Duke Head and Neck Surgery & Communication Sciences Newsletter - 2018 by Duke Surgery

MARCH 2018

CONNECTIONS Inside Head and Neck Surgery & Communication Sciences Global Leader in Promoting Healthier Connections with the World

Duke Hearing Center

Large-Scale, Collaborative Effort Could Help Ease Global Hearing Loss Better Screenings and Processes for BPPV Could Prevent Unnecessary Testing Comprehensive Otolaryngology

First Inspire ÂŽ Upper Airway Nerve Stimulator in North Carolina

OUR MISSION

Message from the Chief The spirit of innovation and collaboration is alive and well at Duke. Head and Neck Surgery & Communication Sciences has not shied away from big issues, such as the growing burden of disability associated with hearing loss across the globe, the growing consequences and risk of falls among our aging population, and the mitigation of childhood hearing loss and its disparate impact on communities based on socioeconomics and geography. Building on a tradition of excellence in patient care and teaching, the division is bringing to bear Duke’s rich tradition of discovery to address persistent challenges that head and neck disorders pose to survival and quality of life. This requires careful collaboration with our colleagues both within and outside the Duke Health System.

Our Audiology partners are expanding their options for hearing care services by unbundling device and service costs. This has markedly expanded options for different budgets. We aim to be a reliable and valued partner to primary care and otolaryngology–head and neck surgery practices throughout the region through our education and service missions, and the continuous improvement of our access and customer service. In this issue, you will learn about a sample of our division’s efforts to advance knowledge and practice, and our impact on patients. Changing Healthcare As healthcare providers, we are motivated by the desire to relieve suffering and restore function, and by an overriding ethos of service and humanitarianism. Within the reality of

Faculty and alumni at the 2017 Graduation and Alumni Weekend.

CHIEF’S MESSAGE

a complex healthcare system, changing incentives, administrative demands, and real or perceived barriers can shape these aspirations. We are currently in a period of unprecedented shifts in the incentives and rules that regulate our profession, and they require significant changes in how we think about and structure our clinical practice. The dominance of Medicare as the single largest payer of healthcare services has made the federal government an influential force in healthcare. In an effort to control rising healthcare costs, for example, lawmakers on both sides of the aisle have dramatically altered the practice landscape by pegging Medicare reimbursements to the quality and cost-effectiveness of care by passing the Medical Access and CHIP Reauthorization Act (MACRA) in 2015. Value-based reimbursement requires infrastructural investments and team-based collaboration across the continuum of care. Anticipated economies of scale and improved negotiating power have accelerated the pace of consolidation in the healthcare marketplace. Academic medical centers and health systems such as Duke are not exempt from these forces and have a unique part to play in defining best practices and their cost-effective implementation in the populations that we serve. In addition to ensuring the best outcomes of our individual patients, we must also concern ourselves with the overall health outcomes of populations. How can we be an asset to our patients while also realizing system-wide cost savings that allow us to invest in our missions? This alignment of cost savings, better patient outcomes, and the creativity and innovation that this

CONTENTS all requires places Duke HNSCS in a unique position to lead through scholarship and innovation at this time of great change. The Division’s Charge As a division, we are well-suited to meet this new challenge and opportunity by building on our legacy of collaboration in education, health services research, and high-quality care. Given our strong record of accomplishment in communitybased and database research, the division is poised to lead the field into a brave new world of value-based reimbursement and population health. In addition to providing a model of tertiary and quaternary care, we are also called upon to collaborate with community-based otolaryngologists, audiologists and speech and language pathologists as well as primary care providers, to establish management pathways that permit delivery of the appropriate level of care in a timely fashion. We also remain committed to developing leaders by providing premier training of residents, fellows, audiological fellows, and speech-language pathology fellows. We are ready to take this mantle of leadership, and we will do so by engaging a rich array of intellectual resources in the Division, the Department of Surgery and Duke University. We are enhancing investments in clinical research infrastructure and the strategic coordination of team research and faculty mentorship. We are actively collaborating with other entities at Duke to expand the institution’s commitment to programs of discovery and innovation that

positively impact disorders of communication and of the head and neck region. These efforts include joint recruitment of new faculty members, developing new programs that will increase the pipeline of solutions to old problems, and effective implementation of these solutions for better clinical and population health outcomes. We are excited by these new initiatives but also realistic that they will take time to bear fruit. Maintaining Purpose We are excited by the opportunity to help reshape the practice of otolaryngology–head and neck surgery, and multidisciplinary communication care in the new practice paradigm, bringing to bear the full spectrum of skillsets at Duke. We must never forget, however, the central tenets of our professional existence, which is to put forth our best efforts on behalf of our patients, to support our colleagues in achieving the highest level of performance, and to bring forth new knowledge and perspectives that advance all of our efforts to fight the scourge of disease. We are grateful for our team of nurses, APPs, and staff assistants, and all members of the Duke family. We value the partnership of our alumni and community of like-minded collaborators, including providers and patients, who have the wherewithal to help us realize these lofty goals. Sincerely,

Chief’s Message

Hearing Center

Rhinology and Endoscopic

Skull Base Surgery Speech-Language Pathology

Duke Cancer Institute Head

and Neck Oncology Pediatric Otolaryngology

HNSCS APPs

Duke Voice Care Center

Facial Plastic and

Reconstructive Surgery Durham VA Medical Center

Comprehensive Otolaryngology

Nurses, Coordinators, and

Managers HNSCS Research

Friends of HNSCS

Residency Program

HNSCS Alumni

Community Outreach

Research Publications

OUR MISSION To Be a Global Leader in Promoting Healthier Connections with the World through: Compassionate care for our patients, their loved ones, and each other Advancing and sharing knowledge in the field Promoting virtuous professional development,

Howard Francis, MD, MBA, FACS

collaboration, and leadership

CONTENTS

MULTISPECIALITY CLINICAL CARE

Large-Scale, Collaborative Effort Could Help Ease Global Hearing Loss

Rising rates of hearing loss demand better access to preventions and treatments A team of hearing experts at Duke University School of Medicine and the Duke Global Health Institute (DGHI) is calling for a comprehensive, worldwide initiative to combat hearing loss. The percentage of people worldwide with hearing loss has been on the rise, increasing from 14 percent to 18 percent over the past 25 years. Recent data estimate half a billion people worldwide have moderate to severe hearing losses. “The trend is ever-upward, despite many efforts that have been mounted worldwide to rein in the growing burden of hearing loss,” said Blake Wilson, PhD, Adjunct Professor in the Department of Surgery at Duke and a DGHI affiliate. “Thus far, those efforts have not put a dent in the problem’s growth and so something more is needed.” The issue is one some U.S. lawmakers have recently 4

HEARING CENTER

Amara Omeokwe Duke Health News

acknowledged. For example, a proposal introduced in the House of Representatives in March calls for the Food and Drug Administration (FDA) to increase accessibility to some hearing aids by allowing them to be sold overthe-counter.

similar program for hearing. It would

Such measures hint at the scope of the problem. In a review article published July 10 in The Lancet, Wilson and colleagues highlight accessibility to screenings, treatments, and preventive measures as keys to stemming the rise of hearing loss not only in the United States, but across the world.

and hopefully including other such

They also offer VISION 2020, the global campaign launched by the World Health Organization and the International Agency for the Prevention of Blindness in 1999 to eliminate avoidable blindness by 2020, as a model for a global hearing loss initiative. “Efforts to combat hearing loss have not been particularly well-coordinated on a global scale,” Wilson said. “That is why the VISION 2020 partnership offers a compelling template for a

provide a focus for support and facilitate the needed efforts.” The authors suggest that the initiative could tap into resources at global health institutes and centers at universities, starting at Duke resources worldwide. “Hearing loss awareness has increased, but prevention and treatments are not regarded as urgent in many places, especially among lowand middle-income countries,” added Debara Tucci, MD, Professor of Surgery and Director of the Cochlear Implant Program at Duke and a DGHI affiliate. “A large-scale, coordinated, global initiative could help to change that.” Howard Francis, MD, MBA, Chief of the Division of Head and Neck Surgery & Communication Sciences, hopes that Duke can take the lead in reducing the burden of hearing loss globally by leveraging the credibility of the institution to enlist corporate and philanthropic support.

”The call to action in this article provides a watershed opportunity in the history of hearing health by presenting a feasible roadmap to marshal disparate global endeavors into a coordinated and effective strategy,” Francis said. “Duke’s legacy of successful collaborations in global health, biomedical engineering and clinical research equips us to serve as a valuable partner with other stakeholders in this global initiative.” Like the proponents of the hearing aid proposal in Congress, the authors emphasize the need to improve access to treatments for hearing loss, particularly through the use of low-cost, tech-savvy interventions. In their report, they highlight recommendations from prior research they believe could be particularly effective if implemented, including: •

•

Reducing treatment costs by using smartphones for hearing assessments, assisted-hearing devices, and telemedicine, particularly in low- and middleincome countries; Increasing access to immunizations in low- and middleincome countries for diseases that cause hearing loss;

From Words to Action: Improving Hearing Loss Screening for Newborns in Kenya Debara Tucci, MD, has partnered with colleagues in Nairobi, Kenya, to develop a hearing screening program for newborns, putting into practice the research published on the global epidemic of hearing loss in The Lancet. With over half a billion people in the world suffering from disabling hearing loss, developing a new infrastructure with better screening is an important step to improving health conditions, especially in developing areas. “I work with an excellent audiologist, Serah Ndegwa, as well as two otolaryngologists—Professor Isaac Macharia and John Ayugi, MD—who are very committed to providing hearing health care in Kenya,” Dr. Tucci says. She and Ms. Ndegwa have trained nurses on how to conduct screening tests, an essential element to enacting lasting change. “We have screened thousands of children at Kenyatta National Hospital at the University of Nairobi,” Dr. Tucci says, “and we have hearing aids ready to fit them, if they need it.”

“One of the difficulties with screening newborns in developing countries has been that the majority of births have been at home,” says Dr. Tucci. “Since these countries often have large rural populations, screening newborns is logistically difficult. But in Kenya, more and more births are taking place in the hospital, increasing the impact of a hospital-based newborn hearing screening program. We also work with immunization clinics, which are the first point of care for many children.” The next step is to identify newborns who are candidates for cochlear implants, and to continue education and training for physicians and other professionals in Kenya, a country with few audiologists and speech therapists. Sponsors MED-EL and Natus have made the one-year pilot possible, contributing the funding for salaries, data collection and analysis, and equipment and supplies.

Nurses screen a newborn patient at Kenyatta National Hospital, Nairobi, Kenya.

Increasing awareness about damagingly loud sounds from headphones and a multitude of other sources, particularly in middle- and high-income countries.

