Harvard Otolaryngology Fall 2021 by HMS Otolaryngology

Fall 2021, vol. 17, no. 1

Confronting

CATASTROPHE Through trailblazing research, the Harvard Medical School Department of Otolaryngology– Head and Neck Surgery has emerged as world leaders in the fight against COVID-19. [ page 4 ]

Department of Otolaryngology Head and Neck Surgery

CONTENTS News from the Harvard Medical School Department of Otolaryngology– Head and Neck Surgery

1 New Chief and Chair Mark A. Varvares, MD, FACS 2 Professor Promotions; BWH Equity Grants

Fall 2021 | Vol. 17, No. 1 Published twice per year.

16 Farewell Class of 2021

Please send comments, requests for additional copies and other inquiries regarding this issue to:

19 New Trainees

Michael Kotsopoulos Communications Manager Department of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear 243 Charles Street, Boston, MA 02114 617-573-3656 | mkotsopoulos@meei.harvard.edu

21 Alumni Giving Society 22 Alumni Profile Daniel S. Alam, MD, FACS 24 Highlights

CONTRIBUTORS Editor-in-Chief Mark A. Varvares, MD, FACS John W. Merriam and William W. Montgomery Professor and Department Chair of Otolaryngology–Head and Neck Surgery Harvard Medical School Chief of Otolaryngology–Head and Neck Surgery Massachusetts Eye and Ear Massachusetts General Hospital

28 Research Advances

FEATURES 4

Confronting Catastrophe

Logging in to DystoniaNet

Reconstructing Skin from Stem Cells Karl Koehler, PhD, and Jiyoon Lee, PhD, have engineered the first appendaged human skin inside a petri dish. Their findings could transform the future of reconstructive surgery.

Managing Editor | Writer Michael Kotsopoulos Design | Layout | Photography Garyfallia Pagonis Cover design: Garyfallia Pagonis

Department of Otolaryngology Head and Neck Surgery Beth Israel Deaconess Medical Center Boston Children’s Hospital Brigham and Women’s Hospital Massachusetts Eye and Ear Massachusetts General Hospital ©2021, Massachusetts Eye and Ear

Amid a once-in-a lifetime pandemic, faculty from the Department of Otolaryngology– Head and Neck Surgery at Harvard Medical School conducted research to combat the spread of COVID-19 and mitigate its long-term symptoms.

A new deep-learning platform has cracked the code to diagnosing dystonia.

NEW CHIEF AND CHAIR

Introducing the New Chief and Chair of Otolaryngology–Head and Neck Surgery

fter a year-long, nationwide search, Mark A. Varvares, MD, FACS, has been officially appointed Chair of the Department of Otolaryngology–Head and Neck Surgery (OHNS) at Harvard Medical School (HMS) and Chief of the Departments of OHNS at Mass Eye and Ear and Massachusetts General Hospital (MGH).

Dr. Varvares, a head and neck cancer surgeon who serves as the John W. Merriam and William W. Montgomery Professor of OHNS, is the department’s seventh Chief in the nearly 200-year history of Mass Eye and Ear. Since July 1, 2020, he had served as interim Chair and Chief following the decision of his predecessor, D. Bradley Welling, MD, PhD, FACS, to step down. “We are delighted that Dr. Varvares has accepted this position,” said John Fernandez, President of Mass Eye and Ear. “He is a gifted academic surgeon who will put his superb leadership skills to work, ensuring that Mass Eye and Ear and MGH remain world leaders in research and patient care to help cure deafness, head and neck cancer and other conditions that impede patients’ quality of life.”

Dr. Varvares graduated from the Saint Louis University School of Medicine in 1986 and completed his residency at the Harvard Otolaryngology Residency Program in 1991. Following residency, he accepted a clinical fellowship in head and neck reconstructive surgery at Mass Eye and Ear under the direction and mentorship of William W. Montgomery, MD. He subsequently helped establish a head and neck free flap program as a junior attending. In 2003, Dr. Varvares moved home to St. Louis, having accepted a position as OHNS Department Chair at Saint Louis University Medical Center. During his 12-year tenure as Department Chair, he concurrently served as Director of the Saint Louis University Cancer Center and held a number of key leadership positions.

Dr. Varvares returned to Mass Eye and Ear and MGH in 2015 as the Associate Chief of OHNS. Over the last five years, he has helped articulate and refine the department’s vision, facilitated programmatic growth and provided educational and administrative oversight. Dr. Varvares’ greatest passion is serving as a teacher and mentor. He finds tremendous satisfaction in helping develop young surgeons, both academic and non-academic. “As the newly installed chair, I have been tasked by hospital leadership to lead the transformation of the department,” said Dr. Varvares. “It is my intent to not just transform how we provide patient care locally, but to change patient care globally through innovation. Together, our department will revolutionize how we educate, perform research and infuse equity into the culture of our academic program. It is my goal that we will become the global leader in all aspects of academic otolaryngology–head and neck surgery and that we will train and inspire the next generation of our specialty’s leaders.” n

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PROFESSOR PROMOTIONS

Promotions to Professor of Otolaryngology– Head and Neck Surgery at Harvard Medical School Congratulations to the following faculty members on their recent appointments. Sharon Kujawa, PhD Principal Investigator, Eaton-Peabody Laboratories, Mass Eye and Ear Dr. Kujawa is a world-renowned auditory neuroscientist. She earned her PhD in speech and hearing sciences from the University of Arizona. Prior to joining the Harvard Medical School faculty in 2001, she completed a clinical fellowship in audiology at the University of Arizona and research fellowships in auditory pharmacology and neurophysiology at the Kresge Hearing Research Lab in New Orleans and the Eaton-Peabody Laboratories at Mass Eye and Ear. Through her work, Dr. Kujawa’s research seeks to clarify mechanisms and functional consequences of common causes of acquired sensorineural hearing loss and translate that knowledge into improved diagnosis and treatment. In 2009, she and M. Charles Liberman, PhD, uncovered a new type of inner ear damage called cochlear synaptopathy, or “hidden hearing loss.” Their discovery has since changed the way scientists understand hearing loss and its possible treatments.

See our full list of faculty promotions on page 24.

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Dr. Kujawa has also been named the Sheldon and Dorothea Buckler Chair in Otolaryngology–Head and Neck Surgery at Mass Eye and Ear. Endowed by Sheldon and Dorothea Buckler, the Chair is awarded to a senior faculty member who embodies the same passion and commitment to innovation that Mr. Buckler, Chairman of the Board of Directors at Mass Eye and Ear from 1996 to 2002, has exemplified. Having spent four decades creating breakthrough film technology for the Polaroid Corporation, Mr. Buckler strongly advocates for bench-to-bedside research in medicine.

Derrick T. Lin, MD, FACS Associate Chief of the Department of Otolaryngology–Head and Neck Surgery, Mass Eye and Ear Dr. Lin received his medical degree from Mount Sinai School of Medicine before completing his residency in otolaryngology– head and neck surgery at Harvard Medical School. He completed a research fellowship at the Memorial Sloan-Kettering Cancer Center as a T-32 resident prior to completing an advanced surgical oncology fellowship under the direction of James L. Netterville, MD, at Vanderbilt University Medical Center. In 2004, Dr. Lin joined the Harvard Medical School faculty and

has since established himself as a world leader in the management of head and neck malignancy and the reconstruction of post-ablative defects. Published in more than 100 peerreviewed publications, Dr. Lin has helped establish the department’s current laboratory-based efforts toward studying the molecular basis of head and neck malignancies. Dr. Lin is also the surgical lead for a national trial evaluating the role of neoadjuvant therapy in sparing the eye of patients with advanced malignancies of the paranasal sinuses. Boston Magazine has recognized him as a “Top Doctor” eight times, a testament to the incredible, high-quality care he provides patients with complex problems involving all areas of head and neck cancer and reconstruction. Dr. Lin’s official Harvard Medical School appointment is the Daniel Miller Professor of Otolaryngology– Head and Neck Surgery.

Daniel B. Polley, PhD Director of the Lauer Tinnitus Research Center, Mass Eye and Ear Dr. Polley graduated with honors from the University of Richmond before earning his MS and PhD in neurobiology and behavior from the University of California, Irvine. Prior to joining the Harvard Medical School faculty in 2010 as an Assistant Professor of Otolaryngology– Head and Neck Surgery, Dr. Polley completed fellowship training at the University of California, San Francisco

s and was an Assistant Professor at the Vanderbilt University School of Medicine. Dr. Polley’s research focuses on the neurobiology of sound perception and the development of new biomarkers and treatment avenues for tinnitus, hyperacusis and other types of “hidden hearing” disorders. He is widely recognized as one of the world’s experts in this area. Using cutting-edge neurotechnology in genetic models of mice, Dr. Polley has pursued questions about these topics and pioneered new approaches for hearing assessments and hearing rehabilitation in human subjects. He also serves as the inaugural Amelia Peabody Chair in Otolaryngology–Head and Neck Surgery at Mass Eye and Ear. n

Did you know?... A team of physicians led by Regan W. Bergmark, MD; Ciersten Burks, MD; Eleni M. Rettig, MD; Rosh K. Sethi, MD, MS; and Mark A. Varvares, MD, FACS, was awarded a Mass General Brigham United Against Racism Grant last winter. The grant will launch an interinstitutional collaboration between Mass General Brigham and Harvard affiliates that will focus on improving multi-lingual resources for patients seeking head and neck cancer care. A goal of the collaboration will be to increase patient access with a particular focus on the racial and ethnic diversity of patients treated in the Mass General Brigham system for head and neck cancer through community outreach.

BWH EQUI T Y GR ANTS

Equity Grants Awarded to Dr. Anju Patel at Brigham and Women’s Hospital

he Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School upholds diversity, equity and inclusion as imperatives to driving meaningful change within and beyond the department. Anju K. Patel, MD, Instructor of Otolaryngology–Head and Neck Surgery at Harvard Medical School and Associate Surgeon at Brigham and Women’s Hospital, was recently awarded a pair of grants that will promote these core values for women across the specialty.

With the support of a Women in Otolaryngology Endowment Grant from the American Academy of Otolaryngology–Head and Neck Surgery, Dr. Patel will create a comprehensive physician experience tool that could evaluate the full spectrum of issues that may culminate in women surgeons leaving their current job or the medical profession. She believes her tool could help improve gender and parental disparities in the physician workforce. A second grant from the Brigham and Women’s Physicians Organization’s BeWell MD Grant Program will fund the development of a program that fosters women underrepresented in medicine at Brigham and Women’s Hospital. Through this program, Dr. Patel will leverage digital sponsorships and mentorship initiatives in hopes of addressing the need for faculty leadership and growth opportunities. n

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Confronting

CATASTROPHE

Amid a once-in-a-lifetime pandemic, faculty from the Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School conducted research to combat the spread of COVID-19 and mitigate its long-term symptoms.

FEATURE

hen the COVID-19 pandemic began in March 2020, a sense of panic surged through the medical community worldwide. The virus responsible for the novel coronavirus, SARS-CoV-2, was spreading at an alarming rate. Even worse, misinformation about the virus had made its spread difficult to stop. By July, over 10 million people had been infected and more than 500,000 had died, according to data collected by the World Health Organization (WHO). Few medical specialties felt the seismic effects of the pandemic more than otolaryngology–head and neck surgery. The SARS-CoV-2 virus is concentrated in areas of the body regularly exposed to ear, neck and throat (ENT) surgeons and clinicians: the upper respiratory tract, sinuses, trachea, larynx and skull base. There, the virus can easily spread from person to person through aerosols produced by talking, sneezing, coughing and breathing. Endoscopic procedures are also capable of producing large amounts of aerosols, but their exact quantity and spread remained a mystery to ENTs, who needed to pause non-emergency surgeries and reassess safety measures. Meanwhile, patients who had been hospitalized with COVID-19 were returning to clinics months after their discharge with difficulty breathing and, in some cases, a total or partial loss of smell. “The enormity of the problem was staggering,” said Phillip C. Song, MD, Assistant Professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School and Director of the Division of Laryngology at Mass Eye and Ear. “While oxygen had to be rationed and personal protective equipment was few and far between, the most significant medical shortage was the lack of knowledge about the virus’ spread and long-term effects.” Using the Joseph B. Nadol, Jr., MD, Otolaryngology Surgical Training Laboratory at Mass Eye and Ear as a base of operations, faculty from the Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School (HMS) combined their resources in an attempt to close these knowledge gaps. After collectively publishing more than 25 peer-reviewed articles about the virus, the department quickly emerged as a global thought leader in COVID-19 research. Their work has since transformed the way surgeons and clinicians understand and treat this disease, and future public health threats, for years to come.

When we went back and looked at the “medical literature, there was no data written about aerosolization in ENT procedures. We were really the first to test how we should be protecting ourselves from COVID-19 during these procedures.

