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					I N N OVATI O NS | 2 0 0 7 E D I T I O N




     Otolaryngology–
 Head & Neck Surgery
           Mission
   The mission of Johns Hopkins
Medicine is to improve the health
 of the community and the world
      by setting the standard of
  excellence in medical education,
 research and clinical care. Diverse
    and inclusive, Johns Hopkins
     Medicine educates medical
   students, scientists, health care
    professionals and the public;
conducts biomedical research; and
provides patient-centered medicine
   to prevent, diagnose and treat
            human illness.


             Vision
Johns Hopkins Medicine provides a
 diverse and inclusive environment
 that fosters intellectual discovery,
  creates and transmits innovative
    knowledge, improves human
    health, and provides medical
      leadership to the world.


        Core Values
      Excellence & Discovery
      Leadership & Integrity
       Diversity & Inclusion
      Respect & Collegiality
Table of Contents




OTOLARYNGOLOGY–HEAD & NECK SURGERY


Department Overview                                               4

Demonstrating Clinical Innovation and New Discoveries             9

Patient Safety and Quality Measures                               26

The Patient Experience                                            31

Our Faculty                                                       35

How to Refer a Patient                                            38

Locations                                                         38

Referral Assistance                                               39

Johns Hopkins Medicine Overview                                   41




                                         JOHNS HOPKINS MEDICINE        1
                                                   Otolaryngology–
                                               Head & Neck Surgery
2   O TOLARYNGOLOGY – H EAD & N ECK S URGERY
Dear Colleague:


       very aspect of our professional life at

E      Johns Hopkins is devoted to patient
       care. Both our clinical work and our
research are designed to illuminate and clar-
ify conditions and diseases to develop
enhanced treatments for our patients.
   We’re pleased to share with you a glimpse
into our ongoing efforts, innovations and discoveries on the journey to
superior patient care. Inside, you’ll find our latest research that trans-
lates into better patient outcomes; innovations that bring treatments to
a new level; and steps we’re taking each day to improve quality, out-
comes and patient safety.
   Each patient we care for remains our first priority. When you refer
to us, you’ve placed tremendous confidence and trust in us, and we’ll
work with you to ensure the best possible results.
   Finally, we are devoted to excellence in everything we do. This
booklet is part of an overall initiative for us to relay information about
activities in our department, report on innovations and discoveries in
the field, and enhance patients’ access and experience. We’re looking
forward to continuing this important initiative.

Warm regards,



Lloyd Minor, M.D.
Andelot Professor and Director of Otolaryngology–Head & Neck Surgery


If you have any questions or would like to speak with Lloyd Minor or any of the Otolaryngology –
Head & Neck Surgery faculty, please call 410-955-1080.

For more information on Johns Hopkins Otolaryngology–Head & Neck Surgery, visit
www.hopkinsmedicine.org/otolaryngology. To refer a patient, call 443-287-6585.



                                                     JOHNS HOPKINS MEDICINE                        3
4   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




    Department Overview

           Johns Hopkins Department                 2006 Highlights
           of Otolaryngology–Head &
           Neck Surgery                             In this booklet, we summarize some
                                                    of the many clinical innovations tak-
           Johns Hopkins Otolaryngology–            ing place at Johns Hopkins Medicine:
           Head & Neck Surgery is consis-
           tently recognized by peers around        I a cure for superior canal dehis-
           the country for our research, ad-          cence syndrome (see page 16)
           vanced treatments, effective use of      I research on cochlear implants and

           technology and focus on patient            BAHA hearing aids that will
           care. Named best in the nation year        transform a patient’s ability to
           after year in U.S. News & World            hear (see page 21)
           Report’s Best Hospital’s ranking,        I the role of HPV in head and

           our faculty, residents and staff de-       neck cancer (see page 24)
           vote themselves to patient safety        I reconstruction surgery after a
           and quality initiatives every day.         patient is treated for head and
               Our physicians include head            neck cancer (see page 30)
           and neck surgeons, facial plastic
           and reconstructive surgeons, endo-
           scopic surgeons, sinus surgeons,
           pediatric otolaryngologists, speech
           pathologists, audiologists, otolo-
           gists, neurotologists, laryngologists,
           swallowing therapists, dentists and
           oral surgeons who collaborate to
           provide comprehensive services to
           each patient.
               Johns Hopkins' expertise ranges
           from common problems like ton-
           sillitis, snoring and ear infections
           to such complex conditions as si-
           nusitis, speech disorders and throat
           cancer.
                                                       D E PA RT M E N T O V E RV I E W




Quality
This past year alone, we’ve devel-
oped more ways to improve our
quality of care and patient safety:
I We created protocols to reduce
  cerebrospinal fluid leaks after
  intracranial procedures to re-
  move acoustic neuromas
  (see page 25).
I In conjunction with other Hop-
  kins clinical departments, we de-
  veloped guidelines for deep-vein
                                      “ My role is to ensure
  thrombosis to reduce the inci-
                                       that every component of
  dence of pulmonary embolism.
                                       otolaryngology–head &
I We’ve embraced electronic
                                       neck surgery shines.
  medical records and provider
                                       What’s most exciting is
  order entry as these tools be-
                                       seeing our faculty, residents
  came universal throughout our
                                       and staff come together
  hospitals for every inpatient. In
                                       to advance our patient
  studies across the nation, these
                                       care mission.
  records have been proven to re-
                                            In the end, this place
  duce medication errors and to
                                        is all about people:
  improve communication and
                                        people working alongside
  quality of care.
                                        one another to fulfill
As always, our efforts are ongoing      common dreams and
to improve outcomes by translat-        aspirations related to the
ing research to clinical care and       excellence that encompasses
better treatments.                      who we are.”
                                              — Lloyd Minor, Director,
                                                      Otolaryngology–
                                                Head & Neck Surgery




                                      JOHNS HOPKINS MEDICINE                              5
6   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




                                                    Research Funds

                                                                                         Direct Costs

                                                                                         Indirect Costs

                                                                                         Total Funds


                        $ 16,000,000
     Research Funding




                          14,000,000
                          12,000,000
                          10,000,000
                           8,000,000
                           6,000,000
                           4,000,000
                           2,000,000
                                   0
                                        FY01      FY02       FY03        FY04     FY05          FY06


                                                           Fiscal Year



                         Research                                   Experience and Outcomes
                         Johns Hopkins Otolaryngology–              Johns Hopkins Otolaryngology–
                         Head & Neck Surgery is at the              Head & Neck Surgery is one of the
                         forefront of discovery. In the             busiest departments in the country.
                         past five years, our National              Last year, we saw nearly 48,000 pa-
                         Institutes of Health funding has           tient visits in our clinics.
                         nearly tripled, making Johns                  We performed more than 4,000
                         Hopkins the top department of              surgical cases at The Johns Hopkins
                         otolaryngology–head & neck sur-            Hospital and Johns Hopkins
                         gery in amount of awarded NIH              Bayview Medical Center. Our head
                         grants. Our physician scientists           and neck cancer surgeons per-
                         study conditions and diseases to illu-     formed more than 500 operations.
                         minate better treatments for our pa-       Our otologists performed nearly
                         tients. As we move forward, patients       200 cochlear implants, making
                         will reap the benefits of our work.
                                                               D E PA RT M E N T O V E RV I E W




                                Patient Visits


                 48000

                 47000
Patient Visits




                 46000

                 45000

                 44000

                 43000
                         FY04             FY05               FY06

                                     Fiscal Year



                                                  Otolaryngology Patient Origin:
                                                         Adult Inpatients
                                                                     2%


Johns Hopkins one of the top five
centers for cochlear implantation in             44%                                      33%
the world.
   Our length of stay remains at ap-
proximately three days, which outper-
forms Milliman and Roberts data
when length of stay for specific diag-
noses and procedures is measured.
   Patients from all over the United
                                                                          21%
States and the world come here for
treatment. Last year, more than one-                   Central Maryland           Other US
third of our adult inpatients were from
                                                       Other Maryland             Foreign
out of state or out of the country.




