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The Ohio State University Medical Center

Department of Otolaryngology –

Winter 2012

Head and Neck Surgery

Greetings to all from the land of the Buckeyes! We are pleased to share with you a few of the highlights from the past year as the Department of Otolaryngology and Medical Center continue to grow and strive for excellence in patient care, education and research. First, we welcomed several new faculty members to our departmental family. Dr. Ricardo Carrau and his wife Silvia, who is also an otolaryngologist, joined us in March. Dr. Carrau brings international recognition for his pioneering endoscopic skull base work. He, along with Drs. Brad Otto and Danny Prevadello, hosted the first Skull Base Surgery Course in October, which was very well-attended and very wellreceived. Guest faculty included Amin Kassam, MD, and Henry Schroeder, MD, PhD. Dr. Jonathan Grischkan is a five-star recruit who joined our pediatric division after completing a pediatric craniofacial fellowship in Minnesota. He brings expertise in congenital malformations, and we are glad to have him rejoin us. We also welcomed Dean Charles Lockwood, MD, MHCM, from Yale. Dr. Lockwood was serving as professor and chair of the Yale University Department of Obstetrics, Gynecology and Reproductive Sciences and is a member of the prestigious Institute of Medicine of the National Academies. Our new James Cancer Hospital and Medical Center Expansion is above ground and rising. This $1.2-billion structure is the largest undertaking of The Ohio State University to date. Dr. David Schuller of our Otolaryngology department leads the campaign, and the construction is on time and below budget. On the research front, Dr. Greg Wiet and Don Stredney successfully competed for renewal of their R01 to continue development of a temporal bone surgical simulator. This is being utilized in a multicentered clinical trial and also in humanitarian outreach teaching in Nicaragua. A $1-million gift to endow a chair in head and neck cancer research was gratefully received from Ron Alford and Barb Cantlin and her husband Mike in honor of their deceased parents. The pledge adds to an original $500,000 donation made by John Alford to create the first research endowment at The James in 1990. Thank you for your interest and support! Best regards, D. Bradley Welling, MD, PhD, FACS Professor and Chair P.S. Go Bucks!!!

Inside this Issue: Forrest Named Director of Ambulatory Services, New House Staff, International Skull Base Surgery Conference, Courage Unmasked for Joan’s Fund, Music Training’s Influence on Speech, Endonasal Endoscopy, Clinical Trials, Publications and Research 2010/1011, Essig Performs Endoscopic Mandible Fracture Treatment


Forrest Named Director of Ambulatory Services

L. Arick Forrest, MD

The Ohio State University Medical Center is internationally known as a comprehensive, fullservice academic research and treatment institution. Investigators here, biomedical and physician-researchers, seek and find answers to medicine’s mysteries and translate them into treatments for patients, who come from across the nation and around the world for the top-quality, research-based care we provide.

The University’s Medical Center offers cutting edge inpatient care in its state-of-the-art hospitals, and serves a far larger population through its Ambulatory Services Program, which handles every kind of outpatient care. In March 2011, L. Arick Forrest, MD was named director of Ambulatory Services at The Ohio State University Medical Center. Forrest, the former vice chair and residency director of Ohio State’s Department of Otolaryngology, also continues to serve as the director of the Voice and Swallowing Disorders Clinic, which he and Michael Trudeau, PhD initiated in 1994. Since most otolaryngology care is ambulatory, this clinic is under the Ambulatory Services umbrella. There are 142 Ambulatory Services clinics available through Ohio State. Because Ohio State’s Medical Center is part of an