”

—Drs. Benjamin Bleier (left) and Alan Workman (right)

Containing the spread At the pandemic’s onset, the immediate concern of ENTs was understanding the spread of the virus during airway and endoscopic procedures. Skull base and nasal endoscopic procedures were widely known to generate the widest ranges of airborne aerosols, and neither the Center of Disease Control and Prevention (CDC) nor the WHO had issued any formal guidance on how to contain viral transmission during these procedures. Without knowing the quantity of the aerosols produced by each endoscopic procedure, ENTs could not properly assess how dangerous their procedures on COVID-19 patients were and what kind of personal protective equipment was necessary inside the clinic and operating room. “When we went back and looked at the medical literature, there was no data written about aerosolization in ENT procedures,” said Benjamin Bleier, MD, FACS, Associate Professor of Otolaryngology–Head and Neck [ continued p. 6 ]

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RESPONDING TO CATASTROPHE continued the procedures were measured in the 1-to-10-micron range, a range too small for surgical masks to contain. Only N95 masks modified to permit endoscopy of the nose and throat could adequately limit the spread of such aerosols during these procedures. As a whole, their work offered valuable guidance to the ENT community on how to safely resume surgeries and patient visits.

Tackling long-term effects

Moving forward, we need to start thinking “of the long-term effects of COVID-19 since millions of more people around the world will be infected by the time the pandemic ends. With our department’s full resources at our disposal, the ability to address many of these serious issues is within our grasp.

—Dr. Phillip Song

”

Surgery at Harvard Medical School and Director of Otolaryngology Translational Research at Mass Eye and Ear. “We were really the first to test how we should be protecting ourselves from COVID-19 during these procedures.” Dr. Bleier worked with Alan Workman, MD, a PGY-4 in the Harvard Otolaryngology Residency Program, to quantify the size and spread of aerosols generated from endonasal procedures performed on cadavers, as well as those generated from clinical simulation. They also tested how well different masks protected physicians from these aerosols. In a study published in Otolaryngology–Head and Neck Surgery, their findings revealed that high-speed drilling and cauterization produced significant airborne aerosols in surgical settings, as did speech and sneezing when tested in office settings. Aerosols produced from 6

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The most serious consequence of a severe COVID-19 infection is acute respiratory failure. During a severe infection, the virus causes pneumonia, which inflames the lungs and fills them with fluid. If too much fluid fills the lungs, acute respiratory distress syndrome ensues and breathing capacity is restricted. Ventilator support, often through intubation, is then needed to maintain basic oxygen requirements for the body and prevent systemic collapse. Three months into the pandemic, Dr. Song noticed a troubling trend among those intubated: patients were returning to the hospital with breathing difficulties. Those who had required ventilator support had sustained significant damage to their trachea, larynx and lungs. Most of this damage was considered irreparable, which prompted Dr. Song to investigate further. In a study published in Laryngoscope: Investigative Otolaryngology, Dr. Song found laryngeal complications in 20 former COVID-19 patients, 13 of whom had been hospitalized and intubated for an average period of over three weeks. Intubated patients were commonly diagnosed with vocal fold immobility, glottic stenosis and subglottic stenosis, whereas those who avoided intubation did not display any evidence of paralysis or stenosis. Unsure of whether the trauma in the airways resulted from intubation, the virus or a combination of both, Dr. Song launched the COVID-19 Central Airway Consortium to better understand and mitigate longterm conditions affecting COVID-19 patients. The consortium consists of dozens of critical care providers, anesthesiologists, pulmonologists, thoracic surgeons and comprehensive ENTs from across Mass Eye and Ear, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital, the Spaulding Rehabilitation Hospital and Boston Children’s Hospital. Together, the specialists combined their expertise to implement new strategies to reduce intubation times,

| 1 | Optical particle sizer utilization for quantification of airborne aerosolization in a variety of clinical scenarios.

| 2 | Droplet spread in a variety of masked and surgical conditions.

| 1 | Copyright © 2020 the Author(s). Reprinted as published by Sage Journals. Workman AD, Jafari A, Welling DB, et al. Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. Otolaryngology–Head and Neck Surgery. May 26, 2020; 163(3):465-470. doi: 10.1177/0194599820931805. Reprinted according to terms of the Creative Commons 4.0 International License (http://creativecommons.org/licenses/by/4.0) | 2 | Used with permission from John Wiley & Sons, Inc. Published by John Wiley & Sons Ltd. Workman, AD, Welling, DB, Carter, BS, et al. Endonasal Instrumentation and Aerosolization Risk in the Era of COVID-19: Simulation, Literature Review, and Proposed Mitigation Strategies. Int Forum Allergy Rhinol. 2020; 10(7):798-805. doi: 10.1002/alr.22577. © 2020 ARS‐AAOA, LLC

limit the frequency of prone positioning and broaden the use of non-invasive ventilation. They also collaborated on tracheal dilations, steroid injections, endoscopic surgeries and chemotherapy to partially restore the normal function of the damaged airways. “Our protocols made an immediate difference across the system,” Dr. Song said. “Despite the surges, we were reducing mortality rates and simultaneously preventing further trauma to the airway.”

A lasting legacy

With an in-depth understanding of aerosol production and a consortium of doctors working together to mitigate the long-term effects of COVID-19, the Department

of Otolaryngology–Head and Neck Surgery at Harvard Medical School has trailblazed new preventive and mitigative practices that will linger far into the future. In fact, Dr. Workman believes patients shouldn’t be surprised to see ENTs wearing masks in the clinic or working in rooms with heightened ventilation long after the pandemic ends. The aerosol study conducted by Drs. Bleier and Workman has been replicated and cited by hundreds of world-renowned physicians who have further assessed the risk endonasal procedures pose to physicians and patients and have confirmed the protective benefits masks provide during these procedures. “I think we’ll be much more prepared to think about what we’re doing in the clinic and in the operating room if another widespread pandemic occurs,” Dr. Workman said. “With our knowledge, we’d be able to address safety concerns quickly and in a way that wouldn’t require us to completely shut down operations.” By transitioning to post-COVID recovery efforts directed at central airway disease, Dr. Song hopes to better manage a plethora of long-term symptoms beyond airway trauma. He believes conditions such as anosmia, chronic respiratory failure, dysphagia, neuropathy and CNS dysfunction will continue to plague patients recovering from COVID-19. By establishing screening guidelines, launching clinical trials and sharing resources across the Harvard network, the consortium could create a much more effective and efficient protocol for treating COVID-19 patients, as well as future outbreaks. “Moving forward, we need to start thinking of the long-term effects of COVID-19 since millions of more people around the world will be infected by the time the pandemic ends,” Dr. Song said. “With our department’s full resources at our disposal, the ability to address many of these serious issues is within our grasp.” n HARVARD Otolaryngology

LOGGING IN TO

DystoniaNet A new deep-learning platform has cracked the code to diagnosing dystonia.

FEATURE

ystonia is a neurological condition that causes involuntary muscle contractions. The majority of cases are isolated, which means they affect a single muscle group, and lead to abnormal movements and postures. In some instances, symptoms are so severe that patients become permanently disabled. Up to 3.5 out of every 100,000 people have isolated dystonia, a figure experts widely believe to be an underestimate. Often without a clear cause, the condition is extremely hard to diagnose. Its wide variability in symptoms, which can range from whole body twisting

“

Dystonia has frustrated clinicians and researchers for decades. Without an objective measure of diagnosing the disorder, physicians often rely on a process of elimination to rule out dozens of similar conditions before arriving at a dystonia diagnosis.

”

—Dr. Kristina Simonyan

to difficulty speaking, and the absence of a universal biomarker, can easily disguise the disorder as another neurological condition. Not only does this diminish a patient’s quality of life, but it prevents them from receiving appropriate care and treatment. “Dystonia has frustrated clinicians and researchers for decades,” explained Kristina Simonyan, MD, PhD, Dr med, Associate Professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School and Director of Laryngology Research at Mass Eye and Ear. “Without an objective measure of diagnosing the disorder, physicians often rely on process of elimination to rule out dozens of similar conditions before arriving at a dystonia diagnosis.” A deep-learning platform called DystoniaNet is giving clinicians a reason to believe a reliable, diagnostic tool for dystonia could soon be on the horizon. Recently developed by Dr. Simonyan and a postdoctoral fellow in her lab, Davide Valeriani, PhD, the platform can detect dystonia from an MRI scan of the brain with near-perfect accuracy.

Photo courtesy of Nutan Sharma, MD, PhD.

If you’re living in “a rural area hundreds

of miles away from a research hospital, a reliable diagnostic test could save a person years of their life trying to understand what is causing their symptoms.

”

—Dr. Nutan Sharma

By using its training algorithm to identify a microstructural neural network in a patient’s MRI, DystoniaNet can objectively measure the disease, derive an accurate diagnosis and ultimately change the way clinicians treat the disease for years to come.

An objective, fast and accurate diagnostic tool

A 2018 study revealed that the agreement rate between clinicians on the diagnosis of laryngeal dystonia is low. Following subjective evaluation of a patient’s symptoms, expert clinicians arrived at the same diagnosis only about 34 percent of the time. Inconsistent evaluations based on a physician’s expertise and experiences with dystonia often lead to conflicting opinions, and nearly 50 percent of cases are misdiagnosed. “Subjectively assessing peripheral symptoms is not a sufficient way of determining a dystonia diagnosis,” said Dr. Simonyan. “Since dystonia is a neurological disease, we need to look at the problem from the perspective of underlying causes and brain alterations.” DystoniaNet does exactly that. The platform uses an algorithm to analyze data collected from individual MRI scans. By identifying subtle structural differences, the algorithm can detect abnormal clusters in several regions of the brain that are known to contribute to the pathophysiology of dystonia. These small changes cannot be seen by the naked eye—they can only be seen through the platform’s ability to zoom into the microstructural details of the MRI. In a recent study published in Proceedings of the National Academy of Sciences in the United States of America, DystoniaNet helped diagnose dystonia with an [ continued p. 10 ]

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LOGGING IN TO DYSTONIANET continued

Based on 3D convolutional neural network (CNN) architecture, the deep learning algorithm, DystoniaNet, used brain structural MRIs to automatically determine the biomarker of diagnostic potential that classified three different forms of dystonia (laryngeal dystonia, cervical dystonia and blepharospasm) with an average 98.8 percent accuracy. The top figure displays the 3D-CNN architecture of DystoniaNet with input brain MRIs. The bottom figure shows 2D visualization of features (microstructural neural network biomarker map) that were automatically discovered and extracted by DystoniaNet from the corresponding convolutional layers at different levels of magnification and used for diagnosis of dystonia. Copyright © 2020 the Author(s). Published by PNAS. Valeriani D, Simonyan K. A Microstructural Neural Network Biomarker for Dystonia Diagnosis Identified by a DystoniaNet Deep Learning Platform. Proceedings of the National Academy of Sciences. Oct 2020; 117(42):26398-26405. doi: 10.1073/pnas.2009165117. This open access article is distributed under Creative Commons Attribution-NonCommercialNoDerivatives License 4.0 (CC BY-NC-ND)

average accuracy of 98.8 percent. The platform analyzed the MRI scans of 612 people enrolled in the study and arrived at a diagnosis in less than one second. Of those enrolled, 392 people were patients with one of the three most common types of isolated dystonia—laryngeal dystonia, cervical dystonia and blepharospasm—and 220 were healthy individuals. Remarkably, the platform accurately diagnosed 100 percent of cervical dystonia cases, 98.2 percent of laryngeal dystonia cases and 98.1 percent of blepharospasm cases. Only six patients were referred for further examination.

A biomarker capable of streamlining clinical care

On average, it can take up to 10 years for a patient to receive a correct dystonia diagnosis. According to Nutan Sharma, MD, PhD, Associate Professor of Neurology at Harvard Medical School and Director of the Mass General Brigham Dystonia Clinic at Massachusetts General Hospital, a

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person might visit a primary care physician at the onset of symptoms, only to be referred to a physical therapist. When physical therapy fails, the patient might see several other specialists before a diagnosis is confirmed. Eventually, a movement disorder specialist is needed to manage the irregular muscle contractions with a combination of botulinum toxin injections and oral medication. DystoniaNet has the potential to streamline this process so that a person can travel straight from a primary care doctor to a movement disorder specialist within days or weeks. “If you’re living in a rural area hundreds of miles away from a research hospital, a reliable diagnostic test could save a person years of their life trying to understand what is causing their symptoms,” said Dr. Sharma. Theoretically, a physician would upload a patient’s MRI to the DystoniaNet platform and, with the click of a button, generate a metric that uses artificial intelligence to determine whether the patient should immediately

Photo courtesy of the Collaborative Center for X-Linked Dystonia Parkinsonism at Massachusetts General Hospital

“

Unlike Huntington’s Disease, where there’s a clear structural abnormality in one part of the brain, dystonia is a circuit disease where the abnormality lies in how different parts of the brain interact.

