Penn State Health Otolaryngology – Head and Neck Surgery: Division Update Summer 2015

PENN STATE HERSHEY OTOLARYNGOLOGY-HEAD AND NECK SURGERY

Division Update PennStateHershey.org/otolaryngology

Message from the Chief Over the last few years, we experienced tremendous progress in the academic, clinical and research programs—including national recognition of faculty members who are leaders in research, education and clinical care. We increased our resident complement to two per year with a third resident performing a research year in the Institute of Personalized

Head and Neck Surgery Team Expands with Addition of Neerav Goyal Neerav Goyal, M.D., MPH, recently joined the Division as assistant professor of surgery and director of head and neck surgery. He returns to Penn State Hershey Medical Center after completing a fellowship in head and neck surgery and microvascular reconstructive surgery at the Massachusetts Eye and Ear Infirmary and Harvard Medical School.

Medicine.

I am inspired by the medical miracles that happen here each day. The team is poised to enter the Division’s next chapter with ambitious research initiatives and an expanding clinical presence.

Explore the pages of this publication to learn about our efforts as we continue to discover, teach and heal.

David Goldenberg, M.D., FACS Professor of Surgery and Medicine Chief, Penn State Hershey Otolaryngology–Head and Neck Surgery Associate Director of Surgery, Penn State Hershey Cancer Institute

Dr. Goyal’s clinical focus includes the surgical management of head and neck cancers, including managing tumors of the paranasal sinuses and skull base. A significant portion of his practice will include reconstruction of head and neck surgical defects to restore form and function through the use of local, regional, and free flaps with strong experience in the utilization of fasciocutaneous, muscular, osseous and composite flaps.

In addition to traditional approaches to the surgical management of head and neck cancer, Dr. Goyal uses minimally invasive approaches when appropriate to resect tumors with the use of surgical robots as well as endoscopes.

His research interests focus on surgical outcomes and quality of life amongst head and neck cancer patients. He previously focused on the epidemiology of thyroid cancer and improving surgical education with the use of the da Vinci surgical robot. He has

How to Refer A Patient • Adult and pediatric otolaryngology, head and neck cancer, facial plastic and reconstructive surgery, audiology and hearing aid services: 717-531-6822 • Cosmetic facial plastic surgery consults: 717-761-8900, option 5 • Fax records for review: 717-531-4907

authored or co-authored over 20 peer-reviewed publications, 30 national and international presentations, and nine book chapters.

Dr. Goyal earned his medical degree from Jefferson Medical College and a Master of Public Health from Johns Hopkins Bloomberg School of Public Health.

He completed his residency in otolaryngology-head and neck surgery at Penn State Hershey.

Dr. Goyal currently cares for patients on the Medical Center campus at University Physician Center, Suite 400, 500 University Drive, Hershey.

For more information or to refer a patient, please call 717-531-6822.

Service Spotlight: Audiology Penn State Hershey Otolaryngology-Head and Neck Surgery’s audiology program offers complete audiology care for infants to adults, and is the region’s only program that provides sedated auditory brainstem response testing for identification of hearing loss in infants. In pediatric patients, the team’s goal is identification of hearing loss by three months of age and intervention or amplification by six months. This is a nationwide standard for all infants as appropriate intervention provides access to audition, acquisition of speech/language and development of social behaviors.

Hearing aid services are provided for all ages. Probe mic measures are used for verification of fittings. Bone-anchored auditory implant or BAHA™ devices are fitted both for implant or softband options.

Assessment and tests offered: • Diagnostic comprehensive audiologic evaluation (tonal and speech audiometry) • Middle ear assessment using multi-frequency tympanometry and acoustic reflex measures • Sleep deprived and sedated auditory brainstem response testing • Sedated auditory steady state measures Vestibular and electrophysiologic tests offered: • Videonystagmography • Vestibular evoked myogenic potential • Electrocochleography • Electroneuronography A dedicated cochlear implant team provides comprehensive evaluation through collaboration with surgeons, audiologists, speech pathologists, development pediatricians and social services to ensure the best possible outcomes for pediatric and adult candidates. Pediatric and adult cochlear implant support group meetings provide information and family support for those candidates.

