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The Ohio State University Medical Center

Department of Otolaryngology —

Autumn/Winter 2008

Head and Neck Surgery

Message from the Department Chair

Dear Colleagues, Greetings from The Ohio State University. As we enter the fall season, we reflect with gratitude upon the opportunities we have been given in our Department to improve patients’ lives. It has been a momentous year, with the recruitment of some wonderful individuals who are devoted to improving patient care through patient-outcomecentered investigation, teaching and clinical care. Improved survival for advancedstage head and neck cancer patients has been reported through our intensification protocols. Minimally invasive robotic techniques are improving patients’ recoveries from head and neck procedures. Across all areas of patient care, improved patient outcomes are our focus, and all our efforts are aimed to assist those for whom we care. Our Department was honored this year for attaining a 93-percent patient satisfaction rate, the highest in our Medical Center, and we will continue striving to provide the best care possible for our patients. Woody Hayes said, “You win with people,“ and that’s certainly true. This year, we are pleased to welcome a number of individuals who will be great contributors to our field in the coming years. Within this report, you will meet: Brad deSilva, MD, an outstanding clinician scientist and assistant professor joining our Laryngology division; Subinoy Das, MD, assistant professor and co-director of our Sinus and Allergy division; Minka Schofield, MD, assistant professor rejoining our General division, and Theodoros Teknos, MD, professor and director of the Division of Head and Neck Surgery. Dr. Teknos holds the David E. and Carole H. Schuller Chair of Head and Neck Oncologic Surgery. Quintin Pan, PhD, Pawan Kumar, PhD, Mozaffar Islam, PhD, and Bhavna Kumar have joined us to form an outstanding head and neck research team. We are also pleased to announce that Karen Calhoun, MD, professor and chair at the University of Missouri will be joining us in early 2009. We are grateful for the opportunity to continue our quest for excellence and for the improved patient outcomes it has produced here at The Ohio State University Medical Center. Please let us know if we can be of any assistance to you. Best regards, D. Bradley Welling, MD, PhD, FACS Professor and Chair Department of Otolaryngology The Ohio State University 456 W. 10th Ave. Columbus, OH 43210 (614)-293-8706 office (614)-293-7292 fax brad.welling@osumc.edu

Inside this Issue: New Recruits Increase Department’s Research and Subspecialty Capabilities, Clinical Trials, Department of Otolaryngology works to establish a Center for Childhood Hearing Loss, Head and Neck Lab Announcement, Awards and Honors


New Recruits Increase Department’s Research and Subspecialty Capabilities

New Recruits

Ohio State’s Department of Otolaryngology is pleased to announce the addition of five clinicians and three researchers to our team. Recent recruits include Ted Teknos, MD, Karen Calhoun, MD, Subinoy Das, MD, and three research staff along with former residents Brad de Silva, MD, and Minka Schofield, MD. We have also added one audiologist, Eryn Staats, MA, FAAA, and two speech pathologists, Christin Hart, MA, CCC-SLP, and Michelle Toth, MA, SLP. Dr. Teknos will be the new director of the Head and Neck Division. He also brought three researchers - Quintin Pan, PhD, Pawan Kumar, PhD, and Mozaffar Islam, PhD - from his prior position at the University of Michigan in Ann Arbor. Dr. Teknos is internationally recognized for his work with head and neck cancer. His addition to our Department and Ohio State’s Comprehensive Cancer Center is very exciting. He will be leading our head and neck cancer surgeons while Ohio State moves forward with the expansion of The James Cancer Hospital and Solove Research Institute. Subinoy Das, MD, joins us from the Medical College of Georgia, where he served as an assistant professor and associate resident director of the Otolaryngology-Head and Neck Surgery Program. Dr. Das will serve as the co-director of the Sinus and Allergy Division. Dr. Das received his medical degree from the University of Virginia, where he attained Alpha Omega Alpha honors and the Bowman Scholarship for the top clinical clerkship performance. His postgraduate education includes an internship in general surgery and an otolaryngology-head and neck surgery residency at the University of North Carolina at Chapel Hill, where he was also a chief resident in otolaryngology-head and neck surgery. He completed a fellowship in advanced rhinologic and sinus surgery at the Medical College of Georgia. Dr. Das is a member of the American College of Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, and the American Rhinologic Society. Dr. Das has conducted research in areas such as “The Effects of RSV Viral Infection on Sinonasal Epithelium” and “Proteomic Profiling for the Diagnosis and Prognosis of Chronic Sinusitis.” He has lectured on subjects such as endoscopic sinus surgical outcomes in smokers, the use of real-time, intraoperative CT scanning in sinus surgery, and the development of a blood test to detect severe forms of chronic sinusitis. Dr. Das is board certified by the National Board of Medical Examiners and the American Board of Otolaryngology - Head and Neck Surgery.

