The OTO ObserverThe Newsletter of the Department of Otolaryngology

Medical College of Georgia

Inside This Issue

Faculty HighlightsMessage from the ChairHonorsKountakis Book Published

Clinical HighlightsThyroid Cancer ScreeningFirst Focus ThyroidectomyNew Members Join Head and

Neck Tumor Board

Staff HighlightsJones Earns CNOR

EducationalTransatlantic Thyroid

TelesurgeryDysphagia Conference

Clinical SpotlightExercising the Swallowing

Muscles

ResearchGrants AwardedPublications

Resident & Alumni NewsWelsh Awarded Hardman CupWhere Are They Now

Dysphagia Program Hits Full Tilt

Clinical trials, nationally-recognized CMEofferings, state-of-the-art patient care, and abrand-new multidisciplinary dysphagiaconference – it is safe to say that the MCGCenter for Voice and Swallowing Disorders ishitting on all cylinders at the direction of GregPostma (Director of the Center) and LoriBurkhead (Assistant Professor and SpeechPathologist). Stir in Albert Chang (newlyrecruited Duke andCleveland Clinic-

trained thoracic surgeon), Robert Schade(Gastroenterology), John Mellinger (Surgery),and Michael Edwards (Surgery) and theingredients for a world-class dysphagia teamare all under one roof. Read more about thelatest clinical and investigational efforts of thisgroup inside.

Volume 5, Issue 2 Winter 2007

Transatlantic

Thyroid

Telesurgery

(See inside for details)

Phone Numbers and Web SiteAddress

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

To learn more about recentevents in the department, visit:www.mcg.edu/otolaryngology

Dr. Lori Burkhead

Dr. Greg Postma

Kountakis Book Published

Stil Kountakis, MD, is senior editor of “Rhinologic andSleep Apnea Surgical Techniques”, the firstcomprehensive reference book on surgical techniques forthe nose, sinuses and sleep apnea. “Instead of having togo multiple places to get information, this book isdesigned as a contemporary, inclusive reference forresidents, otolaryngology fellows and practicingotolaryngologists on surgical indications and techniques,as well as postoperative management,” says Dr.Kountakis. The book has 79 contributors who areleaders in their respective fields.

FACULTY HIGHLIGHTS WINTER 2007

Honors

Gregory Postma was an invited speaker for theAmerican Society of Geriatric Otolaryngology, theMississippi Society of OHNS, and the ALA, and wasvisiting professor at the University of Wisconsin andUniversity Hospital in Palma de Mallorca, Spain. Hewas also named one of America’s Top Doctors for2007.

Stil Kountakis was elected as President-Elect ofthe Georgia Society of OHNS, First Vice Presidentof the American Rhinologic Society, and named toBest Doctors in America for 2007.

David Terris received the AAO-HNS DistinguishedService Award, was elected Secretary of theGeorgia Society of OHNS, and was visitingprofessor at UCLA, USC, and Harvard University.He was also named to the list of both America’s TopDoctors and America’s Top Doctors for Cancer for2007.

Message from the Chair

The department recentlycelebrated its 5-yearanniversary, and we are facingnew challenges and newopportunities. In addition to therapid expansion of theDysphagia program (see pages1, 5), the Head and Neck Tumor

Board continues to grow (see story in this issue), as

the institution prepares to break ground on acomprehensive clinical cancer center.Consolidation of the cancer programs promises toimprove the efficiency of cancer care delivery, andfacilitate our clinical transitional efforts.

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

Three Fellowships Available for 2009-2010Endocrine/Head and Neck Surgery (contact Dr. David Terris)

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

Departmental photograph, Spring 2007

Alumnus William J. Welsh is Awarded the 2007Lamartine Hardman Cup

Bill Welsh (’79), the first resident to finish the program at MCG, was recently awardedthe Lamartine Hardman Cup, the highest award presented annually by the MedicalAssociation of Georgia. The award is presented for achievement that has solved anyoutstanding problem in public health or made a substantial discovery in the science ofsurgery or medicine. Dr. Welsh is the inventor of autologous platelet gel, for which healso received the “Excellence in Cosmetic Surgery” award in 2000. Dr. Welsh maintainsa clinical faculty position and graciously provides a very popular rotation for the residents.