academic institution whose mission is research, education and clinical care, officials wanted a faculty member experienced in all three mission areas as director, Forrest says. In this new role, Forrest has educated himself about areas of medicine ranging from clinical care to the legal, with healthcare reform legislation. The biggest change he sees so far under health reform is its patient-centered medical home, a restructuring that calls for people to have a primary care physician who coordinates all their care. Forrest also recently traveled to Iceland, his childhood home, where his mother still lives, to receive a faculty appointment at the University of Iceland in Reykjavik. He had for two years traveled back and forth, giving lectures and performing some surgeries there. Iceland’s healthcare providers, while current in the latest medical knowledge, are nonetheless behind in securing the most up-to-date technology, he says. Surgeons there are about evenly divided between those trained in America and those trained in Europe. Forrest earned his medical degree at The Ohio State University and has completed fellowships in Laryngology and Microvascular and Reconstructive Surgery at Vanderbilt University. He specializes in swallowing and voice disorders—treating vocal cord nodules and laryngeal cancers, for example. He notes that reconstructive surgery on the vocal cords can restore the voice to 90 - 95 percent of its original quality. One thing Forrest enjoys about his new administrative role in Ambulatory Services is that it balances his practice: “It’s rejuvenated me from a clinical standpoint.”

The Ohio State University Medical Center Department of Otolaryngology page 2


New House Staff - OSU Department of Otolaryngology 2011-2012

Otolaryngology PGY-1 Residents

Sanjeet Rangarajan, MD, MEng • Born in Painesville, Ohio

Candace Hrelec, MD • Born in Youngstown, Ohio • Undergraduate at The Ohio State University majoring in Independent Study in Psychobiology and Behavioral Neuroscience • Medical School: The Ohio State University College of Medicine

• Undergraduate and Graduate at Vanderbilt University majoring in Biomedical Engineering • Medical School: Michigan State University College of Human Medicine • Personal interests include tennis, basketball, filmmaking, photography, and Vanderbilt sports

• Hobbies include softball, golf, traveling and reading.

Head and Neck Oncologic Surgery Fellow Stephen Nogan, MD

Kiran Kakarala, MD

• Born in Redmond, Washington

• Born in Royal Oak, Michigan

• Undergraduate at Grove City College in Grove City, PA majoring in Biochemistry

• Undergraduate: Princeton University

• Medical School: Pennsylvania State University College of Medicine

• Medical School: Harvard Medical School • Residency: Massachusetts Eye and Ear Infirmary

• Hobbies include friends and family, travel, guitar, basketball, mountain biking and Pittsburgh sports

Neurotology, Otology, Cranial Base Surgery Fellow Hafiz Patwa, MD, PharmD • Born in United Republic of Mwanza, Tanzania

Aaron Moberly, MD • Born in Shelbyville, Indiana

• Undergraduate and Graduate at University of Kentucky majoring in PrePharmacy and Doctor of Pharmacy

• Undergraduate: Purdue University majoring in Biochemistry

• Medical School: University of North Carolina at Chapel Hill School of Medicine

• Residency: Indiana University

• Hobbies include outdoor sports, especially squash and soccer, acrylic painting, sketching, hiking and camping

• Personal interests include running, biking, books, dogs, and wife Betsy

• Medical School: Indiana University

The Ohio State University Medical Center Department of Otolaryngology page 3


Carrau Leads International Endonasal Endoscopic Skull-Base Surgery Conference A type of surgery not often done in the past because of its difficulty and complexity will now be more common, thanks to the pioneering work and teaching abilities of a professor at The Ohio State University Medical Center. Ricardo Carrau, MD, FACS helped develop a way to perform surgery on the base of the skull—the area between the face and the cranium. The technique utilizes the same kind of endoscope used to treat sinus conditions. Carrau, professor of Otolaryngology – Head & Neck Surgery and director of the Skull Base Surgery center, is working as part of a team with colleagues at the University of Pittsburgh, where he was on staff prior to coming to Columbus. In October, he directed and taught at the First Endoscopic Skull Base Surgery Course presented by Ohio State’s Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, held here at the Center of Science and Industry (COSI). The four-day international conference was comprehensive, Carrau says, in emphasizing both the surgery and the technique for performing it. Skull-base surgery had been performed as an open procedure, but as a result of progress over time the new endoscopic approach makes it possible for physicians to reach affected areas via the nostrils. Many procedures previously done as standard surgeries can today be performed this way, Carrau adds.