                                             JOHNS HOPKINS MEDICINE                               7
8   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




         Patient Satisfaction
         In our efforts to provide our patients with the best treatment and care, we
         continually solicit patient feedback and use this information to help improve
         the patient experience. Results from our most recent patient satisfaction sur-
         veys in December 2006 indicate that over 90 percent of our patients would
         likely recommend their Hopkins care providers and our practice.

                                          Likelihood to Recommend Practice - 2006

                                100.0
             Percent Response




                                 80.0

                                 60.0

                                 40.0

                                 20.0

                                   0.0
                                         Very Poor   Poor     Fair     Good    Very Good


                                           Overall Quality of Outpatient Care - 2006

                                100.0

                                 80.0
           Percent Response




                                 60.0

                                 40.0

                                 20.0

                                  0.0
                                         Very Poor   Poor     Fair     Good   Very Good
                                         C LI N I C AL I N N OVAT I O N & N E W D I S C OV E R I E S




Demonstrating Clinical Innovation and New Discoveries

Learn on the following pages how we are breaking new ground in patient care.


Demonstrating Clinical               New Discoveries
Innovation
                                     I    BAHA Clinical Trials: Efficacy of
I   Sinus Surgery Technique               the Bone-Anchored Hearing Aid
    Transfers to Skull-Base               for Unilateral Deafness
    Surgery
                                     I    Many Directions in Tissue
I   Using 3-D Rapid Protoyping            Engineering Research
    Surgical Algorithms in Nasal
    Reconstruction                   I    Treating Precancerous Lesions of
                                          the Mouth, Throat and Voice Box
I   A Cancer Vaccine Taps the
    Role of HPV in Head and          I    Abnormal Immune Responses
    Neck Cancer                           in the Nose Linked to
                                          Chronic Sinusitis
I   Mystery Revealed:
    Researchers Create a Cure        I    Study: HPV Status Is Recommended
    for Superior Canal                    for Staging System
    Dehiscence Syndrome
I   A Safe, Effective Algorithm
    for Recurrent/Persistent
    Papillary Thyroid Cancer
I   Novel Approach to
    Evaluation and Treatment
    of Pediatric Sleep Apnea




                                         JOHNS HOPKINS MEDICINE                                        9
10   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




      Demonstrating Clinical Innovation

                                                Sinus Surgery Technique
                                                Transfers to Skull-Base
                                                Surgery
                                                Johns Hopkins Sinus Center sur-
                                                geons have broad expertise in the
                                                medical and surgical management
                                                of paranasal sinus disease, using
                                                the most up-to-date, minimally in-
                                                vasive techniques. Thanks to mu-
                                                cosal-sparing instrumentation and
                                                high-resolution video technology,
                                                today’s endoscopic sinus surgery
                                                offers many benefits to patients
                                                with chronic sinusitis. “We per-
                                                form a targeted removal of bottle-
                                                necks that prevent normal sinus
                                                drainage,” explains Andrew Lane,
           Andrew Lane, M.D.
                                                associate professor and director of
                                                the Rhinology and Sinus Surgery
                                                Center. “It’s all done with small in-
                                                struments passed through the nos-
                                                trils, so there are no external scars
                                                or bruising.”
                                                    For even the most complex si-
                                                nusitis cases, a completely nasal
                                                endoscopic approach has been
                                                made possible by a high-tech map-
                                                ping system that allows the sur-
                                                geon to identify critical anatomic
                                                structures that have been distorted
                                                or obscured by severe disease or
                                                previous surgery. Called stereotac-
                                           D E M O N S T R AT I N G C L I N I C A L I N N O VAT I O N




tic computer-assisted surgical navi-    also appear in the virtual space of
gation, the technology works much       the CT or MRI images. The virtual
like a global-positioning system.       surgical field allows the surgeon to
With this tool, the surgeon can         predict what lies ahead, to avoid
safely operate very near to the thin    damaging vital structures and to as-
layer of bone separating the roof of    sure the complete removal of skull-
the sinuses from the brain.             base tumors.
    But Hopkins surgeons are using         With the advent of new tech-
the surgical navigation system to       nologies in imaging and operative
do even more. “We now use it to         and radiation management, the ef-
perform endoscopic surgery for          fective treatment of skull-base tu-
medical conditions other than si-       mors requires close interdiscipli-
nusitis,” Lane says, “extending our     nary communication.
transnasal approaches to the mini-         “In this complex surgical area,”
mally invasive treatment of tumors      says Lane, “physicians in various
of the nose, pituitary gland and        specialties, such as diagnostics and
eye, as well as to the repair of de-    surgery, must work together to plan
fects in the skull base through         and perform this intricate work.”
which brain fluid and tissue enter
into the nose.”
    Image-guided surgery brings to-
gether the skills of experienced sur-
geons with 2- and 3-dimensional
images of the skull base obtained
using CT or MRI scans. Graphic
displays in the operating room link
those images to the sterile instru-
ments used by the surgeons so that
the instrument tips in real space




                                           JOHNS HOPKINS MEDICINE                                       11
12   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




                                                Using 3-D Rapid Prototyping
                                                Surgical Algorithms in Nasal
                                                Reconstruction
                                                Recreating the human nose is per-
                                                haps the most difficult challenge in
                                                reconstructive surgery. It not only
                                                must have lifelike dimensions and
                                                surface contour, it must be vascular
                                                enough to heal predictably, stable
                                                enough to maintain symmetry, and
                                                functional enough to be acceptable
                                                to the patient’s lifestyle. Normally,
                                                computer models provide 3-D im-
                                                aging of the nasal structure to aid
                                                reconstructive surgeons with
                                                achieving these goals.
                                                   Johns Hopkins physicians now
                                                have developed a way to custom-re-
                                                construct a patient’s own nose.
                                                First, a medical illustrator draws an
               Digital construct.
               The internal surface             initial rendering. This drawing is
               dimensions of the rapid          then converted into a lifelike model
               prototype construct are set      using 3-D laser scanning and a
               back in a manner that takes      process called rapid prototyping,
               into consideration the
               expected thickness of the
                                                which creates a solid object by de-
               forehead flap                    livering material in a sequential,
                                                layered approach for each cross-sec-
                                                tion of the drawing. The end result:
                                                a translucent surgical guide that fits
                                                like a mask on the patient’s face.
                                                   “During the surgery, the steril-
                                                ized guide can be placed directly on
                                                the patient’s face to help achieve
                                        D E M O N S T R AT I N G C L I N I C A L I N N O VAT I O N




stability and completeness of
the nasal reconstruction,” says
Patrick Byrne, assistant profes-
sor of otolaryngology–head &
neck surgery and director of the
Division of Facial Plastic and
Reconstructive Surgery. “These
guides improve the accuracy of
creating a subsurface framework
of an appropriate size, shape
and contour. To our knowledge,
ours is the first report of the use
of custom-made 3-D translu-
cent intraoperative surgical
guides for nasal reconstruction.”
   The technique is used in pa-
tients with complex, subtotal or
total nasal defects.