“These actions are relatively inexpensive and they show that unprecedented opportunities are available to increase access to hearing healthcare worldwide,” Wilson said. In addition to Wilson and Tucci, authors include Michael Merson, MD, Wolfgang Joklik, Professor of Global Health at Duke, and Gerard O’Donoghue, MD, Professor of Otology at the University of Nottingham in the United Kingdom. HEARING CENTER

MULTISPECIALITY CLINICAL CARE (top row, left to right) HEARING CENTER FACULTY AND STAFF

Howard Francis, MD, MBA Professor of Surgery

Alex Berlin, MS AuD Resident (not pictured)

Michelle Hicks, AuD

Debara L. Tucci, MD, MBA, MS

Erin L. Blackburn, AuD, CCC-A

Newborn Hearing Screening Coordinator

Professor of Surgery Co-Director, Cochlear Implant Program

Susan Emmett, MD, MPH

Associate Professor of Surgery and Global Health

David M. Kaylie, MD, MS

Associate Professor of Surgery

Calhoun D. Cunningham III, MD Associate Professor of Surgery

Joshua F. Smith, MMS, PA-C (second row, left to right) Audiologists Andrea Bailey, MA, CCC-A

Director of Audiology Services

Laura Barth, MS AuD Resident (not pictured) Susan Bergquist, MS, CCC-A Senior Clinician (not pictured)

Co-Director, Cochlear Implant Program

(not pictured)

Rebecca Kane, AuD, CCC-A

Diane Catalano, AuD, CCC-A

Daniel M. King, AuD, CCC-A

Clinical Specialist - Audiology

Clinical Director of Audiology

Richard Clendaniel, PT, PhD

Ann Mabie, MSPA, CCC-A

Head of Vestibular Therapy

(not pictured)

Cleft/Craniofacial Team Coordinator

Kensi Cobb, PhD, AuD, CCC-A William Dillon, AuD, CCC-A Senior Clinician

Christy Holmes, AuD, CCC-A

(not pictured)

Sara Pastoor, AuD, CCC-A (not pictured) Noelle Radko, AuD, CCC-A

Rebecca Doll, MA, CCC-A

Elizabeth Rooney, AuD, CCC-A (not pictured)

Graciela DeAngelis LaVack, MEd, CCC-A (not pictured)

Kristal Riska, AuD, PhD

Clinical Coordinator-Audiology

(bottom row, left to right)

Krista Roper, AuD, CCC-A Senior Clinician

Doug B. Garrison, AuD Director, Vestibular Lab

Karma Tockman, MA, CCC-A Senior Clinician (not pictured)

Hannah Heet, AuD, CCC-A (not pictured)

Holly VanHorn, AuD, CCC-A Senior Clinician (not pictured)

Course Trains Residents from Three Medical Centers

HEARING CENTER

The 4th Annual Duke–MUSC–Wake Forest resident temporal bone dissection course was held on December 8–9, 2017, directed by Calhoun D. Cunningham III, MD. The two-day course focused on temporal bone anatomy, hearing loss, and chronic otitis media, with hands-on training in the temporal bone dissection lab.

Improving Care for Children in Need of Cochlear Implants Each year in North Carolina ,120,000 children are born, and 3% of those children are born with some form of permanent hearing loss. While not all are eligible for a cochlear implant, all children with hearing loss can benefit from therapy and treatment. Duke is currently researching methods of expanding its model of pediatric surgery, audiology, and speech- language care to better meet the needs of diverse patients across the state. During the second half of 2017, the Division of Head and Neck Surgery, under the leadership of Chief Howard Francis, conducted internal and external assessments across North Carolina, determining what needs exist and how Duke can best offer support to local providers. When a child is in need of a cochlear implant,

often the greatest barriers are not within the operating room, but in how to connect the child to care. Few centers exist across the state that can provide treatment, so transportation, missed work, and follow-up therapy are often troublesome for patients with limited means. While the assessments revealed a clear area of need, a feasible solution will take time to develop. Through maximizing systems already in place and building new partnerships, Duke can create a stronger network of care for its pediatric patients. The goal of the expansion is to increase opportunities for parents to connect their children to care and to receive follow-up treatment. Over the next year, the team will explore the best avenues to achieve this goal.

Aural Rehab Bridges Gap Between CI Dreams and Reality Speech pathologists, cochlear implant (CI) audiologists, and surgeons at Duke work closely with CI patients of all ages to help them meet their hearing goals. Many times, patients’ expectations do not match up with the immediate outcomes after surgery. The members of the Duke CI team, each with unique roles, work with these patients to maximize listening and their ability to participate in social interactions. After CI activation, the speech pathologist is the team member who creates an individualized treatment plan based on the patient’s personal listening goals. In conjunction with treatment, the speech pathologist

also encourages recipients, monitors progress, builds confidence, and provides motivation and accountability. The speech pathologist’s goal in therapy is to merge what is important to the recipient with practical activities to improve listening. Frequently, recipients want to be able to have conversations with family or friends, attend live theater, listen to and enjoy music, or talk on the phone successfully. These activities are broken down into therapy tasks that the recipient can work toward using different strategies found to be effective in the process.

Blake Wilson, PhD, displaying a cochlear implant.

AURAL REHAB STRATEGIES FOR ADULTS 1. Brainstorm and implement creative, functional ways the recipient can compensate for issues that arise. 2. Discuss environmental modifications that can be made to maximize listening in different real-life settings. 3. Focus on technology and how to best use the devices they own to augment listening. 4. Identify and drill listening skills to practice the sounds they need to achieve their listening goals. 5. Support, motivate, and encourage at their current level and help define their goals. Receiving a CI is a routine surgical intervention that can dramatically improve hearing, but for many patients, surgery coupled with aural rehabilitation can make the recipient’s real-life dreams regarding a CI a reality. HEARING CENTER

MULTISPECIALITY CLINICAL CARE

In the last three years, Rhinology and Endoscopic Skull Base Surgery has grown significantly in clinical volume with over 350 surgeries each year, including 100 procedures for skull base tumors. Clinical research has been presented at national and international meetings, including research on chronic rhinosinusitis in the lung transplant population and quality of life and olfactory outcomes after skull base surgery. The section also offers a one-year post-graduate fellowship.

Specialists Often Necessary for Complicated Diagnoses Juvenile Nasopharyngeal Angiofibroma Mr T., a healthy 28-year-old patient, had progressive nasal obstruction 10 years ago. When he started having recurrent episodes of severe epistaxis that prompted multiple trips to the emergency room, his doctor decided to get imaging of the nasal cavity and skull base. The scans revealed a tumor the size of an apple, located at the base of his skull and protruding into his nasal cavity. The doctor diagnosed Mr. T. with a juvenile nasopharyngeal angiofibroma. Local ENT doctors were apprehensive about removing the tumor, especially since Mr T. is a Jehovahâ&#x20AC;&#x2122;s Witness. His religious beliefs prohibit him from accepting

blood transfusions, no matter how dire the circumstances. Mr T. was referred to Dr. Ralph Abi Hachem, a fellowship-trained rhinologist and skull base surgeon at the Duke Skull Base Center, who explained that it was possible to surgically remove his tumor with minimal blood loss. With his colleague, Duke neurosurgeon Dr. Ali Zomorodi, Dr. Abi Hachem performed

Sagittal MRI with contrast showing 5 x 7 cm tumor, avidly enhancing with flow voids, extending into the nasal cavity and infratemporal fossa

a complete resection of the tumor through the endonasal endoscopic approach. Mr T. was discharged from the hospital on the second postoperative day with no external incisions and preservation of all of his major nerves and blood vessels. He was able to return to his normal life and activities almost immediately after the surgery. One year later, he was

Postop MRI showing no sign of residual or recurrent tumor

Recalcitrant Nasal Polyp Disease Although healthy her entire life, patient Martha M. developed severe nasal congestion, anosmia, and wheezing in 2014. Examination by an otolaryngologist revealed nasal polyps. She was subsequently diagnosed with aspirin-exacerbated respiratory disease (AERD) and underwent functional endoscopic sinus surgery (FESS) followed by aspirin desensitization. However, her

symptoms recurred within months

she started budesonide drops twice

of surgery. She was prednisone-

daily and started aspirin desensitization

dependent and had gained significant

at the Duke Asthma, Allergy, and Airway

weight by the time she presented to

Center.

Duke University Otolaryngology Clinic

Preoperative CT scan

Postoperative photos

for a second opinion.

Because she did not respond to

Since then, she has been off of oral

steroids and has been symptom-free with no evidence of polyp recurrence at

topical and oral steroids, the patient

her two-year follow-up visit.

underwent revision surgery with Dr.

David Jang in 2015. Postoperatively,

especially that associated with AERD,

RHINOLOGY AND ENDOSCOPIC SKULL BASE SURGERY

Recalcitrant nasal polyp disease,

Better Screenings and Processes for BPPV Could Prevent Unnecessary Testing

doing well with no recurrence on MRI. Nasal cavity and skull base tumors can be challenging to treat given their location and proximity to critical structures. At the Duke Skull Base Center, patients benefit from a multi-disciplinary team, which includes highly trained surgeons, radiation oncologists, and a dedicated nurse navigator.

FACULTY

David W. Jang, MD

Assistant Professor of Surgery

Ralph Abi Hachem, MD, MSc Assistant Professor of Surgery

can be a frustrating problem for otolaryngologists and their patients. At Duke University, patients benefit from multidisciplinary care that includes revision surgery, an individualized medication regimen, and long-term follow-up with a fellowship-trained rhinologist. Moreover, patients benefit from the expertise of allergists and pulmonologists at the Asthma, Allergy, and Airway Center who can initiate aspirin desensitization, immunotherapy, and monoclonal antibody therapy when appropriate. Over the last four years, Dr. David Jang has performed surgery for over thirty patients with AERD. With mean follow-up of about two years, only two patients have required a subsequent surgery.

Kristal Riska, PhD, Medical Instructor in the Department of Surgery, believes a better screening process in the ER and by primary care physicians could help patients suffering from benign paroxysmal positional vertigo (BPPV) to access rehabilitation more quickly, and prevent costly additional testing. Furthermore, this research may help prevent falls in the most vulnerable patients. Dr. Riskaâ&#x20AC;&#x2122;s research interests focus on patients with inner ear conditions that contribute to symptoms of vertigo. Frequently, when a patient with BPPV presents to their primary care doctor or emergency medicine, the main complaint is dizziness/vertigo. While this is a symptom of a variety of ailments, BPPV exhibits stereotypical conditions: sudden, brief spells of vertigo often triggered by movements or certain positions of the head. Though disorienting to the patient, BPPV is easily treated through a variety of processes collectively known as Canalith Repositioning Procedures (CRP). The condition occurs when otoconia, small crystals of calcium carbonate attached to the utricle of the ear, become detached and migrate into the semicircular canals. When the patient moves their head in a

specific manner, the otoconia will displace the fluid in the semicircular canals, sending false signals to the brain and triggering dizziness. CRP treatment involves maneuvering the patientâ&#x20AC;&#x2122;s head and using gravity to return the crystals to the proper location in the inner ear. In an ideal scenario, a patient would present to the ER or their physician, be diagnosed, and be treated for BPPV bedside in a procedure requiring no special equipment and taking less than five minutes. The problem, however, is that BPPV often goes misdiagnosed, or is not identified until patients undergo extensive and often expensive tests resulting in several thousand dollars in cost. The solution is to create a better screening process to be used in emergency medicine and by primary care physicians. Because the symptoms of BPPV are easily defined, a symptoms-based questionnaire screening could be used for patients, and treatment or a referral could be provided. The project is still in its infancy stage. Dr. Riska is currently engaging with frontline providers through surveys to determine the most effective mechanisms to facilitate identifying cases of BPPV in a way that fits naturally with clinical flow. This qualitative assessment will help inform a grant proposal focused on assessing the effectiveness and implementation of a symptoms-based questionnaire as part of BPPV screening process. If successful, this work may improve access to timely rehabilitation and prevent BPPV patients from receiving dizzying medical bills from unnecessary testing.