techniques pertaining to the supraorbital keyhole craniotomy approach. Carrau’s team covered the nuances and technological requirements of the surgery. Along with the didactic and handson elements of the course, there was a link to a live surgery, and attendees could speak with the surgeons and others involved in the procedure. The course also touched on robotics, a technique that will complement endoscopy. In addition to Carrau, course directors were Bradley Otto, MD, assistant professor, Department of Otolaryngology Head & Neck Surgery and Daniel Prevedello, MD, assistant professor, Department of Neurological Surgery. Both also are members of Ohio State’s Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC-James). College of Medicine faculty who are members of the OSUCCCJames were Mario Ammirati, MD, MBA, professor of Neurological Surgery and of Radiation Oncology; Steven Katz, MD, associate professor of Ophthalmology and director of Neuro-Ophthalmology; Matthew Old, MD, assistant professor, Department of Otolaryngology –Head & Neck Surgery; and Enver Ozer, MD, associate professor, Department of Otolaryngology– Head & Neck Surgery. Department of Anatomy research fellows were Leo Ditzel Filho, MD and Daniele de Lara, MD. Guest faculty members were Amin B. Kassam, MD, professor, Department of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada and Henry W.S. Schroeder, MD, PhD, professor and chairman, Department of Neurosurgery, Ernst Moritz Arndt University, Sauerbruchstr, Germany.

The technique causes less pain than open surgery, and recovery is faster. Minimally invasive surgery has been known for some time, and its benefits include less pain, less scarring and faster recovery. But Carrau doesn’t call this surgery minimally invasive; his term, since the method and the visualization are different, is “minimal access.” The conference, held October 6-9, 2011, drew 96 attendees— neurosurgeons, otolaryngologists,head and neck surgeons and other skull-base surgeons—from 15 countries. The course offered CCME (OSU Center for Continuing Medical Education) credit. This was a hands-on seminar, Carrau explains. It included lectures, dissection, and a 3-D anatomical presentation. A course brochure listed areas covered, including the following: indications for the procedure’s use; limitations and surgical techniques for skull-base endoscopic endonasal surgery, pituitary fossa, orbit and craniocervical junction; indications, limitations and

The Ohio State University Medical Center Department of Otolaryngology page 4


Courage Unmasked for Joan’s Fund Celebrates Patients’ Strength, Educates Public about HNC Melinda Fenholt Cogley summed it up in six words: “We put a face on cancer.” Cogley was the driving force behind Courage Unmasked for Joan’s Fund, an art installation, attention-getter and a tool to educate people about head and neck cancer, or HNC. She is the executive director and campaign chair for the Joan Levy Bisesi Foundation, whose namesake died in November 2001 after a courageous battle with squamous cell carcinoma. The Foundation, formed last year, raises money for the Joan Bisesi Fund for Head and Neck Oncology Research (Joan’s Fund), an endowment supporting research at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James). Courage Unmasked was created by Cookie Kerxton, an artist and cancer survivor, whose idea was to make art pieces from radiation masks that HNC patients wear during treatment. Kerxton granted Cogley permission to launch this second Courage Unmasked for Joan’s Fund installation.

Couple share their story behind the Spirit of Courage mask by Teda Theis. there, Courage Unmasked for Joan’s Fund traveled to other locations where the public would see and learn from it— important because people don’t really know about HNC, Cogley said. Common thinking is that risk factors include cigarette smoking, drinking and bad hygiene, but research at The Ohio State University has revealed human papillomavirus, or HPV, as another cause. “The link to HPV was an amazing result of research,” she said. “Dr. Maura Gillison, Professor, The Ohio State University, College of Medicine, found the connection between HPV and head and neck cancer”, said Ted Teknos, MD, David E. and Carol H. Schuller Chair of Head and Neck Oncologic Surgery. Cancers of the tonsils and the back of the tongue among nondrinkers and nonsmokers had been known for some time, Teknos said. Gillison reviewed a large study and probed tumors for HPV–and found it in nonsmokers. She then examined lifestyles and discovered that patients with larger numbers of oral sex partners, and or who were marijuana smokers had a higher incidence; marijuana is an independent predictor. Many strains of HPV exist, Teknos said, but 92 percent of malignancies are caused by HPV 16. Vaccination can protect against it. Word is getting out now. Cogley says that every venue where Courage Unmasked for Joan’s Fund appeared was provided free. The display gridwall was donated. Moving and storage were covered without charge.