Ted Teknos, MD

Subinoy Das, MD

Karen Calhoun, MD

Another addition to our Division of Sinus and Allergy is Karen Calhoun, MD. She joins us from the University of Missouri, where she serves as the William E. Davis Professor and Chair of their Department of Otolaryngology. Dr. Calhoun earned her medical degree at The University of Louisville School of Medicine in Kentucky. She completed her general surgery internship at The University of Louisville and went on to complete her otolaryngology residency and fellowship at The University of Texas Medical Branch, Galveston. Dr. Calhoun is a fellow with both the American College of Surgeons and the American Academy of Facial Plastic and Reconstructive Surgery. She is also a member of the Triological Society, the American Academy of Otolaryngology - Head and Neck Surgery, The American Academy of Otolaryngic Allergy and the Society of University Otolaryngologists. She is the current president of the American Society of Geriatric Otolaryngology. Her research interests include the immunology of allergic disease, immunotherapy for allergies and the study of food allergies. She serves on the review board of the American Journal or Otolaryngology and the editorial board of the American Journal of Rhinology. Dr. Calhoun is board certified in Otolaryngology Head and Neck Surgery Brad deSilva, MD, our former chief resident, has decided to stay in Columbus to start his practice as well as his fellowship in Laryngology. He will be the first fellow in this division, led by Arick Forrest, MD. He has already started seeing patients for general ENT in our practice. Dr. deSilva’s clinical interests are laryngology, general otolaryngology, voice and swallowing disorders, nasal obstruction, chronic rhinosinusitis and thyroid/ parathyroid disorders. His research interests are vocal cord paralysis, tracheal stenosis, glottis stenosis and laryngeal injury. He completed his medical degree at The University of Kentucky Lexington and is a graduate of The Ohio State University Medical Center. He is an outstanding addition to our department (and an outstanding ping pong player). Minka Schofield, MD, after spending two years in private practice at The Greater Baltimore Medical Center and Kaiser Permanente Mid Atlantic Group, another former resident has returned to Columbus to start her own practice. Her clinical interests include adult and pediatric otolaryngology, chronic rhinosinusitis and nasal obstruction, thyroid and parathyroid disorders, salivary gland disorders and sleep disordered breathing. She will be seeing patients at Ohio State University Hospital East.

Brad deSilva, MD

Minka Schofield, MD

The Ohio State University Medical Center Department of Otolaryngology page 2


Clinical Trials

Citation 01/2007 - present

“Delayed Facial Nerve Paresis after Vestibular Schwannoma Resection: A Randomized Prospective Trial Evaluating Prophylactic Antiviral and Steroid Therapy.”

Elmaraghy, Charles

01/2007 - present

“Incidence of Vestibular Stenosis in NICU Patients on Nasal CPAP.”

Jacob, Abraham

01/2007 - present

“Factors Predicting the Response of Melatonin on Tinnitus.”

Jacob, Abraham

01/2007 - present

“Delayed Facial Nerve Paresis after Vestibular Schwannoma Resection: A Randomized Prospective Trial Evaluating Prophylactic Antiviral and Steroid Therapy.”

Jacob, Abraham

01/2007 - present

“The Use of Plating in Mastoidectomy Defects.”

Welling, D. Bradley

01/2007 - present

“Delayed Facial Nerve Paresis after Vestibular Schwannoma Resection: A Randomized Prospective Trial Evaluating Prophylactic Antiviral and Steroid Therapy.”

Welling, D. Bradley

01/2007 - present

“Factors Predicting the Response of Melatonin on Tinnitus.”

Welling, D. Bradley

01/2007 - present

“The Use of Plating in Mastoidectomy Defects.”

Wiet, Gregory

05/2006 - 04/2007

“Pathophysiology of Aerodigestive Reflexes in Infants.”

Bakaletz, Lauren

06/2007 - 05/2008

“Identification and Assessment of Several Targeted and Novel Candidate Antigens for the Prevention of NTHI-induced Otitis Media.” GlaxoSmithKline Biologicals.

Agrawal, Amit

07/2006 - 06/2011

“Chemoprevention of Oral Cancer in Appalachia.” American Cancer Society.

Agrawal, Amit

12/2004 - 11/2007

“Chemopreventive Agent-Responsive Genes in Oral Cancer.” NIH/NIDCR.

Nationally Ranked For the 16th year in a row, our Department was ranked as one of the best ENT programs in the nation by U.S. News & World Report.

