UNC Otolaryngology–Head and Neck Surgery Annual Report 2023-2024

2023-2024 ANNUAL REPORT

TABLE OF CONTENTS 5 6 8 9 11 16 20 24 28 31 33 36 42 48 50 51 53 55

Who We Are Message From The Chair Leadership 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 Quality Improvement Communications Moving Forward...

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CLINICAL FACULTY

RESEARCH FACULTY

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21

FELLOWS

RESIDENCY FACTS

TOTAL RESEARCH FUNDING

WHO WE ARE

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

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RESIDENTS

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ADJUNCT FACULTY

APP ⁄ OTHER

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POSTDOCTORAL RESEARCHERS

PROVIDERS

RESEARCH STAFF

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CLINICAL STAFF

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ADMINISTRATIVE STAFF

$5.2 MILLION #15

OVERALL OTOLARYNGOLOGY RESIDENCY PROGRAMS

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POSTER PRESENTATIONS

#5

OTOLARYNGOLOGY RESIDENCY RESEARCH OUTPUT

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ORAL PRESENTATIONS

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PUBLICATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

MESSSAGE FROM

THE CHAIR

The Department of Otolaryngology/Head and Neck Surgery at UNC has enjoyed a remarkable year that we are proud to share with you. We continue to make significant strides toward our mission to improve the health and wellbeing of North Carolinians and others whom we serve through excellence in patient care, education and research. Marked by significant achievements in our tripartite mission, a common theme has been growth: with new clinics, our first mobile clinic, and notable contributions in research and education.

I hope that you will enjoy our annual report, where we highlight our clinical care, treating a range of disorders from the most to the least complex; our research, where we are pushing boundaries to improve cutting-edge care; and our education, where we continue to excel in training the next generation of surgeons and scientists, enabled by a welcoming academic environment, high clinical volume, and diverse faculty expertise.

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 2024 Annual Report

LEADERSHIP DEPARTMENT CHAIR

WENDELL G. YARBROUGH, MD, MMHC, FACS

VICE CHAIRS OUTPATIENT OPERATIONS & IMROVEMENT

KEVIN D. BROWN, MD, PHD

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

DANA CLIFTON

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

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

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

FACULTY & STUDENT WELLNESS BRIAN S. JEWETT, MD

WELLNESS Faculty, Resident, and Fellow night out on the town, 2024

Resident and Fellow bowling outing, 2024

Residents and Fellow outings to hone their golf skills, 2024 P9

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

NC FAMILY DAY 2024

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 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

W E N IRE H

THOMAS J. DARK DISTINGUISHED PROFESSOR

ROBERT L. FERRIS, MD, PHD PROFESSOR DIRECTOR, LINEBERGER COMPREHENSIVE CANCER CENTER

JEFFERY M. BLUMBERG, MD, FACS ASSOCIATE PROFESSOR

CATHERINE J. LUMLEY, MD ASSISTANT PROFESSOR

TRAVIS P. SCHRANK, MD, PHD ASSISTANT PROFESSOR

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

HEAD & NECK SURGICAL ONCOLOGY C. BLAKE SULLIVAN, MD ASSISTANT PROFESSOR

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ALESSA COLAIANNI, MD, M.PHIL ASSISTANT PROFESSOR

COURTNEY HITPAS, PA-C PHYSICIAN ASSISTANT

HANNAH EADIE REID, NP FAMILY NURSE PRACTITIONER

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

HEAD & NECK SURGICAL ONCOLOGY

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he Division of Head and Neck Surgical Oncology has seen tremendous success and growth over the past fiscal year. Managing over 1500 new patient encounters and providing 216 reconstructive cases, the faculty in our top-ranked state-wide program continue to provide high volume, high quality patient care unmatched in North Carolina, while also training the head and neck surgeons of the future. We are proud and grateful to announce the matching of our 14th consecutive Head and Neck Surgical Oncology Fellow since the fellowship inception in 2012. We are additionally thrilled to announce the expansion of our clinical faculty to 8 members, including 5 reconstructive surgeons and 3 physician scientists. Dr. Alessa Colaianni, joining us from Oregon Health Sciences University, brings additive expertise in Narrative Medicine, and Dr. Robert L. Ferris, nationally recognized surgeon-scientist and leader in our field has joined our faculty and assumed the role of Director of the UNC Lineberger Comprehensive Cancer Center, as well as leader of our statewide Cancer Service Line.

Within the realm of research, we have seen continued groundbreaking achievements. The Head and Neck Oncology Laboratory under the direction of Wendell Yarbrough and Natalia Isaeva, continues to lead the way understanding the carcinogenesis of HPV-related cancer and radiation sensitivity. With a U01 study validating HPV DNA genotyping and prognostic genomic biomarkers for diagnosis and treatment of HPVassociated HNSCC and an active SPORE, Drs. Yarbrough, Schrank, and Isaeva are leading the understanding of HPV carcinogenesis, vulnerabilites, and how to best personalize therapy.

With the additions of Dr. Ferris’ remarkable cancer immunology research and the tremendous collaborative multidisciplinary clinical trial experience shared with our medical and radiation oncology teams, we are excited about the future directions of scientific and translation research and advancement of care for our patients.

