Penn State Health Otolaryngology – Head and Neck Surgery: Division Update Summer 2019

Summer 2019

PENN STATE HEALTH | OTOL ARYNGOLOGY

Division Update hmc.PennStateHealth.org/otolaryngology

In this Issue 4

Physician Spotlight

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Welcome New Residents

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Presentations and Conferences

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Otolaryngology in the News

Turn the page to read about this photo of the molecular structure of the Human Papilloma Virus in head and neck cancer.

Molecular Structure of the Human Papilloma Virus (HPV) in Head and Neck Cancer Dr. Max Hennessy, 2018-2019 research track resident, has focused his research on determining the molecular structure of HPV in head and neck cancer. Due to decreased smoking rates, the incidence of most types of head and neck cancers has been falling since the mid-1980s. However, the incidence of oropharyngeal cancer (cancer of the swallowing passage, tongue base and tonsils) has more than doubled in the same time frame, and is reaching epidemic proportions.

Oropharyngeal cancer caused by HPV typically occurs in younger patients, and has a better prognosis than non-HPV induced oropharyngeal cancer. With that said, approximately 20 percent of patients with HPV caused oropharyngeal cancer have a very poor prognosis, and require more aggressive treatment to survive. In order to determine why some patients have a better prognosis than others, we must understand the molecular profile of HPV in oropharyngeal cancer. In other words, classifying the tumors for diagnostic, prognostic and predictive purposes based on tumor gene expression.

Thus far Hennessy has made great strides in describing the molecular structure of HPV in head and neck cancer. For the very first time, otolaryngology at Penn State Health Milton S. Hershey Medical Center have developed a technique to utilize optical genomic mapping in addition to whole genome sequencing in constructing the genome of HPV induced oropharyngeal cancer. This method allows us to definitively identify the molecular structure of HPV in the oropharyngeal cancer genomes, while determining the damage it causes to the human genome. Based on our preliminary data and existing data in the literature, we believe the virus exists in one of three molecular states, integrated into the human genome, as an extrachromosomal ring, and as a hybrid human/viral extrachromosomal ring. Once a molecular structure and mutational profile of HPV is determined for each individual sample, the profile will be correlated with the clinical outcomes of patients to determine what effect viral structure has on prognosis. We expect to see better outcomes when the virus is not integrated into the genome and exists as a ring outside of the cancer genome.

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Message from the Chief Summer has arrived here in beautiful central Pennsylvania.

Penn State Health Otolaryngology – Head and Neck Surgery continues to grow in leaps and bounds.

As of Jan. 1, we are proud to announce the opening of an Otolaryngology – Head and Neck Surgery clinic at Penn State Health Lime Spring Outpatient Center in Lancaster County. This is manned by Dr. Guy Slonimsky and full-time audiologist, Jackie Price.

Dr. Jessyka Lighthall continues to lead the highly successful Penn State Multidisciplinary Facial Nerve Disorders Clinic. This unique clinic is dedicated to the treatment of patients with facial weakness and facial paralysis caused by injury, surgery or disease.

We welcomed Dr. Karen Choi to our division back in October. Karen is an MD Anderson trained head and neck surgeon, and we are pleased she has joined our busy practice. See page 4 for more information on Dr. Choi.

Dr. John McGinn will start his term as president of the Pennsylvania Academy of Head and Neck Surgeons and will host this year’s annual meeting at the Hotel Hershey on June 14-15, 2019. For more information, go to otopa.org/scientific-meetings.html.

I remain in awe of our talented faculty, residents and dedicated staff that take care of a growing number of patients each year.

Best wishes for a happy summer season.

David Goldenberg, MD, FACS Steven and Sharon Baron Professor of Surgery Chief, Division of Otolaryngology – Head and Neck Surgery

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Physician in the Spotlight – Dr. Karen Choi Karen Y. Choi, MD, joined the head and neck division of Otolaryngology as assistant professor of surgery in October 2018. After completing her residency training at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, N.Y., she went on to complete a head and neck surgical oncology fellowship at the University of Texas MD Anderson Cancer Center in Houston.