Mask from exhibition

“It’s been a perfect way to start the conversation.”

In October, the Joan Levy Bisesi Foundation held a gala and auctioned the masks. All 30 sold and 15 were donated back for more awareness exhibits and, ultimately, a permanent exhibit at the OSUCCC-James. Cogley said the Columbus Museum of Art is planning a health exhibit. Courage Unmasked for Joan’s Fund will be there.

The exhibition opened in early 2011 in the art gallery at Worthington Kilbourne High School in Columbus, Ohio. From

To see the masks and photographs from the gala, visit www. joansfoundation.org.

The Foundation matched patients with artists who captured an essence of the people and their stories. The exhibit included 30 masks, transformed into beautiful works—a metaphor for the transformation patients go through, Cogley said.

The Ohio State University Medical Center Department of Otolaryngology page 5


Tong Study Is Published in Infection and Immunity

A researcher at The Ohio State University Medical Center and her colleagues recently published an article about a study whose findings support the idea that activation of the alternative complement pathway is part of the innate immune system that defends against pneumococcal middle ear infection in its early stage. Hua Hua Tong, MD is a research assistant professor in the Department of Otolaryngology – Head & Neck Surgery. Her interests include host innate immune response in otitis media, and this was the subject of the article, “Essential Role of Factor B of the Alternative Complement Pathway in Complement Activation and Opsonophagocytosis During Acute Pneumococcal

Otitis Media in Mice.” The article was published in the July 2011 edition of Infection and Immunity. The journal’s editors selected it as an article of significant interest. The abstract appears here: http://iai.asm.org/content/79/7/2578.abstract. In the study, Tong and her team used mice deficient in C1qa, factor B, or factor B/C2. The researchers found that during the first 72 hours of infection, complement activation in middle ear lavage fluids was greater than in serum samples. Also, complement C3 activation and opsonophagocytosis of Streptococcus pneumoniae were greatly weakened in mice deficient in factor B- and factor B/C2.

Nittrouer Studies Phonological Development in Children with Hearing Loss

How do children learn to differentiate one sound in their language from another? How do they learn to speak? And how do they progress toward these achievements when hearing loss or other barriers complicate the process? These are questions Susan Nittrouer, PhD is working to answer. She is professor and director of research in Otolaryngology – Head & Neck Surgery at The Ohio State University. She and her research staff are currently conducting a multi-year longitudinal study involving 205 children with hearing loss. Nittrouer says that hearing loss is the most common congenital impairment, occurring in three Susan Nittrouer, PhD out of every thousand children. Language is acoustically complex, and the way a child processes it influences other language skills, such as reading. The purpose of her current research is to examine how well children with hearing loss learn spoken language and how their hearing loss affects other developmental areas, such as social interactions with playmates and adults. According to the Otolaryngology Speech Development Laboratory’s website (http://www.speechdevelopment.org/), “The principal motivation for this work is to improve our understanding of the languagelearning problems faced by children with hearing loss.”

When the children in this study were 12 months old, nothing indicated they had any risk factors for language problems other than hearing loss. But now, at 8 years of age, the language development of these children ranges from levels close to that of normal hearing children to significant learning deficits. “Even with early identification of hearing loss and cochlear implants, many children still lag in language development,” Nittrouer says. Researchers hope to learn what accounts for this variability so adjustments can be made in their treatment to provide greater effectiveness. Prior to Nittrouer’s work, there hadn’t been the necessary longitudinal data to do that. Data collection consists of two-day summer “data camps” at The Ohio State University Eye and Ear Institute. There, researchers collect data on speech and language development, reading abilities, phonological awareness and psychosocial development. Recent advances in early identification of hearing loss and new technologies for treating it, including cochlear implants, have raised hopes that children with permanent sensorineural hearing loss may grow up without experiencing deleterious effects. However, it is clear that there is still a lot to learn about language development in general, and about how to intervene with deaf children in particular before those hopes are realized. The research in the speech development laboratory in the Department of Otolaryngology – Head & Neck Surgery helps move us toward that realization.