The Ohio State University Medical Center Department of Otolaryngology page 3

Clinical Trials

Dodson, Edward


Center for Hearing Loss

Department of Otolaryngology works to establish a Center for Childhood Hearing Loss

There has been a profound change in medical options available for children with hearing loss in recent years. In particular, we can now commonly diagnose hearing loss very soon after birth and we can provide useable auditory stimulation to all children with hearing loss, regardless of the degree of that loss. These advances increase the likelihood that we will be able to help children attain their full potential. However, intervention methods have not kept pace with these medical options. There is good reason to suspect that these new medical treatments are not enough. In particular, we know that language learning involves more than just access to auditory input. The primary mission of this research performed by Dr. Susan Nittrouer, Director of Research in the Department of Otolaryngology is to examine how new medical options are interacting with typical language learning for children with hearing loss, and to develop new, effective methods of early intervention. We are taking a lead in investigating treatment and intervention options for these children and their families, as well as providing state-of-the-art intervention. In this way, we will serve our patients with the best possible services and be a leader in establishing new standards of care. The changes in treatment available for children with hearing loss have occurred very rapidly, which explains why intervention options have not kept pace. This discrepancy in current intervention options and needs requires that research efforts be heightened.

We do not know the best options for intervention. Consequently, it is imperative that high-quality research be conducted. At the same time, we must be providing some kind of early intervention for children receiving medical care. The Center for Childhood Hearing Loss will combine these functions of research and intervention in collaboration with our pediatric faculty at Nationwide Childrens Hospital. We hope to design a center that will have several administrative offices, one or two large classrooms, approximately six medium-sized classrooms along with six-dual purpose intervention/ research rooms, two rooms with sound booths and control chambers; two rooms for infant services; a model apartment and consultation room, a kitchen and eating area for children, with a child-high preparation area, an indoor exercise and music room; and an outside play area. Children will receive services in the Infant Services Center until they are 2 years of age. At 2 years, children will attend a toddler group a couple days each week. At 3 years, children will attend regular preschool programming. Some children with normal hearing are included in the larger group. Ongoing research will be conducted on these children, including studies of language and speech development, movement control, and auditory and speech perception.

Melatonin for Tinnitus The Division of Otology is enrolling patients in a study involving the effects of the dietary supplement melatonin on chronic tinnitus. Patients are asked to participate in the study if they have a diagnosis of tinnitus and may benefit from this experimental therapy. Approximately 62 adult subjects are expected to participate in the study. Currently 38 patients are enrolled. During the first visit, a clinical history is obtained. The patient also receives a hearing test and a baseline tinnitus matching test to measure the severity of the tinnitus. In the tinnitus matching test, while wearing headphones, the patient is presented with different levels of tone loudness. The tone increases slowly until the patient can no longer hear their tinnitus. This determines the level of loudness of the tinnitus. The patient also completes three questionnaires: Tinnitus Severity Index, to assess the severity of tinnitus; Pittsburg Sleep Quality Index, to determine sleep

patterns and quality; and Beck Depression Inventory, to screen for depression. The study is double-blind, and each patient is enrolled for a total of 12 weeks. During the first visit, the patient receives a 30-day supply of a pill; it will be either melatonin or placebo. The patient is asked to take one pill nightly, 20 minutes before sleep, for 30 nights. After 30 days, the patient returns to the clinic and again are asked to complete the same three questionnaires and repeat the tinnitus matching. There is then a four-week break, after which the patient returns to the clinic and is asked to fill out the three questionnaires again. The patient is then given a 30-day supply of either melatonin or the placebo. After 30 days, the patient has a final clinic visit for the study and is asked to fill out the three questionnaires again and complete tinnitus matching. Preliminary results will be available by the end of this year.

The Ohio State University Medical Center Department of Otolaryngology page 4


Head and Neck Lab Announcement

To help accomplish that goal, Quintin Pan, PhD, will serve as director of Head and Neck Oncology Research. He received his doctoral degree in pharmacology and post-doctoral training in oncology. He has been a very productive scientist, achieving the rank of assistant professor on the tenure track at the University of Michigan. In addition, he has successfully competed for prestigious grants from the NIH/NCI, the American Cancer Society, SPORE Career Development, the U.S. Department of Defense and FAMRI. His knowledge has been utilized as an external expert reviewer for the Prostate Cancer Foundation of Australia as well. The other scientists include Pawan Kumar, PhD, and Bhavna