Meet the Team Beth Czarnecki, AuD, Director of Audiology For the last five years, Dr. Czarnecki has been nominated by her patients for Penn State Hershey’s “Honor Your Doctor” program. Currently, she is working with Penn State Hershey Pediatrics to research noise-induced hearing loss in teenagers. Her past research includes comparison of behavioral audiometric thresholds with thresholds obtained through electrophysiology or auditory brainstem response testing.

Ashley Barr, AuD Dr. Barr joined the audiology team in 2011. She serves as the extern clinical coordinator and also works with Penn State Hershey Pediatrics to research noise-induced hearing loss in teenagers. While Dr. Barr enjoys many aspects of audiology, her special interests include pediatric and adult cochlear implants, electrophysiology measures and amplification.

Roxanne Hagenbuch, MS Ms. Hagenbuch has practiced audiology since 1987. She tests both pediatric and adult patients in the outpatient clinic, and conducts newborn hearing screenings in the neonatal intensive care unit and pediatric intensive care unit. Ms. Hagenbuch manages Pennsylvania’s Newborn Hearing Screening Program for Penn State Hershey and coordinates this information with the Pennsylvania Department of Health. She enjoys the professional challenges her work provides.

Educating Future Audiologists Penn State Hershey Otolaryngology-Head and Neck Surgery’s audiology program is dedicated to teaching future audiologists. Audiology externs provide care in the outpatient clinic, Penn State Hershey Children’s Hospital and neonatal intensive care unit, support groups, and volunteer settings while working under the audiologists’ supervision. Externs gain hands-on experience in all areas of audiology and graduate with confidence and advanced clinical skills. A full range of hearing and vestibular services that are available to a diverse population creates an ideal learning environment and entices students from all over the country to apply each year. Externs maintain the highest quality of care and professionalism while displaying respect and compassion to all.

Patel and Lighthall Complete Surgical Mission Trips Fourth-year resident Hetal Patel, M.D., participated in a surgical mission trip with the World Surgical Foundation (WSF) to General Santos City in the Philippines to provide care to this underserved patient population. Funded by Domingo Alvear, M.D., of Harrisburg, WSF is a multidisciplinary team of general surgeons, specialty surgeons, gynecologists, urologists, anesthesiologists, nurses, and trainees as well as local providers, nurses, staff, and hospital facilities.

During this trip, Dr. Patel had the opportunity to work with Dr. James Sidman, a well-respected pediatric otolaryngologist and cleft surgeon at the Children’s Hospitals and Clinics of Minnesota. As part of this team, she experienced the amount of time, effort, and personnel required to create a successful surgical trip, and saw first-hand what is involved in planning and executing a safe, high-quality, effective international mission. She assisted with screening patients and treating a wide variety of otolaryngologic diseases, such as surgical excision of a large plunging ranula, thyroidectomy for bulky symptomatic goiters, and a parotidectomy to treat a facial mass.

Dr. Patel notes that this trip allowed her to experience the passion, generosity, and sacrifice made by those involved in caring for patients in need. “One of the most valuable aspects of the experience was being part of a team that was truly interested in the well-being of others. I was able to appreciate the goodness of perfect. There were many volunteers who worked for hours at a time with little sleep and yet were always smiling, laughing and doing their best to care for patients. Most of all, it was amazing to spend time with the people we were helping. The patients and families genuinely appreciated the services we provided and the chance to have a surgery that they may not have been able to afford otherwise.”

Jessyka Lighthall, M.D., also has a passion for international outreach.

She joined the Foundation for the Advancement of Cleft Education and Services (FACES Foundation) earlier this year for their annual surgical mission trip to Lambayeque, Peru, to repair cleft lip and palate deformities. FACES provides comprehensive and sustainable cleft care to medically isolated populations in northern Peru. The international

Pictured from left to right: Members of the facial plastics team James Sidman, M.D., Asma Akbar, M.D., Hetal Patel, M.D., and Travis Reeves, M.D., taking a short break from operating at the General Santos Hospital.

Myriam Loyo, M.D., facial plastic and reconstructive surgery fellow at Oregon Health and Science University, and Jessyka G. Lighthall, M.D., assistant professor of otolaryngology-head and neck surgery, Penn State Hershey

cleft team works primarily from Belen Hospital, but recently expanded to include Hospital Regional in the neighboring city of Chiclayo, Peru.