FULL ARTICLES
                                      The template is placed on the
Byrne PJ, Garcia J. Complex nasal     face as a visual reference. The
reconstruction: improving accuracy    magnitude of the individual’s
with the use of reverse engineered    reconstruction is demonstrated.
3-dimensional surgical guides.
Plastic and Reconstructive Surgery
(accepted for publication).

Byrne PJ, Garcia J. Autogenous
nasal tip reconstruction of complex
defects: a structural approach
employing rapid prototyping.
Archives of Facial Plastic Surgery
(in press).




                                         JOHNS HOPKINS MEDICINE                                      13
14   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            A Cancer Vaccine Taps the               was found to reduce the tumor
            Role of HPV in Head and                 burden or decrease the number of
            Neck Cancer                             HPV-associated cancer cells. It
            Recent research shows a common          works by enhancing the immune
            factor among one-fifth of all head      system’s already vital role in con-
            and neck cancers, and specifically,     trolling HPV infections.
            almost 70 percent of all oropha-           “An HPV vaccine made of
            ryngeal cancers: the human papil-       DNA triggers a rapid response of
            lomavirus (HPV). Once a cell is         immune cells that target HPV and
            infected with the virus, HPV            helps the immune system kill cells
            works to transform the normal cell      infected by the virus,” explains
            into a cancer cell. Now, scientists     Sara I. Pai, assistant professor of
            are using that mechanism to fight       otolaryngology–head & neck sur-
            the very cancer it causes.              gery. “Because normal cells do not
               Johns Hopkins researchers are        contain HPV DNA, the therapy
            developing a novel, multimodality       would be delivered only to the
            treatment regimen for HPV-associ-       HPV-transformed cancer cells.”
            ated tumors that consists of a mild        At the same time, the EGCG
            chemotherapeutic agent, epigallo-       induces apoptosis (cell death)
            catechin-3-gallate (the active ingre-   within the cancer cells. “Since the
            dient in green tea), plus a DNA         immune system is already primed
            vaccine that enhances the immune        by the DNA vaccine, we are able
            system’s ability to recognize and       to broaden the response to other
            kill HPV-infected cells. In preclini-   tumor-specific proteins/peptides
            cal animal models, the combina-         released by the dying cancer cells,”
            tion of the DNA vaccine and epi-        she says. In preclinical models, the
            gallocatechin-3-gallate (EGCG)                       – continued on page 16
                                             D E M O N S T R AT I N G C L I N I C A L I N N O VAT I O N




    Combined HPV DNA vaccination and oral EGCG
 treatment generated synergistic antitumor therapeutic
       effects compared with monotherapy alone.




     30
                                                                         EGCG+RTE7

     25
                                                                         CRTE7


     20                                                                  EGCG+vector


     15                                                                  Vector


     10

      5

      0
          Day 21   Day 26    Day 29     Day 32     Day 35

For the tumor treatment experiments, C57BL/6 mice (five per group) were inoculated
subcutaneously with 1 x 105 HPV tumor cells per mouse. Three days after tumor
inoculation, mice were vaccinated with the CRTE7 HPV DNA vaccine. Mice received a
booster of CRTE7 HPV DNA vaccine with the same dose every four days after the
first vaccination for a total of three vaccine administrations. EGCG was given in the
drinking water at a concentration of 0.5 mg/mL at the start of the vaccination and
continued for 18 days. Tumor volumes were measured and recorded twice per week
for eight weeks following immunization. Tumor treatment experiments were repeated
three times to generate reproducible data. The graph demonstrates that those mice
receiving the combination of EGCG + CRTE7 HPV DNA vaccine (as depicted by the
triangles) have the smallest tumor size as compared to animals receiving no treatment
(squares), EGCG alone (diamonds), or CRTE7 HPV DNA alone (circles).
Cancer Res 2007. Jan15:67(2); 802–811


                                                 JOHNS HOPKINS MEDICINE                                   15
16   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            combination treatment led to an              “We’re introducing targeted im-
            enhanced tumor-specific immune           munotherapy for patients with
            response and enhanced antitumor          HPV-associated cancers,” she says.
            effects, resulting in a higher cure      “It’s the concept of providing treat-
            rate than either the vaccine or          ment tailored specifically to the in-
            EGCG alone.                              dividual and his or her disease
                The research, Pai says, exempli-     process. We’re excited to be partici-
            fies a new approach to treating can-     pating in this novel research.”
            cer. Patients are traditionally treat-       If the vaccine proves effective, it
            ed according to where the cancer         can serve as adjuvant therapy, gen-
            occurs. This new approach looks at       erating long-lasting, circulating im-
            what is causing the patient to de-       mune cells in the body that can rec-
            velop the cancer—in this case,           ognize and destroy microscopic
            HPV—and then aims treatment at           cancer cells to prevent local-regional
            that uniquely identified cause.          or metastatic recurrence of disease.
                                          D E M O N S T R AT I N G C L I N I C A L I N N O VAT I O N




Mystery Revealed:                          Minor and his team discovered
Researchers Create a                   that surgically closing the dehis-
Cure for Superior Canal                cence, or the area in the superior
Dehiscence Syndrome
                                       canal where the bone casing has the
Cases of people who grow dizzy         cracks, with a plug of fascia and
or lose their balance because of       bone puts an end to the symptoms.
excess noise or changes in pres-           The surgery, which takes from
sure—even by merely coughing or        four to six hours, is extremely deli-
laughing—had stumped clinicians        cate. Surgeons first cut a hole
for decades. But research conduct-     above the ear and open the skull,
ed at Johns Hopkins has led to ad-     then move aside a part of the
vances in defining and treating this   brain to reach the superior canal
rare and little-known medical phe-     of the inner ear. The canal is
nomenon, called superior canal         plugged with fibrous tissue and
dehiscence (SCD) syndrome.             small chips of the patient's bone
   Fascinated by the relationship      taken from the area of incision and
between balance problems and           skull opening. Once the plug is po-
eye movements, Lloyd Minor and         sitioned within the lumen of the
colleagues tracked the eye move-       canal, the surgeon tamps it into
ments in his patients with dizzi-      the canal’s opening and allows the
ness problems and found a num-         brain’s dura to return to its posi-
ber of patients had tiny holes in      tion over the spot.
the upper arch of the inner ear            Since the team saw its first pa-
cavities directly above the superior   tient with the condition in 1995,
semicircular canal. Changes in in-     it has successfully operated on 50
tracranial pressure carry through      people. The surgeons are learning
the minute openings to cause the       more about SCD all the time; fur-
balance-sensitive canal to bulge;      ther knowledge could lead to earli-
this sometimes leads to a chronic      er diagnosis with simpler tools
state of imbalance and causes the      that physicians across the country
ear to be hypersensitive to sound      could use.
and motion.




                                          JOHNS HOPKINS MEDICINE                                       17
18   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




             “The results of our work should
          allow surgeons to better counsel
          their patients with SCD on what is
          the likely improvement in symp-
          toms after the procedure,” says
          surgeon John Carey, one of the
          lead authors of the studies.


          FULL ARTICLES

          Carey J, Migliaccio A, Minor L.
          Semicircular canal function before
          and after surgery for superior canal
          dehiscence. Otology & Neurotology
          2007;28:356–364.