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NEW PATIENT ENCOUNTERS

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RECONSTRUCTIVE CASES

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FACULTY MEMBERS

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HEAD & NECK SURGICAL ONCOLOGY

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PUBLICATIONS

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PRESENTATIONS

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

HEAD & NECK SURGICAL ONCOLOGY 6

MENTORED STUDENTS

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MEDICAL STUDENTS

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POST-DOCTORATE STUDENT

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 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

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

W NEIRE H

WADE MCCLAIN, MD ASSISTANT PROFESSOR SURGICAL DIRECTOR, NORTH CAROLINA MULTI-DISCIPLINARY PEDIATRIC THYROID CLINIC

VICTORIA CLAIRE JAMES, MD ASSISTANT PROFESSOR

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

PEDIATRIC OTOLARYNGOLOGY

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s the Division of Pediatric Otolaryngology, we have collaboratively developed a clinical pathway to guide the planning of care for pediatric patients requiring tracheostomy. This pathway includes comprehensive assessments of medical, social, and respiratory support needs. In addition to Pediatric Otolaryngology, the Divisions of Pediatric Pulmonology, Pediatric ICU, and the tracheostomy nursing team serve as critical partners in this initiative. Barriers and challenges to care are identified and, when possible, addressed prior to surgery. This collaborative approach has fostered improved communication and planning for postoperative placement when necessary. All members of the Division have actively contributed to this effort.

The clinical pathway is being refined to accommodate a range of providers.

Using the same multidisciplinary approach, the Division established a new thyroid clinic developed in partnership with Pediatric Endocrinology– the UNC Pediatric Mulidisciplinary Thyroid Clinic. This clinic serves patients with coordinated and streamlined medical and surgical care for all thyroid pathologies. While Dr. Zdanski established the clinic, he is now excited to pass that leadership role as the Director of the clinic to Dr. Wade McClain.

The Division continued it's work in clinical trials led by Dr. Amelia Drake, as she consulted on a multi-institutional grant on care of patients with Craniofacial Microsomia, led by researchers at Seattle Children’s Hospital (Consultant, Craniofacial microsomia: Accelerating Research and Education (CARE), NIDCR R01 DE029510-01 (PIs Heike and Stock) 05/01/2020 - 2/28/2025.

As well as working as a co-investigator on a grant led within the UNC Craniofacial Center: "Development of Stop Consonants in Children with Repaired Cleft Palate: Continuation Study", NIDCR # 1R01DE022566-01A1 (Zajac PI) 2013 – 2018 NIDCR #: 2R01DE02256606A1 (Zajac PI) 2019 – 2024.

The Pediatric Otolaryngology faculty celebrated Allison Keane, who completed her fellowship in June of 2024. Dr Austin Rose subsequently retired and Dr. Wade McClain and Dr. Claire James were recruited to support comprehensive pediatric care provided by the Division.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

PEDIATRIC OTOLARYNGOLOGY Wade McClain and Fellow Nicole Ruszkay performing an airway assessment on a premature infant. Katherine, a visiting acting intern from Jefferson University, is observing. Having completed her residency in Otolaryngology at Penn State University, Nicki Ruszkay enjoys the range and complexity of clinical practice that she is experiencing at UNC. She has functioned capably as a pivotal part of the pediatric otolaryngology team this year.

We welcome the arrival of Dr. Claire James– previously of the University of Florida– significantly contributing to our goals for the coming year: outreach to Sanford, NC with the Audiology Mobile Unit, helping establish the Pediatric OHNS role within The UNC Trisomy 21 Clinic, establishing the UNC Pediatric Complex Sleep Clinic, and establishing the UNC Voice and Swallowing Clinic.

We also welcome the addition of Dr. Virginia Drake in the Division of Facial Plastics and Reconstructive Surgery to the UNC Microtia Team! We continue our work offering a variety of repair options as we look forward to the approval of osseointegrated implants in children 5 years and older!

Dr. Carlton Zdanski has continued involvement with The Malawi Surgical Initiative where he is a Visiting Professor of Otolaryngology/Head and Neck Surgery at Kamuzu Central Hospital, Lilongwe, Malawi and with the Global Smile Foundation where he is a Surgeon at Guayquil, Ecuador.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

PEDIATRIC OTOLARYNGOLOGY Pediatric Otolaryngology has further expanded outreach with Dr. Zdanski and his spouse, Laurel Zdanski, AuD, partnering with the UNC Division of Infectious Diseases in West Africa studying the otolaryngologic and audiologic effects of Lassa Fever and vaccines for Lassa Fever.

Dr. Zdanski continues efforts on quantitative evaluation of the pediatric airway in human studies for his R01 "Predicting the Need for Surgery in Pediatric Subglottic Stenosis using Airway Elastography derived from Endoscopic OCT and Intraluminal Pressure Measurement."

Aurelia Monk, fourth year medical student, after her talk at the Combined Otolaryngology Spring Meetings. The oral presentation was entitled “Improving Craniofacial Team Collaboration: A multicenter interview study of effective team meetings”

Amelia F Drake MD continues longitudinal work with the CARE group studying Craniofacial Microsomia, (Craniofacial microsomia: Accelerating Research and Education).

The research group met in person at the spring meeting of the American Cleft Palate Association and some members are shown here with Adam Levy, the Executive Director of ACPA in Denver in April 2024.

Numerous scholarly works have resulted from this collaboration.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 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

BRIAN S. JEWETT, MD PROFESSOR

VIRGINIA DRAKE, MD ASSISTANT PROFESSOR

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

NICOLE A. HUGHES, LE ACADEMIC AESTHETICIAN

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

FACIAL PLASTIC & RECONSTRUCTIVE SURGERY

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he Facial Plastic and Reconstructive Surgery Division continues to grow, and with the addition of Dr. Ginny Drake (winner of the John Orlando Roe Award from the AAFPRS), our group offers the full scope of practice of facial plastic surgery.