HEARING CENTER

MULTISPECIALITY CLINICAL CARE

New Devices Seek to Improve Respiratory Muscle Training Research Speech Pathology at Duke uses respiratory muscle training with a wide variety of patient populations, including patients with dysphagia, obstructive sleep apnea, vocal cord dysfunction, amyotrophic lateral sclerosis (ALS), tracheostomies, lung transplant, failure to wean from the ventilator, and geriatric patients in preparation for surgery.

Respiratory muscle training, or RMT, is a technique used to strengthen the breathing muscles when they become weakened from disease or surgery. Most RMT exercises use devices that add resistance to inhalation or exhalation, but these devices are currently limited in functionality. Harrison Jones, PhD, SpeechLanguage Pathologist and Associate Professor in HNSCS, and Matthew Brown in Biomedical Engineering were driven by limitations in the currently available technology to develop two new devices with applications in RMT research and clinical practice. The devices have earned provisional patents and are being used in an NIHfunded clinical trial at Duke evaluating the effects of RMT in patients with lateonset Pompe disease. The first invention, currently known as the Reverser, is a custom adapter for use with commercially available RMT devices. Typically, RMT is provided

Senior lab administrator Matthew Brown demonstrating the RMT monitor. Courtesy of Duke Health Photography.

SPEECH-LANGUAGE PATHOLOGY

with the use of handheld devices that provide resistance during either inspiration or expiration. The Reverser allows inspiratory-type devices to be used to provide expiratory resistance and vice versa. The researchers’ second invention is the RMT monitor, a handheld unit that integrates with commonly used RMT devices to offer enhanced functionality. Features of the RMT monitor include automated data collection, enhanced control over RMT dose and regimen, and delivery of feedback to the user regarding their performance. “The Reverser allows RMT to be completed across the whole range of human performance,” Dr. Jones says. “For example, there are substantial limitations in terms of inspiratory-type RMT devices that offer medium to high resistance. This invention allows us to quickly and easily adapt medium to high resistance expiratory-type devices

Speech-Language Pathologists

CLINICAL DIRECTOR

“The RMT monitor was developed to address a different problem,” Dr. Jones says. In his pilot study to assess the effects of RMT in patients with late-onset Pompe disease, participants completed a home-based training regimen and recorded their adherence in a log. However, he soon recognized the need for an automated tool that could collect more precise quantitative adherence data.

PROFESSOR

ASSOCIATE PROFESSOR

Frank DeRuyter, PhD

Harrison Jones, PhD

CLINICAL SPECIALISTS

CLINICAL COORDINATORS

Carlee Jones, MS

Kelly Gordon, MS

Lindsay Dutko, MA

Barron Suarez, MS

Jenny Kern, MS

Megan Urban, MA

In response, Dr. Jones and Brown developed the RMT monitor. This invention provides auditory and visual feedback to the user as to whether an individual RMT repetition has been successful, and tracks the number of repetitions remaining. The device also allows improved control over the RMT regimen by allowing the duration and frequency of rest periods between individual and sets of repetitions to be programmed. The device has an automatic shutoff feature that’s deployed when the user has completed their repetitions for the day in order to prevent overtraining.

Jen Blum, MA

Deborah McMechan, MA

Dianamari Castillo-Ruiz, MS

Meredith Nye, MS

Kelly Crisp, MA

Melinda Roman, MA

Karen Everitt, MS

Janet Strollo, MS

Katie Flynt, MS

Jamie Thomson, MS

Lauren Gardner, MS

Dina Vallabh, M.Ed.

Julie Garris, MS

Lauren Wick, MS

Joy Kerner, MA

Christine Wilkie, MA

for inspiratory training and expand the training range.”

Dr. Jones anticipates that in the future, the two devices will have a wide range of applications: “These technologies could be used in wideranging patient populations, including those with pulmonary diseases like chronic obstructive pulmonary disease and pulmonary fibrosis or neuromuscular diseases like ALS and Pompe disease. There is also increasing use of RMT in patients with upper airway disorders like obstructive sleep apnea. Patients with speech, swallowing, and voice disorders may also benefit. Ultimately, my hope is that these inventions will enhance the overall use of RMT in both the clinic and the lab.”

Kimberly Irby, MS

SENIOR CLINICIANS

CLINICAL SPEECH PATHOLOGISTS Brian Bacchi, MS

Jillian Nyswonger, MS

Olivia Beasley, MS

Sarah Plascyk, MS

Katie Broadwell, MS

Kimberly Powell, MS

Ashley Edds, MS

Omnia Radwan, MEd

Nicole Frisco, MS

Haley Reiff, MS

Jennifer Jurgenson, MS

Leigh Shepherd, MEd

Jenna Kneepkens, MS

Lucia Smith, MS

Katherine Loebner, MS

Jacquelyn Vorndran, MA

Lanif Lopez, MA

Milisa Batten, MS

Jennifer Lord, MSC

Megan Lynch, MA

Chelsea Kildow, MS

Jill Marcus, MA

Katie Kommer, MA

Bethany Robeson, MS

Kelsie Mitchell, MS

Megan Theiling, MSP

Cindy Murashima, MS

Jacqueline Vanderbilt, MS

Kaylea Nicholson, MA

Anna Weinberg, MS

SPEECH-LANGUAGE PATHOLOGY

MULTISPECIALITY CLINICAL CARE

Tailored Treatment for Head-and-Neck Cancer Mystery Rob Vaughn found a lump on his neck that turned out to be cancer that had spread from somewhere else in his body. The trouble was, doctors couldn’t find the original site of the cancer. That made his treatment decisions difficult—until two Duke specialists offered him options, including the option for watchful waiting instead of extensive treatment. Photo courtesy of Duke Photography.

A Search for the Source of Cancer Rob Vaughn, a Charlotte, NC, father of two, was 47 and in good health when he felt the lump on his neck, just above his left collarbone. It turned out to be a tumor in a lymph node. He had it removed, and the pathology report showed it was squamous cell carcinoma—a type of cancer that usually starts on your skin or in your mouth or throat. Tests also showed that the cancer had spread beyond the lymph node, so Vaughn would need follow-up treatment. Knowing where the cancer had started could help doctors determine the best way to treat it. Vaughn traveled to some of the best-known cancer centers in the U.S., undergoing tests and looking for answers. He even had his tonsils removed as a preventive measure. “Nobody seemed to know where the cancer started,” he

said. “So there were differing opinions on what course of treatment to pursue.” Still unsure but wanting to take the most cautious approach, Vaughn scheduled surgery followed by radiation at a cancer center far from home. Because there was no specific cancer site to target, the radiation would cover a large part of Vaughn’s mouth and throat. Search Leads to Duke Head and Neck Cancer Specialists Before his surgery date—and for the second time since his odyssey began—someone suggested Vaughn see Duke radiation oncologist David Brizel, MD. Dr. Brizel reviewed Vaughn’s test results and treatment plan, and the extent of the planned radiation concerned him. “Radiation therapy causes lots of side effects during treatment, and it can cause

DUKE CANCER INSTITUTE HEAD AND NECK ONCOLOGY PROGRAM

lots of long-term side effects as well,” he said. Side effects can range from a severe sore throat—making it painful to eat, drink, and swallow—to loss of taste to ongoing dry mouth, which increases the risk for dental diseases and infections. Dr. Brizel brought in Duke Head and Neck cancer surgeon Walter T. Lee, MD, MHS, to collaborate on Vaughn’s case. Teaming Up to Find the Right Treatment Together the doctors searched for the primary cancer. Each time, Vaughn’s tests came back negative. At that point, the doctors theorized, “as likely as not, this was a skin cancer that either originated in the location where Mr. Vaughn first felt it, or it started somewhere on his face and spontaneously regressed—which can happen,” said Dr. Brizel.

FACULTY

(top row, left to right)

(bottom row, left to right)

Surgical

Radiation Oncology

Medical Oncology

Ramon M. Esclamado, MD, FACS

David M. Brizel, MD

Jennifer Hsing Choe, MD, PhD Medical Instructor of Medicine

Richard H. Chaney, Sr. Professor

Daniel J. Rocke, MD, JD

Assistant Professor of Surgery

Walter T. Lee, MD, MHS

Associate Professor of Surgery and Radiation Oncology

Russel Roy Kahmke, MD

Assistant Professor of Surgery

Leonard Prosnitz Professor of Radiation Oncology Professor in Surgery

David S. Yoo, MD, PhD

Neal E. Ready, MD, PhD Professor of Medicine

Assistant Professor of Radiation Oncology

Yvonne Mowery, MD, PhD Assistant Professor of Radiation Oncology

Liana Puscas, MD

Associate Professor of Surgery

If it was a skin cancer, removing

and testing additional lymph nodes in Vaughn’s neck might be the only treatment he needed. Dr. Lee performed the surgery, removing 30 lymph nodes. None tested positive for cancer.

That was good news, but it meant

Vaughn had a choice to make in terms of what to do next. He could choose the typical approach for “unknown primary” cancer: extensive radiation with the potential for long-lasting side effects. Or he could choose active surveillance in the form of frequent imaging tests. “We felt that, whatever the cancer was, it was very small,” said Dr. Lee. “With our current technology and PET scans, we could follow where this primary cancer might show up. If it ever did show up, we could catch it very early.”

The Choice to Watch and Wait Drs. Brizel and Lee explained the potential risks and benefits of each option. Vaughn was particularly struck by the fact that a radiation oncologist was suggesting he consider not having radiation therapy. Dr. Brizel says that’s essential to his role. “Whether you’re a radiation oncologist or a surgeon, it’s mandatory that you know how to do what you’re trained to do extraordinarily well,” he said. “But it’s equally important, whatever specialty you’re in, to know when not to do something.” Ultimately, Vaughn chose active surveillance. “I went back every couple of months at first, did some PET scans, had some other X-rays, and started alternating between seeing Dr. Lee and Dr. Brizel—which I still do today,” he said. Gradually,

the doctors increased the amount of time between scans, as the results continued to show no evidence of cancer. More than four years later, Vaughn remains in good health. He enjoys a variety of activities, including playing football and racquetball with his kids, and coaching their basketball and baseball teams. Looking back on his experience with Drs. Brizel and Lee, Vaughn said, “What I appreciated was not only the collaborative effort, but also the creative thinking—the recognition that, while certain treatments may be more likely to knock out a cancer, everything has consequences and they needed to weigh the pros and the cons and come up with a course of therapy that made sense for me as an individual. I really appreciated that.”