The Ohio State University Medical Center Department of Otolaryngology page 6


Researcher Investigates Music Training’s Influence on Speech Perception

Tony Shahin, PhD started with the question, “Does musical training help in understanding speech?” His review of the literature is pointing toward a “yes” answer. He is synthesizing findings from a number of studies, including his own. Shahin, an assistant professor in Ohio State’s Department of Otolaryngology – Head & Neck Surgery, is talking about tonality here, not lyrics. Trained as a physicist, Shahin is interested in what the quality of the sound conveys and how the brain perceives it. Using functional neuroimaging, he can evaluate how a person hears the sounds of speech or music by examining electrical and magnetic changes in the brain. “These physical ‘brain markers’ are of paramount importance to classifying what is normal and what is not,” he says. Shahin’s work grew out of his interest in the neuroplasticity of the brain—modifications it undergoes with experience and learning. With knowledge of the changes in the brain as people hear music and learn speech, it’s possible to determine what has gone wrong in cases of hearing loss or learning disability. “If we catch the problem very early, we can intervene early as well,” he says, adding that speech and music are our most basic and most important forms of communication, and that they can bring cultures and ideas together. In English speech, he says, we don’t vary our pitch much. Women typically have a higher pitch than men, and children’s voices are still higher-pitched. When we show emotion in speech, the pitch of the voice changes, and listeners can understand the emotion through that change. Music brings a much wider array of pitch changes, and it can carry clues to feeling, offering a basis for understanding emotion. In contrast to English, most languages do rely on tone, with pitch changes signifying differences in meaning. Shahin uses Chinese as an example: Two words can have the same pronunciation,

but the pitch is what conveys the sense of what the speaker is saying. Musical training may be helpful in enhancing speech perceptions in such languages. And this might be especially useful in any language where hearing loss is an impediment to communication. People who have cochlear implants hear a degraded quality of speech. “That is why it is very hard for them to identify the pitch, let alone fine changes in pitch,” Shahin says. Meanings are sometimes lost in emotional states, such as the tone of sarcasm, or anger. Training that incorporates actively listening to music, he says, has been hypothesized to enhance cochlear implant users’ abilities to identify pitch changes and their associated meanings. Shahin’s studies have shown that brain response to music is more pronounced in musicians than in nonmusicians. In children aged 4 to 5 who have had musical training, brain response to music resembles that of a child two to three years older, he says. “This suggests that musical training may accelerate the development of the child brain.” Preliminary evidence hints that this musically induced response may transfer to speech sounds as well. Shahin’s current work includes studies to understand how the brain uses visual cues such as lip reading to help those with normal hearing in noisy situations. As for the question you may be considering: No, there is no evidence that one type of music is more helpful than another. “Any music’s fine,” Shahin says.

The Ohio State University Medical Center Department of Otolaryngology page 7


Medical Center Expansion Update

The construction of the new James Cancer Hospital and Solove Research Institute and Critical Care Tower on The Ohio State University Medical Center’s main campus continues on time and on budget, set for completion in 2014, even with an exciting new addition to the facility. On December 29, 2010, Ohio Senator Sherrod Brown’s office announced that the Medical Center had been selected to receive a $100 million grant from the U.S. Department of Health and Human Services, Health Resources Administration to build a new radiation oncology center. Medical Center Administration, along with the architects and construction firms for the new hospital, decided the best place for the new radiation oncology facility would be inside the new James, so modifications were made to the foundation’s structure and design to accommodate additional floors and equipment. The new James Cancer and Critical Care Tower will now rise to 20 stories, making it one of the tallest hospitals in the world. The foundation for the new hospital will be complete in December 2011. The steel framework began going up on August 8, 2011, with the setting of the top piece scheduled for May 2012. The two tower elevator cores are nearing completion as well. The core for the east elevators that will reach the 15th floor was completed on November 10 and the west elevator core that reaches the top floor will be completed in April 2012.

