

Gregory Postma to the faculty has completed adoubling in the size of the faculty over a three yearperiod. Dr. Postma’s arrival has facilitated thecreation of the MCG Center for Voice andSwallowing Disorders, and resulted in the offering ofa laryngology fellowship, increasing to three thenumber of fellowship offerings (along with rhinologyand endocrine/head and neck surgery).

Our growing academic enterprise entered the realm of book publishingthis summer as the first two textbooks edited by MCG faculty memberswere released (see inside).

Finally, Christine Gourin has accepted the responsibility of editor of theOTO Observer. We believe you will enjoy reading about the recentevents of our department in the pages that follow.

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

Volume 3, Issue 2 WINTER 2005

MCG Center

for Voice and

Swallowing

Disorders Opens

Phone Numbers and Web SiteAddress

Appointments: (706) 721-4400Academic Office: (706) 721-6100Fax: (706) 721-0112

To learn more about recent eventsin the department, visit:

www.mcg.edu/otolaryngology

FACULTY HIGHLIGHTS WINTER 2005

Honors

Achih Chen was inducted as a Fellow of theAmerican College of Surgeons.

Stilianos Kountakis was elected Secretary-Treasurer of the Georgia Society of Otolaryngology-Head and Neck Surgery.

Christine Gourin wasnamed to the editorialboard of TheLaryngoscope, selected tothe 2006 ProgramCommittee for theAmerican Head and NeckSociety, and was chosenby the Consumer’sResearch Council to belisted in the 2005-2006

edition of America’s Top Physicians.

David Terris was elected to the council of theTriological Society for 2005-2008.

Stilianos Kountakis and David Terris served asOral Board examiners for the American Board ofOtolaryngology Annual Certifying Examination.

Best Doctors: 5 Otolaryngology faculty members were named tothe 2005-2006 list of The Best Doctors® in America.Drs. Mitchell Austin, Christine Gourin, StilianosKountakis, Gregory Postma, and David Terrisreceived this distinction. The Best Doctors databaseincludes the top 3%to 5% of specialistsin America, chosen froman exhaustive peer-review survey of over 33,000physicians. The Best Doctors database includesspecialists in more than 30 countries around theworld, representing over 400 subspecialties ofmedicine.

Textbooks Published

Two new textbooks devoted to frontal sinus diseaseand sleep apnea and snoring were edited byDepartment faculty members.

Stilianos Kountakis,MD is senior editor of“The Frontal Sinus”,published this year bySpringer-Verlag. This isthe first comprehensivetext devoted to themanagement andtreatment of frontal sinusdisease. Co-editors areDrs. Brent Senior of theUniversity of NorthCarolina-Chapel Hill and

Wolfgang Draf of Philipps-University Marburg inGermany. Drs. David Terris and Christine Gourin ofthe Department of Otolaryngology and Drs. RamonFigueroa and Joseph Sullivan of the Department ofRadiology contributed chapters.

David Terris, MD is senioreditor of “SurgicalManagement of SleepApnea and Snoring”, acomprehensive textbookincorporating the latestsurgical treatments forsleep disordered breathingpublished this year by theTaylor & Francis Group.Dr. Richard Goode ofStanford University is co-editor. Dr. Chris McMains ofthe Department ofOtolaryngology contributedchapters.

Three Fellowships Available for 2007-2008Endocrine/Head and Neck Surgery (contact Dr. David Terris)

Rhinology/Sinus Surgery (contact Dr. Stil Kountakis)Laryngology (contact Dr. Gregory Postma)

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

WINTER 2005 RESIDENT AND ALUMNI UPDATE

The Pig Roast is an annual tradition, hosted by theDepartment for more than 20 years. Every year,over Memorial Day weekend, otolaryngologyresidents camp out overnight at a local state parkcampsite and roast a whole pig, which serves asthe main course for the annual Department PigRoast Picnic held the following day.