Our expert clinicians offer innovative solutions to some of the most challenging problems in facial plastic surgery. Patients from all over the country, as well as international patients, continue to seek care from our expert faculty. Dr. Matt Miller continues to lead the internationally recognized UNC Facial Nerve Center, and is joined by Dr. Drake in providing cutting-edge solutions for our facial nerve patients.

The FPRS fellowship continues to be one of the most sought after in the country. Our current fellow, Dr. Tyler Rist, did his residency training at MUSC. Next year’s fellow is Dr. Lauren Gardiner, following graduation from the University of Pittsburgh otolaryngology residency program. One of the highlights for the faculty and fellows alike is our Annual Fellowship Alumni Dinner, held at the AAFPRS Annual Meeting. This year’s Guest of Honor was Dr. Tom Wang, Dr. Clark’s fellowship director (photo below).

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

FACIAL PLASTIC & RECONSTRUCTIVE SURGERY The FPRS Division has grown to be one of the premier FPRS research programs in the country.

The Division had 15 publications in major international journals in the 2023-24 academic year.

The 5 publications we would like to highlight are the following: 1. Drake VE, Smith C, Watkins MO, Rudy SF, Joseph AW, Stucken CL, Brenner MJ, Kim JC, Moyer JS. Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Graft in Rhinoplasty. Facial Plast Surg Aesthet Med. 2024 Mar 19. doi: 10.1089/fpsam.2023.0334.

Epub ahead of print. PMID: 38502836.

2. Mims MM, Shockley WW, Clark JM. Casual observers’ perception on the aesthetics of the butterfly graft. Laryngoscope. 2023 Oct. doi: 10.1002/lary.30562 PMID: 36602076.

3. Drake VE, Moyer JS. The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction. Facial Plast Surg. 2023 Oct;39(5):501-507. doi: 10.1055/s0043-1769807. Epub 2023 Jun 8. PMID: 37290453.

4. Varman R, O’Rourke SP, Nix E, Miller MQ. Mid-term Effects of Selective Denervation Surgery on Facial Symmetry in Patients with Nonflaccid Facial Paralysis: Intermediate FollowUp of Rest and Smile Symmetry. Facial Plast Surg Aesthet Med. 2023 Nov 7. PMID: 37934132.

5. Kim SG, Mims MM, Menapace DC, Stack T, Shockley WW, Clark JM. Biochemical Variability of Nasal Cartilages: Implications in Functional Rhinoplasty.

Laryngoscope. 2024 May 15. doi: 10.1002/lary.31480. PMID: 38747457.

In addition to these publications in international journals, the “doctors Miller” were asked to write the British Medical Journal’s Best Practice Guidelines for Ramsay Hunt Syndrome: 1. Miller JR, Miller MQ. Ramsay Hunt Syndrome. British Medical Journal Best Practice Guidelines. 2023 October 2.

The bolded names are medical students, residents, and fellows who have worked alongside faculty in these projects and deserve special recognition.

In addition, Division members garnered 10 national and international podium presentations in the 2023-24 academic year.

The 5 presentations we would like to highlight are the following: 1. Varman R, Clark JM. Secondary Contouring for the Butterfly Graft: Improving Form and Preserving Function. Rhinoplasty and Advances in Facial Rejuvenation. Orlando, FL, April 5, 2024 2. Ridley M, Strauss RP, Drake AF, Miller MQ. Narrative study of resilience in facial paralysis: Similarities and differences in the resilience profiles and psychosocial responses of patients P22

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

FACIAL PLASTIC & RECONSTRUCTIVE SURGERY with congenital and acquired types. Appearance Matters 10. Bristol, United Kingdom. June 2024.

3. O’Rourke SP, Miller MQ. Changes in perceived emotions in facial paralysis patients after depressor anguli oris excision. Triological Combined Sections Meeting. Palm Beach, Florida.

January 2024.

4. Clark JM. Panel Discussion: “ Just Say No…But How?” Triological Society Combined Sections Meeting. West Palm Beach, FL, January 25-28, 2024 5. Varman R, Miller MQ. Changes in Resting and Smile Symmetry after Selective Denervation.

AAFPRS Annual Meeting. Las Vegas, Nevada. October 2023.

Grants 1. UNC medical student, Yang Lee, was awarded a $2,000 Carolina Medical Student Research Program (CMSRP) award for her work with Dr. Madison Clark.

2. UNC resident, Dr. Nazineen Kandahari, was awarded a UNC School of Medicine $750 grant for her work with Dr. Miller investigating disparities in access to facial paralysis care.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

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

CHRISTINE KLATT-CROMWELL, MD ASSOCIATE PROFESSOR

ADAM J. KIMPLE, MD, PHD, FACS, FARS ASSOCIATE PROFESSOR FELLOWSHIP CO-DIRECTOR

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JACKSON VUNCANNON, MD ASSISTANT PROFESSOR

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY

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

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he Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery continues to grow in fulfilling our mission to provide world-class, cutting-edge care to the people of North Carolina and beyond. Jackson Vuncannon, MD joined our group of seven providers seeing patients at our Meadowmont facility and our new Cary facility. Our group continues to be recognized by outside organizations for our outstanding care resulting in Castle Connelly Top Doctors, Best Doctors, and Carolina Cares awards.