As a fellowship-trained head and neck surgical oncologist, Choi’s clinical practice focuses on the diagnosis and surgical management of the breadth of head and neck neoplasms. This includes neoplasms of the upper aerodigestive tract, which covers the oral cavity, pharynx, larynx and nasal cavity, as well as salivary gland, with a special interest in oral cavity malignancies.

Choi also treats cutaneous malignancies of the head and neck, including melanoma, advanced and high-

risk squamous and basal cell carcinomas, as well as rare cutaneous malignancies such as Merkel cell carcinoma, adnexal malignancies and cutaneous sarcomas. Her practice includes integrating cutting edge surgical innovations such as minimally invasive approaches with transoral robotic surgery and transoral laser microsurgery, as well as sentinel lymph node biopsy for early stage oral cavity cancers.

Choi’s research interests focus on surgical and quality of life outcomes for patients treated for head and neck cancer. As a former New York City public school teacher, she also maintains a passion for education and teaching, both for her residents with surgical training as well as for her patients in helping them understand their disease processes.

Dr. Choi earned her Bachelor of Arts degree in neuroscience from Wellesley College in Wellesley, Mass., and her medical degree from the State University of New York at Buffalo in Buffalo, N.Y., as well as a Master of Science in Teaching from Pace University in New York.

Welcome New Residents Please congratulate and welcome our new residents, Nicole Ruszkay from Drexel University School of Medicine, and Brandon Labarge from Penn State College of Medicine who became part of our team as of July 1. Nicole will join current research resident Max Hennessy as a PGY1, and Brandon will take over as our research resident.

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International Symposium on Facial Plastic and Reconstructive Surgery Dr. Jessyka Lighthall was an invited speaker and panel member at the 12th International Symposium on Facial Plastic and Reconstructive Surgery in Dallas, Oct. 14-18. She presented on the use of “Nerve Blocks and Longacting Local Anesthetics in Facial Plastic Surgery” to decrease the need for post-operative narcotics to address the growing opioid epidemic. Additionally, she was part of a panel discussing “Postoperative Analgesia in Facial Plastic Surgery: Current Trends and Future Directions.” At the meeting, she was proud to have one of her residents, Dr. Tom Shokri, present one of their research projects, “Facial Trauma Among Pediatric Patients: A National Database Study.”

The 25th Pennsylvania Academy of Audiology Conference The conference was held in October 2018 in Lancaster, Pa. Penn State Health’s Director of Audiology, Beth Czarnecki , AuD has been the chair for the past three years, and to date. This year’s meeting had the largest attendance in the last five years. The twoday event encompassed speakers throughout the U.S. and topics included pediatric hearing loss to adult depression associated with hearing loss. This years’ conference will be held in October 2019.

Please see paaudiology.org for more details.

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Biannual Facial Reconstruction and Soft Tissue Course On Oct. 27, Dr. Jessyka Lighthall participated as faculty at the 10th Biannual Facial Reconstruction and Soft Tissue Course at Rutgers New Jersey Medical School in Newark, N.J. She presented the topic of “Lip Reconstruction” and was pleased to be invited by course director, Dr. Paul Carniol, to participate.

Dr. Isildak Presents at Johns Hopkins Dr. Huseyin Isildak lectures on “Current trends in the Management of Ménièrs Disease” at Johns Hopkins Department of Otolaryngology – Head and Neck Surgery Baltimore.

Otology/Neurotology Scientific Session Mitchell Dunklebarger, MS3, gave an oral presentation at the Otology/ Neurotology scientific session, titled “Current Trends in the Surgical Management of Vestibular Schwannoma” coauthored by Vijay A. Patel, MD, Tom Shokri, MD, Huseyin Isildak, MD.

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Otolaryngology in the News

Dr. Jessyka Lighthall was featured during an abc27 live broadcast discussing aesthetic surgery with Esteem Penn State Health Cosmetic Associates

Otolaryngologist, Dr. Meghan Wilson and neurosurgeon, Dr. Brad Zacharia talk about the Penn State Health skull base tumor program on Good Day PA, a lifestyle show on the local abc station, abc27.

