Department of Otolaryngology-Head and Neck Surgery Annual Report 21-22

2021-2022 Report

TABLE OF CONTENTS 4 5 7 8 12 18 21 27 33 35 37 41 47 57 63 64 65 66

Who We Are Message From The Chair Leadership DEI and Wellness Head and Neck Surgical Oncology Pediatric Otolaryngology Facial Plastic Reconstructive Surgery Rhinology, Allergy and Endoscopic Skull Base Surgery Otology, Neurotology, and Lateral Skull Base Surgery General Otolaryngology Voice and Swallowing Children’s Cochlear Implant Center Research Education Administration Outpatient Operations Quality Improvement Communications

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RESEARCH FACULTY

6

21

FELLOWS

RESIDENCY FACTS P4

11

CLINICAL FACULTY

TOTAL RESEARCH FUNDING

WHO WE ARE

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

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RESIDENTS

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ADJUNCT FACULTY

APP ⁄ OTHER

2

16

POSTDOCTORAL RESEARCHERS

PROVIDERS

RESEARCH STAFF

$5.2 MILLION #15

OVERALL OTOLARYNGOLOGY RESIDENCY PROGRAMS

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POSTER PRESENTATIONS

#5

OTOLARYNGOLOGY RESIDENCY RESEARCH OUTPUT

43

ORAL PRESENTATIONS

40

PUBLICATIONS

48

CLINICAL STAFF

8

ADMINISTRATIVE STAFF

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

MESSSAGE FROM

THE CHAIR

In 2022, the Department of Otolaryngology/Head and Neck Surgery celebrated its 70year anniversary. Dr. Newton Fischer founded Otolaryngology as a Division of Surgery in 1952 when the medical school transitioned to a 4-year medical school. Since its founding, the Department has experienced tremendous growth, and the excellence of the faculty has positioned the Department as one of the Nation’s leading program for clinical care, research, and education.

As we look back at the last year with continued COVID challenges, I am proud of our exceptional faculty, staff, and learners who have displayed remarkable resiliency to continue providing excellent care for our patients, to make groundbreaking discoveries advancing care, and to excel during training. In addition to excelling in learning and training activities, our residents continue to have amazing academic productivity - being ranked 1st in the South.

Translational and basic researchers in our Department continue to innovate to improve patient outcomes and have increased our research funding from the National Institute of Health where we now rank in the top 20 in the Nation. We are also expanding clinical research with several divisions now engaging in new and innovative clinical trials. We are actively increasing patient access as our new Wake County Pediatric Otolaryngology Clinic has rebounded from effects of the COVID pandemic, and we opened a Head and Neck Surgical Oncology clinic at the UNC Health/Rex Cancer Center.

I am truly thankful to lead such an outstanding Department and hope that you enjoy learning about the leading role that we play within the UNC School of Medicine and UNC Health. In partnership with these entities, we will no doubt continue to provide the highest quality of care to patients while we innovate and advance care through research and education.

Wendell G. Yarbrough, MD, MMHC, FACS Thomas J. Dark Distinguished Professor and Chair Department of Otolaryngology/Head & Neck Surgery UNC School of Medicine

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

LEADERSHIP DEPARTMENT CHAIR

WENDELL G. YARBROUGH, MD, MMHC, FACS

VICE CHAIRS

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OUTPATIENT OPERATIONS & IMROVEMENT

FINANCE

KEVIN D. BROWN, MD, PHD

AUSTIN S. ROSE, MD, MBA, FARS

EDUCATION

RESEARCH

ROBERT A. BUCKMIRE, MD

EMILY BUSS, PHD

INPATIENT OPERATIONS & IMROVEMENT

FACULTY DEVELOPMENT

TREVOR G. HACKMMAN, MD, FACS

ACADEMICS & OUTREACH

AMELIA F. DRAKE, MD, FACS

ADMINISTRATION (ACA)

BRENT A SENIOR, MD, FACS, FARS

SARA BELAND, MHA

DIVISION CHIEFS GENERAL OTOLARYNGOLOGY

VOICE & SWALLOWING DISORDERS

CHRISTINE E. DEMASON, MD

ROBERT A. BUCKMIRE, MD

OTOLOGY⁄ NEUROTOLOGY & LATERAL SKULL BASE SURGERY KEVIN D. BROWN, MD, PHD

FACIAL PLASTIC & RECONSTRUCTIVE SURGERY J. MADISON CLARK, MD, FACS

HEAD & NECK SURGICAL ONCOLOGY

TREVOR G. HACKMAN, MD, FACS

PEDIATRIC OTOLARYNGOLOGY CARLTON J. ZDANSKI, MD, FAAP, FACS

CCIC LISA PARK, AUD

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY BRENT A. SENIOR, MD, FACS, FARS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

DIVERSITY, EQUITY & INCLUSION AMELIA F. DRAKE, MD, FACS

DEI LIAISON

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he UNC Department of Otolaryngology⁄Head and Neck Surgery recognizes and values all people and the differences of all people, and we are committed to creating an inclusive environment for all our faculty, staff, and patients to experience.

We are not blind to the injustices that many of our minority community face outside of the hospital and we are here to stand with you and advocate for you within our department. We do not stand for discrimination of any individual of any kind, whether for race, ethnicity, religion, disability status, gender identity, or sexual orientation.

Our department is created of equals, working together to make people’s lives better. Together we can support each other beyond diagnoses through empathy, communication, and compassion.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

DIVERSITY, EQUITY & INCLUSION

Ebony Walker, CMA, is our Staff Diversity Champion. She has organized presentations and celebrations for many diversity awareness days this year. We all learn so much from her diligent caring for equality!

The DEI Journal Club getting together to discussing plans for continued work to make our department more inclusive!

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

DIVERSITY, EQUITY & INCLUSION o o o o o o o

DEI EFFORTS

Faculty Pay Equity DEI Journal club DEI Committee – Faculty and staff involvement DEI Climate Survey “Blazing a Trail Award” Castillo Scholar Program DEI Focused Grand Rounds Presentations

WELLNESS

o Department Events o OHNS Zoo day o Hearing Loss 5k o Southern States Plant donation to clinic spaces o Wellness Week celebrations and events o Well-being survey o Department Wellness Committee o Residency Wellness Committee P10

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

NC ZOO DAY 2022

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

HEAD & NECK SURGICAL ONCOLOGY TREVOR G. HACKMAN, MD, FACS DIVISION CHIEF FELLOWSHIP DIRECTOR NATHANIEL & SHEILA HARRIS DISTINGUISHED PROFESSOR

WENDELL G. YARBROUGH, MD, MMHC, FACS THOMAS J. DARK DISTINGUISHED PROFESSOR

JEFFERY M. BLUMBERG, MD, FACS ASSISTANT PROFESSOR

CATHERINE J. LUMLEY, MD ASSISTANT PROFESSOR

TRAVIS P. SCHRANK, MD, PHD ASSISTANT PROFESSOR

W NEIRE H

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C. BLAKE SULLIVAN, MD ASSISTANT PROFESSOR

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

HEAD & NECK SURGICAL ONCOLOGY

COURTNEY HITPAS, PA-C PHYSICIAN ASSISTANT

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HANNAH EADIE REID, NP FAMILY NURSE PRACTITIONER

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

HEAD & NECK SURGICAL ONCOLOGY

I

n 2022, we saw the retirement of an accomplished regional and national leader in head and neck surgery, Mark Weissler. He not only led as division chief for many decades, but also was well regarded through his many national leadership roles, including being Vice President Elect and Regent for the American College of Surgeons and a longstanding Board Member of the American Board of Otolaryngology/Head & Neck Surgery. He trained countless head and neck surgeons throughout his career and among his many academic accomplishments notably co-founded the CHANCE study, which to this day remains the largest cohort population database of head and neck cancer patients in the Nation, from which numerous publications and insights about the epidemiology and societal implications of head and neck cancer have emerged. As we look forward to Dr. Trevor Hackman’s leadership as Division Chief, we will miss Dr. Weissler’s steady hand and guidance.

Despite the challenges of the COVID era, this past year the division continued to deliver high quality care to an expanding population throughout the state of North Carolina registering more than 3300 outpatient visits and performing more than 200 free flap reconstructions. In an effort to meet this growing demand for surgical oncologic care, we hired Dr. C. Blake Sullivan, who recently completed his fellowship training at the Cleveland Clinic, and expanded our clinic presence into Raleigh this fall at the UNC Health/Rex Cancer Center.

UNC is regionally and nationally regarded as a center of excellence for minimally invasive surgery including SP TORS and office-based sialendoscopy, where Dr. Trevor Hackman currently runs the highest volume outpatient sialendoscopy practice in the country, treating over 80 patients per year with office-based endoscopy techniques. Within the realm of robotic surgery, after recently demonstrating the ability for our unique 3D robotic simulator to distinguish among novice and expert users (published in Laryngoscope), current research is underway to validate the UNC TORS simulator as a potential training tool.