Members of our group continue to provide leadership in all of our major professional organizations, including the American Rhinologic Society, the American Academy of Otolaryngic Allergy, the North American Skull Base Society, the European Rhionologic Society, and the International Rhinologic Society. This leadership has resulted in numerous international mentees joining us for clinical and research experiences, as we have welcomed otolaryngologists from Iran, Albania, Turkey, and Japan for extended experiences over the last year.

Our Rhinology Research Group, led by Dr. Adam Kimple, has worked collaboratively to expand high-level translational and basic science research, impacting all levels of patient care, while at the same time mentoring numerous residents, fellows, and students in the art of developing quality research. Indeed, mentorship is in our DNA, having trained three students from the Carolina Medical Student Summer Research Program: Morgan McCain, Nina Westcott, and Michael Ly; in addition to three students who have joined for one year of training: Jared Martin, Yasine Mirmozaffari, and Lauren Cook. Two of our Carolina ENT NIH T-32 residents, Cameron Worden, MD and Ezer Benaim, MD have had a very productive experience being jointly mentored with Ilona Jaspers, PhD from the Center for Environmental Medicine, Asthma, and Lung Biology. While collaboration with Zheng Li, PhD from Morgan State University has resulted in National Science Foundation and NIH grants.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY The Division is also home to one of the most desired fellowships in the United States for Advanced Neurorhinology. This year, we said good-bye to our outstanding graduates of 2024, Matt Lelegren, MD who is joining a private group in central California, and Scott Hardison, MD who is joining the faculty of the University of Texas Medical Branch, while we said hello to our new fellows Michael Armstrong, MD, from Mayo Clinic and Tom Raz Yarkoni, MD from the Hebrew University of Jerusalem.

Contributing to the Departments' outreach missions, Dr. Brent Senior led a team of otolaryngologists from UNC, UTMB, University of Minnesota on his 25th educational mission to Vietnam. The team performed numerous surgeries and gave several lectures in conjunction with the 55th anniversary celebrations for the National ENT Hospital in Hanoi.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RHINOLOGY, ALLERGY ENDOSCOPIC SKULL BASE SURGERY

Tom Raz Yarkoni, MD with Family

Michael Armstrong, MD with Family

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NATIONAL PRESENTATIONS

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MENTORED STUDENTS AND RESIDENTS

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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 ASSOCIATE PROFESSOR

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

NICHOLAS J. THOMPSON, MD ASSISTANT PROFESSOR

TRAM TRAN, FNP-C NURSE PRACTITIONER

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OTOLOGY⁄ NEUROTOLOGY AND LATERAL SKULL BASE SURGERY

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he Division of Neurotology and Skull Base Surgery, in collaboration with Vanderbilt University, co-hosted the 2024 Fall Cochlear Implant Conference in Asheville, North Carolina. Dr. Brown co-directed the conference, and Dr. Dedmon contributed as a member of the scientific committee, while both presented and/or moderated sessions. Dr. Thompson also presented at the event.

Additionally, Dr. Brown, alongside Dr. Margaret Dillon, organized the International Hearing Structure and Preservation Meeting in Chapel Hill, NC. Dr. Selleck remained active in the Academy of Otolaryngology – Head and Neck Surgery, participating on the Hearing Committee and the Otology/Neurotology Education Committees.

Dr. Brown was also involved with the Hearing and Implantable Hearing Devices Committees.

Dr. Selleck continued her work with the Women in Otolaryngology Leadership and Mentorship Committee.

Dr. Brown served on the Finance Committee for the American Otologic Society and participated in the scientific committees for both the 2025 Triological Society Combined Section Winter Meeting and the American Otologic Society Meeting. He completed his final year as Treasurer of the American Cochlear Implant Alliance (ACIA), where he also remains on the Board.

Additionally, Dr. Brown serves on the Editorial Board of Otology and Neurotology.

Together with a multidisciplinary team of national experts, Dr. Brown and Dr. Selleck developed a position statement and accompanying white paper in Otolaryngology – Head and Neck Surgery advocating for neonatal testing for congenital cytomegalovirus. They also continue to co-direct the ACGME-approved Neurotology Fellowship.

Dr. Brown was invited to speak at several prestigious meetings, including the Triological Society in Chicago, where he addressed cochlear implantation for single-sided deafness. He also presented on place-pitch mapping in cochlear implant recipients at the Asia Pacific Cochlear Implant meeting in Korea, and discussed the translabyrinthine approach for acoustic neuroma at the North American Skull Base Society Meeting in Atlanta. In Madrid, he spoke on cochlear volume and hearing preservation outcomes at the European Investigators Conference, and delivered a keynote lecture at the Arab Cochlear Implant Conference in Abu Dhabi on optimizing speech outcomes in cochlear implant recipients. He was also invited to serve as faculty at Ludwig Maximillian University in Munich, where he lectured on otosclerosis management and preoperative predictors of hearing preservation.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

OTOLOGY⁄ NEUROTOLOGY AND LATERAL SKULL BASE SURGERY The Division is currently conducting several clinical trials, including studies on bone conduction implantation in young children (led by Dr. Selleck), cochlear implantation for single-sided deafness in children (led by Dr. Brown), robot-assisted cochlear implantation (led by Dr. Brown), and cochlear implantation in infants and toddlers (co-led by Dr. Brown), among others.