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Penn State Women in Surgery Dr. Jessyka Lighthall participated in a panel discussion for the Penn State Women in Surgery medical student interest group. This was the inaugural meeting of the group and featured 11 female surgeons at Penn State Health (pictured) and had more than 80 students registered to attend. Dr. Lighthall acts as co-advisor for the group with Dr. Amy Burns. The group is designed to foster interest, support and mentorship for our female medical students when considering a career in surgery.

Otolaryngology Lead Pennsylvania Keynote Speaker As the end of the year approached Katie Kugler, PA-C, one of our advance practice providers and president of the Pennsylvania Society of Physician Assistants was invited to be the Keynote Speaker for the University of Pittsburgh School of Health and Rehabilitation Sciences Graduation Ceremony on Dec. 15, 2018.

Katie presented a talk titled “From Freaking Out to Master of Your Own Universe” to eight undergraduate students, three clinical doctoral students and 45 Masters students including 42 physician assistant students.

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Marco Island – Continuing Medical Education The Penn State Health Division of Otolaryngology – Head and Neck Surgery hosted its second annual “The Cutting Edge – Update in Otolaryngology Head and Neck Surgery” course at the Hilton Marco Island Beach Resort and Spa in Marco Island, Fla. Participants spent four days enjoying the beautiful Gulf Coast beaches, sunsets over the water, cocktails and family time while reviewing “cutting edge” updates across the breadth of Otolaryngology – Head and Neck Surgery. Topics included head and neck surgery, laryngology, facial plastic surgery, otology, skull base surgery, reconstructive surgery and pediatric otolaryngology. Several Penn State Health faculty members were featured as presenters, including Dr. Janette Foster, Dr. David Goldenberg, Dr. Neerav Goyal, Dr. Jessyka Lighthall, Dr. Jonathan McGinn and Dr. Meghan Wilson. Current faculty were joined by Penn State alumni including Dr. Michael Orsini from ENT and Allergy Associates of Western Pennsylvania, Dr. James Malone from Associated Otolaryngologists of Pennsylvania and Dr. Stuart Ort from ENT and Allergy Associates of New York and New Jersey.

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Dr. Bert O’Malley

Dr. Barry Schaitkin

In addition to Penn State Health faculty, the Marco Island course also featured presentations from several nationally and internationally renowned Otolaryngologists. Presenters included Dr. Frank Lin from Johns Hopkins University, who discussed hearing aids and cochlear implants; Dr. Bradley Goldstein from the University of Miami, who provided updates in rhinology; Dr. Phillip Pellitteri from Guthrie Robert Packer Hospital, who reviewed new developments in head and neck endocrine surgery; and Dr. Barry Schaitkin from the University of Pittsburgh, who provided novel insight into the use of sialendoscopy.

The course was topped off by several keynote talks. Dr. Bert O’Malley, chair of the Department of Otorhinolaryngology at Penn Medicine, discussed groundbreaking developments in trans-oral robotic surgery (TORS) and skull base surgery. In addition, Dr. Andrew Murr, chairman of the Department of Otolaryngology at the University of California San Francisco, updated attendees on the management of mandible and frontal sinus fractures. The course was well attended by otolaryngologists, residents and physician assistants from Penn State Health and many other locations across the U.S. and Canada.

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Our nurses at the Hershey Bears hockey game promoting knowledge about head and neck cancer.

Otolaryngology nurses – Betty Cek, LPN, Alethea Viars, LPN and Veronica Fies, LPN

Veronica Fies, LPN, Dr. Johnathan McGinn, MD and Alethea Viars, LPN

September was thyroid cancer awareness month.

Our thyroid cancer physicians as well as our thyroid cancer patients and their loved ones participated in the 2018 Biennial Thyroid Cancer Symposium in Hershey.

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Mission Trip On Jan. 5, Katie Kugler, PA-C, embarked on a trip to Zambrano, Honduras with International Impact through Medicine Foundation for a week long medical mission trip. During her week in Honduras, she also traveled to two smaller villages to provide much needed medical care. The Foundation makes two routine trips per year to Honduras to follow patients with chronic medical conditions such as high blood pressure and diabetes. In addition, the team treats patients with acute illnesses such as flu and injuries. As Katie was the first medical provider who has otolaryngology training to participate in a mission trip to Zambrano, many patients with complaints related to the ear, nose and throat were seen. These

conditions included, facial skin cancer, benign positional vertigo, hearing loss, ear infections, tympanic membrane perforation, neck mass and nasal complaints.