          Limb C, Carey J, Srireddy S, Minor
          L. Auditory function in patients
          with surgically treated superior
          semicircular canal dehiscence. Otology   Image navigation is used during the
          & Neurotology. 2006;27:969–980.          surgery to repair superior canal
                                                   dehiscence. The patient's CT scan,
                                                   obtained preoperatively to confirm the
                                                   diagnosis and show the location of the
                                                   dehiscence, is displayed in three planes of
                                                   view referenced to an instrument used in
                                                   the surgery. The lower right panel shows
                                                   the image through the operating
                                                   microscope.
                                            D E M O N S T R AT I N G C L I N I C A L I N N O VAT I O N




A Safe, Effective Algorithm                 “Increasingly sensitive diagnostic
for Recurrent/Persistent                 tests in the surveillance for recur-
Papillary Thyroid Cancer                 rent or persistent cancer have driv-
Papillary thyroid cancer (PTC) ac-       en us to treat all disease, macro-
counts for 75 percent of thyroid         scopic or microscopic,” says
cancer cases in the United States; it    Tufano. “The dilemma centers on
is treated primarily with total thy-     the question, Are we overdiagnos-
roidectomy with or without neck          ing and treating recurrent/persist-
dissection. Though the incidence         ent cancers that are of no clinical
of well-differentiated thyroid can-      significance? When do the risks
cer is on the rise, mortality rates      outweigh the benefits of treat-
are not—they have remained the           ment?” Until physicians are better
same for 30 years. The majority of       able to identify patients who
cases responsible for this increase      should be treated aggressively ver-
in incidence are those of tumors         sus those who should be monitored
that are less than 2 cm in size.         carefully, surgeons must continue
    The reported incidence of recur-     to operate on all of them.
rent/persistent thyroid papillary thy-      To conquer that challenge, Tu-
roid cancer is increasing as well,       fano and his team of researchers
chiefly due to increasingly sensitive    have created an algorithm for safe
follow-up tests. Compared to pri-        and effective RTBS for recurrent/
mary thyroidectomy, though, re-op-       persistent thyroid cancer. In a retro-
erative thyroid bed surgery (RTBS)       spective study of 33 patients, Tu-
has a significantly higher frequency     fano’s team evaluated treatments
of operative complications, especial-    and outcomes to define a manage-
ly in recurrent laryngeal nerve          ment algorithm that includes three
(RLN) injury and hypocalcemia.           main components:
Physicians are faced with an evolv-
ing clinical management dilemma,
says Johns Hopkins head and neck
surgeon Ralph Tufano.




                                             JOHNS HOPKINS MEDICINE                                      19
20   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




              I Detection of recurrent/persist-         “Safe and effective RTBS is based
                ent PTC with high-resolution            on a multidisciplinary approach
                neck ultrasound examination             that enables the identification
              I Pre-RTBS high-resolution neck           and localization of recurrent/per-
                ultrasound examination to map           sistent PTC,” Tufano explains.
                location and size of suspicious         “The surgical algorithm de-
                lesions within the thyroid bed          scribed provides a pathway that
                and neck                                all head and neck surgeons can
              I Guidelines for operative tech-          comfortably utilize to treat this
                nique, including using recurrent        complex and challenging patient
                laryngeal nerve monitoring              population to prevent disease
                                                        progression.”
                                                            In the future, Tufano says,
                                                        nonsurgical techniques such as
                                                        ultrasound-directed radiofre-
                                                        quency ablation may enhance
                                                        treatment while reducing mor-
                                                        bidity. He and his colleagues
                                                        plan to start a pilot study to de-
                                                        termine safety and feasibility of
                                                        this technique later this year.

            Electrodes located within the
                                                        FULL ARTICLE
            endotracheal tube allow recurrent
            laryngeal nerve activity to be              Farrag T, Agrawal N, Sheth S,
            monitored during complex thyroid            Bettegowda C, Ewertz M, Kim M,
            and parathyroid surgeries.                  Tufano R. An algorithm for safe
                                                        and effective re-operative thyroid
            NIM™ STANDARD EMG REINFORCED ENDOTRACHIAL
            TUBE COURTESY OF MEDTRONICS ENT             bed surgery for recurrent/persistent
                                                        papillary thyroid carcinoma.
                                                        Head and Neck 2007; (epub ahead
                                                        of print).
                                             D E M O N S T R AT I N G C L I N I C A L I N N O VAT I O N




Novel Approach to                         offer two advanced methods of ade-
Evaluation and Treatment                  notonsillectomy—powered intracap-
of Pediatric Sleep Apnea                  sular and coblation—that reduce
Sleep apnea is common in children         bleeding and postoperative pain
but often goes unrecognized. If left      compared with other methods.
untreated, sleep apnea may result             The powered intracapsular ton-
in health problems as well as be-         sillectomy and adenoidectomy uses
havioral and academic problems.           a precision microdebrider that re-
Johns Hopkins pediatric otolaryn-         moves nearly all of the tonsils and
gologists have created novel proto-       adenoids, leaving a minute amount
cols for diagnosing and treating          of tissue intact to protect the throat
this and other disorders.                 muscles and decrease postoperative
   “We use a multidisciplinary ap-        pain. This method also decreases
proach to treating children with sus-     recovery time from two weeks to
pected sleep disorders that includes a    less than four days.
full, comprehensive evaluation using          Coblation uses radio waves that
a group of specialists with experi-       turn saline into a lukewarm stream
ence in such sleep problems to ob-        of charged ions that carry enough
tain a focused diagnosis and treat-       energy to quickly dissolve the target-
ment,” says pediatric otolaryngology      ed tissue, resulting in minimal tissue
director David Tunkel.                    damage to surrounding areas. Bene-
   Most patients undergo special-         fits include less postoperative pain
ized pediatric sleep studies per-         and a faster recovery period with a
formed at Johns Hopkins—studies           return to eating in one to three days,
that, many times, are not offered at      as opposed to seven to 10 days.
other facilities. “The standards for          In addition, for the 5 percent of
pediatric sleep studies are very dif-     pediatric patients who require a
ferent from those for adults,” Tunkel     more extensive treatment regimen,
explains. “It is vital that a child re-   including craniofacial surgery, ex-
ceives an evaluation at a facility that   perienced Johns Hopkins facial
specializes in pediatric studies.”        plastic and reconstructive surgeons
   If the child must have surgery,        are available.
Hopkins pediatric otolaryngologists



                                              JOHNS HOPKINS MEDICINE                                      21
22   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




      New Discoveries

            BAHA Clinical Trials:
            Efficacy of the Bone-
            Anchored Hearing Aid for
            Unilateral Deafness
            The bone-anchored hearing device
            now provides an effective alterna-
            tive for those with hearing loss due
            to chronic otitis media, congenital
            ear canal malformations and single-
            sided deafness who cannot benefit
            from conventional hearing aids.
               In studies over the past three
            years, Johns Hopkins researchers
            found that a bone-anchored hear-        Bone anchored hearing device
            ing device (made by Cochlear
            Corp.) placed on the side of the
            deaf ear works better in subjects       FULL ARTICLE
            with normal monaural hearing
                                                    Lin L, Bowditch S, Anderson J,
            than does contralateral routing of      May B, Cox K, Niparko J.
            signal (CROS) amplification.            Amplification in the rehabilitation
            These patients showed improved          of unilateral deafness: speech in
            word discrimination in noise and        noise and directional hearing
            said they were consistently satisfied   effects with bone-anchored
            with BAHA amplification; they           hearing and contralateral routing
                                                    of signal amplification.
            rated CROS poor. General direc-         Otology & Neurotology. 2006;
            tional hearing decreased with           27:172–182.
            CROS use and was unchanged by
            the BAHA device. Twenty-two of
            23 subjects followed up in the
            2006 study continue to use their
            BAHA device over an average fol-
            low-up that now exceeds two years.
                                                                 NEW DISCOVERIES