Where are They Now? John P. Bent, III

John P. Bent, III (’94), has recently returned to full-time academic medicine at AlbertEinstein School of Medicine. He is primarily at Children’s Hospital at Montefiore and holdsthe rank of Associate Professor in the Departments of Otolaryngology and Pediatrics. Dr.Bent has had a productive academic career, and has received multiple honors includingthe Seymour R. Cohen Award, and the William P. Potsic Basic Sciences Research Award.

First Faculty-Resident Paintball Contest

Pictured at left are the women warriors who distinguishedthemselves during the first faculty-resident paintballcontest. The faculty put on their game faces (see LoriBurkhead in combat helmet) and slightly edged thedetermined residents. Most valuable players wereCreighton Vaught for the resident team, and Subinoy Das for the faculty.

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

WINTER 2007 RESIDENT AND ALUMNI UPDATE

Research Grants Awarded Subinoy Das was the recipient of a 2007 NIH ClinicalResearch Loan Repayment Program Grant sponsoredby the National Institute of Allergy and InfectiousDiseases.

Paul Weinberger was awarded the AmericanAssociation for Cancer Research AFLAC Scholar-In-Training award for his research on protein expressionprofiling in thyroid cancer.

PublicationsWeinberger PM, Adam BL, Gourin CG, Moretz WH,Bollag RJ, Wang BY, Liu Z, Lee JR, Terris DJ.Association of nuclear, cytoplasmic expression ofGalectin-3 with b-catenin/wnt-pathway activation inthyroid carcinoma. Arch Otolaryngol Head Neck Surg133(5):503-10, 2007.

Seybt MW, Gourin CG, Terris DJ. 100 consecutivecollaborative percutaneous tracheostomies. OtolaryngolHead Neck Surg 136(6):934-37, 2007.

Terris DJ, Chen NC, Seybt MW, Gourin CG, Chin E.Emerging trends in the performance of parathyroidsurgery. Laryngoscope 117(6):1009-12, 2007.

Terris DJ, Seybt MW, Chin E. Cosmetic thyroidsurgery: Defining the essential principles.Laryngoscope 117(7):1168-72, 2007.

Hockstein NG, Gourin CG, Faust RA, Terris DJ. Ahistory of robots: From science fiction to surgicalrobots. J Robotic Surg 1(2):113-118, 2007.

Ling TKF, Kountakis SE. Important clinical symptomsin patients undergoing functional endoscopic sinussurgery for chronic rhinosinusitis. Laryngoscope117:1090-3, 2007.

Hendon M, McMains KC, Kountakis SE. Presentationand management of extensive frontal-orbital-ethmoidmucoceles. Am J Otolaryngol. 28(3):145-7, 2007.

Ling TKF, Kountakis SE. Rhinosinusitis task forcesymptoms vs. the sinonasal outcomes test in patientsevaluated for chronic rhinosinusitis. Am J Rhinol21(4):495-8, 2007.

Kim J, Kountakis SE. Incidence of Samter’s inconsecutive patients undergoing functional endoscopicsinus surgery. ENT J 86(7):396-9, 2007.

Seybt WM, McMains KC, Kountakis SE. The incidenceand the effect of asthma on consecutive patients withchronic rhinosinusitis. ENT J 86(7):409-11, 2007.

Koufman JA , Rees CJ, Frazier WD, Kilpatrick LA,Wright SC, Halum SL, Postma GN. Office-basedlaryngeal laser surgery: A review of 443 cases usingthree wavelengths. Otol Head Neck Surg 137:146-151,2007.

Cunningham JJ, Halum SL, Butler SG, Postma GN.Intraobserver and interobserver reliability inlaryngopharyngeal sensory discrimination thresholds: apilot study. Ann otol rhinol laryngol 116(8):582-588,2007.

Postma GN, et al. Laryngopharyngeal findings inhospitialized patients with dysphagia. Laryngoscope117:1720-2, 2007.

Burkhead LM, et al. Strength-training exercise indysphagia rehabilitation: principles, procedures, anddirections for future research. Dysphagia 22(3):251-65,2007.

Velesrubio F, Walters D, Fulcher J, Ganapathy M,Klippert F. Auricular cryptococcosis as the initialpresentation of AIDS. Otolaryngol Head Neck Surg136(3):493-4, 2007.