Three operating suites and surgical teams were active during the trip and a total of 47 patients with cleft deformities were treated in six days.

Dr. Lighthall and the FACES Foundation believe in providing highquality, multidisciplinary, long-term care for patients. In addition to providing cleft surgery, other services provided include speech therapy over the Internet, social services, dental care, orthodontia and other general health care, and family support by collaborating with local partners in Lambayeque. Dr. Lighthall looks forward to continuing this rewarding international work with FACES.

For more information or to see pre- and post-op photos, please visit facesfoundation.org.

Happenings 25th Annual Mayo Clinic Audiology Conference Webcast On February 7, Penn State Hershey Otolaryngology-Head and Neck Surgery hosted the 25th annual Mayo Clinic Audiology Conference webcast. This marks the first time that the Medical Center was a host site.

Nineteen professionals and students attended. Topics presented include “Vestibular and Balance Effects of Traumatic Brain Injury in Children,” “Asymmetric Hearing Loss and Cochlear Implantation,” “Maximizing Auditory Development Outcomes in Children with Hearing Loss,” and “The NeuroAudiologic Patient: From Symptoms to Treatment.”

Head and Neck Surgery Ultrasound Course Penn State Hershey Otolaryngology-Head and Neck Surgery held its second annual head and neck surgery ultrasound course on October 24. The course highlighted the principles and technique of ultrasound followed by an anatomical review of the head and neck as seen via ultrasound. Esteemed guests from Johns Hopkins Division of Pediatric Radiology Renee Flax-Goldenberg, M.D., and Thangamadhan Bosemani, M.D., provided the lectures. Catherine Abendroth, M.D., chief of the Division of Anatomic Pathology at Resident Aaron Baker, M.D., practices his ultrasound skills.

Penn State Hershey, presented the principles of cytology and technique of fine needle aspiration. This lecture was followed by a hands-on workshop using five state-of-the-art ultrasound machines donated by Siemens for the 20 attendees. David Goldenberg, M.D., and Brian Saunders, M.D., along with the aforementioned faculty, spent their time with the otolaryngology and general surgery residents to improve their ultrasound and fine needle aspiration techniques.

First Basic Microvascular Workshop for Residents This workshop was an introduction to microvascular instrumentation, ergonomics and positioning, basic suturing techniques, and included a hands-on training session under the operating microscope. For the hands-on portion of the course, residents practiced microsurgical techniques on a latex model followed by a chicken wing model where an arterial anastomosis was performed. This was the first course in a series of microsurgical training events. Residents train to competence in microsurgery and once they successfully perform two arterial anastomoses in an anesthetized rat model, they receive a certificate of competency in microsurgery. Course instructors included John Potochny, M.D., John Ingraham, M.D., and Mingjie Sun, M.D., Penn State Hershey Plastic Surgery; and Jessyka Lighthall, M.D., Penn State Hershey Otolaryngology–Head and Neck Surgery.

Dr. Jessyka Lighthall Co-hosts Sirius XM Doctor Radio Show

Dr. Jessyka Lighthall and Sean McMenomey, M.D.

Dr. Jessyka Lighthall was invited as a guest host on the Sirius XM Otolaryngology Show on channel 81 with host Dr. Sean McMenomey, professor of otolaryngology, at NYU. During the two-hour show, Dr. Lighthall and Dr. McMenomey discussed facial plastic and reconstructive surgery with a focus on minimally invasive and surgical aesthetic facial plastic surgical interventions.

Cosmetic Surgery Open House Dr. Jessyka Lighthall hosted an informational session for the community on aesthetic facial plastic surgery procedures, provided a video on botoxulin toxin injection and performed a live demonstration of filler injections.

Free Annual Oral, Head and Neck Cancer Screening During this screening event as part of oral, head and neck cancer awareness month, the team evaluated 88 people, identifying two people for urgent follow-up and 12 people requiring routine otolaryngology consultation.

21st Annual George H. Conner Visiting Professor Dr. Randal Weber, M.D., from University of Texas, MD Anderson, presented “Non-melanoma skin cancer: management of aggressive disease.”

Adult Cochlear Implant Meeting The cochlear implant team hosted a combined pediatric and adult cochlear implant support group. Pediatric patients were entertained by Bloomsburg and Towson externs, while their families gathered for a panel discussion featuring the Penn State Hershey cochlear implant team.