DUKE CANCER INSTITUTE HEAD AND NECK ONCOLOGY PROGRAM

MULTISPECIALITY CLINICAL CARE

Optical Endoscopes Offer a Clearer Picture in Pediatric Middle Ear Surgery

The practice of ear surgery

For children, use of the optical

has long been the domain of the

endoscope for middle ear surgery

operating microscope. The view

has further significant benefits. Given

during microscopic surgery is limited

that the ear canal is often smaller in

by the narrowest segment of the ear canal, which results in limitations in exposure and access to the middle ear space. This basic limitation has forced surgeons to create a parallel port through the mastoid to gain keyhole access to the attic, the facial recess, and the hypotympanum. In contrast, transcanal operative

children, this technique allows for improved exposure, magnification, and illumination for transcanal approaches to the middle ear space. Besides avoiding a postauricular incision with its inherent downsides from scarring and pain from much more extensive soft tissue dissection, children are able to heal faster and with much less pain from a transcanal-only approach,

endoscopy bypasses the narrow

which is of significant postoperative

segment of the ear canal and provides

benefit.

a wide view that enables surgeons to

Often, even anteriorly based post-

look “around the corner,” even when a

tympanostomy tube perforations

zero-degree endoscope is used.

are able to be adequately visualized

Endoscopic view of the left tympanic membrane perforation

Endoscopic view of the left tympanic membrane underlay cartilage and Biodesign® Otologic Repair Graft

FACULTY

Eileen Raynor, MD

Associate Professor of Surgery and Pediatrics

Rose J. Eapen, MD

Assistant Professor of Surgery

Jeffrey Cheng, MD

Assistant Professor of Surgery and Pediatrics

Physician Assistant Laura Geraghty, BS, MPA, PA-C (not pictured)

PEDIATRIC OTOLARYNGOLOGY

from a transcanal approach with an endoscope, which may be much more challenging with an operating microscope without a postauricular incision or canalplasty. Jeffrey Cheng, MD, pediatric head and neck surgeon, has found optical endoscopes to be an effective part of his practice. “I have adopted this approach in my own clinical practice for the past several years and found it to be tremendously successful with my operative approach and clinical outcomes,” he says. “Families who have had children who have experienced both types of surgery are surprised and amazed at the difference in the postoperative experience.”

Endoscopic view of completed left tympanoplasty with overlay Biodesign® Otologic Repair Graft sandwiching underlay cartilage graft

Advanced-Practice Providers Improve Access to Care and Surgical Services Tami Runyan, PA-C, an Advanced-Practice Provider (APP) at Duke Otolaryngology in Raleigh, speaks to the importance of a collaborative approach between surgeons and APPs in Duke HNSCS. Access to medical care is a multifaceted subject of concern for medical providers, public health policy makers, and our patients. Compounding this issue is the concept of a looming physician shortage linked to an expanding and aging population in the United States.(1) In head and neck surgery, national health statistics and U.S. census data demonstrate an anticipated substantial increase in the workload for surgeons. Calls for efforts should be directed toward assessing manpower requirements in head and neck surgery based on the impact of an aging U.S. population.(2) Such efforts

have called for collaborative practice utilizing Advanced Practice Providers.(3) Within Duke HNSCS, we have made it a priority to address and minimize delays to care, especially as many of our referrals are of an urgent nature given our surgical specialty. Duke HNSCS has three full-time APPs, all of whom are physician assistants. Each APP practices autonomously within a collaborative environment. Collectively, our APPs have over 35 years of ENT experience. Studies have shown that patients are satisfied with the care they receive from mid-level providers.(4) As APPs, we offer Duke HNSCS and its patients several benefits. Our APP data demonstrates that we provide improved access to care with wait times significantly decreased compared to other Duke specialty practices. With improved access to care, we make a difference in affecting outcomes in several ways: by directly treating

patientsâ&#x20AC;&#x2122; acute and chronic illnesses, consulting with surgeons to deliver comprehensive care, making appropriate in-house referrals, providing continuity of care within the practice, and, if surgery is indicated, shortening the wait time to the operating room by performing history, physicals, and diagnostic studies while coordinating care with the surgeon. 1. Bhattacharyya N. Involvement of physician extenders in ambulatory otolaryngology practice. Laryngoscope 2012;122(5):1010-3. 2. Bhattacharyya N. The increasing workload in head and neck surgery: An epidemiologic analysis. Laryngoscope 2011;121(1):111-5. 3. Reger C, Kennedy DW. Changing practice models in otolaryngology-head and neck surgery: The role for collaborative practice. Otolaryngol Head Neck Surg. 2009;141(6):670-3. 4. Hooker RS, Cipher DJ, Sekscenski E. Patient satisfaction with physician assistant, nurse practitioner, and physician care: A national survey of Medicare beneficiaries. J Clin Outcomes Manage. 2005;12(2):88-92. Photo: Matthew Ellison, MD, FACS, Assistant Professor of Surgery, discusses a patient case with Advanced Practice Provider Tami Runyan, PA-C.

HNSCS APPs

MULTISPECIALITY CLINICAL CARE

Timely Referrals to Voice Care Specialists Reduce Healthcare Costs and Improve Patient Quality of Life Our voices enable communication with other people—a unique signifier of each individual and often vital to our ability to interact with the outside world. Diseases of the larynx can disrupt this communication, as well as one’s ability to swallow and breathe. Laryngologists and speech-language pathologists are specially trained to diagnose, treat, and manage these voice and upper airway problems. Voice problems sometimes get better over time, but can develop debilitating and sometimes lifethreatening complications. Too often, the inability to identify which patients are most at risk causes long waits for voice care specialist referrals, often months after a patient seeks help. Two recent studies funded by the American Academy of Otolaryngology– Head and Neck Surgery and authored by Seth M. Cohen, MD, MPH, a laryngologist and Associate Professor of Surgery at the Duke Voice Care Center, examined this dilemma. Results indicate that accurately identifying at-risk patients and expediting referrals to voice specialists will significantly reduce healthcare costs and improve patients’ quality of life. To accomplish this, greater collaboration and communication across specialties and among specialists and primary care providers is needed, Dr. Cohen says. Published in Otolaryngology Head & Neck Surgery in April 2017, the first study showed that patients with voicerelated problems who saw physicians— including general medicine, allergists, pulmonologists, physical therapists, gastroenterologists, and neurologists— for periods of more than 30 days accrued more visits, procedure claims, and pharmacy claims than those with 30 days or less of voice-related health care. 16

DUKE VOICE CARE CENTER

Patients with laryngeal cancer and other disorders, such as thyroid and lung cancer, vocal fold paralysis, chronic laryngitis, and benign laryngeal/vocal fold pathology, had much longer periods of voice-related health care utilization, with some exceeding 90 days. Comparatively, those with less serious acute laryngitis and non-specific dysphonia generally used voice-related care services for 30 days or less. Patients with more serious conditions and certain comorbid diseases should be considered at risk and referred to a voice care specialist without delay. Patients 65 and older are also at higher risk of developing a chronic voice disorder and would benefit from being referred promptly. The second study, published in The American Journal of Medicine in April 2015, showed that patients referred to a voice care specialist within one month or less had significantly lower

utilization and health care costs than those referred after more than one month or more than three months. Cohen says that some patients should be referred automatically, such as those who depend on their voice for their livelihood. “Anybody who needs their voice for their job,” for example, teachers, singers, broadcasters, and others, “should be seen by a specialist sooner rather than later,” he says. An important mission of the Duke Voice Care Center is to educate providers and the public about the impact of voice problems on patients, the health care system, and society. “We take a holistic, collaborative approach to treating patients,” says Dr. Cohen. “We need to understand how care is delivered across specialties. We know that the longer it takes to see a voice care specialist, the more costly it is for everyone.”

Speech pathologist Leda Scearce, MM, MS, CCC-SLP, (left) and Seth Cohen, MD, MPH, Assistant Professor of Surgery, visit with patient Abigail Dowd, a folk singer who lives in Greensboro, at Duke Otolaryngology of Raleigh.

Clinical SpeechLanguage Pathologist Cristen Paige, MS, Joins HNSCS Cristen Paige, MS, CCC-SLP, joined the Duke Voice Care Center team as a clinical speech-language pathologist in August 2017 and was promoted to Senior Clinician in December 2017. Cristen received her bachelorâ&#x20AC;&#x2122;s degree in acting from Boston University in 1995. She was a professional stage actor and singer and performed in over 40 professional productions with a focus on musical theatre as a member of the Actorâ&#x20AC;&#x2122;s Equity Association.

(top row, left to right) FACULTY

David L. Witsell, MD, MHS Professor of Surgery Medical Director, Duke Voice Care Center

Seth M. Cohen, MD, MPH

Associate Professor of Surgery

Eileen Raynor, MD

Associate Professor of Surgery and Pediatrics

(second row, left to right) Leda Scearce, MM, MS, CCC-SLP

Duke Voice Care Center Speech-Language Pathology Staff Caroline Banka, MS, CCC-SLP Senior Clinician

Hilary Bartholomew, MS, CCC-SLP Clinical Speech-Language Pathologist

(bottom row, left to right) Lauren Lindigrin, MS, CCC-SLP Clinical Speech-Language Pathologist

Clinical Associate, Clinical Singing Voice Specialist, Director of Performing Voice Programs and Development, Duke Voice Care Center

Tara Nixon, MM, MS, CCC-SLP

Gina Vess, MA, CCC-SLP

Senior Clinician (pictured right)

Clinical Associate Director of Clinical Voice Programs, Duke Voice Care Center

Senior Clinician, Clinical Singing Voice Specialist

Cristen Paige, MS, CCC-SLP Emily Scheuring, MEd, CCC-SLP Clinical Singing Voice Specialist

Support Staff (not pictured) Karen Stark

Duke Voice Care Center Liaison

Briana Gift

Administrative Clerk

In 2013, she received a Master of Science degree in speech-language pathology at the University of North Carolina at Chapel Hill. She completed her clinical fellowship at the Vanderbilt Voice Center in Nashville, Tenn., and continued to work there after her fellowship ended. She directed both the Vanderbilt Voice Therapy Workshop and Stroboscopy Course. She has supervised several graduate student clinicians, some of whom are currently working as speech-language pathologists who specialize in voice. While in Nashville, she taught anatomy and physiology of the voice in the graduate vocal pedagogy program at Belmont University. Ms. Paige specializes in evaluating and treating all aspects of voice, including professional speaking and singing voice and voice rehabilitation after head and neck cancer treatment. Her current research interests include laryngeal movement disorders. She recently presented her work on Characterizing the Rate of Laryngeal Tremor at the Fall Voice Conference in Washington, D.C.

DUKE VOICE CARE CENTER

MULTISPECIALITY CLINICAL CARE

Distinct Approaches Form a Well-Rounded Team in Facial and Reconstructive Surgery Facial plastic and reconstructive surgery encompasses all reconstructive and aesthetic procedures in the head and neck. A team that can provide this comprehensive care is the cornerstone of a successful program. At Duke, we are fortunate to embrace this team-based approach in providing these services. Each of the key players in the subspeciality were asked to define their unique approach.

Russel Roy Kahmke, MD In addition to cosmetic outcomes, reconstruction of the head and neck needs to address function as well. In my practice, that is both the most rewarding and most challenging part of the job. Whether it be swallowing, talking, breathing, or cosmetics, each patient has a unique situation that requires a unique reconstruction. As part of the team, I focus on assessing the patient and their situation from a multidisciplinary approach and devise a solution that will optimize both form and function.

Dane Barrett, MD The face is one of the most visible areas of the body.  It is the vital structure we use to communicate with others and present ourselves to the world.  Not only is it important for the face to have a natural and appealing visage, but each structure must function as intended.  As a facial plastic surgeon, my work focuses on this sensitive and intricate area of the body.  My goal is to help my patients achieve their best selves. Whether this involves improving the appearance and function of the nose, rejuvenating an aging face, reanimating a paralyzed face, or reconstructing facial bones after traumatic injury, I ultimately want to help others feel comfortable and confident to live and thrive in our social world.

FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY

Charles Woodard, MD My philosophy centers around achieving the patient’s desired outcome. Listening to the patient is the most important part of the initial encounter. I take my time with each patient to identify their concerns and ensure that I am able to meet their expectations. As a fellowship-trained facial plastic surgeon, it is my job to balance form and function to accomplish a refreshed, rejuvenated, and balanced outcome. It has been my experience that patients want to avoid the “operated” look that is pervasive in the aesthetic realm. In addition, I perform surgeries for functional reasons, including nasal obstruction, cancer defects of the face following Mohs surgery, facial paralysis, and craniofacial trauma. I take pride in being able to offer these services at a nationally recognized medical center with state-of-the-art facilities and support staff.