”

—Dr. Laurie Ozelius

visit a movement disorder specialist for a follow-up on a dystonia diagnosis. The metric generated by DystoniaNet wouldn’t be the lone variable in determining a diagnosis, however. Clinicians would need to evaluate the metric alongside a slew of other variables such as medical history, symptoms and medications. Dr. Simonyan compared the metric to that of a blood test for the diagnosis of diabetes. “Blood work alone isn’t enough to determine a diagnosis for diabetes, and DystoniaNet isn’t designed to deliver a final diagnosis for dystonia,” she said. “Rather, it is one powerful variable being weighed alongside the patient’s history and evaluation of symptoms.”

The next steps for DysoniaNet

Funded by a R01 grant from the National Institutes of Health (NIH) and in part by philanthropic gifts from Keith and Roberta Richardson and Amazon Web Services, Dr. Simonyan’s research on DystoniaNet has garnered attention around the world. In January of 2021, Dr. Simonyan was awarded a Mass General Brigham Innovation Discovery Grant to continue her research. Working in collaboration with Dr. Sharma and Phillip C. Song, MD, Assistant Professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School and Director of the Division of Laryngology at Mass Eye and Ear, Dr. Simonyan and a team of researchers will test the efficacy of her deep-learning platform in clinical settings at Mass Eye and Ear and MGH. Outside the clinic, DystoniaNet has already changed how researchers assess the disorder. According to Laurie Ozelius, PhD, Associate Professor of Neurology at Harvard Medical School, the platform confirms that

dystonia affects communication between different structures of the brain, as opposed to the function of a single brain structure. “Unlike Huntington’s Disease, where there’s a clear structural abnormality in one part of the brain, dystonia is a circuit disease where the abnormality lies in how different parts of the brain interact,” Dr. Ozelius said. “Once we understand why these signals misfire and how we can get them to work together again, we would move one step closer to a possible long-term treatment.” As research on dystonia expands, DystoniaNet will continue to play an integral role in diagnosing patients, understanding its underlying causes and pioneering a cure. n

Dr. Simonyan awarded $11.9 million NIH grant to lead new multi-institutional center for neurological voice disorders

In September 2021, Kristina Simonyan, MD, PhD, Dr med, was awarded an $11.9 million P50 Clinical Research Center Grant from the National Institute on Deafness and Other Communicable Disorders of the National Institutes of Health (NIH). The grant will fund the formation of a new, multi-disciplinary center across four academic medical institutions committed to conducting research on laryngeal dystonia and voice tremor. Led by Dr. Simonyan, the center will include Mass Eye and Ear, Massachusetts General Hospital, the University of California, San Francisco and the University of Utah. Dr. Simonyan has also been awarded a separate R01 grant from the NIH to initiate a phase-one clinical trial on the use of brain-computer interfaces for rehabilitation of patients with laryngeal dystonia.

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Photo courtesy of Karl Koehler, PhD, and Jiyoon Lee, PhD.

Reconstructing

Karl Koehler, PhD, and Jiyoon Lee, PhD, have engineered the first appendaged human skin inside a petri dish. Their findings could transform the future of reconstructive surgery.

SKIN from STEM CELLS

Hairy human skin grown in a dish. Skin can be grown from stem cells by guiding growth signals within cells. Fully grown skin is shaped like a sphere planet, growing flare-like hairs as shown in green fluorescence. The laboratory-grown skin also contains neurons (shown in red/orange/ yellow) that will transmit senses that the skin receives to the brain. Karl Koehler, PhD, (left) and Jiyoon Lee, PhD, (right) from Boston Children’s Hospital

FEATURE Associate at the F.M. Kirby Neurobiology Center at Boston Children’s Hospital. “The mind instantly wanders to its applications for facial plastic surgery and using the artificial grafts to rebuild skin sites in pediatric head and neck cancer cases.” Working in collaboration with Jiyoon Lee, PhD, an Instructor in Surgery at Harvard Medical School and a Research Associate at Boston Children’s Hospital, Dr. Koehler has successfully implemented a novel method of engineering stem cells into the first-ever appendaged human skin organoid. Reported for the first time in Nature, their findings have provided a foundation for studies that could completely change the future of reconstructive and facial plastic surgery.

A proof-of-concept that began in the ear

kin disorders are one of the most common non-fatal conditions in the world. In fact, experts predict one in four people in the United States alone will develop a skin disease. Many of these disorders, such as alopecia or deep scarring from head and neck cancers, are benign. Others, such as third-degree burns and congenital skin blisters, can lead to severe infections. Nonetheless, a disfigured appearance from any of these conditions, no matter how severe, may cause immeasurable psychological and emotional harm. While skin grafts are a conventional method of reconstructing damaged skin, they also require transplanting healthy, yet sometimes mismatched, tissue from another part of the body. Skin grafts from a donor are another option, but one that risks rejection by the immune system or complications such as hematomas and limited range of motion. Researchers have turned to engineering artificial skin organoids, or clusters of cells and tissues grown from stem cells, as a more effective way of reconstructing skin back to its natural appearance and function. However, no human skin organoid has ever been engineered with the appendages necessary for retaining fluids or mediating sensation. These appendages, which include nerves, fats, glands and hair follicles, allow skin to perform its essential functions. “Growing these appendages has been the ‘holy grail’ of the skin biology field for decades,” said Karl Koehler, PhD, Assistant Professor of Otolaryngology–Head and Neck Surgery at Harvard Medical School and Research

For more than 50 years, researchers have attempted to grow appendaged human skin organoids in a myriad of ways. One of the most common methods has been growing the top layer of skin, also known as the epidermis, separate from the bottom layer of skin, the dermis. By manipulating stem cells so that each layer is engineered separately, researchers thought they could control how the two layers communicated with one another. In theory, this method would facilitate the development of nerves, fats and hair follicles. However, these attempts have failed. In 2013, Dr. Koehler, then an Associate Researcher at the Indiana University School of Medicine, was researching the development of hair cells in mice when he attempted to develop a complete inner ear organoid ex vivo. He stumbled upon something unexpected: the epidermis and dermis of an ear canal growing together next to the inner ear. “We almost thought of it as a weed in our garden,” Dr. Koehler said. “Ironically, we were trying to eliminate this unwanted byproduct and maximize the development of the inner-ear tissue.” Once hair follicles appeared on the unwanted skin tissue, Dr. Koehler recognized the opportunity at hand and shifted some of his focus away from inner-ear hair cells to characterizing this new method of generating hair-bearing skin. In a 2018 study published in Cell Reports, Drs. Koehler and Lee reported their step-by-step approach to hair follicle development in mouse organoids. Instead of developing the dermis and epidermis separate from [ continued p. 14 ]

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RECONSTRUCTING SKIN FROM STEM CELLS continued

one another, they had induced the mouse organoid so that the two layers of skin would grow together in a 3D design. The subsequent hair follicles developed at around the same time they normally would in pre-natal development, providing a proof-of-concept that could be applied to human skin organoids. “The approach we’ve stumbled on is that we need to get these cells to develop together,” Dr. Koehler explained. “It’s exactly how they develop in the embryo; juxtaposed right next to each other and going through each stage of development and progression in concert with each other.”

Finding the “holy grail”

Dr. Koehler arrived at Boston Children’s Hospital in 2020 ready to test his new methodology on human stem cells in collaboration with Dr. Lee. They began by reverting human red blood cells back to an embryonic state, creating pluripotent stem cells. After organizing the cells into a sphere, the researchers screened numerous human embryonic growth factors and drugs — such as transforming growth factor β inhibitors and fibroblast growth factors — to grow a dermis and epidermis within the cluster of cells. After 80 days, not only had the dermis and epidermis grown together inside an organoid, but so had hair follicles and other appendages, including nerves, fats and Merkel cells. Single-cell RNA sequencing and direct comparison to fetal specimens revealed that the skin organoid was equivalent to the facial skin of human 14

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fetuses in the second trimester of development. “It was hard not to get too excited at the sight of these hair follicles,” said Dr. Lee. “It has allowed us to hypothesize that, at some point very early in development, there’s a period when the precursor cells of the epidermis and the precursor cells of the dermis need to be together to develop skin as we know it.” Taking their study one step further, the team transplanted the appendaged human organoid onto a nude, immunosuppressed mouse. According to their findings published in Nature, Drs. Koehler and Lee witnessed the transplanted graft reconstitute skin on the mouse, providing the first translational evidence that skin organoids could feasibly be used for human skin reconstruction and wound healing.

The future of skin reconstruction

According to the American Academy of Dermatology, the direct health care cost of skin disease in the United States is $75 billion, inclusive of patient visits, medications and procedures used to manage symptoms. Dr. Koehler believes doctors could one day rely on appendaged organoids grown in laboratories to reconstruct damaged skin and eliminate the costs of traditional treatments. Researchers across the Harvard Department of Otolaryngology–Head and Neck Surgery have already expressed interest in using the appendaged organoids to test gene therapies for rare skin conditions, such as epidermolysis bullosa. Other members of the otolaryngology–

Hair-bearing skin organoid derived from human pluripotent stem cells. The skin organoid is generated in a 3D sphere-like and inside-out structure (endogenous Desmoplakin-GFP+ epithelium, green), that the hair follicles grow inward toward the core of the sphere (green). The organoid contains sensory neurons (TUJ1+; red, NEFH+; green, overlap; orange and yellow) that intertwine and innervate skin and hair follicles. Figure used with permission from John Wiley & Sons, Inc. Published by John Wiley & Sons Ltd. Lee J, Koehler KR. Skin Organoids: A New Human Model for Developmental and Translational Research. Experimental Dermatology. Exp Dermatol. 2021;30:613620. doi: 10.1111/exd.14292. © 2021 John Wiley & Sons A/S Figure reprinted with permission from Springer Nature Customer Service Centre GmbH Springer: Springer Nature. Nature. Lee J, Rabbani CC, Gao H, et al. Hair-Bearing Human Skin Generated Entirely from Pluripotent Stem Cells. 2020; 582(7812):399-404. doi: 10.1038/s41586-020-2352-3. Copyright © 2020, Springer Nature

head and neck surgery community would like to use the organoids to better understand the evolution of human face anatomy, and how melanoma develops in melanocytes, the skin cells responsible for pigment in the skin. While the potential of these organoids seems limitless, plenty of barriers exist before they can reach the clinic for reconstructive purposes, which is Dr. Koehler’s ultimate goal. Researchers must first find a way to convert the appendaged human organoids from its spherical shape

into planar layers that match the physiology of natural skin, all while ensuring the organoids can withstand immune responses. Researchers must also consider the cost of generating pluripotent stem cells from blood or urine samples, which Dr. Koehler said can be millions of dollars. “Growing fully-functional skin in a petri dish once sounded like something you’d only read about in a science fiction novel,” Dr. Koehler said. “Now that we know it’s at least a possibility, it’s time to leverage our existing partnerships across the Harvard network and work together to bring these organoids from the bench to the bedside.” n

Growing these “appendages has been the ‘holy grail’ of the skin biology field for decades. The mind instantly wanders to its applications for facial plastic surgery and using the artificial grafts to rebuild skin sites in pediatric head and neck cancer cases.

”

—Dr. Karl Koehler

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FAREWELL CLASS OF 2021

Harvard Medical School Celebrates 2021 Otolaryngology–Head and Neck Surgery Graduation

aculty and staff from the Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School (HMS) celebrated the 2021 graduating class of residents and fellows on Friday, June 11. Graduating residents were honored inside the Meltzer Auditorium at Mass Eye and Ear with their immediate families, while faculty, staff and fellows joined the celebration remotely.

Awards and Honors Jeffrey P. Harris, MD, PhD, Research Prize Presented to one of the graduating chiefs for their FOCUS research project.

Five chief residents graduated from the program, which is led by HMS Otolaryngology– Head and Neck Surgery Residency Program Director Stacey T. Gray, MD; Associate Residency Program Director Kevin S. Emerick, MD; Associate Residency Program Director Alice Z. Maxfield, MD; and Chair of Otolaryngology–Head and Neck Surgery Mark A. Varvares, MD, FACS. Twelve clinical fellows graduated from the Department of Otolaryngology–Head and Neck Surgery; eight fellows from Mass Eye and Ear, three fellows from Boston Children’s Hospital and one fellow from Beth Israel Deaconess Medical Center.

Vivek V. Kanumuri, MD Development of a Novel Flexible Auditory Brainstem Implant

In her address to residents, Dr. Gray acknowledged the immense success of this year’s graduating class. While the 2021 graduating class was incredibly prolific from a scholarly standing—collectively publishing more than 175 peer-reviewed articles during their time in the program—Dr. Gray said she will forever remember the class for the resilience and grace each resident demonstrated amid the COVID-19 pandemic.