Dr. Selleck was honored with the Faculty Teacher of the Year award, presented by the chief resident class. Dr. Dedmon assumed the role of Professionalism Lead for the Department of Otolaryngology – Head and Neck Surgery and continued to direct the temporal bone course for residents. Dr. Thompson serves as the Clinical Liaison for the Department’s new clinic in Cary, NC.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

GENERAL OTOLARYNGOLOGY

CHRISTINE E. DEMASON, MD ASSOCIATE PROFESSOR

DORIS LIN, MD ASSISTANT PROFESSOR

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PUBLICATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

GENERAL OTOLARYNGOLOGY

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he Division of General Otolaryngology had another successful year. Drs. DeMason and Lin, joined by Dr. Jewett (Facial Plastic and Reconstructive Surgery), have expanded their footprint in Chatham County with a focus on providing care to this growing suburban area and to more rural areas of North Carolina. Dr. Lin has led many clinical outreach sessions in Chatham County this past year. The Division of General Otolaryngology is highly involved in medical education. Dr. Lin‘s medical student otolaryngology elective for those interested in primary care has been very popular again this year. Dr. DeMason continues in her role as the Director of Medical Student Education for the Department as well as one of the residency’s Associate Program Directors. She also wrote one of the modules for the new national Otolaryngology Core Curriculum.

The Division is very involved in research and mentoring medical students through projects.

One of Dr. DeMason’s projects with a medical student won third place in the General Otolaryngology poster category at the Triological Society Meeting in January 2024. In collaboration with Audiology researchers, Dr. Lin has continued her studies on tinnitus therapy.

Dr. DeMason continues to be heavily involved in the American Academy of Otolaryngic Allergy (AAOA) where she is on the annual meeting program committee for the November 2024 meeting and was just elected to serve as a board member at large.

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MENTORED STUDENTS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

VOICE AND SWALLOWING

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

RUPALI (PALI) N. SHAH, MD PROFESSOR

HEATHER DAVIS, MA, CCC-SLP SENIOR VOICE THERAPIST

JOSEPH HALL, CCC-SLP SPEECH AND LANGUAGE PATHOLOGIST

H. ALDEN PRIDGEN, CCC-SLP SPEECH AND LANGUAGE PATHOLOGIST

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PRESENTATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

VOICE AND SWALLOWING

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he Division of Voice and Swallowing enjoyed another productive year. The UNC Voice Center continues to provide state-of-the-art, multidisciplinary care for voice, airway, and swallowing disorders for the citizens of North Carolina. The members of the Voice and Swallowing Division/ UNC Voice Center participated in, and published research across fields including airway stenosis, gender-affirming voice care, image guided intra-laryngeal injection trainers, as well as tackling topical challenges in medical education. These areas of inquiry, led to multiple local, regional and national presentations and publications in the leading periodicals within our specialty.

For the 8th consecutive year members of the Voice and Swallowing Division mentored multiple students including an individual who received a Carolina Medical Student Research Program grant, a competitive research grant program for first year medical students.

Currently, novel projects are being developed with new research collaborators within the UNC Departments of Health Sciences (Speech and Hearing Sciences) and Applied Physical Sciences, as well as NC State’s College of Engineering, focusing upon topics ranging from chronic cough to tissue healing/engineering to wearable voice monitoring devices.

Dr. Rupali Shah was named as a the “Medexcel program Advisor” in addition to her standing roles as Academic career goal advisor and Head ENT career goal Advisor within the UNC School of Medicine. She will additionally serve as an Oral Board Examiner for the ABOTO HNS in the 2024-2025 cycle. Dr. Shah was invited to participate as a panelist at the NC/SC Otolaryngology Society on management of patients with cricophayrngeal dysfunction.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

VOICE AND SWALLOWING Dr. Robert Buckmire, as treasurer of the American Laryngological Association, is participating in a historical strategic planning initiative of this senior professional society that will shape its future footprint. He was an invited speaker at the National Medical Association, delivering a presentation entitled : ”Building a Diverse (Otolaryngology) Workforce”.

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MENTORED STUDENTS

2

GRANTS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

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

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

JENNIFER WOODARD, AUD, CCC-A ASSISTANT PROFESSOR

MELISSA ANDERSON, AUD, CCC-A ASSISTANT PROFESSOR

DAKOTA SHARP, AUD, CCC-A ASSISTANT PROFESSOR

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

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

W E N IRE H

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

SARAH SPENCER, MS, CCC-SLP, LSLS CERT. AVT ASSISTANT PROFESSOR

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

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MENTORED STUDENTS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

CHILDREN’S COCHLEAR IMPLANT CENTER

T

he Children’s Cochlear Implant Center at UNC is excited to introduce the Mobile Speech and Hearing Clinic. Our clinic on wheels is traveling to rural sites across the state providing audiology and speech language services. The mission of the Mobile Speech and Hearing Clinic is to reduce loss to follow-up for children at risk or with hearing loss and to support our most vulnerable patients. Furthermore, we are pleased to introduce Natalie Giduz, MSW, our Family Care Coordinator. This is a new position in the clinic, and over the last year she has made a tremendous impact on increasing the number of referred patients evaluated by the team while supporting our active cochlear implant families. The number of pediatric cochlear implant surgeries were reduced due to impacts from COVID, but with a huge assist from Natalie, over the last year cases have rebounded, exceeding pre-pandemic levels at the Children’s Cochlear Implant Center at UNC. To advance our research mission, faculty at CCIC are involved in several clinical trials. Members of our team are part of the pediatric arm of two studies investigating cochlear implantation in children and adults with single-sided deafness (SSD). Dr. Park is principal investigator of a clinical trial known as “Little SSD” which investigates outcomes of early cochlear implantation in infants and toddlers with SSD. Faculty are also working on collaborative projects with other institutions such as Lurie Children’s Hospital, Vanderbilt University, and the University of Texas at Dallas. Providers continue to publish clinical retrospective research on a variety of topics including cochlear nerve deficiency, cochlear implant device use, and trends in pediatric cochlear implants on social media.