Pictures from the Archives

Opportunities to Invest

Charitable support is a critical component forsuccessful resident research and educationalendeavors. Four funds have been established toprovide an opportunity to invest in the futuresuccess of the Department: the Porubsky LibraryFund, the Barton Otolaryngology fund, the TemporalBone Laboratory Fund, and the OtolaryngologyResearch Fund. In addition, opportunities exist fornaming and supporting research pursuits in specificareas of interest such as thyroid, head and neckcancer, sinus, or laryngology/voice research. Allgifts are tax-deductible. For further information,please contact Kenny Brace, Department ofOtolaryngology-Head and Neck Surgery at (706)721-6100.

Giving Opportunities

Designate Your Gift to MCG Otolaryngology■■ Porubsky Library Fund..........................$ __________■■ Barton Otolaryngology Fund................ $ __________■■ Temporal Bone Lab Fund .................... $ __________■■ Otolaryngology Research Fund ...........$ __________■■ Area of Greatest Need......................... $ __________■■ Other: ________________________...$ __________

TOTAL ...........$ __________■■ Check enclosed to MCG Foundation, Inc. ■■ CREDIT CARD please complete the following

____MC ____Visa ____AE ____DiscoverCard #_____________________________Exp._______Name on card: _________________________________Signature Required:__________________________________________________________________________Full Name ____________________________________Address ______________________________________City ________________State__________ Zip________Daytime Telephone _____________________________Email Address _________________________________

Gifts are tax-deductible to the extent provided bylaw. MCG fiscal year runs July 1 to June 30. For

more information, call 706-721-6100 or visitwww.mcg.edu/giving.

Alan Johnson (left) visits with alumni Chris McMains(center), currently on the faculty at the University ofTexas-San Antonio, and Scot Stewart (right), in privatepractice in Gainesville, GA during the Chief ResidentGraduation/Alumni Weekend.

Residents Lana Jackson, Tammara Watts, RussBlankenship and David Walters (from left to right) servechopped pork at the 2005 Pig Roast.

limits of the percutaneous tracheostomy. Laryngoscope115:987-989, 2005.

Jackson LL, Gourin CG, Thomas DS, Porubsky ES,Klippert FN, Terris DJ. Use of the harmonic scalpel insuperficial and total parotidectomy for benign andmalignant disease. Laryngoscope 115:1070-1073,2005.

Gourin CG, McAfee WJ, Neyman KM, Howington JW,Podolsky RH, Terris DJ. Effect of comorbidity andquality of life on treatment selection in patients withsquamous cell carcinoma of the head and neck.Laryngoscope 115:1371-1375, 2005.

Idrees MT, Hessler RH, Terris DJ, Mixson C, Wang BY.Unusual polypoid laryngeal myxoma. Mt Sinai J Med72:282-4, 2005.

McMains KC, Kountakis SE. Revision functionalendoscopic sinus surgery: Objective and subjectivesurgical outcomes. Am J Rhinol 19:344-7, 2005.

Farhat FT, Figueroa RE, Kountakis SE. Anatomicmeasurements for the endoscopic modified Lothropprocedure. Am J Rhinol 19:293-6, 2005.

Weinberger PM, Yu Z, Kowalski D, et al. Differentialexpression of EGFR, c-Met and Her2/neu in chordomacompared to 18 other malignancies. Arch OtolaryngolHead and Neck Surg 131:1-5, 2005.

Yu Z, Weinberger PM, Provost E, et al. Beta-cateninfunctions mainly as an adhesion molecule in patientswith squamous cell cancer of the head and neck. ClinCancer Res 11:2471-2477, 2005.

Yu Z, Weinberger PM, Haffty BG, et al. Cyclin d1 is avaluable prognostic marker in oropharyngeal squamouscell carcinoma. Clin Cancer Res 11:1160-6, 2005.

Butler AP, O’Rourke AK, Wood BP, Porubsky ES. Acutelaryngeal trauma: Experience with 112 patients. AnnOtol Rhinol Laryngol 114:361-368, 2005.

Rai AJ, Stemmer PM, Zhang Z, Adam BL, et al.Analysis of Human Proteome Organization PlasmaProteome Project (HUPO PPP) reference specimensusing surface enhanced laser desportion/ionization-timeof flight (SELDI-TOF) mass spectrometry: Proteomics,5:3467-3474, 2005.