In the realm of reconstructive surgery, UNC offers a diverse reconstructive experience for patients, including more than 20 various of soft tissue and osseous reconstructions, same-day dental

200+

FREE FLAP CASES (ANNUAL INCREASE OF 10%)

200

ADMISSIONS PER YEAR

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OUTPATIENT PATIENTS

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

HEAD & NECK SURGICAL ONCOLOGY restoration, and craniofacial reconstruction with unique excellence in skull base reconstruction and the use of scapula tip flaps for reconstruction of complex oromandibular defects and Within the division, Dr. Trevor Hackman was named Division Chief, the Nathaniel & Sheila Harris Distinguished Professor of Otolaryngology and celebrated his 10th year as Director of the UNC AHNS Head and Neck Fellowship. Dr. Catherine Lumley accepted promotions to Director of Outreach and Medical Director of the Head and Neck Clinic. Dr. Jeffrey Blumberg assumed the role of Inpatient Service Line Leader, as well as supervising physician to our expanding HN Advanced Practice Provider program, which welcomed both Hannah Eadie and Courtney Hitpas this year.

Dr. Travis Schrank, one of the few HN surgeon scientists in the country awarded a K08 by the NIDCR, continues his research investigating the oxidative stress response in HNSCC, and was the recent recipient of a Carolina Caregivers Grant.

UNC continues to be a national leader in epidemiologic HNSCC research. Following up on the tremendous success of the Carolina Head and Neck Cancer Epidemology (CHANCE) cohort population database conceived by Dr. Andrew Olshan (UNC School of Public Health) and Dr. Mark Weissler, which garnered numerous publications, CHANCE-2 and INHANCE studies are underway. The Carolina Head and Neck Cancer Study, CHANCE-2, will provide the first comprehensive population-based resource to examine molecular heterogeneity among HPV+ and HPV- tumors from head and neck cancer patients and their outcomes.

The Multidisciplinary Head and Neck Oncology program boasts a robust clinical trial research.

Following up on the prior novel single institution risk adaptive induction chemoimmunotherapy surgery trial LCCC1125 published in Oral Oncology 2020, the second-generation multiinstitutional induction therapy / surgery trial with risk adaptive therapy for advanced stage surgically resectable HNSCC, LCCC1621 which completed accrual this fall with a manuscript anticipated in the near future.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

HEAD & NECK SURGICAL ONCOLOGY DIVISIONAL RESEARCH

Celebrating the 9th anniversary of the UNC Head and Neck Cancer Research Foundation Fund, supported by grateful patients since 2013, which has sponsored over 20 faculty, resident and medical student Head & Neck Cancer focused research projects ranging from genominc/ translation, clinical outcomes, quality improvement and epidimiologic research.

GRANTS & FUNDING

o K08 NIDCR - PI Travis Schrank - Mechanisms Determining Dysregulation of the NRF2 Oxidative Stress Response in Head and Neck Squamous Cell Carcinoma o U01 NIDCR - PIs Wendell Yarbrough and Natalia Issaeva (UNC) and Kathryn van Abel and Daniel Ma (Mayo Clinic) - Observational study to validate circulating HPVDNA and prognostic genomic biomarkers for diagnosis and treatment of HPV-associated OPSCC o R01 - co-PI Trevor Hackman - Role of CRTC1-MAML2 in Salivary Mucoepidermoid Carcinoma Pathobiology o Multi-institutional SPORE grant - UNC co-PI - Wendell Yarbrough - $11.7 million grant between UNC, Fox Chase and Yale to develop better treatments for head and neck squamous cell carcinoma. o R01 NIDCR - PIs Wendell Yarbrough (UNC) and Natalia Issaeva (UNC) with Karen Anderson (Yale) - Exploring mechanisms of therapeutic demethylation effects in HPV-associated head and neck cancer.

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PUBLICATIONS

PROVISIONAL PATENT AWARDED FOR A UNC ENT DEVELOPED NOVEL TORS 3D TRAINING SIMULATOR, PUBLISHED IN LARYNGOSCOPE P16

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

HEAD & NECK SURGICAL ONCOLOGY

These photos advertise our advance reconstruction efforts, showing VSP surgical planning where we did a fibula flap with dental implants.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

PEDIATRIC OTOLARYNGOLOGY

CARLTON J. ZDANSKI, MD, FAAP, FACS CHIEF, DIVISION OF PEDIATRIC OTOLARYNGOLOGY HERBERT H. THORP ⁄ JULIAN T. MANN DISTINGUISHED PROFESSOR

AAMELIA F. DRAKE, MD, FACS NEWTON D. FISCHER DISTINGUISHED PROFESSOR

AUSTIN S. ROSE, MD, MBA, FARS PROFESSOR

LAUREN A. LEEPER, MD, FACS ASSOCIATE PROFESSOR FELLOWSHIP DIRECTOR

JAIME P. DOODY, MD ASSISTANT PROFESSOR

ALI GROESSER, MSN, RN, CPNP PEDIATRIC NURSE PRACTICIONER

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PEDIATRIC OTOLARYNGOLOGY

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he Division of Pediatric Otolaryngology continues its strong dedication to research, education and clinical care here at UNC Department of Otolaryngology!

The Division continues to expand its services in the Triangle with the addition of new faculty Dr. Jaime Doody, and Ali Groesser, Pediatric Nurse Practitioner. We continue to work out of our newest clinic location at Lake Boone Trail in Raleigh, NC, in addition to our Meadowmont Clinic, Carolina Crossing Clinic, and UNC Cleft Palate Clinic.

Additionally, we have one Pediatric Fellow who completes a Pediatric Fellowship every year with our group and then transitions to an academic program. This year we were pleased to welcome Dr. Ramjee Vikram.

Research and Education continue to thrive in the division with an ever-growing research portfolio Which resulted in over 25 presentations at national and international meetings. Further, members of the Division authored 11 scientific articles.

The Division continues to serve as Co-Host of the Carolina Pediatric Airway Course (CPAC), every other year, with the Medical University of South Carolina (MUSC). This course mentors’ residents and fellows from UNC, MUSC, Duke, Wake Forest, Emory, Medical College of Georgia, Eastern Virginia Medical School, and Vanderbilt on Pediatric Airway issues.

DIVISION HONORS AND AWARDS AUSTIN ROSE

COMMITTEE OF EXCELLENCE AWARD, MEDICAL DEVICES & DRUGS COMMITTEE, AAO-HNSF BOARD OF DIRECTORS AWARDS TASK FORCE, 2022

CARLTON ZDANSKI BEST DOCTORS IN AMERICA 2009-2022

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

PEDIATRIC OTOLARYNGOLOGY RESEARCH AND FUNDING ACCOMPLISHMENTS

o Dr. Carlton Zdanski continues his work on an R01 funded by the National Heart, Lung and Blood Institute related to anatomic optical coherence tomography for quantitative bronchoscopy as well as a second study related to predicting the need for surgery in pediatric subglottic stenosis using airway elastography derived from endoscopic OCT and intraluminal pressure measurement. o Dr. Amelia Drake continues her work as Co-PI on a COVID-19 related grant related to retaining clinical scientists funded by the Doris Duke Charitable Foundation. o Dr. Amelia Drake also continues to do meaningful and impactful work with the UNC Dental School pertaining to craniofacial microsomia. o Dr. Austin Rose participates in the FastTraCS grant supported by NC TraCs as a Clinical Advisor.

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PUBLICATIONS

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25+

NATIONAL AND INTERNATIONAL ORAL PRESENTATIONS

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

FACIAL PLASTIC & RECONSTRUCTIVE SURGERY

J. MADISON CLARK, MD, FACS CHIEF, DIVISION OF FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY FELLOWSHIP DIRECTOR

MATTHEW Q. MILLER, MD ASSISTANT PROFESSOR UNC FACIAL NERVE CENTER DIRECTOR

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BRIAN S. JEWETT, MD PROFESSOR

W E N IRE H

NICOLE A. HUGHES, LE ACADEMIC AESTHETICIAN

WILLIAM W. SHOCKLEY, MD, FACS EMERITUS PROFESSOR FOUNDING VICE CHAIR FOUNDING CHIEF

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FACIAL PLASTIC & RECONSTRUCTIVE SURGERY

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he FPRS Division has experienced explosive growth over the past several years, and not only has this required almost constant recruitment for new faculty to keep up with clinical demand.

We have done our very best to make sure that we continue to serve the loyal referring doctors from around the state.

Dr. Brian Jewett joined the department in September, after spending over 20 years at the University of Miami. His commitment to the department includes a reinvigoration of his teaching, research, and active participation in national meetings. Dr. Jewett will serve an important role in the division as he develops our presence in the UNC satellite clinics. With the addition of our 5th faculty member in July/August 2023, we anticipate return to the timely service that was provided by Dr. Shockley for so many years.