Head and Neck Lab Team left to right: Bhavna Kumar, MS, Pawan Kumar, PhD, Ted Teknos, MD, Quintin Pan, PhD, Mozaffarul Islam, PhD Kumar, MS, who are an extraordinarily talented husband and wife team with equally remarkable scientific success. Dr. Kumar and Bhavna graduated at the top of their respective classes from the All India Institute of Medical Sciences, India’s foremost academic institution. Dr. Kumar completed post-doctoral fellowships in tumor immunology and biochemistry and rose to the rank of research associate professor at the University of Michigan Dental School. He has won numerous scientific travel awards and young scientist awards. He has an extensive publication record and has been funded through the NIH and SPORE programs. Bhavna Kumar has conducted groundbreaking biomarker research in the laboratory of Drs. Tom Carey and Carol Bradford. She has also been an invited speaker at numerous high profile scientific meetings. The final member of the group is Mozaffarul Islam, PhD, who was a research scientist at the University of Michigan. Dr. Islam has extensive expertise in molecular biologic techniques and is discovering novel anti-angiogenic therapies for head and neck cancers. His work has resulted in continuous research funding for the past seven years. Dr. Teknos states that, “We have assembled an outstanding team of clinicians and scientists here at The Ohio State University Medical Center and James Cancer Hospital. With leading edge research and outstanding personalized care, we aim to be one of the pre-eminent head and neck cancer programs in the world.”

Moving forward, moving location… The Department is taking steps to set up offsite clinical and research space. That will allow us to update the clinical exam rooms, create a temporal bone lab and expand our audiological and vestibular department services. The new location was recently approved by the University Board of Trustees and will open in the summer of 2009. The temporal bone lab will be designed with multiple drilling stations in the hopes that, not only ENT residents, but other medical students, residents, and practicing physicians will use these facilities to broaden their surgical skills.

The Ohio State University Medical Center Department of Otolaryngology page 5

Announcement

Ohio State’s Department of Otolaryngology - Head and Neck Surgery, as well as Ohio State’s Comprehensive Cancer Center, welcomed a new head and neck cancer research team to The Ohio State University Medical Center in August. This dynamic team of translational scientists consists of Ted Teknos, MD, Quintin Pan, PhD, Pawan Kumar, PhD, Mozaffarul Islam, PhD, and Bhavna Kumar, MS. The team’s research will focus on novel translational science angiogenesis, tumor immunology, tumor microenvironment and experimental therapeutics. Dr. Teknos, who had formerly been the division chief of Head and Neck Surgery, associate director of Microvascular Reconstruction, and residency director at the University of Michigan, will become division director of Head and Neck Surgery at Ohio State and will be the inaugural holder of the David E. and Carole H. Schuller Chair in Head and Neck Oncologic Surgery. At the University of Michigan, Dr. Teknos distinguished himself as a clinician and scientist by successfully competing for numerous grants, including NIH RO1 and NCI SPORE funding. Clinically, he has been recognized since 2003 by “America’s Top Doctors,” “America’s Top Doctors for Cancer,” “Best Doctors,” “Who is Who in Medicine,” and “Detroit’s Top Docs” magazines. He has also been recognized for his teaching efforts with the Frank N. Ritter Teaching Award and Leonard Tow Humanism in Medicine Award. According to Dr. Teknos, “The projected growth of Ohio State’s James Cancer Hospital and Solove Research Institute, coupled with the extraordinary talent present at this great institution, makes this an exciting place to be. Under the leadership of Drs. Saunders and Schuller, this Department has always been a dominant player in head and neck cancer care. My hope is to continue to build on that tradition of excellence with a world-class basic and translational research program.”


Awards and Honors

L. Arick Forrest, MD, has accepted an invitation to be a part of an upcoming training course for oral and maxillofacial surgeons, otolaryngology - head and neck surgeons and plastic and reconstructive surgeons. Dr. Forrest is one of 13 physicians from around the world who were invited to be a part of the international faculty for this course. Please visit www.aona.org for more information.

Awards and Honors

Abraham Jacob, MD, has received the Triological Society Career Development Award for his project “Combination EGFR and AKT Pathway Inhibition for Treating Vestibular Schwannoma.” Dr. Jacob has also been named as an honoree of Columbus Business First’s “40 Under 40” in recognition of his accomplishments in the field of adult and pediatric ear disease. Hua Hua Tong, MD, presented a poster at the 108th General Meeting of the American Society of Microbiology for her abstract entitled “The Effect of Differential Oponisixation and Phagocytosis of Streptococcus Pneumonia Opacity Variants on Bacterial Clearance in Middle Ear in the Mouse Model of Otitis Media.” We congratulate her on her work in our otologic laboratory. She was awarded an RO1 from the National Institute of Health for support of her research.