Katie describes the trip as one of the most rewarding patient care experiences of her career and hopes to return to Honduras in the next few years.

Cochlear Implant Support Group We had another successful Cochlear Implant Support Group meeting in March. Potential candidates and patients with cochlear implants, as well as their families, learned about recent updates from a cochlear implant manufacturer. They also heard from our speech-language pathologist, Melissa Montano, MS, CCC-SLP, about the importance of aural rehabilitation after cochlear implantation. Lastly, they had opportunities to talk with surgeons, audiologists, representatives from manufacturers and each other to discuss experiences and answer their questions.

Cochlear Implant Team

Cochlear Implant Team

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ET Balloon Dilation and Endoscopic Ear Surgery Under the direction of Dr. Jason May and Dr. Huseyin Isildak, Penn State Health Otolaryngology has begun to offer endoscopic and endoscopic-assisted ear surgery (EES). While not a new concept in ear surgery, use of the endoscope has seen a resurgence in the past few years due to improved optics both telescopic lenses and camera technology. Surgeon comfort with endoscopic techniques used in transnasal surgery also likely plays a large role in the expansion of EES. EES allows for a significant improvement in field of view compared to traditional microscopic techniques.

Additionally, the use of angled telescopes allows the surgeon to “see around corners” into areas that would not be visible using line-of-sight microscopy. This is especially important in cases for cholesteatoma, allowing the surgeon to inspect difficult to visualize areas, such as the antrum,

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anterior epitympanum and sinus tympani, to verify that no disease is left behind, while minimizing bony dissection. Improved visualization for anterior perforations allows for tympanoplasty to be performed without the increased morbidity

of a larger approach (endaural or postauricular), or need for canaloplasty. Finally, EES helps to facilitate resident teaching as both attending surgeon and resident have the same view of the surgical field.

Dean’s Award for Excellence in Teaching Dr. Neerav Goyal was recently selected by Dr. Craig Hillemeier, dean of the Penn State College of Medicine, to receive 2018 Dean’s Award for Excellence in Teaching for making outstanding contributions to medical and graduate education at Penn State.

Congratulations Dr. Goyal!

Publications, Presentations and Awards PRESENTATIONS:

McGinn J.D. Use of Topical Therapy in Rhinology. Penn State College of Medicine Update in Otolaryngology — Head and Neck Surgery. Marco Island, Fla. Jan. 2019.

Lighthall J.G. Local Flaps and Nasal Reconstruction. Penn State College of Medicine Update in Otolaryngology Head and Neck Surgery. Marco Island, Fla. Jan. 2019. Invited Lecturer.

Kugler K. Leadership in the PSPA. Pennsylvania Society of Physician Assistants Leadership Academy. Feb. 2019.

Lighthall JG. Septal Perforations: A Challenging Clinical Problem. Penn State College of Medicine Update in Otolaryngology Head and Neck Surgery. Marco Island, Fla. Jan. 2019.

Invited Lecturer.

Wilson M. Adenotonsillectomy technique: does it make a difference? Penn State College of Medicine Update in Otolaryngology Head and Neck Surgery. Marco Island, Fla. Jan. 2019.

Invited Lecturer.

Wilson M. Imaging in Children: Radiation Safety and New Technology.

Jefferson University Department of Otolaryngology Grand Rounds. Feb. 2019. Invited Lecturer.

Wilson M. Pain control in Pediatric Patients. Penn State College of Medicine Update in Otolaryngology Head and Neck Surgery. Marco Island, Fla. Jan. 2019. Invited Lecturer.

Lighthall J.G. Utilizing Fillers and Botox in your Practice. Penn State College of Medicine Update in Otolaryngology Head and Neck Surgery.

Marco Island, Fla. Jan. 2019. Invited Lecturer.

Wilson M. Imaging in Children: Radiation Safety and New Technology.

University of Maryland Department of Otolaryngology Grand Rounds. Feb. 2019. Invited Lecturer.