The addition of Dr. Matt Miller in September 2021 not only has provided outstanding learning opportunities for our fellows and residents, but has also brought previously unoffered surgical and non-surgical services for our patients with facial nerve disorders. He has developed the Facial Nerve Center at a pace not previously seen at any program in the country. Dr. Miller’s presentations are always “standing room only”. [photo of 2022 DC meeting]

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FACIAL PLASTIC & RECONSTRUCTIVE SURGERY

Finally, Dr. Shockley continues to be a big part of the FPRS Division, despite retiring from clinical work. His wisdom and mentorship is extraordinarily valuable to our fellows and residents. In addition, he is a highly sought-after speaker at national meetings. We are indeed standing on the broad shoulders of Dr. Shockley’s foundation.

FELLOWSHIP

The fellowship is designed for the candidate who intends to pursue a career in academic medicine. All aspects of the fellowship prepare the fellow for a highly successful academic career, and all graduates of the fellowship are current fulltime faculty at institutions across the US. Having experienced significant clinical and research growth in recent years, the breadth of clinical experience for the fellow is intentionally vast. The UNC FPRS Division faculty has grown to 4 (an additional faculty member is being recruited for July 2023).

The graduating fellow would expect to be competent in the areas practiced by the 4 Division Faculty. A licensed aesthetician further enhances the aging face experience and is essential to practice-building. Collaborative opportunities also exist with our skull base division, providing additional experience with complex revision DCR, intra/extraconal orbital pathology and other anterior skull base reconstruction. Microtia repair, cleft lip and palate repair, and limited head and neck microvascular reconstruction is also offered for the interested fellow.

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FACIAL PLASTIC & RECONSTRUCTIVE SURGERY Our current fellow, Dr. Rahul Varman, arrived from Texas Tech University Medical Center where he was the very first OHNS resident in a oneresident-per-year program. He received outstanding training and is a consummate self-starter. With multiple publications in the first quarter of his fellowship, it is not surprising that he has been highly sought after for academic positions across the country.

Next year’s fellow, Dr. Jonas Miller, arrives from Johns Hopkins University where he distinguished himself as an all-star among a talented pool of fellowship candidates. He has already begun several research projects, and has started his pursuit of an academic position.

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he Annual Alumni Dinner, a tradition that began with our very first fellow (Dr. Brittany Howard), Special Guest (Dr. Richard Holt), and Drs. Clark and Shockley seated at a table of 4…now requires a private room with seating for 12! The setting was wonderful for our first gathering in several years due to COVID. This year’s Special Guest (Dr. Jennifer Kim) was a big hit with all of us, making connections with Dr. Candace Waters-Jenn has 2 children at Harvard, Candace’s alma mater. As always, this event allows our former fellows, current and future fellow, to gather together and get to know each other better, and to learn from a “giant” in the field. Drs. Rahul Varman and Jonas Miller will select next year’s special guest.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

FACIAL NERVE CENTER

CARTER BALLARD MEDICAL ASSISTANT

HEATHER DAVIS CUEVAS SPEECH PATHOLOGIST

AMBER SHARPE, RN NURSE

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he UNC Facial Nerve Center has quickly become one of the fastest growing comprehensive treatment centers for facial paralysis in the world. Its mission is to provide cutting-edge treatments for patients with facial paralysis around the country, while advancing the subspecialty with rigorous clinical outcomes research. This past year, Dr. Miller published 6 papers in international journals relating to management of facial paralysis. He also frequently gives presentations discussing facial paralysis management at international and national meetings and was an invited visiting professor at two institutions this past year. The UNC Facial Nerve Center has also been featured on the regional and national news for the work they are doing this past year.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

FACIAL NERVE CENTER MEDIA STORIES

o WRAL Nightly Regional News segment on UNC Facial Nerve Center, 3/23/2022

o

CBS 17 National News segment on Ramsay Hunt Syndrome, 6/26/2022

o

UNC The Well Story on Facial Paralysis, 7/19/2022

RESEARCH o o o o

Published 6 papers relating to facial paralysis management Gave two invited international oral presentations on management of facial paralysis Gave five national oral presentations on management of facial paralysis Visiting professor at two institutions

881

258

FACIAL PARALYSIS PATIENT VISITS

FACIAL PARALYSIS PATIENTS TREATED

222

CHEMODENERVATION (BOTOX®) INJECTIONS FOR FACIAL PARALYSIS PERFORMED

265

FACIAL REANIMATION SURGICAL PROCEDURES PERFORMED

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RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY

BRENT A. SENIOR, MD, FACS, FARS DIVISION CHIEF HAROLD C. PILLSBURY, III DISTINGUISHED PROFESSOR

CHARLES S. EBERT, JR., MD, MPH, FARS, FAAOA, FACS FELLOWSHIP CO-DIRECTOR MEDICAL DIRECTOR OF OTOLARYNGIC ALLERGY SERVICES PROFESSOR

BRIAN D. THORP, MD, FACS, FARS FELLOWSHIP CO-DIRECTOR ASSOCIATE PROFESSOR

W E N IRE H

CHRISTINE KLATT-CROMWELL, MD ASSOCIATE PROFESSOR

ADAM J. KIMPLE, MD, PHD, FACS, FARS ASSISTANT PROFESSOR,

MEGHAN NORRIS, MS, MSPAS, PA-C PHYSICIAN ASSISTANT

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY

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he Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery continues its over two decade tradition of regional, national, and international leadership in Rhinology research, education and clinical care, right here in the heart of North Carolina!

While we were already one of the largest and clinically active divisions in the United States, the Division continues to expand its services in the Triangle with the addition of two new faculty, Cristine Klatt-Cromwell, MD and Meghan Norris, PA, giving us six full-time Rhinologists.

Additionally, this summer saw our two fellows, Drs. Albert Kong and Mark Chaskes, depart to join academic programs at the University of Mississippi and Hofstra University. With that transition, we were pleased to welcome two new fellows in our Neurorhinology program, Drs. Erin Lopez and Daniel Alicea.

Research and education continue to thrive in the division with an ever-growing research portfolio accompanied by mentorship of over a dozen students and residents from around the country. Division research resulted in over 50 presentations at national and international meetings, 30 of which were presented by mentees. Further, members of the Division authored 43 scientific articles of which 22 were first authored by mentees.

In addition, the division is the site of two ongoing cutting edge clinical trials in the management of chronic rhinosinusitis and nasal polyps with GlaxoSmithKline and Lyra Therapeutics, which Dr. Senior serves as Global PI. The Division continues to serve as co-host of the second longest running Rhinology education course in the United States, the Southern States Rhinology Course now in its 17th year. This course, co-hosted with MUSC, Emory, and Medical College of Georgia takes place in the spring of every year on Kiawah Island, South Carolina, and had its largest attendance ever in 2022.

Our international presence remains strong with Dr. Senior’s service as President of the International

2

NEW CLINICAL TRIALS STARTED

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STUDENTS AND RESIDENTS MENTORED

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY Rhinologic Society, while our outreach to international physicians has been able to resume following COVID slowdowns. So far in 2022, we have been honored to host five otolaryngologists from around the globe who are interested in increasing their knowledge of Rhinology.

Honors and accolades for members of the division continue to come with Dr. Thorp being selected as inaugural Chair of the Skull Base and Orbital Surgery Section of the American Rhinologic Society. Dr. Ebert was named Secretary of the American Academy of Otolaryngic Allergy, while Dr. Kimple received the UNC Academy of Educators Mentorship Award. Finally, in recognition of 25 years of surgical work in Vietnam, Dr. Senior was honored with the 2021 American College of Surgeons/Pfizer Award for International Volunteerism.

WELCOME NEW FACULTY Meghan Norris, PA

Meghan received her Bachelor of Science in Biology and Psychology from UNC Chapel Hill in 2014 where she also worked as a CMA in the Otolaryngology/Head and Neck Surgery clinic. She went on to receive a Master of Science in Physiology from NC State University in 2018 and a Master of Science in Physician Assistant Studies from Pfeiffer University in 2022 where she was selected to the Pi Alpha Honor Society.

Cristine Klatt-Cromwell, MD Dr. Klatt-Cromwell received her undergraduate and medical degrees from the University of Oklahoma. She then finished her residency in otolaryngology/head and neck surgery at the University of North Carolina at Chapel Hill where she also completed a fellowship in Advanced Rhinology and Endoscopic Skull Base Surgery. She started her academic career at Washington University in St. Louis where she remained for 5 years, but we were pleased to be able to recruit her back to her to her alma mater in the summer of 2022.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY RESEARCH AND FUNDING ACCOMPLISHMENTS

Dr. Adam Kimple has continued his work with the Genetics Disorders of Mucociliary Clearance (GDMCC) funded by the National Heart Lung Blood Institute (U54HL096458). This study is defining the sinonasal and otologic phenotype of patients with primary ciliary dyskinesia and primary immune deficiency. Despite slower than expected roll out of this project due to COVID-19, Dr. Kimple and his team enrolled their first patient this year and have multiple patients scheduled for the fall. Dr. Kimple is also co-PI on a Chan Zuckerberg Initiative grant for “Mapping the Pediatric Inhalation Interface: Nose, Mouth, and Airways.” This international project led out of UNC, aims to create transcriptome, proteome, and epigenome reference data from birth to preadolescence in diverse and inclusive manner from the mouth and nose to the alveoli.