The Children’s Cochlear Implant Center at UNC is proud of the career milestones met this year!

Dr. Jennifer Woodard, Erin Thompson, and Sandra Hancock were recognized for 20 years of service, and Dr. Erika Gagnon was recognized for 10 years of service. The Children’s Cochlear Implant Center at UNC is proud to have strong staff retention and experienced providers working

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

CHILDREN’S COCHLEAR IMPLANT CENTER with our patients.

Dr. Dakota Sharp was accepted into the American Speech Language Hearing Association (ASHA) Early Career Professionals program, a selective professional development program for audiologists in their first 5 years of practice. His cohort completes an 11-month program, culminating in an in-person meeting at the ASHA 2024 Convention.

Faculty in the Division have published and distributed their research findings including national and international presentations. Drs. Lisa Park and Erika Gagnon were invited speakers at the Asia Pacific Symposium on Cochlear Implants and Related Sciences in Seoul, South Korea. Dr. Park presented her research on Factors Influencing Performance and Device Use in Children with Unilateral Hearing Loss Who Use a Cochlear Implant and Outcomes in Cochlear Implantation in Children with Preoperative Residual Hearing. Dr. Gagnon presented her research on Pediatric Cochlear Implant Device Use and Early Language Development.

Sandra Hancock traveled to Nairobi, Kenya with The Global Foundation for Children with Hearing Loss.

This foundation is one of only a few that that work in developing countries to identify and treat young children with hearing loss. They partner with local governments and professionals to educate local providers on treatment for children with hearing loss. Sandra traveled to teach Auditory-Verbal therapy in conjunction with the University of Nairobi.

Dr. Lisa Park was named Co-Chair of the Cochlear Implant Patient Access to Hearing (CI-PATH) Pediatric Collaborative. This is a multi-institutional professional organization designed to ensure that every parent of a child who could benefit from a cochlear implant will have timely and accurate information to make an informed decision about their child’s hearing. The goal of the collaborative is to double the adoption rate for pediatric cochlear implants by 2032.

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PUBLICATIONS

30

PRESENTATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

CHILDREN’S COCHLEAR IMPLANT CENTER Lillian Henderson was awarded a Junior Faculty Grant to provide books, retention supplies and learning to listen kits to patients served on the Mobile Speech and Hearing Clinic. She formed committees of other staff members at the Children’s Cochlear Implant Center to collaborate on this project to bring supplies to help children seen in rural areas of North Carolina successfully use their cochlear implant and hearing technology.

Dr. Jennifer Woodard was appointed to the North Carolina Governor’s Council for the Deaf and Hard of Hearing as a Representative for Cochlear Implants. The Governor’s Council of the Deaf and Hard of Hearing advises the Department of Health and Human Services and the Department of Public Instruction on matters pertaining to deaf and hard of hearing individuals throughout North Carolina. Dr. Woodard is excited to begin this 4-year appointment on the Council and bring her cochlear implant expertise to the group.

Sandra Hancock and Natalie Giduz at the CARE Project’s Parent Professional Collaborative Event in Wilmington, NC

Dr. Jennifer Woodard, Sandra Hancock and Erin Thompson joined the “Carolina 20-Year Society”

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

CHILDREN’S COCHLEAR IMPLANT CENTER Dr. Dakota Sharp was an invited speaker for the Panel: Early Career Professionals by the National Student Academy of Audiology

Pediatric patients receiving care on the Mobile Speech and Hearing Clinic.

Activation Day! A pediatric cochlear implant patient is fit with external speech processors to hear for the first time!

Participating in pediatric cochlear implant research is fun!

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

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 ASSOCIATE PROFESSOR

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RESEARCH

KENDALL A. HUTSON, PHD ASSISTANT PROFESSOR

MICHAEL KASTEN, PHD ASSISTANT PROFESSOR

NATALIA ISAEVA, PHD ASSISTANT PROFESSOR

AMANDA D. SLOOP, AUD ASSISTANT PROFESSOR

MARGARET RICHTER, AUD ASSISTANT PROFESSOR

W NEIRE H

SAMANTHA SCHARF, AUD ASSISTANT PROFESSOR

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RESEARCH I

n addition to our thriving program of clinical research, there are a number of productive labs focused on basic research in the Department. Those include the Hearing Research Laboratories, the Manis Laboratory, the Head and Neck Oncology Lab, the Cochlear Implant Research Laboratory, and the Facial Plastic and Reconstructive Surgery Research Lab. We also maintain active cross-Department and cross-institution collaborations. Recent work in two of the labs within the Department is highlighted below.

The Cochlear Implant Clinical Research Laboratory, directed by Margaret “Meg” Dillon, AuD, PhD, continues to investigate outcomes of cochlear implant use for children and adults with different hearing configurations and the effectiveness of individualized mapping and device fitting procedures. This group, which also includes faculty members Drs. Margaret “Gretta” Richter, Lisa Park, Amanda Sloop, and Samantha Scharf, collaborates with OHNS faculty in the Division of Otology, Neurotology, and Lateral Skull Base Surgery, Division of Pediatric Otolaryngology, and the Children’s Cochlear Implant Center, and with co-investigators in the UNC Health Department of Audiology. Notable recent publications include those conveying findings of studies for long-term outcomes of cochlear implant use for children with unilateral hearing loss (Park et al., 2023), comparisons of mapping procedures that account for the placement of the electrode array (Dillon et al., 2023), and the effectiveness of modified study designs in recruiting a participant sample that reflects the demographic composition of our patient population (Nix et al., 2024). Additional accomplishments this year are the opening of a third laboratory in the UNC Multispecialty Otolaryngology Clinic in Cary and implementation of new methods to broadly disseminate research findings, such as tutorials and reviews of research findings on social media and participation on audiology/otology-related podcasts.