The New James Cancer Hospital, conceptual rendering Other significant upcoming events in the overall project are the demolition of Cramblett Hall, which will begin in late 2012. The new Chlois G. Ingram Spirit of Women Park, which was moved to accommodate the construction of the new James Cancer Hospital, is now being developed in the plaza in front of Rhodes Hall. The new park will feature recreations of the original park’s artwork in a beautiful water and glass installation, and is scheduled to reopen in the spring of 2012.

Essig Performs Endoscopic Mandible Fracture Treatment A fracture in the subcondylar region—below the hinge joint but above the angle of the mandible—can be difficult to treat because it’s difficult to see. But a transoral endoscopic entry offers the kind of visibility a surgeon needs. Garth F. Essig Jr., MD, an assistant professor in the Department of Otolaryngology – Head & Neck Surgery at The Ohio State University, is an accomplished practitioner of endoscopic mandible fracture repair surgery. “The endoscope is placed transorally, using the same type of incision to gain access to the mandible that is routinely used,” he says. “The difference is that the endoscope allows us to visualize and plate the subcondylar region, which is otherwise a difficult area to expose without performing an external approach.” Essig had a patient with a unilateral subcondylar fracture accompanied by malocclusion and loss of mandibular height. In cases like this, a common treatment is to close the fracture by wiring the jaw shut for a period of time. But, he says, that doesn’t allow for certainty that the fracture has been adequately reduced. With endoscopy, the surgeon can tell that the fracture is reduced, plate the site accurately and help the patient regain mobility of

the mandible faster. This also lessens the risks presented by an open incision. Endoscopy isn’t new to otolaryngology, says Essig, but as a minimally invasive technique, it has gained favor in recent years. “This is a natural transition for many otolaryngologists, as we have extensive training in nasal endoscopy, laryngoscopy, esophagoscopy and bronchoscopy.” Fractures of the mandible are among several types of endoscopic surgery for the head and neck. Other conditions that can be treated successfully this way include sinus problems and issues with the larynx and hypopharynx, Essig says. And sometimes, head and neck surgeons work together with dentists and oral and maxillofacial surgeons. Essig trained extensively in facial trauma and reconstructive surgery at the University of Virginia and completed a fellowship in Otolaryngology/Head and Neck Surgery at the Princess Alexandra Hospital in Brisbane, Australia. He earned his medical degree at The Ohio State University College of Medicine.

The Ohio State University Medical Center Department of Otolaryngology page 8


Highlighted Clinical Trials Active in 2010/2011

PI

Division

Charles Elmaraghy, MD Pediatric Otolaryngology Kris Jatana, MD

Title Incidence of Vestibular Stenosis in NICU Patients on Nasal CPAP

Enver Ozer, MD Head and Neck Oncology A Pilot Study Assessing Transoral Robotic Surgery (TORS) for Oral and Laryngopha- ryngeal Benign and Malignant Lesions Using the Da Vinci Robotic Surgical System D. Bradley Welling, MD, PhD Otology, Neurotology, Cranial Base Surgery

Exploration and Estimation of Intratumoral Concentration and Activity of Lapatinib in Vivo in Vestibular Schwannomas

D. Bradley Welling, MD, PhD

Evaluation of the Nucleus Hybrid L24 Cochlear Implant System

Otology, Neurotology, Cranial Base Surgery

Amit Agrawal, MD Head and Neck Oncology

Food-Based Modulation of Biomarkers in Human Tissues at High Risk for Oral Cancer

Amit Agrawal, MD Head and Neck Oncology

A Phase 3, Prospective, Open-Label, Multicenter Study of Lymphoseek® as Lymphoid Tissue Targeting Agent in Patients With Known Cutaneous or Mucosal Head and Neck Squamous Cell Carcinoma Who Are Undergoing Lymphadenectomy

Ohio State University Department of Otolaryngology Ranked as One of the Best in Nation For the 18th year in a row, U.S.News & World Report ranked Ohio State’s Department of Otolaryngology as one of the best ear, nose and throat programs in the nation. The rankings are based on discharges, resident’s scores on national tests and reputation. In 2010, our Department advanced 13 positions in the rankings to 18th nationally — an outstanding achievement — and in 2011 advanced to 17th nationally.