Drs. Senior and Kimple served as co-Investigators for “Assessment of CFTR Modulators and Sinus Disease in CF” sponsored by the Cystic Fibrosis Foundation, Anna Zemke, PI, University of Pittsburgh. This is a multi-center study with the University of Pittsburgh understanding the effects of the newly release modulator therapy for patients with cystic fibrosis. This therapy has demonstrated amazing pulmonary results for patient with CF but it is unknown how this life change medication improves sinus disease. The study team has recently published it’s findings.

Dr. Senior was named Global PI, Lyr-220 Phase 2 Trial sponsored by Lyra Pharmaceuticals. This novel drug eluting implant is being studied in patients with persistent sinusitis despite previous sinus surgery.

DIVISION PARTICIPATION IN CLINICAL TRIALS

o Lyra Therapeutics Beacon Phase 2 Trial

This is a clinical trial of a novel drug eluting implant placed in the middle meatus of patients with CRS who have had sinus surgery as an alternative to undergoing surgery o GSK Anchor Trial

This is a trial of a long-acting biologic given by injection one time every 6 months

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5

SCIENTIFIC ARTICLES AUTHORED

GLOBAL OTOLARYNGOLOGISTS HOSTED

50+

NATIONAL AND INTERNATIONAL PRESENTATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY for patients with chronic rhinosinusitis with nasal polyps.

MENTORING

o Division Mentored 12 different students and residents in research projects resulting in presentations and/or publications o Hosted two MS1/2 UNC medical summer students are part of the Carolina Medical Student Research Program (CMSRP). o Mentored 2Howard Holderness Distinguished Medical Scholars Program o Welcomed 5 international otolaryngologists for prolonged periods of observation and participation in research projects

PUBLICATIONS

Members of the Division published 43 peer-reviewed articles covering all aspects of Rhinology, Allergy, and Endoscopic Skull Base Surgery. 22 of these were first-authored by mentored students, residents or fellows in the Department.

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OTOLOGY⁄ NEUROTOLOGY AND LATERAL SKULL BASE SURGERY

KEVIN D. BROWN, MD, PHD DIVISION CHIEF JOSEPH P. RIDDLE DISTINGUISHED PROFESSOR

MATTHEW M. DEDMON, MD, PHD MEDICAL DIRECTOR OF AUDIOLOGY ASSISTANT PROFESSOR

A. MORGAN SELLECK, MD FELLOWSHIP CO-DIRECTOR ASSISTANT PROFESSOR

KAYLA WILKERSON, DNP, FNP-BC, RN OTOLOGY NURSE PRACTITIONER

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ACTIVE GRANTS

12

ACADEMY/SOCIETY SERVICE ROLES

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OTOLOGY⁄ NEUROTOLOGY AND LATERAL SKULL BASE SURGERY DIVISION ACHIEVEMENTS

Within our division, Dr. Selleck was awarded resident educator of the year for 2021-2022. Dr. Brown recieved the 2022 American Academy of Otolaryngology – Head and Neck Surgery, Honor Award. He was also invited to lecture at the Metro Atlanta ENT Society in Atlanta, GA on “Expanded indications in pediatric cochlear implantation” in March of 2022. Additionally, he was an invited professor to speak at Emory University’s Department of Otolaryngology Grand Rounds in Atlanta, GA. He spoke on “Considerations for cochlear implantation in unilateral hearing loss in adults and children.” March 2022.

GRANTS & FUNDING

Active o “Single-Sided Deafness and Asymmetric Hearing Loss Post-Approval Study" - Industry Sponsored FDA Clinical Trial - Lead site UNC, Study Principal Investigator - $438,200. o U01 DC018920-01 - “Clinical Utility of Residual Hearing on Deafness and Other Communication Disorders” - Site Principal Investigator - National Institutes of Health - 2020-2025 - $610,858 total o R21 DC018389-01A1 - “Place-Based Mapping in Electric-Acoustic Stimulation Listeners” - Co- Principal Investigator National Institutes of Health - 2020-2022 - $427,625 total o “Expanded Indications in the MED-EL Pediatric Cochlear Implant Population” Co-investigator - industry Sponsored FDA Clinical Trial with Investigational Device Exemption - $614,216.40.

CLINICAL TRIALS

Pending R01 - “Neural Prediction to Enhance Language Outcomes in Children with Cochlear Implants“ - Co-Investigator (Site Principal), 4% effort, National Institutes of Health - $291,659 P34

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

GENERAL OTOLARYNGOLOGY

CHRISTINE E. DEMASON, MD ASSISTANT PROFESSOR

DORIS LIN, MD ASSISTANT PROFESSOR

ANDREA JARCHOW-GARCIA, MD ASSISTANT PROFESSOR

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

GENERAL OTOLARYNGOLOGY

T

he Division of General Otolaryngology continues to drive diversity in out department with Dr. Lin being on the UNC Asian American Faculty Association (AAFA) Mentoring Committee and Dr. DeMason starting a Diversity, Equity, and Inclusion (DEI) Journal Club within the department.

This is a quarterly faculty run journal club for faculty, residents, and medical students to discuss DEI journal articles that relate to health care and medical education. We have already discussed a variety of articles including gender biases in residency applications, ways to improve diversity in academic departments and the role of health professionals in supporting diversity.

Within the medical school, our division is incredibly active as well. Dr. Lin started a Rural Otolaryngology Medical Student Course for 4th year students interested in primary care. Dr. DeMason is in her third year as the Director of the Medical Student Affairs for the department.

This job entails being the course director for all otolaryngology related courses for medical students from first year to graduation. Dr. DeMason was part of a group for UNC through the Academy of Educators who helped make educational modules about UNC School of Medicine and topics about teaching medical students and residents. The goal of these modules is to help new faculty who come to UNC get an understanding of the curriculum and some basic teaching skills. Finally, Dr. Todd Lambert, one of the UNC residents will be presenting on “Formal Career Goal Advising Program for Otolaryngology, the UNC Experience,” at the academy meeting in September. Drs. Shah, Buckmire and DeMason are the faculty advisors for the paper.

Outside of general practice and the additional work mentioned above, Dr. Lin is working on a collaboration with UNC Audiology for a clinical tinnitus initiative. Dr. DeMason continues to be highly active in sleep surgery and performing hypoglossal nerve implantations.

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VOICE AND SWALLOWING

ROBERT A. BUCKMIRE, MD DIVISION CHIEF MARCH FLOYD RIDDLE DISTINGUISHED PROFESSOR

RUPALI (PALI) N. SHAH, MD ASSOCIATE PROFESSOR

OUR MULTIDISCIPLINARY CLINIC

The UNC Voice Center has a long standing tradition (over 17 years) of providing high quality multidisciplinary care of patients with voice and swallowing disorders. The current team includes 2 fellowship trained laryngologists, Dr. Buckmire and Dr. Shah, along with three voice specialized speech language pathologists: Heather Davis, MA, CCC-SLP and Joseph Hall, CCC-SLP, and Harriett Alden Pridgen, CCC-SLP. Together we also treat professional voice users including teachers, singers, actors, clergy and others. We have seen significant growth of telehealth services in voice therapy leading to our ability to serve an even larger volume of patients throughout the state. This led to our wonderful new addition to the team, H. Alden Pridgen, CCC-SLP. We offer diagnosis and leading-edge treatment of the full spectrum of voice, swallowing, and airway disorders.

We perform over 400 endoscopic and open operative cases annually. We have a state of the art in office laryngology practice that offers innovative, minimally invasive treatment of laryngeal disorders inluding laryngeal botox, transnasal flexible laser treatments and biopsies and awake vocal fold augmentation procedures. We perform over 300 office based procedures annually.

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VOICE AND SWALLOWING FOSTERING COLLABORATION

We are proud to have strong, collaborative working relationships with interventional pulmonology, gastroenterology, and thoracic surgery often performing joint cases such as complicated airway treatments, rendezvous procedures, and laryngotracheal reconstructions. We are part of the North American Airway Collaborative (NoAAC), a national consortium founded to provide information about the management of adult airway disorders in North America and Europe.

With this group, we have participated in and published multiple research projects. During the COVID-19 pandemic, we led institutional airway procedure protocols including tracheostomies in COVID-positive patients and participated in multidisciplinary care of these complicated patients.