Terris DJ, Haus BM, Gourin CG, Lilagan PE. Endo-robotic resection of the submandibular gland in acadaver model. Head Neck 27:946-951, 2005.

RESEARCH WINTER 2005

Presentations

Terris DJ, Haus BM, Lilagan PE, Moll F. Endo-roboticresection of the submandibular gland in a cadavermodel. Annual Meeting of the American Head andNeck Society, 2005.

Pang K, Terris DJ, Dillard T, Gourin CG, Blanchard A,Podolsky R. A comparison of polysomnography andthe SleepStrip in the diagnosis of OSA. AnnualMeeting of the American Academy of Otolaryngology-Head and Neck Surgery, 2005.

Kountakis SE. Frontal sinus: Anatomy and surgicalmanagement. Annual Meeting of the AmericanAcademy of Otolaryngology-Head and Neck Surgery,2005.

Mixson CM, Deal RT, Munday J, Johnson A.Suitability of Formalin-fixed acellular dermis fortympanic membrane repair in chinchillas. AnnualMeeting of the American Academy of Otolaryngology-Head and Neck Surgery, 2005.

McMains KC, Figueroa RE, Kountakis SE. Anatomicmeasurements and cadaver dissection for endoscopicmodified Lothrop procedure. Annual Fall Meeting ofthe American Rhinologic Society, 2005.

Walters DM, McMains KC, Adam B, Kountakis SE.Serum inflammatory protein profiles in patients withchronic rhinosinusitis undergoing sinus surgery: Apilot study. Annual Fall Meeting of the AmericanRhinologic Society, 2005.

Mixson CM, Weinberger PM, Austin MB. Comparisonof microdebrider subcapsular tonsillectomy withharmonic scalpel and electrocautery totaltonsillectomy. Annual Meeting of the American Societyof Pediatric Otolaryngology, 2005.

Publications

Blankenship DR, Chin E, Terris DJ. Contemporarymanagement of thyroid cancer. Am J Otolaryngol26:249-260, 2005.

Terris DJ, Bonnet A, Gourin CG, Chin E. Minimallyinvasive thyroidectomy using the Soffermantechnique. Laryngoscope 115:1104-1108, 2005.

Blankenship DR, Kulbersh BD, Gourin CG, BlanchardAR, Terris DJ. High-risk tracheostomy: Exploring the

We are pleased to announcethat Dr. Gregory Postmajoined the Department ofOtolaryngology-Head andNeck Surgery at the MedicalCollege of Georgia inOctober 2005 as Chief ofLaryngology and Director ofthe new MCG Center forVoice and SwallowingDisorders.

Dr. Postma comes to MCG from Wake ForestUniversity where he was an Associate Professor atthe Center for Voice and Swallowing Disorders. In1984, Dr. Postma received his medical degree fromHahnemann University in Philadelphia and hecompleted his residency in Otolaryngology at theUniversity of North Carolina at Chapel Hill in 1993.He took a fellowship in laryngology and professionalvoice at Vanderbilt University and joined the faculty atWake Forest in 1996.

Dr. Postma’s clinical interests span the entire field oflaryngology. These include voice disorders,professional and singing voice care, dysphagia andassociated swallowing disorders, airway surgery and

reconstruction, spasmodic dysphonia,extraesophageal and gastroesophageal reflux, andchronic cough. In addition, he is one of the pioneersin the area of in-office surgery including transnasalesophagoscopy and un-sedated laryngeal and airwaylaser surgery.

Dr. Postma’s research interests includeextraesophageal reflux, surgical and non-surgicalmanagement of swallowing disorders, and in-officesurgery. He is the author or co-author of more than70 peer-reviewed publications and has written morethan 50 chapters and invited articles. He has givenmore than 130 presentations on a wide array oflaryngologic topics.

The Medical College of Georgia Center for Voice andSwallowing Disorders is a collaborative effort involvingthe Departments of Otolaryngology, Gastroenterology,Neurology, Pulmonary, Gastrointestinal Surgery, andSpeech-Language Pathology. This team approach tothe evaluation and management of patients allows usto provide optimal care for individuals with voice,swallowing, and airway problems.