Congratulations to the following team members: • Drs. Ron and Erin Mitzner welcomed their first daughter, Noa, on January 5, 2015.

• Dr. and Mrs. Antonio Portela welcomed their first child, Penelope, on March 12, 2015.

• Dr. Ashley O’Connell married Michael Ferster on Sunday, May, 17, 2015.

Residents with Dr. Lighthall at the first basic microsurgical skills course.

Residents with Dr. Potochny Residents Shivani Shah, at the first basic microsurgical M.D., and Irina skills course.

Chaikhoutdinov, M.D., practice their microsurgical skills on a chicken wing vessel.

• Drs. Sakeena and Russell Payne welcomed their first child, Layla, on May 26, 2015.

Residency Program Approved for Complement Increase Penn State Hershey Otolaryngology-Head and Neck Surgery’s ACGME residency program was recently approved for a complement increase.

The program now accepts two residents per year for a full complement of 10 residents. Additionally, the residency program received approval to pursue a research resident year during the PGY-1 timeframe. The team accepted three residents this season, with one dedicating one year to translational research in collaboration with the Penn State Hershey Institute for Personalized Medicine. This melds well with the overall complement increase and speaks to the Division’s continued growth and expansion.

Resident News The team is pleased to welcome incoming interns Vijay Patel-Penn State College of Medicine, Hershey, Pennsylvania (categorical track); Tom Shokri-George Washington School of Medicine and Health Sciences, Washington, DC, (categorical track); and Darrin Bann-Penn State College of Medicine, Hershey, Pennsylvania (research track).

After graduating in June 2015, Irina Chaikhoutdinov, M.D., is pursuing a facial plastic and reconstructive surgery fellowship at Lenox Hill Hospital, New York, New York, under the direction of Drs. Costantino and Pearlman. Congratulations, Dr. Chaikhoutdinov.

Save the Date Penn State Hershey Alumni and Friends Function Penn State Hershey Otolaryngology-Head and Neck Surgery will hold its annual alumni function at the academy meeting in Dallas, Texas, from 6:30-9 p.m. on Monday, September 28, 2015, at Sambuca Restaurant, 2120 McKinney Ave., Dallas.

For more information, please contact Beth Shultz at eshultz@hmc.psu.edu or 717-531-6718.

Thank You for Your Contribution!

The residency program extends its sincere thanks to the alumni and friends who have contributed to the Resident Gift Fund. The continued support from generous donors allows the Division to further its resident research and educational missions. Your funds send residents to regional and national conferences, workshops and on mission trips. Donations of any size are accepted and are tax-deductible. Please contact Beth Shultz at eshultz@psu.edu with any questions.

To mail your contribution, please make your check payable to Penn State College of Medicine Otolaryngology Resident Gift Fund and mail to: Penn State Hershey Otolaryngology-Head and Neck Surgery Penn State Milton S. Hershey Medical Center PO Box 850, Mail Code H091 Hershey, PA 17033-0850

Publications, Presentations and Awards Publications Lighthall JG, Kempton JB, Hausman F, MacArthur CJ, Trune DR. Control of middle ear inflammatory and ion homeostasis genes by transtympanic glucocorticoid and mineralocorticoid treatments. PLoS One 2015;10:e0119228.

Oberman B, Khaku A, Camacho F, Goldenberg D. Relationship between obesity, diabetes and the risk of thyroid cancer. Am J Otolaryngol 2015;pii:00064-2.

Goyal N, Goldenberg D: Reply letter to the editor. HED-12-1085.R1.

Head Neck 2015;37:461-2.

Magrini A, Schubart J, Bann DV and Goldenberg D: The effects of race and ethnicity on the rise in thyroid cancer Incidence. JAMA Otolaryngol Head Neck Surg 2015;141: 319-23.

Straight CE, Patel HH, Lehman EB, Carr MM: Prevalence of smoke exposure amongst children who undergo tonsillectomy for recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 2015;79:157-60.

Adil E, Setabutr D, Ghossaini SN, Goldenberg D: Metastatic squamous cell carcinoma of the tonsil presenting as otorrhea: A case report. Ear Nose Throat J 2015;94: E7-9.