Our group has additionally collaborated and published with a multi institutional study group on contemporary management of Zenker’s diverticulum.

EDUCATION

Dr. Buckmire and Dr. Shah have a strong interest and commitment to the education of the community, the institution, and learners of all levels. Dr. Buckmire served as the Residency Program Director for 11 years with Dr. Shah as an Associate Program Director for 8 years. Dr. Buckmire now continues as Vice Chair for Education overseeing all educational activities in the Department, while Dr. Shah serves as an Academic Advisor of over 70 students in the School of Medicine and our head career goal advisor for the department. We provide numerous lectures to students and residents on laryngeal pathology annually. The division has mentored 8 students and residents in multiple research projects resulting in multiple local and national presentations and publications. Over the last 8 years, the division has supported a summer research fellow through he Carolina Medical Student Research Program (CMSRP). We also participate in annual continuing educational didactic lectures to other clinical departments including Radiology, Pediatric Pulmonology, Speech Pathology, Allergy, and Geriatrics. The Voice Center team also provides community outreach lectures to the UNC School of Music, Fearrington Village, and the wellness center. Dr. Shah presented on Zenker Diverticulum to Otolaryngology Updates: 48 hours of Live, a multiinstitutional international educational course aimed at providing contemporary and relevant content for general otolaryngologists in practice.

Dr. Buckmire has been elected to the American Laryngological Association (ALA) Council, our most esteemed national organization providing continuing education to our specialty.

PROFESSIONAL LEADERSHIP

Dr. Buckmire Dr. Buckmire was elected to the ALA Council after serving as Program Chair for the annual ALA meeting, 2022. Additionally, he was named Vice Chair of Education for the UNC Department of P38

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

VOICE AND SWALLOWING Otolaryngology/Head & Neck Surgery. He is also on the Society of University Otolaryngologists (SUO) Diversity Committee.

Dr. Shah Dr. Shah continues to excel in educational efforts by working as both the Head Career Goal Advisor for Otolaryngology/Head & Neck Surgery, and the Academic Advisor, UNC School of Medicine. Dr. Shah is also furthering the DEI efforts by serving on the Diversity & Inclusion Council, and the Advisory Board to the Vice Dean for Diversity & Inclusion for the School of Medicine.

RESEARCH HIGHLIGHTS

This year at the annual American Laryngological Association meeting (Dallas,TX, April 2022), Dr. Shah was awarded the inaugural ALA post grad member best paper for a paper entitled “Can the remote use of a peak flow meter predict severity of subglottic stenosis and surgical timing?”

With the ongoing support of the UNC Otolaryngology/Head & Neck Surgery Small Research Grant and the American Laryngological Association’s Seymour R. Cohen, MD Research Grant, Dr. Shah and the UNC Voice Center, initiated as: Encore: remotely tracking patient reported outcomes in real-time through a mobile application platform. This novel, user friendly smartphone application platform efficiently collects validated survey responses and voice recordings in realtime following intervention. The app is now developed and tested and is currently in enrollment phase. Over the last year, Dr. Buckmire is hosted a one-year international (South Korea) research fellow, Dr. Changmyeon Song, MD, within the division. The Laryngology/Educational Research group works actively in the DEI/medical education realm, publishing and presented 5 paper/ presentations in this realm in the last 3 years.

SELECTED PRESENTATIONS

o Lambert T, Shah RN, Buckmire RA, Demason C. “Formal Career Goal Advising Program for Otolaryngology, the UNC experience”. Accepted for oral presentation, AAO-HNSF. September 2022. Philadelphia, PA o “Zenker’s Diverticulum.” Shah RN. Otolaryngology Updates: 48 Hours of Live. Education course aimed at providing contemporary and relevant content for the general otolaryngologist in community practice. Invited Speaker

13

PUBLICATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

VOICE AND SWALLOWING o Park M, Tie K, Davis H, Hall J, Buckmire RA, Shah RN. “Can the remote use of a peak flow meter predict severity of subglottic stenosis and surgical timing?” Oral Presentation, American Laryngological Association Annual Meeting at COSM. April 2022. Dallas, TX. o Lambert T, Ghodke T, Berk G, Buckmire RA, Shah RN. “Encore: Remotely tracking voice outcomes in real-time through a new custom mobile application.” Oral presentation, American Laryngological Association annual meeting at COSM. April 2022. Dallas, TX. o Ghodke A, Park MA, Selleck AM, Adams K, Davis H, Buckmire RA, Shah RN. “Smartphone applications offer superior voice data collection from patients over traditional methods.”

Oral presentation, Fall Voice Conference. October 2021. Miami, FL. o Dorismond C, Farzal Z, Shah, RN, Ebert CS, Buckmire RA. “Effect of Applicant Screening Methods on Racial/Ethnic Diversity in Otolaryngology.” Oral presentation, American Academy of Otolaryngology- Head and Neck Surgery (AAO-HNSF) meeting. Oct 2021. Los Angeles, CA.

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CHILDREN’S COCHLEAR IMPLANT CENTER LISA PARK, AUD DIVISION CHIEF ASSISTANT PROFESSOR

ERIKA GAGNON, AUD, CCC-A CLINIC MANAGER - AUDIOLOGY ASSISTANT PROFESSOR

JENNIFER WOODARD, AUD, CCC-A ASSISTANT PROFESSOR

MELISSA AUCHTER, AUD, CCC-A ASSISTANT PROFESSOR

DAKOTA SHARP, AUD, CCC-A ASSISTANT PROFESSOR

W NEIRE H

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CHILDREN’S COCHLEAR IMPLANT CENTER LILLIAN HENDERSON, MSP, CCC-SLP, LSLS CERT. AVT CLINIC MANAGER - SPEECH ASSISTANT PROFESSOR

SANDRA HANCOCK, MS, CCC-SLP, LSLS CERT. AVT ASSISTANT PROFESSOR

CHRISTINE KRAMER, MS, CCC-SLP, LSLS CERT. AVED ASSISTANT PROFESSOR

ERIN THOMPSON, MS, CCC-SLP, LSLS CERT. AVT ASSISTANT PROFESSOR

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PEDIATRIC COCHLEAR IMPLANT ACTIVATIONS

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CHILDREN’S COCHLEAR IMPLANT CENTER TEAM ADDITIONS/ CHANGES

This year, the Children’s Cochlear Implant Center saw many changes, including becoming its own division with Lisa Park as the first Division Chief. Because of that big change, our clinic managers are now Lillian Henderson for speech and Erika Gagnon for audiology. Within our faculty we welcomed Dakota Sharp, AuD, all of our audiologists and the SLPs were changed from staff to faculty. We sent off newly retired Robert Humphreys and are excited to say welcome in Ronisha McCartney, who is taking over as business manager. In addition to Robert, Velma Grose will retire at the end of the year- we appreciate their work for our team!

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CHILDREN’S COCHLEAR IMPLANT CENTER MOBILE UNIT

Thanks to generous grant funding, we began work on UNC’s first Mobile Speech and Hearing Clinic, targeted to open in the fall of 2023.

The mission of this project is to improve the health and well being of North Carolinians by improving hearing health equity. Our goal is to provide quality services for children who are deaf or hard of hearing throughout our state, with a focus on children in vulnerable populations or rural locations. We will partner with community based care providers to increase access to quality hearing health care for all children in NC.

CCCDP GRANT

We have served 200 children through the CCCDP grant in FY 22 Paul Biggers Carolina Children’s Communicative Disorder Program (CCCDP) financial assistance program funds hearing aids and other hearing devices for children with hearing loss in North Carolina.

The North Carolina general assembly has generously provided a grant to assist families in our state with children who are deaf or hard of hearing since 1993.

Children enrolled in the financial assistance program must be North Carolina residents under 21 years of age. Their acceptance is also based on family size, income, other medical expenses, and the limitations of insurance and other resources such as Medicaid.

CAROLINA SUMMER INSTITUTE

The CCIC hosted the Carolina Summer Institute with a blended on-site and virtual model. The Carolina Summer Institute is a highly sought after training program that coaches teachers of the deaf, early interventionists, and speech-language pathologists in NC and around the country to develop listening and spoke language in children who are deaf or hard of hearing. This was our 24th year of hosting this event.

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CHILDREN’S COCHLEAR IMPLANT CENTER PATIENT STORIES …

1. Activation hands: we began our activation hands wall one year ago today as pictured with the first hand below and many hands later celebrating many hearing birthdays!

2. Activation days are always our favorites!

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CHILDREN’S COCHLEAR IMPLANT CENTER PRESENTATION HIGHLIGHTS

o Erika Gagnon, AuD and Hannah Eskridge, MSP were joined by a colleague from Oregon Health Science, Kim Reynolds, PhD to present “Facilitating Full Time Use of Hearing Devices” through Hearing First. They had over 100 attendees that joined from all over the globe. o Sandra Hancock: Presented a talk titled “Speech therapy Considerations and Concerns for Patients with SSD who Receive a Cochlear Implant” for the Children’s Hospital of Colorado.