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Publications, Presentations and Awards Lighthall J.G. Managing the Difficult Patient. Penn State College of Medicine Update in Otolaryngology Head and Neck Surgery. Marco Island, Fla. Jan. 2019. Panelist.

McGinn J.D. Does Your Patient Need a PPI? The Overdiagnosis of Reflux. Penn State College of Medicine Update in Otolaryngology – Head & Neck Surgery. Marco Island, Fla. Jan. 2019.

Goyal N. Obstructive sleep apnea: the role of the head and neck surgeon, Penn State College of Medicine Update in Otolaryngology – Head and Neck Surgery. Marco Island, Fla. Jan. 2019.

Goyal N. Managing the voice prosthesis. Penn State College of Medicine Update in Otolaryngology – Head and Neck Surgery. Marco Island, Fla. Jan. 2019.

Kugler, K. Physician Assistants: History and Future.

University of Pennsylvania Advance Practice Provider Week: Legislative Update, APP History and Impact.

Philadelphia, Pa. Oct. 2018.

Kugler, K. Let’s Hurt Tonight: Differential of Throat Pain.

Pennsylvania Society of Physician Assistants annual CME conference. Pocono Manor, Pa. Oct. 2018.

Dunklebarger M., Patel V., Shokri T., Isildak H. Current trends in the surgical management of vestibular schwannoma. American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting. Atlanta, Ga. Oct. 2018.

Shokri T., Loloi J., Lighthall J. Perfusion Dynamics in Pedicled and Free Tissue Reconstruction: Infrared Thermography and Laser Fluorescence Video Angiography.

American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting. Atlanta, Ga. Oct. 2018.

Saadi R., Loloi J., Lighthall J. Outcomes of Cadaveric Allograft versus Autologous Graft in Septorhinoplasty.

American Academy of Facial Plastic and Reconstruction Surgery. Dallas, Tex. Oct. 2018.

Shokri T., Lighthall J.G. Facial Trauma Among Pediatric Patients: A National Database Study. 12th International Symposium on Facial Plastic and Reconstructive Surgery.

Dallas, Tex. Oct. 2018.

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Lighthall J.G. Nerve Blocks and Long-acting Local Anesthetics in Facial Plastic Surgery. 12th International Symposium on Facial Plastic and Reconstructive Surgery.

Dallas, Tex. Oct. 2018. Invited Lecturer.

Lighthall J.G. Post-operative Analgesia in Facial Plastic Surgery: Current Trends and Future Directions.

12th International Symposium on Facial Plastic and Reconstructive Surgery. Dallas, Tex. Oct. 2018. Panelist with Sturm A., Dobratz E., Kridel R., Butts S. Lighthall J.G. Lip Reconstruction. 10th Biannual Facial Reconstruction and Soft Tissue Course. Rutgers New Jersey Medical School. Newark, N.J. Oct. 2018. Invited Lecturer.

POSTERS: Lee J.H., Goyal N. Mental health disorders in patients receiving treatment for skin cancer of the head and neck: Who is at risk? Atlanta, Ga. Oct. 2018.

Benich S., Baker A., Schaefer E., Isildak H. Comparison of MRI and CT Usage and Preferences in Otolaryngology Practice. American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting. Atlanta, Ga. Oct. 2018.

Shokri T., Czarnecki B., Baker A., Isildak H. Hearing Rehabilitation Implementing a Transcutaneous Bone Conduction Device: Single-Center Experience. American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting. Atlanta, Ga. Oct. 2018.

PUBLICATIONS Liaw J., Cochran E., Wilson M.N. Primary papillary thyroid cancer of a thyroglossal duct cyst. ENT Journal.

2019 Feb. 5. https://doi.org/10.1177/0145561319825555 Pool C., Walter V., Bann D., Goldenberg D., Broach J., Hennessy M., Cottrill E., Washburn E., Williams N., Crist H., Imamura Y., Warrick JI. Molecular subtyping of the noninvasive follicular thyroid neoplasm with papillary-kike nuclear features (NIFTP). Virchows Arch. 2019 Jan. 15. doi: 10.1007/s00428-018-02512-6 PMID: 30645670.