Many Directions in Tissue              Treating Precancerous Lesions of
Engineering Research                   the Mouth, Throat and Voice Box
Johns Hopkins researchers are ex-      Johns Hopkins researchers are leading a
ploring tissue engineering—using       one-of-a-kind international, multi-institu-
cartilage and bone—to replace          tional trial of the biological agent Cetux-
missing structures in a patient’s      imab to treat aggressive precancerous condi-
body. This is an early-stage study,    tions of the mouth, throat and voice box.
explains researcher Kofi Boahene,      The study is ideal for patients who have had
but success could lead to tech-        recurrent precancerous lesions, who cannot
niques to use a patient’s own cells    be treated by surgery or who have had previ-
to form new bone to replace bone       ous head or neck cancer.
removed because of cancer, for ex-        Patients eligible for the study have unre-
ample. Traditional methods com-        sectable, diffuse high-grade dysplasia; previ-
monly take bone from the pa-           ously treated head and neck squamous cell
tient’s fibula or scapula to refill    carcinoma with persistent or recurrent high-
such areas.                            grade dysplasia; and lesions with such high-
    Researchers also are studying      risk molecular features as 3p and 9p chro-
the treatment of keloids, or exces-    mosomal loss. These patients have a risk of
sively thick scars. They hope to       progressing to malignancy that ranges from
find a way to engineer proteins to     40 percent to 70 percent over a five- to 10-
help improve scar formation.           year interval.
    A third area of scientific study      Although traditional treatments have in-
is engineering mechanisms that         cluded complete surgical excision, many pa-
would inject fillers into the facial   tients cannot be treated effectively with con-
area as a way of reconstructing de-    ventional surgical therapy. In this study,
formities without open surgery.        supported by a National Cancer Institute
An abstract describing this work,      SPORE grant, as well as funding from Zila
Tissue Engineering with                Inc., and Bristol Myers Squibb, physicians
Photofillers, was well received at     are using Cetuximab to block the epidermal
the Triological Society Annual         growth factor receptor and assessing the re-
Meeting in Chicago, April 2006.        sponse of patients to this novel agent.
                                          For more information on this study,
                                       call Joseph Califano, principal investigator,
                                       at 410-955-6420.


                                          JOHNS HOPKINS MEDICINE                        23
24   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            Abnormal Immune                          ing organisms to gain a foothold
            Responses in the Nose                    in the sinuses. Simultaneously,
            Linked to Chronic Sinusitis              polyp epithelial cells produce
            Although chronic rhinosinusitis af-      high levels of other chemicals
            fects almost 40 million Americans        that are associated with immune
            each year, its causes remain poorly      response against parasites, even
            understood. But ongoing research         though no parasites are present.
            in the Johns Hopkins Sinus Center        This misplaced immune response
            has revealed previously unrecog-         may worsen swelling and allow
            nized abnormalities in the immune        the infection to proceed
            system function that protects the        unchecked.
            lining of the nose and sinuses in           Current Sinus Center research
            patients with hard-to-manage             focuses on how epithelial cells
            chronic sinusitis.                       may be redirected toward a more
                “The local immune system of          normal immune response that
            the nose may be more important           would clear the infection and re-
            in the development of sinusitis          duce the polyp swelling, which
            than previously thought,” says           could lead to new treatments for
            study lead author Andrew Lane,           chronic sinusitis.
            associate professor and director of
            the Rhinology and Sinus Surgery
                                                     FULL ARTICLE
            Center. Hopkins rhinology scien-
            tists have demonstrated that nasal       Ramanathan M, Lee W, Lane A.
                                                     Increased expression of acidic
            lining cells, or epithelial cells, can
                                                     mammalian chitinase in chronic
            sense invading bacteria or fungi         rhinosinusitis with nasal polyps.
            and secrete antibiotic-like chemi-       American Journal of Rhinology.
            cals to inhibit potential infections.    2006;20:330–335.
                But in the chronic sinusitis as-
            sociated with nasal polyps, the
            ability of epithelial cells to recog-
            nize and react to bacteria appears
            to be impaired, allowing the invad-
                                                                  NEW DISCOVERIES




Study: HPV Status Is                        The abstract received the 2007
Recommended for Staging                  American Society of Clinical On-
System                                   cology (ASCO) Bradley Stuart
In a recent abstract praised by the      Beller Foundation Fellowship Merit
American Society of Clinical On-         Award. This award was established
cology, Johns Hopkins researchers        in 1985 to recognize the top ab-
propose that human papillo-              stract submitted by a fellow, as de-
mavirus (HPV) status should be a         termined by the Scientific Program
stratification factor in future clini-   Committee. The manuscript is cur-
cal trials and should be included in     rently under review for publication.
the system used for staging head         Authors in order, Hopkins authors
and neck cancers.                        in bold: Carole Fakhry, William
   In a multicenter phase II clinical    H. Westra, Sigui Li, Anthony
trial, researchers reviewed data on      Cmelak, John A. Ridge, Harlan
patients with head and neck squa-        Pinto, Arlene Forastiere, Maura L.
mous cell cancers. They found that       Gillison.
HPV-positive patients responded
better to concomitant chemoradia-
tion when compared to HPV-neg-
ative patients.




  For more information about our published research, visit PubMed at www.
  pubmed.gov. Articles and abstracts are indexed by author, topic or journal.




                                            JOHNS HOPKINS MEDICINE                  25
26   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




     Patient Safety and Quality Measures

            Safely Reducing Spinal
            Fluid Leakage after
            Removal of Acoustic
            Neuromas
            Great advances have been made
            in the microsurgical technique
            of removing acoustic neuromas,
            but cerebrospinal fluid (CSF)
            rhinorrhea had been—until re-
            cently—one of the few remain-
            ing sources of perioperative
            morbidity.
                Following craniotomy and
            removal of temporal bone sur-
            rounding the tumor, previously
                                                Axial T1-weighted MRI with
            air-filled spaces can become
                                                gadolinium showing large acoustic
            flooded by CSF, which then          neuroma (vestibular schwannoma)
            flows into the ear and then the     occupying the left cerebellopontine
            nose via the eustachian tube.       angle and extending into the internal
            These fistulas increase the risk    auditory canal (arrow) where it is
                                                surrounded by petrous bone (black on
            of meningitis if untreated and      MRI). This tumor was removed via a
            are associated with additional      suboccipital craniotomy with removal
            days in the hospital and the        of the posterior lip of petrous bone
            risks of additional invasive pro-   (arrowhead) for optimal removal and
            cedures. This complication,         preservation of auditory and facial
                                                nerves. When air cells in this bone are
            which occurs in as many as 16       opened, a CSF fistula may develop.
            percent of cases, has encouraged
            surgeons to seek changes in
            technique aimed at eliminating
            fistulas and reducing CSF rhin-
            orrhea.
                                         P AT I E N T S A F E T Y   AND   QUALITY MEASURES




    Johns Hopkins neurosurgeons          “Lowering CSF leak reduces
and neurotologists found that a       the chance for meningitis and
new technique using hydroxyap-        other complications that can ac-
atite bone cement (HAC) at the        company prolonged hospitaliza-
site of surgery to reconstruct the    tion and bed rest, which is used
drilled posterior wall of the porus   to encourage spontaneous healing
acusticus significantly reduces the   of the fistula,” says neurotologist
incidence of CSF leak when            Howard Francis. “The safety of
compared to previous methods.         the surgical management of
Traditional methods included the      acoustic neuromas is now greater
use of bone wax, fat, muscle, fib-    than it was even two years ago as
rin glue or a combination of          we update our techniques.
these placed in the drilled bone.        “We will strive to do even bet-
Less than 6 percent of cases in       ter by continuing to examine our
which surgeons have used HAC          results and seeking additional op-
required revision surgery for         portunities to increase safety and
management of CSF leak.               reduce risks.”