Speech Therapy Considerations and Concerns for Patients with SSD Who Receive a Cochlear Implant o Lisa Park, Sandra Hancock, and Hannah Eskridge joined forces with Taylor Sandrs of MED-EL for a joint presentation titled “Breaking Down Barriers and Improving Outcomes for Children with Unilateral and Asymmetric Hearing Loss and the Early Hearing Detection and Intervention Conference.

CI2022 ANNUAL MEETING

At the CI2022 annual meeting, Lisa Park, AuD was the Scientific Co-Chair. Below are presentations and posters for the team: Lisa Park, AuD (CI2022 Co-Chair) o Podium: MED-EL Symposium o Podium: Improvement in Word Recognition in the Contralateral Ear for Pediatric Cochlear Implant Recipients with Preoperative Residual Hearing Melissa Anderson, AuD o Poster: Alternative Mapping Procedures for Pre-Curved Electrode Array in the Internal Auditory Canal Hannah Eskridge o Poster Highlight: Behavioral Interventions to Increase Patient Adherence to Wear Time: CrossDisciplinary Training Feasibility and Outcomes.

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RESEARCH EMILY BUSS, PHD CHIEF, DIVISION OF AUDITORY RESEARCH PROFESSOR

PAUL B. MANIS, PHD

CHIEF, DIVISION OF RESEARCH TRAINING AND EDUCATION PROFESSOR

MARGARET T. DILLON, AUD, PHD DIRECTOR OF CLINICAL RESEARCH ASSOCIATE PROFESSOR

JOHN H. GROSE, PHD PROFESSOR

DOUGLAS C. FITZPATRICK, PHD ASSOCIATE PROFESSOR

LISA PARK, AUD ASSISTANT PROFESSOR

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RESEARCH

KENDALL A. HUTSON, PHD ASSISTANT PROFESSOR

MEREDITH ANDERSON ROOTH, AUD ASSISTANT PROFESSOR

MICHAEL KASTEN, PHD ASSISTANT PROFESSOR

NATALIA ISAEVA, PHD ASSISTANT PROFESSOR

MARGARET RICHTER, AUD RESEARCH INSTRUCTOR

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FACULTY PUBLISHED PEER-REVIEWED PAPERS

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RESEARCH T

he mission of the Department of Otolaryngology/Head & Neck Surgery (OHNS) is to improve the health of North Carolinians and others whom we serve. One of the objectives to fulfilling this mission is to carry out basic science, clinical, and health services research that advances the field of OHNS. Notable research accomplishments by clinical divisions within OHNS are included in those division reports. Below is an overview of the focus and accomplishments of the laboratories within OHNS that are directed by full-time research faculty.

RESEARCH HIGHLIGHTS

o Margaret Dillon successfully defended her PhD dissertation research on Place-based Mapping With Electric-Acoustic Stimulation o John Grose received a new R01 to study Binaural Processing and Spatial Hearing: Effects of Age and Hearing Loss o Participated in and continued to conduct 7 clinical trials assessing new indications for cochlear implantation in children and adults o Renewal of $700k industry grant (Over $3M since inception) o Added a new research audiologist, Dr. Gretta Richter, to our team o Trained 10 audiology students in cochlear implant clinical research o Drs. Park and Dillon chaired multi-institutional guidelines papers for the American Cochlear Implant Alliance on single-sided deafness

THE HEAD AND NECK ONCOLOGY LAB

The Head and Neck Oncology Lab is guided by Wendell Yarbrough, MD, MMHC, FACS, and Natalia Isaeva, PhD. Research projects in the laboratory are funded by NIH NIDCR and focus on understanding the role of human papillomavirus (HPV) in the development, maintenance, and progression of head and neck squamous cell carcinoma (HNSCC). The discoveries are leveraged to identify and test novel therapeutic strategies that exploit susceptibilities of HPV-associated HNSCC, as well as to find prognostic molecular biomarkers that could be used to personalize treatment.

One big project, led by a postdoc Hina Rehmani, explores demethylation therapy as a potential treatment in HPV+ HNSCC using 5-azacytidine, an FDA approved agent that is utilized clinically to treat myelodysplastic syndromes and refractory cases of acute myelogenous leukemia. The results from this study resulted in 4 publications and were presented by Hina at national and international conferences.

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RESEARCH Another program in the laboratory examines an etiologically distinct subset of HPV+ HNSCC characterized by inactivating mutations or loss of TRAF3 or CYLD leading to constitutively active NF-kB. The first outcomes of this study, directed Travis Shrank, MD/PhD, and the graduate student Aditi Kothari, were presented at AACR meetings and in 2 publications. Dr. Schrank also received NIH NIDCR K08 award to investigate mechanisms NRF2, a crucial regulator of the cellular oxidative stress response, pathway activation head and neck cancer.

COCHLEAR IMPLANT RESEARCH LAB

by

of i n

CLINICAL

Margaret ‘Meg’ Dillon, AuD, PhD directs the Cochlear Implant Clinical Research Lab, with research audiologists Lisa Park, AuD, Margaret ‘Gretta’ Richter, AuD, and Meredith Rooth, AuD. Their current research focuses on outcomes of cochlear implantation in children and adults with residual hearing and unilateral hearing loss, procedures for individualizing and optimizing mapping procedures, and effects of age at implantation on outcomes. The team also includes Michelle Bocanegra (Clinical Research Coordinator), Shannon Culbertson (Research Extern), and 5 graduate Research Assistants: Stephanie Panoncillo, Connor Zimmerman, Darla McDonald, Julie Doherty, and Jacqueline Eberhard. Many of the studies are collaborations with team members from the Divisions of Auditory Research, Neurotology/Otology & Lateral Skull Base Surgery, Pediatric Otolaryngology, Children’s Cochlear Implant Center, and audiologists from UNC Health who specialize in the treatment and management of adult cochlear implant patients.

The Cochlear Implant Clinical Research Lab is funded by the National Institute on Deafness and other Communication Disorders (NIDCD) and an industry grant from MED-EL Corporation.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

RESEARCH Of the 21 peer-reviewed manuscripts this year, 12 were first authored by a trainee (Neurotology Fellow, UNC ENT Resident Physician, Doctorate of Audiology graduate student, or UNC medical student). Also, four trainees received awards for their research: o Shannon Culbertson: James & Susan Jerger Excellence in Student Research Award at the American Academy of Audiology o Victoria Sweeney: James & Susan Jerger Excellence in Student Research Award at the American Academy of Audiology o Erin Lopez, MD: First Place Triological Poster Award – Otology & Neurotology o Heidi Martini-Stoica, MD, PhD: Resident Presentation Award at the North Carolina/South Carolina Societies of Otolaryngology – Head & Neck Surgery 2022 Assembly Other noteworthy accomplishments from the Cochlear Implant Clinical Research Lab this year include the publication of two papers on guidelines for the clinical assessment and management for children and adults with single-sided deafness. Drs. Dillon and Park were invited by the American Cochlear Implant Alliance to lead task forces specific to adult and pediatric patients with single-sided deafness, respectively. These manuscripts were published this year by Ear & Hearing. Drs. Park and Dillon also disseminated this information as part of an AudiologyOnline continuing education series, and Dr. Dillon was a featured guest on the ENT in a Nutshell podcast on single-sided deafness.

HEARING RESEARCH LABS

The Psychophysics & Electrophysiology Auditory Research Laboratory (PEARL) is directed by John Grose, PhD. PEARL launched a new project funded by the NIH NIDCD in the past year that is focused on the hearing difficulties experienced by older listeners, both with and without hearing loss, in everyday settings where multiple sound sources are present at the same time. The purpose of this project is to obtain a comprehensive characterization of the spatial hearing abilities of adults across a wide age range, with a particular emphasis on differentiating effects of age and hearing loss. The findings will be directly relevant to the public health challenge of addressing the communication difficulties experienced by the burgeoning older population.

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RESEARCH As part of this new initiative, the PEARL team welcomed Monica Folkerts, PhD as a post-doctoral fellow. She joins the lab from Vanderbilt University where she completed her doctorate on spatial weighting cues under the direction of Chris Stecker, PhD. Another project in PEARL that is now reaching completion is a feasibility study on simultaneous measurement of the electricallyevoked compound action potential and Wave V of the auditory brainstem response in cochlear implant users. This project, headed up by neurotologist Matthew Dedmon, MD, was largely undertaken by PhD student Stacey Kane, AuD and AuD student Jenna Van Bosch.