Liana Puscas, MD, MHS I chose to go into head and neck reconstructive surgery because I wanted to help patients resume as normal a life as possible. Speaking and eating are social interactions, and the head and neck are very visible parts of the body. Those who cannot eat or speak, or those whose head and neck appearance is altered, often suffer from social isolation and self-consciousness about their altered appearance and function. Being able to help patients resume normal activities is a very gratifying aspect of head and neck reconstruction.

Serving Those Who Serve: Reflections on My Time at the Durham VA Medical Center Joshua Smith, PA-C

VA MEDICAL CENTER FACULTY

Irenee Duncan, MD (not pictured) Consulting Associate in the Department of Surgery

David M. Kaylie, MD, MS

Associate Professor of Surgery Otology and Neurotology

Walter T. Lee, MD, MHS

Associate Professor of Surgery and Radiation Oncology

Joshua Smith PA-C (pictured right) Maria Colandrea, DNP (not pictured)

Over the past decade, I have had the privilege and honor of staffing the HNSCS clinic at the Veterans Affairs Hospital. I have recently been given the opportunity to transition to a new position within the Duke Head and Neck Surgery & Communication Sciences team and will be ending my tenure at the VA. This has given me an opportunity to look back and reflect on my time serving some of this world’s greatest patients. First and foremost, they will be the thing I miss the most. The veteran patients are awesome. They are proud, appreciative, and deserving of the best care we can possibly provide. During my time at the VA, I have formed some amazing relationships with these men

and women and, more than anything, will miss getting to see them on a regular basis. In my experience, some of our veterans have complex medical and socioeconomic situations, making their care challenging. This complexity makes successful outcomes even more rewarding. The VA clinic provides our resident team an avenue to practice medicine in an environment similar to what they will experience once they have completed their training. I have truly come to appreciate seeing their exponential growth as the years move by, and I cherish the relationships I have developed by working with them. My final reflection is how much I’ve learned from my NP and MD colleagues. Our clinic at the VA wasn’t just a place to work. It was a team, and a family. In the end, I am thankful for my time spent with the patients, residents, and faculty. I have learned, grown, and leave a better person for having served those who serve.

RECONSTRUCTIVE SURGERY FACULTY

(pictured on opposite page) Charles R. Woodard, MD

Associate Professor of Surgery

Liana Puscas, MD

Associate Professor of Surgery

Russel Roy Kahmke, MD

Assistant Professor of Surgery

Dane M. Barrett, MD Clinical Associate in the Department of Surgery

DURHAM VA MEDICAL CENTER

MULTISPECIALITY CLINICAL CARE

Duke HNSCS Surgeons Implant First Inspire ® Upper Airway Stimulator in North Carolina The Inspire® upper airway stimulator uses a sensory lead to detect each time the patient breathes, followed by a stimulation to the hypoglossal nerve to maintain an open airway during sleep.

Surgery to treat sleep apnea has developed significantly in recent years. Initially, procedures involved tracheotomy to bypass the obstruction, but gave way to procedures that remove tissue, such as tonsillectomy, traditional uvulopalatopharyngoplasty, and midline glossectomy. Eventually, less invasive procedures were developed to remodel or translocate tissue, such as in maxillomandibular advancement, expansion sphincter pharyngoplasty, and hyoid suspension. These procedures still play a role in the properly selected patient and are performed regularly at Duke. Over the last decade, a new approach harnessing the patient’s own motor neuron system was

developed. Upper airway stimulation— or hypoglossal nerve stimulation (HGNS)—is an implanted and programmable system that is turned on when the patient goes to sleep. HGNS stimulates the hypoglossal nerve on the implanted side in sync with patient’s inspiratory effort. The system includes a stimulator cuff around the distal (protruder) branches of the hypoglossal nerve, an implanted pulse generator, usually placed beneath the clavicle, and a respiratory muscle (intercostal) pressure sensor. The procedure is very welltolerated, and can be performed outpatient. The system is activated and fine-tuned over the next several months.

COMPREHENSIVE OTOLARYNGOLOGY

In August 2017, the first Inspire® HGNS in the state of North Carolina was implanted in a procedure at Duke Raleigh Hospital. The system was activated a month later, in time for the patient to use on a backpacking trip to the Rockies. Drs. Matthew Ellison and Russel Kahmke are currently performing HGNS placement, with other faculty likely to participate in the sleep apnea surgery program at Duke. A multidisciplinary clinic is going to start this year, allowing patients to see sleep medicine specialists and sleep surgeons on the same day. We hope to integrate drug-induced sleep endoscopy (DISE) into the patient’s visit as well.

New Otolaryngology Clinic Coming to Southern Durham All of the pediatric and adult otolaryngology clinical services of Duke HNSCS will soon be expanded and conveniently located in the Southpoint area of Durham. With an opening date in May or June 2018, the new clinic will offer the full range of ear, nose, and throat services, including hearing and balance evaluations, allergy testing and treatment, speech therapy, hearing aids, and cochlear implants.

The new community-based clinic joins Duke Otolaryngology of Durham at Duke Medical Plaza, Duke Otolaryngology of Raleigh at Duke Raleigh Hospital, and Duke Otolaryngology of Person County.

As a well-rounded team, the physicians respond to a variety of patient conditions and concerns at state-of-the-art facilities using the most advanced diagnostic tools and procedures available.

Duke’s otolaryngology community practices complement the sub-specialty services provided by otolaryngologists at Duke’s academic medical centers.

The new clinic address will be: Duke Health Center South Durham 234 Crooked Creek Pkwy, 5th Floor Durham, NC 27731

(top row, left to right)

(bottom row, left to right)

Duke Otolaryngology of Raleigh

Duke Otolaryngology of Durham

Duke Otolaryngology of Person County

Matthew Ellison, MD, FACS, FAAOA

Dane M. Barrett, MD

Sheila Ryan, MD

Assistant Professor of Surgery

Calhoun D. Cunningham III, MD Associate Professor of Surgery

Tami C. Runyan, PA-C

Clinical Associate in the Department of Surgery

James G. Ross, MD

Clinical Associate in the Department of Surgery

Sheila Ryan, MD

Clinical Associate in the Department of Surgery

Duke Otolaryngology of Raleigh 3480 Wake Forest Road, Suite 404 800-385-3646 (for appointments)

Duke Otolaryngology of Durham Duke Medical Plaza 3116 North Duke Street, Entry 2 919-220-2020 (for appointments)

Duke Otolaryngology of Person County 783-C Doctor’s Court, Roxboro NC 855-855-6484 (for appointments)

COMPREHENSIVE OTOLARYNGOLOGY

MULTISPECIALITY CLINICAL CARE

Duke South Clinic Clerical Staff

Duke South Clinic Nursing Staff

Duke Otolaryngology of Raleigh Clerical and Nursing Staff

Melissa Stark, Health Center Administrator Duke Otolaryngology of Raleigh

PATIENTS SERVED

YEARS OF EXPERIENCE

TOTAL NURSING STAFF

68,000

5-35+

TEAM LEADS

LOCATIONS SERVED

Irish Hamilton Lead Staff Assistant

North Carolina Durham, Person, Granville, Orange, Wake & Vance Counties

patient visits per year

Melissa Stark Health Center Administrator Duke Otolaryngology of Raleigh Jacqueline Fuller Clinical Team Leader Duke Clinic, 1F

years per person

Virginia Danville & South Boston

Donna Morris Health Center Administrator Duke Otolaryngology of Durham and Person County Brandi Pinnell Service Access Manager, Access Operations Management Gabberl Houston Service Access Team Leader, Surgery Access Center 22

NURSES, COORDINATORS, AND MANAGERS

including surgical and clinical RNs, LPNs, and CMAs

Nurse Reads Lips to Communicate with, Help Voiceless Patient John McHenry, Duke Health News

Jackie Fuller, RN, BSN, ACN III, has developed a unique skill to bond with her patients who sometimes struggle to speak clearly. She reads their lips when they speak to her. “I love to build strong relationships with my patients and their families in order to provide compassionate and effective care during treatment,” said Ms. Fuller, who works in the ENT clinic on Duke’s main campus. Ms. Fuller recalls a particular case in which her desire to build relationships had a big impact. She was able to use

her lip-reading skills to get to know one patient personally and comfort her during treatment. The patient had stenosis of her airway, a narrowing that obstructs the passage of air to the lungs, and she was unable to speak. “When you have a warm, caring provider, it means a lot to a patient,” Ms. Fuller said. “It gives them a sense that the person really cares about them personally and their treatment. That’s what I strive to be for my patients.” Through her communication with the patient and her mother, Ms. Fuller learned that the patient did not have a home care provider to take care of her in the event of a possible airway emergency while she was home alone. Ms. Fuller promptly took action, requesting and filling out paperwork

to obtain a home care provider for her patient, as well as ordering various needed health supplies the patient didn’t have at home. “I’m thankful that they had enough trust in me to believe that if they expressed a need or asked something of me, that I could help,” she said. A rewarding moment for Ms. Fuller came when she was able to hear the patient speak and call her by name for the first time—after more than two years of working with the patient and larynx reconstructive surgery followed by additional therapy. “When she spoke my name, we all started hugging and crying,” she said. “To go from telling her that there was nothing else we could do for her to being able to hear her speak was amazing. She had been waiting so long for that moment.”

A Farewell Message from Jacqueline Fuller, RN, BSN, ACN III Upon her retirement, Jackie Fuller reflects on the impact of her 37-year career at Duke, and the legacy of exceptional care she leaves behind. I began my nursing career at Duke in 1981 upon graduating from UNC Greensboro. Originally I started working in Plastic Surgery Clinic, and later I was transferred to Otolaryngology Clinic where I have remained for the past 30 years.

Research PI, and Voice Care Center Liaison, and I am currently ending my career as the Clinical Team Lead. Overall, the best part of my career is the relationships that I have developed with my colleagues, the patients, and their families.

Working for the Division of Otolaryngology over the years, I have grown both professionally and personally, and I am grateful for the years of experience I have gained here at Duke. Working at Duke has allowed me several significant opportunities to develop my nursing skills in that I have been privileged to service a diverse population along with overcoming challenges to ensure patients are provided with outstanding health care.

It will be tough to leave the Otolaryngology & Duke team behind as I move to the next chapter in my life. However, rest assured, I will always be in the community somewhere caring for those in need. My plan is to enjoy my family and friends, travel, and indulge in selfcare prior to considering working part-time.

I would like to extend my gratitude to everyone I have had Over the years, I have held the pleasure of working with, and many positions in the Division of my hope is that the Division of Otolaryngology. I have worked as a Otolaryngology continues to provide Staff Nurse, Triage Nurse, Clinical NURSING, COORDINATORS, AND MANAGERS 23 exceptional care to patients.