William W. Montgomery, MD, Faculty Teaching Award Jeremy D. Richmon, MD

“Their response to the past year shows that they’re capable of accomplishing anything,” Dr. Gray said. “They’ve taken the challenges of a year full of adversity and have grown as physicians, led with incredible ease and flourished together as friends.” James Rocco, MD, PhD, Chair of the Department of Otolaryngology–Head and Neck Surgery at the Ohio State University Wexner Medical Center, delivered this year’s Joseph B. Nadol, MD, Graduation Lectureship. Dr. Rocco, who also serves as the Mary E. and John W. Alford Research Chair in Head and Neck Cancer and the Director of Head and Neck Disease Specific Research Group at the James Cancer Hospital and the Solove Research Institute, formerly served as the Director of Head and Neck Cancer Research at Mass Eye and Ear and as a faculty member at HMS for 15 years. In his speech, Dr. Rocco spoke candidly about how each graduating resident and trainee can learn from his or her mistakes over the course of their careers. He reminded them to identify adverse outcomes, use prior experiences to modify behavior and to understand the power of saying “yes.”

Clinical Fellow Teaching Award Matthew P. Partain, MD Chief Resident Teaching Award Shekhar K. Gadkaree, MD

Harvard Otolaryngology Resident Life Award Julianne Richards, PA-C

Their “response to the past year shows that they’re capable of accomplishing anything. They’ve taken the challenges of a year full of adversity and have grown as physicians, led with incredible ease and flourished together as friends.

”

—Dr. Stacey Gray

From left to right: Chief of OHNS, Mark Varvares, MD, FACS; graduating residents, Ashley Miller, MD; Vivek Kanumuri, MD; guest speaker James Rocco, MD, PhD; graduating residents Nicholas Abt, MD; Shekhar Gadkaree, MD; Jenny Chen, MD; Residency Program Director Stacey Gray, MD; and Associate Residency Program Director Kevin Emerick, MD.

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of Otolaryngology–Head and Neck Surgery CORE grant. Dr. Gadkaree is currently at the University of Minnesota pursuing a facial plastic and reconstructive surgery fellowship.

From left to right: Graduating residents, Nicholas Abt, MD; Shekhar Gadkaree, MD; Jenny Chen, MD; Ashley Miller, MD; and Vivek Kanumuri, MD.

Graduating Residents Nicholas B. Abt, MD, is known for his level-headed confidence, love for efficiency and dedication to the craft of surgery. Whenever he steps into the clinic or operating room, he brings unique enthusiasm and a laser-sharp focus. Under the mentorship of Mark A. Varvares, MD, FACS, and Vinod Saladi, PhD, he conducted research on head and neck cancer epigenetics and improving clinical surgical outcomes. As a member of the Harvard Otolaryngology Program Evaluation Committee and the American Academy of Otolaryngology–Head and Neck Surgery’s Head and Neck Education Committee, he demonstrated a tireless commitment to the entire otolaryngology community and a deep appreciation for each specialty. He is now a head and neck oncologic and reconstructive surgery fellow at the University of Miami. With a passion for patient care and educational research, Jenny X. Chen, MD, is deeply committed to pursuing a career in academic otolaryngology. She is known for her love of travel, warm and trusted demeanor and innovative ideas regarding the approach to education

in the operating room. Her research during residency culminated in both an American Academy of Otolaryngology– Head and Neck Surgery (AAO-HNS) CORE grant as well as an AAO-HNS Women in Otolaryngology Research Grant. Dr. Chen is currently earning her Master’s in Education as a 2021 Zuckerman Fellow at the Harvard Graduate School of Education and is an attending physician in the Comprehensive Otolaryngology Division at Mass Eye and Ear. Upon finishing her Master’s degree, she will pursue a neurotology fellowship. Community and friendship are two values Shekhar K. Gadkaree, MD, holds dear. His earnest approach to learning, unwavering commitment to patient care and independent thinking made him a favorite among fellow residents. His mentors, Regan W. Bergmark, MD, and David A. Shaye, MD, MPH, FACS, oversaw his research on the geographic and socioeconomic barriers preventing patients from care and decision making. During his residency, he demonstrated a passion for public health and all other facets of otolaryngology, which culminated in him receiving the Harvard Chan School of Public Health Resident Research Award, the Centers of Excellence Global Health Leadership Program Award and an American Academy

Known for his loyalty and humility, Vivek K. Kanumuri, MD, joined the residency program as a seven-year research resident. He developed a passion for neurotology early in his residency, which prompted his research on the auditory brain stem. His research culminated in numerous prestigious awards and grants, including the Leslie Bernstein Resident CORE grant from the American Academy of Facial Plastic and Reconstructive Surgery and the American Hearing Research Foundation Research Grant. Dr. Kanumuri worked closely with his mentors, M. Christian Brown, PhD, and Daniel J. Lee, MD, FACS, inside the EatonPeabody Laboratories on the development of optical neuro-prosthetics for stimulation of the auditory system. He later developed a novel, flexible auditory brainstem implant for his FOCUS project. Dr. Kanumuri is now at the University of Miami pursuing fellowship training in neurotology. Ashley L. Miller, MD, epitomizes what it means to be a team player. Covering extra shifts during the height of the COVID-19 pandemic, she selflessly volunteers at a moment’s notice. She is known by her colleagues for her thoughtful and considerate nature, as well as for treating every surgical procedure as an opportunity to learn. During residency, Dr. Miller ran the Boston Marathon® for Team Eye and Ear and served on the Graduate Medical Education Committee and the American Academy of Otolaryngology–Head and Neck Surgery’s Patient Safety and Quality Improvement Committee. Her FOCUS project addressed income inequality and how to achieve gender parity in otolaryngology. She is currently a pediatric otolaryngology fellow at Cincinnati Children’s Hospital Medical Center.

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FAREWELL CLASS OF 2021

From left to right: Graduating fellows, Matthew Miller, MD; Jonathon Simmonds, MD; Marianella Paz-Lansberg, MD; Liliana Ein, MD; Divya Chari, MD; Ian Behr, MD; Andrew Larson, MD; and Matthew Partain, MD.

Clinical Fellows, Mass Eye and Ear Ian J. Behr, MD, MS Thyroid and Parathyroid Surgery Fellowship Director: Gregory W. Randolph, MD, FACS, FACE Future Plans: Endocrine Surgeon, OSF Saint Anthony Medical Center, Rockford, IL; Associate Professor, University of Illinois School of Medicine Divya A. Chari, MD Neurotology Fellowship Director: Daniel J. Lee, MD, FACS Future Plans: Assistant Professor in Neurotology, Otology and Skull Base Surgery, University of Massachusetts Memorial Medical Center Liliana Ein, MD Facial Plastic and Reconstructive Surgery Fellowship Director: Tessa A. Hadlock, MD Future Plans: Assistant Professor of Clinical Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine Andrew R. Larson, MD Head and Neck Oncology/ Microvascular Surgery Fellowship Directors: Daniel G. Deschler, MD, FACS; Jeremy D. Richmon, MD Future Plans: Head and Neck Surgeon, Lahey Hospital and Medical Center, Burlington, MA 18

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Matthew Q. Miller, MD Facial Plastic and Reconstructive Surgery Fellowship Director: Tessa A. Hadlock, MD Future Plans: Establishing the Facial Nerve Center at the University of North Carolina at Chapel Hill Matthew P. Partain, MD Pediatric Otolaryngology Fellowship Directors: Christopher J. Hartnick, MD, MS; Michael S. Cohen, MD Future Plans: Assistant Professor in Pediatric Otolaryngology, Riley Children’s Hospital, Indiana University Health System Marianella Paz-Lansberg, MD Rhinology Fellowship Directors: Stacey T. Gray, MD; Eric H. Holbrook, MD; Ralph B. Metson, MD Future Plans: Assistant Professor in Rhinology, Boston Medical Center, Boston University Jonathan C. Simmonds, MD Rhinology Fellowship Directors: Stacey T. Gray, MD; Eric H. Holbrook, MD; Ralph B. Metson, MD Future Plans: Private Practice, WestMed Medical Group, Westchester County, NY

Clinical Fellows, Pediatric Otolaryngology, Boston Children’s Hospital Fellowship Director: Gi Soo Lee, MD, EdM Thomas Chung, MD Future Plans: Assistant Professor of Otolaryngology–Head and Neck Surgery, Penn State Children’s Hospital Ariana Greenwell, MD Future Plans: Pediatric Otolaryngologist, UVA Health, Charlottesville, VA Erica Sher, MD Future Plans: Pediatric Otolaryngologist, UT Health San Antonio, San Antonio, TX

Advanced Head and Neck Surgical Oncology and Microvascular Reconstructive Fellowship, Beth Israel Deaconess Medical Center Fellowship Director: Scharukh M. Jalisi, MD, MA, FACS Abhijit Gundale, MD Future Plans: Otolaryngology– Head and Neck Surgery, Surgery Consultant, McAlester Regional Health Center, McAlester, OK

NEW TRAINEES

Meet our PGY-1 Residents The Harvard Combined Residency Program in Otolaryngology– Head and Neck Surgery Originally from Itajaí, Brazil, Renata M. Knoll, MD, earned her medical degree from the Universidade do Vale do Itajaí. She subsequently completed her training in otolaryngology–head and neck surgery at the Mayor Edivaldo Orsi Hospital Complex. Upon completing an otology fellowship at the Federal University of São Paulo in Brazil, Dr. Knoll joined the EatonPeabody Laboratories at Mass Eye and Ear as a research fellow and has conducted otopathological and clinical research alongside Elliott D. Kozin, MD, and Aaron K. Remenschneider, MD, MPH. Her interests include histopathology of the temporal bone and traumatic brain injury as it relates to auditory and vestibular dysfunction. She is a seven-year research track resident. Originally from West Des Moines, IA, Kathryn S. Marcus, MD, graduated magna cum laude from the University of Miami with a degree in marine science and biology. She matriculated at the University of Iowa Carver College of Medicine where she received a distinction in global health and was inducted into the Alpha Omega Alpha and the Carver Humanism honor societies. Between her second and third years of medical school, Dr. Marcus completed an externship at the University of Iowa Department of Pathology, during which she assessed the prognosis of oral squamous cell carcinoma and EpsteinBarr virus infections. Her interests include clinical outcomes, head and neck pathology, sustainable global health innovation and medical education.

Obinna “Obi” Nwosu, MD, grew up in Carmel, IN, and graduated summa cum laude from Indiana University with a degree in biology. He matriculated at the Indiana University School of Medicine (IUSM) where he was a George H. Rawls Scholar and an inductee into the Alpha Omega Alpha honor society. During medical school, Dr. Nwosu conducted research on skull base surgery, head and neck cancers and laryngectomies at the IUSM Department of Genome and Cell Biology and the Department of Otolaryngology–Head and Neck Surgery. An avid fan of music production and fitness, Dr. Nwosu has interests in robotic surgery, augmented reality and machine learning within otolaryngology.

Originally from Chapel Hill, NC, Allen S. Zhou, MD, graduated summa cum laude from Duke University with a degree in neuroscience and chemistry. He subsequently matriculated at Harvard Medical School where he worked with Jennifer J. Shin, MD, SM, on optimizing patientreported outcome measurements in chronic rhinosinusitis and Mark A. Varvares, MD, FACS, on patient-centered outcomes in head and neck cancer. Dr. Zhou’s research interests include patient-reported outcome measures, as well as quality-of-life, treatment decision-making and medical education. His work has been featured in national, peer-reviewed journals such as Cell, Cell Reports, Otolaryngology–Head and Neck Surgery and Laryngoscope Investigative Otolaryngology.

Chloe Warinner, MD, grew up in Santa Barbara, CA, and graduated from Harvard College with a degree in neurobiology. Prior to matriculating at Harvard Medical School (HMS), she worked in the Van Vactor Lab for a year researching the role of microRNAs in cell synapses. At Harvard, Dr. Warinner worked with mentors Eleni M. Rettig, MD, and Regan W. Bergmark, MD, on researching clinical outcomes, quality of life and health disparities among patients with head and neck cancer at the HMS Center for Surgery and Public Health and the Ariadne Labs at the Harvard School of Public Health. She has interests in clinical outcomes, disparities and epidemiology.