Publications, Presentations and Awards Clyde J.W., Patel V.A., Kanekar S., Isildak H. Magnetic resonance imaging findings in idiopathic sudden sensorineural hearing loss. Acta Radiologica. 2019 Jan. 8. https://doi.org/10.1177/0284185118820053.

Stahl L.E., Stewart R., Carr M.M., Goldenberg D., Schubart J.R. Treatment preferences and decision-making in patients diagnosed with indeterminate thyroid nodules.

Psychooncology. 2018 Dec.; 27(12):2862-2864. doi: 10.1002/pon.4865. PMID: 30144220.

Saadi R., Oberman B.S., Lighthall J.G. Dog-bite-related craniofacial fractures among pediatric patients: a case series and review of literature. Craniomaxillofac Trauma Reconstr.

2018 Dec.;11(4):249-255. PMID: 30574267.

Patel V.A., Dunklebarger M., Zacharia T.T., Isildak H. Otologic manifestations of Susac syndrome. Acta Otorhinolaryngol Ital. 2018 Dec.;38(6):544-553.

Clark C.M., Kugler K., Carr M.M. Common causes of congenital stridor in infants. JAAPa. 2018 Nov.;31(11):3640. doi: 10.1097/01.JAA.0000546480.64441.af.

Moroco A.E., McGinn J.D. Head and neck manifestations of systemic disease. Med Clin N Am 2018 Nov.; 102(6):1095-1107.

Persky M.J., Issa M., Bonfili J.R., Goyal N., Goldenberg D., Duvvuri U. Transoral surgery using the Flex Robotic System: Initial experience in the United States. Head Neck.

2018 Oct. 10. doi: 10.1002/hed.25375. PMID:30303588.

Cottrill E.E., Funk E.K., Goldenberg D., Goyal N. Transoral thyroidectomy using a Flexible robotic system: a preclinical cadaver feasibility study. Laryngoscope. 2018 Oct. 4. doi: 10.1002/lary.27543. PMID: 30284264.

Crist H., Hennessy M., Hodos J., McGinn J., White B., Payne S., and Warrick J.I. Acute invasive fungal rhinosinusitis: frozen section histomorphology and diagnosis with PAS stain. Head Neck Pathol. 2018 Sep. 12. https://doi.org/10.1007/s12105-018-0965-8 Pool C., McGinn J.D. Endoscopic management of subperiosteal orbital abscess. Oper Tech Otolaryngol Head Neck Surg. 2018;29(4):222-225.

Abt N., Puram S., Sinha S., Sethi R., Goyal N., Emerick K., Lin D., Deschler D. Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction.

Laryngoscope. 2018 Sept. 24. DOI: 10.1002/lary.27393 PMID: 30247764.

Benito D., O’Connell Ferster A.P., Sataloff R.T. Bilateral Posterior Cricoarytenoid Myoneurectomy for Abductor Spasmodic Dysphonia. J Voice. 2018 Aug. 30. ii: S08921997(18)30148-6. doi: 10.1016/j.jvoice.2018.07.028.

Shokri T., Lighthall J.G. Antibiotic use in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg. 2018 Aug.;26(4):242-247. PMID: 29750669.

Tollefson T.T., Hadlock T.A., Lighthall J.G. Facial paralysis discussion and debate. Facial Plast Surg Clin North Am. 2018 May;26(2):163-180. PMID: 29636148.

Lighthall J.G. Rejuvenation of the upper face and brow: neuomodulators and fillers. Facial Plast Surg. 2018 April;34(2):119-127. PMID: 29631280.

Sarsfield E. American Head and Neck Society Community Service Award.

Shokri T., Stahl L., Kanekar S., Goyal N. Ossesous changes over time in free fibular Flap reconstruction.

Laryngoscope. 2018 Oct. 3. DOI: 10.1002/lary/27337.

PMID: 30284247.

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How to Refer a Patient Adult and pediatric otolaryngology, head and neck cancer, facial reconstructive surgery, otology/neurotology, audiology and hearing aid services: 717-531-6822

Cosmetic facial plastic surgery consults: 717-531-1386

Pediatric Airway Clinic: 717-531-6822

Facial Nerve Disorders Clinic: 717-531-1405

Fax records for triaging review: 717-531-6160

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