INTERDISCIPLINARY RESEARCH

Research Conference Explores Connections Between Brain Health, Vision, and Hearing Changes In October, Kristine Schulz, MPH, DrPH, attended a national conference that explored the link between changes in vision and/or hearing and brain health. The U13 Bench-toBedside Conference was co-hosted by Heather Whitson, MD, MHS, Associate Professor of Medicine and Ophthalmology and senior fellow in the Center for the Study of Aging and Human Development at Duke, and Frank Lin, MD, PhD, Associate Professor of Otolaryngology-Head and Neck Surgery, Geriatric Medicine, Mental Health, and Epidemiology at Johns Hopkins. Whitson and Lin share an interest in whether better knowledge of vision and/or hearing could stave off changes in cognition or even the development of Alzheimer’s disease. Supported by the National Institute on Aging and the American Geriatrics Society, the conference was attended by basic and clinical scientists from across the country. Dr. Schulz says it kicked off Duke collaborations across several disciplines, including the new Duke Department of Population Health Sciences and the Center for the Study of Aging and Human Development. Following the conference, a letter of intent was submitted to the Retirement Research Foundation

proposing a study on whether a coordinated approach to vision and hearing screening is beneficial. The pilot study would occur among a large CHEER Network made up of multipractice, multidisciplinary members. Dr. Schulz shared several take-home messages for future directions in research from the conference. • Hearing, vision, and brain should be viewed and researched as one integrated system. More research on temporality and causality is needed. • Dual sensory impairment is its own unique category and challenge, especially when assessing cognition, because there is currently no accommodation for the unimpaired sense. For example, someone with both hearing and vision loss could not be accurately measured by being asked a question on an assessment. • Measurement tools in all three areas need improvement. Existing tools need to be enhanced with norms that can be compared to a calibrated bank. • For hearing loss specifically, we need better assessments than the audiogram to measure hearing in all settings. • The U.S. Preventive Services Task Force for hearing screening and

vision screening has indicated that there is insufficient evidence to support investment in screening. We need to assess the measures themselves—for example, age 50 may be too young to support testing, but testing at age 65 and older may be more effective and worthy of investment. Unfortunately, even when screening reveals a problem, many patients don’t receive appropriate care. Research is needed that demonstrates how screening and early detection can improve individual and population health. • Registries should be working together across all domains— interest in collaboration was expressed across the IRIS (eye), REG*ENT (ear), and neurology registries. “As Duke Head and Neck Surgery and Communication Sciences continues to grow and add additional faculty expertise, collaboration is the name of the game,” says Dr. Schulz. “We will continue our quest to develop existing relationships as well as pursuing new relationships with global health, biocomputing, biomedical engineering, and computational phenotyping.”

DR. KRISTINE SCHULZ APPOINTED DIRECTOR OF RESEARCH Kristine Schulz, MPH, DrPH, Associate Professor, has been appointed Director of Research for HNSCS. She received her MPH with a focus on epidemiology from the University of Medicine & Dentistry of New Jersey at Rutgers, and her DrPH from Loma Linda University. She has worked with HNSCS for six years with primary responsibility for carrying out the research goals and deliverables for the NIDCD-funded CHEER practice-based research network, along with multiple contracts and grants funded through industry, the AAO-HNSF, and the Association for Migraine Disorders. Prior to joining HNSCS, Dr. Schulz served as the Chief Research Officer for the AAO-HNSF, and will continue her role as lead on the AAO-HNSF Task Force on Practice-based Research. She is interested in exploring approaches to aggregate and display data in compelling ways for all audiences—patients, providers, and researchers. 24

HNSCS RESEARCH

Susan Emmett, MD, MPH, presents at the TED Global Health Conference in Tanzania. Dr. Emmett is the first-ever otolaryongologist to be selected as a TED fellow.

HNSCS Welcomes Global Hearing Health Specialist Susan Emmett, MD, MPH Susan Emmett, MD, MPH, Assistant Professor of Surgery and Global Health, recently joined the Duke Division of Head and Neck Surgery & Communication Sciences. She studies hearing loss in low resource settings around the world, working to reduce hearing health disparities through a combination of prevention, early detection, and improved access to treatment. Dr. Emmett’s primary project is in Alaska, where she partners with a Native American health organization called the Norton Sound Health Corporation on a community randomized trial to improve school

hearing screening and referral in a remote region near the Bering Sea. Funded by the Patient-Centered Outcomes Research Institute, this study utilizes cell-phone– based screening technology and telemedicine to identify children with undiagnosed hearing loss and efficiently connect them to care. “Merging mobile screening with telemedicine is transformative,” Dr. Emmett recounts. “With the technology to screen and refer directly from a cell phone, mobile telemedicine becomes transferrable to rural communities in other parts of the United States and the world.”

In addition to her work in Alaska, Dr. Emmett studies novel pathways for hearing loss prevention, such as the role of malnutrition in hearing loss in the Gangetic flood plain of South Asia. She is committed to expanding access to cochlear implantation, a treatment for severe-to-profound hearing loss that is often limited to high resource settings. She has worked with a team spanning 14 countries, including Debara Tucci, MD, Professor of Surgery, HNSCS, and Howard Francis, MD, MBA, Chief of HNSCS, to demonstrate that cochlear implants can be a cost-effective treatment option in Sub-Saharan Africa and Latin America. HNSCS RESEARCH

INTERDISCIPLINARY RESEARCH

Preventing Childhood Hearing Loss from CMV

Dr. Raynor prepares for surgery with patient Hunter Lubitz.

Eileen Raynor, MD, hopes to one day make the case for universal screening of newborns for cytomegalovirus (CMV), the leading cause of non-genetic hearing loss worldwide. The Associate Professor of Surgery and Pediatrics in HNSCS has a lengthy—and complex—task ahead of her. She is currently sifting through three years of data on 1,400 newborns to see whether they failed their newborn screening test, whether they were tested for the virus, whether they received follow up hearing exams, and whether they went on to develop hearing problems. “The goal is to identify babies that fall through the cracks or just don’t get the follow up screening done,” says Dr. Raynor. Later, she hopes to 26

HNSCS RESEARCH

look at data on the mothers who had CMV during pregnancy and determine whether the babies passed their newborn screening, had later follow-up screening, and what their outcomes were. CMV is a common virus that affects people of all ages. In the U.S., nearly one in three children are already infected by age 5 and over half of adults are infected by age 40. Once the virus is in the body it stays for life and can reactivate. Most people never show signs or symptoms unless they have a weakened immune system. But the virus can be passed to babies congenitally by their mothers. About 50–60 percent of these babies show no symptoms at birth, but many go on to have hearing loss by age 3.

Members of HNSCS, including Debara Tucci, MD, MBA, MS, Professor of Surgery, are working on the CMV problem on several fronts, including a geospatial mapping project to identify high risk areas of Durham County, and a similar program in Kenya, where CMV is prevalent. There is antiviral treatment, but when a baby shows no signs of infection, it’s debatable whether they should be exposed to the possible side effects of treatment. “The issue is that it affects so many children and so often is not detected until after a lot of things have been missed,” says Dr. Raynor. “If you could do early identification it could help in terms of getting resources for speech and language, and possibly treatment.”

Opportunities for Giving Fund Honors the Legacy of Former Chair William Hudson The William R. Hudson, MD, Endowed Lectureship Fund celebrates the very best examples of leadership within the specialty of otolaryngology. Established with generous support from alumni and friends, the Hudson Lectureship will provide support for lectures in the field of otolaryngology by scientists and clinicians. It honors the legacy of Dr. Hudson, who spent more than 30 years treating patients, educating trainees, and providing leadership. Dr. Hudson joined the Duke faculty in 1961 and retired in 1995 as Chief of the Division of HNSCS. He remained active at Duke until he died on July 4, 2012, after a courageous battle with cancer. Resident Education Gets Boost from Fund Honoring Fisher Annual gifts from friends and alumni have contributed to a fund for residency education that will honor the late Samuel R. Fisher, MD. The proposed Samuel R. Fisher Memorial Resident Education Fund will provide equipment and experiences for HNSCS residents. Dr. Fisher received his medical degree from Duke in 1975 and completed otolaryngology–head and neck surgery training here. He then joined the Duke faculty and spent more than 40 years building Duke Otolaryngology. His love for the specialty, his patients, and those he taught was evident in everything he did until his passing on

November 25, 2015. His passion for resident education was limitless—the proposed new fund will carry on that passion in perpetuity. New Leadership Program Provides Professional Development for Physicians and Staff A new training program developed by HNSCS offers extensive interprofessional training to physicians and staff. Funded by the division and gifts from patients, the Leadership Lived Out Program is based on the Professionalism Intelligence Model with the key components of cognitive, emotional, and leadership intelligence and a set of core values that includes initiative, integrity, responsibility, compassion, and accountability. The year-long program is open to all staff, including nurses, physician assistants, ancillary professionals, physicians, and trainees. “Amidst all the changes that are happening in healthcare, we seem to be losing what is most important in medicine—virtues such as compassion, honesty, integrity, and selflessness,” said Walter Lee, MD, MHS, Assistant Professor of Surgery and Radiation Oncology. “Leadership Lived Out seeks to develop these vital core characteristics that are essential in how we care for patients, their loved ones, and each other.” The division hopes to expand the program across Duke Health. For more information contact Walter T. Lee, MD, at walter.lee@duke.edu, 919-681-8449.

Donors may make gifts to HNSCS by visiting gifts.duke.edu/surgery and selecting the Division of Head and Neck Surgery and Communication Sciences in the drop down menu. Or, please contact our development partner: Marcy Romary Senior Director of Development 919-385-0051 marcia.romary@duke.edu FRIENDS OF HNSCS

TRAINING TOMORROW’S LEADERS

Duke Otolaryngology Welcomes New Residents Otolaryngology residents share what led them to join the team at Duke. Emily Commesso, MD, PGY-1 “When reflecting on where I would want to spend my five years of residency, it was important to me to find a balanced program where I would have exposure to fellowship-trained attendings, a diverse population of patients, and an emphasis on extracurricular development such as leadership skills and research. At Duke, I felt there would be opportunity for me to grow as a surgeon and shape my career.” Education Dr. Comesso received a BS in human biology, health and society from Cornell University, and her medical degree from Upstate Medical University. At Upstate she was a junior member of Alpha Omega Alpha and received several awards, including the American Medical Women’s Association Glasgo-Rubin Award for Academic Achievement in 2017.

Bernard L. Mendis, MD, PGY-1 “I came to Duke first and foremost because I knew it would be a place where I could get great training while being surrounded by a group of great people. I was looking for a supportive training environment with ample opportunity for research and innovation. Equally important, I was looking for strong clinical training. Outside of residency, I was looking for a place to live that had good food, great outdoors, and an easy-going atmosphere. My first few months of residency have been extremely rewarding, both in and out of the hospital!” Education Dr. Mendis received his BS in life sciences from Queen’s University in Ontario, and his medical degree from George Washington University School of Medicine. While at George Washington University, he was elected to Alpha Omega Alpha and received the Kassan Research Award.

Blaine Smith, MD, PGY-1 “I was attracted to Duke because of the program’s example of excellence in patient care as well as academic achievement. Beyond this, the opportunity to learn from worldrenowned faculty in a collegial environment put Duke at the top of my list.” Education Dr. Smith received his BS in biology, summa cum laude, from Abilene Christian University, and his medical degree from the McGovern Medical School at University of Texas Health Science Center. During his junior year of medical school, he was elected to Alpha Omega Alpha. He also was elected to the McGovern Medical School’s Gold Humanism Honor Society.

T32 Fellowship Program

2017 Graduates:

Current Residents

Marisa Ann Ryan, MD Completed June 30, 2017 Instructor of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital

Kevin Choi, MD Rhinology Fellowship at Duke University

PGY-4 Clifford Scott Brown, MD Anatoli Karas, MD Tawfiq Khoury, MD

Where are they now?