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NEW TRAINEES

Harvard Medical School / Beth Israel Deaconess Medical Center Otolaryngology–Head and Neck Surgery Residency Program Originally from Centreville, VA, Brett Campbell, MD, graduated from the University of Virginia with a degree in biology. He subsequently matriculated at the Tulane University School of Medicine, where he conducted several basic science research projects related to adipose stem cells, bioscaffolding and regenerative medicine at the Tulane Center for Stem Cell Research & Regenerative Medicine. By the time he graduated, Dr. Campbell was valedictorian of his class, a member of the Alpha Omega Alpha honor society and the recipient of the James W. McLaurin Award for distinguished thesis on an otolaryngology subject. His interests include outcomes in head and neck cancer, regenerative medicine and medical education. Kevin Tie, MD, grew up in Chapel Hill, NC. He graduated summa cum laude from Duke University with a degree in chemistry and computer science and as a member of the Phi Beta Kappa honor society. He subsequently worked as a lead software developer at Epic Systems prior to matriculating at the University of North Carolina School of Medicine. There, he conducted research on allergen immunotherapy and subglottic stenosis management. His interests include clinical and surgical outcomes, improving management algorithms and the role of technology in advancing otolaryngology. As a member of the group Doctors Against Forced Organ Harvesting, he is also interested in medical ethics. Beth Israel Deaconess Medical Center faculty photos courtesy of Beth Israel Deaconess Medical Center Boston Children’s Hospital faculty photos courtesy of Boston Children’s Hospital Brigham and Women’s Hospital faculty photos courtesy of Brigham and Women’s Hospital

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New Clinical Fellows Mass Eye and Ear Neurotology 1| Yew Song Cheng, MD Facial Plastic and Reconstructive Surgery 2| John Flynn, MD

Pediatric Otolaryngology 3| Orna Katz Kadosh, MD Thyroid and Parathyroid 4| Amanda Silver Karcioglu, MD Facial Plastic and Reconstructive Surgery 5| Tal Kaufman-Goldberg, MD Rhinology 6| Barak Ringel, MD Head and Neck Oncology/ Microvascular Surgery 7| Priya Sivarajah, MD

Mass Eye and Ear

Boston Children’s Hospital Pediatric Otolaryngology 8| Lilun Li, MD 9| Brian Manzi, MD 10| Joseph Peterson, MD

Beth Israel Deaconess Medical Center Advanced Head and Neck Surgical Oncology and Microvascular Reconstructive Surgery 11| Hamdan Pasha, MD

Boston Children’s Hospital

Pre-Residency General Otolaryngology 12| Wyatt Rice-Narusch, MD 10

Beth Israel Deaconess Medical Center

ALUMNI GIVING SOCIETY

The Alumni Giving Society of the Department of Otolaryngology– Head and Neck Surgery at Harvard Medical School

Current Alumni Giving Society members for fiscal year 2021 from October 1, 2020, to September 30, 2021, are listed below. With your gift of $1,000 or more, you will be included in the 2022 Alumni Giving Society.

he Department of Otolaryngology–Head and Neck Surgery at Mass Eye and Ear/ Harvard Medical School established the

Alumni Giving Society in 2015 to recognize faculty and alumni who make gifts of $1,000 or more during the fiscal year (October 1–September 30). Participation is a way to stay connected and to

CHAMPION Gifts of $25,000 or higher

Gifts of $1,000 to $2,499

Jessica L. Fewkes, MD

Blake C. Alkire, MD Nicolas Y. Bu-Saba, MD Adam P. Campbell, MD Daryl G. Colden, MD, FACS Ruth Anne Eatock, PhD Bruce A. Feldman, MD Ramon A. Franco, Jr., MD Robert A. Gryboski, MD Paul E. Hammerschlag, MD, FACS Jeffrey P. Harris, MD, PhD Qasim Husain, MD Man-Kit Leung, MD Giant C. Lin, MD Jamie R. Litvack, MD William W. McClerkin, MD Cliff A. Megerian, MD Eugene N. Myers, MD Joseph B. Nadol, Jr., MD Adrian James Priesol, MD Edward J. Reardon, MD Jeremy D. Richmon, MD Mark F. Rounds, MD Felipe Santos, MD George A. Scangas, MD Ahmad R. Sedaghat, MD, PhD, FACS Herbert Silverstein, MD, FACS Theodoros N. Teknos, MD

VISIONARY

help deliver the finest teaching experience for

Gifts of $10,000 to $24,999

today’s otolaryngology trainees.

Michael S. Cohen, MD Gregory W. Randolph, MD

Our alumni know from firsthand experience that support of the vital work of our students and faculty in the Department of Otolaryngology– Head and Neck Surgery helps drive continued achievement across all areas of education, research and patient care. This fiscal year, we have 50 members who we thank for their generosity and partnership with us to achieve our department goals and institutional mission. If you are not a member, please consider joining your colleagues today by making a gift with the enclosed envelope. As a member, you may designate your gift in the way that is most meaningful to you. To learn more, please contact Julie Dutcher in the Development Office at 617-573-3350.

FRIEND

INNOVATOR Gifts of $5,000 to $9,999 Neil Bhattacharyya, MD John B. Lazor, MD, MBA, FACS Daniel J. Lee, MD, FACS Steven Pletcher, MD Michael B. Rho, MD, FACS Raj Sindwani, MD Jonathan Y. M. Ting, MD

PIONEER Gifts of $2,500 to $4,999 Barry J. Benjamin, MD Christen L. Caloway, MD Nipun Chhabra, MD Richard E. Gliklich, MD Wade W. Han, MD David Healy, MD Kasey K. Li, MD, DDS Ralph B. Metson, MD David E. Nash, MD H. Gregory Ota, MD Harry Dennis Snyder, MD Zachary M. Soler, MD Mark A. Varvares, MD, FACS

Department of Otolaryngology Head and Neck Surgery

HARVARD Otolaryngology

ALUMNI PROFILE

Daniel S. Alam, MD, FACS A picture says a thousand words

henever Daniel S. Alam, MD, FACS, leaves Honolulu, HI, on a medical mission trip, he never forgets his camera. For the past 20 years, he has photographed every child he operates on during these mission trips. The operations are typically cleft lip repairs or free flaps; fairly basic procedures to Dr. Alam, a microvascular head and neck reconstructive surgeon known for conducting the world’s first near-full face transplant in 2008. While the operations on these trips are simple, he insists on keeping every post-op photo he takes – all 700, to date. “I’d love to end my career with 1,500 photos,” said Dr. Alam, a 2001 graduate of the Harvard Medical School Otolaryngology Residency Program. “If I died tomorrow knowing that I touched the lives of 1,500 kids, then I would be at peace.” Together, his photos remind him of something so much more than the legacy he has built in Rwanda, Guatemala and other developing countries. Today, Dr. Alam is the Chief of Otolaryngology at the University of Hawaii’s John A. Burns School of Medicine and Co-Founder of the Queen’s Head & Neck Cancer Institute. His pictures remind him of the purpose behind his work in the South Pacific. “My work here in Hawaii feels a lot like my annual mission trips,” said Dr. Alam, the only clinically active microvascular surgeon in the state. “If you’re unavailable to perform a reconstructive surgery that we might see as a standard procedure at a major research hospital, then a patient needs to fly thousands of miles to the mainland. You really feel this sense of need and gratitude from the people you take care of.” Dr. Alam’s medical career began in 1996 when he graduated as class valedictorian from the Johns Hopkins University School of Medicine. With a fascination for facial plastic and microvascular reconstructive operations, Dr. Alam took immediate interest in the Harvard Otolaryngology Residency Program. At the time, Mass Eye and Ear was on the cutting edge of novel free flap reconstructive procedures. He enrolled in the residency program in the fall of 1997 and was mentored by Mark A. Varvares, MD, FACS, then an attending physician who had helped launch the hospital’s free flap surgery program.

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tomorrow knowing that I touched the “livesIf Iofdied 1,500 kids, then I would be at peace. ” Photo provided by Daniel S. Alam, MD, FACS

A seminal moment of his career occurred during his final year of residency. As a chief resident, he was one of the first trainees selected from Mass Eye and Ear to travel to Guatemala on a Medical Missions for Children trip. “The seeds of my love for global health were laid during that first mission trip.” said Dr. Alam, who has since traveled to Asia, Africa and South America anywhere from one-to-four times a year. “There’s nothing more profound than seeing the immediate impact your expertise can have on a life. It’s forever embedded in my DNA.”

| 2 | A before-and-after rendering of a near-full face transplant, which Dr. Alam successfully conducted at the Cleveland Clinic in 2008. The before image (left) shows a recipient without surface tissue beneath the eyes and nose and above the chin. The after image (right) shows where donor tissue is transplanted onto the recipient.

Photo provided by Daniel S. Alam, MD, FACS

| 1 | After a busy week conducting cleft lip operations on a medical mission trip to Guatemala, Dr. Alam (bottom-left corner) kneels alongside a group of families.

In June 2008, Dr. Siemionow received approval for a near-full face transplant protocol but needed a facial reconstructive surgeon to execute the procedure. She recruited Dr. Alam and tasked him with finding a way to design a viable path forward. “It was like being a designer at Boeing or Ford and someone asking you to make a flying car,” he said. “This was something that hadn’t really been done before and I was being given the reins to find a way to make it work.” After six months of testing mock transplants in a cadaver lab, Dr. Alam performed a successful face transplant that December. The procedure put his medical career in the limelight. Between 2008 and 2014, he appeared as a keynote speaker at several national meetings, including those for the American Academy of Facial Plastic and Reconstructive Surgery and the International Academy of Facial Plastic and Reconstructive Surgery. He also served as a visiting professor at more than 15 universities, all while continuing his medical mission trips. His rapid rise to prominence came at a cost, however. Dr. Alam spent more than 60 days away from home a year, and burnout

Photo courtesy of the Cleveland Clinic.

Upon graduating, Dr. Alam completed a facial plastic and reconstructive surgery fellowship at the University of California, Los Angeles Medical Center and then joined the Cleveland Clinic as its Section Head of Facial Aesthetic and Reconstructive Surgery. There, he met Maria Siemionow, MD, PhD, an orthopedic surgeon who had been awarded a Department of Defense grant to perform allograph transplants.

ensued. Looking for a change, he joined the University of Hawaii as its Chief of Otolaryngology in 2014. The move to a smaller academic program, Dr. Alam figured, would allow him to work more closely with patients and afford him additional opportunities to focus on his beloved mission trips. Today, as one of only two head and neck cancer providers in the entire South Pacific Basin and as its primary reconstructive surgeon, Dr. Alam actually sees two-to-three times more patients than he ever did at the Cleveland Clinic. However, the burnout he felt years ago has subsided, replaced by a deep sense of fulfillment. “It’s so different from what I’m used to in a traditional academic role,” said Dr. Alam. “In the past, these same patients had no simple solutions if their care required a flap. Now, an underserved population is routinely receiving care they deserve, and I couldn’t be prouder.” n

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HIGHLIGHTS

News from every corner of the Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School

New Faculty Introducing the newest ear, nose and throat (ENT) clinicians, clinician-scientists, researchers and educators in the Department of Otolaryngology–Head and Neck Surgery. Matthew G. Crowson, MD, is a fellowship-trained ENT surgeon specializing in adult and pediatric vestibular disorders at Mass Eye and Ear. Dr. Crowson completed his residency training at Duke University and his neurotology fellowship at the University of Toronto. His clinical interests include the medical and surgical management of vestibular disorders and hearing loss. Dr. Crowson is currently developing a research program that harnesses data science to address real-world health care delivery challenges.

Christopher D. Brook, MD, is a fellowship-trained ENT surgeon specializing in rhinology at Beth Israel Deaconess Medical Center. Dr. Brook completed his residency training at Boston Medical Center and a fellowship in rhinology at Mass Eye and Ear. The majority of Dr. Brook’s practice focuses on medical and surgical treatment of inflammatory and neoplastic sinonasal disorders. He works closely with neurosurgeons to perform endoscopic resections of skull base tumors, as well as repairs of skull base defects and cerebrospinal fluid leaks. Jenny X. Chen, MD, is a clinical ENT attending at Mass Eye and Ear. Dr. Chen earned her medical degree at Harvard Medical School and recently graduated from the Harvard Combined Otolaryngology Residency Program. She is a Zuckerman Fellow at the Harvard Graduate School of Education and her clinical interests include treating patients with a broad range of general ear, nose and throat problems.

Amanda E. Dilger, MD, is a fellowship-trained, comprehensive ENT surgeon at Mass Eye and Ear. Dr. Dilger completed her residency training at Northwestern University and a fellowship in facial plastic and reconstructive surgery with Jonathan Sykes, MD, at the Roxbury Institute in Beverley Hills, CA. Her clinical interests include comprehensive otolaryngology, functional and cosmetic rhinoplasty, facial reconstruction after Mohs surgery, scar revision and aesthetic facial surgery.

Recent Promotions | 1 | Carleton Eduardo Corrales, MD, Assistant Professor of Otolaryngology– Head and Neck Surgery | 2 | Daniel L. Faden, MD, Assistant Professor of Otolaryngology– Head and Neck Surgery | 3 | Gwenaelle Géléoc, PhD, Associate Professor of Otolaryngology– Head and Neck Surgery

| 4 | Rosh K. Sethi, MD, MPH, Assistant Professor of Otolaryngology– Head and Neck Surgery | 5 | Peizhe Wu, MD, PhD, Instructor of Otolaryngology–Head and Neck Surgery 24

HARVARD Otolaryngology

Christopher David Dwyer, MD, FRCSC, is a fellowship-trained ENT surgeon specializing in laryngology at Brigham and Women’s Hospital. Dr. Dwyer completed his residency training at Western University’s Schulich School of Dentistry and Medicine in Ontario, Canada. He then completed fellowship training in laryngology and care of the professional voice at the University of California, San Francisco. His clinical interests include voice, airway and swallowing care. Kaashif Eazazuddin, DO, is an ENT surgeon who leads the surgical sleep apnea program at Beth Israel Deaconess Medical Center. Dr. Eazazuddin attended the New York College of Osteopathic Medicine and completed his residency at Saint Barnabas Medical Center. His clinical interests include obstructive sleep apnea, chronic sinusitis, salivary gland disease and thyroid and parathyroid surgery. Dr. Eazazuddin performed the first hypoglossal nerve stimulator placement at the Beth Israel Deaconess Medical Center. Allen L. Feng, MD, is a fellowship-trained, head and neck surgeon at MGH North Shore in Danvers, MA. Dr. Feng completed his residency training at the Harvard Combined Otolaryngology Residency Program and his head and neck oncology and microvascular reconstruction fellowship at the University of Michigan. His clinical interests include complex reconstructions after head and neck surgery and the development of biomedical devices for use in otolaryngology.