Drs. Christopher Weghorst, PhD, Amit Agrawal, MD, David Schuller, MD, and Enver Ozer, MD, were selected to give an oral presentation of their abstract “A Food-Based Approach to Oral Cancer Chemoprevention” at the Seventh International Head and Neck meeting. Their abstract was selected from more than 1,200 abstracts that were submitted. The Vesalius Trust awarded the Frank Netter Award to the Temporal Bone Dissection Simulation project, headed by Dr. Greg Wiet, MD, and Don Stredney. The presentation will be made at the fall AAO-HNS meeting in Chicago. A short video clip is available at www.wosu.org detailing their innovative work. D. Bradley Welling, MD, PhD, completed his term of President of the American Neurotology Society. He served from 2007-2008. He was honored to be the Hitzelberger lecturer for the ANS this fall. Drs. Richard Kang, MD, David Schuller, MD, and D. Bradley Welling, MD, PhD and Ted Teknos, MD were included in the 2007 America’s Best Doctors. Karen Calhoun, MD, is the president of the American Society of Geriatric Otolaryngology and on the Board of the American Academy of Otolaryngology Allergy

Grants Amit Agrawal, MD

07/2006 - 06/2011

“Chemoprevention of Oral Cancer in Appalachia.” American Cancer Society. $959,913.00. Co-Investigator.

Lauren Beth Bakaletz, PhD

09/1999 - 08/2009

“Determinants of H. influenzae Virulence in Otitis Media.” NIH/NIDCD. $3,164,479.00. Principal Investigator.

07/2003 - 06/2010

“Studies on the Biology and Immunogenicity of NTHi.” NIH/NIAID/DMID. $1,119,814.00. Co-Investigator.

12/2005 - 11/2010

“NTHI Type IV Pili: Expression and Vaccine Potential.” NIH/NIDCD. $2,085,386.00. Co-Investigator.

04/2006 - 03/2009

“M. Catarrhalsi Pili: Role in Colonization and Infection.” NIH/NIDCD. $72,950.00. Co-Investigator.

Abraham Jacob, MD

Triological Society Career Development Award: “Combination EGFR and AKT Pathway Inhibition for Treating Vestibular Schwannoma.”

Susan Neva Nittrouer, PhD

01/2005 - 12/2009

“The Ontogeny of segmental speech Organization.” NIDCD Individual Grant R01. Principal Investigator.

D. Bradley Welling, MD, PhD

07/2004 - 06/2009

“Validation/Dissemination Virtual Temporal Bone Dissection.” NIH R01. $1,867,381.00. Co-Investigator.

05/2005 - 04/2010

“Phenotypic Determinants of Vestibular Schwannomas.” NIH R01. $1,673,225.00. Principal Investigator.

09/1999 - 08/2009

“Determinants of H. influenzae Virulence in Otitis Media.” R01 NIH grant. $310,902.00. Collaborator.

07/2004 - 06/2009

“Validation/Dissemination Virtual Bone Dissection.” NIH/NIDCD. $1,867,381.00. Co-Investigator.

09/2005 - 02/2009

“A Phase III Randomized, Double-Blind Trial Comparing HspE7 and Placebo in the Treatment of Children and Young Adults with Recurrent Respiratory Papillomatosis Requiring Frequent Debulking Surgeries.” Stressgen. $24,485.00. Co-principal investigator

Hua Hua Tong, MD

07/2008 - 06/2012

“Complimeat in S. pheumoniae Otitis Media.” NIH R01.

Quintin Pan, PhD

07/2008 - 05/2013

“The Role of PK Cepsilon in Oral Cancer.” NCI R01.

Gregory James Wiet, MD

The Ohio State University Medical Center Department of Otolaryngology page 6


Department Spotlights from the Triological Society Meeting

The following scientific sessions and posters were featured at the 111th annual meeting of the Triological Society in Orlando, FL: “Comparison of Tonsillectomy to Tonsil Biopsies in Detecting Occult Primary Tumors” Joshua Waltonen, MD Enver Ozer, MD David Schuller, MD Amit Agrawal, MD “The Impact of Surgery in the Management of the Head and Neck Carcinoma Involving the Carotid Artery” Enver Ozer, MD David Schuller, MD Amit Agrawal, MD “Formal Psychological Testing in Patients with Paradoxical Vocal Cord Dysfunction”

L. Arick Forrest, MD Omar Husein, MD Tiffany Husein Tendy Chang, MD Michael Trudeau, PhD

Amit Agrawal, MD David Schuller, MD Drs. Schuller and Welling presented the following at CORLAS in Berlin, Germany, this summer:

“Acute Frontal Sinusitis Complicated by Frontal Lobe Abscess-Combined Otolaryngology/Neurosurgery Intervention Utilizing Image Guidance” Alfred Fleming, MD Bradley Otto, MD Ryan Hendricker, MD Charles Elmaraghy, MD “Treatment Patterns and Outcomes of Nasopharyngeal Carcinoma: A 20-year Experience” Brad deSilva, MD Bradley Otto, MD Ronald Glaser, PhD