Alissa Collins, MD Laryngology Fellowship at University of Texas Health San Antonio Helen Moses, MD Facial Plastic and Reconstructive Fellowship at Emory University

PGY-3 Feras Ackall, MD Matthew Cooper, MD Nicholas Mildenhall, MD PGY-2 Dominik Greda, MD Milap Raikundalia, MD David Straka, MD Chief Residents featured on opposite page

RESIDENCY PROGRAM

Preparing for Departure: Chief Residents Share Their Future Plans

Matthew Crowson, MD After his Duke residency, Dr. Crowson will go to the University of Toronto for a two-year fellowship in neurotology. He says, “I am excited to have the opportunity to head back home and enjoy a “real” winter complete with snow. I have been extremely fortunate to have established fantastic mentorship relationships with some of the division’s faculty. As Isaac Newton once said, ‘If I have seen further, it is by standing on the shoulders of giants.’ Living in the South has also been a wonderful opportunity to explore a new part of the United States flush with new cultural and culinary delicacies. As I move on, I look forward to maintaining strong connections with the division and the wonderful people that make it one of the top otolaryngology destinations in the southern states.”

Adam Honeybrook, MD As an Australian living and working in the U.S. for the past 5 years, Dr. Honeybrook feels lucky to have been surrounded by such wonderful supportive individuals in the Duke Division of Head and Neck Surgery & Communication Sciences. In July 2018, he will commence a Fellowship in Facial Plastic and Reconstructive Surgery at the University of Pennsylvania, and after completion of this additional year of training, he intends to undertake various shorter fellowships in both the U.S. and South Korea. He would like to eventually return to Sydney, Australia, to introduce some of the unique skills and techniques that he obtained from working and learning from the faculty at Duke. Dr. Honeybrook extends an invitation to his friends and colleages: “If anyone ever plans to visit Australia, please let me know, we would love to have you!”

Sean Johnson, MD Dr. Johnson will be heading back home to Sioux Falls, South Dakota, once his residency at Duke is completed in June. He will join the Otolaryngology practice at Sanford Hospital, where he had the opportunity to work during his medical school years. He is excited to start the next step in his career and be able to apply the knowledge and experience he acquired while at Duke. Dr. Johnson is looking forward to returning to the Midwest to be closer to family, but stated he will have to make a trip back to North Carolina to get in a Duke basketball game, since he was not able to check that off his list during residency.

RESIDENCY PROGRAM

HNSCS ALUMNI

Servant Leader: An HNSCS Alumnus Shares His Story David Nolen, MD, a 2013 graduate of the Duke University Otolaryngologyâ&#x20AC;&#x201C; Head and Neck Surgery program, has provided world-class care to the citizens of Kenya since completing his facial plastics and reconstructive surgery fellowship training at UC Davis. After an inspiring presentation during the 2017 Graduation and Alumni Weekend, Dr. Nolen sat down with former coresident Dr. Russell Kahmke to share his story.

HNSCS ALUMNI

What drew you to international work in Kenya? The short answer would be that I feel compelled to be there for reasons that are hard to explain outside of my faith. I have been drawn to this kind of work for some time. Itâ&#x20AC;&#x2122;s easy to get discouraged and weighed down by the social and economic pressures in the U.S., but there is a lot of freedom and joy in working with the patients that I see and treat. It is very rewarding and eye-opening, and I would encourage everyone to be involved some way with the vulnerable and marginalized people in our world, whether in the U.S. or abroad. I ended up in Kenya after looking at several different hospitals around the globe. There is a great need for otolaryngologists all over the developing world. In East Africa, there are 151 locally trained otolaryngologists serving a population

of 237 million people, and there are less than 20 fellowship-trained head and neck surgeons on the continent outside of South Africa. The need was obvious, but I also wanted to be in a place where I could practice our specialty, so I needed to be in a place developed enough to have a hospital that could support otolaryngology patients. The hospital where I am located is a non-profit hospital that has a 100year presence in the community, has now been run by Kenyan leadership for over 20 years, is staffed by ex-pat and Kenyan physicians, is involved with training, and is one of the highest functioning hospitals in the East Africa region. All of these things made this hospital a great fit for me because I knew I wanted to go to a place where we could develop an ENT service that could eventually be taken over by local physicians and hopefully initiate some form of training.

What have been the biggest challenges to providing otolaryngologic care in Kenya? One of the biggest challenges is the financial burden of caring for patients with no means. Our mission is to treat the poor and needy people in Kenya, but many of our target patients can pay little to nothing for treatment, which makes it difficult to keep the doors open. Our hospital will do what it can to determine what a patient and their family can afford to pay, and we often try to find outside sources of funding. Itâ&#x20AC;&#x2122;s a struggle because we can now offer high-level care for patients, but this raises the cost beyond what most can afford. Some of the bigger head and neck cases that require lengthy ICU and step-down care cost more than most people make in a year. Until recently, we have been able to find funding for a lot of these patients, but some of our funding sources are drying up.

Another challenge is adjunct treatment that we rely on heavily in the field of otolaryngology. We have a wonderful audiologist in our clinic, which is a huge blessing when seeing otology patients, but many patients cannot afford hearing aids. We have partnered with an organization to help with this problem. We have no radiation oncologist, no medical oncologist, no allergy testing, minimal speech pathology, etc. We can send patients to Nairobi for radiation and/or chemo, but there is a lot of variability in treatment and it is expensive for many patients. What lessons did you learn at Duke that have helped you? Outside of the obvious clinical training, I think leadership and perseverance are two things that really stuck with me.

for time and focused energy, and it can be challenging to push through and give enough effort. The perseverance that is needed to make it through residency is so helpful in starting a clinic in a developing country. Also, the leadership training that we had has been so useful. I had been in a few leadership roles prior to my time in residency, so I was interested in the Duke curriculum that was established. Now that I am the head of a clinic in a developing country, I am so thankful that I got some formal training in what it means to be a servant leader. There are a lot of challenging situations that I have to navigate, and I feel that a large part of my energy is focused on developing and leading our otolaryngology team to provide excellent care for our patients. That has been one of the more challenging and rewarding parts of being there.

Residency training is a challenging time with multiple priorities competing

David Nolen MD performs a direct laryngoscopy and vocal cord resection to open the airway on a bilateral vocal cord paralysis patient who doesnâ&#x20AC;&#x2122;t have the electricity to support tracheostomy care at home. These difficult clinical care situations are far too common at AIC Kijabe Hospital in Kenya.Â

HNSCS ALUMNI

COMMUNITY AND PARTNERS

Connecting with Our Community: HNSCS Education and Engagement Broadway star Lauren Kennedy performs at the 2017 World Voice Day Celebration sponsored by the DVCC.

HNSCS faculty and clinical staff engage in numerous community education events each year. These activities are a crucial component in connecting with people of all walks of life in our community and beyond.

Drs. Russell Kahmke and Dan Rocke both provided seminars for the Healthy Focus lecture series at Duke Raleigh Hospital. In September, Dr. Kahmke presented Obstructive Sleep Apnea, a discussion about

the epidemiology, pathophysiology, and treatment modalities for OSA. In November, Dr. Rocke gave a presentation on thyroid nodules and their treatment. Duke Hearing Center led a number of community engagement events in 2017. Each year, HNSCS sponsors Duke Hearing Centerâ&#x20AC;&#x2122;s participation in the Walk 4 Hearing, which was held on October 15 this year. In September, audiologists participated in the Cochlear Implant Outreach Event for consumers in Durham. The purpose of the event was to educate consumers about cochlear implants, which included information about candidacy and technology. Audiologists also presented at the Acoustic Neuroma Association to educate consumers about hearing loss associated with acoustic neuromas and hearing device technology. Last summer, Doug Garrison, AuD, accompanied a group of audiology

Duke otolaryngologists and audiologists (with family and friends) at the 2017 Walk 4 Hearing.

COMMUNITY OUTREACH

First Duke–Hadassah ENT Global Health Symposium a Success students from UNC and Charlotte Eye Ear Nose & Throat Associates on a visit to the state capitol to meet and talk with the elected representatives who make the laws that govern their profession. The event was organized by the Student Academy of Audiology. The group discussed the relevance of audiology to the baby boomer generation as well as the impact of hearing loss on children and the support services they require. They reviewed the social isolation that can accompany hearing loss and the association between hearing loss and cognitive decline. Dr. Garrison reports that, “Overall, it was a fascinating and enlightening experience for students and preceptors alike.” Duke Voice Care Center hosted their 11th Annual World Voice Day Celebration April 13 at the Cary Arts Center. The event featured interactive learning sessions on vocal health, a voice science fair, and a performance by Broadway sensation Lauren Kennedy, 2017 honoree of DVCC’s Patrick D. Kenan Award for Vocal Health and Wellness. Other community engagement activities by Duke Voice Care Center included the Wrap Her Heart in Red women’s health awareness event and the Healthy Duke Wellness Expo; Vocal Health for Singers presentations for the Raleigh Boychoir and the music departments of Elon University and the University of North Carolina; the 5th Annual DVCC Voice Enhancement Workshop Body of Voices: Vocal Enrichment for Choral Singing (in partnership with Duke Chapel); and Vocal Health for A Cappella Singers at the SoJam XV A Cappella Festival.

In July 2017, the Duke Division of Head and Neck Surgery & Communication Sciences furthered its collaborative relationship with Hadassah Medical Center in Jerusalem through the cosponsorship of the Duke–Hadassah ENT Global Health Symposium, the first otolaryngology conference organized by hospitals in two different countries. The symposium’s mission was to promote the exchange of ideas between Israeli and American medical systems, to generate innovation in global health, to share new technologies, and to foster cross-cultural approaches to patient management.

Research award for his part in the development of the modern cochlear implant. Duke’s initial partnership with Hadassah began in 2015, after David M. Kaylie, MD, began work with Israeli surgeon Dr. Ron Eliasher, the Chair of ENT at Hadassah Medical Center. Through a donation by Duke patient Debbi Schwartz in honor of her mother, the Lilian S. Wilen Hadassah Otology Rotation began an observational fellowship program for Hadassah ENT residents. Options for residents in Israel to pursue advanced training fellowships are limited, and training at Duke is one option to bridge that gap. During the course of the fellowship program, the groups realized the benefit of a Global Health Symposium for two centers with unique medical needs and differing patient populations.

The immense value of international collaboration was a common theme for the event’s speakers, including Professor Abraham (Avi) Israeli, MD, the Chief Scientist of the Ministry of Health and Head of the Department of Health Policy at Hadassah Medical Center. Dr. Israeli’s talk highlighted the effects of international partnerships in research, a key element in improving impact factors of research quality. Alongside speakers from Israel were several Duke otolaryngologists and Blake S. Wilson, PhD, recipient of the 2013 Lasker–DeBakey Clinical Medical

Though sponsorships and funding are always needed, the HNSCS division is committed to furthering its commitment to Hadassah through its fellowship program and other collaborative research projects. The second ENT Global Health Symposium is currently being planned for 2019.

Hadassah Medical Center, Ein Kerem, Jerusalem.