Elliott D. Kozin, MD, is a fellowship-trained ENT surgeon specializing in adult and pediatric otology and neurotology at Mass Eye and Ear. Dr. Kozin completed his residency training at the Harvard Combined Otolaryngology Residency Program and a fellowship in neurotology at Mass Eye and Ear. His clinical interests include the surgical management of chronic ear disease, conductive hearing loss, cochlear implantation and tumors of the lateral skull base. Dr. Kozin leads a National Institutes of Health-funded laboratory that studies auditory dysfunction following traumatic brain injury. Stella Lee, MD, is a fellowship-trained ENT surgeon who serves as Director of the Brigham Sinus Center at Brigham and Women’s Hospital. Dr. Lee completed her residency at Yale New Haven Hospital and her fellowship in rhinology and skull base surgery at Johns Hopkins University. She then served as the Division Chief of Rhinology at the University of Pittsburgh Medical Center for 10 years. Her clinical and research interests include the development of basic to translational approaches to understand and treat patients with chronic rhinosinusitis, olfactory loss and skull base disorders. Rahmatullah Wais Rahmati, MD, MPH, FACS, is a fellowshiptrained, comprehensive ENT surgeon at Mass Eye and Ear. He completed his residency training at New York Presbyterian–University Hospital of Columbia University and his fellowship in head and neck surgical oncology at Memorial Sloan Kettering Cancer Center. Dr. Rahmati’s clinical interests include sialendoscopy, salivary gland diseases and head and neck surgery and oncology.

Devin M. Ruiz, MD, is a comprehensive ENT surgeon at Mass Eye and Ear. He was born and raised in Southern California. After graduating from Jefferson Medical College, Dr. Ruiz moved to Boston to complete his residency training at Tufts Medical Center. His clinical interests include general otolaryngology, management of masses of the head and neck, nasal and sinus diseases and endoscopic sinus surgery. Brikha Shrestha, PhD, is an investigator at Mass Eye and Ear. He earned his PhD from Columbia University and completed his postdoctoral training at Harvard Medical School. He has more than a decade of experience studying the molecular genetics of neural development across model organisms. Research in Dr. Shrestha’s laboratory addresses the plasticity of neural

development and function in the auditory system, with a long-term goal of elucidating mechanisms at play over evolutionary time compared to the life of an organism.

Awards, Grants and Honors Several researchers from the Department of Otolaryngology–Head and Neck Surgery were invited to join the National Institute on Deafness and Other Communication Disorders Strategic Plan Committee to help determine its research focus for the next five years. These researchers included Julie G. Arenberg, MS, PhD; Sharon Kujawa, PhD; M. Charles Liberman, PhD; Richard F. Lewis, MD; Sunil Puria, PhD; Steven D. Rauch, MD; Felipe Santos, MD; and Kristina Simonyan, MD, PhD, Dr med. Regan W. Bergmark, MD, was awarded the H. Richard Nesson Fellowship at Brigham and Women’s Hospital. Through her fellowship, Dr. Bergmark will research inequities in timely access to local surgical care with the intention of expanding healthcare access to local communities of color and individuals of low socio-economic status. [ continued p. 26 ]

New Leadership Julie G. Arenberg, MS, PhD, has been named Director of Audiology, Research and Education at Mass Eye and Ear. Michael S. Cohen, MD, has been named Director of the Pediatric Otolaryngology Fellowship. Kevin S. Emerick, MD, has been appointed Division Chief of Head and Neck Surgical Oncology at Mass Eye and Ear. Gwenaelle Géléoc, PhD, has been named Co-Director of the Harvard Speech and Hearing Bioscience and Technology Program.

Elise R. Lippmann, MD, has been named Division Chief of Comprehensive Otolaryngology and of the Emergency Department at Mass Eye and Ear. Alice Z. Maxfield, MD, has been named Associate Residency Director of the Harvard Combined Residency Program in Otolaryngology–Head and Neck Surgery. Alicia Quesnel, MD, has been named Director of the Otopathology Laboratory at Mass Eye and Ear. Meaghan P. Reed, AuD, CCC-A, has been named Director of Clinical Audiology at Mass Eye and Ear.

Derrick T. Lin, MD, FACS, has been appointed Associate Chief of the Department of Otolaryngology–Head and Neck Surgery at Mass Eye and Ear.

Felipe Santos, MD, has been named Director of the NIDCD National Bone, Hearing and Balance Pathology Resource Registry at Mass Eye and Ear.

Robin W. Lindsay, MD, was appointed Faculty Co-Chair of the Joint Committee for the Status of Women at Harvard Medical School.

Derek Stiles, PhD, CCC-A, has been named Director of the Center for Communication Disorders at Boston Children’s Hospital.

HARVARD Otolaryngology

HIGHLIGHTS

A record number of registrants attended the 2021 Comprehensive Otolaryngology Continuing Medical Education Course hosted by the Harvard Medical School Department of Otolaryngology–Head and Neck Surgery. Seventy-five registrants representing 16 countries attended the course, which was led by Course Director Nicolas Y. BuSaba, MD, and Course Co-Directors Gregory W. Randolph, MD, FACS, FACE, John M. Dobrowski, MD, FACS, and Elise R. Lippmann, MD. The 2021 Patricia & Barry Yellen Young Investigator Award was awarded to Divya Chari, MD. The award, which is named after long-time Mass Eye and Ear Trustee Barry Yellen and his wife, Patricia, will support Dr. Chari in her research on the spatial and non-spatial cognitive deficits that occur in patients with balance disorders.

Daniel J. Lee, MD, FACS, presenting the 2021 Patricia & Barry Yellen Young Investigator Award to Dr. Divya Chari.

Zheng-Yi Chen, DPhil, was awarded a Department of Defense (DoD) grant to expand the scope of his research on hair cell regeneration. The grant will fund testing of whether drug-like molecules can induce hair cell regeneration in large animal models and will help fund testing on how well an FDAapproved drug can protect pigs against noise-induced hearing loss. Dr. Chen was also awarded a two-year UH3 grant by the National Institutes of Health Somatic Cell Genome Editing Program. Through the UH3 grant, he will collaborate with several other researchers from Mass Eye and Ear, Boston Children’s Hospital, the Broad Institute and Tufts Medical Center to develop a lipid nanoparticle delivery system that could be used to deliver genome editing agents into the inner ear and retina of a pig.

HARVARD Otolaryngology

Daniel G. Deschler, MD, FACS, served as lead editor of the recently published textbook Head and Neck Cancer Care in a Pandemic: Prioritizing Safe Care, which provides a comprehensive reference for addressing complex problems inherent in delivering optimal cancer treatment during a pandemic. Dr. Deschler also served as Co-Chair of the American Head & Neck Society Symposium at the 2021 Combined Otolaryngology Spring Meetings. Matthew G. Crowson, MD, has been appointed a Biomedical Informatics and Data Science Research Training Fellow at Harvard Medical School. Through the fellowship, Dr. Crowson will conduct research on the application of data science to health care delivery challenges at Mass Eye and Ear and Mass General Brigham. The National Institutes of Health awarded Daniel L. Faden, MD, a K23 grant to support his research on how head and neck cancer cells might change in response to immunotherapy. Dr. Faden’s work will utilize cutting-edge, single-cell sequencing and imaging approaches to better understand how head and neck cancer cells in tissue and blood change in response to immunotherapy with the goal of identifying changes that confer drug resistance. A 2018 paper authored by Ramon A. Franco, Jr., MD, was listed as the third most influential paper in the field of laryngology since 2000, as decided by a panel of laryngology experts in a 2021 article published in The Laryngoscope. Entitled, “Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis,” the 2018 paper describes the use of steroids for treating idiopathic subglottic stenosis and was originally published in The Laryngoscope. Stacey T. Gray, MD, was elected President of the Society of University Otolaryngologists and was also appointed the Focused Lifelong Education Xperience (FLEX) Curriculum Chair for the American

Academy of Otolaryngology–Head and Neck Surgery. Earlier in 2021, Dr. Gray delivered the Mark A. Varvares, MD, FACS, Endowed Lecture at the residency graduation ceremony for the Saint Louis University Department of Otolaryngology– Head and Neck Surgery. Tessa A. Hadlock, MD, was named Site Principal Investigator of a R01 grant awarded by the National Institutes of Health. In collaboration with Carroll Ann Trotman, BDS, MA, MS, at Tufts University School of Dental Medicine, Dr. Hadlock will use novel 3D models and measures to determine outcomes of mid-facial reanimation surgeries. The National Institutes of Health awarded Christopher J. Hartnick, MD, MS, a five-year, $4 million U01 grant to study if hypoglossal nerve stimulation might improve neurocognition and language in patients with Down syndrome. Phillip A. Huyett, MD, performed the first implantation of a hypoglossal nerve stimulator on an adult patient with Down Syndrome at Mass Eye and Ear. Dr. Huyett was also distinguished for implanting the most stimulators in the world in the first quarter of 2021, which contributed to Mass Eye and Ear being named to Inspire Medical Solutions’ Excellence Program. The National Institutes of Health awarded Artur A. Indzhykulian, PhD, supplemental funding for his R01 grant to promote the use of machine-learning-based research in his laboratory. Together with Christopher Buswinka, a PhD Candidate in the Program in Speech and Hearing Bioscience and Technology at Harvard University, Dr. Indzhykulian and his team will develop machine-learning-based data analysis tools to study cochlear hair cells. Kelly Jahn, AuD, PhD, was awarded a K01 grant by the National Institutes of Health for her research on hyperacusis, a debilitating hearing condition that can make everyday noises unbearable. Hoping to develop diagnostic tools and interventions for hyperacusis, Dr. Jahn

will research the biomarkers of loudness, discomfort and distress associated with the condition. Dr. Jahn also received a New Investigators Research Grant from the American Speech-Language-Hearing Foundation earlier in 2021 in support of her biomarker research. Nathan T. Jowett, MD, PhD, earned his PhD from McGill University. His thesis presented a general approach to managing facial palsy, a condition that causes paralysis or weakness of the muscles on one or both sides of the face, and also introduced a novel approach to unilateral facial reanimation. David H. Jung, MD, PhD, FACS, was awarded the Norman Knight Leadership Development Award. The award was endowed by Norman Knight, a selfmade broadcast pioneer and media mogul who has been a thoughtful champion of Mass Eye and Ear for over 25 years. Recipients of the award are selected for their exceptional promise as future leaders within their specialty in otolaryngology– head and neck surgery.

Elliot D. Kozin, MD, was awarded a K08 grant by the National Institutes of Health to conduct research that could help explain why patients experience auditory dysfunction after traumatic brain injury. His research focuses on developing an animal model and a clinical measure of mild traumatic brain injury that could lead to a new class of biomarkers to help diagnose and treat individuals following head injury. Linda Lee, MD, FACS, celebrated the publication of her medical textbook Hair Transplant Surgery and PlateletRich Plasma: Evidence-Based Essentials. Her textbook presents multiple surgical techniques for hair restoration, including follicular unit transplant, follicular unit extraction, medical management of hair loss and platelet-rich plasma treatment. Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum (CORLAS) awarded M. Charles Liberman, PhD, the James B. Snow Jr., MD, Tinnitus Research Award for his outstanding contributions to advancing tinnitus research. Ralph B. Metson, MD, was elected President of the Triological Society, an honor bestowed to him by the Fellows of the Triological Society. Earlier in 2021, the Ralph B. Metson Lectureship in Rhinology was launched by past and present fellows of Dr. Metson in honor of his commitment to mentorship, research and education in the field of rhinology.

Mark A. Varvares, MD, FACS, presenting the Norman Knight Leadership Development Award to Dr. David Jung.

The Society for Ear, Nose and Throat Advancement in Children (SENTAC) awarded Margaret A. Kenna, MD, the Ruben Scientific Achievement Award for her outstanding scientific achievement towards the care of children’s ear, nose and throat disorders.

Gregory W. Randolph, MD, FACS, FACE, was elected President of the International Thyroid Oncology Group. Earlier in 2021, Dr. Randolph co-led the launch of Mass Eye and Ear’s multidisciplinary Radiofrequency Ablation Clinic for thyroid nodules. Aaron K. Remenschneider, MD, MPH, was elected to a two-year term on the editorial board of the peer-review journal Otolaryngology–Head and Neck Surgery. Jeremy D. Richmon, MD, was awarded the William Montgomery Faculty Teaching Award at the Harvard Medical School Otolaryngology–Head and Neck Surgery graduation ceremony.