The Speech Perception and Auditory Research at Carolina (SPARC) lab, directed by Emily Buss, PhD has been focusing on two main research themes this year. This first is a series of studies of auditory function in children with Auditory Neuropathy Synchrony Disorder (ANSD). This work is directed by Stacey Kane, AuD, and funded by an F32 grant from NIH NIDCD. ANSD is commonly characterized by disruption in the synchronous transmission of acoustic signals within the auditory system, resulting in deficits primarily in the temporal domain. The goal of this project is to better understand the functional consequences of ANSD for the ability to discriminate simple features of sound, for speech perception, and for development of spoken language. Results of these experiments will comprise Dr. Kane’s PhD dissertation.

The second series of experiments in SPARC this year has focused on the measurement and functional utility of audibility above 8 kHz, referred to as the extended high frequency (EHF) range. This research is funded by a subaward of a grant from NIH NIDCD to Brian Monson, PhD at the University of Illinois. This research evaluates optimal procedures for testing EHF sensitivity in children and adults and employs computational modelling to explain the marked threshold differences that can be observed at these frequencies. Preliminary data were presented by Stacey Kane and AuD student Kathryn Sobon at the 2022 meeting of the American Auditory Society.

In addition to the personnel listed above, the hearing research labs run smoothly with help from AuD students Kaitlyn Thompson, Olivia Zimmerman, Selena Marcum, Chloe Gratzek, and Caroline Paroby.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

RESEARCH MANIS LAB: CELLULAR MECHANISMS INFORMATION PROCESSING

OF

AUDITORY

NEURAL

Paul Manis, PhD directs the Cellular Mechanisms of Auditory Neural Information Processing lab. Michael Kasten, PhD and Kendall Hutson, PhD also conduct research in this lab. The team studies the cochlear nucleus and auditory cortex in animals, utilizing a range of electrophysiological and optogenetic stimulation techniques to determine the properties of defined cell types and damage associated with noise or age. Experiments investigate how sensory information about sound is processed in the brain – at a cellular and network level – using experimental approaches and computational models. They study auditory processing in both normal hearing and under conditions of defined hearing loss.

Reginald Edwards, a 4th year graduate student in Cell Biology and Physiology, has joined the Manis Lab this year. Reggie is studying the organization of the axon initial segment in dorsal cochlear nucleus cells, and how that organization is modified by noise-induced hearing loss. The axon initial segment is the cell site where action potentials are initiated, and it has been shown to have activity-dependent structural changes which in turn affect the electrical excitability of the neurons. The neurons he is studying in the cochlear nucleus are thought to play a role in the generation of tinnitus through changes in their electrical excitability.

Dr. Ken Hutson shows the power and beauty of Light Sheet imaging with this image of the gerbil spiral ganglion and hair cells. Type I spiral ganglion cells (and their processes) are immunolabeled with TuJ1 (purple), while Type II spiral ganglion cells are immunolabeled with Peripherin (cyan). Spiral ganglion cells carry afferent information from hair cells (yellow) to the brain via the auditory nerve. Type I cells innervate the single row of inner hair cells, Type II cells innervate the three rows of outer hair cells.

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RESEARCH One notable achievement is the identification of a subset of spiral ganglion cells, thought to be involved in noise-induced and age-related hearing loss, which are specifically labeled in a mouse line that they have been working with for several years. Normal patterns of excitation of these cells have been mapped onto the principal neurons in the auditory brainstem. Current blinded experiments are investigating how these cells, which are thought to be more sensitive to noise-induced hearing loss than other sets of spiral ganglion cells, interact with central auditory neurons following noise-induced hearing loss. The identification of the cells by a combination of fluorescence methods in surface preparations and light-sheet imaging was done initially by lab members Tessa Ropp, PhD, and subsequently refined by Ken Hutson, PhD. Another notable achievement is the use of a combination of serial-blockface electron microscopy and computational modeling to characterize the auditory nerve inputs and patterns of connectivity onto one major cell type, the bushy cell. These patterns affect how the central auditory neurons integrate information from the cochlea and achieve better timing precision than present in the cochlea. Such timing is needed for understanding speech and for identifying the location of sounds around us. This line of work also identified new anatomical structures associated with the central auditory neurons. These studies are at the forefront of “connectomics”, the study of detailed and precise connectivity between neurons in the brain. This work is part of a collaborative project between Drs. Paul Manis (UNC), George Spirou (University of South Florida) and Mark Ellisman (University of California at San Diego).

The Manis Lab is funded by the National Institute on Deafness and other Communication Disorders (NIDCD) and National Institute of Neurological Disorders and Stroke (NINDS).

AUDITORY PHYSIOLOGY LAB

Douglas Fitzpatrick, PhD directs the Auditory Physiology Lab, using both animal and human models in studies to understand the neural basis of auditory processing and associated changes due to hearing loss. Kendall Hutson, PhD works in the Auditory Physiology Lab, contributing expertise in imaging and neuroanatomy including light sheet microscopy of the mammalian cochlea, a method that generates 3D images of spiral ganglion cells, hair cells, and stria vascularis. Currently, the team also includes two undergraduate research assistants, Greta LeitzNajarian and Alex Dunn.

The Auditory Physiology Lab maintains collaborations with many clinicians and researchers in UNC ENT as well as with The Ohio State University, Washington University in St. Louis, and North Carolina State University. These collaborations cover a range of topics, from animal P54

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RESEARCH anatomy and physiology to factors predicting cochlear implant outcomes in humans, to potential new technologies for improved hearing loss therapies.

CLINICAL RESEARCH

The OHNS Clinical Research Accountability Unit (CRAU) was established this year. The role of the OHNS CRAU is to 1) disseminate information and resources from the UNC School of Medicine, its Clinical Research Support Office (CRSO), and the Offices of the Vice Chancellor of Research (OVCR) to research teams in our department, 2) develop methods to verify the accuracy of administrative data to appropriately understand and account for all studies and personnel involved in human subjects research, and 3) disseminate and promote established best practices and standard operating procedures to bolster efficiency.

CRAU Faculty Director: o Wendell Yarbrough, MD, MMHC, FACS, Chair of OHNS CRAU Co-Administrative Directors: o Emily Buss, PhD, Vice Chair of Research o Meg Dillon, AuD, PhD, Director of Clinical Research

Dr. Doug Fitzpatrick’s recent publication shows the different components that contribute to the summating potential.

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EDUCATION

AMELIA F. DRAKE, MD, FACS INTERIM RESIDENCY PROGRAM DIRECTOR

LAUREN A. LEEPER, MD, FACS ASSOCIATE RESIDENCY PROGRAM DIRECTOR

BRIAN D. THORP, MD, FACS, FARS ASSOCIATE RESIDENCY PROGRAM DIRECTOR

CHRISTINE E. DEMASON, MD ASSOCIATE RESIDENCY PROGRAM DIRECTOR

ELLEN DOUTT RESIDENCY PROGRAM COORDINATOR

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EDUCATION RESIDENTS

2022 2023 2024 2025 2026 2027 Erin Mamuyac Lopez, MD PGY5, Class of 2022

Andrew Pappa, MD PGY5, Class of 2022

Kelly Dean, MD PGY5, Class of 2022

Douglas Farquhar, MD, MPH PGY7 - Research Track, Class of 2022

Joseph Conduff, MD PGY4, Class of 2023

John Crenshaw, MD PGY4, Class of 2023

Zainab Farzal, MD, MPH PGY6 - Research Track, Class of 2023

Kathryn Kudlaty, MD PGY4, Class of 2023

Michael Canfarotta, MD PGY5 - Research Track, Class of 2024

Elizabeth Ritter, MD PGY3, Class of 2024

Wesley Stepp, MD, PhD PGY3, Class of 2024

Teresa Vos, MD PGY3, Class of 2024

Todd Lambert, MD, MS PGY2 – Class of 2025

Eric Lee, MD PGY2 – Class of 2025

Heidi Martini-Stoica, MD, PhD PGY2 – Class of 2025

Andrew Prince, MD PGY4 - Research Track, Class of 2025

Ameer Ghodke, MD PGY1, Class of 2026

Habib Khoury, MD PGY1, Class of 2026

Evan Nix, MD PGY2, Class of 2026

Kayla (Hicks) White, MD PGY1, Class of 2026

Cameron Worden, MD PGY1, Class of 2026

Sarah Russel, MD PGY2 - Research Track, Class of 2027

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EDUCATION RESIDENT ACCOLADES AND LEADERSHIP POSITIONS Andrew Prince 09/2022 LiRA, the startup that was co-founded by Dr. Andrew Prince, won a $250k grant from the National Science Foundation 09/2022 Andrew Prince September awarded Honorable Mention for the Haynes Award at Vandy.