David Schuller, MD, (Columbus), Amit Agrawal, MD, Enver Ozer, MD, Anterpreet Neki, MD, John Grecula, MD Improved Survival for Advanced-Stage Resectable Upper Aerodi Gestive Tract Squamous Cell Cancererent Prostheses. D. Bradley Welling, MD, PhD, (Columbus), Mark Packer, MD, Abraham Jacob, MD, Tina Lee, PhD, Elena Akhmametyeva, Ching-Shih Chen, PhD, Long-Sheng Chang, PhD Vestibular Schwannomas: Growth Pathways and Emerging Treatment Options

New Offices Opening in Gahanna and at OSU Medical Center East The Department of Otolaryngology will open a new office in Gahanna, Ohio (an eastern suburb of Columbus), later this year. The office will replace the Reynoldsburg location with updated features. Faculty members Doug Massick, MD, and Abraham Jacob, MD, will evaluate patients in this location. Additionally, the location will offer audiological services. We look forward to serving the northeast suburbs with our updated facility. In July of this year, Minka Schofield, MD, one of our former residents who is now full- time faculty, started practicing at The Ohio State University Medical Center East location. This has expanded

Recent Graduates

our Department’s presence in the community. Although several of the Department’s outpatient procedures are performed at this facility, we have never had a full-time faculty member practice in this location. Dr. Schofield will practice as a general ENT surgeon.

Outreach To serve the population of mid/eastern Ohio, many of our faculty have been traveling to Zanesville once a month to service this community. We also have faculty traveling to southeastern Ohio to run clinics for children in Athens and Logan counties. Pictured left to right: Brad deSilva, MD, Sumit Bapna, MD, Jeff Rastatter, MD and Josh Waltonen, MD. Not pictured is Mark Packer, MD.

This past July, three of our residents and two fellows graduated from our program: Drs. Brad deSilva, MD; Sumit Bapna, MD, and Jeff Rastatter, MD. Dr. deSilva was accepted as our Departments first Laryngology fellow. He will also be practicing general ENT within our Department. Dr. Bapna will be completing a fellowship in Facial Plastics and Reconstructive Surgery at The Maas Clinic in San Francisco. Dr. Rastatter accepted a fellowship in Pediatrics at Children’s Memorial Hospital in Chicago. Our Neurotology fellow Mark Packer, MD, has joined Lackland Airforce Base as a fulltime neurotologist. Josh Waltonen, MD, our former Head and Neck fellow, has accepted a position as a head and neck oncologic surgeon at Wake Forest University Medical Center in North Carolina. We wish them all the best.

The Ohio State University Medical Center Department of Otolaryngology page 7


Match Results

Once again, we are most pleased to have matched out-

Stanley McClurg, MD

standing candidates to our Otolaryngology – Head and Neck Surgery program here at The Ohio State University:

• Completed undergraduate education at Kansas State University where he graduated with Honors with a degree in Chemical Engineering

Sarah Bowe, MD, Michael Cipolla, MD, Stanley McClurg, MD, and Patrick Walz, MD. All four are tremendous individuals whose cumulative Step 1 USMLE scores are in the 99th percentile, and all are members of AOA. We look forward to great things from them through their five years with us and well beyond.

• As a chemical engineering intern at Wilbur Chocolate Co., he upgraded the batch chocolate-making process to a stream-lined transient process, allowing continuous production of chocolate and learned how to expertly sample various forms of chocolate • Conducted research involving biometric hydrogel drug-delivery systems as a research assistant at Kansas State University

Match Results

Sarah (Houghton) Bowe, MD Boston University School of Medicine • In the Air Force • Undergraduate study at University of Massachusetts-Amherst and graduated with Bachelor of Science • Received recognition Honors in every third-year clinical clerkship • Member and co-chair of the Pediatric Education and Development Society, which introduces medical students to pediatrics. Sarah organized lectures for primary care pediatricians and pediatric sub-specialists

Patrick Walz, MD Indiana University School of Medicine • Completed undergraduate education at Xavier University, where he earned a Bachelor of Science degree, summa cum laude • As a research assistant at Indiana University, he investigated the differences in survival and proliferation between laryngeal and skeletal myoblasts and submitted the abstract as an oral presentation to the Triological Society Middle Section Meeting • Member of Big Brothers/Big Sisters of Central Indiana

Michael Cipolla, MD State University of New York at Buffalo • Graduted cum laude from the State University of New York at Geneseo where he graduated with a Bachelor of Science • Was elected to the Tri Beta Biology Honors Society and the Golden Key Honors Society • Participated in Global ENT Outreach, a non-profit organization committed to fighting ear disease and other disorders of the ear, nose and throat in developing countries

• As a volunteer with Habitat for Humanity in Indiana, he participated in the construction of six Habitat houses, took 10 one-week service trips to the Appalachian region of West Virginia and helped design and build 35 home-access ramps for wheelchair-bound individuals

Charles Yates, MD - Neurotology Fellowship (7-1-08) Indiana University – BS, Biochemistry and Biology Indiana University School of Medicine – MS, Physiology Indiana University School of Medicine – MD Indiana University School of Medicine – Internship, General Medicine Indiana University School of Medicine – Residency, Otolaryngology – Head and Neck Surgery Yates’ research interests include vestibular schwannoma and cochlear implantation. His research background is in molecular biology, with work on development of smooth muscle cells.