The American Head & Neck Society invited Srinivas Vinod Saladi, PhD, to serve as a Member of its Basic & Translational Science Service from 2021 to 2024. Eliot Shearer, MD, PhD, was awarded a K08 grant by the National Institutes of Health to help better understand how genes contribute to postoperative speech perception outcomes in children with cochlear implants. Roy Xiao, MD, became the 16th Harvard otolaryngology–head and neck resident since 2011 to win a CORE grant from the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The grant will fund Dr. Xiao’s research on motor end-to-side neurorrhaphy, a common procedure used to treat patients with peripheral motor nerve deficits, including facial palsy. Phoebe Yu, MD, MPH, was awarded the Otolaryngology–Head and Neck Surgery Departmental Clinical Research Day Award. Dr. Yu won the award for her abstract about a clinical trial that evaluated the safety and efficacy of hypoglossal nerve stimulators on children with Down syndrome. The study, led by Christopher Hartnick, MD, MS, Director of the Division of Pediatric Otolaryngology at Mass Eye and Ear, was the first clinical study that evaluated the safety and efficacy of the novel therapy in a pediatric population. n

Mass Eye and Ear and Brigham and Women’s Hospital were both recognized as top hospitals in the nation for otolaryngology– head and neck surgery by U.S. News & World Report in the 2021-2022 “Best Hospitals” issue. U.S. News & World Report Rankings Mass Eye and Ear was ranked #2 in the nation for otolaryngology–head and neck surgery care and Brigham and Women’s Hospital was ranked in the Top 20. Mass Eye and Ear held on to its #1 ranking in New England, a spot the hospital has held for more than 30 years.

HARVARD Otolaryngology

RESEARCH ADVANCES

The following are select research advances from the Harvard Medical School Department of Otolaryngology–Head and Neck Surgery.

Basic science findings

Discovery of HIC1 may lead to pathway for hearing loss reversal

A promising method for delivering neurotrophic activity into the inner ear

More than 400 million people worldwide live with sensorineural hearing loss, which occurs most often when hair cells – the cells in the inner ear responsible for hearing – deteriorate. Aging, infections, medications or exposure to loud noises can damage these cells. There are no built-in replacements for the damaged hair cells – they become permanently lost, resulting in irreversible hearing loss.

For years, researchers have targeted a group of proteins called neurotrophins as a potential treatment for irreversible sensorineural hearing loss. These proteins can stimulate spiral ganglion neurons (SGNs) in the inner ear and have the potential to promote regeneration of the synapses connecting SGNs with inner hair cells (IHCs). Finding a way to successfully deliver these proteins past the cochlear bone and into the inner ear, however, has been a challenge for researchers. David H. Jung, MD, PhD, FACS, of Mass Eye and Ear, and his colleagues demonstrated that a small-molecule analogue of Neurotrophin-3 (NT-3) can stimulate SGNs in vitro. In a study published in Frontiers in Cellular Neuroscience, both the smallmolecule agonist and its bisphosphonatelinked counterpart were demonstrated to be highly active in regenerating synapses between SGNs and IHCs. This approach ultimately aims to use cochlear bone as a reservoir for the extended slow release of NT-3 into the inner ear. Findings from the study support the potential of bisphosphonate conjugation as another feasible strategy to deliver neurotrophic agents to SGNs. Kempfle JS, Duro MV, Zhang A, Amador CD, Kuang R, Lu R, Kashemirov BA, Edge AS, McKenna CE and Jung DH (2021) A Novel Small Molecule Neurotrophin-3 Analogue Promotes Inner Ear Neurite Outgrowth and Synaptogenesis In vitro. Front. Cell. Neurosci. 15:666706. doi: 10.3389/ fncel.2021.666706

HARVARD Otolaryngology

Identifying which molecular pathways allow hair cells to regenerate could help researchers better understand the mechanisms needed to reverse hearing loss. However, studying these pathways has been a challenge for researchers who have long relied on complex mouse models and a limited set of relevant tools in a petri dish. Dunia E. Abdul-Aziz, MD, and Albert Edge, PhD, have reported a novel approach that combines genetic tools with organoid technology to uncover a promising pathway involved in hair cell regeneration. In their study published in Stem Cell Reports, they reveal a new molecular player called “hypermethylated in cancer 1,” or “HIC1,” that hinders the regeneration of hair cells in mammals. Researchers used genetic tools to limit the expression of HIC1 in cochlear organoids and observed changes in the manifestation of ATOH1, an essential gene required for hair cell development. They saw that ATOH1 expression increased, and moreover, that there were markedly more hair cells generated from progenitor cells. Conversely, when the researchers overexpressed HIC1 in the organoid model, they witnessed ATOH1 inhibition and a subsequent decrease in hair cells. They went on to study the mechanism

of HIC1’s repression, which is caused in part by modulating a key developmental pathway known as “Wnt signaling.” Abdul-Aziz, D, Hathiramani, N, Phung, L, Sykopetrites, V, Edge, A. HIC1 Represses Atoh1 Transcription and Hair Cell Differentiation in the Cochlea. Stem Cell Reports. 2021 16(4), 797–809. doi: 10.1016/j.stemcr.2021.02.022

Implanted vestibular prosthesis improves spatial orientation in animals with severe vestibular damage Patients with vestibular damage experience impaired vision, spatial perception and balance. Such symptoms are often irreversible. However, vestibular implants have the potential to improve the perception of head orientation in patients with vestibular damage. In a study published in The Journal of Neuroscience, a team of researchers led by Richard F. Lewis, MD, and Faisal Karmali, PhD, of Mass Eye and Ear tested whether a canal vestibular implant (VI) could improve the perception of head orientation in vestibulopathic animal subjects. Using a subjective visual vertical task, Drs. Lewis and Karmali found that normal subjects accurately sensed the orientation of the head relative to gravity during dynamic tilts. The ability to sense such orientation degraded following bilateral vestibular damage and improved when the canal VI was used. Findings from the study are a promising sign for the use of canal VIs in human patients. Karmali F, Haburcakova C, Gong W, Della Santina CC, Merfeld DM, Lewis RF. An Implanted Vestibular Prosthesis Improves Spatial Orientation in Animals with Severe Vestibular Damage. J Neurosci. 2021 Apr 28; 41(17):38793888. doi: 10.1523/JNEUROSCI.2204-20.2021.

Norrie disease protein deemed essential for cochlear hair cell maturation; offers promising clues for hearing restoration Norrie disease is a rare hereditary disorder that causes deafness, blindness and intellectual disability caused by a mutation in the gene for Norrie disease protein (Ndp). The rare disorder also holds a major clue for treating irreversible hearing loss, as discovered by a team of researchers led by Albert Edge, PhD, of Mass Eye and Ear. By analyzing the downstream expression of the Ndp gene in mice, the researchers found that the Ndp gene plays a vital role in the maintenance and survival of hair cells in the cochlea, which are responsible for detecting sound. Published in Proceedings of the National Academy of Sciences of the United States of America, the study revealed two possible avenues for preventing deafness in mice with a mutated Ndp gene: forced activation of Ndp by secreting the gene’s protein directly from cells adjacent to hair cells, or increasing the level of β-catenin, the intracellular effector of Wnt signaling, to promote hair cell differentiation. Hayashi Y, Chiang H, Tian C, Indzhykulian A, Edge A. Norrie Disease Protein is Essential for Cochlear Hair Cell Maturation. Proc Natl Acad Sci U S A. Sept 2021; 118(39) e2106369118. doi: 10.1073/pnas.2106369118

Clinical findings AI algorithm provides accurate model for diagnosing ear infections Chronic and acute otitis media, or ear infections, can result in significant consequences if misdiagnosed in children. In a study published in Pediatrics, researchers at Mass Eye and Ear attempted to develop a more accurate method of predicting infections in the middle ear using an artificial intelligence algorithm.

Researchers who led the study, including Mass Eye and Ear’s Matthew G. Crowson, MD; Christopher J. Hartnick, MD, MS; Gillian R. Diercks, MD, MPH; Jennifer Setlur, MD; and Michael S. Cohen, MD, developed and trained an artificial intelligence algorithm to accurately predict the presence of middle ear effusion in pediatric patients. The algorithm produced a diagnosis accuracy rate of 84 percent, which was considerably higher than the human-expert, otoscopy-based diagnostic performance reported in previous studies. The high diagnosis accuracy provides hope for patients, families and health care systems looking for improved point-of-care diagnostic accuracy for ear infections. Crowson MG, Hartnick CJ, Diercks GR, et al. Machine Learning for Accurate Intraoperative Pediatric Middle Ear Effusion Diagnosis. Pediatrics. Apr 2021; 147(4) e2020034546. doi: 10.1542/peds.2020-034546

Downregulation of molecular factors for improvement of idiopathic subglottic stenosis Idiopathic subglottic stenosis (iSGS) is a progressive disease characterized by lifethreatening airway narrowing. Although the molecular underpinnings of the disease are unknown, previous reports show that subglottic serial intralesional steroid injections (SILSIs) can improve clinical outcomes, which suggests a steroid-sensitive pathway in iSGS. In an attempt to identify steroid-sensitive profibrotic drivers, a prospective study was led by Ramon A. Franco, Jr., MD, of Mass Eye and Ear to determine changes in profibrotic markers during SILSI. Seven patients who were newly

diagnosed with iSGS were recruited for the study and had their subglottic biopsies before and after SILSI treatments evaluated for histologic and molecular markers. Findings from the study were published in The American Journal of Pathology and revealed that SILSI counteracted a dysregulated axis of transforming growth factor β1, cellular communication factor 2 and matrix metalloprotease 9, all of which are involved in iSGS development. Treviño-Villarreal JH, Reynolds JS, Langston PK, Thompson A, Mitchell JR, Franco RA. Down-Regulation of a Profibrotic Transforming Growth Factor-β1/Cellular Communication Network Factor 2/Matrix Metalloprotease 9 Axis by Triamcinolone Improves Idiopathic Subglottic Stenosis. Am J Pathol 2021; 191(8):1412-1430. doi: 10.1016/j. ajpath.2021.05.013

Effects of age and the electricalto-neural interface on perceptual measures in cochlear implant listeners Cochlear implants can restore hearing in individuals with severe to profound hearing loss. However, despite the success of cochlear implants in restoring hearing thresholds, speech perception outcomes are highly variable in children and adults who wear these devices. Contributing factors to this variability are considered either peripheral or central. Peripheral factors may be related to the quality of the electrical interface of the device and the auditory neurons within the inner ear, whereas central factors may be related to age-related changes in a person’s auditory temporal processing. A study authored by Julie G. Arenberg, PhD, AuD, and Kelly Jahn, AuD, PhD, of Mass Eye and Ear examined the interaction between peripheral and central factors and how they might contribute to outcomes in cochlear implanted adults. Published in The Journal of the Acoustical Society of America, the study aimed to evaluate a potential link between [ continued p. 30 ]

HARVARD Otolaryngology

RESEARCH ADVANCES

a person’s age, temporal processing and the estimated quality of the electrical interfaces on cochlear implants. Researchers observed a decline in auditory temporal processing in older patients and a more pronounced decline in older individuals with poorer quality electrical interfaces. From these results, researchers believe the interaction between electrical interface quality of cochlear implant channels and auditory aging warrants further study to tailor programming and rehabilitative approaches for older listeners. Jahn KN, DeVries L, Arenberg JG. Recovery from Forward Masking in Cochlear Implant Listeners: Effects of Age and the Electrode-Neuron Interface. J Acoust Soc Am. 2021 Mar;149(3):1633. doi: 10.1121/10.0003623.

Improvement of pulmonary function in cystic fibrosis patients following endoscopic sinus surgery Sinus disease is one of the most common manifestations of cystic fibrosis (CF), a hereditary disease that results in thickened viscous secretions in the sinuses and lower airways. These secretions impair pulmonary function along the airways, adversely affecting morbidity and mortality rates among CF patients. Surgeons often treat sinus disease by conducting endoscopic sinus surgery (ESS). Exactly how well ESS improves the pulmonary function of CF patients, however, has yet to be determined; past studies of the procedure on CF patients have produced conflicting results and have not accounted for varying pulmonary symptoms and disease factors among CF patients. Eelam A. Adil, MD, MBA, of Boston Children’s Hospital, evaluated the pulmonary function of a large cohort of CF patients before and after ESS using several mixed-effect models that controlled for variables such as age, gender, genotype, medications, nutritional status and medical history. According to the study, which was published in The Laryngoscope, patients with moderate to severe lung

HARVARD Otolaryngology

disease sustained improved pulmonary function following ESS, even 12 months after surgery. The study accounted for a total of 427 surgeries performed on 188 patients with CF between 1996 and 2018. Kosuke K, Dombrowski N, Sawicki GS, Adil EA. Improvement of Pulmonary Function in Cystic Fibrosis Patients following Endoscopic Sinus Surgery. Laryngoscope. Sept 2021;131: 1920-2938. doi: 0.1002/lary.29409

Increasing the utility of a non-invasive technique for diagnosing hearing loss Middle- and inner-ear disorders that alter the mechanical properties of the ear are common and result in conductive hearing loss. Such disorders include middle-ear fluid, otosclerosis, ossicular discontinuity and superior canal dehiscence, and are currently difficult to diagnose noninvasively and inexpensively. Wideband tympanometry (WBT) is a quick, non-invasive and inexpensive acoustic measurement that shows great promise for detecting and distinguishing middleand inner ear disorders much better than standard tympanometry used in current clinical practice. To date, WBT has seen only limited clinical use due to intermeasurement variability. To improve WBT as a diagnostic tool, Mass Eye and Ear research fellow Kristine E. Eberhard, MD, and researcher Michael Ravicz, MS, explored how to make WBT more accurate and reliable in the laboratory of Heidi Nakajima, MD, PhD. In a study published in Ear and Hearing, the researchers discovered an artifact in WBT data processing and developed a processing technique that automatically mitigates this artifact, reduces measurement variability and preserves critical information to improve WBT’s diagnostic capabilities.