The Ohio State University Medical Center Department of Otolaryngology page 9


Highlighted Publications for 2010/2011

Wan D, Wiet GJ, Welling DB, Kerwin T, and Stredney D. Creating a cross-institutional grading scale for temporal bone dissection. Laryngoscope, 120:1422-1427, 2010. Bush ML, Oblinger J, Brendel, V, Santarelli G, Huang J, Akhmametyeva EM, Burns SS, Wheeler J, Davis J, Chaudhury AR, Kulp S, Chen C-S, Yates C, Chang L-S, Welling DB, Jacob A. AR42, A Novel Histone Deacetylase Inhibitor, as a Potential Therapy for Vestibular Schwannomas and Meningiomas. NeuroOncology, 13:983-989, 2011. PMID: 21778190 Hurtuk A, Dome C, Holloman CH, Wolfe K, Welling DB, Dodson EE, Jacob A. Melatonin: Can it Stop the Ringing? Ann Otol Rhinol Laryngol, 120(7):433-440, 2011.

Jacob A, Oblinger J, Bush ML, Brendel V, Santarelli G, Chaudhury AR, Kulp S, La Perle K, Chen C-S, Chang L-S, Welling DB. Preclinical Validation of AR42, a Novel Histone Deacetylase Inhibitor, as Treatment for Vestibular Schwannomas. Laryngoscope, In Press. Bush ML, Oblinger J, Davletova S, Burns S, Chang LS, Welling DB, Jacob A. Treatment of Vestibular Schwannoma Cells with ErbB Inhibitors. Accepted, Otology & Neurotology. Nittrouer, S. & Lowenstein, J. H. (2010). Learning to perceptually organize speech signals in native fashion. Journal of the Acoustical Society of America, 127, 1624-1635. Nittrouer, S. & Pennington, B.F. (2010). New approaches to the study of childhood language disorders. Current Directions in Psychological Science, 19, 308-313.

Highlighted NIH Research Funding

Susan Nittrouer, PhD 12/01/1988-02/28/2016 NIH/NIDCD R01DC000633

Susan Nittrouer, PhD 09/01/2003-02/28/2015 NIH/NIDCD R01DC006237

The long-term goal of this research program is to develop a complete theoretical account of how children acquire access to segmental speech structure when there are no apparent landmarks for that structure in the acoustic signal. Early work on this project examined how children’s sensitivity to and weighting of acoustic cues affected the emergence of segmental structure in their speech perception and production. That work revealed that young children weight dynamic spectral cues (formant transitions) especially strongly and certainly more than adults. Because formant transitions are brief sections of longer, continuously changing patterns of vocal-tract resonances, those results were interpreted as suggesting that the research focus should move beyond the cue. Building upon the work of others showing that that there are optimal strategies for perceptually organizing the acoustic speech signal, this project currently focuses on how children learn to use global acoustic structure in speech perception and production.

The goal of this research project is to examine how children with hearing loss (HL)whose parents wish for them to be mainstreamed without a sign-language interpreter are faring in the early elementary grades. For that purpose, children with HL are being tested from kindergarten through grade four on a variety of measures evaluating psychosocial development, cognition, spoken language perception and production, reading and writing. Results are compared to data collected from children with normal hearing (NH) tested as part of the same protocol. All children to be tested participated in the first cycle of this project, and so were evaluated between the ages of one and four years. On all dependent language measures, means for children with HL were roughly one standard deviation below means for their typically developing peers with NH in those early years, leaving them at a disadvantage going into elementary school. The primary focus of this next cycle is to examine how these children do when they enter mainstream educational settings where language demands are expected to escalate. An increasing mismatch between the language abilities of the deaf children and the language requirements of the classroom is predicted, such that deaf children fall progressively behind academically.