152

FACULTY PUBLISHED PEER-REVIEWED PAPERS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RESEARCH There are two labs within the Division of Facial Plastics that have been pushing the envelope on research. The Facial Reanimation Lab, directed by Matthew Miller, MD, is a first of its kind center dedicated to investigating how emotions conveyed by patients with chronic Bell’s palsy, chronic Ramsay Hunt Syndrome, and other causes of nonflaccid facial paralysis change after depressor anguli oris muscle excision and selective denervation surgery. This group recently reported that patients objectively convey more happiness when smiling after surgery compared to before their procedures (O’Rourke et al. 2024; Varman et al., 2023). The Facial Plastic and Reconstructive Surgery Research Lab, co-led by Madison Clark, MD, and Virginia Drake, MD, continues to build its capabilities as one of the only Divisions in the country to objectively study conditions impacting nasal breathing and facial movement. A recent publication highlighed the culmination of a multi-year project that discovered biochemical differences in the critical structural area of the nasal cartilage that supports the internal nasal valve (Kim et al., 2024).

This research showed that the nasal dorsal septal cartilage has low glycosaminoglycans and high collagen levels in patients with nasal valve collapse, providing a mechanistic explanation as to why some patients are resistant to nasal changes with aging and minor trauma.

RESEARCH HIGHLIGHTS

o Drs. Sloop and Dillon co-authored a Featured Article on new indications for cochlear implantation for Audiology Today, which is a journal distributed to members of the American Academy of Audiology. o Dr. Virginia Drake was awarded the John Orlando Roe Award from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) for her research project investigating autologous versus cadaveric rib use in rhinoplasty surgery.

Drs. Dillon, Dedmon, Nix, and Vos

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RESEARCH Participant taking part in a study on sound source localization

Drs. Richter and Sloop participating in the Annual Cochlear Implantation Simulation Lab.

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

Drs. Davis (Sloop) and Dillon reviewed new candidacy criteria for cochlear implantation and new methods to individualize the fitting of cochlear implants in the July/August 2024 issue of Audiology Today.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

RESEARCH

Dr. Ken Hutson's image of a mouse cochlea and its constituents, including spiral ganglion cells and their axons that form the auditory nerve, carrying information about sounds to the brain. Note as the auditory nerve enters the brain, each fiber bifurcates to terminate in each Division of the cochlear nucleus - the first step for analyzing auditory information by the brain.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

EDUCATION

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

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

CHRISTINE E. DEMASON, MD ASSOCIATE RESIDENCY PROGRAM DIRECTOR

ELLEN DOUTT RESIDENCY PROGRAM COORDINATOR

T

he residency program within The Department of Otolaryngology/Head and Neck Surgery has seen significant evolution in its educational structure, with leadership now transitioning to Dr. Brian Thorp. Under Dr. Thorp’s guidance, and with the valuable support of Drs. Leeper and DeMason as associate directors, the Department continues to uphold its reputation as one of the nation’s premier residency programs. The commitment to excellence in education remains steadfast, with a focus on developing future leaders in the field. In parallel, the Department has expanded its fellowship offerings, ensuring that these programs are equally rigorous and enriching. This dual focus on both residency and fellowship training positions the department at the forefront of academic medicine, fostering a dynamic environment for growth and learning at every level of professional development.

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

EDUCATION RESIDENTS

2024

Teresa Vos, MD PGY5, Class of 2024

Elizabeth Ritter, MD PGY5, Class of 2024

Michael Canfarotta, MD PGY7 - Research Track, Class of 2024

2025

Wesley Stepp, MD, PhD PGY5, Class of 2024

Eric Lee, MD PGY4 – Class of 2025

Todd Lambert, MD, MS PGY4 – Class of 2025

Andrew Prince, MD PGY6 - Research Track, Heidi Martini-Stoica, MD, PhD Class of 2025

2026

Habib Khoury, MD PGY3, Class of 2026

Ameer Ghodke, MD PGY3, Class of 2026

2027

PGY4 – Class of 2025

Kayla (Hicks) White, MD PGY3, Class of 2026 Cameron Worden, MD Evan Nix, MD PGY3, Class of 2026 PGY3, Class of 2026

John Henrich, MD PGY2, Class of 2027

Sarah Russel, MD PGY5 - Research Track, Class of 2027

2028

Nazineen Kandahari, MD PGY1, Class of 2028

Graham Cochrane, MD, PhD PGY1, Class of 2028

Saima Wase, MD PGY2, Class of 2027 Scott Lamm, MD PGY2, Class of 2027

Elizabeth "Liz" Crowder, MD PGY1, Class of 2028 Zachary Elliott, MD PGY1, Class of 2028

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

ADMINISTRATION O

ur ENT admin team played a pivotal role in the Department of Otolaryngology’s numerous accomplishments and successes in FY24! This exceptional team of six women expertly coordinated, booked, and reimbursed over 100 domestic and international travels for more than 60 faculty members, fellows, residents, staff, scholars, and students. They were also key to academic achievements across five fellowship programs: Head and Neck, Plastics, Neurotology, Rhinology, and Pediatrics. Our fellowship coordinators not only onboarded the FY25 fellows but also supported them throughout the year, managing interviews and applicant selection to secure future fellows for these programs.