                                          JOHNS HOPKINS MEDICINE                             27
28   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




          Oropharynx Cancer                                      chemotherapy) demonstrates excellent
          Responds Well to Neck                                  overall and disease-free survival rates.
          Dissection with Radiotherapy                               All 16 patients whose cases were
          Many methods are used to treat                         reviewed for the study survived; in
          oropharynx squamous cell carci-                        all but one (94 percent) there was no
          noma. Patients with small primary                      evidence of the disease at last follow-
          tumors (T1–T2) without nodal                           up (follow-ups ranged from six to 75
          metastasis will have similar out-                      months). The study shows a signifi-
          comes in terms of local control                        cant improvement in outcomes in
          and disease-free survival with ei-                     selected patients with T1/T2 primar-
          ther surgery alone or radiation                        ies and stage III/IV disease.
          therapy alone. But when bulky
          nodal disease (N2 or greater) is
                                                                 FULL ARTICLE
          present, there is no consensus on
          the best treatment.                                    Reddy A, Eisele D, Forastiere A, Lee
                                                                 D, Westra W, Califano J. Neck
             Now, research at Johns Hopkins
                                                                 dissection followed by radiotherapy or
          shows that treating small orophar-                     chemoradiotherapy for small primary
          ynx primary tumors presenting                          oropharynx carcinoma with cervical
          bulky nodal disease with early initial                 metastasis. Laryngoscope. 2005;115:
          neck dissection followed by radia-                     1196–1200.
          tion therapy (with or without




         Artwork Copyright Tim Phelps/Johns Hopkins University
                                         P AT I E N T S A F E T Y   AND   QUALITY MEASURES




Reducing Severity of                      “We initiated protocols that
Percutaneous Tracheostomy             eliminated scheduling difficulties
Complications                         for inpatients and standardized cri-
Johns Hopkins otolaryngologists       teria for candidates as well as the
have led efforts to standardize the   actual way we perform the proce-
protocol for performing percuta-      dure,” says Nasir Bhatti, assistant
neous dilatational tracheostomy       professor of otolaryngology–head
(PDT) on ICU patients. The proto-     & neck surgery. “In addition, we
col has reduced complications by      developed a comprehensive postop-
50 percent; now, all tracheostomy     erative care model involving the en-
procedures for inpatients are per-    tire multidisciplinary team. The
formed following this protocol.       complication rate drops significant-
   The PDT is arranged directly       ly with experience.
between the intensive care team           “We’ve established this procedure
and the surgeon, leading to a high-   and are now seeing the result—opti-
ly efficient “tracheostomy team.”     mal outcomes.”




                                         JOHNS HOPKINS MEDICINE                              29
30   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            Quality-of-Life for Pediatric              For example, physicians at the
            Patients                               Pediatric Fiberoptic Endoscopic
            Johns Hopkins head and neck sur-       Evaluation of Swallowing Clinic
            geons have established multidisci-     care for children with swallowing
            plinary clinics for swallowing dis-    disorders secondary to neurologic
            orders and for hearing loss, and       injuries, vocal fold paresis, burns
            they are performing research stud-     and other injuries. The team con-
            ies (including one assessing quality   sists of Brown and pediatric oto-
            of life for children who have          laryngologist Stacey Ishman work-
            tongue-tie) to better understand       ing with speech pathologist
            pediatric otolaryngologic disorders    Maureen Lefton-Greif. Using a flex-
            and their causes, treatments and       ible fiberoptic endoscope, they can
            effects on young patients. In addi-    see a child’s upper airway while he
            tion to establishing trends and un-    or she swallows liquids and soft
            derstanding the long-term effect       foods and identify the patient’s par-
            of current methods of treatment,       ticular swallowing disorder. Then
            they hope their work translates to     the team gives the family strategies
            better care, says pediatric oto-       to help the child safely swallow
            laryngologist David Brown.             foods. More than 30 children are
                                                   seen in this clinic each year.
                                                       T H E PAT I E N T E X P E R I E N C E




The Patient Experience

Cancer Resection, Facial
Reconstruction:
Multidisciplinary Team
Gets Patient Rocking Again
For 55-year-old musician and mu-
sic teacher Paul Yutzy, Johns Hop-
kins surgeons Paul Flint, Patrick
Byrne and Ralph Tufano rank right
up there with Jimi Hendrix on the
list of people who have changed
his life.
    Hendrix sealed a 15-year-old as-
piring rocker’s fate as a guitarist and
vocal performer when Yutzy saw
him in concert in the 1960s. This
winter, Flint, Byrne and Tufano
successfully treated Yutzy when ton-
sil/base-of-tongue cancer recurred
fairly quickly after chemotherapy
and radiation treatment.
    Flint, a friend and former guitar
student of Yutzy’s, brought Yutzy
to his Hopkins colleagues after
symptoms indicated the return of
his cancer. In a 14-hour operation,
Tufano, a head and neck surgical
                                          Paul Yutzy
oncology specialist, resected the
base of the tongue and a portion of
the lateral pharyngeal wall via a
mandibulotomy approach. For the
facial reconstruction, Byrne, a fa-




                                             JOHNS HOPKINS MEDICINE                            31
32   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            cial plastic and reconstructive sur-         A recent benefit concert in his
            geon, performed a microvascular          honor gave him the chance to leap
            free tissue transfer (a radial forearm   back into performing.
            free flap) using donor tissue from           “It was perhaps my career high-
            Yutzy’s arm near the wrist.              light when Paul took the stage to
                “Dr. Byrne performed the re-         sing and play an amazing version
            construction from tissue on my           of ‘Mustang Sally,” Byrne says.
            right hand, so that my left hand         “Folks were dancing in the aisles.”
            was not impeded in playing the               Yutzy was touched by the pres-
            guitar,” Yutzy says.                     ence of his physicians.
                Yutzy, who has performed in lo-          “Half my medical team was
            cal rock bands during his career,        there. When I announced I would-
            has spent the past 22 years teaching     n’t be here if it weren’t for them,
            music at Friends School in Balti-        the audience gave them a standing
            more. After his bout with cancer         ovation,” he says. “Now, I plan on
            left him weakened, he returned to        performing until they have to
            instructing third-, fourth- and          wheel me down the stage.”
            fifth-grade rock bands one day a
            week. He hopes to return soon to
            one of his favorite gigs—initiating
            4-, 5- and 6-year-olds into the
            world of music.
                “When introducing a child to
            music, you need to encompass the
            spirit of the song in addition to the
            words and notes,” he says.
                                      T H E PAT I E N T E X P E R I E N C E