The Ohio State University Medical Center Department of Otolaryngology page 10


Welcome, Dr. Grischkan

Any mom who has ever taken a son in for PE tubes, any dad who has seen his daughter face a tonsillectomy, every parent who has dealt with a child’s ear, nose and throat problem —and that is every parent— knows the value of good physician training. Leaders at The Ohio State University know it, too, and that’s why only the best instructors step to the front of the class here. So it is that The Ohio State University College of Medicine welcomes Jonathan Marc Grischkan, MD, MS as assistant professor of Otolaryngology – Head & Neck Surgery. Board-certified by the American Board of Otolaryngology, Grischkan served his fellowship in Pediatric Otolaryngology/Facial Plastic Surgery at Children’s Hospitals and Clinics of Minnesota-Minneapolis and the University of Minnesota Medical Center. He attended the Case Western Reserve University School of Medicine and completed his residency in Otolaryngology here at The Ohio State University, where he also earned his Bachelor of Science Degree in Biology.

Jonathan Marc Grischkan, MD, MS

Welcome home, Dr. Grischkan.

New Research/Funding 2010/2011

NF2 Center: Neurofibromatosis Preclinical Consortium Children’s Tumor Foundation 11/01/2011 - 10/31/2013 $300,000

• “Phase I Study to Determine the Safety and Efficacy of Fibroblast Growth Factor-1 in the Treatment of Chronic Tympanic Membrane Perforations”

• Working with Phage Pharmaceuticals, Inc., San Diego, California

“Phase 0 Evaluation of AR-42, a Histone Deacetylase Inhibitor in the Treatment of Vestibular Schwannomas and Meningiomas” • Working with ARNO Therapeutics, Parsippany, New Jersey. Additionally, Dr. Welling has just received funding from the Children’s Tumor Foundation to serve as an NF2 Center in the Foundation’s Neurofibromatosis Preclinical Consortium. This grant will provide funding for two years at $150,000 per year.

The Ohio State University Medical Center Department of Otolaryngology page 11


Non-Profit Org. U.S. Postage

PAID Columbus, Ohio Permit No. 711

The Ohio State University Medical Center Department of Otolaryngology – Head and Neck Surgery Eye and Ear Institute 915 Olentangy River Road, Fourth Floor Columbus, OH 43212 614-293-8150 ent.osu.edu

Carrau Brings Top-Flight Endonasal Endoscopy to The Ohio State University Medical Center The base of the skull, where the top of the palate meets the bottom of the cranium, is a warren of nerves and blood vessels creating a maze of a place for a surgeon to work. Tumors here can impair breathing, swallowing and vision.

State recruited him, along with Daniel Prevedello, MD, to bring the endonasal endoscopy program to its present level. Carrau is a professor of Otolaryngology – Head & Neck Surgery, and director of the Department’s Skull Base Surgery Center.

But this is territory that Ricardo Carrau, MD, FACS knows well—so well, in fact, that he has helped blaze a new trail in the treatment of tumors and other conditions at the base of the skull. Most surgeries to this region had been open, leaving scars across the scalp and face. Seeking another way, Carrau and his colleagues have refined an endoscopic technique by which they access the problem via the nostrils. The new method hasn’t Ricardo Carrau, MD, FACS completely replaced open surgery, but it offers attractive alternatives in appropriate instances.

Using the endonasal approach, physicians can operate on adults and children. Dr. Carrau says his youngest patient so far was a baby four weeks old, delivered prematurely at 34 weeks’ gestation. She had a tumor obstructing her airway. He says he saw her three or four years later and she was doing well —she was a normal child.

Carrau began his work in this area while with the University of Pittsburgh, and he still collaborates with associates there. Ohio

© 2012 The Ohio State University Medical Center UHOS20110218

While most endoscopic skull-base procedures are for tumors, physicians can treat other conditions, too. Carrau says these include fractures and trauma to the skull base, some problems with the spine, malformations, compressions of nerves, bone problems, and even decompression of the optic nerve channel. Skull-base endoscopy is similar to other types – surgeons view the procedure on a monitor while guiding a camera and their instruments. With the high-definition camera, “The resolution is fantastic,” says Carrau.


Winter Newsletter 2012