RESEARCH WINTER 2007

Giving OpportunitiesDesignate 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 by law.MCG fiscal year runs July 1 to June 30. For more

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

The comprehensive Head and Neck Tumor Board continues toattract world-class talent, benefiting the citizens of Georgia andthe Southeast. John Greskovich (newly recruited Chief of

Radiation Oncology, most recently at CaseWestern) arrived in July. Hadyn Williams(Chief of Nuclear Medicine) now participateson a regular basis, a reflection of theincreasingly important role of PET and PET-CT scans in the management of patients withhead and neck cancer. Finally, Scott DeRossi (Chief of Oral Health & DiagnosticSciences and newly recruited from University of Pennsylvania) represents an anchor inthe School of Dentistry, and brings vital knowledge and expertise.

The Department ofOtolaryngology-Head and NeckSurgery conducted a thyroidcancer screening day inrecognition of Thyroid CancerAwareness month (September).

As part of the MCG Thyroid/Parathyroid Center’sefforts to improve early detection of thyroidmalignancy, thyroid screenings including ultrasoundevaluation were provided free of charge to thecommunity.

WINTER 2007 CLINICAL HIGHLIGHTSThyroid Cancer Screening Day

Staff Highlights

Donald Jones, RN, BSN, (senior staff nurse in the adult OR) earned the CNORcertification. Achieving a CNOR credential demonstrates proficiency in support ofquality patient care and sets a standard of commitment to the profession of operatingroom nursing

Donald Jones, RN, BSN

Dr. JohnGreskovich

Dr. HadynWilliams

Dr. ScottDeRossi

First Focus Thyroidectomy in the World

MCG had the distinction of being thesite of the very first Focusthyroidectomy performed in theworld, followed soon thereafter byPaolo Miccoli (Pisa) and ThierryDefechereaux (Belgium), both ofwhom will be involved in the spring

Thyroid Symposium (see relatedarticle in this issue). The Focusdevice, produced by Ethicon Endo-Surgery, is the first ultrasonichandpiece designed specifically forthyroid surgery and other head andneck procedures.

New Members Join Head and Neck Tumor Board

Transatlantic ThyroidTelesurgeryIn yet another first for the thyroid program, the springsymposium will feature live telesurgery broadcastsfrom Pisa, Italy. Paolo Miccoli will moderate fromAugusta as his partner, Piero Berti, performs anendoscopic thyroidectomy and an endoscopicparathyroidectomy. The 6th consecutive thyroidcourse will feature a world-class faculty and promisesto be another robust educational offering. Otherupcoming CME events include the first Facial PlasticsSymposium, the first Dysphagia conference targetedat SLPs, and the annual Temporal Bone Conferencefeaturing Rick Pillsbury.

MultidisciplinaryDysphagia Conference

In order to enhance our ability to care forpatients with complex swallowing and aspirationdifficulties, a multi-departmental dysphagiaconference has been started at MCG. Individualswith challenging swallowing problems arediscussed, and evaluation and treatment optionsare reviewed at length. This “full service” approachbrings together the disciplines of Otolaryngology,Speech/Language Pathology, Gastroenterology,Gastrointestinal and Thoracic Surgery, as well asselected other subspecialties such as Pediatricsand Neurology. Not only do patients benefit fromthe experience and expertise of a wide variety ofhealth care specialists but this also brings togethera wide battery of sophisticated diagnostic and

treatment tools available at few centers. The diagnostic options at our center include:• laryngovideostroboscopy• acoustic and spectroscopic voice analysis

by a PhD voice scientist• laryngeal and pharyngeal electromyography• fiberoptic endoscopic evaluation of

swallowing with and without sensory testing. • unsedated transnasal esophagoscopy• high resolution esophageal and pharyngeal

manometry• prolonged ambulatory pH (acid) testing for

esophageal and extraesophageal reflux• videoflouroscopyTreatment modalities at the Center are also on

the cutting edge. Dr. Postma is a pioneer in thearea of in-office surgery, which includes unsedatedlaser treatment of laryngeal and esophagealdisorders using two different types of in-officelasers, unsedated dilation of throat, esophagus andtrachea scar tissue under topical anesthesia as wellas the injection of Botox or other materials intomuscles of the larynx, pharynx, and esophagus toimprove voice and swallowing. Benefits of in-officeprocedures include greater safety, decreased costs,and a strong patient preference.