Patel HH, Siltumens A, Bess L, Camacho F, Goldenberg D: The Decline of Tracheotomy among Otolaryngologists: A 14-Year Review. Otolaryngol Head Neck Surg 2015;152: 465-9.

Goldenberg D, Goyal N: Guest Editorial Impact Factor: What is it and is it still relevant?

Ear Nose Throat J 2015;94:14-9.

Goyal N, Camacho F, Mangano J, Goldenberg D: Evaluating for a geospatial relationship between radon levels and thyroid cancer in Pennsylvania. Laryngoscope 2015;125:E45-9.

Presentations

Hussain S, O’Connell AP, Carr M. Post-operative time to rebleed in post-tonsillectomy hemorrhage patients: a retrospective analysis. 2015 PAO-HNS Annual Scientific Meeting. poster presentation Saadi, R, Oberman, B, Lighthall, JG. Subcutaneous Nasal Angioleiomyoma: A Surgical Approach for a Rare Tumor. 2015 PAO HNS Annual Scientific Meeting. poster presentation DiSalvo DS, Carr MM. Direct Laryngoscopy Findings in Pediatric Patients with Obstructive Sleep Apnea Without Adenotonsillar Hypertrophy. 2015 PAO HNS Annual Scientific Meeting. poster presentation Bann DV, Goldenberg D. Four cystic parathyroid adenomas in a man with primary hyperparathyroidism. 2015 PAO HNS Annual Scientific Meeting. poster presentation DiSalvo DS, Carr MM, Lighthall JG. Late Presentation of a Congenital Midline Cervical Cleft Involving the Thyroid: An Uncommon Anomaly.

2015 PAO HNS Annual Scientific Meeting. e-poster presentation O’Connell AP, Hu A. Evaluating the quality and readability of swallowing treatment resources on the Internet. 2015 PAO-HNS Annual Scientific Meeting. e-poster presentation Patel V, Oberman B, Zacharia T, Isildak H: Magnetic resonance imaging findings in ménière’s disease. American Neurotologic Society / Combined Otolaryngology Spring Meetings Boston, MA. April 2015 poster presentation Goldenberg D, Hollenbeak C: The cost of dying: Hospice utilization in terminally ill head and neck cancer patients. Combined Otolaryngology Spring Meetings Boston, MA. April 2015 oral presentation Lighthall, JG. Lip height and aesthetic outcomes with the Mohler variation of the rotation-advancement repair in unilateral cleft lip.

Triological Society Conference at COSM April 2015. oral presentation

Payne SJ, Mitzner R, Kunchala S, Shaeffer E, Roland L, McGinn, JD. Acute Invasive Fungal Sinusitis: 15-year Experience with 41 Patients.

2015 PAO-HNS Annual Scientific Meeting. oral presentation

Goldenberg D, Zacharia TT, Shah S: 4D-CT scoring and protocol optimization of parathyroid adenomas. Challenging diagnosis made simple. Combined Otolaryngology Spring Meetings Boston, MA. April, 2015. oral presentation

Roberts CA, Shah-Becker SU, McGinn JD, Carr MM. Intraoperative IV Acetaminophen for Pain Control Following Pediatric Tonsillectomy.

2015 PAO-HNS Annual Scientific Meeting. poster presentation

Magister M, Goldenberg D, Chaikhoutdinov I: Comparison of FNAB and path for 1, 2 and 4 cm thyroid nodules. Combined Otolaryngology Spring Meetings Boston, MA. April, 2015. oral presentation

DiSalvo D, Oberman BS, Warrick J, Goldenberg D. Pharyngeal presentation of Goltz Syndrome: Case report with review of literature.

2015 PAO-HNS Annual Scientific Meeting. poster presentation

Payne SJ: Anti-pseudomonal activity of taste receptor agonists and antagonists. American Rhinologic Society at Combined Otolaryngology Spring Meetings Boston, MA. April, 2015. poster presentation

Shah-Becker S, Oberman BS, May JG. Scalping of a Newborn: Complication During Cesarean Section. 2015 PAO-HNS Annual Scientific Meeting. poster presentation

Payne SJ: Comparison of outcomes- management of the middle vault in open vs endonasal elective rhinoplasty. American Academy of Facial Plastics and Reconstructive Surgery at Combined Otolaryngology Spring Meetings Boston, MA. April, 2015. oral presentation

Faculty Spotlight: Huseyin Isildak, M.D. Huseyin Isildak, M.D., joined Penn State Hershey Otolaryngology-Head and Neck Surgery in August 2013 as assistant professor of surgery. He is the director of otology and neurotology, as well as director of the Cochlear Implantation Program.