The Ohio State University Medical Center Department of Otolaryngology page 8


Match Results

Matthew Miller, MD - Head and Neck Oncologic Surgery Fellow (7-1-08) Elmire College – BA SUNY Upstate Medical University – MD Thomas Jefferson University Hospital – Residency, Otolaryngology - Head and Neck Surgery Miller earned the Excellence in Medical Student Teaching Award: Department of Surgery, from Thomas Jefferson University Hospital. He intends to pursue an academic career and would like very much to play a role in the education of a new generation of otolaryngologists. Miller graduated magna cum laude from the college of medicine at SUNY Upstate Medical Center and was a junior inductee in AOA.

Brad deSilva, MD – Laryngology Fellowship (7-1-08) University of Kentucky – BS, Biological Sciences The Ohio State University College of Medicine – MD Mount Carmel Medical Center – Internship, General Surgery The Ohio State University College of Medicine – Residency, Otolaryngology – Head and Neck Surgery Senior AOA inductee, administrative chief resident and representative for residency advisory council and graduate medical education committee Research interests include laryngeal pathology secondary to prolonged intubation and treatment of vocal cord paralysis

Our Department is also adding a new Laryngology Fellowship this year. This will be a one-year program with L. Arick Forrest, MD, as the program director. We are also pleased to announce that Brad deSilva, MD, has accepted this position and will be our Department’s first Laryngology Fellow.

Residents Agnes Oplatek, MD and Laura Matrka, MD

The Ohio State University Medical Center Department of Otolaryngology page 9


Molecular Pathogenesis of Vestibular Schwannomas D. Bradley Welling, MD, PhD Chair and Professor, Department Otolaryngology – Head and Neck Surgery Vestibular schwannomas are benign tumors of the vestibular nerves, which often lead to disequilibrium, tinnitus, hearing loss, facial hypoesthesia and facial paralysis. These tumors can be broadly classified as sporadic unilateral or bilateral tumors. Bilateral tumors are the hallmark of neurofibromatosis type 2 (NF2), an autosomal dominant disorder characterized by mutations in the tumor suppressor gene NF2.1 The NF2 gene, identified by two independent groups in 1993, encodes merlin (moesin [membrane-organizing extension spike protein]-ezrin-radixin-like-protein), a protein that shares significant sequence homology with the ezrin, radixin, and moesin (ERM) proteins, which are thought to link with plasma membrane receptors to the actin-based cytoskeleton.2,3 Although merlin may have structural domains that are similar to those of ERMs, its function as an antimitogenic agent is truly unique. Evidence of the tumor-suppressing ability of merlin has been discovered through genetic analyses of NF2. “About 40 percent of these tumors have missense or nonsense mutations in NF2, at the molecular level,” explains D. Bradley Welling, MD, PhD, chair and professor of the Department Otolaryngology – Head and Neck Surgery. Mutations have not only been found in NF2-associated vestibular schwannomas, but also in sporadic unilateral schwannomas and cystic schwannomas. In addition, mutations have been identified within NF2 in other tumors, such as meningiomas, thyroid carcinomas, melanomas and mesotheliomas. In association with the loss of p16, a well-characterized tumor suppressor gene, merlin deficiency causes mesotheliomas in mouse models, indicating that NF2 lesions work synergistically with other genetic perturbations to promote tumorigenesis.2 Therefore, understanding the molecular mechanism of the tumor suppressor function of merlin could assist in the development of targeted therapies for a broad range of cancers. Previous work has demonstrated that merlin is an important regulator of cell and tissue proliferation. Inactive merlin promotes cell growth at low cell densities, whereas at high cell densities, merlin is activated and inhibits cell growth.3 The activity of merlin is also regulated by phosphorylation of the C-terminus, preventing merlin from interacting with the N-terminal band 4.1, ERM (FERM) domain, leaving merlin in an open, inactive confirmation. Once the protein is dephosphorylated, merlin enters a closed, active confirmation, allowing it to interact with itself, as well as with other proteins. Many missense mutations identified in NF2 lead to amino acid substitutions in the FERM domain or the C-terminus tail of merlin. Additionally, some nonsense mutations truncate the protein at the C-terminus.2 The growth inhibition activity of merlin depends on many protein-protein interactions, approximately 34 of which are known interacting proteins. This process is modulated by the kinases (p21-activated kinases [PAK] and protein kinase A [PKA]), and by the phosphatase complex myosin phosphatase-protein phosphatase 1 (MYPT-1-PP1δ; Figure 3).4