Ellen Doutt, our residency coordinator, was essential to the success of our residency program, overseeing the onboarding of a new class of residents. Ellen maintained constant communication with all 22 residents, guiding them through each unique year of their training.

Grace Senior, our Public Communications Specialist, spearheaded numerous projects throughout the year. She managed our daily social media content across multiple platforms and coordinated beloved ENT events like the ENT Farm Day and Holiday Party, bringing us all together. Grace is truly an invaluable asset to our team and Department!

We have also welcomed Dana Clifton as the new Associate Chair for Administration for the Department of Otolaryngology/Head and Neck Surgery. Her expertise and dedication to advancing our Department's mission will help us continue to provide exceptional care and innovative solutions to our patients.

Ellen Doutt My favorite star-struck moment was meeting and riding on the bus with the famous Mavis Staples of the Staple Singers.

She called me her “sister”, loved my boots, and told me stories of what it was like coming up in the music industry in the 60s and 70s, and beyond. She is a pure legend!

Danielle Pockett I love my cat, JoJo, and going to renaissance festivals.

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Crystal Boney I just made my 5 years with UNC. My favorite color is pink & I am an active volunteer in my community.

Ashlee Lo My left foot is bigger than my right foot. I am the middle child of 5 total children. I graduated from UNC with a B.S. in Statistics & Analytics.

Joy Maxwell In addition to working with ENT, I am also working on getting my master's degree right now.

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

QUALITY IMPROVEMENT The Department is pleased to be amongst the top performing in: o Mortality (0.17) o Length of Stay (1.27) o Readmissions Rate (4.5%) o > 4300 cases FY24 Quality Improvement Projects: o Optimization of Enhanced Recovery After Surgery Pathway (ERAS) for HN surgery patients, results of which were recently published. As a multidisciplinary effort between Anesthesia, Otolaryngology, Pain Management, Speech/language Pathology, an ERAS pathway was developed for patients undergoing laryngectomy or partial glossectomy with flap reconstruction, as this population of patients typically require complex post operative care, average a LOS of >7 days and share similar perioperative morbidities and risks. Current work is underway, lead by our APPs, to optimize and revamp the pathway. o Opiod Driven QI Projects o Implementation and Optimization of Comprehensive Inpatient Multimodal Pain Management Protocol (protocol and publication references below) o A multidisciplinary working group including anesthesia, chronic pain, otolaryngology, pharmacy and nursing researched and designed a multimodal pain management regimen for inpatient and outpatient procedures. o Readmission Nomogram Project to help identify at risk patients for readmission o Retrospective project study evaluating readmissions of UNC otolaryngology patients over a 5-year period. Patient demographics, co-morbidities, risk factors, perioperative data were analyzed to determine factors associated with readmission. Among 365 discharges, 21 patients had unplanned readmissions within 30 days. On univariable analysis, acute myocardial infarction, number of total comorbidities, prior chemotherapy/radiation, active smoking, airway surgery, and enteral feeding, and on multivariable analysis, prior chemotherapy/radiation and active smoking were identified as significant readmission risk factors. Readmission risk increased from 2.43% to 7.48% and 41.67% with the addition of each risk factor.

Inpatient Length of stay Reduction Projects: o Enteric feeding optimization project for inpatients after major HN surgery– This retrospective project examined the utilization of gastrostomy tubes after major head and neck surgery, and included free flap reconstruction, including days to oral diet, date of g-tube placement and length of stay. The intent of the project is to identify patient populations at high risk for g-tube P51

UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

QUALITY IMPROVEMENT placement needs, so as to allow for either 1) earlier g-tube placement in the post-operative setting or 2) arrangement for discharge home with NGT, and thereby expedite discharge of the patient home to reduce LOS and increasing virtual bedspace for new patients. o Patient Education Project– After querying free flap patients and their families/support systems at discharge about their preparedness for the surgery and the perioperative course, educational content was developed for patients and families, initially delivered in clinic to the patient at the first encounter. The patients/families received a follow up phone visit with a head and neck APP to review the upcoming surgery, operative course and perioperative plan with emphasis on to improving patient experience and understanding, and optimization of perioperative convalescence.

The Pediatric Otolaryngology Division is working jointly with pediatric Pulmonary on optimizing evaluations for pediatric tracheostomy placement. A clinical pathway is proposed:

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

COMMUNICATIONS

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

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UNC Department of Otolaryngology ⁄ Head and Neck Surgery 2024 Annual Report

MOVING FORWARD...

A

dvancing complex, state of the art otolaryngology care in the Triangle with new clinics opening throughout the region--Check!

Providing state of the art audiology assessments for children around the state of North Carolina with the first mobile testing facility of its kind--Check!

Providing nationally recognized best in class otolaryngology care to North Carolinians--Check!

Over this last year, UNC Otolaryngology/Head and Neck Surgery has made great strides in advancing our tri-partite mission to provide internationally recognized, outstanding clinical care to the people of North Carolina; to educate our next generation of physicians in Otolaryngology; and to do research which helps to treat or cure diseases of the head and neck.

And this next year only looks brighter!

As patients, physicians, and contributors, thank you for supporting the UNC Department of Otolaryngology/Head and Neck Surgery in helping to achieve our missions. Together, we are improving the health of the Triangle, North Carolina, and beyond!

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2023-2024 Annual Report UNC Department of Otolaryngology ⁄ Head and Neck Surgery