Dr. Burkheadincorporatestechnology such asbiofeedback withsurfaceelectromyography(sEMG), manometryand sEMG-triggeredneuromuscularelectrical stimulation(NMES) into treatmentto maximize efficiencyand effectiveness of treatment.

There is no “one size fits all” managementalgorithm for individuals with swallowing or voiceproblems. The team approach to swallowingdisorders with sophisticated diagnostic testing andtargeted treatment allows a rapid evaluation andtargeted treatment for individuals suffering fromthese disorders.

EDUCATIONAL WINTER 2007

Transcutaneous neuromuscular electricalstimulation (NMES) is an exercise modality that haslong been used by physical therapists, occupationaltherapists and athletic trainers to improvemovement performance. Its use in dysphagiarehabilitation has received increasing attention overthe past several years, with growing enthusiasm.NMES should be used to augment intensive, task-specific exercise and not as a substitute fortargeted exercise treatments.

Following this model for the use of NMES, wehave witnessed a number of impressive outcomes.Recently, a 60 year-old man was referred to ourCenter as a “last resort” with a goal to resume atleast some sort of oral intake. He had a left lateralmedullary stroke in July 2006. After nearly a yearof traditional dysphagia therapy with a speech-language pathologist, he remained PEG dependent.We developed an intensive exercise programtailored to address his specific impairmentsidentified on a modified barium swallow study

(MBSS). He was instructed in these exercisesusing surface electromyography (sEMG)biofeedback to insure he was performing themproperly and to his greatest capacity. NMES wasadded to the regimen. At the end of 6 weeks, anMBSS revealed that this gentleman had a functionalswallow without penetration or aspiration. He wasnot only able to manage his own secretions but hewas also able to resume an unrestricted oral dietand have his PEG removed. Currently, he enjoysmeals at home as well as in restaurants and atfamily gatherings, exponentially improving thequality of life of all involved.

Cases like this have prompted us to developresearch to help distinguish the cases in whichNMES may be of benefit. In the meantime, weview NMES as an emerging technique that mayhave some value in the armamentarium for thedysphagia clinician. Just as in physical therapy,occupational therapy and athletic training, theremay be selected instances in which NMES can beof benefit in conjunction with task-specific, intenseexercise.

WINTER 2007 CLINICAL SPOTLIGHT

Exercising the Swallowing Muscles: Role ofNeuromuscular Electrical Stimulation in Dysphagia Rehabilitation

“The teamapproach to

swallowing disorderswith sophisticateddiagnostic testing andtargeted treatmentallows a rapidevaluation andtargeted treatment”

– Lori Burkhead

Minimally Invasive SurgicalManagement of Thyroid and

Parathyroid Disorders_____________________

April 18-19, 2008Augusta, Georgia

1079 11/07

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 Faculty and Areas of Interest

David J. Terris, MD, ChairmanThyroid and Parathyroid Surgery

Stilianos Kountakis, MD, Vice ChairmanRhinology and Sinus Surgery

Lori M. Burkhead, PhD, CCC-SLPSpeech Language Pathology

Achih H. Chen, MDFacial Plastic and Reconstructive Surgery

Subinoy Das, MDRhinology and Sinus Surgery

Frederick N. Klippert, MDGeneral Otolaryngology

Brian J. McKinnon, MD, MBAOtology and Neurotology

Edward S. Porubsky, MDGeneral Otolaryngology

Gregory N. Postma, MDLaryngology and Swallowing Disorders

Paolo Miccoli, M.D.University of Pisa, Pisa, ItalyJames I. Cohen, M.D., Ph.D.

Oregon Health & Science University, Portland, ORThierry Defechereux, M.D., Ph.D.

University of Liege, BelgiumRichard T. Kloos, M.D.

Ohio State University, Columbus, OHLarry M. Kohse, M.D.

Macon, GALaurie A. Loevner, M.D.

University of Pennsylvania, Philadelphia, PAGregory W. Randolph, M.D.

Harvard Medical School, Boston, MAMark L. Urken, M.D.

Beth Israel Medical Center, New York, NY

Program ChairDavid J. Terris, M.D.

Medical College of Georgia

Register early. Participation in the Lab is limited.