In a separate collaboration with Aaron K. Remenschneider, MD, MPH, Nakajima Laboratory researchers utilized wideband acoustic immittance to understand the mechanics of reconstructed tympanic membranes (TMs) and to explain poor hearing outcomes. Their study, published in Otolaryngology–Head and Neck Surgery, revealed that ears with a fascia graftreconstructed TM transmitted sound poorly at mid- to high frequencies compared with ears with a normal and healthy TM. Eberhard KE, Ravicz ME, Merchant GR, et al. Preserving Wideband Tympanometry Information with Artifact Mitigation. Ear and Hearing, Aug 11 2021; e-pub ahead of print. doi: 10.1097/AUD.0000000000001117 Eberhard KE, Masud SF, Knudson IM, et al. Mechanics of Total Drum Replacement Tympanoplasty Studied with Wideband Acoustic Immittance. Otolaryngol Head Neck Surg, July 2021; e-pub ahead of print. doi: 10.1177/01945998211029541.

Low-cost educational intervention reduces unplanned extubation in low-resourced pediatric intensive care units A significant percentage of unplanned extubations (UEs) result in a destabilizing event, such as cardiac collapse, which can contribute to heightened morbidity and mortality rates. In low-income pediatric intensive care units (PICU)s, UEs are most prevalent and severe due to the lack of training and resources clinicians receive to treat intubated patients. A team of researchers led by Christopher J. Hartnick, MD, MS, of Mass Eye and Ear, evaluated UEs among pediatric patients before and after introducing low-cost materials and a multidisciplinary educational curriculum to clinicians in an El Salvadorian PICU. The researchers developed online video-module trainings by otolaryngologists, anesthesiologists, respiratory therapists and nurses that were accessible to clinicians through a bedside QR code.

Nine-hundred-fifty-seven patients met inclusion criteria for the study. According to findings published in the International Journal of Pediatric Otorhinolaryngology, patients with one or more UEs decreased significantly from 29.4 percent to 17.3 percent, which contributed to a 4.3 percent decrease in pediatric mortality. The multi-faceted intervention strategy proved an accessible, scalable and costeffective means of reducing UE and has implications in reducing pediatric mortality. Jayawardena A, Ghersin Z, Guzman LJ, et al. A Low-Cost Educational Intervention to Reduce Unplanned Extubation in Low-Resourced Pediatric Intensive Care Units. Int J Pediatr Otorhinolaryngol. 2021; 149: 110857, doi: 10.1016/j.ijporl.2021.110857

Low-cost medication for lymphatic malformations in Rwanda In Rwanda, congenital malformations such as lymphatic malformations can be a challenge to treat surgically. While sclerotherapy offers a less invasive treatment option, medical sclerosing agents can be expensive in a country where resources are scarce. David A. Shaye, MD, MPH, FACS, Ciersten A. Burks, MD, and Shekhar K. Gadkaree, MD, of Mass Eye and Ear led a study published in Facial Plastic Surgery & Aesthetic Medicine that analyzed a cost-effective approach to treating lymphatic malformations at Rwanda’s University Teaching Hospital. The paper reported that, when pharmaceutical alternatives were not available, handcrushed doxycycline sclerotherapy provided a low-cost treatment option. The authors conducted their study alongside Rwandan counterparts Isaie Ncogoza, MD; Aaron Gasore, MD; Victor Nyabyenda, MD; and Gratien Tuyishimire, MD. According to the study, 10 patients underwent 21 sclerosing sessions at an

average cost of four cents per patient. All patients in the study achieved at least 80 percent resolution; the majority achieved 100 percent resolution, with none requiring surgery. Shaye DA, Ncogoza I, Nyabyenda V, et al. Ultra Low-Cost Doxycycline Sclerotherapy for Lymphatic Malformations in Rwanda. Facial Plast Surg Aesthet Med. Jun 24 2021;. doi: 10.1089/fpsam.2021.0096. Epub ahead of print.

Neurotization preferences in smile reanimation A key component of facial palsy treatment is reanimation of a patient’s smile. Smile reanimation necessitates use of a donor nerve through neurotization, or a nerve transfer. Neurotization options for smile reanimation include transferring either the ipsilateral trigeminal motor branches or the contralateral facial nerve branches. While use of contralateral facial nerve branches carries greater potential for restoring smile spontaneity, the approach has a higher failure rate compared to neurotization options that utilize the trigeminal motor branches. Which approach a patient chooses is influenced by multiple factors that are not yet fully understood. In a study published in Plastic & Reconstructive Surgery, a team of researchers from Mass Eye and Ear led by senior author Nathan Jowett, MD, PhD, and co-first author Matthew R. Naunheim, MD, MBA, demonstrated that the majority of community volunteers enrolled in the study would prefer a surgical strategy that utilized the contralateral facial nerve, despite its higher risk of procedural failure. The volunteers accepted theoretical procedural failure risks up to 33-to-44 percent for the chance to restore smile spontaneity, quantifying the importance of a smile activated by laughter and joy. Dusseldorp JR, Naunheim MR, Quatela O, Fortier E, Hadlock TA, Jowett N. Neurotization Preferences in Smile Reanimation: A Discrete Choice Experiment. Plast Reconstr Surg. Sep 2021; 148(3):407e-415e. doi: 10.1097/PRS.0000000000008302.

Severe sinonasal inflammation linked to changes in brain activity A study published in JAMA Otolaryngology– Head and Neck Surgery reported that changes in brain activity, specifically the neural networks that modulate cognition, introspection and response to external stimuli, were reported in patients with severe sinonasal inflammation. Several meaningful advances in the understanding of the cognitive effects of severe sinonasal inflammation had been made in recent years, but never before had there been an investigation of a possible link between the condition and higher-order neural processing. Authors of the study included Mass Eye and Ear’s Benjamin Bleier, MD, FACS, the study’s lead author, and Kristina Simonyan, MD, PhD, Dr med. The study reported that participants with severe sinonasal inflammation showed decreased brain connectivity within a major functional hub with a central role in modulating cognition. Twenty-two patients with severe sinonasal inflammation and 22 healthy controls were included in the analysis. Despite the brain-activity changes, however, no significant deficit was seen in the behavioral and cognitive testing of study-group participants, though it may be plausible that untreated sinusitis can lead to more clinically meaningful symptoms. Jafari A, Xavier LDL, Bernstein J, Simonyan K, Bleier B. Association of Sinonasal Inflammation With Functional Brain Connectivity. JAMA Otolaryngol Head Neck Surg. 2021; 147(6):534-543. doi:10.1001/jamaoto.2021.0204

Sleep disorders tally $94.9 billion in health care costs each year Approximately 13.6 million adults in the Unites States have been diagnosed with a sleep disorder. The total healthcare costs of these disorders, however, has long been left untallied. [ continued p. 32 ] HARVARD Otolaryngology

RESEARCH ADVANCES

Mass Eye and Ear’s Neil Bhattacharyya, MD, MA, FACS, and Phillip A. Huyett, MD, recently examined the increased health care utilization and expenditures associated with sleep disorders using national databases. The study, which was published in the Journal of Clinical Sleep Medicine, found that individuals with sleep disorders had eight additional office visits, 18 additional prescriptions and $7,000 greater total costs per year when compared to similar patients without sleep disorders. Overall, the study estimated that the direct health care costs of sleep disorders in the U.S. were $94.9 billion. The study included data from a nationally representative survey of more than 22,000 Americans.

recovered from a case of sudden SNHL. The team found that patients with hearing thresholds that completely recovered from the condition had poorer speech intelligibility performance than predicted by their audiogram. Dr. Maison and his coauthors also found evidence that recovery in hearing sensitivity depended on hearing loss configuration.

subtle EBSLN injuries and of optimizing voice outcomes during a thyroidectomy.

The study received “Editor’s Choice” honors from the publication and has led researchers to suspect hidden hearing loss as a possible explanation for the lack of clarity in speech discrimination reported by some patients following their recovery from sudden SNHL.

Furthermore, sleep disorders are woefully underdiagnosed, as highlighted by a separate study published by Drs. Huyett and Bhattacharyya in The Laryngoscope, and therefore so are the costs attributed to the disorders in such studies.

Superior laryngeal nerve attenuation influences voice outcomes in thyroid surgery

There is little data to support prescribing prophylactic antibiotics following endoscopic sinus surgery (ESS), despite it being common practice among surgeons. Stacey T. Gray, MD, and Eric H. Holbrook, MD, of Mass Eye and Ear, worked with Marlene L. Durand, MD, of Massachusetts General Hospital and Mass Eye and Ear, to assess the impact of antibiotics on patients following ESS.

Huyett P, Bhattacharyya N. Incremental Health Care Utilization and Expenditures for Sleep Disorders in the United States. J Clin Sleep Med. 2021 May 4. doi: 10.5664/ jcsm.9392. Epub ahead of print. Huyett P, Siegel N, Bhattacharyya N. Prevalence of Sleep Disorders and Association With Mortality: Results From the NHANES. 2009-2010. Laryngoscope. 2021 Mar;131(3):686689. doi: 10.1002/lary.28900.

Sudden deafness reveals link to hidden hearing loss Sudden sensorineural hearing loss (SNHL), or sudden deafness, is one of the most common emergencies seen by ENT physicians. While hearing thresholds may recover in some patients, its cause and lasting effects remain uncertain. In a study published in Ear and Hearing, a team of researchers led by Mass Eye and Ear’s Stéphane Maison, PhD, CCC-A, examined the audiologic profiles of 166 patients at Mass Eye and Ear who had partially or fully

Okada M, Parthasarathy A, Welling DB, Liberman MC, Maison S. Idiopathic Sudden Sensorineural Hearing Loss: Speech Intelligibility Deficits Following Threshold Recovery. Ear and Hearing. July/August 2021; 42:782-792. doi: 10.1097/AUD.0000000000000987.

Gregory W. Randolph, MD, FACS, FACE, of Mass Eye and Ear, led a prospective multicenter case series to examine whether injury to the external branch of the superior laryngeal nerve (EBSLN) correlates with postoperative changes in voice quality. As reported in The Laryngoscope, electromyography waveforms of EBSLN stimulation before and after superior pole dissection were evaluated using endotracheal tube (ETT) electrodes and cricothyroid intramuscular (CTM) electrodes. A total of 80 patients who contributed 131 at-risk EBSLNs were enrolled in the study. Based on measurements recorded from CTM needle electrodes, patients experienced worse voice outcomes when at least one EBSLN response amplitude decreased by more than 50 percent after dissection. Findings from the study also suggested that CTM electrodes may represent a safer method of deducing

Iwata AJ, Liddy W, Barczyński M, Wu CW, et al. Superior Laryngeal Nerve Signal Attenuation Influences Voice Outcomes in Thyroid Surgery. Laryngoscope. 2021 Jun;131(6):1436-1442. doi: 10.1002/lary.29413.

Usage of prophylactic antibiotics after endoscopic sinus surgery

The research team performed a randomized, double-blind clinical trial that compared the effect of the antibiotic amoxicillinclavulanate on ESS patients to that of a placebo. Published in The International Forum of Allergy & Rhinology, findings from the study revealed that antibiotics did not provide any benefit when used after routine ESS and when an infection was not present during surgery. In fact, the rate of gastrointestinal complications was significantly higher in patients who were given antibiotics versus placebo. The study added to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post-ESS and, instead, significantly increases the rate of diarrhea. Lehmann, AE, Raquib, AR, Siddiqi, SH, et al. Prophylactic Antibiotics after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Randomized, Double-Blind, PlaceboControlled Noninferiority Clinical Trial. Int Forum Allergy Rhinol. 2021; 11: 1047– 1055. doi: 10.1002/alr.22756

Beth Israel Deaconess Medical Center faculty photos courtesy of Beth Israel Deaconess Medical Center Boston Children’s Hospital faculty photos courtesy of Boston Children’s Hospital Brigham and Women’s Hospital faculty photos courtesy of Brigham and Women’s Hospital

HARVARD Otolaryngology

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