COMMUNITY OUTREACH

RESEARCH PUBLICATIONS

Highest Impact Factor Publications HNSCS faculty collectively publish dozens of publications each year in a wide array of journals. The publications listed here were published in journals with the highest Impact Factors, a measure of the average number of citations to articles in that journal. For a complete listing of HNSCS publications, visit surgery.duke.edu/research/publications. Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Megadatabase Claims Analysis. Sajisevi M, Schulz K, Cyr DD, Wojdyla D, Rosenfeld RM, Tucci D, and Witsell DL. Otolaryngol Head Neck Surg. 2017;156(1):87-95.

Factors Influencing Likelihood of Voice Therapy Attendance. Misono S, Marmor S, Roy N, Mau T, and Cohen SM. Otolaryngol Head Neck Surg. 2017;156(3):518-524.

Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada. Crowson, MG, Chen, JM, and Tucci, D. Otolaryngol Head Neck Surg. 2017;156(1):137-143.

Neurosurg. 2017;99:200-209.

Respiratory Muscle Training in Late-Onset Pompe Disease. Jones HN, Nicholson K, and Crisp KD. Mol Genet Metab. 2017;120(1–2):S72. Microbiomic Differences In Tumor And Paired-Normal Tissue In Head And Neck Squamous Cell Carcinomas. Wang H, Funchain P, Bebek G, Altemus J, Zhang H, Niazi F, Peterson C, Lee WT, Burkey BB, and Eng C. Genome Med. 2017;9(1):14. Images in Anesthesiology: Laryngeal Cleft. Eapen RJ, Taicher BM, Benner E, and Machovec K. Anesthesiology. 2017;126(2):325. Role of 18 F-Fdg Pet/Ct Differentiating Olfactory Neuroblastoma from Sinonasal Undifferentiated Carcinoma. Elkhatib AH, Soldatova L, Carrau RL, Hachem RA, Ditzel L, Campbell R, Prevedello DM, Prevedello L, Filho LFSD, and Campbell RG. Laryngoscope. 2017;127(2):321-324.

Rare Lesions of the Internal Auditory Canal. Watanabe K, Cobb MI-PH, Zomorodi AR, Cunningham CD, Nonaka Y, Satoh S, Friedman AH, and Fukushima T. World

CHEER National Study of Chronic Rhinosinusitis Practice Patterns: Disease Comorbidities and Factors Associated with Surgery. Chapurin N, Pynnonen MA, Roberts R, Schulz K, Shin JJ, Witsell DL, Parham K, Langman A, Carpenter D, Vambutas A, Nguyen-Huynh A, Wolfley A, and Lee WT. Otolaryngol Head Neck Surg. 2017;156(4):751-756. Chronicity of Voice-Related Health Care Utilization in the General Medicine Community. Cohen SM, Lee H-J, Roy N, and Misono S. Otolaryngol Head Neck Surg. 2017;156(4):693-701. Complications of Bilateral Neck Dissection in Thyroid Cancer From a Single High-Volume Center. McMullen C, Rocke D, and Freeman J. JAMA Otolaryngol Head Neck Surg. 2017;143(4):376-381 Three-Dimensional Sterophotogrammetry for Measuring Volumtric Changes in Submental Cryolipolysis. Honeybrook A, Canfield D, Bloom J, Woodard, C, and Bernstein, E. Laser Surg Med. 2017;49(4):428.

What is the Role of Preoperative Imaging for Cochlear Implants In Adults With Postlingual Deafness? Choi KJ, and Kaylie DM. Laryngoscope. 2017;127(2):287-288.

Capillary Hemangioma of the Tympanic Membrane. Crowson MG, and Cunningham CD. Otolaryngol Head Neck Surg. 2017;156(5):964-965.

The Emerging Phenotype Of Late-Onset Pompe Disease: A Systematic Literature Review. Chan J, Desai AK, Kazi ZB, Corey K, Austin S, Hobson-Webb LD, Case LE, Jones HN, and Kishnani PS. Mol

Intelligibility in Speech Maskers with a Binaural Cochlear Implant Sound Coding Strategy Inspired by the Contralateral Medial Olivocochlear Reflex. Lopez-Poveda EA, Eustaquio-Martín A, Stohl, JS Wolford, RD, Schatzer R, Gorospe JM, Ruiz SSC, Benito F, and Wilson BS. Hear

Genet Metab. 2017;120(3):163-172.

Res. 2017;348:134-137.

RESEARCH PUBLICATIONS

National Database Analysis of Single-Level versus Multilevel Sleep Surgery. Brietzke SE, Ishman SL, Cohen S, Cyr DD, Shin JJ, and Kezirian EJ. Otolaryngol Head Neck Surg. 2017;156(5):955-961. Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center. Choi KJ, Kahmke RR, Crowson MG, Puscas L, Scher RL, and Cohen SM. JAMA Otolaryngol Head Neck Surg. 2017;143(5):472477. Current Interview Trail Metrics in the Otolaryngology Match. Cabrera-Muffly C, Chang CWD, and Puscas L. Otolaryngol Head Neck Surg. 2017;156(6):1097-1103. USMLE and Otolaryngology: Predicting Board Performance. Puscas L, Chang CWD, Lee H-J, Diaz R, and Miller R. Otolaryngol Head Neck Surg. 2017;156(6):1130-1135. Global Hearing Health Care: New Findings And Perspectives. Wilson BS, Tucci DL, Merson MH, and O’Donoghue GM. Lancet. 2017;390(10111):2503-2515. Laser-Assisted Indocyanine Green Dye Angiography for Postoperative Fistulas After Salvage Laryngectomy. Partington EJ, Moore LS, Kahmke R, Warram JM, Carroll W, Rosenthal EL, and Greene BJ. JAMA Otolaryngol Head Neck Surg. 2017;143(8):775-781.

Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance. Vanhille DL, Garcia GJM, Asan O, Borojeni AAT, Frank-Ito DO, Kimbell JS, Pawar SS, and Rhee JS. JAMA Facial Plast Surg. 2018;20(1):63-69. Investigating the Effects of Laryngotracheal Stenosis on Upper Airway Aerodynamics. Cheng T, Carpenter D, Cohen S, Witsell D, and Frank-Ito DO. Laryngoscope. 2017. doi: 10.1002/lary.26954. Adverse Events in Endoscopic Sinus Surgery for Infectious Orbital Complications of Sinusitis: 30-Day NSQIP Pediatric Outcomes. Cheng J, Liu B, Farjat AE, and Jang DW. Otolaryngol Head Neck Surg. 2017;157(4):716-721. How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of Nidilrr’s Rehabilitation Engineering Research Centers. Reinkensmeyer DJ, Blackstone S, Bodine C, Brabyn J, Brienza D, Caves K, DeRuyter F, Durfee E, Fatone S, Fernie G, Gard S, Karg P, Kuiken TA, Harris GF, Jones M, Li Y, Maisel J, McCue M, Meade, MA, Mitchell H, Mitzner TL, Patton JL, Requejo PS, Rimmer JH, Rogers WA, Zev Rymer W, Sanford JA, Schneider L, Sliker L, Sprigle S, Steinfeld A, Steinfeld E, Vanderheiden G, Winstein C, Zhang L-Q, and Corfman T. J Neuroeng Rehabil. 2017;14(1):109.

Pharmacologic Management of Voice Disorders by General Medicine Providers and Otolaryngologists. Cohen SM, Lee H-J, Roy N, and Misono S. Laryngoscope. 2017. doi: 10.1002/lary.26875.

Radiodensity of the Ostiomeatal Complex in Recurrent Acute Rhinosinusitis. Johnson SM, Honeybrook AL, Ramprasad VH, Abi Hachem R, and Jang DW. Otolaryngol Head Neck Surg. 2017;157(5):887890.

Burden of Hearing Loss on Communication Partners and Its Influence on Pursuit of Hearing Evaluation. Schulz KA, Modeste N, Lee JW, Roberts R, Saunders GH, and Witsell DL. Ear Hear. 2017;38(5):e285-e291.

Bilateral Upper Lobe Bronchi Originating from the Trachea. Machovec KA, Greene NH, Raynor EM, and Taicher BM. Anesthesiology. 2017;127(6):1015.

Voice Disorders and Associated Risk Markers Among Young Adults In The United States. Bainbridge KE, Roy N, Losonczy KG, Hoffman HJ, and Cohen SM. Laryngoscope. 2017;127(9);2093-2099. Hearing Loss On Social Media: Who Is Winning Hearts And Minds? Crowson MG, Tucci DL, and Kaylie D. Laryngoscope. 2017. doi: 10.1002/lary.26902.

Rehabilitation and Psychosocial Determinants of Cochlear Implant Outcomes in Older Adults. Tang L, Thompson CB, Clark JH, Ceh KM, Yeagle JD, and Francis HW. Ear Hear. 2017;38(6):663-671. What is the Potential Clinical Utility of vHIT When Assessing Adult Patients with Dizziness? Stevens MN, Garrison DB, and Kaylie DM. Laryngoscope. 2017;127(12):2689-2690.

Distinct Angiogenic Changes During Carcinogenesis Defined by Novel Label-Free Dark Field Imaging in a Hamster Cheek Pouch Model. Hu F, Martin H, Martinez AF, Everitt J, Erkanli A, Lee WT, Dewhirst MW, and Ramanujam N. Cancer Res. 2017;77(24):7109-7119.

RESEARCH PUBLICATIONS

First Class Mail U.S. Postage PA ID Durham, NC Permit No. 60

Duke South, White Zone, Room 1571-A DUMC 3707 Durham, NC 27710

Dr. Trineice Robinson-Martin to Receive 2018 Patrick D. Kenan Award Trineice Robinson-Martin, an artist, educator, and scholar, will receive the 2018 Patrick D. Kenan Award for Vocal Health and Wellness during events to celebrate World Voice Day at the Duke Voice Care Center April 13–14 at the Hayti Heritage Center in Durham.

Duke physician and performer Patrick D. Kenan, whose family established the Patrick and Julia Kenan Voice Care Endowment Fund. World Voice Day is a worldwide annual event that takes place on April 16 and is devoted to celebrating the

Dr. Robinson-Martin is an accomplished performer in styles including classical, jazz, R&B, pop, and gospel. Her research has led her to create a teaching methodology for singers of African-American folkbased music. She has devoted her career to singing styles that have been historically underserved by traditional Western vocal pedagogy. The Patrick D. Kenan Award was established in 2010 by the Duke Voice Care Center. It honors the legacy of

Contributing Writers Gowan Communications Group, LLC Scott Behm, Publications Specialist, Duke Surgery Editor Leda Scearce, Director of Performing Voice Programs and Development

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voice. The aim is to demonstrate the importance of the voice in our daily lives as a tool of communication and it’s connection to a large number of sciences, including physics, psychology, phonetics, art, and biology. Previous PDK Award honorees have included Durham’s all-male chorus 100 Men In Black, Grammy-nominated jazz vocalist Nnenna Freelon, international opera star bass-baritone Simon Estes, American Idol winner and country music sensation Scotty McCreery, Broadway sensation Lauren Kennedy, Grammy-nominated singersongwriter Tift Merritt, National Public Radio broadcaster Carl Kasell, and the band Delta Rae.   To learn more about World Voice Day and to register, visit www.events.duke.edu/voice.

Creative Design and Layout: Scott Behm Publications Speclialist, Duke Surgery Adapted from Bud Northern Design Cover Design: Megan Llewellyn Medical Illustrator, Duke Surgery Photography: Duke Photography

For appointments, please call 919-684-3834.

Donors may make gifts to HNSCS by visiting gifts.duke.edu/surgery and selecting the Division of Head and Neck Surgery and Communication Sciences in the drop down menu.