Dr. Postma can be reached at gpostma@mcg.edu.For an appointment, call 706-721-4400.

WINTER 2005 VOICE AND SWALLOWING CENTER

Greg Postma Joins Faculty to Direct New Voice andSwallowing Center

Staff HighlightsGlenn Bedell recently joinedthe Otolaryngology team asAdministrative Director ofAmbulatory Care SurgicalServices for MCG Health, Inc.He is responsible for theoperation of theotolaryngology practice site.

Glenn joins us after serving for the past 9 years inhealthcare management at Johns Hopkins MedicalCenter. He holds a Master of Health ServicesAdministration from George Washington University,and is an associate of the American College ofHealthcare Executives.

Marquetta Howard joined theDepartment as SurgicalCoordinator. Marquetta willhave her hands full as wehave doubled the size of ourfaculty in the past 3 years.

Kenny Brace, DepartmentAdministrator, was namedPresident-elect of the CSRAMedical ManagersAssociation. He has servedon the board of this localaffiliate of the Medical GroupManagement Association(MGMA) for the past 3 years.

CME WINTER 2005

Grand Rounds 2005-2006

September 6 Willard E. Fee, Jr., MDStanford University “Aesthetic Parotid Surgery”

October 4 Scott P. Stringer, MD, MBAUniversity of Mississippi“Health Economics”

November 1 Dennis H. Kraus, MDMemorial Sloan Kettering“Anterior Craniofacial Resection”

December 6 Patrick J. Antonelli, MDUniversity of Florida“Labyrinthine Injury”

January 3 Gayle E. Woodson, MDSouthern Illinois University“Update on Phonosurgery”

February 7 Bert W. O’Malley, Jr., MDUniversity of Pennsylvania“Emerging Technology in OHNS”

March 7 Bruce J. Davidson, MDGeorgetown University“Management of the Neck in ThyroidMalignancy”

April 11 Frank M. Kamer, MDThe Laskey Clinic, Beverly Hills“Endonasal Rhinoplasty”

Dr. Marvin Fried (second from left) was a featured GrandRounds speaker in 2005. (1st row from left: Drs. AlanJohnson, Marvin Fried, Frederick Klippert, Achih Chen: 2nd

row from left: Drs. Ed Porubsky, David Terris, StilKountakis, Christine Gourin.

Dr. Michael Maves, Vice President and CEO of theAmerican Medical Association, shown with Dr. EdwardPorubsky (left) served as keynote speaker for the 3rd

annual Porubsky Symposium on June 10-11, 2005.

Continuing Education Symposia

The Department will host several major CME symposia in the 2005-2006 calendar year. Dr. Greg Postma willdirect the 2

ndTransnasal Esophagoscopy Symposium on December 3, 2005. The symposium will feature Milan R.

Amin, MD, (New York University Voice Center), Mark S. Courey, MD, (UCSF Voice Center), and C. BlakeSimpson, MD, (UT-San Antonio) as distinguished guestfaculty. Hands-on experience with TNE is emphasized.

A symposium on Minimally Invasive SurgicalManagement of Thyroid and Parathyroid Disease,directed by Drs. David Terris and Christine Gourin, will beheld on April 21-22, 2006. Distinguished guest facultyinclude Dr. Paolo Miccoli of the University of Pisa,pioneer of minimally invasive thyroid and parathyroidsurgery techniques; Dr. Ronald Weigel, Chairman ofSurgery at the University of Iowa; and Dr. Phillip Pellitteri,of Geisinger Medical Center. This year’s course willfeature an expanded laboratory providing hands-onexperience with minimally invasive approaches to thethyroid compartment.

The 2005 Thyroid/Parathyroid Symposium featured(clockwise, starting from left) Drs. Maisie Shindo, GregPostma, David Terris, Robert Sofferman, HelmuthGoepfert, Gregory Randolph, David Eisele and ChristineGourin.