A double fellowship-trained surgeon, Dr. Isildak focuses on otology and neurotology. He provides the full spectrum of otologic/neurotologic surgical procedures, including cochlear implantation; implantable hearing aid surgery (bone-anchored auditory implant or BAHA™ devices); stapedectomy, cholesteatoma and other chronic ear problems; glomus tumor excision; lateral temporal bone resection; acoustic neuroma and other skull base surgeries. He is trained in balance and vestibular disorders.

Dr. Isildak’s clinical interests are hearing and vestibular disorders, including congenital hearing loss, age-related hearing loss, cholesteatoma, chronic ear disease, eustachian tube dysfunction, temporal bone fractures, ear tumors, glomus tumors, vertigo and dizziness.

A major part of Dr. Isidak’s vestibular and balance disorders practice focuses on Meniere’s disease. He is an expert at office-based intervention, including intratympanic steroid and gentamicin injections, and surgical treatment such as labyrinthectomy, endolymphatic shunt surgery, and vestibular neuroectomy for Meniere’s disease.

Dr. Isildak was trained in gamma knife surgery in Pittsburgh and offers this to patients with acoustic neuromas.

Dr. Isildak completed one of two fellowships at the Paparella Ear, Head and Neck Institute in Minneapolis, Minnesota, directed by Michael Paparella M.D., and the second at Christiana Care Health System in Wilmington, Delaware, directed by Michael Teixido, M.D. He earned his medical degree from the Istanbul University School of Medicine and completed his otolaryngology residency at the Cerrahpasa Medical School, Istanbul University, Turkey.

Dr. Isildak’s research focuses on Meniere’s disease and implantable hearing devices. He has multiple book chapters and more than 30 peerreviewed scientific publications.

Recently, Dr. Isildak attended a meeting in Denver, Colorado, to review global clinical data and share his experience with the Baha Attract System. Learn more at: thebahablog.com/2014/09/10/proven-goodperformance-with-the-baha-attract-system.

Presentations continued

Awards

Trune, DR, Lighthall, JG, Hausman, F, Kempton, B, MacArthur, C. The mineralocorticoid effect of glucocorticoids in the ear is more relevant than their immune suppression function. Association for Research in Otolaryngology February, 2015. oral presentation

Gold Humanism Honor Society Honorary Induction 2014 - Irina Chaikhoutdinov and Benjamin Oberman

Goldenberg D. Challenges in parotidectomy. Second Annual Atlantic Otolaryngology Head and Neck Surgery Update San Juan, Puerto Rico February, 2015. oral presentation Goldenberg D. Contemporary evaluation and management of the unknown primary. Second Annual Atlantic Otolaryngology Head and Neck Surgery Update San Juan, Puerto Rico February, 2015. oral presentation Goldenberg D. Humor and sarcasm in surgical education society of distinguished educators. Penn State College of Medicine Hershey, PA January, 2015. oral presentation

Arnold P. Gold Foundation Humanism and Excellence in Teaching Award 2014 - Irina Chaikhoutdinov and Benjamin Oberman First place award for Resident Research Contest: Effect of Laryngotracheal Topical Anesthesia on Recurrent Laryngeal Nerve Monitoring During Thyroid Surgery - Benjamin Oberman 2015 Central Penn Parent Best ENT - Jason May

Penn State Milton S. Hershey Medical Center P.O. Box 855, MC A140 Hershey, PA 17033

New Multidisciplinary Aerodigestive Clinic for Pediatric Patients Children with complex medical needs often need multiple pediatric subspecialists, such as pediatric surgery, otolaryngology, pulmonology, gastroenterology, speech therapy and feeding specialists. Jason May, M.D., assistant professor of otolaryngology-head and neck surgery, recently started a combined aerodigestive clinic for children.

A multidisciplinary team of specialists from pediatric otolaryngology, pediatric pulmonology, and pediatric gastroenterology care for children with complex airway problems, such as subglottic stenosis and tracheostomy tube dependence, and their families. For more information about this new clinic, please call 717-531-6822.

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