                     A Life in Balance:
                     SCD Causes Vertigo, Falls,
                     but Surgery Corrects All
                     Richard Christian’s life came un-
                     hinged with a belly laugh. In the fall
                     of 2004, the Illinois high school
                     teacher doubled over with laughter at
                     a joke his son told. Then the athleti-
                     cally built 55-year-old kept tilting
                     forward until he collapsed.
                        At first worried that he might have
                     suffered a stroke, family members felt
                     reassured when they noted that
                     Christian was speaking clearly and in
                     perfect control of his extremities. But
                     in the coming weeks, he had similar
                     episodes, with escalating variations.
                     Even the slightest exertions would
                     give him the illusion that he was
                     tumbling. He began hearing the
                     sound of his own heartbeat thrum-
                     ming in his ear as he tried to sleep, or
                     the strange echoes of his joints mov-
Richard Christian.   ing when he tried to resume his jog-
                     ging routine. A sudden sense of verti-
                     go would seize him when the organ
                     at church hit a certain note.
                        Christian saw many physicians for
                     a diagnosis. Some explored cardiac is-
                     sues. Others probed his cranial vascu-
                     lature. Others thought it was a blood
                     flow issue. Finally, in December




                        JOHNS HOPKINS MEDICINE                                33
34   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            2005—after 13 months with this         aside a piece of the brain to reach
            mysterious condition—Christian         the holes. Once the holes are
            was referred to one of the national    plugged with fibrous tissue and
            experts on these rare disorders:       small chips of the patient's bone,
            Lloyd Minor, the director of the       the surgeon tamps the mixture
            Department of                          down and closes the skull. It’s a
            Otolaryngology–Head & Neck             four- to six-hour procedure.
            Surgery at Johns Hopkins.                 After months of falling and lim-
               Further testing at Hopkins per-     ited movement, Christian decided
            formed by Minor and John Carey,        to have the surgery. It was a success.
            associate professor, confirmed that        Minor says Christian’s was a
            the group of symptoms Christian        textbook case. For Christian, the
            was experiencing could be ex-          surgery helped him return to his
            plained by a disorder first de-        normal life.
            scribed at Hopkins and termed su-         “I’ve gotten more stability and
            perior canal dehiscence (SCD)          maneuverability back than I’d ever
            syndrome.                              imagined I’d have again,” he says.
               “Tiny holes in the skull in the     He no longer fears slopes and
            inner-ear cavities cause changes in    stairs, and his sensations of dis-
            intracranial pressure, leading to      equilibrium are virtually gone.
            dizziness after loud noises,” Minor
            explains. His research into this
            phenomenon led to the discovery
            of a cure: Plugging the holes erases
            the symptoms.
               Minor explained to Christian
            the delicate operation that could
            give him back his balance. Sur-
            geons cut a hole above the ear and
            open the skull, where they move
                                                                   O U R F A C U LT Y




Our Faculty

Lloyd B. Minor is the Andelot            In 1998, Dr. Minor and his col-
Professor and director of the         leagues described a clinical syndrome
Department of Otolaryngology–         of vertigo and balance disturbance
Head & Neck Surgery at The            caused by a dehiscence of bone over-
Johns Hopkins University School       lying the superior semicircular canal.
of Medicine. He is an otologist       After making the discovery by study-
and neurotologist with research       ing the abnormal eye movements in
interests in basic and clinical       these patients caused by loud noises,
vestibular physiology.                he devised a surgical procedure to
   Dr. Minor received his bache-      correct the anatomical abnormality.
lor’s degree from Brown University    Other areas of research interest in-
in 1979 and his medical degree        clude the effects of Ménière’s disease
from Brown in 1982. He complet-       on vestibular function and signal pro-
ed his two-year core surgical resi-   cessing mechanisms in vestibular
dency at Duke University, followed    pathways.
by a four-year postdoctoral re-          Dr. Minor is a past president of
search fellowship in vestibular       the Association for Research in Oto-
physiology and a residency in oto-    laryngology and has completed a
laryngology–head & neck surgery       term as chair of the Auditory Re-
at the University of Chicago. He      search Study Section of the National
then was a clinical fellow at The     Institutes of Health.
Otology Group and The EAR
Foundation in Nashville, Ten-
nessee. He was recruited to Hop-
kins in 1993 and is a professor of
otolaryngology–head & neck sur-
gery, of biomedical engineering
and of neuroscience. He became
the director of the Department of
Otolaryngology–Head & Neck
Surgery in 2003.




                                         JOHNS HOPKINS MEDICINE                         35
36   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




      Johns Hopkins Otolaryngology–Head & Neck Surgery Faculty

              Audiology and Hearing Aids         Head and Neck Surgery
              Stephen P. Bowditch, M.S., CCC-A   Nasir Islam Bhatti, M.D.
              Roni E. Dinkes, Au.D., CCC-A       Joseph Califano, M.D.
              J. Sue Garman, M.S., CCC-A         Charles W. Cummings, M.D.
              Angela Lataille, Au.D., CCC-A      Paul Flint, M.D.
              Mariah Menichino, Au.D., CCC-A     Patrick Ha, M.D.
              Colleen Ryan, M.S., CCC-A          Masaru Ishii. M.D., Ph.D.
              Alicia White, M.S., CCC-A          Matthew Kashima, M.D.
                                                 Young J. Kim, M.D., Ph.D.
              Dentistry and Oral Surgery         Wayne Koch, M.D.
              James Christian, D.D.S., M.B.A.    Sara Pai, M.D., Ph.D.
              William Henderson, D.D.S.          Ralph Tufano, M.D.
              David C. Bastacky, D.D.S.          Cancer
              Linda Niculescu, D.D.S.            Joseph Califano, M.D.
              Ghassan Sinada, D.D.S.             Charles W. Cummings, M.D.
                                                 Patrick Ha, M.D.
              Facial Plastic and                 Wayne Koch, M.D.
              Reconstructive Surgery             Ralph Tufano, M.D.
              Patrick Byrne, M.D.
              Kofi Boahene, M.D.                 Snoring Disorders/Sleep Apnea
              Lisa Earnest, M.D.                 Charles W. Cummings, M.D.
                                                 Stacey Ishman, M.D.
                                                 Matthew Kashima, M.D.
              Johns Hopkins
                                                 Wayne Koch, M.D.
              Bayview Medical Center
              Lisa Earnest, M.D.                 Swallowing Disorders
              Masaru Ishii, M.D.                 Charles W. Cummings, M.D.
              Matthew Kashima, M.D.              Paul Flint, M.D.
              Jean Kim, M.D., Ph.D.              Matthew Kashima, M.D.
              Young Kim, M.D., Ph.D.             Wayne Koch, M.D.
              Choon Park, M.D.
                                                 Voice Disorders
                                                 Charles W. Cummings, M.D.
                                                 Paul Flint, M.D.
                                                                O U R F A C U LT Y