WINTER 2005 Clinical SpotlightTransnasal Esophagoscopy (TNE)

Chevalier Jackson and other otolaryngologistspioneered the use of rigid esophagoscopy years agofor examination, dilation, biopsy, and foreign bodyremoval. Now, thin, flexible TNE endoscopes areavailable with distal-chip cameras for high-qualityoptics. These endoscopes can be passed safelytransnasally, while providing air insufflation, irrigation,and biopsy capability. TNE is particularly useful in themanagement of individuals with dysphagia, reflux,and head and neck cancer. It has proven to be safeand well tolerated in the vast majority of patients andit may come to facilitate or even replace routinepanendoscopy for many cancer patients.

Indications

The following are current TNE indications:

(1) A screening tool in patients with LPR or chroniccough to evaluate for reflux esophagitis, Barrett’sesophagus, and esophageal adenocarcinoma.

(2) A biopsy tool to obtain tissue specimens andperform in-clinic panendoscopy in patients withlesions suspicious for malignancy.

(3) An evaluation tool to assess the esophagealmucosa of patients exposed to previous sourcesof damage such as caustic ingestion or radiationtherapy.

(4) To rule out anatomic obstruction (stricture,diverticulum) and assess motility in patients withdysphagia.

(5) A therapeutic tool for procedures such assecondary tracheoesophageal puncture, foreignbody management, and placement of wireless pHcapsules.

Technique

Although it is preferred that patients have nothing toeat for 3 hours, a recent meal is not a contraindicationto TNE. Topical nasal anesthesia and decongestion isaccomplished with oxymetazoline (0.05%) andlidocaine (4%), or cocaine (2%) soaked pledget(s) forapproximately 10 minutes.

One spray of 20% benzocaine (Hurricaine) to theoropharynx is optional.

The Endoscope is advanced with visualization ofnasopharyngeal closure, tongue base, hypopharynx,vocal fold motion, and possible pooling of oralsecretions.

The endoscope is then advanced into the stomachand retroflexion is performed to assist in theidentification of small or medium sized hiatal hernias.If mucosal lesions or irregularities are noted, multiplebiopsies are obtained. The endoscope is slowlywithdrawn to re-examine the mucosa of the entireesophagus.

Complications

The complication rate for TNE is very low. A recentreview of over 700 TNE procedures revealed only 6cases of self-limited epistaxis and 2 vasovagalepisodes.

Conclusion

TNE is a safe and effective procedure that maintainsall the advantages of conventional endoscopictechniques, while offering the distinct advantage ofperformance in the office without sedation. In addition,it gives the head and neck surgeon the ability toperform a remarkable variety of procedures in theoutpatient setting without sedation. This results inbetter patient care and significant cost savings.

1079 5/05

Department of OtolaryngologyMedical College of Georgia1120 Fifteenth StreetAugusta, Georgia 30912-4060

The OTO Observer

Newsletter

Non-Profit Org.

U.S. POSTAGE

PAIDPermit No. 210

Augusta, Georgia

Otolaryngology-Head and Neck Surgery Clinical Faculty and Areas of Interest

David J. Terris, MD, ChairmanThyroid and parathyroid surgery

Stilianos Kountakis, MD, Vice Chairman Rhinology, sinus and skull base surgery

Mitchell B. Austin, MDPediatric otolaryngology

Achih H. Chen, MDFacial plastic and reconstructive surgery

Christine G. Gourin, MDHead and neck oncologic surgery

Alan J. Johnson, MDOtology and neuro-otology

Frederick N. Klippert, MDGeneral otolaryngology

Edward S. Porubsky, MDGeneral otolaryngology

Gregory N. Postma, MDLaryngology and swallowing disorders

Minimally Invasive SurgicalManagement of

Thyroid and ParathyroidDisorders

April 21-22, 2006Augusta, Georgia

Distinguished Guest Faculty

Paolo Miccoli, M.D.Pioneer of Minimally Invasive Thyroid

and Parathyroid SurgeryUniversity of Pisa, Pisa, Italy

Phillip K. Pellitteri, D.O., F.A.C.S.Geisinger Medical Center, Danville, PA

Ronald J. Weigel, M.D., Ph.D., F.A.C.S.University of Iowa, Iowa City, IA

Program Co-Chairs

Christine G. Gourin, M.D. and David J. Terris, M.D.Medical College of Georgia