Through basic research, new modalities for vestibular schwannomas are being targeted and tested by Welling, in collaboration with Drs. Abraham Jacob and Long-Sheng Chang at Ohio State University Medical Center and Nationwide Children’s Hospital. Some treatments focus on either blocking the proliferation of schwannomas through the perturbation of certain signaling pathways or restoring functional merlin to mutant cells. In the OSU Neurosciences program, Dr. Jacob has demonstrated that the PI3K/AKT pathway is activated in human schwannomas.5 Recent studies using cultured schwannoma cells further show that both a novel AKT inhibitor (OSU_03012)and a histone deacetylase inhibitor could suppress schwannoma cell growth by blocking the PI3K pathway; the efficacy of these new compounds is being tested in a quantifiable xenograft nude mouse model for vestibular schwannomas.1 A phase II trial also is being initiated in order to investigate the usefulness of an epidermal growth factor receptor (EGFR)-ERBB2 inhibitor for the treatment of vestibular schwannomas. These research efforts, combined with clinical and surgical advances, demonstrate the OSU Neurosciences program’s commitment to providing patients with a broad, multifaceted approach to the treatment of skull base tumors.

Figure. The role of merlin in cell signaling pathways Source: D. Bradley Welling, MD, PhD References 1. Welling DB, Packer MD, Chang LS. Molecular studies of vestibular schwannomas: a review. Curr Opin Otolaryngol Head Neck Surg. 2007;15(5):341–346. 2. Okada T, You L, Giancotti FG. Shedding light on Merlin's wizardry. Trends Cell Biol. 2007;17(5):222–229. 3. Neff BA, Welling DB, Akhmametyeva E, Chang LS. The molecular biology of vestibular schwannomas: dissecting the pathogenic process at the molecular level. Otol Neurotol. 2006;27(2):197–208. 4. Scoles DR. The merlin interacting proteins reveal multiple targets for NF2 therapy. Biochim Biophys Acta. 2008;1785(1):32–54. 5. Jacob A, Lee TX, Neff BA, Miller S, Welling B, Chang LS. Phosphatidylinositol 3-kinase/AKT pathway activation in human vestibular schwannoma. Otol Neurotol. 2008;29(1):58–68.

The Ohio State University Medical Center Department of Otolaryngology page 10


Faculty and Staff

Amit Agrawal, MD

Russell Faust, MD, PhD

Quintin Pan, PhD

Assistant Professor

Assistant Professor

Associate Professor

Head and Neck Surgery

Pediatrics

Research

L. Arick Forrest, MD

David Schuller, MD

Lauren Bakaletz, PhD

Associate Professor

Professor

Professor

Laryngology

Head and Neck Surgery

Research Minka Schofield, MD

Scientist

Assistant Professor

Assistant Professor

Research

General Otolaryngology

Research Abraham Jacob, MD

Stephen Smith Jr., MD

Karen Calhoun, MD

Assistant Professor

Assistant Professor

Professor

Otology

Facial Plastics and Reconstructive Surgery

Sinus and Allergy D. Richard Kang, MD Long-Sheng Chang, PhD

Associate Professor

Ted Teknos, MD

Professor

Pediatrics

Professor

Research

Head and Neck Surgery Pawan Kumar, PhD

Subinoy Das, MD

Assistant Professor

Hua Hua Tong, MD

Assistant Professor

Research

Scientist

Sinus and Allergy

Research James Lang, PhD

Brad deSilva, MD

Associate Professor

Michael Trudeau, PhD

Assistant Professor

Research

Associate Professor

Laryngology

Voice Center Douglas Massick, MD

Edward Dodson, MD

Assistant Professor

D. Bradley Welling, MD, PhD

Associate Professor

General Otolaryngology

Professor

Otology

Otology Meridith Merz, MD

Charles Elmaraghy, MD

Assistant Professor

Gregory Wiet, MD

Assistant Professor

Pediatrics

Associate Professor

Pediatrics

Pediatrics Susan Nittrouer, PhD Professor Research Enver Ozer, MD Assistant Professor Head and Neck Surgery

The Ohio State University Medical Center Department of Otolaryngology page 11

Faculty and Staff

Mozaffar Islam, PhD Kamran Barin, PhD


The Ohio State University Department of Otolaryngology Head and Neck Surgery Cramblett Hall, Suite 4A 456 West 10th Avenue Columbus, Ohio 43210-1250 614-293-8150 http://ent.osu.edu/

Sumit Bapna, MD, Jeff Rastatter, MD and Eugene Chio, MD


Autumn/Winter 2008