The Listening Center                Pediatric Otolaryngology
Audiology                           David Brown, M.D.
Stephen P. Bowditch, M.S., CCC-A    Stacey Ishman, M.D.
Courtney Carver, Au.D., CCC-A       Sandra Y. Lin, M.D.
Ryan Carpenter, Au.D., CCC-A        David Tunkel, M.D.
Jill Chinnici, M.A., CCC-A
Andrea Marlowe, M.A., CCC-A         Research
Jennifer Yeagle, M.Ed., CCC-A       John Doucet, Ph.D.
                                    Paul Fuchs, Ph.D.
Cochlear Implant Surgery            Elisabeth Glowatzki, Ph.D.
Charley C. Della Santina, M.D.,     Mohammed Hoque, Ph.D.
   Ph.D.                            Bradford May, Ph.D.
Howard W. Francis, M.D.             Chul-So Moon, M.D., Ph.D.
Charles Limb, M.D.                  David Ryugo, Ph.D.
John K. Niparko, M.D.               Michael Schubert, Ph.D.
                                    Mark Shelhamer, Sc.D.
Speech Language Pathology/
                                    David Sidransky, M.D.
Rehabilitation Therapy              Barry Trink, Ph.D.
Deborah G. Bervinchak, M.A.
Kristin Ceh, M.Ed.                  Sinus
Andrea Gregg, M.S., CCC-SLP
Jennifer Gross, M.S., CCC-SLP       Masaru Ishii, M.D., Ph.D.
                                    Jean Kim, M.D., Ph.D.
                                    Wayne Koch, M.D.
Otology                             Andrew Lane, M.D.
Ear and Hearing Disorders           Sandra Y. Lin, M.D.
John P. Carey, M.D.                 Douglas Reh, M.D.
Charley C. Della Santina, M.D., Ph.D.
Howard W. Francis, M.D.               Speech Language Pathology
Michael Holliday, M.D.                Heather Starmer, M.A.
Charles Limb, M.D.                      CCC-SLP
Lloyd Minor, M.D.                     Donna Tippett, M.P.H.,
John K. Niparko, M.D.                   M.A., CCC-SLP
                                      Kimberly Webster, M.A.,
Balance (Vestibular) Disorders          M.S. CCC-SLP
John P. Carey, M.D.
Charley C. Della Santina, M.D., Ph.D.
Lloyd Minor, M.D.
Michael Schubert, Ph.D.



                                       JOHNS HOPKINS MEDICINE                        37
38   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            How to Refer a Patient                 Locations

            Johns Hopkins Otolaryngology–          Johns Hopkins Otolaryngology–
            Head & Neck Surgery welcomes           Head & Neck Surgery offers pa-
            referrals of new patients. We look     tient consultations in offices
            forward to working with you to         throughout the Baltimore metro-
            determine the most appropriate         politan area, including the Outpa-
            care for your patients.                tient Center at The Johns Hopkins
               There are several ways to refer a   Hospital, Johns Hopkins Bayview
            patient. For urgent physician to       Medical Center, and ambulatory
            physician referrals or consultation,   outpatient centers at Green Spring
            please call the Hopkins Access         Station and White Marsh. For di-
            Line (HAL) at 1-800-765-5447.          rections and maps, please visit our
               You may also refer patients         Web site at www.hopkinshospital.
            to any of the Johns Hopkins            org/directions.
            Otolaryngology–Head &
            Neck Surgery faculty, by calling
            443-287-6585.
               For more information
            about Johns Hopkins
            Otolaryngology–Head & Neck
            Surgery, visit our Web site at
            www.hopkinsmedicine.org/
            otolaryngology
                                                            R E F E R R A L A S S I S TA N C E




Referral Assistance

Hopkins USA                            cient manner. The staff also pro-
                                       vides medical records reviews be-
Hopkins USA provides one point
                                       fore the patient travels to the
of contact for our out-of-town pa-
                                       United States, language inter-
tients. Our staff can help patients
                                       preters, cost estimates and assis-
identify appropriate physicians or
                                       tance with travel arrangements.
specialists, coordinate multiple
                                       For more information, call
medical appointments, arrange sec-
                                       +1-410-955-8032 or visit the
ond opinions and obtain general
                                       Web site at www.jhintl.net.
information on Johns Hopkins’
numerous services. In addition,
                                       Accommodations Assistance
Johns Hopkins USA staff can pro-
vide information about transporta-     Accommodations Office
tion, lodging and other travel         The Johns Hopkins Hospital has
needs. Call 443-287-6585 to talk       arranged special rates (and shuttle
with Hopkins USA. For family ac-       service in some instances) at local
commodations on the patient            hotels for patients and their fami-
floor, see the Marburg Pavilion in-    lies. A full-service travel agency is
formation (at right).                  available to help patients and their
                                       families with air, hotel or ground
Johns Hopkins                          accommodations. It is open Mon-
International Services                 day through Friday, 8:30 a.m. to 5
The professional staff of Interna-     p.m. Please call 1-800-225-2201
tional Services coordinates all as-    or 410-614-1911 for assistance.
pects of international patients’
medical care, paying special atten-
tion to personal, cultural and trav-
el-related needs. The staff will
arrange consultations, second
opinions or treatments and coordi-
nate appointments in a time-effi-




                                          JOHNS HOPKINS MEDICINE                                 39
40   O TOLARYNGOLOGY – H EAD & N ECK S URGERY




            Marburg Pavilion                           At Johns Hopkins Bayview Med-
            Located in the historic Marburg         ical Center, call 410-550-0626 to
            Building, the Marburg Pavilion of-      speak with a patient representative
            fers deluxe accommodations for          about any patient care concerns.
            adult patients. A limited number        Hours are 8:30 a.m. to 5 p.m., Mon-
            of private rooms and two-room           day through Friday. The office is lo-
            suites are available for an addition-   cated in the Bayview Medical Office
            al charge and feature fine wood         on the main level.
            furniture, private baths, entertain-
            ment centers and an array of serv-      Sign Language
            ices such as expanded dining            Deaf and hearing-impaired patients
            menus and overnight sleeping ac-        can arrange for interpreters or use
            commodations for family mem-            the TTY in the patient relations of-
            bers. For more information, call        fices at both The Johns Hopkins
            410-614-4777.                           Hospital and Johns Hopkins
                                                    Bayview Medical Center. For more
            Patient Relations                       information, call 410-955-2273 at
            Patient representatives are available   JHH or 410-550-0626 at Bayview.
            to help resolve any concerns about
            patient care, interpret the policies
            and procedures of the                    For more information, please visit
            hospital, and arrange for services       the Johns Hopkins Hospital Web site
            patients may need. At The                at www.hopkinsmedicine.org or The
            Johns Hopkins Hospital, call             Johns Hopkins Bayview Medical Center
                                                     Web site at www.hopkinsbayview.org
            410-955-CARE (2273) to speak
            with a patient representative.
                                                     For patient information and a visitors
            Hours are 8:30 a.m. to 5 p.m.,           guide to The Johns Hopkins Hospital,
            Monday through Friday. The of-           visit www.hopkinshospital.org/patients/
            fice is located in the hospital at       hopkinshospital.org/patients
            Carnegie 100.
                                            J O H N S H O P K I N S M E D I C I N E O V E RV I E W




Johns Hopkins Medicine Overview

Johns Hopkins Medicine, estab-          well as other elements of an inte-
lished in 1995 to unite Hopkins’        grated system, from a community
biomedical research, clinical,          physicians group to home care.
teaching and business enterprises,      The components of Johns Hopkins
brings together The Johns Hop-          Medicine consistently are named at
kins University of School of Medi-      the top of national rankings for
cine and its faculty with the facili-   best hospital and best school of
ties and programs of The Johns          medicine, and its faculty consis-
Hopkins Health System. The              tently win the largest share of NIH
Health System, which has its ori-       research funds. Results of this re-
gins in the founding of the world       search continue to advance efforts
famous Johns Hopkins Hospital,          to diagnose, treat and prevent
now comprises three hospitals, as       many diseases.




                                           JOHNS HOPKINS MEDICINE                                    41
            To contact the
    Department of Otolaryngology–
        Head & Neck Surgery
          call 443-287-6585

        Visit our Web site at
www.hopkinsmedicine.org/otolaryngology

				
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