Erin Lopez 05/2022 Triological Society 1st place Otology/Neutology poster award, “Long-Term Trends in Tinnitus Severity of Cochlear Implant Recipients with Asymmetric and Unilateral Hearing Loss”; Triological Society Conference at Combined Otolaryngology Sections Meeting Zainab Farzal 08/2022 AAO-HNS-sponsored Women in Otolaryngology National Exemplary Senior Trainee Award for excellence in leadership, research, education, and mentoring 2018-2022 Resident Leadership Travel Award, AAO-HNS (National) 9/2022-Present

ENT Political Action Committee (PAC) Resident/Associate Delegate

8/2021-Present Resident & Associate Liaison Representative to the American College of Surgeons Advisory Council on Otolaryngology, American College of Surgeons 09/2021-Present Member, Imaging Committee, American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) 09/2022 Immediate Past Chair, Section for Residents and Fellows (SRF), American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS)

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EDUCATION Wesley Stepp 2022, Resident Leadership Travel Award, AAO-HNS (National) 2022, Selection to AAO-HNS Section for Residents and Fellows (SRF) Governing Council, Member-at-Large, AAO-HNS (National) 2021, Top Basic Science Abstract, “A Human Paranasal Sinus Model of SARS-CoV-2 Infection“, American Rhinologic Society (National) Sarah Russel Russell P. Harris Award, Gillings School of Global Public Health April 2022 Selected by Population Health for Clinicians program leadership for excellence as a critical reader of the health literature, enthusiasm about evidence-based prevention, and commitment to the integration of medicine and public health Triological Society Combined Sections Meeting Resident Travel Award January 2022 *Awarded for this project: Russel, Sarah M, Dennis O. Frank-Ito. “A Computational Method to Identify Greatest Obstructive Sites in Patients with Nasal Airway Obstruction.” Triological Society 2022 Combined Sections Meeting, January 2022. Oral presentation.

Monogram Mover Award, University of Notre Dame Monogram Club August 2022 Nominated by my peers and selected by a panel of former Notre Dame student-athletes for making an impact to my community and profession

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EDUCATION Heidi Martini-Stoica 2022 Edgar C. Garrabrant II, MD Award, North Carolina Society for Otolaryngology and Head & Neck Surgery 2022 NCSOHNS Annual Meeting Resident Paper Competition winner awarded to best oral presentation at North Carolina and South Carolina Societies of Otolaryngology Annual Assembly 2022 Association of Research in Otolaryngology Annual Meeting Travel Award.

Project title: “Psychophysical and electrophysiological measures of frequency modulation acuity: Effects of age and modulator phase” Kayla Hicks 2022 AAO-HNS Section for Residents and Fellows (SRF) Delegate to the American College of Surgeons (National)

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NEWTON D. FISCHER 2022 As the first chairman of the Division of Otolaryngology/Head and Neck Surgery, Dr. Newton D. Fischer’s enduring emphasis on medical students and resident education, as well as research continues to shape the philosophy of the Department, specifically through the Annual Newton D. Fischer Conference!

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 21-22 Annual Report

ADMINISTRATION T

he last year has seen several changes to our administrative team, with additional duties and new program requirements leading to the need for growth. We’re so excited to now be fully staffed with the additions of Crystal Boney, Ashlee Lo, and Grace Royster in the last 6 months, and so grateful to Dawn Wilson, Ellen Doutt, and Kathy Bogie for being cornerstones of our team while navigating the seasons of change! Our goal as an admin team in FY23 is to continue providing the highest quality support to our faculty, fellows, and residents, while also refining and improving our knowledge and understanding of the many processes and systems we utilize, including Concur Travel, Departmental Onboarding, and Qgenda.

We also are excited to announce Blair Allen as our new Business Manager. Blair has worked with our department for many years through the service center and is a wonderful new addition to our team!

Speaking of new additions, we also hired Grace Senior as our new Public Communication’s Specialist. In this role, she handles everything from our website, social media to department events, outreach and marketing. You can probably see from this annual report and our social media pages the impressive impact she has had on our department already!

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OUTPATIENT OPERATIONS O

ur clinical leadership team is gearing up for some long-awaited restructuring this upcoming year. We are happy to announce Hannah Eskridge as our new Clinical Director for all our outpatient clinics. Hannah Eskridge started at UNC Otolaryngology/Head and Neck Surgery in 2001 as a Speech Language Pathologist. Since 2018, she has been the Director of the Children’s Cochlear Implant Program. We want to thank Elizabeth Ramsey for all her contributions to our department as she has held the interim clinical director role since December of this year.

We are also celebrating the well-deserved promotion of Michelle Solano to the Clinic Manager role. She joins Joanne McClain, our other fearless leader, in leading the way for our wonderful clinic staff. We will be recruiting a third clinic manager as our department expands clinical locations. Since 2018 we have doubled our outpatient clinic presence from 3 to 6 sites and are in the planning phases of adding another in 2023.

We opened our Head and Neck oncology clinic at the new Rex Cancer Hospital in September 2022 and plan to open a Cary Adult Subspecialty Non-oncologic clinic in summer 2023. We were also approved to install a second CT scanner that will be located at our Meadowmont clinic which will be extremely beneficial to use with our new Rhinology Image Guidance equipment.

At our current clinical locations, we have been hard at work on improvement and quality projects.

We recently kicked off a project to improve our no-show rate and another project to improve and streamline our front desk processes. We also implemented a quarterly award to recognize staff members that are identified in positive Press Ganey comments! Speaking of awards, one of our nurses, Katy Kallam, from our Head and Neck Oncology Clinic, received a Daisy Award for being an “extraordinary” nurse.

We are proud of and thankful for all our wonderful staff that help us to provide exceptional patient care.

Carolina Care Award Winners o Brent Senior o Brian Thorp o Jeff Blumberg o Madison Clark o Mark Weissler o Robert Buckmire o Wendell Yarbrough

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QUALITY IMPROVEMENT o Otolaryngology service line improved inpatient HCAHP scores from 70% to above 88% in the last fiscal year despite battling constraints to staffing shortage, depleted app support and bedspace capacity through the pandemic. o Despite the constraints of the pandemic and growth of free flap and overall major case volume which should drive up los and increase readmission and morbidity/mortality rates - through routine inpatient service line-directed operational improvement projects/initiatives the following key inpatient metrics saw significant results/improvements. o Length of stay < 7 days with LOS index <1.3 o Mortality rate of 0.4 o Readmission rate of <5% o Exemplary observed Morbidity rate of 2.6% (NSQIP)

QUALITY IMPROVEMENT PROJECTS

o Development and implementation of Enhanced Recovery After Surgery Pathway for HN surgery patients o Development and Implementation of a Comprehensive Inpatient Multimodal Pain Management Protocol (below) o Development and Implementation of a Comprehensive Outpatient Pain Management Protocol (attachment) o Readmission Nomogram Project to help identify at risk patients for readmission o Length of stay Reduction Project o Outpatient JP drain management project o Enteric feeding optimization project for inpatients after major HN surgery o Validation of NiRADS grading system for HPV positive cancer

OUTPATIENT QUALITY IMPROVEMENT PROJECTS

o No Show Pilot at Pediatric Otolaryngology Lake Boone Trail Clinic- lowered our no show rate from 8.7% to 6.1% o SAFE Culture Improvement: increased SAFE reports and monthly reporting to staff the results and improvements created from their reports o Virtual Scribe Pilot- 5 Physicians working with virtual scribes to provide feedback to department leaders if we should implement more widely o Staff survey that informed clinical leadership on areas in need of improvement o Implemented provider wait time screen at Meadowmont to update patients

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COMMUNICATIONS

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MOVING FORWARD...

W

hat is the one word to describe us this last year? Growing!

While COVID-19 continues to percolate and impact us all, UNC Otolaryngology/Head and Neck Surgery is moving forward despite this. With new clinical operations in Raleigh, Cary and Chatham County, we continue to expand in order to effectively care for the ear, nose and throat needs of the people of North Carolina. And we will continue to move forward over 2023 as well, quite literally with our new UNC Otolaryngology/Head and Neck Surgery Mobile Unit, traversing the state in order to assist our state’s children with hearing loss. Be on the lookout for it!

Further, as we enter 2023 UNC Otolaryngology/Head and Neck Surgery will continue to lead the way in the state, in the nation, and around the globe, providing world class education in diseases and disorders of the ear, nose, and throat to the next generation of doctors, from Manteo to Malawi, Lumberton to Lebanon, Sylva to Singapore, Durham to Dubai, and even Chapel Hill to China! While through our innovative and cutting edge research, we will continue to work to manage, and indeed, eradicate, head and neck cancer, hearing loss, sleep apnea, and sinus and allergy disease to name just a few. But at our heart, we are doctors, researchers, trainees, and neighbors, providing some of the best care for ear, nose and throat disorders and expanding knowledge and innovating to advance care right in your backyard here in Triangle, a clinical tradition of excellence extending back decades. So whether it is children or adults suffering from ear infections, hearing loss, sinusitis, allergy, voice disorders, or tumors of the head, neck, and skull base, our team of dedicated providers offer unrivaled care and are available for you.

We are very proud to be the University of North Carolina Department of Otolaryngology/Head and Neck Surgery, moving forward in 2023 for the people of North Carolina.

Its what we do; its who we are.

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